Nurses' perceptions of compassionate care in pediatric oncology: a qualitative interview study.

BACKGROUND: Compassion is a crucial aspect in the management of pediatric oncology patients as it has the potential to enhance nurse satisfaction levels, thereby further enhancing the quality and safety of the care they deliver. This study aimed to investigate nurses' understanding and experience of compassionate care when working in pediatric oncology departments. METHODS: This research utilized a qualitative descriptive design. Content analysis was used to make sense of data collected via individual and semi-structured interviews conducted with nurses (n = 32) working in pediatric oncology departments. RESULTS: Nurses' understanding of compassionate care for children with cancer was organized into two categories: Humanistic compassionate care and compassionate end-of-life care. The humanistic compassionate care category comprised of three subcategories: (1) empathy, (2) altruism, and (3) respect for the cultural values and beliefs of the family. The compassionate end-of-life care category comprised of two subcategories: (1) facilitating parents' presence at the child's bedside and (2) creating suitable conditions for accepting the death of a child. CONCLUSION: Compassionate care for children with cancer is marked by a strong emphasis on humanistic, cultural, and end-of-life considerations. Our findings further emphasize the paramount importance of taking families' presence, wishes and beliefs into consideration within this context.

Living less safely through the pandemic in England for people with serious mental and physical health conditions: qualitative interviews with service users and carers of Black African, Caribbean, and South-Asian descent.

BACKGROUND: COVID-19 Ethnic Inequalities in Mental health and Multimorbidities (COVEIMM) is a mixed methods study to explore whether COVID-19 exacerbated ethnic health inequalities in adults with serious mental and physical health conditions. We analysed data from electronic health records for England and conducted interviews in Birmingham and Solihull, Manchester, and South London. Sites were selected because they were pilot sites for the Patient and Carer Race Equality Framework being introduced by NHS England to tackle race inequalities in mental health. Prior to the pandemic people in England with severe mental illnesses (SMIs) faced an 11-17-year reduction in life expectancy, mostly due to preventable, long-term, physical health conditions. During the pandemic there was a marked increase in deaths of those living with an SMI. AIMS: This qualitative interview study aimed to understand the reasons underlying ethnic inequalities in mortality and service use during the COVID-19 pandemic for adult service users and carers of Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds living with serious multiple long-term mental and physical health conditions. METHODS: We took a participatory action research approach and qualitative interviews undertaken by experts-by-experience and university researchers Participants were purposively sampled by ethnicity, diagnoses, and comorbidities across three geographically distinct sites in England. Transcriptions were coded inductively and deductively and analysed thematically. RESULTS: Findings indicated multiple points along primary and secondary health pathways for mental and physical health that have the potential to exacerbate the unjust gap in mortality that exists for Black and Asian people with SMIs. Issues such as timely access to care (face-to-face and remote), being treated in a culturally appropriate manner with empathy, dignity and respect, and being able to use services without experiencing undue force, racism or other forms of intersectional discrimination were important themes arising from interviews. CONCLUSION: These poor experiences create systemic and enduring healthcare harms for racialised groups with SMIs that need to be addressed. Our findings suggest a need to address these, not only in mental health providers, but across the whole health and care system and a need to ensure more equitable healthcare partnerships with service users, carers, and communities from racialised backgrounds who are often excluded.

Living With and Beyond Cancer With Comorbid Conditions: Qualitative Insights to Understand Psychosocial Support Needs.

