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OBJECTIVE: Active patient involvement in promoting quality and safety is a priority for healthcare. We investigated how dental patients perceive their role as partners in promoting quality and safety across various dental care settings. METHODS: Focus group sessions were conducted at three dental practice settings: an academic dental center, a community dental clinic, and a large group private practice, from October 2018-July 2019. Patients were recruited through flyers or word-of-mouth invitations. Each session lasted 2.5 h and patients completed a demographic and informational survey at the beginning. Audio recordings were transcribed, and a hybrid thematic analysis was performed by two independent reviewers using Dedoose. RESULTS: Forty-seven participants took part in eight focus group sessions; 70.2% were females and 38.3% were aged 45-64 years. Results were organized into three major themes: patients overall perception of dental quality and safety; patients reaction to an adverse dental event; and patients role in promoting quality and safety. Dental patients were willing to participate in promoting quality and safety by careful provider selection, shared decision-making, self-advocacy, and providing post-treatment provider evaluations. Their reactions towards adverse dental events varied based on the type of dental practice setting. Some factors that influenced a patients overall perception of dental quality and safety included provider credentials, communication skills, cleanliness, and durability of dental treatment. CONCLUSION: The type of dental practice setting affected patients desire to work as partners in promoting dental quality and safety. Although patients acknowledged having an important role to play in their care, their willingness to participate depended on their relationship with their provider and their perception of provider receptivity to patient feedback.

IntroductionWe elicited Vietnamese Americans' perspectives on culturally appropriate recruitment into a new research registry: Collaborative Approach for Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) Research and Education (CARE).MethodsThree focus groups were conducted with 21 Vietnamese Americans. Topics included knowledge about and experiences with research, outreach and recruitment methods for research participation and registry enrollment, and views about research incentives. Focus group transcripts were analyzed thematically.ResultsMean age of participants was 41 years (range 18-73), 57% were male, 86% were non-US born, and 81% had never participated in a research study. Themes that emerged included (1) motivations to participate in research to gain knowledge: for oneself, for family's benefit, and for the Vietnamese American community as a whole; (2) necessity of trustworthy and credible individuals/spokespersons to promote the research initiative; (3) recruitment strategies that are age-specific and culturally appropriate, and (4) importance of monetary incentives.ConclusionFindings from this study will be used to guide recruitment into and engagement with CARE among Vietnamese Americans but are also relevant for other registries aiming to diversify their participants.

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]

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]

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: 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]

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: 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: 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]

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: 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]

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: 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]

This study investigates the perspectives of key stakeholders—teachers, principals, and parents of students with disabilities—regarding the 2022 Revised Curriculum, which integrates sustainability and climate change education into the Creative Experiential Activity (CEA) curriculum in special education. It focuses on their perceptions and needs for improving CEA to reflect hands-on learning and sustainable development goals (SDGs), particularly in areas like ICT integration and social inclusion. Through a focus group interview (FGI) and the KJ method of analysis, key themes were derived and organized into six levels to structure the transcripts. The teacher group identified 69 perceptions and 73 needs, with main themes related to 'extracurricular operation status', 'evaluation of extracurricular activities', and 'experience activities'. Their needs highlighted 'suggestions for the revised curriculum' and 'expectations for new activities'. The school expert group recognized 37 issues and expressed 74 needs, focusing on incorporating ICT and SDGs, particularly SDG 4 (Quality Education) and SDG 10 (Reduced Inequalities) into the revised curriculum. The parent group, with 58 recognitions and 56 needs, expressed perceptions of extracurricular activities in terms of 'related knowledge', 'negative emotions', 'school status', and 'positive attitude toward their child's participation'. Their primary needs included 'request for student guidance', 'expectation for successful social integration of children (SDG 3: Good Health and Well-being)', and 'opportunities for participation in education'. Furthermore, this study addresses gaps previously unexamined in the field of special education by analyzing the distinctive needs of special education settings and proposing concrete solutions to address these unmet needs. The findings underscore the necessity of tailoring educational content to the diverse needs of students with disabilities, promoting inclusive practices that align with SDGs and reflect the evolving educational landscape in special education. [ABSTRACT FROM AUTHOR]

