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In this study, we develop a new paradigm, Circular Lean Six Sigma 4.0 (CLSS4.0) to promote manufacturing sustainability. This paper aims to provide a practical and holistic view of the drivers and barriers that can help companies design an integrated CLSS4.0 model. The paper is based on a qualitative exploratory study using multiple case studies within 12 Moroccan manufacturing firms conducted through semi-structured interviews with top executive managers. The results show that the drivers are related to expected operational and environmental performance, increasing customer requirements, gaining competitive advantage and market growth while barriers are related to insufficient tangible (finance, human and equipment) and intangible (skills and techniques) resources, data privacy, technical issues and management support. The proposed framework identifies the assessment of drivers and barriers and their attributes as a starting point for managers to lead the CLSS4.0 transformation, thereby contributing to its successful implementation. To the best of our knowledge, this study is among the very first studies to discuss the CLSS4.0 drivers and barriers. It could be useful to managers as a diagnostic tool to assess their ability to implement CLSS4.0 before investing in the initiative. [ABSTRACT FROM AUTHOR]

Purpose: Sexual dysfunction is often experienced by lymphoma patients during the disease trajectory and even during survivorship. However, lymphoma patients' perceptions about sexual challenges and dysfunction experienced during cancer treatment are not well known. The purpose of the study was to explore lymphoma patients' lived experiences with sexual dysfunction and related sexual distress during cancer treatment. Methods: A narrative qualitative approach of inquiry was used, with individual semi-structured interviews. Twenty lymphoma patients were recruited to participate in semi-structured interviews about their experiences with sexual dysfunction and related sexual distress during cancer treatment. We followed a systematic, inductive approach to the qualitative data that moved analysis from concrete description to thematic interpretation. Results: Eight themes emerged: (1) sexual functioning before lymphoma diagnosis and treatment; (2) sexual functioning after lymphoma diagnosis and during treatment; (3) emotional responses to sexual changes; (4) psychological effects; (5) emotional and social support from loved ones; (6) attitudes toward discussing sexual changes with healthcare professionals; (7) coping mechanisms; and (8) participants' expectations of sexual health after lymphoma treatment. Conclusions: Cancer treatment such as surgery, chemotherapy, and radiation therapy can have a negative impact on sexual health. Therefore, further research is recommended to continue exploring the lived experiences of lymphoma patients. Implications for cancer survivors: Healthcare professionals should routinely assess sexual functioning in lymphoma patients as sexual health is a component of quality of life. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to describe the facilitators and barriers of physical activity for patients with coronary heart disease. Methods: A qualitative descriptive study using semi-structured interviews was conducted with 15 participants with coronary heart disease. The interview guide was developed based on a multi-theory model. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Results: Two main themes were identified: facilitators of initiation and maintenance of physical activity (behavioral motivation, perceived benefits, behavioral confidence, supportive physical environment, positive emotional experience, self-regulation, supportive social environment, illness perception, and excellent self-control), barriers of initiation and maintenance of physical activity (perceived barriers, restricted physical environment, psychological distress, insufficient social support, and poor self-control). Conclusions: This study presents an in-depth theory-based exploration of facilitators and barriers to initiating and maintaining physical activity among people with coronary heart disease. Relevant factors should be taken into account to increase their effectiveness when designing the target interventions to encourage a physically active lifestyle in this population. IMPLICATIONS FOR REHABILITATION: Before commencing cardiac rehabilitation, it is imperative to assess patients with coronary heart disease (CHD) to ascertain whether they have limited activity capacity, psychological distress, insufficient social support, and poor self-control. A customized cardiac rehabilitation plan should be meticulously devised for each patient with CHD. For patients in the early stage of initiating physical activity (PA), rehabilitation professionals should assist them in recognizing the severity of their condition and the advantages of engaging in PA. Rehabilitation professionals should also promote active utilization of social networks, stimulate CHD patients' motivation, and enhance their behavioral confidence. When guiding patients during the maintenance stage of PA, it is essential to regularly evaluate their psychological well-being, assist them in self-regulation based on their physical condition, and foster the development of self-control. Rehabilitation professionals should consistently provide social support to reinforce the patients' motivation to maintain their PA behavior. [ABSTRACT FROM AUTHOR]

Background: Academic achievement is one of the most important criteria in assessing students' ability to complete their university studies and reach the graduation stage. Students in medical sciences are considered the primary recipients of educational services and are the best source for identifying problems in medical or clinical education, as they are directly and indirectly involved in this interaction process. Methods: This study was conducted in the years 2022–2023 using conventional content analysis at Tabriz University of Medical Sciences. A total of 23 students from various faculties of this university were selected through purposive sampling, and their experiences and perspectives were utilized until data saturation was reached. Data was collected through semi-structured, in-depth individual interviews using an interview guide. Content analysis was performed using the conventional content analysis method. Results: Two main themes were extracted with the titles "Facilitators of Academic Achievement" and "Barriers to Academic Achievement ". "Teacher-related Factors," "Assessment and Evaluation," "Student-related Factors," "Learning Environment," and "Support Systems" were the categories derived from the analysis of the data for academic achievement, and "Poor Educational Quality and Teaching Methods," "Lack of Interdisciplinary Collaboration and Integration," "Inappropriate Educational Planning and Administration," "Communication Issues," and "Contextual barriers," were the categories derived for "Barriers to Academic achievement" based on 238 codes and 36 subcategories. Conclusion: Since factors such as satisfaction with educational and welfare facilities and academic motivation impact the quality of education, examining these variables from students' perspectives is beneficial for formulating regulations, providing appropriate facilities, planning for the training of capable students, and selecting suitable educational and learning processes. [ABSTRACT FROM AUTHOR]

Background: Different countries, including Iran, have implemented various policies to address substance use disorder. This study aims to describe the policies related to substance use disorder treatment and identify challenges related to these policies in Iran since the beginning of the Iranian Revolution in 1979. Methods: This qualitative study utilized document analysis and interviews with policymakers and implementers. We reviewed a total of 22 documents related to substance use disorder treatment and harm reduction. The results from document analysis complemented and validated the interview data. The research population comprised policymakers and implementers, including individuals directly involved in formulating and implementing substance use disorder treatment policies. Purposive sampling was employed, with a snowball strategy utilized to maximize diversity. Data saturation was achieved after conducting 32 semi-structured interviews. Conventional content analysis was used for data analysis. Results: In general, the policy landscape for substance use disorder treatment in the Islamic Republic of Iran can be divided into two periods: the "Moral Model" era (1979–1993) and the "Disease Model" era (1993–present). Challenges within the content of substance use disorder treatment policies in Iran encompass the lack of law revisions, existence of contradictions in laws and nature of disease, the absence of evidence-based policymaking, and an inadequate comprehensive perspective on the phenomenon of substance use disorder. Conclusions: The presence of multiple authorities with different perspectives on substance use disorder and its treatment, coupled with the application of personal preferences in policymaking and the absence of evidence-based policymaking, have contributed to weaknesses in decision-making and policy formulation. The true philosophy of Disease Model appears not to have been fully grasped by health policymakers in Iran, as all Disease Model policies have been pursued with an emphasis on abstinence and quitting. Iran and other nations facing similar challenges should place more reliance on evidence-based approaches and shift away from the "Moral Model" paradigm to develop more effective substance use disorder treatment policies. [ABSTRACT FROM AUTHOR]