INTRODUCTION: There is a pressing need to understand and explore the complex experiences and psychosocial support needs of people LWBC-CM and their informal caregivers, to inform survivorship and supportive care interventions. METHODS: In-depth qualitative interviews were conducted with people LWBC-CM and their informal caregivers in Scotland, invited via primary care. One-to-one, face-to-face interviews were conducted with informed consent exploring experiences of symptoms, psychosocial support needs and interactions with health services. Interviews were transcribed and analysed using a thematic approach. RESULTS: Forty-one people LWBC-CM and twenty-three informal caregivers were interviewed. Four themes were identified: the Physical and Psychological Impact of Cancer and Comorbidity, Dominant Storie-Prioritising Conditions and Making Sense of Illness, Navigating Health Services and Treatments and Caring for People with Complex Health Conditions. Type and severity of conditions mediated people's experiences and daily living. Complex fatigue-fatigue arising from a number of health conditions-dominated symptomology. Participants navigated multiple appointments and complex medication regimes. Patients identified the need for acknowledgement of other chronic conditions and for streamlined care provision. Mutual caring and social isolation were also identified as part of the caring relationship. CONCLUSIONS: There is a mandate to address the psychosocial support needs of people LWBC-CM, and their informal carers, given the burden of treatment for cancer survivors with moderate to severe complex conditions as they navigate health services. PATIENT OR PUBLIC CONTRIBUTION: A patient representative has been involved in all stages of the study from development of the application through study design, commenting on documentation, analysis of transcripts and writing the manuscript. They are included as an author on the manuscript.

Key informant perspectives on overcoming HPV vaccination barriers in low-immunization NY counties.

Human papillomavirus (HPV) infection is an important public health concern, with nearly 2,900 cases of HPV-related cancers reported in New York State (NYS) each year. Despite concerted efforts to enhance vaccine uptake in NYS, HPV vaccination rates among 13-15-year-olds failed to meet the 2020 healthy People target, and continue to lag behind the 2030 goal, of 80%. In counties with low immunization levels, understanding factors influencing decision-making among unvaccinated adolescents is crucial. This study aimed to identify barriers, facilitators, and potential interventions to improve HPV vaccine uptake. Qualitative semi-structured interviews were conducted with key informants in 15 NYS counties within the lowest quartile of HPV vaccine coverage among 13-year-old adolescents. Public health representatives, including Immunization Quality Improvement for Providers (IQIP) consultants, vaccine coordinators, medical directors, and primary care providers, were identified through purposive and snowball sampling. Interviews explored vaccination coverage knowledge, barriers and facilitating factors, and recommended strategies for improvement. All conversations were audio-recorded, transcribed, and analyzed using ATLAS.ti. Forty-four interviews were conducted, revealing barriers to HPV vaccination such as limited vaccine knowledge, vaccine misinformation, and accessibility. Key informants asserted barriers could be primarily addressed through education efforts, such increased public awareness, improved parent-doctor conversations, additional provider education on vaccine benefits, and supplementary education in patient spaces. Targeted education efforts and improved provider communication strategies have the potential to bolster HPV vaccination rates in NYS. These findings offer valuable insights for guiding future initiatives in communities facing significant barriers to vaccination.

Persistent low HPV vaccination rates emphasize the critical need for tailored interventions aimed at optimizing public health outcomes. This report identifies barriers to HPV vaccination in New York State (NYS), particularly within counties with low coverage rates, underscoring the importance of focused education efforts, enhanced accessibility, and improved communication between providers and patients. The study highlights ongoing challenges in boosting HPV vaccination rates across 15 NYS counties, advocating for innovative strategies to overcome existing barriers. Key recommendations include tailored education initiatives, improved provider communication, increased community engagement, potential policy changes, and proactive follow-up measures, to ensure vaccine completion.

Exploring a role for community pharmacists in the identification of alcohol-related liver disease: a qualitative interview study with professionals, patients, and the public.

