Iron supplementation: A qualitative study on the perception of blood donors, blood collection staff and donor physicians.

BACKGROUND AND OBJECTIVES: Iron supplementation is an effective strategy to mitigate donation-induced iron deficiency in blood donors. However, evidence on the perception of individuals involved in blood donation on iron supplementation as a blood service policy is lacking. This study aimed to evaluate the knowledge and perception of whole blood donors (donors), blood collection staff (collection staff) and donor physicians (physicians) regarding donation-induced iron loss and iron supplementation. MATERIALS AND METHODS: Online focus group discussions had four to six participants and followed a structured questioning approach. All participants had to be fluent in Dutch to participate, and donors had donated at least five times. Sixteen donors, eight collection staff members and four physicians participated in this study. Recordings were transcribed, coded and analysed using a grounded theory approach. RESULTS: Awareness of donation-induced iron loss was limited in donors. Donors and physicians were predominantly positive towards iron supplementation; the primary motivator for donors was to prevent deferral and reduce iron-deficiency-related symptoms. Improving donor health was the main argument for physicians to advocate iron supplementation. Staff had a critical view on iron supplementation as a policy, as they perceived it as unethical and possibly ineffective. A knowledge gap might underlie their concerns. CONCLUSION: Most individuals involved in blood donation are positive towards iron supplementation as a blood service policy. If implemented, guidance and monitoring is desired and adequate education of all stakeholders is required.

Developing criteria for a profession to be considered as profession of allied health in Malaysia: a qualitative study from the Malaysian perspective.

BACKGROUND: The Malaysian Allied Health Profession Act (Act 774) regulates the practice of allied health practitioners in Malaysia, with two described professions viz. allied health profession (AHP) and profession of allied health (PAH). While AHPs have been clearly identified by the law, comprehensive implementation of the act requires development of specific criteria in defining any profession as PAH in the Malaysian context. Hence, the research aims to explore and identify the criteria for defining such professions for healthcare policy direction in Malaysia. METHODS: This research utilised two methods of qualitative research (document review and focus group discussions (FGDs) involving 25 participants from four stakeholders (higher education providers, employers, associations and regulatory bodies). Both deductive and inductive thematic content analysis were used to explore, develop and define emergent codes, examined along with existing knowledge on the subject matter. RESULTS: Sixteen codes emerged from the FGDs, with risk of harm, set of competency and skills, formal qualification, defined scope of practice, relevant training and professional working within the healthcare team being the six most frequent codes. The frequencies for these six codes were 62, 46, 40, 37, 36 and 18, correspondingly. The risk of harm towards patients was directly or indirectly involved with patient handling and also relates to the potential harms that may implicate the practitioners themselves in performing their responsibilities as the important criterion highlighted in the present research, followed by set of competency and skills. CONCLUSIONS: For defining the PAH in Malaysia, the emerged criteria appear interrelated and co-exist in milieu, especially for the risk of harm and set of competency and skills, with no single criterion that can define PAH fully. Hence, the integration of all the empirically identified criteria must be considered to adequately define the PAH. As such, the findings must be duly considered by policymakers in performing suitable consolidation of healthcare governance to formulate the appropriate regulations and policies for promoting the enhanced framework of allied health practitioners in Malaysia.

Factors influencing interprofessional collaboration in long-term care from a multidisciplinary perspective: a case study approach.

Systematic assessments of interprofessional collaboration barriers and enablers in long-term care settings are critical for delivering person-centered healthcare. However, research on factors influencing interprofessional collaboration in long-term care settings is limited. For this study, 65 healthcare professionals across multiple facilities experienced in long-term care in Japan participated in online focus group discussions and individual interviews to discuss cases. The qualitative data were analyzed using qualitative content analysis. Seven themes emerged: coordination, the need for care manager training, hierarchy among healthcare professionals, specialization but not the mind-set of overspecialization, casual conversations, electronic group communication tools, and excessive fear of personal information protection. These findings highlight the need to develop coordinator roles and for interprofessional education on the proper approach to personal information protection laws. Furthermore, daily casual conversations, the use of online platforms, and the prevention of patients being left behind due to overspecialization are required.