Importance: Euthanasia or assisted suicide (EAS) in patients suffering from a psychiatric disorder (PD) is a controversial topic worldwide. In the Netherlands, this practice is regulated by law. All cases of EAS have to be reported and are assessed by the Regional Euthanasia Review Committees (RTEs), who publish a selection of all cases on their website. Objective: To provide insight into the Dutch practice of EAS in patients suffering from a psychiatric disorder. Design, setting and participants: We performed a retrospective case review study in which all published cases of EAS in patients suffering from a PD between 2017 and 2022 were analyzed. Intervention(s) or exposure(s): Not applicable Main outcome(s) and measure(s): Characteristics of patients who died by EAS because of suffering from a PD, characteristics of the reporting physician and consultant(s) and the RTEs assessment of published cases. Results: Of the 72 cases studied, the majority of patients were female (n=48, 67%), suffered from 3 or more conditions (n=38, 53%) and died by euthanasia instead of assistance in suicide (n=56, 78%). In 63% of cases (n=45), the life termination was performed by a physician from the Euthanasia Expertise center (EE). The RTEs' judgement that the case did not meet the due care criteria (n=11) was in all cases related to issues regarding the (advice of the) independent physician or psychiatric expert. Conclusion and relevance: This qualitative study shows that the RTEs attach great importance to a careful evaluation procedure of physicians handling EAS requests and to the physician demonstrating ability to reflect on his views, especially when the independent consultant evaluates the case different than the physician. Training for physicians and more transparency in the assessment of EAS requests in patients with a PD may lower the threshold for physicians to handle requests of these patients themselves. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background:​ Empathy is a fundamental component of the therapeutic relationship between healthcare providers and patients and has the potential to yield significant benefits, including heightened care satisfaction, enhanced care quality, and improved mental well‐being for patients. As nursing assistants (NAs) are primary direct care providers in long‐term care facilities (LTCFs), it is necessary to understand NAs' views on empathy in their care provision for residents, but a gap exists in the literature regarding NAs' perspectives on empathy in this context. Aim: In this study, we aimed to explore perceptions of empathy among NAs in LTCFs. Research Design: A qualitative approach was applied in this study. Participants and Research Context: Through purposive and snowball sampling, 18 NAs who provided care for residents in six LTCFs in Taiwan were recruited. Face‐to‐face in‐depth interviews were conducted using a semistructured interview guide, and data were analyzed using a content analysis. Ethical Considerations: Ethical approval was obtained from the Institutional Review Board. All participants signed a written informed consent form prior to the interview. Results: Four themes encompassing 11 categories were generated including "being fundamental to caregiving to establish trust and enhance quality care," "practicing altruistic behavior in the pursuit of ethical caregiving," "cycling empathic flow in care," and "facing challenges in delivering empathetic care." Conclusions: NAs in LTCFs viewed empathy as an essential element of the caregiving process. They saw empathy as selfless care, assistance to others, and alleviation of residents' suffering. Understanding residents' emotions, thoughts, and needs, active listening and compassionate engagement were vital to expressing empathy. However, NAs faced challenges in expressing empathy due to demanding tasks, time limitations, and insufficient knowledge and communication skills. In addition, emotional desensitization further complicated the provision of empathic care. The findings of this study can provide information for nurse managers and directors to understand NAs' perspectives on empathy and difficulties when providing empathic care in the long‐term care context. [ABSTRACT FROM AUTHOR]

Importance: Euthanasia or assisted suicide (EAS) in patients suffering from a psychiatric disorder (PD) is a controversial topic worldwide. In the Netherlands, this practice is regulated by law. All cases of EAS have to be reported and are assessed by the Regional Euthanasia Review Committees (RTEs), who publish a selection of all cases on their website. Objective: To provide insight into the Dutch practice of EAS in patients suffering from a psychiatric disorder. Design, setting and participants: We performed a retrospective case review study in which all published cases of EAS in patients suffering from a PD between 2017 and 2022 were analyzed. Intervention(s) or exposure(s): Not applicable Main outcome(s) and measure(s): Characteristics of patients who died by EAS because of suffering from a PD, characteristics of the reporting physician and consultant(s) and the RTEs assessment of published cases. Results: Of the 72 cases studied, the majority of patients were female (n=48, 67%), suffered from 3 or more conditions (n=38, 53%) and died by euthanasia instead of assistance in suicide (n=56, 78%). In 63% of cases (n=45), the life termination was performed by a physician from the Euthanasia Expertise center (EE). The RTEs' judgement that the case did not meet the due care criteria (n=11) was in all cases related to issues regarding the (advice of the) independent physician or psychiatric expert. Conclusion and relevance: This qualitative study shows that the RTEs attach great importance to a careful evaluation procedure of physicians handling EAS requests and to the physician demonstrating ability to reflect on his views, especially when the independent consultant evaluates the case different than the physician. Training for physicians and more transparency in the assessment of EAS requests in patients with a PD may lower the threshold for physicians to handle requests of these patients themselves. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Vaginal Birth after Cesarean Birth (VBAC) is a birth mode recommended for reducing repeat cesarean which potentially contributes to adverse outcomes. However, VBAC is not normally practiced in some countries. Providers are an important part of the decision-making process on modes of birth among pregnant individuals. Providers' perspective on VBAC can influence whether they support or avoid conducting VBAC. This review aimed to explore providers' perspective on VBAC. Methods: The comprehensive search was conducted from six databases including PubMed, MEDLINE, Scopus, Cochrane Library, EMBASE, and Google scholar. The studies published in English between 2013 and 2023 were review. The Medical Subject Heading terms for VBAC and perspective were used to search. The eligible studies were selected by the PRISMA flow chart. The initial search yielded 558 articles. After excluding duplicates, articles not retrieved for full-text, and not meeting inclusion and exclusion criteria, eight articles were recruited. Quality appraisal of the studies was performed by the tool of the Joanna Briggs Institute. The meta-aggregation approach was applied to synthesize the findings. Results: Eight qualitative articles were included in this review, and six themes were developed including (1) different recognition of VBAC, (2) differences of willingness level of conducting Trial of Labor after Cesarean (TOLAC) (the approach attempting to have VBAC), (3) skills and resources needed when performing TOLAC, (4) protocol for recruiting candidacy and TOLAC management, (5) final decision making on VBAC, and (6) onset and duration of providing TOLAC information. Conclusion: Providers play an important role in influencing individuals' decision on modes of birth. Providers' positive recognition and willingness of conducting TOLAC potentially impact successful VBAC rate. However, the lawsuit caused by adverse outcomes from TOLAC/VBAC is a main reason for choosing repeat cesarean. Trial registration: PROSPERO registration number of this systematic review: CRD42023427662. Plain english summary: Repeat cesarean is a primary contributor to high cesarean rates globally. Vaginal Birth after Cesarean Birth (VBAC) is a vaginal birth of individuals with previous cesarean. While some countries have high successful VBAC rates, many countries have very low VBAC rates and do not support a vaginal birth in subsequent pregnancy among individuals with previous cesarean. Healthcare providers especially obstetricians and nurse-midwives play an important role in individuals' decision on mode of birth, so do individuals with previous cesarean. Healthcare providers' perspective on modes of birth among individuals with previous cesarean is very essential to support or not support individuals to have VBAC. In high VBAC rate countries, healthcare providers think VBAC is an optimal option for individuals with previous cesarean and have high confidence to do VBAC. On the other hand, healthcare providers in low VBAC rate countries think VBAC can cause a catastrophic birth outcome as uterine dehiscence and they are scared of being sued from the adverse outcome. One approach to support VBAC, most healthcare providers suggest that individuals with previous cesarean should be educated about VBAC right after the first cesarean or first antenatal visit because VBAC is not a common mode of birth for individuals in some countries and they need time to make a decision on mode of birth for their subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Background: Shared decision-making is recommended for stroke rehabilitation. However, the complexity of the rehabilitation modalities exposes patients to decision-making conflicts, exacerbates their disabilities, and diminishes their quality of life. This study aimed to explore the experiences and needs of older patients with stroke in China during rehabilitation decision-making, providing a reference for developing decision-support strategies. Methods: A qualitative phenomenological design was used to explore the experiences and needs of older patients with stroke in China. Purposive sampling was used to recruit 31 older Chinese patients with stroke. The participants participated in face-to-face, semi-structured, and in-depth interviews. Data were analyzed using inductive thematic analysis. Results: The key themes identified include (1) mixed feelings in shared decision-making, (2) multiple barriers hinder the possibility of participating in shared decision-making, (3) Delegating rehabilitation decisions to surrogates, (4) gaps between reality and expectation, and (5) decision fatigue from lack of continuity in the rehabilitation health care system. Conclusions: Older patients with stroke in China have complex rehabilitation decision-making experiences and needs and face multiple obstacles when participating in shared decision-making. They lack an effective shared decision-making support system to assist them. Providing patients with comprehensive support (such as emotional and informational), strengthening the construction of a continuous rehabilitation system, alleviating economic pressure, and promoting patient participation in rehabilitation decision-making are necessary. [ABSTRACT FROM AUTHOR]