AIMS: To explore the views and attitudes of professionals, patients and the public to a role for community pharmacists in the identification of alcohol-related liver disease (ArLD). METHODS: Semi-structured interviews were conducted with a purposive sample of patients with ArLD, members of the public, pharmacy staff, and clinicians managing patients with ArLD across the Wessex region of south England. The interviews explored experiences of alcohol, ArLD and health advice in pharmacies and elicited views of what a pharmacist role in identifying ArLD could entail and factors influencing this. Transcripts were analysed using reflexive thematic analysis. RESULTS: Twenty-six participants were interviewed and three themes were generated: (i) acknowledging, seeking help and engaging with a hidden problem; (ii) professional roles, boundaries and attributes; (iii) communication, relationships, collaboration and support. Participants reported key challenges to identifying people at-risk of ArLD. Offering testing for ArLD was perceived to motivate engagement but there were concerns about pharmacists performing this. A role was mostly seen to be finding people at-risk and engaging them with further care such as referral to liver services. This was perceived to require developing interprofessional collaborations, remuneration and training for pharmacy staff, and community-based liver testing. CONCLUSIONS: Professionals, patient and public participants recognized a role for pharmacists in the identification of ArLD. This was envisaged to incorporate educating pharmacy users about ArLD risk, and identifying and directly engaging those at-risk with liver and support services through development of interprofessional collaborations. The findings of this study support and can inform future work to develop this role.

Gaining Respect and Mitigating Risk: A Qualitative Exploration of How New Attendings Navigate Interpersonal Relationships with Recent Resident Peers.

Background: Physicians moving through training experience changes in personal and professional relationships, which can increase stress, uncertainty, and burnout. Social connection can be an important resource but can introduce complexity and conflict. This study aimed to explore how early-career attendings navigate and manage changing organizational and friendship roles with recent resident peers (near-peers) through this critical transition. Methods: We conducted a reflexive thematic analysis of interviews with early-career attendings working with near-peers from the same institution where they trained. Twenty three of 27 (85%) eligible attendings from two United States health systems participated in semi-structured interviews between April and June 2023. Results: Familiarity from working at the same institution where new attendings completed training made it more difficult to command authority. Early-career attendings at times struggled with insecurities about their ability to fulfill their new role and challenges from others in recognizing their new attending identity. These tensions could heighten emotions in the clinical setting and spill over into relationships with residents outside the workplace, impacting social lives and well-being. Early-career attendings engaged in strategies to manage the social realm of their transition with near-peers, including prioritizing their organizational role in the clinical setting and mitigating risks to their professional reputation by creating stronger boundaries between their personal and professional lives. Conclusions: This study provides new insight into how attendings navigate changing personal and professional relationships with recent resident peers and offers strategies on how to manage the social realm of this liminal transition.

Analysis of social investment in health systems reform: a case study of results-based financing in Marondera District, Zimbabwe.

Introduction: suboptimal use of donor funds and poor health systems performance is rife across most developing countries; to address this, results-based financing (RBF) models were developed. However, it is imperative to explore the emic and context specific influence of results-based financing in health systems performance. This study therefore sought to explore the influence of results-based financing on health worker motivation and governance, temporal perspective, distributional principle, and policy coherence. Finally, the influence of results-based financing on interrelations across donors, technical partners, and health workers was explored. Methods: the study adopted a qualitative, exploratory, descriptive, phenomenological design using audio-recorded face-to-face semi-structured interviews to capture diverse perspectives from the remaining and available two health financing experts, two technical partner organization representatives, and six health workers who have been implementing results-based financing from 2011 to 2022 in the Marondera district of Zimbabwe. Data was transcribed and collectively analyzed using NVIVO software. Results: improved staff motivation, better governance, health system development, equity, and policy consistency were attributable to results-based financing, notwithstanding several challenges including understaffing, increased workload, procurement red tape, financial rigidity, and delays in subsidy payments, which eroded gains of better performance. Additionally, a lack of continuum of care due to user fees faced by the poor at higher levels of care, and limited engagement between donors and healthcare facility workers were also observed. Conclusion: reinforcing pinpointed positives is vital for sustaining realized health gains; however, urgent attention is required to address the challenges to safeguard the milestones achieved thus far.

The Rehabilitation Landscape in a Low-to-Middle-Income Country: Stakeholder Perspectives and Policy Implications-A Qualitative Study.

