Co-producing an intervention to prevent mental health problems in children and young people in contact with child welfare services.

BACKGROUND: Children and young people (CYP) in contact with child welfare services are at high risk of developing mental health problems. There is a paucity of evidenced-based preventative interventions provided to this population. OBJECTIVE: This project worked in partnership with CYP, their parents/caregivers and the professionals who support them to co-produce a preventative mental health intervention for CYP in contact with child welfare services. PARTICIPANTS AND SETTING: We recruited a purposive sample of CYP in contact with child welfare services (n = 23), parents/caregivers (n = 18) and practitioners working within child welfare services and mental health services (n = 25) from the North East of England and convened co-production workshops (n = 4). METHODS: This project followed the established principles for intervention development, applying the six steps to quality intervention development (6SQUID) approach. The mixed method research consisted of four work packages with continuous engagement of stakeholders throughout the project. These were: a systematic review of reviews; focus groups with practitioners; interviews with parents/caregivers and CYP; co-production workshops. RESULTS: We identified that the primary risk factor affecting CYP in contact with child welfare services is the experience of childhood adversity. The quality of relationships that the CYP experiences with both their parent/caregivers and the professionals involved in their care are considered to be the main factors amenable to change. CONCLUSIONS: We found that a trauma-informed, activity-based intervention with an embedded family-focused component provided to CYP who have experienced adversity is most likely to prevent mental health problems in those in contact with child welfare services.

Building capacity for local public health: lessons from a mixed-methods evaluation of an academic-public health partnership used in response to COVID-19.

Introduction: The Massachusetts Academic Health Department Consortium (AHD) established the Academic Public Health Volunteer Corps (APHVC) to support Local Health Departments (LHDs, n = 351) to meet rapidly emerging needs during the COVID-19 pandemic through engaging student volunteers. A program evaluation captured lessons learned and informed recommendations for sustainability and future replication. Methods: The mixed-methods evaluation leveraged the Consolidated Framework for Implementation Research (CFIR). Data were stratified by LHD engagement with APHVC. Quantitative surveys informed probes for qualitative focus groups and interviews; findings were categorized into CFIR constructs using a deductive approach. Results: One-fifth of LHDs (n = 76, 27 used APHVC services, 45 did not) completed the survey. Eleven employees participated in follow-up focus groups or interviews. APHVC filled resource gaps, built capacity, and provided high-quality deliverables. LHDs experienced issues with reliability and communication of volunteers and lacked time to train volunteers. Conclusions: CFIR aided in evaluating APHVC in real time, producing actionable recommendations for best practices, dissemination, and future iterations of the program. Results are being used to enhance program effectiveness and sustainability, community health, and health equity across Massachusetts, and may help inform academic practice-based programs across the United States.

Motivators and mechanisms for an international rural health collaboration.

Collaborations are critical to address rural health challenges. We evaluated a new international collaboration between institutions in Georgia, the United States (US), and Scotland, United Kingdom (UK), to address rural health issues and to understand the barriers and facilitators to effective international collaboration efforts. A qualitative approach was used through in-depth interviews and focus groups with educators, researchers, and healthcare providers in the US and Scotland who were involved in the CONVERGE international rural health collaboration. Transcriptions were imported into the NVivo qualitative software program. A reflexive thematic analysis was employed to identify key themes from the collected data. Twelve interviews and two focus groups were conducted virtually with 17 participants. Two primary domains were identified from the thematic analysis: (1) motivators that increase engagement in international collaboration, and (2) mechanisms for, and barriers to, the continuity needed to create meaningful change. Six themes emerged related to commonality of issues, prospect of sharing knowledge, need of sustained funding and institutional support, and selection of human resources. Participants of CONVERGE were more likely to engage when they had a space to share ways to address challenging issues and integrate knowledge and practice. They were motivated by their desire for growth and the institutions they serve and emphasized that infrastructure support is vital for sustainable collaborations.

"Killing two birds with one stone" - a qualitative study on women's perspectives on the dual prevention pill in Johannesburg, South Africa.