Background: Understanding the motivations driving family members to continue caring for individuals with Alzheimer's disease is crucial for enhancing social support programs within community health systems. This study specifically explores the factors influencing Iranian family caregivers' ability to persist in their caregiving roles. Methods: This qualitative study was conducted using conventional content analysis with 22 participants in 2022 in Babol (a city in northern Iran). The inclusion criteria for the study included caregivers of Alzheimer's patients who had been the primary caregivers for at least one year for patients with a confirmed diagnosis of Alzheimer's disease. The sampling method was purposive, ensuring maximum variation in social position, demographic status, and stages of Alzheimer's disease after the onset of symptoms. In this research, data were collected from caregivers of Alzheimer's patients through semi-structured interviews and in-depth individual interviews. The data were analyzed using MAXQDA software. Results: One category and four subcategories were identified to explain the continuity of the caring role in family caregivers of Alzheimer's patients. The category was "on the Fence of the Caring Role." The subcategories included Commitment to Care (Being Determined, Being Indebted, Feeling Dutiful), Coercion to Care (Giving in to the Caring Role Due to Family Requirements, Patient Care Due to Financial Problems), Socio-Cultural Beliefs and Concerns (Spiritual and Religious Tendencies, Social Stigma and Social Fears), and Attachment and Love for the Patient (Feeling Pity, Feeling Nostalgia for Kinship). Conclusion: Family caregivers are deeply engaged in their roles, often feeling trapped by various pressures. Recognizing these dimensions can inform policymakers and health practitioners in developing targeted interventions, such as respite care programs, financial support, and community resources, aimed at alleviating caregiver burden and enhancing the quality of care for patients. By addressing the complexities of the caregiver experience, effective strategies can be implemented to support both patients and their caregivers, ultimately improving health outcomes within the community. [ABSTRACT FROM AUTHOR]

Background: Many palliative cancer patients require inpatient hospital treatment for medical reasons, which contrasts their frequent desire to be at home. Virtual reality (VR) could be a way of bringing the home environment closer to them. First observations have shown benefits from VR for inpatients in palliative care. The aim of this qualitative, descriptive study was to explore the expectations of in-patients suffering from incurable cancer and their relatives about VR, in particular individualized VR images of the patients' own home. Methods: Semi-structured interviews with inpatients suffering from incurable cancers and their relatives in three medical settings (palliative care, hematology, radiotherapy) of a German university hospital. Qualitative content analysis about expected benefits and concerns regarding VR-videos showing their private home; defining the main topics deductively and the subcategories inductively. We also assessed the patients' subjective perspective on their remaining time to live to estimate the impact of double awareness on the results. The Patient Advisory Board informed the study protocol and conduct. Results: We interviewed 15 patients (8 men; age M = 63.4, SD = 11.34; range 39–82) under palliative care, and four relatives. We organized the interview content in 6 themes (general interest, desired content, non-desired content, expected benefits, concerns, and irregularities) and 26 sub-themes. Most patients and relatives were interested in using VR during hospital treatment. They often preferred viewing nature or tourist sites over seeing their home or family. Reasons could be linked to privacy concerns and the general desire for distraction from the current situation that they specified with their expectation of well-being, a break from the patient-experience, the pursue of curiosity, and the VR evoking fond memories. Conclusion: VR seems to be of interest for palliative cancer patients, especially as distraction and relief from their illness. The desired content can be very different, so a choice from a selection of VR-content should be made available. If patients want to see videos of their own home, recordings by relatives instead of study or hospital staff seem to meet the need for privacy. Trial registration: Registered at Deutsches Register Klinischer Studien; registration number: DRKS00032172; registration date: 11/07/2023. https://drks.de/search/de/trial/DRKS00032172. [ABSTRACT FROM AUTHOR]

The current study aims to explore the role of family involvement in developing social skills among children with Autism Spectrum Disorder (ASD) from the perspective of their mothers. The development of social skills significantly impacts these children's opportunities for integration and engagement with society in recent years. To achieve this, the researchers employed a qualitative methodology, conducting semi-structured interviews. The participants were Eight mothers of children with ASD aged between four and six years old, were selected. There children were enrolled in early childhood programs at special education schools and daycare centers in Makkah region. The data was analyzed, and the results revealed several important themes, such as family experiences in family involvement, the child's social characteristics, and the family's implementation of strategies for enhancing social skills. The study recommended creating diverse knowledge sources that provide the most effective strategies for enhancing social skills in children with ASD during early childhood, and suggested further research to investigate the gap between the social support provided and the social inclusion of individuals with ASD. [ABSTRACT FROM AUTHOR]

This study explores the factors influencing teacher enthusiasm in Turkish public schools through a qualitative, exploratory case study design conducted in two provinces in the northwestern region of Türkiye. Data were collected from 28 teachers using semi-structured interviews, with participants selected through convenience and maximum variation sampling methods. Content analysis was employed to analyze the data. The research identified three primary themes: personal factors, contextual factors, and external factors. Personal factors include motivation, affection for teaching and job satisfaction. Contextual factors encompass students' academic performance and behaviors, school leadership practices, relationships with colleagues, and working conditions. External factors involve parental attitudes, educational policies, the value perception of the teaching profession, and incentives and rewards. The findings emphasize the critical role of personal motivation, affection for teaching, and job satisfaction in fostering teacher enthusiasm. Additionally, supportive leadership, positive student interactions, and a collaborative work environment are crucial contextual factors. External factors such as positive parental attitudes, consistent educational policies, societal recognition of the teaching profession, and appropriate incentives and rewards also play a vital role in fostering teacher enthusiasm. These results suggest that policymakers should prioritize consistent educational policies as well as recognition and rewards for teachers, while school principals should create supportive and collaborative environments. By addressing these areas, stakeholders can enhance teacher enthusiasm, ultimately improving teaching quality and student outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The elderly population faces reduced levels of health and performance, which necessitates the use of rehabilitation assistive technologies to maximize functional independence in daily activities. This study aimed to explain the experiences of the elderly regarding the use of rehabilitation assistive technologies based on the Unified Theory of Acceptance and Use of Technology. Methods: The present study was a qualitative study of the type of content analysis that was conducted in the city of Hamadan in 2022. Participants included 20 elderly aged 60 years or above who were selected as a purposive sample and subjected to individual semi-structured in-depth interviews. Data were analyzed using directed qualitative content analysis based on Hsieh and Shannon's approach. Data were coded using MAXQDA software (MAXQDA Analytics Pro 2020, VERBI GmbH Berlin). Results: According to the results, 260 primary codes were extracted, and they were classified into five predetermined categories of the Unified Theory of Acceptance and Use of Technology, including performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioral intention, as well as two new categories of technology anxiety and perceived need for technology. After extracting 260 primary codes based on the Unified Theory of Acceptance and Use of Technology, 75 sub-categories were identified in 14 main categories. Conclusion: The themes obtained from the study indicate the necessity of providing the required conditions to maintain the complete independence and health of the elderly and strengthen their morale. The results can be helpful in the development of support strategies for family members, healthcare providers, and policymakers. IMPLICATIONS FOR REHABILITATION: Assistive rehabilitation technologies include low-tech assistive technologies. The use of assistive rehabilitation technologies is a potential solution to improve balance, quality of life, and increase activity and functional independence in the elderly. Since peers play a very important role as technology advocates in the intention to accept and use assistive technologies, the expression of the experiences and views of the elderly can encourage and support the use of assistive rehabilitation technologies by other elderly. This study found that the use of assistive rehabilitation technologies by the elderly is a relatively complex issue with various personal, social, economic, cultural and physical aspects. [ABSTRACT FROM AUTHOR]

Agile meetings are an essential part of modern software development, but they often face challenges such as lack of focus, communication problems, technological difficulties, and the like. Previous research has often addressed individual issues of agile meetings but has not provided sufficiently integrated or practical models to comprehensively address these challenges. This research fills this gap, developing a theoretical model that not only identifies key issues but systematically links them to provide a deeper understanding of their impact on meeting effectiveness.In this paper, we present a theoretical model that depicts intra-team problems in agile meetings developed through a systematic literature review (SLR). After initial development, the model was validated and improved through the qualitative analysis of semi-structured interviews with IT experts. This research aimed to confirm the coverage and relevance of the content of the preliminary model, as well as to identify the need for modification. The results of the interviews suggest that the presented model is adequate but that there is a need for potential improvement. IT experts agreed with the items in the model, and some of them suggested improvements. The model is promising because it illustrates the key issues that influence the effectiveness of agile meetings in a promising way. IT experts agreed on the items in the model, and some of them suggested improving the model. [ABSTRACT FROM AUTHOR]