Background: Urban neighborhood environments play an important role in facilitating or hindering residents to engage in active mobility and social participation. However, while there is much quantitative research, in-depth knowledge that contextualizes residents' subjective perceptions of barriers and facilitators of active mobility and social participation is still insufficient. Therefore, a qualitative approach was used to collect subjectively perceived barriers and facilitators of active mobility and social participation of residents from different neighborhoods with objectively determined high vs. low walkability. Furthermore, to better understand (non) concordance of objective environmental characterizations and actual levels of behavior, low and high walkability neighborhood-specific barriers, proposed improvements, and particularities that determine (non) engagement in active mobility and social participation were explored. Methods: Three focus groups (N = 6, N = 6, and N = 5) with 17 participants (7 women, 10 men) aged 21–64 (mean age 43.4 ± 14,6 years) were conducted utilizing a pre-structured interview guideline. Participants lived in 11 different neighborhoods with either high or low objectively determined walkability. The focus groups were transcribed verbatim, followed by a thematic analysis of the content with deductive and inductive code categories, utilizing the MAXQDA software. Results: Notable was the consensus of many perceived barriers and facilitators of active mobility and social participation along with their assignability to the same context (points-of-interest, infrastructure; safety, communication, community; topography, physical compositions, weather, aesthetics; personal / individual attitudes, influences, evaluations). Another main finding was that high and low walkability neighborhood-specific particularities were revealed that are in contrast to some objective characterizations of walkability: For example, too high density can inhibit active mobility, and too many options can inhibit social participation. Conclusions: The consensus of many barriers and facilitators of active mobility and social participation suggests that valuable synergies could be created by coordinating interventions aiming to promote both active mobility and social participation in urban neighborhoods. Also, considering subjective perceptions of residents helps to identify neighborhood-specific factors that determine (non) engagement in active mobility and social participation. The findings can help city planners and public health officials improve the promotion of active mobility and social participation in the creation of health-enhancing urban neighborhoods. [ABSTRACT FROM AUTHOR]

Objective: The present study was investigate parents' experiences of children with Epidermolysis bullosa. So, this descriptive phenomenological qualitative study was conducted on 17 parents of children with EB from five hospitals affiliated with the University of Medical Sciences, west of Iran. Data was collected through semi-structured interviews. COLAIZZI's method was also used to analyze the data. Results: Three main themes were extracted in this study: invasion of psychological crisis, alive but no living, and comprehensive support, including 10 categories. The parents of these children are the target of psychological crises that severely reduce their quality of life. In this regard, they need extensive support to improve their living conditions. Therefore, it is suggested to provide cultural and institutional contexts in which all components of the children's dignity are emphasized. [ABSTRACT FROM AUTHOR]

Background: Iran's fee-for-service (FFS) payment model in neonatal intensive care units (NICUs) is contentious due to the involvement of multiple stakeholders with differing interests, leading to increased costs, fragmentation, and reduced quality of care. This study explores the experiences and challenges of stakeholders with the NICU payment system and considers alternative payment methods. Method: A qualitative research approach was used, involving key informant interviews with stakeholders at various levels of the health system. Data were collected between March 2022 to September 2023 using a purposive sampling method with a snowball strategy. The transcribed data were analyzed using an inductive thematic approach in MAXQDA, with themes and sub-themes emerged and assessed by two independent coders. Four trustworthiness criteria were applied to ensure the quality of the results. Results: The study involved 23 participants with diverse NICU payment backgrounds, identifying issues related to service accessibility, rising costs, neonatologists' income, and service quality. Stakeholders held differing views on the best payment model: health insurance executives favored a prospective payment method, faculty members favored supported modified FFS or per diem, and neonatal specialists expressed concerns about low tariffs and delayed payments. Conclusion: Iran's NICU payment system is unsatisfactory and requires urgent reform. Although stakeholders disagree on the best approach, reforms must be evidence-based and collaborative, addressing structural and cultural issues within the health system. The identification of an optimal payment system is essential for supporting neonatal care, benefiting newborns, families, society, and the broader health system. [ABSTRACT FROM AUTHOR]

Background: Application of data-driven strategies may support veterinarians' decision-making, benefitting pig disease prevention and control. However, little is known about veterinarians' need for data utilisation to support their decision-making process. The current study used qualitative methods, specifically focus group discussions, to explore veterinarians' views on data utilisation and their need for data tools in relation to pig health and welfare management in Spain, the Netherlands, and Ireland. Results: Generally, veterinarians pointed out the potential benefits of using technology for pig health and welfare management, but data is not yet structurally available to support their decision-making. Veterinarians pointed out the challenge of collecting, recording, and accessing data in a consistent and timely manner. Besides, the reliability, standardisation, and the context of data were identified as important factors affecting the efficiency and effectiveness of data utilisation by veterinarians. A user-friendly, adaptable, and integrated data tool was regarded as potentially helpful for veterinarians' daily work and supporting their decision-making. Specifically, veterinarians, particularly independent veterinary practitioners, noted a need for easy access to pig information. Veterinarians such as those working for integrated companies, corporate veterinarians, and independent veterinary practitioners expressed their need for data tools that provide useful information to monitor pig health and welfare in real-time, to visualise the prevalence of endemic disease based on a shared report between farmers, veterinarians, and other professional parties, to support decision-making, and to receive early warnings for disease prevention and control. Conclusions: It is concluded that the management of pig health and welfare may benefit from data utilisation if the quality of data can be assured, the data tools can meet veterinarians' needs for decision-making, and the collaboration of sharing data and using data between farmers, veterinarians, and other professional parties can be enhanced. Nevertheless, several notable technical and institutional barriers still exist, which need to be overcome. [ABSTRACT FROM AUTHOR]