Cultural factors and family influences on adolescent oral health: qualitative research in a socially disadvantaged population.

AIM: This qualitative study sought to assess the influence of cultural factors and family on oral health behaviour of 12- to 15-year-old adolescents from the socially disadvantaged population. DESIGN: A qualitative design was developed with focus group discussions (FGDs) among 12- to 15-year-old adolescents. Four focus groups (n = 32 participants) were created from a selected sample to capture oral health beliefs and practices, oral health-seeking behaviour along with other relevant information. Focus group discussions were audio-recorded, transcribed verbatim and translated. Data were analysed thematically and structural coding was applied. RESULTS: Three key themes that emerged from FGDs were importance of oral health; role of family in oral health behaviour; and beliefs influencing access, prevention and treatment of oral diseases. Cultural background, family values and beliefs were imperative in moulding the behaviour of adolescents towards oral health. The use of traditional oral hygiene aides was a norm in this population. CONCLUSIONS: Findings of the study provide greater insights into the authoritative role of family and cultural barriers in the uptake of dental services. The study also highlights the potential value of qualitative research and emphasizes the need to integrate oral health-associated cultural beliefs and attitudes of the adolescents towards a wider evidence base.

Adolescents' Perceptions About Healthy and Sustainable Diets: A Qualitative School-Based Study in Portugal.

In this qualitative study, we explored Portuguese adolescents' perceptions of diet, sustainability, and health through six focus group discussions (FGDs). Fifty-five adolescents (10-18 years) participated. FGDs focused on sustainability in food choices and its health impact, with our primary interest in their perceptions. Results showed a limited comprehension of "sustainable/sustainability," especially among younger participants. Those aware of sustainability recognized its diverse aspects, including health, economic, and ecological domains. Some adolescents recognized the link between health and sustainability in their diets, emphasizing the need for food literacy. These findings emphasize the importance of public health and sustainable policies among Portuguese adolescents.

Antimicrobial Resistance in Slaughterhouses, Kenya.

Slaughterhouses are hotspots for the transmission of antimicrobial-resistant pathogens. We conducted stakeholder discussions on antimicrobial-resistant pathogens within the slaughterhouse setting. Butchers were described as powerful stakeholders; challenges included limited funding and staff, inadequate infrastructure, and limited laboratory capacity. Slaughterhouse workers understood that their work increased their risk for exposure.

Exploring activities and behaviours potentially increases school-age children's vulnerability to malaria infections in south-eastern Tanzania.

BACKGROUND: Strengthening malaria control activities in Tanzania has dramatically declined human malaria infections. However, there is an increasing epidemiological shift in the burden on school-age children. The underlying causes for such an epidemiological shift remain unknown in this context. This study explored activities and behaviours that could increase the vulnerability of school-age children to transmission risk to provide insight into protection gap with existing interventions and opportunities for supplementary interventions. METHODS: This cross-sectional study conducted twenty-four focus group discussions (FGDs) in three districts of Rufiji, Kibiti and Kilwa in south-eastern Tanzania. Sixteen FGDs worked with school-age children (13 to 18 years) separating girls and boys and eight FGDs with their parents in mixed-gender groups. A total of 205 community members participated in FGDs across the study area. Of them, 72 participants were parents, while 133 were school-age children (65 boys and 68 girls). RESULTS: Routine domestic activities such as fetching water, washing kitchen utensils, cooking, and recreational activities such as playing and watching television and studying were the reported activities that kept school-age children outdoors early evening to night hours (between 18:00 and 23:00). Likewise, the social and cultural events including initiation ceremonies and livelihood activities also kept this age group outdoors from late evening to early night and sometimes past midnight hours. Parents migrating to farms from December to June, leaving behind school-age children unsupervised affecting their net use behaviour plus spending more time outdoors at night, and the behaviour of children sprawling legs and hands while sleeping inside treated bed nets were identified as potential risks to infectious mosquito bites. CONCLUSION: The risky activities, behaviours, and social events mostly occurring outdoors might increase school-age children's vulnerability to malaria infections. The findings provide preliminary insight on potential risk factors for persisting transmission. Further studies to quantify the risk behaviour and activities are recommended to establish the magnitude and anticipated impact on supplementary control strategies to control infection in school-age children.