The low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet (LFD) is a second-line dietary intervention for irritable bowel syndrome (IBS) patients, involving FODMAP restriction, reintroduction, and personalization, and it needs to be delivered by dietitians. However, the application of this diet among Malaysian IBS patients is not well understood. This study aimed to explore the practices and barriers in delivering the LFD among Malaysia dietitians. Semi-structured qualitative interviews were conducted online with practicing dietitians until the data reached saturation. All the interview sessions were audio recorded and transcribed verbatim. Thematic analysis was used to analyze the data. Eleven dietitians were interviewed, with 36.4% (n = 4) having more than 10 years of experience. The following four themes regarding their practices emerged: 1. dietary advice on FODMAP restriction; 2. duration of FODMAP restriction phase; 3. references used to get information about FODMAPs, and 4. strategies on reintroduction. Meanwhile, the following seven barriers were identified: 1. lack of culturally relevant educational materials; 2. limited knowledge about the LFD; 3. inadequate formal training among dietitians; 4. lack of integration in multi-disciplinary care; 5. low health literacy of patients; 6. low compliance rate among patients, and 7. restrictions for certain populations. LFD implementation in Malaysia is not standardized as only experienced dietitians can provide dietary evidence-based advice. Lack of training and culturally specific resources are some of the main barriers that were identified to be limiting the implementation of the diet. Therefore, there is a need for training programs and resource development to support Malaysian dietitians in managing IBS patients. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of the study was to identify effective teaching strategies to bridge the gap between theory-based and practical-based approaches to teaching a history curriculum. Methods: A qualitative exploratory case study was used. Twenty educators who taught history in K-12 classrooms participated in the study. Semi-structured interviews and document analysis served as data sources. Results: The findings indicated that History is better taught by actively engaging students. Innovative activities integrated with traditional methods to activate engagement and promote historical skills. Discussion: The key to making history come alive is using multiple teaching strategies. The strategies to bridge theory to practical application include engagement, innovative teaching, and authentic teaching. Limitations: It was difficult for some participants to commit to the scheduled interview. Conclusions: The content of the study may be used as a reference for practitioners to reflect on current teaching practices and developed strategies to implement in a history lesson or other content areas. [ABSTRACT FROM AUTHOR]

Introduction: Clinical trials are crucial for advancing medical knowledge and improving healthcare outcomes. Despite an increase in research publications in Saudi Arabia, clinical trial productivity has lagged behind. Understanding the barriers to conducting clinical trials in Saudi Arabia is essential. This study aims to explore the challenges and propose solutions for improving clinical trial capacity in the Kingdom. Specifically, we aim to develop national strategies to enhance clinical trial infrastructure, identify educational needs, and suggest ways to strengthen research education and training in Saudi Arabia. Methods: The study utilized a qualitative research design with a grounded theory approach. Participants were recruited through purposive sampling, including clinical trial professionals from Riyadh, Jeddah, and Al Khobar, who participated in three half-day workshops. Discussions focused on required skillsets, barriers to conducting trials, improvement recommendations, gaps in research education, and strategies for the Saudi National Institute of Health (SNIH) to support clinical trials. Data were collected through pre-workshop surveys and focus group discussions, and thematic analysis was employed to identify common themes. Results: A total of 35 participants, mainly from the government sector (67%), attended the workshops. Physicians represented the largest professional group (31%), with the majority being Saudi nationals (83%) and engaged in clinical practice (65%). The study identified key challenges, including limited resources (82%), inadequate infrastructure (82%), time constraints (80%), and insufficient funding (80%). While satisfaction with educational programs was mixed, a need for improved infrastructure and support for clinical trials in Saudi Arabia was evident. The focus group discussions further highlighted the importance of research competency, identifying 11 essential domains such as research methodology, data management, and project leadership. Nine major challenges were noted, including funding, infrastructure, and collaboration deficits. A total of 38 recommendations were proposed to address these challenges and enhance the national clinical trial ecosystem. Conclusions: This study underscores the importance of addressing the challenges in conducting clinical trials in Saudi Arabia through targeted educational programs, training initiatives, and enhanced support from the SNIH. By implementing strategies that focus on funding, resources, training, and collaboration, Saudi Arabia can significantly advance its clinical trial landscape, improve research quality and efficiency, and position itself as a leader in global health research. [ABSTRACT FROM AUTHOR]

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Purpose: Coronavirus disease (COVID-19) has challenged leadership in hospitals worldwide. The experiences of leadership during the pandemic changed leadership significantly. This study aims to describe nurse leaders' perceptions of what future leadership in hospital settings in the post-pandemic era needs to be like. Design/methodology/approach: A qualitative descriptive study was used. A total of 20 nurse leaders from the Finnish central hospital were interviewed from June to October 2021. The data were analysed using inductive content analysis. Findings: The analysis revealed five main categories describing nurse leaders' perceptions of future leadership in hospital settings in the post-pandemic era: digitalisation and hybrid working culture, development of sustainable working conditions, moving smoothly to the post-pandemic era, dissolution of traditional regimes of organisation and flexibility in leadership. Practical implications: In the post-pandemic era, the constantly changing demands and challenges currently facing healthcare systems have significantly increased the complexity of hospital organisations. This requires critical evaluation and change to traditional leadership. Enhancing flexibility and authenticity in leadership, strengthening competencies, implementing a wide range of digital resources and increasing the appeal of the nursing profession to build the next generation of nurses – all of these are needed to provide sustainability in future healthcare. Originality/value: The results identify the critical points of leadership that need to be developed for future challenges and for maintaining a sufficient supply of qualified professionals. Acting on this information will enhance flexibility in organisations and lead to acceleration of changes and the development of new kinds of leadership in the future [ABSTRACT FROM AUTHOR]

Indigenous leaders in higher education are restive, disaffected, and dissatisfied with the slow gyrations of change. Using Interest Convergence Theory, this paper will unravel the constraints inherent in institutional reform that delimit the influence of Indigenous senior leaders in the sector. Positioned amidst the burgeoning impact of neoliberalism, an architecture of colonial governance models, and systemic resistance to change, Indigenous leaders are affecting reform. By providing examples of reform-driven agential actions shouldered by senior Indigenous leaders across Canada, Aotearoa, America and Australia, this paper, underpinned by relationality, details how Indigenous leaders are engaging with Indigenous Institutional work and Entrepreneurship, speaking back to interest-driven institutional policies and practices in the sector with a pronounced focus on nation building. Drawn from an international, comprehensive qualitative study, we investigate how Indigenous leaders in higher education are disrupting systemic racism to promote equity and justice within higher education amid macro-level resistance to change. [ABSTRACT FROM AUTHOR]

Aim: To develop a conceptual framework for proactive health behavior among middle‐aged and older adult females with urinary incontinence. Design: Qualitative grounded theory study. Background: There is a growing body of research emphasizing the pivotal significance of proactive health behavior. Proactive health behavior can empower patients to actively manage their illnesses and facilitate disease recovery. Clearly defining patients' relevant beliefs and assumptions regarding proactive health behavior can effectively promote their adoption. However, there is currently a lack of relevant research in this area. Methods: We conducted in‐depth interviews with middle‐aged and older adult females with urinary incontinence (n = 17) and nursing caregivers (n = 9). We used theoretical sampling, whlie conducting continuous comparative analysisi and data collection. Results: The study has yielded a substantive theory to facilitate healthcare professionals' comprehension of proactive health behavior in middle‐aged and older adult females with urinary incontinence. The foundation for middle‐aged and older adult females to adopt proactive health behavior is having a certain level of health literacy regarding their conditions. Patients' internal motivation to engage in proactive health behavior includes a sense of health responsibility and health demands. Additionally, external support received by patients can also facilitate their adoption of proactive health behavior. The proactive health behavior practices of middle‐aged and older adult females mainly include proactive medical care behavior and establishing a healthy lifestyle. Conclusions: The conceptual framework established in this study offers theoretical support for middle‐aged and older adult females with urinary incontinence to adopt proactive health behavior. It provides a basis for future exploration of proactive health behavior among this demographic and informs the development of more effective health interventions and support measures tailored to their needs. Impact: The study specifically elucidates the mechanisms and manifestations of proactive health behavior adopted by middle‐aged and older adult females with urinary incontinence, laying the foundation for clarifying the level of proactive health among patients and implementing corresponding intervention measures. Additionally, it can also serve as a reference for related research on other diseases. [ABSTRACT FROM AUTHOR]