Background: Unintended teenage pregnancies are associated with greater health and socio-economic risks for teenage mothers and newborns. In Kenya, the government has declared a target for ending teenage pregnancy by 2030. However, the prevalence of teenage pregnancy has only decreased slightly, demonstrating the need for further efforts. Understanding teenage mothers' own experiences and perspectives is necessary to design appropriate interventions. Methods: A community-based qualitative study was conducted from March to May 2023. Two focus group discussions were conducted with community health volunteers and the mothers of teenage girls. Semi-structured interviews were conducted on the case histories of 19 teenage mothers and 18 key informants. Thematic analysis was subsequently performed using MAXQDA 2022. Findings: Four major reasons emerged for unintended teenage pregnancies: (1) lack of knowledge or awareness about the human reproductive system, (2) lack of knowledge about family planning (FP), (3) financial challenges, and (4) low access to FP. At the study site, cultural norms and stereotypes, such as "infertility caused by FP," "freedom of sex by promoting FP," and "cultural taboos on having sex before marriage and talking about sexuality," were observed as barriers in promoting FP to teenagers. In addition, teenagers from low socio-economic backgrounds were found to be more vulnerable because they can be easily exploited by men who can afford to provide for some of their basic needs. Regarding the influences of unintended teenage pregnancy on teenage mothers' lives, the 19 cases were classified into four categories: (1) dropping out of school, (2) financial challenges, (3) changing relationships with parents, and (4) no major influence. Crucially, unintended teenage pregnancies negatively influenced most study participants. Continuing education, supportive parental attitudes, positive perceptions of the relationship with the child's father, and having future perspectives were identified as factors mitigating the negative influences. Conclusions: Strengthening culturally appropriate comprehensive sexuality education and the school re-entry policy with a supportive environment may prevent unintended teenage pregnancy and mitigate its negative influences. As financial challenges can be both a reason for and a negative influence of unintended teenage pregnancy, economic empowerment interventions are necessary. Plain English summary: Teenage girls becoming pregnant unexpectedly face higher health and socio-economic risks, which can affect both the lives of teenage mothers and newborns. In Kenya, the government has targeted ending teenage pregnancies by 2030, but the decrease has been limited. Although understanding teenage mothers' experiences and perspectives is important for designing appropriate interventions, only a few studies have been conducted. This study focused on 19 teenage mothers and other key participants to gain a deeper understanding of their backgrounds. Four major reasons were identified for unintended teenage pregnancies: (1) lack of knowledge or awareness about the human reproductive system, (2) lack of knowledge about birth control methods, (3) financial challenges, and (4) low access to birth control methods. At the study site, cultural norms and stereotypes were observed as barriers in promoting the use of birth control methods to teenagers. In addition, teenagers from poor backgrounds were found to be more vulnerable because they can be easily taken advantage of by men who can afford to provide for some of their basic needs. Regarding the influences of unintended teenage pregnancy on teenage mothers' lives, the 19 cases were classified into four categories: (1) dropping out of school, (2) financial challenges, (3) changing relationships with parents, and (4) no major influence. In this study, unintended teenage pregnancies negatively influenced most participants. Continuing education, supportive parental attitudes, positive perceptions of the relationship with the child's father, and having future perspectives were identified as factors mitigating the negative influences. [ABSTRACT FROM AUTHOR]

Background: The global migration of health professionals in general and nurses in particular, has led to nursing shortages and socioeconomic impacts on health systems in both source and destination countries. Adding to the complexity of the situation is the fact that the nursing profession itself is evolving from a vocational to an academic one. Although nursing migration and academization have been studied from either an institutional or an individual perspective, there is a gap in the literature regarding how nursing teams experience these transitions. This study aims to explore how nursing teams navigate through the transitions of academization and internationalization of the current dynamic nursing landscape in Germany. Methods: Based on social constructivism epistemology this qualitative study involved face-to-face focus group discussions conducted at several hospital sites in Germany from September 2021 to May 2023. The focus group discussions were audio-recorded, transcribed, and analysed using content analysis; the four dimensions of transition theory according to Schlossberg's Four S (4 S) framework (self, situation, support, and strategy) were used as a priori items to construct the coding framework. Results: Nine focus group discussions were conducted with a total of 40 nurses from different educational and migrant backgrounds. The analysis showed that the transition experiences of the nursing teams were heterogeneous, with educational and national backgrounds playing an important role in how realistic their expectations of their professional roles and identities were. The dynamic situation characterized by a shortage of qualified nursing staff, increases the pressure on nursing teams and underscores the importance of employer-provided and peer support. Onboarding and communication are key strategies used depending on the duration of the employee turnover. Conclusion: This study provides insights into the challenges and coping strategies of nursing teams in the current dynamic scene of migration, academicization and professional socialisation in Germany. Extending the Schlossberg 4 S framework from the individual to the team perspective provides a comprehensive view of the transitional experiences of nursing teams. Within each domain of the framework, the experiences of nursing teams are remarkably diverse. Educational background (vocational or academic) and origin (German or foreign trained) play an important role in shaping the transitional experiences of nursing teams. [ABSTRACT FROM AUTHOR]