BACKGROUND: HIV incidence remains high in South Africa, with ~ 60% of all new HIV infections among adolescent girls and women (Country factsheets HIV and AIDS Estimates, 2022). Oral pre-exposure prophylaxis (PrEP), approved for HIV prevention in South Africa since 2015, is hampered by low uptake and adherence, particularly among adolescent girls and young women (AGYW). Combining oral PrEP with oral contraceptives could increase PrEP uptake, persistence and address unmet needs for contraception. We investigated the acceptability of a dual prevention pill (DPP), combining oral PrEP and a combined oral contraceptive (COC) for HIV and pregnancy prevention among women in Johannesburg, South Africa. METHODS: Between March-July 2021, we conducted 12 focus group discussions (FGDs) with adolescent girls and women (n = 74) aged 16-40 stratified by ages (16-17, 18-24, 25-40), half of whom were COC users. We explored adolescent girls and women's opinions about the DPP concept, existing HIV and pregnancy prevention options, and input on perceived facilitators and barriers to DPP use. FGDs were conducted in English or isiZulu, using a standardized interview guide. FGDs were audio-recorded, transcribed to English and analyzed using ethnographic content analysis. RESULTS: The majority viewed the DPP favorably as a multipurpose option preventing unplanned pregnancy and HIV. Most saw it as a convenient "two-in-one" solution, requiring one clinic visit for both PrEP and COCs. AGYW were viewed as the most likely to benefit from the DPP due to the likelihood of multiple partners and unplanned sex, possibly preventing school dropout from unplanned pregnancy or HIV acquisition. The DPP was perceived to be more reliable than condoms, especially when condom negotiation is limited. Benefits were also seen by participants in rape cases, protecting against pregnancy and HIV. DPP use barriers included side effect concerns, unsupportive partners and judgmental healthcare providers. CONCLUSIONS/SIGNIFICANCE: The DPP was perceived as acceptable for HIV and pregnancy prevention to AGYW in Johannesburg and its dual indications helpful in supporting improved PrEP uptake and persistence. DPP implementation programs need to consider solutions to potential barriers, like education on DPP benefits, coupled with reliable side effect support and healthcare provider sensitization as part of routine sexual health services to encourage uptake and adherence.

What happens at two? Immunisation stakeholders' perspectives on factors influencing sub-optimal childhood vaccine uptake for toddlers in regional and remote Western Australia.

BACKGROUND: In Western Australia (WA), children aged 24 months living regionally or remotely (non-urban) have suboptimal vaccine uptake. As there has not yet been a systematic approach to understanding the facilitators and barriers to childhood vaccination in regional and remote WA, this study aimed to understand the views of key immunisation stakeholders regarding barriers and solutions. METHODS: Drawing on the World Health Organization's "Tailoring Immunization Programmes" approach, we undertook a qualitative study with three forms of data collection: (1) semi-structured interviews with immunisation experts within Australia's immunisation system, (2) a semi-structured focus group with immunisation coordinators and health workers working in regional or remote WA, and (3) member checking with senior staff from WA Health. Data from the interviews and focus group was deductively analysed using the Capability-Opportunity-Motivation-Behaviour (COM-B) model on NVivo 20. RESULTS: There was no clear consensus on the typical under-vaccinated child in country WA. A range of barriers were identified: lack of awareness of the vaccine schedule, difficult access to vaccination services, a shortage in a workforce able to have meaningful conversations with vaccine hesitant parents, ineffective reminder systems, and the rapid spread of misinformation. Participants described previous efforts used to improve vaccine uptake, and felt the following would improve uptake: better access to vaccine clinics, building capacity of Aboriginal Health Workers, and vaccine reminders. CONCLUSION: This is the first time the facilitators and barriers to routine childhood vaccine uptake in country WA has been explored. Addressing some of these barriers may see an increase in uptake.

Do cash or digital payment modalities affect community health worker performance? - a case study of a remote refugee settlement in Western Uganda.