Background: Maintaining patients' dignity is a key ethical requirement in healthcare and is emphasized in nursing standards. This issue is particularly significant for patients with schizophrenia because they face unique challenges such as physical and psychological difficulties, dependence on others, and social isolation, making them more vulnerable. Organizational factors can either threaten or preserve their dignity. However, there is little knowledge in this domain within the sociocultural context of Iran. Research Objective: This study aimed to explore the role of the healthcare organization in the dignity of patients with schizophrenia, based on the opinions of patients, healthcare personnel, and family caregivers. Research Design: This qualitative study was conducted with 26 participants (16 patients, 4 family caregivers, 2 nurses, 3 psychologists, and 1 service worker) who were selected using a purposeful sampling method. The data were collected through semi-structured, in-depth face-to-face interviews until data saturation was reached. The data were analyzed via Graneheim and Lundman's method. Ethical Considerations: The study protocol was approved by the Research Ethics Committee of Urmia University of Medical Sciences (IR.UMSU.REC.1401.099). Findings: Based on data analysis, participants reported the three following challenges as organizational hidden threats to patients' dignity: "Lack of facilities," "premature management," and "ineffective communication." Conclusion: The study findings indicated that the healthcare organization does not support the dignity of patients. Management inefficiency and lack of facilities are evident in psychiatric hospitals, and healthcare centers are not monitored based on standard criteria. Limited interactions between healthcare personnel and patients were identified as the main reasons for the neglect of patients with schizophrenia and the violation of their dignity. The results of this study can help healthcare policymakers in designing and implementing effective programs to preserve the dignity of patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Objective: To understand rural older farmers' perspectives and attitudes toward skin cancer risk and prevention. Design and sample: This study used a grounded theory approach and semi‐structured interviews with 12 rural older farmers (farm owners, farmworkers ages 50 years or older) in Washington. Participants' perspectives were explored relative to Health Belief Model constructs. Inductive and deductive analyses were used to generate relevant themes. COREQ guidelines were followed. Results: The findings fit well and extended the Health Belief Model, which was used to arrange key themes identified in relation to skin cancer risk and prevention, specifically participants' perceived barriers to accessing primary care and protection when outdoors, perceived benefits of sun‐protective behaviors, perceived hereditary susceptibility to skin cancer, perceived severity of the increased skin cancer risk, and cues to action for skin checks. A new construct of hope was identified to emphasize the importance of establishing emotional, instrumental, and informational support systems for promoting skin cancer prevention. Participants also indicated their hope of raising awareness of skin cancer prevention among all ages. Conclusions: Findings highlighted the importance of integrating skin cancer prevention services for rural older farmers and across the lifespan. Public health approaches are needed to enhance the awareness of and access to preventive care in these underserved populations. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to address the experiences of diabetic patients from a psychosocial perspective, examine the burden of disease, and determine their practices for symptom management. Materials and Methods: In this study, a phenomenological research design, a qualitative research design, was used. The study included 20 diabetic patients. Individual and face‐to‐face interviews were performed, and Colaizzi's phenomenological analysis method was used to analyze the data. Results: As a result of the data analysis, four categories (challenges with care and treatment, coping with the disease, effects, and healthy life behaviors) and eleven main themes (knowledge, application, symptoms, support resources, spiritual coping methods, physical coping methods, physical effects, spiritual effects, social effects, physical practices, and psychological practices) emerged. Conclusion: It was concluded that the disease burden of diabetic patients is intense and that the participants of the study were not effective in coping with the disease through symptom management and found spirituality important in coping. [ABSTRACT FROM AUTHOR]

Purpose: The present study delves into the causes of relatively lower retail participation in the Indian REIT market. Specifically, it investigates investors' attitudes and perceptions towards REITs as a unique asset class. This paper provides a comprehensive understanding of the perception and factors influencing Indian retail investors' reluctance to participate in the REIT market. Design/methodology/approach: Qualitative research was conducted through semi-structured interviews to gather insights from non-investors in REITs. The data were transcribed and analyzed using content analysis techniques. Finally, coding techniques were used to identify broad study themes. Findings: According to the study results, many retail investors are unfamiliar with REITs. Even among those knowledgeable about REITs and with a favorable view, it is not commonly seen as a feasible investment option due to its early stage, unattractive returns and limited number of REITs. Practical implications: Developed countries have established REIT markets, while it is still in its infancy in developing countries such as India. Financial advisors, fund houses and the media should focus on educating investors to increase awareness. Originality/value: The study is the first qualitative investigation into the perception of retail investors to understand the reasons for lower retail engagement in the Indian REIT market. [ABSTRACT FROM AUTHOR]

Introduction: The inclusion of older players in the gaming world is growing rapidly, leading to the emergence of specific categories for them at major esport events. The aim of this study is to analyze the psychological issues faced by older people when engaging with the competitive context of esport. Materials and methods: The study was conducted in 2021 within the French association Silver Geek, which offers digital workshops using Nintendo Wii consoles to older people living in retirement homes and organizes annual amateur competitions between teams of older adults. This qualitative study involved 16 participants (eight women, eight men) aged 63 to 97 years. Semi-structured interviews were used to explore the motivations, emotional wellbeing, and social impact of esport on older people. Results: The results show that older people who participate in esport are motivated by the discovery and mastery of new game skills, as well as the pleasure of performance through social comparison. All experience a psychological well-being that translates into intense positive emotions. Moreover, the esport context, whether during the pre-competition workshops or the competitions themselves, proved to be a strong vector for positive social relationships, especially with the young e-sports coaches. However, this activity had little impact on existing family relationships. Conclusion: This study highlights the potential of esport as a recreational activity to promote mental health and social integration in older adults. The challenge for future research is to identify the levers that will enable this activity to become a true medium for intergenerational communication. [ABSTRACT FROM AUTHOR]

Background: Research suggests that people with intellectual disabilities have a higher risk for cardiovascular disease than the general population. The aim of this study was to identify barriers for the prevention, diagnosis, and treatment of cardiovascular disease for people with intellectual disabilities. Method: We conducted individual interviews with relatives and general practitioners and focus group interviews with staff working at an assisted home facility, a cardiac ward, an obesity clinic and two rehabilitation centres (n = 33) in Norway. Inductive approach and thematic analysis were used to analyse the data. Results: We identified barriers on an individual and a structural level. The underlying reason for these barriers is that health problems, such as cardiovascular disease, are regularly overlooked as the condition of intellectual disability overshadows other possible diagnoses. Conclusion: This focus on intellectual disability rather than other explanations leads to shortcomings in the prevention, diagnoses, and treatment of cardiovascular disease in this group. [ABSTRACT FROM AUTHOR]

Objective: To investigate the needs of patients with SLE in terms of discharge planning, to outline the practical perspectives of clinical healthcare professionals regarding the enablers and impediments to SLE patients' discharge planning, and to establish a basis for the creation of SLE discharge plans for subsequently diagnosed patients. Methods: Descriptive qualitative research methodology was used in this study, with the researcher herself as the research instrument. Healthcare professionals formally employed in the rheumatology and immunology department, as well as SLE patients admitted to a tertiary-level hospital in Anhui Province between August and December 2023, were chosen for the study using a purposeful sample technique. In-person, semi-structured in-depth interviews were carried out, and used thematic analysis to analyze the interview data and distil themes. Result: A total of 17 patients and 13 healthcare professionals were interviewed. Five themes and sixteen sub-themes in all were extracted: ①the needs of SLE patients for discharge planning; ②the present state of discharge planning implementation; ③factors conducive to the implementation of discharge planning; ④factors hindering the implementation of discharge planning; ⑤recommendations for implementing of discharge planning. Conclusion: Planning for the discharge of SLE patients is essential, and in order to support patients' successful discharge, management should strengthen training, thoroughly evaluate the needs of SLE patients, and create customized discharge plans. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative study aims to investigate the critical success factors (CSFs) driving the adoption of virtual reality (VR) in the hospitality industry, shedding light on key determinants for successful implementation. Design/methodology/approach: Drawing on a diverse set of interviews conducted in Italy, Pakistan, the USA and Turkey, this study uses thematic analysis facilitated by NVivo 12 to comprehensively explore and identify the CSFs influencing VR adoption within the global hospitality industry. Findings: This study identifies distinct CSFs at various phases of VR adoption in the hospitality industry. Preimplementation emphasizes budget planning and stakeholder engagement, implementation highlights safety training and feedback mechanisms and postimplementation underscores the importance of innovation, feedback utilization and maintenance for sustained success. These findings offer a strategic roadmap for VR integration in hospitality. Practical implications: The study informs hospitality industry stakeholders of crucial success factors for VR adoption, thereby guiding strategic decision-making. Sustained VR integration success is ensured by emphasizing budget planning, stakeholder engagement, safety training, feedback mechanisms and postimplementation innovation. Originality/value: To the best of the authors' knowledge, this groundbreaking research is the first in-depth investigation into CSFs for the adoption of VR in the hospitality industry. This research advances our understanding of and provides fresh guidance for effective VR integration by revealing novel insights into the key variables at various deployment phases. [ABSTRACT FROM AUTHOR]