Virtual home visits during COVID-19 pandemic: mothers' and home visitors' perspectives.

BACKGROUND: The experiences of mothers enrolled in Maternal, Infant and Early Childhood Home Visiting (MIECHV) program with virtual home visiting (VHV) during the pandemic remain mostly unknown. This study aimed to describe in detail the experience of home visitors and mothers with VHV during COVID-19 pandemic. This is a prerequisite for guiding future efforts to optimize MIECHV services that are provided through virtual operation. METHODS: Focus groups discussion were conducted with home visitors (n = 13) and mothers (n = 30) who were enrolled in BabyCare program in Virginia from January 2019 to June 2022. This included mothers who received in-person home visiting (IPHV), VHV, or both (hybrid IPHV and VHV). Inductive analysis was used to identify emergent themes from the transcripts, then coding was conducted following a codebook that was developed by the research team. RESULTS: Both mothers and home visitors considered IPHV necessary for a proper assessment of developmental milestones of children, for the assessment of the growth of the child through measuring the weight and height/length of the child, for the mothers to open up and discuss sensitive issues like domestic violence, for building a relationship between home-visitor and the parents, and for other potential benefits (comprehensive assessment of the environment around the child inside and outside the house from home visitors' perspective and detecting abnormal health conditions in children from mothers' perspective). Both mothers and home visitors see that VHV has some role to play but not to be a replacement for IPHV. If VHV is to be used, video conference is preferred by both mothers and home visitors, as it allows for some assessment. CONCLUSION: Mothers and nurses considered IPHV critical for proper and comprehensive assessment of the child and the family and also essential to build the nurse-client relationship. Both mothers and home visitors considered VHV supplementary to IPHV that can be used from time to time particularly with busy mothers. VHV may have little room with parents with intellectual disabilities and the difficulty in dealing with technology seems to be no longer a major issue.

Understanding knowledge, attitudes and practices on Ebola Virus Disease: a multi-site mixed methods survey on preparedness in Rwanda.

BACKGROUND: The overall goal of this survey was to understand the knowledge, attitudes, and practices related to the Ebola Virus Disease (EVD) in Rwanda. METHODS: This mixed-method cross-sectional survey was conducted in five selected districts of Rwanda. Quantitative data were collected from 1,010 participants using Kobo Collect Software and the analysis was performed using SPSS and Python software. Qualitative data were specifically collected from 98 participants through Key Informant Interviews (KIIs) and Focus Group Discussion (FGDs). Interview transcripts were imported into NVIVO 8 for coding and subsequent analysis. RESULTS: As per our quantitative findings, we report that from the 1,010 respondents, 99.6% reported having previously heard of Ebola, 97.2% believed that vaccination is important in combatting the disease and 93.3% of individuals reported a willingness to receive vaccination should one become available. Around 54% of the respondents were correct in identifying that the disease is of a viral origin which originates from wild animals (42.1%). When asked if they believed that Rwanda is at risk of an EVD outbreak, 90% of the respondents believe that the country is at risk of an EVD outbreak, and the cofactors *gender* and *whether people dwell in Rubavu/Rusizi* were found to significantly impact their perception of threat. As per our qualitative findings, the respondents mentioned that both geographical proximity and relations with the Democratic Republic of Congo place Rwanda at risk of developing an internal outbreak. Although the respondents seemed to be aware of the Ebola prevention behaviours, it was noted that some of them will require significant time before reintegrating into the community an EVD survivor, as they will first need assurance that the patient has fully recovered. Therefore, the qualitative findings reinforce what we originally reported in the quantitative approach to this study. CONCLUSION: Our results show that there was high EVD-related knowledge and awareness among the general population in Rwanda. However, for strong public health awareness, preparedness, and protection, a massive investment should always be made in education about EVD with a special focus on districts neighboring countries where the disease is consistently being reported.

Analysis of the Doctor of Public Health (DrPH) training and identity needs in the United States: a qualitative study.