BACKGROUND: There is inadequate evidence about the influence of digital and cash payment modalities on the performance of Community Health Workers (CHWs) in underserved communities, such as refugee settlements. OBJECTIVE: To compare the performance of CHWs when paid in cash or digitally in Kyaka II refugee settlement, Uganda. METHODS: A comparative cross-sectional mixed methods design was used. Secondary data comprising 247 CHW reports during a six-month period of cash and digital payments were analyzed using Stata v14. Eleven focus group discussions, four in-depth interviews, and ten key informant interviews were conducted among the settlement stakeholders to explore perceptions of the payment methods. Qualitative data were analyzed thematically using Atlas.ti v9. RESULTS: CHWs performed better when paid cash than digital payments (t = 5.28; df = 246; p < 0.001). During the cash payment period, at least secondary education (APR 1.71 CI: 1.14-2.58) and having a side occupation (APR 1.58; CI: 1.13-2.21) were positively associated with performance. For digital payments, being male (APR 0.58; CI: 0.34-0.98), serving longer than 9 years (APR 0.87; CI: 0.82-0.93), and being allocated more than 60 households per month (APR 0.31; CI: 0.19-0.52) were negatively associated with CHW performance. Qualitative data revealed that most stakeholders preferred cash due to inconsistent and delayed digital payments. CONCLUSION: CHWs preferred and performed better with cash payments because digital payments were associated with delays and payment shortfalls that demotivated them. Implementers should invest towards averting digital payment shortfalls in remote settings to enhance CHW motivation and performance.

Main findings: Regarding the influence of payment modalities on Community Health Workers' performance, this study found that community health workers were motivated to perform better when paid with cash compared to digital payments.Added knowledge: Cash payments offer better reliability than digital payments in refugee settlements, which underscores the need to understand further the barriers to digital payments, particularly in hard-to-reach areas.Global health impact for policy and action: Health systems adapting to digital payments should consider a gradual transition through a hybrid approach that includes cash and digital payments while addressing the challenges associated with digital payments, especially in refugee settings and similar resource-constrained contexts.

Young people's views and experience of diet-related inequalities in England (UK): a qualitative study.

Inequalities in diets contribute to overall inequalities in health. Economic inequality and inequalities in access to healthy food are key drivers of poor diet and ill health among young people (YP). Despite mounting evidence of structural barriers to healthy eating, less is known about how YP view and experience these inequalities where they live, and how to address them. To explore YP's perspectives on the drivers of diet-related health inequalities, we conducted three interlinked focus groups with YP aged 13-21 years from six youth groups across three geographical areas in England. We analysed the data inductively and deductively using reflexive thematic analysis and generated themes by examining how social structure, context and agency interact and impact YP's diet. YP were aware of how inequalities in employment conditions impact their families' income and ability to eat a healthy diet. They cited the high availability of hot food takeaways in their local areas as a significant barrier to healthy eating but did not support closing or restricting these outlets. They held strong views on policies to tackle diet inequality and showed a nuanced understanding of the strengths and limitations of universal and targeted approaches. Our study showed that YP have an awareness and understanding of food as important in relation to health, and of diet-related inequalities. However, further efforts are needed to shape and promote policies that resonate with YP and address both their health and wider social concerns.

Adapting Gamification Strategies According to Targeted Health Behavior Change: Findings from a Focus Group.

In healthcare, improving lifestyle behaviors like medication adherence remains challenging, with an impact on treatment success and patient outcomes. Mobile health (mHealth) applications offer promising solutions by leveraging smartphone ubiquity and digital accessibility. However, sustaining user engagement and behavior change presents obstacles. This study explores the specificities of gamification-integrating game-like elements into non-game contexts-to improve mHealth applications for 3 health behaviors. During a focus group, 15 participants discussed the potential of 17 gamification strategies to improve medication adherence, physical activity, and diet within mHealth applications. Individual choices varied widely, with preferences influenced by targeted behaviors. Physical activity focused on self-monitoring and challenges, while dieting emphasized cooperation. Simulation models were particularly intriguing, projecting long-term benefits of behavior changes. Future research should explore personalized design options and consider individual characteristics. Iterative design cycles with end-users are crucial for refining concepts and sustaining user engagement. Overall, gamification presents an innovative avenue for empowering patients and transforming healthcare delivery.

Exploring User Views on Telemedicine to Support Cancer Patients: Insights from Focus Group Discussions in the Context of the eCAN Joint Action.

This paper provides insights into user perspectives on telemedicine for cancer based on Focus Group Discussions (FGDs) within the eCAN Joint Action. Two FGDs centered on the eCAN mobile app and the eCAN dashboard, aiming to confirm user acceptance and understand cancer patients' and healthcare professionals' views. The findings highlight the importance of personalized deployment of telemedicine technologies to meet the specific needs of end users.