The need for rehabilitation is increasing on a global level due to a rise in non-communicable diseases, aging and medical advances, and in South Africa (SA), due to the quadruple burden of disease. More information is required regarding rehabilitation scope and practices in SA to optimize the provision of rehabilitation interventions in the context of the transforming health care sector in SA, a low-to-middle-income country (LMIC). The purpose of this study is to explore the perspectives of South African rehabilitation stakeholders on the landscape of rehabilitation in SA. A descriptive qualitative study, with an interpretive approach, was used to explore stakeholder perspectives on rehabilitation practices in the public health care sector of SA. Semi-structured interviews were conducted with 12 rehabilitation stakeholders. Data were analyzed using a combination of deductive and inductive processes to generate themes and categories. We identified 5 main themes, with subsequent categories and sub-categories. The themes include a composite definition of rehabilitation, core elements of rehabilitation provision, challenges affecting rehabilitation practices, the importance of policy implementation, and the progress of rehabilitation in SA. Despite a common understanding of rehabilitation practices in SA amongst stakeholders, many persistent challenges hamper the delivery of effective rehabilitation services. We recommend that further research explore the rehabilitation needs of end-users, together with collaborative research for priority setting on the translation of policy to practice ensuring equitable and quality rehabilitation service delivery.

Exploring the lack of continuity of care in older cancer patients under China's 'integrated health system' reform.

BACKGROUND: Continuity of care is essential to older patients' health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused. OBJECTIVES: To explore the experience and perception of continuity of care in older cancer patients, and to examine how PHCs play a role in the continuity of care within the healthcare system in China. METHODS: A qualitative study using semi-structured interviews was conducted in two tertiary hospitals in Nantong city, Jiangsu province, China. A combination of deductive and inductive analysis was conducted thematically. RESULTS: Interviews with 29 patients highlighted three key themes: no guidance for patients in connecting with different levels of doctors, unmet patients' needs under specialist-led follow-up care, and poor coordination and communication across healthcare levels. This study clearly illustrated patients' lack of personal awareness and experience of care continuity, a key issue despite China's drive for an integrated healthcare system. CONCLUSION: The need for continuity of care at each stage of cancer care is largely unmeasured in the current healthcare system for older patients. PHCs offer benefits which include convenience, less burdened doctors with more time, and lower out-of-pocket payment compared to tertiary hospitals, especially for patients with long-term healthcare needs. However, addressing barriers such as the absence of integrated medical records and unclear roles of PHCs are needed to improve the crucial role of PHCs in continuity of care.

Patient and Community Health Worker (CHW) Perspectives on a CHW-delivered Nutrition Intervention for Low-Income Adults with Hypertension: A Qualitative Study.

INTRODUCTION/OBJECTIVES: Adults with food insecurity (FI) face barriers to hypertension management, including difficulty adhering to diet recommendations. Few community health worker (CHW) interventions focus on diet to improve blood pressure. This qualitative study elicited patient and CHW perspectives on healthy eating and a future CHW nutrition intervention for patients with hypertension. METHODS: Twenty-five patients with hypertension and FI and 5 CHWs participating in a hypertension health coaching program from 5 Boston-area health centers participated in semi-structured interviews from July to September 2023. Interviews were audio recorded, transcribed, and analyzed using the Framework Method. RESULTS: Themes included: 1) Variable patient knowledge about dietary patterns for hypertension management and low confidence in interpreting nutrition labels; 2) Culture influenced healthy food perception; and 3) Barriers to healthy eating included cost, limited cooking abilities/supplies, and competing demands. Patients and CHWs favored simple nutrition education materials (e.g., traffic light nutrition ranking, healthy meals on a budget). Patients had mixed opinions about CHW-accompanied supermarket visits. CONCLUSIONS: This study identified culture, knowledge gaps, and budget constraints as factors influencing diet among patients with hypertension and FI. A CHW-delivered intervention could include simplified nutrition education, strategies for healthy eating on a budget, and linkage to community-based food programs.

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study.

