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Purpose: To investigate how people with neuromuscular disease or spinal cord injury experience living with a personal assistance service. Materials and methods: Qualitative study using the Interpretive Description methodology with Aaron Antonovsky's theory of sense of coherence as a theoretical framework. The method was semi-structured individual interviews (n = 3) and focus group interviews (n = 5). In all, 19 adults with neuromuscular disease (n = 13) or spinal cord injury (n = 6) participated. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: Three themes were identified to understand living with personal assistance and how this affected everyday life: 1) Making meaning of a personal assistance service, 2) Managing a personal assistance service, and 3) Living with a personal shadow. Our findings provide an understanding of living with assistance and how it, among other things, is influenced by the legislation and the local authorities' administration of the service. Participants explained this by an experience of a sense of coherence. Conclusion: For people with NMD and SCI, there are complex nuances associated with living with a personal assistance service. The findings illustrate that despite personal challenges of managing assistance services, it can meaningfully contribute to one's life by enhancing one's sense of coherence. IMPLICATIONS FOR REHABILITATION: Policy initiatives are important to help people living with neuromuscular disease (NMD) or spinal cord injury (SCI) access flexible personal assistance services, which can enable them to lead independent lives with enhanced meaningfulness. Professionals of people with NMD and SCI should provide knowledge and counseling on how to manage their personal assistance service, which includes taking into account practical, physical, and psychosocial considerations. To ensure optimizing the design and delivery of personal assistance services for the NMD and SCI populations, it is critical that policymakers are made aware of both the positive and challenging aspects of personal assistance services, and should consider engaging persons with lived experience when developing (or re-evaluating) them. [ABSTRACT FROM AUTHOR]

Background: In Swedish intensive care units, nine percent of patients do not survive despite receiving advanced life-sustaining treatments. As these patients transition to end-of-life care, ethical considerations may become paramount. Aim: To explore the ethical challenges that critical care nurses encounter when caring for patients at the end of life in an intensive care context. Research design: The study used a qualitative approach with an interpretive descriptive design. Research context and participants: Twenty critical care nurses from eight intensive care units in an urban region in Sweden were interviewed, predominately women with a median age of fifty-one years. Ethical considerations: This study was approved by The Swedish Ethics Review Authority. Findings: Critical care nurses described encountering ethical challenges when life-sustaining treatments persisted to patients with minimal survival prospects and when administering pain-relieving medications that could inadvertently hasten patients' deaths. Challenges also arose when patients expressed a desire to withdraw life-sustaining treatments despite the possibility of recovery, or when family members wanted to shield patients from information about a poor prognosis; these wishes occasionally conflicted with healthcare guidelines. The critical care nurses also encountered ethical challenges when caring for potential organ donors, highlighting the balance between organ preservation and maintaining patient dignity. Conclusion: Critical care nurses encountered ethical challenges when caring for patients at the end of life. They described issues ranging from life-sustaining treatments and administration of pain-relief, to patient preferences and organ donation considerations. Addressing these ethical challenges is essential for delivering compassionate person-centered care, and supporting family members during end-of-life care in an intensive care context. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultConclusionInterpretive description is a constructivist, flexible, qualitative research approach used to generate knowledge to inform practice in applied disciplines. Despite potential value for the speech-language pathology profession, there has been limited discussion of interpretive description in our field to date. The purpose of this scoping review was to describe how interpretive description has been used in speech-language pathology research. We asked: a) How and to what extent has interpretive description been used as a methodological framework for primary research in the field of SLP and b) what features of interpretive description are most salient in the speech-language pathology studies that have used interpretive description to date?Arksey and O’Malley’s (2005) methodological framework for scoping reviews was used. In May 2023, we searched five databases for peer-reviewed, primary research publications that reported using ID, were specific to speech-language pathology, and were written in English. Two researchers independently reviewed articles for inclusion. A third researcher provided input when consensus could not be reached.Nineteen articles met criteria. Data were extracted regarding article characteristics including use of theory, types of findings, clinical applicability, and description of disciplinary epistemology.Interpretive description is an emerging methodological framework in speech-language pathology research. Advantages and challenges of interpretive description for speech-language pathology are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background Following an earlier mixed-method survey in which we asked stakeholders to report on their perceptions of the progress made in relation to Canada’s Framework on Palliative Care and Action Plan, the purpose of this study was to conduct an in-depth qualitative exploration of the factors influencing that progress, or lack thereof. Methods This was a qualitative interview study conducted in Canada. Inclusion criteria included experience with palliative care in Canada in a professional or volunteer capacity. Interviews were conducted by telephone using an interview guide that asked specific questions in relation to the Framework on palliative care priorities (e.g., education, caregiver support, and equitable access). Data was analyzed using qualitative descriptive methods. Results Thirty-five diverse stakeholders with extensive experience in palliative care were interviewed. In relation to palliative education, participants indicated that although there were excellent palliative care resources available across the country there was further need for embedding palliative care in undergraduate education and for mentored opportunities to engage in care across diverse contexts. The identification, development, and strategic positioning of champions was an important strategy for improving palliative care knowledge and capacity. The development of standard competencies was viewed as an important step forward; although, there was a need to include more members of the care-team and to create pathways for life-long learning. In relation to support for family caregivers, even as participants cited numerous community-based resources offered by not-for-profit organizations, they described significant barriers including a shortage of in-home support, lack of understanding of what caregivers do, and policy-based contractual and privacy issues. In relation to palliative care access, participants described a nurse-centered, consult-based, multi-site and multi-provider model of care that was facilitated by technology. Barriers to this model were systemic healthcare issues of siloed, fragmented, and for-profit care. Conclusion Participants in this study had clear insights into the factors that would support or impede progress to the development of palliative care in Canada. Some of those factors were achievable within current health and educational systems. Other factors were going to require longer term and more comprehensive solutions.