Physicians' Attitudes Towards Artificial Intelligence: Results of the PEAK Project.

Artificial intelligence (AI) is rapidly reshaping the medical field. This study aimed to investigate the attitudes of physicians towards AI in medical care using focus groups. Most participants seemed to be open to the use of AI in medicine if transparency in AI systems is ensured, regulatory barriers are addressed and personal contact to the patient is maintained. This qualitative study allows insights into how German physicians perceive the use of AI in medical care. Gaining input from physicians is important when designing future applications of AI for the practical use in medical care.

A Qualitative Study with Informal Caregivers and Healthcare Professionals for Individuals with Head and Neck Cancer on the Usage of AI Chatbots.

Informal caregivers (ICs), including the patient's spouse, close relatives, or friends, play an important role in caregiving individuals with head and neck cancer (HNC). AI-based chatbots might offer information and assistance related to caregiving. This study presents the viewpoints of ICs and healthcare professionals (HCPs) on using AI-based chatbots in caring for individuals with HNC. A total of six focus groups were conducted with 15 ICs and 13 HCPs from three Swedish university hospitals. The study uncovers a widespread hesitancy toward the intention to use AI-based chatbots among ICs and HCPs. Factors contributing to this reluctance include their distrust in chatbot-provided information, negative past experiences of using chatbots, and lack of human connection in chatbot interactions. Embracing a holistic approach is crucial when designing chatbots, ensuring active user engagement and incorporating their perspectives into the design process.

Detection and management of localized prostate cancer in Nigeria: barriers and facilitators according to patients, caregivers and healthcare providers.

BACKGROUND: Prostate cancer mortality rates are high in Nigeria. While prostate cancer is highly curable with early detection and effective multidisciplinary management, the quality of care is suboptimal in this setting. Sustainable delivery of high-quality care for patients with localized prostate cancer is needed to save more lives. To inform future interventions to improve care, this study aimed to identify barriers and facilitators that influence prostate cancer detection and management in Nigeria. METHODS: Six focus group discussions (FGDs), stratified by stakeholders were conducted with a purposive sample of prostate cancer patients (n = 19), caregivers (n = 15), and healthcare providers (n = 18), in two academic tertiary hospitals in northern and southern Nigeria. A discussion guide organized based on the socio-ecological model was used. FGDs were recorded, transcribed, and analysed using the framework technique. RESULTS: Barriers and facilitators were identified at the individual, interpersonal, and organizational levels. Barriers to detection included limited knowledge and misperceptions among patients, caregivers, and community-based non-specialist healthcare providers, and limitations of centralized opportunistic screening; while facilitators included the potential for religious institutions to encourage positive health-seeking behaviour. Barriers to management included non-uniformity in clinical guideline usage, treatment abandonment amidst concerns about treatment and survival, absence of patient interaction platforms and follow-up support systems, difficulty in navigating service areas, low health insurance coverage and limited financial resource of patients. Facilitators of management included the availability of resource stratified guidelines for prostate cancer management and the availability of patient peers, caregivers, nurses, and medical social workers to provide correct medical information and support patient-centred services. Participants also provided suggestions that could help improve prostate cancer detection and management in Nigeria. CONCLUSION: This study identified multiple determinants affecting the detection and management of localized prostate cancer. These findings will inform the refinement of implementation strategies to improve the quality of prostate cancer care in Nigeria.

Mapping the way: functional modelling for community-based integrated care for older people.

BACKGROUND: Healthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery. METHOD: The functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting. FINDINGS: Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care. CONCLUSIONS: A transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.

Perceptions of patients and healthcare providers regarding barriers and enablers of HIV anti-retroviral therapy among women at a regional hospital in Ghana: implications for national HIV/AIDS control.