Background: The enhancement of nurses' disaster literacy is crucial for effective disaster emergency management, especially for clinical nurses with no prior experience in disaster rescue. This study aims to explore the perspectives of nurses who have been involved in disaster rescue operations on strategies to advance nurses' disaster literacy. Methods: A qualitative descriptive study, which follows unified qualitative study reporting guidelines. Thirty disaster rescue nurses were recruited to participate in this study, who came from 30 third-class hospitals in China. From October to December 2021, information was acquired by conducting semi-structured telephone interviews with participants. Qualitative content analysis was used to examine the data. Results: Six categories and eleven subcategories were created. Strengthening disaster education and training was the main focus, and its subcategories included continuing education, nursing curriculum development, and disaster rescue experience guide. The second focus, which included scene simulation, actual combat/military simulation, and virtual reality simulation, was strengthening disaster simulation and drill. The third focus was on providing psychosocial support, which included improving self-psychological adjustment, developing resilience, and engaging in active coping. The fourth category was to strengthen nurse/hospital managers roles and leadership, which included enhancing professional identity and policies/leadership support. The fifth category was disaster preparedness, and the sixth was enhancing knowledge transformation. Conclusions: Government agencies or healthcare organizations should actively promote the formation of nurses' disaster literacy from multiple viewpoints. Disaster education and training, simulation exercises, and psychosocial support should be prioritized. [ABSTRACT FROM AUTHOR]

Background: The demand for nursing professionals with advanced education and specialized knowledge is growing, which encourages nursing undergraduates to pursue postgraduate studies. Therefore, an in-depth investigation into the barriers and facilitators affecting the motivation of nursing undergraduates to take postgraduate entrance exams was necessary. This may provide more targeted recommendations for the formulation of relevant policies and the provision of student support. The purpose of this study is to explore the barriers and facilitators affecting the motivation of nursing undergraduates for postgraduate entrance examination. Methods: Data for this study were collected from in-depth semi-structured interviews with 15 nursing undergraduates from Nantong University between October and December 2023. Thematic analysis was employed to analyze the data. Results: Four barriers were identified, including study pressure and internship fatigue, self-doubt and fear of failure, employment pressure, and lack of information and resources. Four facilitators were also identified, including the desire to upgrade academic qualifications and professional skills, career development and transition, escaping clinical work and delaying employment, as well as the power of role models, and social support. Conclusions: The findings may help nursing undergraduates navigate the path to postgraduate entrance exams more effectively and ultimately succeed in their studies and future careers. The study underscores the importance of addressing these barriers and leveraging these facilitators to support the holistic development of nursing students. [ABSTRACT FROM AUTHOR]

Background: Implementing an electronic system of service categorization and a referral system in healthcare is a strategic approach to improving overall health outcomes and optimizing resource use. This study aimed to investigate challenges experienced with the electronic patient referral system in Mashhad University of Medical Sciences (MUMS). Methods: In this qualitative research, data were collected using semi-structured interviews. Participants included physicians, experts, and stakeholders working in the Family Physician Program and the referral system, selected through purposive sampling. The data were analyzed using a thematic analysis framework, in which a thematic framework was developed, and key themes were identified. Data analysis was performed using Atlas.ti8 software. Results: According to the interviewees, the challenges of digitizing the referral system can be categorized into three main themes: structure, process, and outcomes. These themes include ten sub-themes, such as challenges related to Internet Infrastructure and the Sina System, Patients' Choice of Desired Specialists, Receiving Payment for Services, Appointment Scheduling, Interdepartmental Coordination, Recording Definitive Diagnosis Codes Before Referral, False Referrals, Dissatisfaction, Feedbacks, and Health Indicators. Conclusion: To improve the e-referral in Iran's health system, several strategies can be implemented. These include sustainable resource allocation, designing consequence mechanisms within the referral system to motivate collaboration and improving appointment scheduling systems. Furthermore, addressing these challenges requires a collaborative approach involving healthcare providers, IT professionals, and patient representatives to ensure that the system is efficient, user-friendly, and effectively meets the needs of all parties involved. Not paying enough attention to these issues cause reform failure while solving them requires multi-dimensional, systematic and coordinated interventions with a deep understanding of the obstacles and challenges. Disregarding these factors may result in apathy over time, ultimately impacting both the quantity and, more importantly, the quality of services. [ABSTRACT FROM AUTHOR]