BACKGROUND: Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies. METHODS: Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach. RESULTS: Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies. CONCLUSION: Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

Clinicians' roles and necessary levels of understanding in the use of artificial intelligence: A qualitative interview study with German medical students.

BACKGROUND: Artificial intelligence-driven Clinical Decision Support Systems (AI-CDSS) are being increasingly introduced into various domains of health care for diagnostic, prognostic, therapeutic and other purposes. A significant part of the discourse on ethically appropriate conditions relate to the levels of understanding and explicability needed for ensuring responsible clinical decision-making when using AI-CDSS. Empirical evidence on stakeholders' viewpoints on these issues is scarce so far. The present study complements the empirical-ethical body of research by, on the one hand, investigating the requirements for understanding and explicability in depth with regard to the rationale behind them. On the other hand, it surveys medical students at the end of their studies as stakeholders, of whom little data is available so far, but for whom AI-CDSS will be an important part of their medical practice. METHODS: Fifteen semi-structured qualitative interviews (each lasting an average of 56 min) were conducted with German medical students to investigate their perspectives and attitudes on the use of AI-CDSS. The problem-centred interviews draw on two hypothetical case vignettes of AI-CDSS employed in nephrology and surgery. Interviewees' perceptions and convictions of their own clinical role and responsibilities in dealing with AI-CDSS were elicited as well as viewpoints on explicability as well as the necessary level of understanding and competencies needed on the clinicians' side. The qualitative data were analysed according to key principles of qualitative content analysis (Kuckartz). RESULTS: In response to the central question about the necessary understanding of AI-CDSS tools and the emergence of their outputs as well as the reasons for the requirements placed on them, two types of argumentation could be differentiated inductively from the interviewees' statements: the first type, the clinician as a systemic trustee (or "the one relying"), highlights that there needs to be empirical evidence and adequate approval processes that guarantee minimised harm and a clinical benefit from the employment of an AI-CDSS. Based on proof of these requirements, the use of an AI-CDSS would be appropriate, as according to "the one relying", clinicians should choose those measures that statistically cause the least harm. The second type, the clinician as an individual expert (or "the one controlling"), sets higher prerequisites that go beyond ensuring empirical evidence and adequate approval processes. These higher prerequisites relate to the clinician's necessary level of competence and understanding of how a specific AI-CDSS works and how to use it properly in order to evaluate its outputs and to mitigate potential risks for the individual patient. Both types are unified in their high esteem of evidence-based clinical practice and the need to communicate with the patient on the use of medical AI. However, the interviewees' different conceptions of the clinician's role and responsibilities cause them to have different requirements regarding the clinician's understanding and explicability of an AI-CDSS beyond the proof of benefit. CONCLUSIONS: The study results highlight two different types among (future) clinicians regarding their view of the necessary levels of understanding and competence. These findings should inform the debate on appropriate training programmes and professional standards (e.g. clinical practice guidelines) that enable the safe and effective clinical employment of AI-CDSS in various clinical fields. While current approaches search for appropriate minimum requirements of the necessary understanding and competence, the differences between (future) clinicians in terms of their information and understanding needs described here can lead to more differentiated approaches to solutions.

Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis.