BACKGROUND: The Acquired Immune Deficiency Syndrome (AIDS) pandemic has created a lot of devastation over the last four decades and continues to be a public health threat. Anti-retroviral treatment (ART), a group of medications that people who have been diagnosed with the Human Immunodeficiency Virus (HIV) infection take, has been shown to be efficacious and has significantly improved the fight against the disease. In Ghana, women carry a higher prevalence and incidence of HIV. The study's objectives were to understand the experiences of women living with HIV/AIDS on ART and determine the barriers and enablers for ART uptake from the perspective of both the females living with HIV and their healthcare providers in the Upper East Regional Hospital of Ghana. METHODS: This was a qualitative study that used interviews to acquire data from women living with HIV on the perceived barriers and enablers for ART. The Upper East Regional Hospital in Ghana was the study site. We used a phenomenological approach to explore the lived experiences, perceptions, and meanings associated with ART among women. We collected data until we reached thematic saturation, interviewing a total of sixteen women living with HIV. We conducted a focus group discussion with nine healthcare workers providing care at the ART clinic. Data were analysed using thematic analysis. RESULTS: Women living with HIV and their healthcare providers viewed an environment that provided encouragement and support from healthcare workers and patients' relatives, the ability to conceal HIV status, peer counselling, and the perceived benefits of therapy as enablers of ART uptake and medication adherence. The following were barriers to ART uptake and adherence: ill health, forgetfulness, long distances to ART clinics, cultural and spiritual beliefs, and fear of stigma. CONCLUSIONS: Enablers of ART uptake should be expanded upon and encouraged so that women living with HIV/AIDS can access drugs in a timely and stress-free manner. On the other hand, the barriers identified can be addressed through education, the expansion of healthcare infrastructure, and the economic empowerment of women.

Co-Designing a Smoking Cessation Chatbot: Focus Group Study of End Users and Smoking Cessation Professionals.

BACKGROUND: Our prototype smoking cessation chatbot, Quin, provides evidence-based, personalized support delivered via a smartphone app to help people quit smoking. We developed Quin using a multiphase program of co-design research, part of which included focus group evaluation of Quin among stakeholders prior to clinical testing. OBJECTIVE: This study aimed to gather and compare feedback on the user experience of the Quin prototype from end users and smoking cessation professionals (SCPs) via a beta testing process to inform ongoing chatbot iterations and refinements. METHODS: Following active and passive recruitment, we conducted web-based focus groups with SCPs and end users from Queensland, Australia. Participants tested the app for 1-2 weeks prior to focus group discussion and could also log conversation feedback within the app. Focus groups of SCPs were completed first to review the breadth and accuracy of information, and feedback was prioritized and implemented as major updates using Agile processes prior to end user focus groups. We categorized logged in-app feedback using content analysis and thematically analyzed focus group transcripts. RESULTS: In total, 6 focus groups were completed between August 2022 and June 2023; 3 for SCPs (n=9 participants) and 3 for end users (n=7 participants). Four SCPs had previously smoked, and most end users currently smoked cigarettes (n=5), and 2 had quit smoking. The mean duration of focus groups was 58 (SD 10.9; range 46-74) minutes. We identified four major themes from focus group feedback: (1) conversation design, (2) functionality, (3) relationality and anthropomorphism, and (4) role as a smoking cessation support tool. In response to SCPs' feedback, we made two major updates to Quin between cohorts: (1) improvements to conversation flow and (2) addition of the "Moments of Crisis" conversation tree. Participant feedback also informed 17 recommendations for future smoking cessation chatbot developments. CONCLUSIONS: Feedback from end users and SCPs highlighted the importance of chatbot functionality, as this underpinned Quin's conversation design and relationality. The ready accessibility of accurate cessation information and impartial support that Quin provided was recognized as a key benefit for end users, the latter of which contributed to a feeling of accountability to the chatbot. Findings will inform the ongoing development of a mature prototype for clinical testing.

"Moving beyond silos": focus groups to understand the impact of an adapted project ECHO model for a multidisciplinary statewide forum of substance use disorder care leaders manuscript authors.

