METHODS: An interpretative phenomenological analysis (IPA) study design was used to recruit a purposive sample of foster carers in Tower Hamlets, United Kingdom, from a range of backgrounds (maximum variation sampling). Participants were aged 21 years and older and provided full-time foster care for children for a minimum of 1 year. The foster carers took part in focus groups that were audio-recorded and transcribed verbatim. Data analysis followed a five-step IPA process, which included reading the transcripts, note taking, identifying emerging themes, connecting related themes and writing up the final themes. Iterative data gathering and analysis continued to reach thematic saturation.
RESULTS: Three focus groups were conducted, involving a total of 12 foster carers. Eight of the 12 participants had fostered children for more than 10 years and they were currently fostering 22 children aged five to 18 years old. Four themes emerged from within the context of the supportive and nurturing foster family environment that described how foster carers' responded to and managed the oral health of their foster children. Foster carers had adopted an oral health caregiving role, "in loco parentis" responding to the poor oral health of their vulnerable foster children. They were hypervigilant about establishing and monitoring children's oral health routines and taking their children to see a dentist; these were seen as an integral part of being good foster carers. They were knowledgeable about the causes of children's oral ill health, gained from their own dental experiences and from looking after their own children. Foster carers had experienced tensions while adopting this oral health caregiving role with dentists who had refused to see younger children. Foster carers had also experienced tensions with teenage foster children who questioned their parental authority and legitimate right to set rules about smoking and healthy eating.
CONCLUSIONS: This is the first study to explore foster carers' oral health perspectives and the foster family environment within the oral health context. It highlights the unrecognized and important role that foster carers have in improving the oral health of vulnerable children. Further research is needed to explore the relationship between foster carers and dentists and to support the development of health and social care interventions to improve foster children's oral health.
METHODS: 151 adolescent vaccine providers and 118 mothers of adolescent girls aged 9-14 were recruited from five geographically-diverse countries: Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preferences for single-purpose human papillomavirus (HPV) vaccine versus MPVs (including HPV+herpes simplex virus (HSV)-2, HPV+HIV, or HPV+HSV-2+HIV) via quantitative surveys. Maternal MPV attitudes were assessed in four focus group discussions (FGDs) in each country.
RESULTS: Most providers preferred MPVs over single-purpose HPV vaccination, with preference ranging from 61% in Malaysia to 96% in South Africa. HPV+HSV-2+HIV was the most preferred MPV formulation (56-82%). Overall, 53% of the mothers preferred MPVs over single-purpose HPV vaccines, with strongest support in South Africa (90%) and lowest support in South Korea (29%). Convenience and trust in the health care system were commonly-cited reasons for MPV acceptability. Safety and efficacy concerns were common barriers to accepting MPVs, though specific concerns differed by country. Across FGDs, additional safety and efficacy information on MPVs were requested, particularly from trusted sources like HCPs.
CONCLUSIONS: Though maternal acceptability of MPVs varied by country, MPV acceptability would be enhanced by having HCPs provide parents with additional MPV vaccine safety and efficacy information. While most providers preferred MPVs, future health behavior research should identify acceptability barriers, and targeted provider interventions should equip providers to improve vaccination discussions with parents.
METHODS: A mixed method design was used. Fourth-year medical students participated in a consultation/liaison psychiatry service to two government-operated primary care clinics. Each student attended two half-day consultations to the clinics during the psychiatry clinical clerkship. Students joined in discussions with primary care clinicians, performed supervised clinical assessments, and administered a depression screening instrument. The learning experience was evaluated through four focus groups, each with 9-10 participants, held throughout the academic year. An end-of-year, anonymous, online questionnaire survey was administered to the entire class. Thematic analysis of focus group transcripts was performed and quantitative statistics were calculated (Stata version 13).
RESULTS: Focus group themes included the following: (a) active learning opportunities in primary care psychiatry consultation had perceived added educational value, (b) students benefited from contact with patients with previously undiagnosed common mental disorders, and (c) students' primary care experience raised their awareness of societal and professional responsibilities. Of the class of 113 students, 93 (82%) responded to the questionnaire. The survey responses reflected the qualitative themes, with 79 respondents (85%) stating that the learning experience met or exceeded their expectations.
CONCLUSIONS: Academic psychiatry has been criticized for its overreliance on secondary care settings in undergraduate clinical teaching. Our findings suggest that supervised clinical placements in primary care are feasible and provide added educational value as a routine component of the undergraduate psychiatry clinical clerkship.
METHODS: This was a qualitative study utilising the constructivist grounded theory approach. A total of 31 individuals aged 30 years and above from the community were sampled purposively. Eight interviews and six focus groups were involved, using a semi-structured topic guide.
RESULTS: A conceptual framework was developed to explain the public's decision-making process on health check participation for CVD prevention. The intention to participate in health checks was influenced by the interplay between perceived relevance and the individual's readiness to face the outcome of health checks. Health checks were deemed relevant if people perceived themselves to be at risk of CVD and there was an advantage in knowing their cardiovascular status. People were ready to face the outcome of health checks if they wanted to know the results and were prepared to deal with the subsequent management. The decision to participate in health checks was also influenced by external factors such as the views of significant others, and the accessibility and availability of resources including time and finances.