BACKGROUND: Medication reconciliation is essential for optimizing medication use. In part to promote effective medication reconciliation, the Department of Veterans Affairs (VA) invested substantial resources in health information exchange (HIE) technologies. The objectives of this qualitative study were to characterize VA clinicians' use of HIE tools for medication reconciliation in their clinical practice and to identify facilitators and barriers. METHODS: We recruited inpatient and outpatient prescribers (physicians, nurse practitioners, physician assistants) and pharmacists at four geographically distinct VA medical centers for observations and interviews. Participants were observed as they interacted with HIE or medication reconciliation tools during routine work. Participants were interviewed about clinical decision-making pertaining to medication reconciliation and use of HIE tools, and about barriers and facilitators to use of the tools. Qualitative data were analyzed via inductive and deductive approaches using a priori codes. RESULTS: A total of 63 clinicians participated. Over half (58%) were female, and the mean duration of VA clinical experience was 7 (range 0-32) years. Underlying motivators for clinicians seeking data external to their VA medical center were having new patients, current patients receiving care from an external institution, and clinicians' concerns about possible medication discrepancies among institutions. Facilitators for using HIE software were clinicians' familiarity with the HIE software, clinicians' belief that medication information would be available within HIE, and their confidence in the ability to find HIE medication-related data of interest quickly. Six overarching barriers to HIE software use for medication coordination included visual clutter and information overload within the HIE display; challenges with HIE interface navigation; lack of integration between HIE and other electronic health record interfaces, necessitating multiple logins and application switching; concerns with the dependability of HIE medication information; unfamiliarity with HIE tools; and a lack of HIE data from non-VA facilities. CONCLUSIONS: This study is believed to be the first to qualitatively characterize clinicians' HIE use with respect to medication reconciliation. Results inform recommendations to optimize HIE use for medication management activities. We expect that healthcare organizations and software vendors will be able to apply the findings to develop more effective and usable HIE information displays.

The Experiences of Native Irish speaking Older Adults Navigating Healthcare Services.

Aim: This research aims to understand the experiences of native Irish speaking older adults navigating healthcare services in Ireland. Methods: Semi-structured interviews in the Irish language were conducted with seven participants. Interviews were audio recorded and transcribed. Data was coded and analysed using MAXQDA® software and thematic analysis. Results: Two major themes were identified: 1) Factors influencing the relationship between patients and HCPs (2) What's more important? A doctor or an Irish speaker? Shared communications preferences were discussed but above all, participants preferred if HCPs were proficient in both Irish and English. Discussion: Language discordant care exists in rural Gaeltacht areas. Bilingualism does not completely mitigate language barriers in Gaeltacht area healthcare settings, as some HCPs are neither fluent in English nor Irish. Opinions around the use of interpreters are mixed. All participants expressed the value of direct communication between patient and provider. This study highlights the need for language concordant care to be available for native Irish speaking older adults living in rural Gaeltacht areas, and further emphasises the importance of language concordant care for minority language speaking populations. The findings of this study provide an insight into the lives of native Irish speaking older adults navigating the healthcare system and contribute to understanding an underserved patient group.

The perceived long-term impact of peer teaching in the skills lab. A descriptive interview study.

Teaching is an essential skill for future doctors. Peer-assisted learning (PAL)-where students take up a teaching role at an early stage of their training-is widely used in medical curricula. No studies have explored the long-term perceived impact of peer teaching. Therefore, we aimed to determine how former peer teachers reflected on PAL and its perceived long-term impact. In this longitudinal descriptive study, we conducted 42 semi-structured interviews with 11 former peer teachers at the University of Antwerp. Five of them were interviewed 6 months after PAL; 6 of them 9 years after PAL. This latter group was also interviewed during PAL in a previous study. We conducted secondary analyses of previously collected interviews, consistently comparing the findings with new data gathered from the current interviews. Using realist thematic analysis, topic summary themes were generated. Former peer teachers reflected on their PAL experience with a lot of satisfaction. Those meanwhile working as residents are still passionate about teaching. Peer teachers experienced a gain in clinical examination- and professional skills in the long-term, facilitating a smoother transition to their internship. Our findings suggest that PAL selects diverse but committed students. The longitudinal data demonstrate how PAL initiates or stimulates different skills in diverse students, including public speaking, teaching, time management, and self-efficacy in specific clinical skills. Regarding the chicken-and-egg question, our study encompasses both longitudinal cases illustrating the pre-existing skill theory and cases demonstrating how achieved competences were induced by PAL. Former peer teachers experienced long-term benefits of PAL, which eased their transition into the internship. PAL has the potential to ignite a lasting passion for teaching, providing diverse and unique learning opportunities not only for the most talented and 'pre-selected' medical students but also for a range of dedicated future clinicians.