BACKGROUND: Although clinical substance use disorder (SUD) care is multidisciplinary there are few opportunities to collaborate for quality improvement or systems change. In Oregon, the Project ECHO (Extension for Community Healthcare Outcomes) model was adapted to create a novel multidisciplinary SUD Leadership ECHO. The objective of this study was to understand the unique effects of the adapted ECHO model, determine if the SUD Leadership ECHO could promote systems change, and identify elements that enabled participant-leaders to make changes. METHODS: Four focus groups were conducted between August and September of 2022 with a purposive sample of participants from the second cohort of the Oregon ECHO Network's SUD Leadership ECHO that ran January to June 2022. Focus group domains addressed the benefits of the adapted ECHO model, whether and why participants were able to make systems change following participation in the ECHO, and recommendations for improvement. Thematic analysis developed emergent themes. RESULTS: 16 of the 53 ECHO participants participated in the focus groups. We found that the SUD Leadership ECHO built a multi-disciplinary community of practice among leaders and reduced isolation and burnout. Three participants reported making organizational changes following participation in the ECHO. Those who successfully made changes heard best practices and how other organizations approached problems. Barriers to initiating practice and policy changes included lack of formal leadership authority, time constraints, and higher-level systemic issues. Participants desired for future iterations of the ECHO more focused presentations on a singular topic, and asked for a greater focus on solutions, advocacy, and next steps. CONCLUSIONS: The adapted ECHO model was well received by focus group participants, with mixed reports on whether participation equipped them to initiate organizational or policy changes. Our findings suggest that the SUD Leadership ECHO model, with fine-tuning, is a promising avenue to support SUD leaders in promoting systems change and reducing isolation among SUD leaders.

Supporting caregivers of people with dementia: insights from Demensia KITA mobile application online content development.

Dementia significantly impacts caregivers, particularly in low and middle-income countries where support is often inadequate. Given the gap in affordable and culturally relevant digital resources for Malaysian dementia caregivers, we developed "Demensia KITA," a mobile application (app) specifically tailored to their needs. This study utilized a theoretical framework proposed from existing literature and the "Model of Carer Stress and Burden". This paper discusses our app content development, highlighting key findings and challenges. To assess caregivers' needs, the Nominal Group Technique (NGT) with five dementia caregivers was conducted, followed by a Focus Group Discussion (FGD) with eight medical professionals. Both sessions were conducted online via Google Meet. In the NGT, ideas were generated, organized, prioritized, reviewed, and refined by medical professionals in the FGD. Content relevant to addressing the complexities of dementia caregiving was then discussed. Topics were either adapted from established modules or newly developed from credible sources. Subsequently, these were organized into modules and themes, and subsequently underwent expert validation. From the NGT, three key domains emerged: Knowledge, Services, and Support. These were further organized into two modules: 'Patient Care for Caregivers' and 'Caregiver Wellbeing'. Within these, twelve sub-modules were identified, covering a range of topics including basic knowledge on dementia, patient care, nutritional management, oral and dental care, simple exercises, daily activity and memory rehabilitation, service directories, support groups, emotional and stress management, welfare assistance, and daily motivation. This framework was developed to address the specific needs of dementia caregivers in terms of psychoeducation, psychosocial and caregiving skills, incorporating expert opinions in the field. This study corroborates the feasibility of online methods for mobile health app content development and encourages similar research. Future studies should evaluate Demensia KITA's effectiveness in alleviating caregiver burden across all regions, assess users' acceptance, and ensure it meets the evolving needs of Malaysian caregivers with regular updates.

Process evaluation of an mHealth-based school education program to reduce salt intake scaling up in China (EduSaltS): a mixed methods study using the RE-AIM framework.