Objectives: The main objective of the study was to explore the perspectives of healthcare professionals (HCPs) regarding artificial intelligence (AI) and to identify challenges in its incorporation in the healthcare sector of Pakistan. Methods: A qualitative exploratory study design was adopted. The study was conducted from January 15th to February 29th, 2024, and HCPs (doctors, pharmacists and nurses) from two tertiary care teaching hospitals in southern Punjab, Pakistan were taken as the study population. The interviews were conducted with the help of a semi structured interview schema. A thematic approach was adopted to analyse the data. Results: Out of 40 HCPs approached, 25 participated in the study with a response rate of 62%. The participants included in the study were doctors (14), pharmacists (6) and nurses (5). The participants had limited knowledge regarding AI and its basics. However, they showed positive perceptions about its incorporation. They believed that many of the problems faced by the healthcare sector of Pakistan can be minimized by AI incorporation. They believed that AI can boost up the efficiency of healthcare providers, reduce their workload, save time and minimize medical errors. Four main themes with multiple subthemes were identified: (1) Cognizance of AI, (2) Acceptability of AI among HCPs and training requirements for effective incorporation, (3) Merits and Demerits of AI, and (4) Challenges in incorporation of AI with proposed solutions. Conclusion: HCPs showed a willingness to embrace AI incorporation and believed that it may bring numerous benefits to the health system. Policymakers should take necessary steps to ensure AI incorporation in our healthcare sector. [ABSTRACT FROM AUTHOR]

Background: Transgender individuals often face stigma, discrimination, and various forms of abuse, which negatively impact their mental and physical health. They face a significantly greater risk of HIV, with a higher prevalence than the general population. Despite these challenges, transgender people have limited access to healthcare due to violence, legal barriers, and societal stigma, further exacerbated in countries like Uganda, where transgender identities are criminalized. Therefore, this study explored the lived experiences of HIV researchers working with gender minority populations in criminalizing contexts. Methods: This was an interpretative phenomenological analysis (IPA) qualitative study. Twelve (12) research team members at all levels were involved in the study. Participants had less than five years of involvement in HIV research among gender minority populations. Data were collected using field notes, reflective journals, documentation from daily team debriefing sessions, and semi-structured interviews. The analysis used NVivo software. Results: Positive experiences, barriers, and challenges were captured. The positive experiences were 'respecting cultural diversity', 'expanding networks', 'addressing misconceptions' and 'finding allies'. The barriers included 'experiencing stigma', 'lengthy research processes', 'feeling isolated', 'fearing for personal safety', 'unexpected logistical costs', and 'criminalization of sexual and gender minorities'. The key themes that emerged from the lessons learned were: 'dealing with gatekeepers', 'diversity and sensitivity training', 'leveraging networks', 'meaningful community engagement', 'reflexivity', 'ensuring safety', 'equal partnership', 'giving feedback' and 'awareness of legal implications'. Conclusions: This study highlights the importance of cultural sensitivity, community engagement, and reflexivity in research design and implementation. The findings emphasize the need for innovative strategies to navigate legal, social, and logistical barriers that researchers and participants face. Despite these challenges, the study demonstrates that meaningful collaboration with community members and building trust can significantly enhance the research process and outcomes. Future research should continue to explore these strategies while addressing ethical and safety concerns. [ABSTRACT FROM AUTHOR]

Background: Research has identified a strong link between stress and drug use behaviours. Also, it has been established that the prolonged use of crack cocaine stimulates emotional, cognitive, neurological and social changes. This paper explores the psychological stressors that occur from crack cocaine use and the coping mechanisms used to mitigate them. This will provide an understanding of the intricate relationship between substance use and psychological well-being. Methodology: The study is qualitative and uses a descriptive phenomenological approach. The coping circumplex model is the theoretical model that underpins the study. Data was collected through 26 face-to-face in-depth semi-structured interviews with people who use crack cocaine. Data were analysed using thematic analysis. Participants consisted of 15 males and 11 females between the ages of 24–57 years, guaranteeing multiplicity within the study sample. Results: Cravings, financial burdens, relationship breakdown and emotional /cognitive stimulation were revealed as psychological stressors. Maladaptive coping which includes self-harm, isolation, not speaking about/not dealing with emotions and using substances were adopted by study participants. Also, positive coping such as seeking help and keeping busy were adopted by study participants. Social and environmental factors such as stigma, easy accessibility of crack and flashbacks served as barriers to positive coping. Positive coping was linked to the availability and easy accessibility to social support and strong family bonds, underlining the importance of accessible support systems in managing the challenges linked with crack cocaine use. Conclusion: The challenges faced by study participants in coping with the psychological stressors linked to their crack cocaine use highlight the importance of adopting personalised and comprehensive strategies to tackle the intricate dynamics between psychological stress, coping and crack cocaine use. [ABSTRACT FROM AUTHOR]

Objective: Sexual health is an essential part of overall health and well-being. Breast cancer affects the marital relationships and sexual activity of patients and their sexual partners. The present qualitative study was conducted to discover the experiences of women undergoing breast cancer treatment and their husbands regarding marital relationships after breast cancer. Methods: Semi-structured interviews were conducted with the 37 women undergoing breast cancer, their husbands, and healthcare providers. Recorded interviews were transcribed and analyzed using a qualitative content analysis approach. Results: Four categories of 'Utilization of couple-based approach,' 'Consequences of relationship breakdown,' and 'A need for the spouse's support and compassion' were revealed. Conclusion: The present study showed that the husbands of women undergoing breast cancer treatment played a dual role in marital relationships. It seems that using couple-based approaches, such as mental and sexual health counseling, should be considered by healthcare providers. [ABSTRACT FROM AUTHOR]

