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Background: Low- and middle-income countries (LMICs), including South Africa, are currently experiencing multiple epidemics: HIV and the rising burden of non-communicable diseases (NCDs), leading to different patterns of multimorbidity (the occurrence of two or more chronic conditions) than experienced in high income settings. These adversely affect health outcomes, increase patients' perceived burden of treatment, and impact the workload of self-management. This paper outlines the methods used in a qualitative study exploring burden of treatment among people living with HIV/NCD multimorbidity in South Africa. Methods: We undertook a comparative qualitative study to examine the interaction between individuals' treatment burden (self-management workload) and their capacity to take on this workload, using the dual lenses of Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) to aid conceptualisation of the data. We interviewed 30 people with multimorbidity and 16 carers in rural Eastern Cape and urban Cape Town between February-April 2021. Data was analysed through framework analysis. Findings: This paper discusses the methodological procedures considered when conducting qualitative research among people with multimorbidity in low-income settings in South Africa. We highlight the decisions made when developing the research design, recruiting participants, and selecting field-sites. We also explore data analysis processes and reflect on the positionality of the research project and researchers. Conclusion: This paper illustrates the decision-making processes conducting this qualitative research and may be helpful in informing future research aiming to qualitatively investigate treatment burden among patients in LMICs. [ABSTRACT FROM AUTHOR]

Background: Empirical studies suggest that gratitude positively influence the quality of life of palliative patients and relatives. However, the literature is marked by a lack of conceptual clarity about what gratitude is and whether it can bring about individual and social benefits. Aim: This paper explores how palliative care patients and relatives understand gratitude, how discursive representations of gratitude may affect their positions, perceptions and relations, and how to conceptualise gratitude in the palliative context. Design: We examine 33 gratitude letters written by patients and relatives and 25 semi-structured interviews conducted as part of a pilot gratitude intervention study. We use a qualitative approach, thematic analysis, within a conceptual framework of discourse analysis. Settings/participants: Data were collected from 23 patients and 13 relatives recruited through three hospital palliative care services in French-speaking Switzerland. Results: Participants articulate gratitude in five ways: (1) appreciating others; (2) love; (3) need to reciprocate; (4) appreciating the little things; (5) solace amid serious illness. While some of these representations are sources of positive emotions and outlook, wellbeing and hope, others may confirm self-perceptions of powerlessness and burden. These results support a tridimensional conceptualisation of gratitude in palliative care as source of individual benefits, valuing closest relationships and moral obligation. Conclusion: Our study suggests that gratitude is a key to a good (end of) life, whilst highlighting potential negative effects. It could help healthcare professionals to better understand what gratitude means to patients and relatives, which may facilitate awareness and fostering of gratitude in palliative care. [ABSTRACT FROM AUTHOR]

Background: The onset of the COVID-19 pandemic challenged healthcare providers to adapt their models of care and leverage technology to continue to provide necessary care while reducing the likelihood of exposure. One setting that faced a unique set of challenges and opportunities was free and charitable clinics. In response to the emerging pandemic, The North Carolina Association for Free and Charitable Clinics (NCAFCC) offered their 66 member clinics access to a telehealth platform, free of charge. Objective: This paper explores the varied perspectives of leaders in the NCAFCC member clinics regarding the implementation of telehealth services to facilitate continuity of care for patients during the height of the pandemic. Design: This qualitative study is part of a broader research effort to understand and contextualize the experience of implementing and using telehealth services by North Carolina free and charitable clinics during and after the COVID-19 pandemic. The research team conducted 13 key informant interviews and employed thematic analysis and grounded theory to explore critical themes and construct a model based on the CFIR to describe the use of telehealth in free and charitable clinics. Results: Twelve clinic managers and executive directors from free and charitable clinics across the state participated in the key informant interviews providing their unique perspective on the experience of implementing telehealth services in a free and charitable clinic environment during the COVID-19 pandemic. When examined within the lens of the consolidated framework for implementation research (CFIR), 3 key themes emerged from the key informant interviews: mission driven patient centered care, resilience and resourcefulness, and immediate implementation. Conclusions: This study aligns with existing literature regarding telehealth implementation across other safety net provider settings and highlights the key implementation factors, organizational elements, provider perspectives, and patient needs that must collectively be considered when implementing new technologies, especially in a low-resource, high need healthcare setting. The study showcases the implementation climate, resourcefulness, and mission driven approach that allowed many NCAFCC clinics to respond to an emergent situation by adopting and implementing a telehealth platform in a period of 2 weeks or less. [ABSTRACT FROM AUTHOR]