BACKGROUND: The Doctor of Public Health (DrPH) is the highest attainable degree in the field of public health, specifically designed to prepare professionals to address complex public health challenges in practical settings. This study was designed to explore the importance of achieving a shared and uniform understanding of DrPH education, assess the optimal direction for DrPH training, and investigate the specific curriculum requirements by gathering insights from current DrPH students and alumni in the United States. METHODS: A total of 13 focus group discussions and two in-depth interviews (total participants: 50) were conducted through Zoom to see how DrPH students and alumni assessed their DrPH educational programs. RESULTS: Three overarching findings emerged from the analysis of focus group discussions and in-depth interviews. First, participants expressed a preference against a national DrPH board examination, but advocated for a standardized common core curriculum that extends across the entire nation. Second, the ideal direction for DrPH training was perceived to involve a practice-based approach, emphasizing the importance of multi-, inter-, and trans-disciplinary instruction delivered by faculty with practical experience. Last, there was a demand for a DrPH-specific unique curriculum encompassing areas such as mixed method analysis, leadership and management, applied communication, crisis and change management, proficiency in addressing contemporary topics, and tailored applied and integrative learning requirements specific to the DrPH program. CONCLUSIONS: We explored a range of DrPH training and identity needs among 50 participants, comprised of students and alumni who directly benefit from DrPH education. By considering these inputs, individuals from institutions that offer the DrPH degree can further enhance the quality of public health practice training and make significant contributions to the overall advancement of the field of public health.

Stakeholder views on informed consent models for future use of biological samples in Malawi and South Africa.

BACKGROUND: Current advances in biomedical research have introduced new ethical challenges in obtaining informed consent in low and middle-income settings. For example, there are controversies about the use of broad consent in the collection of biological samples for use in future biomedical research. However, few studies have explored preferred informed consent models for future use of biological samples in Malawi and South Africa. Therefore, we conducted an empirical study to understand preferred consent models among key stakeholders in biomedical studies that involve collection of biological samples in Malawi and South Africa. The main objective of the study was to explore views of key stakeholders on current policies on informed consent in Malawi and South Africa. METHODS: This was a qualitative study involving in-depth interviews and focus group discussions. Thirty-four in-depth interviews and 6 focus group discussions were conducted with REC members, Funders, Policymakers, CAB members and Research Participants in Malawi and South Africa to gather their views on models of informed consent. The study was conducted in Cape Town, South Africa, and Blantyre and Lilongwe in Malawi. RESULTS: Most key stakeholders preferred broad consent and tiered consent to specific consent. Some participants expressed a strong preference for specific consent to other models of informed consent in biomedical research. Few participants did not have any preference for a consent model, opting for any consent model which provides adequate information about the proposed research and what their national consent regulations require. Finally, very few participants preferred blanket consent to other informed consent models. CONCLUSIONS: This study aimed to help fill the gap in the scientific literature on key stakeholder views on consent models for future use of biological samples in Malawi and South Africa. The findings of the study have provided some evidence that may support policies on permissible consent models for future use of biological samples in sub-Saharan Africa considering the differences in informed consent regulations and guidelines. Finally, the findings can inform ongoing discussions on permissible consent models to be used for future use of biological samples.

Development of a Communication Tool between Patients and Physicians for Recognizing COPD Exacerbations in Japan.

In Japan, exacerbations are underreported compared with other countries, possibly due in part to a failure to recognize them. This study aimed to create a simple chronic obstructive pulmonary disease (COPD) Exacerbation Recognition Tool (CERT-J) specifically for Japanese patients. Patients ≥40 years with confirmed COPD or asthma-COPD overlap were included. Focus groups were held to identify words and phrases used by patients to describe symptoms associated with an exacerbation, resulting in candidate items being identified. Following cognitive debriefing, the items were refined based on item frequency, level of endorsement and effect of demographic factors. Exploratory factor analysis (EFA) was then performed to inform an expert panel's choice of items to form the new tool. A total of 41 patients were included in the focus groups and nine patients performed the cognitive debrief. Following this, the expert panel identified 26 items for testing in a further 100 patients (mean age 72 years, forced expiratory volume in 1 s 54.8% predicted and 1.8 exacerbations in the preceding 12 months). Eleven items were associated with breathlessness or activity limitation and seven of these were the most frequently endorsed. EFA identified four factors, with one (breathlessness) being dominant. The expert panel recommended that the CERT-J should include six items: breathlessness and activity limitation (3 items), cough (1 item) and phlegm (2 items). The final CERT-J should benefit patients with COPD by providing them with an increased understanding and recognition of exacerbations.Clinical Trial Registration: GSK K.K (jRCT1080224526).