Shaping Adoption and Sustained Use Across the Maternal Journey: Qualitative Study on Perceived Usability and Credibility in Digital Health Tools.

BACKGROUND: Maternal and child health outcomes are positively influenced by early intervention, and digital health (DH) tools provide the potential for a low-cost and scalable solution such as informational platforms or digital tracking tools. Despite the wide availability of DH tools out there for women from before to after pregnancy, user engagement remains low. OBJECTIVE: This study aims to explore the factors that shape women's DH adoption and sustained use across the maternal journey from preconception to postbirth, to improve user engagement with DH tools. METHODS: One-hour semistructured qualitative interviews were conducted with 44 women from before to after pregnancy (age range 21-40 years) about their experiences with DH. This study is part of a larger study on women's maternal experiences with health care and DH and focuses on the factors that affected women's DH adoption and sustained use. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis. RESULTS: Five main themes and 10 subthemes were identified that affected women's adoption and sustained use of DH tools. These included themes on their preexisting attitudes to DH, perceived ease of use, perceived usefulness, perceived credibility, and perceived value of the tool. CONCLUSIONS: The themes that emerged were fully or partially mapped according to the Unified Theory of Acceptance and Use of Technology 2 model. The applicability of the model and the need to consider specific cultural nuances in the Asian context (such as the importance of trust and social influence) are discussed. The interaction of the 5 themes with DH adoption and sustained use are explored with different themes being relevant at various points of the DH adoption journey. The insights gained serve to inform future DH design and implementation of tools for women to optimize their DH engagement and the benefits they derive from it. TRIAL REGISTRATION: ClinicalTrials.gov NCT05099900; https://clinicaltrials.gov/study/NCT05099900.

"Jumping on the Blood Pressure Bandwagon": Nurse, GP, and Patient Perspectives of a General Practice Nurse-Led Hypertension Management Intervention.

To explore the perceptions and experiences of general practice nurses, general practitioners, and patients who participated in a nurse-led intervention to improve blood pressure control. Given the impact of hypertension on rates of premature death and disability, it is important that interventions be evaluated to reduce blood pressure. A key component of such evaluation is understanding the experiences of participants and clinicians. Understanding these experiences can provide insight into acceptability and feasibility that informs future research and implementation. Qualitative descriptive study within a mixed methods project. Semi-structured interviews were conducted post-intervention with six patients, five nurses, and three general practitioners. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. The COREQ checklist guided reporting. Three themes around the need for change, navigating change, and sustaining change were revealed. In highlighting the need for change, participants recognized that it was time to actively work toward improved blood pressure control. In navigating change, general practice nurses were perceived as ideally placed to communicate risks around uncontrolled blood pressure and support lifestyle change. The final theme, sustaining change revealed the feasibility of the intervention in practice, however, clinician participants identified that appropriate funding is required to ensure sustainability. Nurse-led intervention to improve blood pressure control in general practice is feasible in practice and acceptable to patients. This highlights an opportunity for nurses to play a more proactive role in hypertension management within general practice. To ensure sustainability, however, issues such as funding, teamwork, and collaboration need to be addressed. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12618000169246.

How influencers motivate inactive adolescents to be more physically active: a mixed methods study.