Copyright of Social & Cultural Geography is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Organizations attempt to keep pace with the dynamic, ever-changing environment through technology up-gradation, human resource restructuring, diversification of product or service lines, and other similar actions. In most cases, these actions have taken the form of organizational downsizing, leading to the loss of jobs. The primary purpose of this study is to propose an approach that organizations may adopt against the cascading impact of layoffs on separated employees (victims), associates and co-workers (survivors). Online platforms were used for the collection of data. A total of 864 statements were analysed. Sentiment analysis was conducted using the SEMRUSH software. Miles and Huberman's (1994, Qualitative data analysis: An expanded sourcebook) method was used to categorize the data obtained into meaningful categories to provide results that would support the research objectives. The analysis shows a considerable cascading psychological impact on the human resource ecosystem. This article puts forward the causal model, capturing the interplay of the effects of the stakeholders on one another and their social well-being. Further, the article proposes that the downsizing cycle be constituted such that it minimizes the impact of layoffs. Extant research on job loss has mostly considered one or two stakeholders at a time. We have attempted a multi-stakeholder approach. The study also suggests changes in the human resource (HR) cycle that organizations must examine to mitigate the adverse effects of layoffs. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Human Lactation is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Mood assessment is challenging when people have cognitive and receptive communication impairments after severe brain injury. This study explored how UK-based medical and psychology professionals working with people with severe cognitive and communication impairments after brain injury assess mood in this population. Design: Following their participation in an online survey, professionals were invited to participate in individual semi-structured interviews. Interviews were analysed using thematic analysis to label explicit data (semantic themes) and implicit data (latent themes). Participants: Twenty-three clinical psychologists and nine medical professionals participated in online or in-person interviews. Results: Both groups explicitly reported using a combination of collateral information, history, observations, and patient interviews when assessing mood in this population. Medical professionals did not routinely use standardised measures and clinical psychologists often adjusted them when they used them. The respondents discussed difficulties conceptualising depression after brain injury, the experience needed by the assessor, and the need for an individualised approach for this population. Clinical psychologists discussed the pressures of working in healthcare systems and medical professionals discussed how symptoms may influence prescription choices. Seven latent themes were labelled which highlighted additional challenges and complexities experienced by those assessing mood, beyond the actual assessment process itself. Conclusions: No 'gold standard' approach to assessing mood in those with cognitive and communication difficulties after severe brain injury was identified. There was overlap in assessment approaches but no clear consensus. Interviewees felt that mood assessment must be approached differently in this population and that self-report measures are not useful. [ABSTRACT FROM AUTHOR]

BACKGROUND: Improving acceptance of the COVID-19 vaccine among nursing students is an important strategy for both preventing infection and building public confidence in the vaccine. OBJECTIVE: The aim of this study was to describe the views of intern nursing students on the COVID-19 vaccine and to evaluate their experiences in the COVID-19 vaccination unit. METHODS: This was a phenomenological qualitative study with a descriptive design. The 46 intern nursing students included in this study were all trained in the COVID-19 vaccination unit. The data was collected at focus group interviews conducted during June 2021 and October 2021. RESULTS: The mean age of intern nursing students was 22.78±0.91. From the focus group interviews, two themes were identified regarding the views of intern nursing students on the COVID-19 vaccine and their experiences in the COVID-19 vaccination unit: Theme 1. Positive views; Theme 2. Negative views. Intern nursing students described that they trust the COVID-19 vaccine and believe in its protection. Intern nursing students who performed their clinical practices in COVID-19 vaccination unit stated that they realized their responsibilities toward patients and the community. CONCLUSIONS: From the INSs' point of view, confidence in the vaccine, responsibility towards patients, their families and the community, and VU practice experience, the health risk associated with COVID-19 positively affected their decision to be vaccinated against COVID-19. The participation of intern nursing students in clinical practice during the pandemic influenced both intern nursing students and population in terms of the uptake of COVID-19 vaccines. [ABSTRACT FROM AUTHOR]

This study identifies the stigma experienced by 12 bereaved parents 2 and 5 years after losing a child in the Sewol ferry disaster in South Korea. Using thematic analysis, we categorized the experience of stigma into two components based on Corrigan and Kosyluk's social cognitive model of stigma: public stigma and self-stigma, and each was analyzed into three types of stigma: stereotype, prejudice, and discrimination. We identified four additional factors related to stigma mitigation. The potential implications for characterizing the experiences of bereaved parents, particularly those facing stigma, are discussed in light of these findings in the longitudinal perspective. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the emergence of social entrepreneurial intentions (SEIs) of youngsters at the base of the pyramid (BoP). A small but growing literature is emerging at the intersection of social entrepreneurship (SE) and BoP perspectives. However, little is known about the emergence of SEI in this context. Drawing on a qualitative approach, our findings highlight perceived self-efficacy, self-fulfilment and reciprocity as important drivers of SEIs of youngsters at the BoP. At a practical level, our study also highlights how social support could aid to develop individuals' perceptions of their own capabilities and help them to project themselves as social entrepreneurs. [ABSTRACT FROM AUTHOR]

Background: Newly graduated registered nurses face more challenges than their experienced counterparts, as they not only confront the high pressures of an increasingly complex medical environment but also need to quickly adapt to their jobs and role transitions. The emotional burden arising at this stage is referred to as transitional shock. Self‐depletion, as proposed by Baumeister, refers to the process by which individuals exhaust their internal psychological control resources when facing challenges, subsequently affecting cognition and emotion. The occurrence of transitional shock and the process of individual self‐depletion appear to be closely related. However, to our knowledge, there has been limited research exploring the occurrence of transitional shock from the perspective of self‐depletion theory. Aim: Investigating the emergence process of transition shock through the lens of self‐depletion theory entails an examination of the mechanisms by which individuals engage in self‐regulation when confronted with challenges and how transition shock manifests throughout this process. Designs: A descriptive qualitative study. Methods: Between August and November 2023, using maximum variation sampling and purposive sampling methods, 16 nurses were selected for semistructured interviews at a tertiary hospital in Suzhou, China. Results: Employing thematic analysis, three interconnected themes were identified, encompassing the entry‐level workforce challenges, the subsequent effects of energy depletion, and the sources and replenishment of energy. Conclusion: As new nurses adapt to their roles and environments, they encounter numerous pressures that markedly drain their psychological energy. This ongoing depletion of self‐regulation energy can lead to transitional shock, impulsive decision‐making, and missed nursing care. Implications for Nursing Management: Managers should implement comprehensive support strategies, including optimized work environments, enhanced training, and personal development, to help newly graduated nurses successfully transition and improve care quality and retention. [ABSTRACT FROM AUTHOR]