Students' perception on flipped classroom with formative assessment: A focus group study.

OBJECTIVE: To explore students' perception on the implementation of flipped classroom (FC) combined with formative assessment during the undergraduate teaching of orthodontic wire-bending skills. METHODS: Third-year undergraduate dental students were taught wire-bending skills via FC teaching method using a series of pre-recorded online video demonstrations. As part of the formative assessment, the students were given the results and assessment rubrics of their prior wire-bending assessment before every subsequent session. Purposive sampling method for focus group discussion was used to recruit eight students comprising four high achievers and four low achievers. Strengths, weaknesses and suggestions for improvement of the FC with formative assessment were explored. Data were transcribed and thematically analysed. RESULTS: Students perceived that FC allowed for a more convenient and flexible learning experience with personalised learning and improved in-class teaching efficiency. The pre-recorded online videos were useful to aid in teaching wire-bending skills but lacked three-dimensional representation of the wire-bending process. Students suggested better standardisation of instructions and access to the marking rubric before and after assessment. CONCLUSIONS: FC teaching with continuous formative assessment and constructive feedback as a form of personalised learning was viewed favourably by students. The implementation of periodic individual feedback can further enhance their learning experience.

[Evaluation of the front-of-package warning labels of prepackaged food in China based on focus group discussion].

OBJECTIVE: To understand the public's perceptions and preferences on the designed front-of-package warning labels of prepackaged food, and to evaluate and identify the effective warning label. METHODS: A total of 116 participants were recruited from six provinces(autonomous regions/municipalities) in China. Focus group discussions were conducted with four types of warning labels on prepackaged food. And the score of attitude on different warning labels were compared. RESULTS: There was no difference in the total score of the four warning labels. Total score of black shield label was higher in citizen participants and college education level participants than in their respective counterparts(P<0.05). Parents or primary caregiver of children under 16 years old gave higher scores to each labels than their respective counterparts(P<0.05). The black shield label was most likely to attract the attention of the respondents, most likely to influence the decision on eating and drinking, and most likely to have an unhealthy warning effect. The yellow hexagonal label was least likely to attract the attention of the respondents, least likely to affect the decision to eat and drink food, and least likely to have an unhealthy warning effect. CONCLUSION: Black shield warning label is the most effective.

Secondary school students' and peer educators' perceptions of adolescent education in rural Tanzania: a qualitative study.

BACKGROUND: In many African countries, cultural norms and values hinder conversations about sexuality among adolescents and their parents. Currently, there are no sex education classes in the curriculum at schools in Tanzania. Even when sex education is provided, the content is often abstinence-oriented, and there is a lack of in-depth instruction and exploration on the topic. To help overcome this, peer education is encouraged. After implementing peer-based adolescent education via a non-profit organization, this study aims to (1) identify students' and peer educators' perceptions of adolescent education and (2) identify the changes that occur as a result of adolescent education with peer educators. METHODS: This was a qualitative descriptive study using focus group discussions (FGDs). Secondary school students, including peer educators as well as students who received adolescent education, were asked about their perception of peer-based adolescent education. The FGDs were conducted in Swahili with the support of local collaborators. Data were transcribed and translated into English and Japanese. Content analysis was conducted to merge the categories and subcategories. RESULTS: A total of 92 students (57 girls and 35 boys) were included from three urban and three rural secondary schools where peer education was being implemented. Six FGDs were conducted for girls and four for boys, for a total of 10 FGDs. The students had both positive and negative perceptions of peer-based adolescent education. Both the peer educators and the other students felt that they gained more confidence through the process, based on the conversations they had and the trusting relationship that formed as a result. The peer educators were also successful in eliciting behavioral changes, and the students shared their sex-related knowledge with other peers as well. CONCLUSION: The peer education process helped students gain confidence in teaching their peers and elicit behavioral changes. Adult supervision for peer educators is suggested.