Introduction: Regular physical activity offers numerous health benefits, particularly for adolescents. However, only 14% of school-aged children in Switzerland achieve the World Health Organization's recommendation of 60 min of moderate to vigorous physical activity per day. Changing health behaviors is a complex process in which understanding behavioral and communication patterns is crucial. Because adolescents spend substantial time on social media channels and obtain information from them, these are potential channels for accessing health-related content. This study explores the questions of which influencers and what content motivate adolescents to be more physically active and whether influencers can impact enjoyment and the intention to engage in physical activity. Methods: The study employed a convergent mixed methods approach, combining self-assessment questionnaires and semi-structured interviews. Ninety-three adolescents aged 14-20 years who exercised < 1 h per day participated. They followed one of the six participating influencers on Instagram. Over 6 weeks, the questionnaires collected quantitative data, measuring enjoyment, stages of change, and physical activity levels. Furthermore, semi-structured interviews were conducted with 23 adolescents and six influencers to gain in-depth insights. Results: The quantitative findings indicate that adolescent followers enjoyed physical activity more after the social media intervention and at follow-up than at the beginning of the study. The followers' stages of change progressed over time. Compared with those following more athletic influencers, followers of nonathletic influencers (that is, a singer, a journalist, and an eFootballer) showed increased physical activity over time. Qualitative analysis highlighted Instagram factors influencing physical activity, including resonance with influencers' lifestyles and preference for simple, relatable activities. Authentic content was positively associated with increased exercise, particularly among already motivated followers. Discussion: Unexpectedly, nonathletic influencers, such as a singer, a journalist, and an eFootballer, motivated adolescents best despite their nontraditional focus on physical activity. Their success stems from relatable lifestyles and simple activities that are easily incorporated into their daily routines. Conversely, athletic influencers demonstrated challenging exercises that were fascinating but difficult to adopt. This finding suggests the potential for utilizing nonathletic influencers in future campaigns targeting inactive adolescents.

'The company is using the credibility of our profession': exploring experiences and perspectives of registered dietitians from Canada about their interactions with commercial actors using semi-structured interviews.

OBJECTIVE: To gain insight into the experiences and perspectives of registered dietitians (RD) in Canada regarding their interactions with commercial actors and actions undertaken to manage these interactions. DESIGN: Qualitative study using semi-structured interviews combined with a document analysis. SETTING: Quebec, Canada. PARTICIPANTS: RD aged ≥ 18 years (n 18). RESULTS: All participants reported interacting with commercial actors during their careers, such as receiving continuing education provided or sponsored by food companies. RD in Quebec perceive these interactions as either trivial or acceptable, depending on the commercial actor or interaction type. Participants discussed how certain interactions could represent a threat to the credibility and public trust in dietitians, among other risks. They also discussed the benefits of these interactions, such as the possibility for professionals to improve the food supply and public health by sharing their knowledge and expertise. Participants reported ten mechanisms used to manage interactions with commercial actors, such as following a code of ethics (individual level) and policies such as partnerships policy (institutional level). Finally, RD also stressed the need for training and more explicit and specific tools for managing interactions with commercial actors. CONCLUSIONS: RD in Quebec, Canada, may engage with commercial actors in their profession and hold nuanced perspectives on this matter. While some measures are in place to regulate these interactions, they are neither standardised nor evaluated for their effectiveness. To maintain the public's trust in RD, promoting awareness and developing training on this issue is essential.

Reducing low-value imaging - stakeholders' assessment of an intervention to improve imaging services.

BACKGROUND: An intervention to reduce low-value magnetic resonance imaging (MRI) was designed and implemented in private imaging centres in Norway in October 2022. The intervention used return letters for poor referrals of MRI of the lower back, brain and knee at private imaging centres in Norway. The study aimed to investigate key stakeholders' experiences and assessment of the intervention and the specific research questions were: • How many return letters were sent during the study period? • What were the medical directors' and managers' experiences with and reflection on success factors for the intervention implementation and using return letters? METHODS: The number of return letters sent was collected directly from Norway's two main private imaging providers. Two semi-structured individual interviews were conducted with the medical directors of the imaging providers, as well as two focus group interviews with nine managers from the various private imaging centres operated by the two imaging providers. RESULTS: In total, 1,182 return letters were sent for patients undergoing one of the three types of MRI examinations, and the number of return letters was highest at the beginning of the intervention. The interview analysis resulted in five categories: general experience, anchoring, organisation, return letter procedure and outcome. Sufficient information, anchoring and support were identified as crucial success factors. CONCLUSIONS: This study provides insights into the practical and crucial details of implementing interventions to reduce low-value imaging. The intervention was generally well received, and the high initial number of return letters decreased rapidly over the course of the study. Several key success factors were identified.