Purpose: Psychosocial factors are a barrier to recovery for people with musculoskeletal pain and psychosocial screening tools are consistently recommended by best practice guidelines to assist in identification. However, many physiotherapists do not use these tools. Presently, the perspectives on psychosocial screening tools of Australian physiotherapists are unknown. Exploration of these factors may create targets for increased uptake. The purpose of this paper is to qualitatively explore Australian physiotherapists' attitudes, perceptions, and behaviours towards psychosocial screening tools for musculoskeletal pain conditions. Materials and Methods: An Interpretive description qualitative study design was employed. Seventeen Australian physiotherapists were interviewed about their attitudes, perceptions, and behaviours towards psychosocial screening tools. Interviews were transcribed verbatim and analysed according to interpretive description. Results: Analysis highlighted three major themes: (1) understanding the patient through psychosocial screening, (2) confidence and competence with psychosocial factors, and (3) factors outside of my control influence screening. Conclusions: This study presents a deeper understanding of Australian physiotherapists' diverse attitudes and practices regarding psychosocial screening tools. The research highlights not only the variability in perspectives towards the relevance of psychosocial factors in patient assessments, but also the influence of external elements such as patient demographics and clinic culture on the utilization of these screening methods. IMPLICATIONS FOR REHABILITATION: Australian physiotherapists' varying attitudes and limited understanding of the impact of psychosocial factors may hinder the use of recommended psychosocial screening. Concerns about scope of practice, tool appropriateness for different patients, and clinic culture further challenge the integration of psychosocial assessments. The findings from this study indicate the need to provide more education to Australian physiotherapists on the importance and use of psychosocial risk factor screening, as part of clinical care standards and best practice guidelines in the management of patients, with musculoskeletal pain conditions. The findings from this study can support the creation of targeted training/innovations to improve the uptake of screening tools in Australian musculoskeletal clinical practice, to improve the care of patients with musculoskeletal pain conditions. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo investigate challenges with sexuality experienced by people with neuromuscular diseases and their needs for knowledge and guidance on sexual life to target future rehabilitation services.11 semi-structured individual interviews with 10 women and one man with neuromuscular diseases. The methodology was Interpretive Description, using the Crip Theory as the theoretical lens to guide the analysis.The sexual expression of people with neuromuscular diseases was affected by three overall themes. Knowledge and approach in society was characterized by a dichotomous relation of being disabled or nondisabled, causing the nondisabled to consider people with neuromuscular diseases to be asexual even though sexual notions were not affected by the neuromuscular disease. Perceptions and notions represented discovering and unfolding sexuality and how a limited representation of people with disabilities in the public discourse made it difficult to find inspirational role models. Self-confidence and autonomy demonstrated how the personal assistants or partners play significant roles to ensure autonomy of people with neuromuscular diseases.The challenges related to how sexuality of people with neuromuscular diseses was affected by the lack of knowledge and general approach in society which was either silence or misconceived considerations. The healthcare professionals’ reluctance toward addressing sexuality should be considered when planning rehabilitation services.To enhance the knowledge and strengthen rehabilitation counseling on sexuality for people with neuromuscular disease (NMD) it is important to provide:Knowledge from sexual advisors who can contribute with education of healthcare professionals for them to initiate conversations and counseling regarding sexual topics, and to expand the representation of disability in the sexuality debate.Knowledge and counseling, from health professionals on sexuality when living with a NMD that should be provided from an early stage of the disease and for parents of young people with NMD to decrease stigmatization and reduce taboo.Counseling and guidance from sexual advisors on how to practically perform sex with an impaired function and on attention on hiring personal assistants who can be trusted to support during intimate tasks.Professionally structured peer support for young and adult people with NMD to understand their sexual feelings and bodies through role models and shared experiences to enhance the feeling of belonging and normalcy.Information on possible exercises in physiotherapy for hips, legs, jaws which may promote flexibility and mobility.Knowledge from sexual advisors who can contribute with education of healthcare professionals for them to initiate conversations and counseling regarding sexual topics, and to expand the representation of disability in the sexuality debate.Knowledge and counseling, from health professionals on sexuality when living with a NMD that should be provided from an early stage of the disease and for parents of young people with NMD to decrease stigmatization and reduce taboo.Counseling and guidance from sexual advisors on how to practically perform sex with an impaired function and on attention on hiring personal assistants who can be trusted to support during intimate tasks.Professionally structured peer support for young and adult people with NMD to understand their sexual feelings and bodies through role models and shared experiences to enhance the feeling of belonging and normalcy.Information on possible exercises in physiotherapy for hips, legs, jaws which may promote flexibility and mobility. [ABSTRACT FROM AUTHOR]