Background Rates of congenital syphilis (CS) in the United States have risen sharply in recent years. There has been sparse research centering the voices and experiences of birthing parents who have delivered infants with CS and prenatal providers in Chicago or the surrounding Midwestern United States to date. Additionally, there has been little research on the role of extrinsic factors, such as stigma and attitudes surrounding CS in an individual's community, in their entry into and retention in the CS prevention cascade. Methods Semistructured interviews seeking to gather perspectives and factors related to the rise of CS were conducted with birthing parents who delivered infants with CS at a major academic medical institution (AMI) and the prenatal providers who served them. This was supplemented by retrospective data of birthing parent outcomes. Results Barriers elicited during the interviews included insufficient penicillin uptake, limited transportation, poor communication between providers and patients, gaps in patient understanding or knowledge around CS contraction and treatment, missed appointments, appointment burden for patients, life stressors of patients, housing instability, childcare difficulties, and stigma related to the CS diagnosis. The quantitative data revealed differing proportions of CS outcomes and care between those with care within the AMI, those with care outside the AMI, and those who had no prenatal care. Conclusions This study found numerous perspectives and factors that may explain the rise of CS along various stages of the syphilis care continuum through in-depth interviews of prenatal providers and birthing parents. [ABSTRACT FROM AUTHOR]

Background/Objectives: Physiotherapists face significant challenges in managing chronic pain; a complex condition best addressed through a biopsychosocial (BPS) approach. Although substantial evidence exists globally, research specific to Spain remains limited. This study explores the experiences and challenges Spanish physiotherapists encounter in integrating BPS elements across public and private healthcare settings. Methods: Semi-structured interviews with 12 experienced physiotherapists were conducted, using a qualitative approach with purposive sampling and reflexive thematic analysis. The analysis, grounded in a constructivist/interpretivist framework, allowed themes to emerge naturally from the data, supported by relevant quotes. Results: Three primary themes were identified: (1) challenges in implementing the BPS approach, including patient resistance and limited training; (2) facilitators for adopting the BPS model, such as multidisciplinary support and positive patient outcomes; and (3) emotional and psychological aspects of the physiotherapists. The findings highlight the complexities of chronic pain management in physiotherapy, emphasizing the need for enhanced psychological training, integrated multidisciplinary care, early diagnosis, and effective family involvement. These insights are critical for improving both patient care and physiotherapist well-being. Conclusions: This study provides valuable guidance for future strategies, focusing on educational enhancements, multidisciplinary collaboration, healthcare policy reform, and emotional support for physiotherapists within the Spanish healthcare context. [ABSTRACT FROM AUTHOR]

Introduction: Electronic cigarettes, or e‐cigarettes, are rapidly gaining popularity throughout the globe as safer alternatives to traditional cigarette smoking. There are significant public health concerns due to the uncertainty of long‐term health consequences. This study aims to examine the experiences, attitudes and social dynamics of e‐cigarette users to provide guidance for public health policies and interventions. Methods: In this qualitative descriptive study, semi‐structured interviews were conducted. Fifteen e‐cigarette users were recruited using a snowball sampling strategy, where initial participants referred other suitable users. All participants had at least 6 months of regular e‐cigarette use. Data were collected through face‐to‐face interviews with open‐ended questions. The interviews were transcribed verbatim and reviewed by the researchers. This review identified four main themes and eight sub‐themes. Results: The four main themes identified as a result of the analysis are as follows: (1) initiation and usage experiences; (2) perceptions of health effects; (3) social and environmental factors and (4) addiction and future plans. Participants primarily began using e‐cigarettes out of curiosity, due to the appealing fragrance and the belief that they were less harmful than traditional cigarettes. Usage patterns varied among participants, with some reporting minimal cravings in the early morning hours. Opinions on the long‐term health effects of e‐cigarettes were diverse, with many participants acknowledging uncertainty. Peers and family members perceived e‐cigarettes as more socially acceptable than traditional smoking, resulting in fewer negative reactions. Finally, participants' levels of addiction and intentions to quit varied, with some expressing a desire to reduce or cease usage due to health concerns. Conclusion: The findings of this study indicate that the adoption of e‐cigarettes is influenced by a confluence of factors, including curiosity, the perception of reduced damage in comparison to conventional cigarettes and social acceptance. Notwithstanding these claimed advantages, users have a diverse array of beliefs and understandings concerning the enduring health consequences of e‐cigarettes. The presence of varying levels of addiction and the corresponding aspirations to cease the behaviour highlight the necessity for focused public health interventions. Patient or Public Contribution: E‐cigarette users were actively involved in this study, providing essential insights and feedback throughout. Their first‐hand experiences shaped the interview guide and contributed to the identification of key themes. Participants also reviewed and confirmed the accuracy of the interview transcripts, ensuring the reliability of the data. [ABSTRACT FROM AUTHOR]