Peer education, such as sharing correct knowledge, skills, and behaviors, is encouraged for maintaining a healthy lifestyle in later life. The non-profit organization Class for Everyone conducted adolescent education in collaboration with a local NGO, the New Rural Children Foundation, to prevent unwanted pregnancy and social isolation among adolescent girls. In secondary schools, the NGO members provided adolescent education led by peer educators.In this study, we conducted focus group discussions to understand how peer educators and other secondary school students perceived peer-based adolescent education. The study included 92 students (57 girls and 35 boys) from three urban and three rural secondary schools where peer education was being implemented. We used content analysis to merge the categories and subcategories.We found that students had both positive and negative perceptions about peer-based adolescent education. The participants felt that they gained more confidence through the peer education process. The peer educators were also successful in eliciting behavioral changes. Moreover, the students receiving peer education shared their sex-related knowledge with other peers as well.In conclusion, the peer education process helped students gain confidence in teaching their peers and elicit behavioral change. Adult supervision for peer educators is suggested.

Perception of online and face to face microbiology laboratory sessions among medical students and faculty at Arabian Gulf University: a mixed method study.

BACKGROUND: The COVID-19 pandemic has impacted all spheres of society including medical education and healthcare systems. In response to the pandemic, there has been a transition in medical education practice from traditional forms of teaching to online instruction delivery and virtual learning. Effective clinical microbiology education involves a combination of 'hands-on' practical learning and instructional delivery of scientific knowledge. Microbiology practical laboratories are critical learning environments offering 'hands-on' learning experiences that cannot be replicated through online learning. We conducted a mixed-methods study to understand the perception of online and face-to-face microbiology laboratory sessions among the medical students and microbiology faculty at Arabian Gulf University (AGU). METHODS: The study participants were third and fourth-year undergraduate medical students and faculty involved in delivering microbiology labs at AGU. The questionnaire consisted of questions ranging from perceived learning style to attitude towards online delivery of microbiology curriculum. After the questionnaire administration (google form), focus group discussion (FGD) was conducted for students and microbiology faculty separately. RESULTS: Among 168 students, 50.6% preferred face-to-face lab sessions as compared to 30.4% who preferred online labs, and 51.8% considered online labs to be an essential addition to face-to-face labs. Among the faculty, 85.7% preferred the face-to-face mode of teaching. All the faculty (100%) disagreed that all the microbiology labs teaching should be online. 57.2% considered online labs to be an essential addition to traditional face-to-face labs. Both faculty and students hold that a blended mode of instructional delivery is vital and indispensable for the transfer of skills and knowledge for microbiology students. CONCLUSION: The blended mode of delivering microbiology laboratory sessions in medical school is successful and well-received by both students and faculty. Students take the responsibility for furthering their own learning and understanding of concepts. Instructors have also noticed that blending learning strategies also successfully enhances the development of cognitive skills and problem-solving abilities in students. A review of the microbiology lab curriculum is necessary to identify content areas that can be delivered effectively through online, face-to-face lab sessions, or both, supported with appropriate tools and infrastructure.

Perspectives of Healthcare Providers and the General Population on a Cancer Awareness Portal: a Qualitative Study.

This study was aimed at a qualitative assessment of a cancer informational website, "India Against Cancer," developed by the ICMR-National Institute of Cancer Prevention and Research with the dual purpose of promoting cancer awareness among the general population and providing comprehensive information to healthcare providers. We used the narrative qualitative approach (data collection using in-depth interviews (IDIs) and focused group discussions (FGDs)) and content analysis. Purposive sampling was undertaken for both IDIs and FGDs. Thematic analysis was done on four themes: general cancer awareness, ease of comprehension of the Web portal, the relevance of the website content, and general comments and suggestions. Readability assessment of content of the website was conducted using Flesch-Kincaid Readability methodology. The general cancer awareness was enhanced among the participants after visiting the website. Ease of comprehension of the Web portal content was reported to fare well. The sections on "risk factors," "warning signs," and "diet and cancer" were mentioned as most relevant by the general population, whereas "myths and facts" and "screening guidelines" were most relevant for the healthcare workers. Similarly, references and epidemiology sections were most useful for healthcare researchers/professionals. Readability scores of content in English were appropriate for high school pass audience. The content on "India Against Cancer" website was found to serve its intended purpose of promoting cancer awareness among the general population and providing authentic cancer-related information to the healthcare providers. The suggestions received would enable us to enhance the utility of our website by tailoring it to the needs of the target audience.