Purpose: There are several factors that negatively impact the well-being of those working in the screen industry. Consequently, the need to introduce Well-being Coordinators has been identified. This study explored the experiences of participants who undertook a Well-being Coordination course tailored for the screen sector. Additionally, it sought to delve into perspectives regarding well-being within the screen industry. Methods: Semi-structured interviews were conducted. The study was guided by an interpretive descriptive approach. Reflexive thematic analysis was used to analyse data. Findings: Five themes were identified: Opportunities and challenges working in the screen industry, co-existing with harassment, the need for change: importance of wellbeing, becoming a well-being co-ordinator: learning from the course, and the future of the well-being co-ordinator role: opportunities and challenges. The reality that cast and crew co-exist with several forms of harassment within the industry was noted. Despite this, there is hope for the future of the screen sector, particularly the positive impact the role of the Well-being Coordinator could have. Conclusions: The experiences of professionals across the screen industry vary; however, a pervasive culture of bullying and harassment is commonplace. Through the introduction of Well-being Coordinators, there is the potential to enact positive change. [ABSTRACT FROM AUTHOR]

Non-communicable diseases such as chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) represent major challenges for health systems all over the world. In an interview study, we explored patient experiences and perspectives of being diagnosed and living with COPD or T2D in Greenland. Participants (n = 24) were selected by purposeful sampling and recruited by phone. We conducted individual semi-structured interviews at the National Hospital in Nuuk and the four regional hospitals. Interviews were audio-recorded, transcribed verbatim, and analysed using interpretive description. Three themes emerged: shock and shame on receiving the diagnosis, coping with a changed life, and varying needs for care and communication. We found that being diagnosed with COPD or T2D required a rapid change in the participants' everyday lives and lifestyle behaviours. Some self-managed their disease well and were able to transfer their knowledge and integrate it into their daily lives, while others struggled to make lifestyle changes. Additionally, living with COPD or T2D could be related to silence and shame. The findings contribute to a better understanding of living with COPD or T2D in the Arctic region and the development of future, culturally-adapted patient education initiatives. [ABSTRACT FROM AUTHOR]