Background: The unprecedented COVID-19 pandemic has become an endemic disease of global public health importance. Mass COVID-19 vaccination has been an essential global control strategy amidst challenges of limited acceptance. Because of globalization, COVID-19/similar diseases vaccination acceptance and the determinants in any particular setting are important global public health issues. Using a novel and pragmatic framework, this study explored determinants of COVID-19 vaccination acceptance among community members during the pandemic in Ebonyi state, Nigeria, and made policy-relevant recommendations on how to increase vaccination acceptance in subsequent outbreaks/pandemics. Methods: This qualitative study was based on the novel and pragmatic Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four 'Cis') Determinants of Vaccination Acceptance Conceptual Framework – Omale INDEPT FORCIS Framework. On April 26 and 27, 2022, 20 semi-structured face-to-face focus group discussions were conducted in local language and pidgin English with 100 purposively selected consenting/assenting community members aged 15 years and above who had resided in the community for at least one year. Data was analysed using deductive (with some inductive) thematic analytic approach. Results: The many, diverse, and significant determinants of COVID-19 vaccination acceptance found were factors that were individual-related (individual experiences and perceptions and knowledge about COVID-19, COVID-19 vaccine/vaccination, and the vaccination process/system, sociodemographic, individual's condition (e.g. pregnancy)); COVID-19-related (factuality, transmissibility, frequency, severity, fatality); COVID-19 vaccine/vaccination-related (safety/side-effects, effectiveness, speedy production); COVID-19 vaccination process/system-related (real availability/accessibility); family, group, and other individual-related (experiences and perceptions and actions); and broader local, national, international, and global (LONING) context-related (socio-political, economic, historic, health system factors). The broader LONING contextual factors included the unprecedented disinformation/conspiracy theories, non-sustained COVID-19 risk/behaviour change communication, enforcement and non-enforcement or termination of peculiar control policies/measures (lockdowns, social/physical distancing, use of face mask etc.), mandatory COVID-19 vaccination policies, provision of incentives, past experiences regarding the Ebola viral disease outbreak, (un)trustworthiness of the Nigerian health system and her international/global partners, and the (un)trustworthiness of the governments in Nigeria and bad/good governance, inclusive of the failure of the Ebonyi state government to distribute the COVID-19 palliatives to the people during the lockdowns. Conclusion: The evidence illuminates complex and interrelated, specific underlying, and peculiar policy-relevant LONING determinants of COVID-19 vaccination acceptance and emphasizes the need for concerted and comprehensive LONING strategies (involving all the relevant LONING stakeholders/policy makers) in addressing these determinants to increase vaccination acceptance among community members in subsequent outbreaks/pandemics in Ebonyi state/Nigeria and similar settings. [ABSTRACT FROM AUTHOR]

Background: In aging societies, emergency departments (ED) face an increasing number of older, geriatric patients. Research shows that older emergency patients have a greater burden of comorbidities and a higher risk of adverse events. It has been questioned whether contemporary ED structures can meet the specific needs and characteristics of older patients. Little is known about how professional health care providers perceive and experience ED care for older patients. This study aimed to get insight into the perspective of healthcare providers working with older ED patients and to explore the challenges they experience in their daily work. Methods: The study used a qualitative research design with a social-constructivist perspective and a Grounded Theory based methodology. Data were collected through qualitative interviews with N = 25 healthcare providers from different urban EDs in Berlin, Germany, and adjacent healthcare institutions. Following the Ground Theory approach, categories and central themes were identified, analyzed, and interpreted to gain a comprehensive understanding of the healthcare provider perspective. Results: The interviews revealed a significant and increasing relevance of geriatric ED patients for healthcare providers. However, there was no shared definition of 'the geriatric patient'. Most interviewees found ED structures to be inadequate for older patients. They described specific challenges, such as information gathering and safety risks in the ED, as well as an increased use of resources (both time and personnel) when caring for older patients. In addition, specific problems in the collaboration with other professions and institutions were addressed, namely nursing homes, hospital wards, consultations, and the hospital social service. Conclusion: Healthcare providers experience a structural mismatch between contemporary EDs and the specific needs of geriatric patients. They are aware of the vulnerabilities of geriatric patients and try to compensate for inherent structural shortcomings. Such structures and limited resources often cause practical, organizational, and ethical problems. There is a great need to develop, implement, and evaluate systematic approaches and care concepts that address the specifics of ED care for geriatric patients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to understand the key barriers to successfully implementing Social Prescribing (SP) initiatives from different perspectives. Methods: An in-depth process evaluation using a multi-method qualitative design was conducted. Qualitative data was collected via semi-structured interviews (N = 23) and Focus Group Discussion (FGD' N = 4). Twenty-three stakeholders took part in the study, including community support providers (n = 7), SP link workers (n = 6), service users (n = 6), NHS employees/referrals, and those who were involved in SP leadership and coordination (n = 4). MAXQDA Version 20.0 was used for management and data analysis. Results: We identified eight themes representing challenges for a successful implementation of a SP programme. The themes included (i) financial issues and sustainability, (ii) human resources challenges, (iii) partnership working challenges, (iv) inadequate and inconsistent implementation, (v) information system challenges, (vi) referral system issues, (vii) training and knowledge gaps, and (viii) accessibility and privacy concerns. Conclusion: Study findings provide insight for commissioners, providers, and link workers to guide the delivery of appropriate SP services by identifying a range of factors that hinder the successful implementation of the programme. Future policy, service development, and research should consider tackling these challenges and generating different ideas for potential solutions to address the root causes of problems. [ABSTRACT FROM AUTHOR]

Objectives: To describe the essential competencies required for patient engagement in their own safety. Method: We adopted a phenomenological approach in qualitative research to conduct semi-structured interviews with nurses (n = 14) and adult patients (n = 13) from different departments. By deeply exploring their experiences and feelings about patient engagement in patient safety, we sought to understand their views on the qualities that patients need to possess in order to participate in their own safety. Results: From the interviews, we identified six major themes, including competence of information sharing, competence of taking patient engagement as responsibility and right, competence of making equal communication, competence of maintaining trust relationship with health personnels, competence of accepting non-punitive safety culture, need of resource support, five of them showed essential competences for patients and one of them showed patients' need for promoting their engagement. Conclusion: The findings of this study show necessary competence and needs in patient engagement process of patient, offer a foundational reference for constructing a measurement tool for patient engagement in patient safety competence in the future, so that medical staff and patients can provide reference for the future targeted construction of patient competence improvement programs. At the same time, improving patient competence and engagement to better achieve safety goals requires the joint efforts of patients, medical staff, medical institutions, the government, and society. [ABSTRACT FROM AUTHOR]

Introduction: A growing body of literature supports the use of Acceptance-and commitment therapy (ACT) for a wide range of mental health problems in children and adolescents, but less is known about ACT when given to adolescents in a group format. Consequently, this study aimed to explore the subjective experiences of adolescents who had completed a group-based ACT for symptoms of anxiety and depression. Adolescents’ perceptions of the core therapeutic processes of ACT and the means used to enhance them, as well as the interplay between ACT processes and the group format, were of primary interest. Methods: Semi-structured qualitative interviews were conducted with seven adolescents, of which five were girls and two were boys, between 16 and 19  years old. Transcripts were analyzed using reflexive thematic analysis. Results: The adolescents varied greatly in their experience of ACT’s core processes and the methods used to enhance them. Most found the core processes meaningful and educational, especially appreciating the concept of values and value-based action. However, some perceived the core processes as irrelevant and provocative, particularly interpreting acceptance as “giving up.” The metaphors and practical exercises were experiences as playful and instructive supplements to the more theoretical elements of therapy, but also as childish and embarrassing. The group format facilitated normalization and support and seemed to increase the adolescents’ motivation and adherence to therapeutical work, but it also triggered socially anxious thoughts and self-censoring for some. Conclusion: The results from the current study support previous literature indicating that group-based ACT is an acceptable and feasible treatment format for adolescents. Yet, the varying experiences underscores the need for further studies exploring how to accommodate the group format to the diverse personal and developmental disparities in this age group. Randomized controlled trials are also needed to compare the effectiveness of individual versus group format of ACT for adolescents. [ABSTRACT FROM AUTHOR]

Childfreeness remains a largely unexplored subject in Poland. We provide insights into the scale of childlessness by choice and the motivations and characteristics of childfree people in the country. We conducted a quantitative study (national stratified random sample, n = 665, age 18–50 (M = 34.14, SD = 9.22), October 2021) and a qualitative exploration (n = 461, age 18–58 (M = 29.07, SD = 7.01), May 2020–January 2021). The quantitative analyses revealed that 14.89% of adult Poles of reproductive age did not have children and were not planning to have them. The decision not to have children was significantly predicted by lower age and left-wing political and liberal social beliefs. The qualitative analyses showed that the most common reasons for being childfree were lack of parental instinct (I do not feel the maternal instinct), not liking children (I cannot stand children) and desire for autonomy (I want to be independent). The results suggest that the Polish childfree population is substantial and diverse in their reasons for not wanting to have children. [ABSTRACT FROM AUTHOR]