CONCLUSIONS: The intention to screen for CVD is motivated by two internal factors: the perceived relevance of the disease and readiness to face screening outcomes. Strategies targeting the internal decision-making process may prove to be key in improving the uptake of screening.
MATERIALS AND METHODS: Twelve focus group discussions (n = 64) were conducted with women with breast cancer from two public and three private hospitals. This study specifically focused on (a) health costs, (b) nonhealth costs, (c) employment and earnings, and (d) financial assistance. Thematic analysis was used.
RESULTS: Financial needs related to cancer treatment and health care varied according to the participant's socioeconomic background and type of medical insurance. Although having medical insurance alleviated cancer treatment-related financial difficulties, limited policy coverage for cancer care and suboptimal reimbursement policies were common complaints. Nonhealth expenditures were also cited as an important source of financial distress; patients from low-income households reported transport and parking costs as troublesome, with some struggling to afford basic necessities, whereas participants from higher-income households mentioned hired help, special food and/or supplements and appliances as expensive needs following cancer. Needy patients had a hard time navigating through the complex system to obtain financial support. Irrespective of socioeconomic status, reductions in household income due to loss of employment and/or earnings were a major source of economic hardship.
CONCLUSION: There are many unmet financial needs following a diagnosis of (breast) cancer even in settings with universal health coverage. Health care professionals may only be able to fulfill these unmet needs through multisectoral collaborations, catalyzed by strong political will.
IMPLICATIONS FOR PRACTICE: As unmet financial needs exist among patients with cancer across all socioeconomic groups, including for patients with medical insurance, financial navigation should be prioritized as an important component of cancer survivorship services, including in the low- and middle-income settings. Apart from assisting survivors to understand the costs of cancer care, navigate the complex system to obtain financial assistance, or file health insurance claims, any planned patient navigation program should also provide support to deal with employment-related challenges and navigate return to work. It is also echoed that costs for essential personal items (e.g., breast prostheses) should be covered by health insurance or subsidized by the government.
METHODS: A qualitative study with four focus-group discussions was conducted with 20 registered nurses from general wards in a Malaysian public hospital. Semi-structured interviews were used to elicit participants' opinions. NVivo 10 software was used for data management and content analysis was used to analyze the data.
RESULTS: Several participants used inconsistent methods to involve patients in bedside handovers and others did not involve the patients at all. The participants' interpretations of the concept of patient-centered care were ambiguous; they claimed that patient involvement during bedside handovers was impractical and, therefore, not reflective of patient-centered care. Some nurses' subjective views of patient involvement as impractical during bedside handovers were manifested in their deliberate exclusion of patients from the handover process.
CONCLUSIONS: Changes in patient involvement and nursing practices congruent with patient-centered care require that nurse educators in hospital settings reform nursing education to focus on fostering of communication skills needed to function in nurse-patient partnerships. Guidelines for patient involvement consistent with patient-centered values should be developed using ward nurses' subjective views and introduced to all registered nurses in practice.
METHOD: A cross-sectional qualitative study in which focus group interviews were conducted by 5 trained senior Cambodian dental students. A convenience sample of 56 older adults and caregivers was recruited across urban, semi-urban and rural locations. Focus group conversations were recorded, transcribed and analysed thematically.
RESULTS: The themes that emerged were around low expectations for both general health and oral health. A communal responsibility for health was expressed, and both money and transport were identified as key barriers to accessing care. Participants recognised that they had oral health problems, and acknowledged the impact of poor oral function on health and nutrition.
CONCLUSION: This study is an important first step in better understanding the oral health experiences and perceptions of older people in Cambodia. Participants described the impacts of poor oral health as being important, even when compared with other general health conditions.
METHOD: This study was conducted using an exploratory qualitative approach on purposely selected healthcare providers at primary healthcare clinics. Twenty focus group discussions and three in-depth interviews were conducted using a semi-structured interview guide. Consent was obtained prior to interviews and for audio-recordings. Interviews were transcribed verbatim and thematically analysed, guided by the Consolidated Framework for Implementation Research (CFIR), a framework comprised of five major domains promoting implementation theory development and verification across multiple contexts.
RESULTS: The study revealed via CFIR that most primary healthcare providers were receptive towards any proposed changes or intervention for the betterment of NCD care management. However, many challenges were outlined across four CFIR domains-intervention characteristics, outer setting, inner setting, and individual characteristics-that included perceived barriers to implementation. Perception of issues that triggered proposed changes reflected the current situation, including existing facilitating aspects that can support the implementation of any future intervention. The importance of strengthening the primary healthcare delivery system was also expressed.
CONCLUSION: Understanding existing situations faced at the primary healthcare setting is imperative prior to implementation of any intervention. Healthcare providers' receptiveness to change was explored, and using CFIR framework, challenges or perceived barriers among healthcare providers were identified. CFIR was able to outline the clinics' setting, individual behaviour and external agency factors that have direct impact to the organisation. These are important indicators in ensuring feasibility, effectiveness and sustainability of any intervention, as well as future scalability considerations.