Introduction: This paper provides a report of social validity and its usefulness in understanding study effects. Social validity data were drawn from a larger single-case study designed to investigate the effectiveness of the Matrix Approach in the practice of early intervention visual impairment professionals. Methods: Qualitative measures were used to assess social validity. According to Wolf (1978), validation of a study should encompass the significance of goals, appropriateness of procedures, and importance of outcomes. Therefore, data sources were created to provide evidence of social validity in these areas including pre- and post-intervention interviews of parents and professionals. Results: Three themes emerged from the social validity data. These are organized under the topics introduced by Wolf (1978) and identified as measures of quality by Horner et al. (2005). The themes are (a) Goals: role of the parent as learner and the professional as expert before using the Matrix Approach, (b) Procedures: helpfulness of coaching and the structure of the Matrix Approach, and (c) Outcomes: personal and professional growth as a result of using the Matrix Approach. Discussion: Evaluation of social validity in single-case research is an important component in a study's design and in interpreting the study's outcomes. Wolf's framework proved valuable in promoting a robust evaluation of study effectiveness, especially when incorporated into the study design. Intentionally planning to measure social validity held the researchers accountable to the practical needs of the participants. In fact, there is value in gathering social validity data at various points in a study. Further, hearing the perspective of stakeholders can provide valuable insights as researchers seek to understand the complexities of change evident in the outcomes of a study. Implications for Practitioners: Collaborative planning is an essential component of early intervention. The Matrix Approach shows promise as a mechanism to foster such collaboration. [ABSTRACT FROM AUTHOR]

Objective: To identify barriers and facilitators to international implementation of a prospective system for standardized outcomes measurement in cleft care. Design: Cleft teams that have implemented the International Consortium for Health Outcomes Measurement Standard Set for cleft care were invited to participate in this 2-part qualitative study: (1) an exploratory survey among clinicians, health information technology professionals, and project coordinators, and (2) semistructured interviews of project leads. Thematic content analysis was performed, with organization of themes according to the dimensions of the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework: reach, effectiveness, adoption, implementation, and maintenance. Results: Four cleft teams in Europe and North America participated in this study. Thirteen participants completed exploratory questionnaires and 5 interviewees participated in follow-up interviews. Survey responses and thematic content analysis revealed common facilitators and barriers to implementation at all sites. Teams reach patients either via email or during the clinic visit to capture patient-reported outcomes. Adopting routine data collection is enhanced by aligning priorities at the organizational and cleft team level. Streamlining workflows and developing an efficient data collection platform are necessary early on, followed by pilot testing or stepwise implementation. Regular meetings and financial resources are crucial for implementing, sustaining, analyzing collected data, and providing feedback to health care professionals and patients. Fostering patient-centered care was articulated as a positive outcome, whereas time presented challenges across all RE-AIM dimensions. Conclusions: Identified themes can inform ongoing implementation efforts. Intentionally investing time to lay a sound foundation early on will benefit every phase of implementation and help overcome barriers such as lack of support or motivation. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to obtain baseline data on bone mass density for Native Hawaiian women and to better understand the socio-cultural context for assessing bone health and risk of osteoporosis for this underserved population. Method: A sequential mixed-method design guided by Leininger's Culture Care Theory of Diversity and Universality consisted of two phases: (a) an initial exploratory focus group and (b) dual-energy X-ray absorptiometry (DEXA) scans and individual interviews. Data were analyzed using descriptive statistics and thematic analysis. Results: Phase a (n = 12) suggested that Native Hawaiian women have limited knowledge of bone health, but recognize traditional and cultural ways of health. Phase b (n = 50) showed that Native Hawaiian women have healthy bones, according to the T -score results. The interviews suggested that perspectives of bone health are culturally anchored. Discussion: Understanding cultural values and practices are vital for care. Preliminary recommendations for health professionals are included. [ABSTRACT FROM AUTHOR]

While health services are expected to have public involvement in service (re)design, there is a dearth of evaluation of outcomes to inform policy and practice. There are major gaps in understanding why outcome evaluation is under-utilised. The aims of this interpretive descriptive study were to explore researcher participants' experiences of and/or attitudes towards evaluating health service outcomes from public involvement in health service design in high-income countries. Additionally, the aims were to explore barriers and enablers of evaluation, and reasons for the use of evaluation tools or frameworks. Semi-structured interviews (n = 13) were conducted with researchers of published studies where the public was involved in designing health services. Using framework analysis, four themes were developed that captured participants' experiences: Public involvement is hard – evaluation is harder; power, a diversity of agendas, and the invisible public; practical and methodological challenges; and genuineness and authenticity matter. Evaluation is driven by stakeholder requirements, including decision-makers, funding bodies, researchers, and academics, and evaluation tools are rarely used. The public is largely absent from the outcome evaluation agenda. There is a lack of commitment and clarity of purpose of public involvement and its evaluation. Outcome evaluation must be multi-layered and localised and reflect the purpose of public involvement, what constitutes success (and to whom), and use the most appropriate methods. Multi-level supports should include increased resources, such as funding, time, and expertise. Without improved evaluation, outcomes of investment in public involvement in health service design/redesign remain unknown. [ABSTRACT FROM AUTHOR]

In this article, we rethink the ways that analysis within narrative research might occur based on the topic being studied and provide an example using the Afro-Brazilian martial art capoeira. Locating our work at the intersection of Derridean freeplay and the spirit of play present in the Afro-Brazilian martial art capoeira, we reconceive of the ways that narratives may be constructed, and suggest that the topic under study, capoeira, may actually become an analytic. This piece offers one of many potential directions for rethinking analysis of narrative data and representing participant experiences and suggests blurring lines between content and method of analysis. While our own analysis occurs using play as it appears in capoeira, we suggest that any number of research topics may be used to inform the ways that we analyze data. [ABSTRACT FROM AUTHOR]