Background and Objective: Mental health treatment for psychosexual problems is effective, but treatment rates are low. Metaverse‐based therapy offers one solution to increase overall treatment rates. Understanding attitudes towards this novel approach could lead to wider adoption of metaverse‐based therapy, resulting in higher treatment rates for psychosexual problems. Methods: Twenty‐one participants across three focus groups of different ages shared their perceptions and attitudes about metaverse‐based therapy broadly and for treating sexual disorders. A content analysis of the transcribed text from the focus groups using qualitative data analysis software was conducted. Results: Participants identified several perceived benefits of metaverse‐based intervention, including avoiding the perceived embarrassment of going to a clinic and accessing patients (a) with diverse physical or mental functionality, (b) living in remote areas and/or (c) balancing different family/work obligations or duties. The two main concerns with metaverse‐based therapy were the fear of online therapy being less personal than traditional therapy and the technological fluency needed. Clarifying their acceptance of the therapy, participants reported that they would be more likely to engage in metaverse‐based therapy if they trusted their therapist. Also, although it might be effective for mild and moderate disorders, participants were more reluctant about its use for severe mental illness. Conclusions: Results suggest that attitudes towards metaverse‐based intervention are mainly positive, since it removes some barriers that hinder access to psychological treatment in general and, specifically, for problems of a sexual nature. Patient and Public Contribution: During the design stage, a person with sexual difficulties was consulted to understand the patient's perspective. Members of the public advised the implementation of the focus groups. Three potential service users were involved in the coding of the text during the content analysis. [ABSTRACT FROM AUTHOR]

Objectives: Recently, a set of consensus criteria and near‐consensus criteria for the evaluation of chronic rhinosinusitis (CRS) disease control was identified by an international multidisciplinary panel of key stakeholders. The objective of this study is to evaluate patient perspectives on these disease control criteria. Methods: This is a qualitative phenomenological study using constant comparative methodology. Twenty‐one one‐on‐one interviews, ranging from 6 to 15 min and based on a standardized semi‐structured script, with CRS patients from diverse backgrounds were performed. The authors analyzed transcripts of the interviews to identify recurrent themes in patient responses. Conclusions were drawn based on these themes. Results: All participants agreed with the consensus criteria (overall symptom severity, nasal obstruction severity, patients' self‐assessed CRS control, and need for CRS‐related oral corticosteroids), and most participants agreed with near‐consensus criteria (nasal endoscopy, smell loss and nasal drainage severities, impairment of day‐to‐day activities, and overall quality of life) identified by the international multidisciplinary panel. Some patients disagreed with inclusion of smell loss due to common etiologies—such as post‐viral or iatrogenic causes—that would not necessarily be an indicator of active sinonasal inflammation. One theme that emerged was the need for a facial pain/pressure criterion to be added. Conclusions: CRS patients overwhelmingly affirmed recently described consensus and near‐consensus criteria for CRS disease control with the caveat that a question asking about facial pain/pressure should be included as well. Recently, identified consensus criteria for CRS disease control should be interpreted within the context of patient perspectives. [ABSTRACT FROM AUTHOR]

Backgroud: Cancer‐related cognitive impairment is one of the common complications in children with cancer, but our understanding of their experience with cognitive deficits remains limited. From the perspective of parents, this study aimed to explore the distress and demands faced by children with cancer‐related cognitive impairment, to provide references for developing targeted intervention strategies for cancer children. Methods: We used a purposeful sampling method to conduct semi‐structured interviews with the parents of 18 children with cancer‐related cognitive impairment. The transcripts were analyzed using Colaizzi's method. Results: Three categories and 11 subcategories were obtained from the data analysis, including diverse levels of cognitive impairment in children (speech communication difficulties, impaired executive function, attention deficit, and intellectual disability), persistent negative emotions (anxiety and worry, complaints and resentment, negative avoidance and positive experiences after psychological adjustment), multiple needs (need for disease information, need for professional management, and an urgent need for more external support). Conclusion: Parents of children with cancer‐related cognitive impairment face a significant psychological burden, coupled with confusion and numerous inquiries regarding the symptoms and management of their children's cognitive impairment. It is imperative for medical professionals to strengthen the dissemination of information related to cancer‐associated cognitive impairments, while promptly recognizing and intervening in related symptoms. Rational allocation of resources, establishment of targeted support systems, and enhancement of social acceptance may be the key points that policymakers could consider. These efforts hold immense significance, as they play a pivotal role in elevating cognitive capabilities and enhancing the overall quality of life for children with cancer. [ABSTRACT FROM AUTHOR]