Many normalized coaching behaviors are often abusive yet are seen by coaches and athletes as instrumental in achievement and competition. The current study was designed to extend past research and theory by subjectively exploring how and why former intercollegiate athletes identified their head coach as emotionally abusive. Twenty former intercollegiate student-athletes (M age = 26.0 years) from nine sports participated in semi-structured interviews ranging from 65 to 189 min (M = 105.8, SD = 58). Interpretive description methodology was used with reflexive thematic analysis to generate a coherent conceptual description of the themes and shared experiences that characterized emotionally abusive coaching. The themes that associated with an athlete labeling a coach as emotionally abusive fall under two aspects of Stirling and Kerr's 2008 definition: non-contact coach behaviors and the resulting harmful outcomes experienced by the athletes. Non-contact behaviors were ones that diminished performance , neglected holistic development , and were inconsistent. The harmful effects were the negative emotional responses and dehumanization experienced by athletes. Finally, participants felt that a coach's desire for power and control over athletes explained the coach's behaviors generally. Based on these results, we put forth the conceptual claim that emotional abuse, and psychological violence more broadly , cannot be defined or identified based solely on the perpetrator's behaviors. The athlete's cognitions, perceptions, emotions, and behaviors are critical in determining whether emotional abuse occurred, and these interpretations are shaped by an athlete's existing relationship with the coach. [ABSTRACT FROM AUTHOR]

Background: Following an earlier mixed-method survey in which we asked stakeholders to report on their perceptions of the progress made in relation to Canada's Framework on Palliative Care and Action Plan, the purpose of this study was to conduct an in-depth qualitative exploration of the factors influencing that progress, or lack thereof. Methods: This was a qualitative interview study conducted in Canada. Inclusion criteria included experience with palliative care in Canada in a professional or volunteer capacity. Interviews were conducted by telephone using an interview guide that asked specific questions in relation to the Framework on palliative care priorities (e.g., education, caregiver support, and equitable access). Data was analyzed using qualitative descriptive methods. Results: Thirty-five diverse stakeholders with extensive experience in palliative care were interviewed. In relation to palliative education, participants indicated that although there were excellent palliative care resources available across the country there was further need for embedding palliative care in undergraduate education and for mentored opportunities to engage in care across diverse contexts. The identification, development, and strategic positioning of champions was an important strategy for improving palliative care knowledge and capacity. The development of standard competencies was viewed as an important step forward; although, there was a need to include more members of the care-team and to create pathways for life-long learning. In relation to support for family caregivers, even as participants cited numerous community-based resources offered by not-for-profit organizations, they described significant barriers including a shortage of in-home support, lack of understanding of what caregivers do, and policy-based contractual and privacy issues. In relation to palliative care access, participants described a nurse-centered, consult-based, multi-site and multi-provider model of care that was facilitated by technology. Barriers to this model were systemic healthcare issues of siloed, fragmented, and for-profit care. Conclusion: Participants in this study had clear insights into the factors that would support or impede progress to the development of palliative care in Canada. Some of those factors were achievable within current health and educational systems. Other factors were going to require longer term and more comprehensive solutions. [ABSTRACT FROM AUTHOR]

Background: The mental health service delivery gap remains high globally. Appropriate telehealth use may increase capacity through flexible remote care provision. Despite the historical lack of telehealth integration into publicly funded mental health services, during COVID‐19 lockdowns, services rapidly switched to telephone and audiovisual care provision. In Aotearoa New Zealand (NZ), this was abandoned when no longer required by COVID‐19 restrictions. This study explores environmental factors associated with telehealth implementation and ongoing use or discontinuation across a multiregional outpatient mental health service. This work contributes to understanding system‐level factors influencing telehealth use and thus informs policy and practice in postpandemic environments. Methods: This mixed methods study applied an interpretive description methodology. Semistructured interviews with 33 mental health clinicians were thematically analysed. Qualitative findings were reframed and evaluated using time series analyses of population‐level quantitative data (prior to and throughout the pandemic). Findings were synthesised with qualitative themes to develop an understanding of environmental factors contributing to telehealth use. Results: Findings highlighted an increase in clients assessed by mental health services and declining clinician numbers, contributing to pressure placed on clinicians. There was a lack of culture supporting telehealth, including limited awareness, leadership, and champions to facilitate implementation. Some teams provided services suited to telehealth; other subspeciality teams had limited applications for telehealth. There was a general lack of policy and guidelines to support telehealth use and limited technical support for clinicians unfamiliar with audiovisual software. Conclusion: Disorganised telehealth adoption in the study regions provides insight into wider environmental drivers affecting telehealth uptake. For telehealth to become a workable service delivery mode following COVID‐19, stewardship and culture shifts are required, including policy development, technical support, and resources to support clinical teams. Telehealth may address growing service demand by improving interfaces with primary care and providing timely access to specialist input. [ABSTRACT FROM AUTHOR]