BACKGROUND: An mHealth-based school health education platform (EduSaltS) was promoted in real-world China to reduce salt intake among children and their families. This progress evaluation explores its implementation process and influencing factors using mixed methods. METHODS: The mixed-methods process evaluation employed the RE-AIM framework. Quantitative data were collected from a management website monitoring 54,435 third-grade students across two cities. Questionnaire surveys (n = 27,542) assessed pre- and post-education effectiveness. Mixed-effects models were used to control cluster effects. Qualitative interviews (23 individuals and 8 focus groups) identified program performance, facilitators, and barriers. Findings were triangulated using the RE-AIM framework. RESULTS: The program achieved 100% participation among all the third-grade classes of the 208 invited primary schools, with a 97.7% registration rate among all the 54,435 families, indicating high "Reach." Qualitative interviews revealed positive engagement from children and parents through the "small hands leading big hands" strategy. The high completion rate of 84.9% for each health cloud lesson and the significant improvement in salt reduction knowledge and behaviors scores from 75.0 (95%CI: 74.7-75.3) to 80.9 (95%CI: 80.6-81.2) out of 100 demonstrated the "Effect" of EduSaltS. The program's "Adoption" and "Implementation" were supported by attractive materials, reduced workload via auto-delivered lessons/activities and performance evaluation, and high fidelity to recommended activities, with medians 3.0 (IQR: 2.0-8.0)/class and 9.0 (IQR: 5.0-14.0)/school. Stable course completion rates (79.4%-93.4%) over one year indicated promising "Maintenance." Apart from the facilitating features praised by the interviewees, government support was the basis for the scaling up of EduSaltS. Barriers included the lack of smartphone skills among some parents and competing priorities for schools. Unhealthy off-campus environments, such as excessive use of salt in pre-packaged and restaurant foods, also hindered salt reduction efforts. The program's scalability was evident through its integration into existing health education, engagement of local governments and adaptation across various mobile devices. CONCLUSIONS: The mHealth-based school health education program is scalable and effective for public salt reduction in China. Identified barriers and facilitators can inform future health program scale-ups. The program's successful implementation demonstrates its potential for broader application in public health initiatives aimed at reducing dietary salt intake.

Through the eyes of Spanish-speaking patients, caregivers, and community leaders: a qualitative study on the in-patient hospital experience.

BACKGROUND: Spanish-speakers with non-English language preference and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Communication challenges during prolonged hospitalizations for complex illnesses negatively influence how this group engages in their care and decision-making while hospitalized. Limited literature capturing the perspectives of Spanish-speaking patients in this context exists. Given the impact of language barriers on care and medical decision-making, this study documents the experiences of Spanish-speaking patients with NELP and hospitalized with complex care needs as well as caregivers and community leaders. METHODS: Using community-engaged recruitment strategies and semi-structured interviews and a focus group, we gathered insights from Spanish-speaking patients hospitalized for prolonged periods, caregivers, and community leaders from three geographic regions. Data were deidentified, transcribed, translated, coded in duplicate, and analyzed guided by grounded theory using NVivo. RESULTS: We interviewed 40 participants: 27 patients, 10 caregivers and 3 community leaders. We identified four major themes: (1) Disconnected experiences impeding interactions, communication, and decision-making (2) Inadequate interpreter services (3) Benefits and consequences of family at the bedside (4) Community -informed recommendations. CONCLUSION: The study showed that in-person interpreters were preferred to virtual interpreters; yet interpreter access was suboptimal. This resulted in ad hoc family interpretation. Participants noted language negatively impacted patient's hospital experience, including decreasing confidence in medical decision-making. Recommendations from patients, caregivers, and community leaders included expanding interpreter access, bolstering interpreter quality and accuracy, and increasing resources for patient education.

'Everyone needs to be educated': pupils' voices on menstrual education.

BACKGROUND: Physical, affective and behavioural symptoms associated with the menstrual cycle are commonplace. Adolescents with problematic symptoms have reported a negative impact on school attendance, behaviour and participation in physical activity. In the United Kingdom, evidence suggests that menstrual health education delivered by teachers focusses on menstrual cycle biology as opposed to management of menstruation and menstrual cycle related symptoms. Through obtaining the pupil voice, this study aimed to understand young people's perceptions and experiences of menstrual education in schools and their experiences of menstruating whilst at school, including within Physical Education. METHODS: To address the aims, a qualitative descriptive study was conducted. Nine focus groups with female pupils (n = 48; ages 10-15 years) were completed across six school locations in England and Wales, including primary and secondary schools. A range of elements relating to the menstrual cycle, education at school and PE were discussed by pupils. RESULTS: Four main themes were developed (a) Education preferences, (b) Period positive environments, (c) Personal experiences and (d) Impact on school. Similarities were reflected across focus groups in terms of current (lacking) education, lesson style and preferences, comfort of conversations, lack of school support and impact on school and PE. CONCLUSION: The findings highlight the lack of menstrual education received and subsequent impact of menstruation and menstrual-related symptoms in school and PE. The abundance of information requested by pupils highlights the deficit in understanding about how to manage periods in school and remain engaged in physical activity. Schools can utilise information from the current study to; create period positive environments; consider lesson content and format; and explore how to support girls to stay physically active in PE.