Background: Flash floods can cause significant damage if people perceive them as low risk. Media plays a crucial role in improving risk perception. This study aims to survey the perceptions of residents in Yazd, Iran, about the performance of local TV during the flash flood in 2022. Materials and Methods: This is a qualitative study using a content analysis method that was conducted on 22 residents (14 males and 8 females) who had a history of watching local TV programs during the 2022 flash flood in Yazd City. They were selected by purposive sampling method until data saturation. The data was collected through a semi-structured face-to-face interview using open-ended questions about the news received from local TV regarding the flash flood in the city. Qualitative data analysis was done using Colaizzi's seven-step method. Results: Data analysis led to the emergence of one main concept (information quality), five themes (time of broadcasting news, content of programs, trust in the media, and ability to increase social sensitivity), 12 sub-themes, and 48 codes. Conclusion: The effectiveness of local TV during the flash flood in Yazd is low due to incorrect weather predictions, insufficient risk emphasis, lack of prime-time broadcasts, generic messaging, and absence of news headlines. Addressing these issues can enhance people's perceived sensitivity and response to flood warnings from the local TV. [ABSTRACT FROM AUTHOR]

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Objective Individuals with chronic mental disorders face various challenges, which are not merely confined to the individual but also involve family caregivers and specialists in the field. Psychological and social rehabilitation assists in improving the functioning of individuals with mental disorders and facilitates their return to mainstream life. This study aims to investigate the challenges encountered in the rehabilitation process of these individuals. Materials & Methods This study employed a qualitative directional content analysis method. The sample consisted of 13 individuals with chronic mental illnesses, 3 family members, and 6 specialists with experience in patient care. Following ethical approval and obtaining informed consent, in-depth, unstructured interviews were conducted, aligning with the research objectives. Purposeful sampling and maximum diversity strategies were utilized to select and invite participants subjected to in-depth, semi- structured interviews. Data analysis followed Granheim and Lundman's approach. Results The analysis of the interviews revealed that the essence of this study is "striving to respond to weakened identity." The categories and subcategories extracted in this study include social limitations (social exclusion, societal negligence), instability (turbulent lifestyle, family as an overlooked entity, and economic pressures), therapeutic challenges (treatment inconsistency, therapist-related challenges, the complex nature of the illness, and postdischarge concerns), structural and macro challenges (social media neglect, incomplete perspectives, financial and credibility challenges) and loss of agency and volition (identity weakening, lack of balance between independence and support). Conclusion The rehabilitation of individuals with chronic mental disorders faces various challenges at individual, interpersonal, familial, organizational and structural levels. Strengthening the psychological and social aspects of rehabilitation can provide a better and more sustainable basis for treatment for these patients. Enhancing the roles and interventions of psychological and social rehabilitation teams, coordinating therapeutic interventions, supporting the families of patients, socializing behaviors toward these patients and their families, and paying more attention to the psychological and social rehabilitation of patients can result in better short-term and long-term outcomes for various stakeholders involved in the rehabilitation process. [ABSTRACT FROM AUTHOR]

Continuing professional development (CPD) is an essential tool for healthcare professionals to remain up-to-date with the latest advancements in their field. In Saudi Arabia, pharmacists are officially registered healthcare professionals by the Saudi Commission for Health Specialties (SCFHS). To uphold their licensure, they must complete 40 h of CPD every two years. This qualitative study aimed to explore hospital pharmacists' perceptions, barriers, and challenges of CPD, as well as their recommendations for improving CPD activities. A qualitative descriptive approach with semi-structured face-to-face interviews was employed. Using purposive sampling, 12 hospital pharmacists were interviewed. The recorded data were transcribed and analyzed using thematic analysis. Pharmacists generally showed positive perceptions of CPD, recognizing its importance for their professional development and the provision of high-quality patient care. However, some pharmacists expressed dissatisfaction with the current system. Several barriers to participation such as heavy workloads, lack of time, and limited financial support were highlighted. The primary motivations for engaging in CPD included fulfilling regulatory requirements. Workshops were the most beneficial CPD activities among others. Additionally, importance of more specialized, practice-oriented programs was highlighted. The study provides valuable insights into the needs and challenges faced by hospital pharmacists in Saudi Arabia regarding CPD. The insights gained can inform theory, policy, and practice relating to pharmacists' CPD at both professional and governmental levels. [ABSTRACT FROM AUTHOR]

Introduction: This qualitative study aimed to understand the lived experiences of adolescents with depression seeking help in our healthcare system, with the focus on initial symptoms, experience of care and reflection after recovery. Methods: Semi-structured interviews were conducted with 14 adolescents, aged between 13 and 19 years, who were diagnosed and treated for diagnostic and statistical manual of mental disorders, 5th edition major depressive disorder and clinically judged to have recovered at the time of recruitment. Data were analysed qualitatively using thematic analysis, with a focus on how the adolescents spoke about their experience of depression. Results: The findings suggested that our adolescent participants had initially tried managing depression within their own circle, and that thoughts of suicide and self-harm, as well as anhedonia--avolition symptoms were the most challenging to deal with. Recovered participants were observed to express a high degree of empathy towards others going through depression. Conclusion: This study is the first to have surveyed adolescents in our Asian city-state on multiple aspects of their experience of depression. It allows a wide-ranging description of this condition and has the potential to improve understanding and inform care delivery. [ABSTRACT FROM AUTHOR]