Introduction: Knee OA (KOA) can lead to pain, loss of muscle strength, and changes in gait. Knee stiffness is a classic feature of KOA that can increase the risk of falls but has been understudied. Objective: To evaluate the impact of knee stiffness, the factors influencing the severity of stiffness, and the repercussions on participation for patients with KOA. Methods: This qualitative study used an interpretive description approach. Purposeful sampling was used for patients with KOA over 45 years of age, fluent in English, diagnosed with KOA and reported KOA stiffness within the last 6 months. Participants were recruited through social media and Ontario clinics. Semi‐structured interviews were conducted over the phone or using zoom, recorded, and transcribed verbatim. Open, axial, and selective coding were used to identify clinically relevant themes. Results: Twelve participants (5F, 7M) with a mean age of 60 years were included. The five themes identified include elusive and variable perceptions of joint stiffness, inactivity or too much activity exacerbates stiffness, adapting to the ebb and flow of symptoms, risk experiences and safety fears leads to reduced participation, and KOA stiffness impairs quality of life. Conclusion: This study highlights characteristics of knee stiffness, consequences on participation, and quality of life for people with KOA. Monitoring knee stiffness for KOA is recommended for more appropriate treatment intensity, which could improve adherence to a home programme and potentially reduce the risk of falls. [ABSTRACT FROM AUTHOR]

Rationale: Despite cardiac rehabilitation and medical treatment being integrated parts of the pathway of patients with cardiovascular disease, as well as the well‐establish positive effect, cardiac rehabilitation remains underutilised. In recent years, cardiac rehabilitation has increasingly been moved from the hospitals to the community healthcare services. This transition may be challenging for patients with cardiovascular disease. Aim: To investigate reflections and perspectives of patients opting out of cardiac rehabilitation in community healthcare services to improve participation and adherence to cardiac rehabilitation in the future. Results: A total of eight patients opting out of cardiac rehabilitation participated in individual interviews. Opting out of cardiac rehabilitation is defined as never enroled or did not complete cardiac rehabilitation. The Interpretive Description methodology was used in the analysis where two themes and six subthemes were identified: (1) 'Structural and organisational factors' with three subthemes; Being a patient in the healthcare system, Enroling into CR when it is meaningful, and Getting back to work is vital, and (2) 'Patients' internal factors' with three subthemes; Feeling a desire to regain control, Seeing yourself as recovered, and Being aware of own needs. The analysis indicates that patients' decision to opt out of CR was multidimensional and based on a combination of factors. Conclusion: Ensuring that the healthcare professionals in the community have sufficient information regarding the patient and a clear communication plan between the healthcare professionals and the patient may reduce the transition causing confusion and frustrations for patients. Incorporating a vocational element in CR and ensuring that employers understand the importance of CR may hamper returning to work as a challenge to CR. Ensuring timely CR referral and enrolment and a transition coordinator may reduce the challenge of patients not viewing CR as meaningful. However, further studies are needed to fully understand how CR could become meaningful for patients opting out of CR. [ABSTRACT FROM AUTHOR]

Informal conversations have been used in qualitative research for over 100 years. Whilst originally identified as a minor part of ethnographic study, scholarly literature in the 2020s has aimed to promote a greater use of the informal conversation method in qualitative research. In agreement with Swain and King (2022), informal conversations create a greater ease of communication and often produce more naturalistic data than other forms such as interviews. Using experiences from two qualitative studies at a range of multi-purpose arenas in the UK and Europe and English association football stadia, this article explores the use of informal conversations as a research method at live events. It provides strategies and guidance regarding how to successfully implement this method when collecting data; explains how informal conversations can be recorded effectively; and outlines how beneficial they are in producing valid and authentic data. The article also explores the ethical challenges that are faced when conducting informal conversations in live event spaces in terms of ethics, validity, and reliability. [ABSTRACT FROM AUTHOR]