Introduction: People in low socioeconomic circumstances are more susceptible to dyslipidemia and cardiovascular disease than those living in more affluent populations. Limited healthcare access and low preventive care uptake widen health inequalities. Understanding how primary care can better serve socioeconomically disadvantaged communities is urgently needed. Aim: To explore lipid management delivery in socioeconomically disadvantaged areas and identify barriers and enablers for lipid optimization for socioeconomically disadvantaged populations. Method: Individual semi-structured remote interviews with clinicians, purposively recruited from primary care practices serving extremely socioeconomically disadvantaged communities in Northern England, UK, who were involved in the delivery and organization of lipid management. Interviews were recorded, transcribed, and analyzed thematically following framework analysis. Results: Fifteen interviews were undertaken. Five themes emerged: complex and multimorbid patients with competing priorities, limited access and follow-up to supporting services, being flexible and working beyond guidelines, high workload with inadequate staff support, and the need for care integrity and sustainable support. Conclusion: The findings of this study have been fed back to the delivery of the national program to improve cardiovascular health. Socioeconomically disadvantaged communities have complex health needs posing risks of multimorbidity but living with low health literacy, competing demands upon time, and financial constraints. Clinicians are willing to adapt services but a lack of guidance for care and funded services remains a significant barrier to targeted service delivery. Research is needed to inform the effectiveness and acceptability of interventions for lipid management tailored for those experiencing low socioeconomic disadvantage. [ABSTRACT FROM AUTHOR]

Background: This study explored the career development experiences of Korean medical educators who have forged their paths amid dynamic medical education landscapes. Additionally, it explored their career development process by introducing a protean career theoretical framework, that is, an individual-led career development theory. Methods: This study employed Interpretative Phenomenological Analysis (IPA) to gather in-depth insights regarding the experiences of medical educators who have successfully built their careers in Korea. Semi-structured interviews were conducted with nine medical educators to investigate the significance of these experiences. The emerging themes were categorised based on the protean career theory during data analysis. Results: The findings revealed that medical educators navigated their careers in line with the protean career development model, characterised by protean career orientation, process and outcomes. Their experiences in the medical education domain were aligned with eight factors of the protean career model – self-direction, intrinsic work values, awareness, adaptability, agency, subjective career success, objective career success and organisational commitment. Conclusion: In the context of less structured career pathways and a rapidly evolving regional environment, medical educators have developed individual-driven careers with self-direction and intrinsic values, formed their identities and demonstrated flexibility and proactive strategies. Hence, the protean career model successfully explains the characteristics of self-directed career development for medical educators, while emphasising the need for organisational support. [ABSTRACT FROM AUTHOR]

Background: The single-child issue is a significant contributor to population decline, which adversely affects both parents and children. Despite government-approved incentives, the single-child problem remains a major population challenge. This study was conducted to explore the perceptions and experiences of single-child couples regarding childbearing incentives. Methods: This qualitative study used conventional content analysis and was performed on 21 single-child couples in Mashhad, North East Iran, selected through purposive sampling from urban health centers. Data were collected using semi-structured interviews until saturation was reached. The data were analyzed using the Elo and Kyngas (J Adv Nurs 62(1):107-15, 2008. 10.1111/j.1365-2648.2007.04569.x) method with MaxQDA10 software. Results: Two generic categories emerged from the data analysis including (1) "Advertising and providing information as an influencing factor to encourage childbearing", which included two subcategories of "Attention to the key lever of advertising" and "Necessity of adopting advertising policies and creating a culture of respecting maternal role", and (2) "Focusing on effective incentive policies", which consisted of three subcategories of "Adopting incentive policies to reduce people's financial problems", "Avoiding punitive policies" and "Need to adopt incentive policies for working women and elites". Conclusions: Incentive policies should focus on the culture building of the general public, implementing effective incentive policies, and addressing economic challenges, particularly for specific groups such as working women and higher education students. In addition, a public mobilization effort is needed to effectively implement population laws. Plain English summary: Single-child issue is a challenge, being a cause of population decline, and poses adverse effects on both parents and children. Various childbearing incentive policies exist, but single-child couples' perceptions regarding these incentives have been less explored. To encourage childbearing, it is crucial to implement effective advertising and information release among the target groups, based on respecting the maternal role and addressing conflicting attitudes towards the influence of employment and education on maternal role. Avoiding punitive policies, using financial incentive policies to reduce people's financial burdens and being ensured of their implementation, and adopting incentives to support working women and elites (female students in higher education), would be among the effective fertility incentives. [ABSTRACT FROM AUTHOR]

Background: Patients with Fabry disease (FD) consider their quality of life to be significantly affected. The majority of studies evaluate the quality of life using quantitative measures and standardised scales that offer relevant information about experience with the disease in multiple aspects. The main objective of the research was to examine in depth the quality of life and unmet needs of patients diagnosed with FD in relation to their disease and treatment. A qualitative and transversal study was carried out in two stages: (a) nine semi-structured qualitative interviews with patients and one representative of the patient association, conducted individually by phone; (b) a focus group was set up with three patients diagnosed with FD and one relative. A deductive, thematic analysis approach was used for data coding and analysis. Results: The analysis of the interviews revealed various relevant themes: experience with the disease, impact on daily activities, experience of the family and work environment, experience related to treatment and healthcare professionals, and unmet support needs. Diagnosis has a significant impact on both those suffering from the disease and on the family environment. The symptoms and evolution of the disease are highly variable among the patients interviewed and depend on the years diagnosed as well as the time taken to receive the diagnosis. The families of the interviewees have to go through an adjustment process in light of the significant psychological impact brought about by the disease. Patients show various unmet needs. The need mentioned most is to have more information, support, and understanding from people around them and society, improving empathy and raising awareness about the difficulties faced by people with FD while giving the disease visibility. A lack of social understanding is highlighted as one of the main challenges, as this does not only affect the emotional management of the disease but also has repercussions on working life and social relationships. Conclusions: It seems necessary to define possible strategies that help to improve the quality of life of patients and their experience with the disease. Some recommendations obtained from the study include: facilitate access to mental health professionals for patients and their families; improve training for specialists and coordination among them; and carry out actions to raise awareness of the disease that are aimed at the general public, the patients themselves, and the people around them. [ABSTRACT FROM AUTHOR]

Background: Inappropriate prescribing (IP) is a common problem in the older population. Despite numerous attempts to tackle this issue, it remains a public health concern. In most European countries, general practitioners (GPs) are responsible for global primary care and are thus gatekeepers for the adequacy of medicines, specifically for older people. An in-depth analysis of the situation is necessary to understand why this phenomenon is still prevalent and to identify solutions that could help avoid IP in primary practice. Method: A qualitative study based on five focus groups (FG) comprising nine to thirteen general practitioners was conducted in the French-speaking part of Belgium. Participants were recruited among the Local Medical Evaluation Groups (LMEG) and selected to guarantee heterogeneity in working organisations, years of professional experience, gender and age. All interviews were recorded with prior agreement and transcribed in verbatims. The transcripts were coded and analysed to highlight the primary themes, considering dominant and marginal discourses. Results: Fifty four GPs participated in the study, with an average experience of 30 years. IPs are perceived as a significant problem in the older population, leading to dangerous health situations. The issue is associated with polypharmacy and multimorbidity, and GPs stated to manage IP using their clinical experience. Most of the study participants faced difficulties managing IP, mostly due to the specificity and complexity of elderly care. Indeed, managing an older patient is challenging due to medical complexity, poor adherence to drug regimes, or low medical literacy. In addition, the medical environment of general practice is challenging, with multiple providers, lack of time, prescribing routine and the absence of effective communication with specialists or other care providers. Additionally, the tools and support available to help medication management in primary care are inadequate. Enhancing collaboration with pharmacists is perceived as a strong potential facilitator. Conclusion: This article addresses the complex management of IP in the old age, from the point of view of GPs. Interesting clues were highlighted, like the need to clarify roles of healthcare providers, the better fit of tools to facilitate medication's review with particularities of GPs needs and the empowerment of pharmacist collaboration. [ABSTRACT FROM AUTHOR]