Re-Conceptualizing Bereavement Care Practices: Insights Gained from Service Providers.

The management and delivery of bereavement care and support services present practical challenges. A national-level, qualitative study was conducted to examine the current practices in Singapore. The study's purpose was to inform bereavement care practices by drawing from perspectives of service providers offering death, dying and bereavement-related services. This qualitative study was undertaken using focused group discussion (FGD) with service providers from the health, social and death-related sectors. Ten FGDs were conducted with a total of 69 participants. Thematic analysis yield two themes - identifying challenging circumstances to provide bereavement care and strategies for dealing with the gaps in service delivery. The service providers' experiential knowledge could be borrowed to strengthen the current bereavement care practices for the good of the community. The findings have informed the reconceptualization of a local bereavement care and support service model, with the public health model as the recommended underpinning conceptual framework.

Perceptions of Healthcare Workers Regarding Palliative Care Services in a Tertiary Care Teaching Hospital in North India - A Mixed Methods Observational Study.

Objectives: Cancers and various terminal illnesses need integrated palliative care with curative management, but, unfortunately, our health care system mainly focuses on the treatment of disease. Lack of awareness, difficulty in pain management and untrained staff are some of the challenges in palliative care services.The study was done to explore the perception of healthcare workers regarding availability, utilisation and challenges in the delivery of palliative care services. Material and Methods: A mixed method study was conducted at tertiary care teaching hospital in North India. Qualitative approach using interviews and focus group discussions (FGDs) among healthcare workers was done to understand their knowledge, perception, barriers and challenges in implementing palliative care services. One hundred and thirteen healthcare workers were interviewed using a semi-structured questionnaire and FGD was conducted to gain more insight into the issues of palliative care. The data obtained was analysed with the help of computer software Microsoft Excel and SPSS version 23 for windows. The data was presented as proportion and mean (S.D.) as deemed appropriate for qualitative and quantitative variables respectively. Thematic analysis was done with the data of FGD. Results: The knowledge, attitude and practices regarding palliative care were poor across the HCW. During FGD with faculty and residents, the participants showed great concern about the absence of palliative care across many specialties while expressing an acute need for the establishment of a separate interdisciplinary unit on palliative care to improve the quality of life in patients. Conclusion: The study shows that there are gaps that need to be addressed to make palliative services available in our hospital.

Barriers and facilitators of household provision of dairy and plant-based dairy alternatives in families with preschool-age children.

OBJECTIVE: This study aimed to explore barriers and facilitators of the provision of dairy and plant-based dairy alternatives (PBDA) by parents of preschool-age children, a previously unexplored area of research. DESIGN: Five focus groups of parents were conducted and audio-recorded. Verbatim transcripts were analysed using thematic analysis. SETTING: University of Guelph, in Guelph, ON, Canada in 2019. PARTICIPANTS: Thirty-two (n 19 mothers, 13 fathers) parents of preschool-age children. Most (59 %) were university or college educated. RESULTS: Facilitators common to both dairy and PBDA provision included perceived nutritional benefits, such as dairy's Ca, protein and fat content, and PBDA's protein content, and the perception that PBDA adds variety to the diet. Facilitators unique to dairy v. PBDA provision included the taste of, familiarity with, and greater variety and accessibility of dairy products, specifically child-friendly products. A facilitator unique to PBDA v. dairy provision was ethical concerns regarding dairy farming practices. Barriers common to both dairy and PBDA provision included perceived cost, concerns regarding the environmental impact of production, and high sugar content. Barriers specific to dairy included use of antibiotics and hormones in dairy production. A barrier specific to PBDA was the use of pesticides. CONCLUSION: Behaviour change messages targeting parents of preschoolers can emphasise the nutrition non-equivalence of dairy and some PBDA and can educate parents on sources of affordable, unsweetened dairy and PBDA.