Young people with impaired functioning and/or disability do not receive as much education or as high an education as fully functioning young people, thus limiting their job opportunities. Therefore, the aim of this study was to investigate perspectives of young people with neuromuscular diseases regarding their choice of educational programs and possibilities to complete program requirements to gain knowledge for use in future counselling and the development of a national questionnaire survey. The design for this study was qualitative using the interpretive description methodology and Anthony Giddens' theory on modernity and self-identity. Data were generated through two focus group interviews with seven people between 18 and 30 years of age. Beginning and completing an education was influenced by the creation of identity: the importance of experiencing demands and expectations, the meaning of social relations when learning, and the consequences of accessibility for educational opportunities. The participants' sense of self-identity was built by testing boundaries and developing images through social relations with peers, parents, and teachers. How they acted and behaved in the social arena of school and education influenced their choices and chances of completing educational programs. [ABSTRACT FROM AUTHOR]

Cervical cancer is one of the leading causes of cancer-related death among African women. Unfortunately, in most sub-Saharan African nations, women are vulnerable if they are unaware that cervical cancer is preventable with frequent screening and early treatment. The aim of this study was to examine Black African immigrant women's perceptions and experiences of cervical screening in British Columbia, Canada. Twenty Black African immigrant women were interviewed using the qualitative research method Interpretive Description. Data collection approaches included indepth interviews and analytic memos. Data were analyzed using a constant comparative technique guided by a socioecologic framework to capture subjective experiences and perceptions. Four key themes were identified, including confusing conceptualizations about cancer and cancer screening, competing priorities, concerns for modesty, and commitment to culture. The study findings point to the need for more active approaches to promoting cervical screening for this population. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusions Impact Reporting Method Patient or Public Contribution To explore frontline decision‐making, adaptation, and learning in ambulance care during the evolving COVID‐19 pandemic.Descriptive and interpretative qualitative study.Twenty‐eight registered nurses from the Swedish ambulance services described 56 critical incidents during the COVID‐19 pandemic through free‐text questionnaires. The material was analysed using the Critical Incident Technique and Interpretive Description through the lens of potential for resilient performance.The findings were synthesized into four themes: ‘Navigating uncharted waters under never‐ending pressure’, ‘Balancing on the brink of an abyss’, ‘Sacrificing the few to save the many’ and ‘Bracing for the next wave’. Frontline decision‐making during a pandemic contribute to ethical dilemmas while necessitating difficult prioritizations to adapt and respond to limited resources. Learning was manifested through effective information sharing and the identification of successful adaptations as compared to maladaptations.During pandemics or under other extreme conditions, decisions must be made promptly, even amidst emerging chaos, potentially necessitating the use of untested methods and ad‐hoc solutions due to initial lack of knowledge and guidelines. Within ambulance care, dynamic leadership becomes imperative, combining autonomous frontline decision‐making with support from management. Strengthening ethical competence and fostering ethical discourse may enhance confidence in decision‐making, particularly under ethically challenging circumstances.Performance under extreme conditions can elevate the risk of suboptimal decision‐making and adverse outcomes, with older adults being especially vulnerable. Thus, requiring targeted decision support and interventions. Enhancing patient safety in ambulance care during such conditions demands active participation and governance from management, along with decision support and guidelines. Vertical communication and collaboration between management and frontline professionals are essential to ensure that critical information, guidelines, and resources are effectively disseminated and implemented. Further research is needed into management and leadership in ambulance care, alongside the ethical challenges in frontline decision‐making under extreme conditions.Findings are reported per consolidated criteria for reporting qualitative research (COREQ).No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Background/Aims: Interpretive description is a qualitative methodology that combines detailed descriptions with thoughtful interpretation. This approach is especially effective for producing practical insights and deepening the understanding of phenomena in clinical or practice-based settings. The aims of this study were to explore how interpretive description could be used to research the experiences and views of women with obstetric fistula. Methods: Interpretive description was used to explore the experiences and views of 15 purposively selected women affected by obstetric fistula. Participants were recruited via the Evangel Vesico Vaginal Fistula Centre of Bingham University Teaching Hospital. Data were collected via in-depth interviews and concurrently analysed thematically. Results: Interpretive description provided women with a unique opportunity to share their experiences of the causes and avoidable risk factors of obstetric fistula. The approach yielded qualitative findings and allowed for the representation of different views, leading to an understanding of how to mitigate obstetric fistula in the community. Conclusions: Interpretive description was used to listen to the voices of women affected by obstetric fistula, learn from their experiences and highlight the interventions that may alter risk factors for the condition in the community. This is the first study to use interpretive description to facilitate under-represented women's contributions to maternity care by listening to their experiences and views. This enabled identification of gaps in maternity care provision, which would be of interest to the community and health service leaders as well as policymakers in sub-Saharan Africa. Implications for practice: Interpretive description allows for deep capture of women's perspectives, allowing implementation of interventions designed to target issues as perceived by those most affected. This also ensures that under-represented groups are included in the research process. [ABSTRACT FROM AUTHOR]