During the outbreak of the COVID-19 pandemic, Norwegian health authorities introduced social distancing measures in nursing homes. The aim was to protect vulnerable residents from contracting the potentially deadly infection. Drawing on individual interviews with nursing home managers and physicians, and focus groups with nursing staff, we explore and describe consequences the social distancing measures had on nursing home residents’ health and wellbeing. The analysis indicates that most residents became socially deprived, while some became calmer during the nursing home lockdown. Nursing home staff, physicians and managers witnessed that residents’ health and functional capacity declined when services to maintain health, such as physiotherapy, were put on hold. In conclusion, we argue that although Norwegian health authorities managed to keep the infection rates low in nursing homes, this came at a high price for the residents however, as the social distancing measures also negatively impacted their health and wellbeing. [ABSTRACT FROM AUTHOR]

Adoption of new instructional standards in science demands high-quality information about classroom practice. Teacher portfolios can be used to assess instructional practice and support teacher self-reflection anchored in authentic evidence from classrooms. This study investigated a new type of electronic portfolio tool that allows efficient capture of classroom artifacts in multimedia formats using mobile devices. We assess the psychometric properties of measures of quality instruction in middle school science classrooms derived from the contents of portfolios collected using this novel tool—with instruction operationalized through dimensions aligned to the Next Generation Science Standards. Results reflect low rater error and adequate reliability for several dimensions, a dominant underlying factor, and significant relations to some relevant concurrent indicators. Although no relation was found to student standardized test scores or course grades, portfolio ratings did relate to student self-efficacy perceptions and enjoyment of science. We examine factors influencing measurement error, and consider the broader implications of the results for assessing the validity of portfolio score interpretations, and the feasibility and potential value of this type of tool for summative and formative uses, in the context of large-scale instructional improvement efforts. [ABSTRACT FROM AUTHOR]

An examination of the interaction of pre- and post-migration stressors is critical to understanding Canadian Muslim immigrant women's experience of intimate partner violence (IPV). This study uses a dominant qualitative design, supplemented by quantitative data to understand eight Canadian Muslim immigrant women's experience of IPV from six countries of origin. Five themes were identified: (a) childhood exposure to trauma and violence, (b) iron cage of society, (c) the fusion of love and violence, (d) postmigration challenges and assistance, and (e) toll and consequences of IPV. These themes are described to illustrate the trajectory in the development of IPV and the participants' eventual decision to leave their relationship. Pre-migration experiences included adverse childhood experiences, family history of IPV, and difficulty with help-seeking for IPV. Post-migration challenges of language difficulties, lack of social connections, internalized familial patriarchal values, and sexism influenced women's help-seeking and decision-making. Results from this sample suggested that immigrant Muslim women are likely more affected by IPV in comparison to Canadianborn Muslim women, experienced more stressors, less support, delayed help-seeking process, and more serious mental health consequences. Quantitative measures revealed negative effects of IPV on women's mental and overall health. The roles of ethnic communities, religious institutions, law enforcement, and service providers in supporting Canadian Muslim women with experience of IPV are discussed. [ABSTRACT FROM AUTHOR]

This article explores the evolution of a novel approach designed to advance qualitative methods in cross-cultural health research. This methodology was developed by synthesising several research methods and involved in-depth stakeholder consultation with participants of a Pacific-based nursing and midwifery health leadership program. Many of these participants played a crucial role in creating, exploring and evaluating several research methods and implementing and evaluating this co-designed research methodology. Starting with a Participatory Action Research framework, the research methodology evolved as it was informed by the local Pacific methodologies (in particular Talanoa and Kakala frameworks), where researchers, co-researchers and participants alike, working from within their own collectivist/individualist paradigms, negotiated cultural differences. Finally, a methodological framework of 'best practice' for future health research methods was developed for use with capacity building research. The new methodology could provide a foundation for future co-designed cross-cultural research in collectivist cultures. [ABSTRACT FROM AUTHOR]

Self-management programs improve health outcomes and self-management is recommended for chronic conditions. Yet chronic disease self-management supports have rarely been applied to people who use drugs (PWUD). Thus, our objective was to explore self-management experiences among marginalized PWUD. We used community-based participatory methods and conducted qualitative interviews. Participants self-identified as having long-term and past year experience using non-prescribed drugs, one other chronic condition, and socioeconomic marginalization. We analyzed the data using reflexive thematic analysis. Although many participants considered drug use a chronic health issue, self-medicating with non-prescribed drugs was also a key self-management strategy to address other health issues. Participants also described numerous other strategies, including cognitive and behavioral tactics. These findings highlight the need for a safe supply of pharmaceutical-grade drugs to support self-management among marginalized PWUD. Self-management supports should also be tailored to address relevant topics (e.g., harm reduction, withdrawal), include creative activities, and not hinder PWUD's agency. [ABSTRACT FROM AUTHOR]