BackgroundThe maternity continuum of care plays a vital role in improving maternal and neonatal outcomes. However, its uptake remains low in Ethiopia, highlighting the need to identify challenges within the primary health care system to inform practice. Hence, this study aimed to explore the challenges of the maternity continuum of care within the primary health care system in northwest Ethiopia.MethodsAn interpretive description approach was employed from March 3, 2022, to November 27, 2022, within the primary health care system in northwest Ethiopia. Maximum variation sampling was utilized, comprising 28 in-depth interviews, three focus group discussions with 29 participants, and four key informant interviews. The reflexive thematic analysis method was applied, and the results were mapped onto the constructs of the socio-ecological model.ResultsThe analysis identified four main themes: low maternity healthcare-seeking behavior (intrapersonal level), lack of peer and family support (interpersonal level), cultural influences on maternity care and low community responsiveness (community level), and inadequate health system readiness and response (health facility/system level). Some of the sub-themes include low health literacy and self-efficacy and misconceptions regarding maternity care at the intrapersonal level; peer and family pressure against seeking maternity care, low autonomy, and intimate partner violence at the interpersonal level; cultural influences on pregnancy disclosure and postnatal care and low social accountability at the community level; and delays in accessing ambulance services, long waiting times for maternity care, shortages of essential healthcare supplies, poor coordination of care, inadequate monitoring and evaluation, disrespectful maternity care, and dissatisfaction among healthcare workers at the health facility/system level.ConclusionIntrapersonal, interpersonal, community, and health facility- and system-level challenges have influenced the maternity continuum of care within the primary health care in northwest Ethiopia. Since these challenges are interdependent, considering a holistic approach within primary health care could lead to an improved maternity continuum of care.

Non-communicable diseases such as chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) represent major challenges for health systems all over the world. In an interview study, we explored patient experiences and perspectives of being diagnosed and living with COPD or T2D in Greenland. Participants (n = 24) were selected by purposeful sampling and recruited by phone. We conducted individual semi-structured interviews at the National Hospital in Nuuk and the four regional hospitals. Interviews were audio-recorded, transcribed verbatim, and analysed using interpretive description. Three themes emerged: shock and shame on receiving the diagnosis, coping with a changed life, and varying needs for care and communication. We found that being diagnosed with COPD or T2D required a rapid change in the participants’ everyday lives and lifestyle behaviours. Some self-managed their disease well and were able to transfer their knowledge and integrate it into their daily lives, while others struggled to make lifestyle changes. Additionally, living with COPD or T2D could be related to silence and shame. The findings contribute to a better understanding of living with COPD or T2D in the Arctic region and the development of future, culturally-adapted patient education initiatives.

This article examines the methodological choices made for a research study into Health Systems Leadership. Reflections on key learnings are provided as a way of offering insight for researchers navigating these decisions for the first time. Embarking on qualitative research to effect change is purposeful but challenging; choosing the most appropriate methodology and methods can often be confounding and stressful for new researchers. This article explores the decision to use Interpretive Descriptive methodology with an Appreciative Inquiry lens and makes visible decision junctures in the development of this research. Literature provides a wealth of expert guidance and excellent insights into research methodology and methods. However, very little expounds on the learnings of those who have gone before and what their insights and learnings may be. Research into allied health clinicians and their journey into health systems leadership roles provides an opportunity to reflect on an applied research journey.

Many normalized coaching behaviors are often abusive yet are seen by coaches and athletes as instrumental in achievement and competition. The current study was designed to extend past research and theory by subjectively exploring how and why former intercollegiate athletes identified their head coach as emotionally abusive. Twenty former intercollegiate student-athletes (Mage = 26.0 years) from nine sports participated in semi-structured interviews ranging from 65 to 189 min (M = 105.8, SD = 58). Interpretive description methodology was used with reflexive thematic analysis to generate a coherent conceptual description of the themes and shared experiences that characterized emotionally abusive coaching. The themes that associated with an athlete labeling a coach as emotionally abusive fall under two aspects of Stirling and Kerr's 2008 definition: non-contact coach behaviors and the resulting harmful outcomes experienced by the athletes. Non-contact behaviors were ones that diminished performance, neglected holistic development, and were inconsistent. The harmful effects were the negative emotional responses and dehumanization experienced by athletes. Finally, participants felt that a coach's desire for power and control over athletes explained the coach's behaviors generally. Based on these results, we put forth the conceptual claim that emotional abuse, and psychological violence more broadly, cannot be defined or identified based solely on the perpetrator's behaviors. The athlete's cognitions, perceptions, emotions, and behaviors are critical in determining whether emotional abuse occurred, and these interpretations are shaped by an athlete's existing relationship with the coach.

Abstract Background Diabetes distress is commonly seen in adults with pre-existing diabetes and is associated with worsened glycemic management and self-management practices. While a majority of women report increased stress during pregnancy, it is unknown how women with type 1 or type 2 diabetes experience diabetes distress during this unique and transitional time. Purpose This study aimed to understand the experiences and perceptions of diabetes distress in women with pre-existing diabetes during pregnancy. Methods A qualitative study using an interpretive description approach was conducted. In-depth, one to one interviewing was used to capture rich descriptions of the pregnancy experience. Nested, stratified, and theoretical sampling was used to recruit 18 participants with type 1 and type 2 diabetes from the quantitative strand of this mixed methods study. Constant comparative analysis was used to inductively analyze the data and develop themes. Findings Four themes, each with several subthemes, emerged under the main finding of “Diabetes Distress”: 1) Worry for Baby’s Health – “What’s this going to do to the baby?”’ 2) Feeling Overwhelmed with Diabetes Management—“It just seemed unattainable”; 3) Living with Diabetes – “There’s no way out” and 4) Cycle of Diabetes Distress. Conclusions The findings from this study identify the sources and experiences of diabetes distress during pregnancy in women with pre-existing diabetes. Diabetes distress often presents as cyclical and multifaceted during pregnancy, with elements of fear for the unborn baby, difficulties with diabetes management, and having negative lived experiences of diabetes. Further work is needed to develop appropriate screening tools for pregnancy and interventions to mitigate diabetes distress. Diabetes educators are well-positioned provide emotional support and person-centred self-management education to individuals with diabetes.

This study explored severe malaria-related disability in children from the perspectives of their caregivers. The interpretive description qualitative approach was employed. The participants were selected using the purposive sampling technique considering the child's history of severe malaria, age (0–10 years), and location (urban/rural). Data were collected through face-to-face interviews with sixteen caregivers. Reflexive thematic data analysis was utilized. Through prolonged engagement, reflective journaling, an audit trail, and co-authors' review, trustworthiness was enhanced. The study generated five themes from the interviews: mitigators of disability, contributors of disability, impact on body function, impact on activities and participation, and uncertainties about future well-being. The findings revealed previously unstudied social components of disability and environmental factors. Furthermore, the research uncovered health-related quality of life aspects that are out of the scope of the current comprehensive disability framework. The study contributes to a deeper understanding of severe malaria-related disability in children from the biopsychosocial perspective. The findings could help policymakers, researchers, and clinicians who want to design rehabilitation interventions for the affected children or examine the components of disability on a large scale using quantitative methods. Various contextual factors interacted with severe malaria and influenced functioning either as facilitators or barriers, implying disability related to malaria can be prevented or created. The long-term impacts of severe malaria are not limited to functioning and disability but also affect the health-related quality of life of children who survive severe malaria. Rehabilitation professionals should consider applying comprehensive functioning and disability frameworks such as the ICF when designing (or applying) screening tools, planning interventions, and evaluating the outcomes of intervention for children with severe malaria-related disability. Rehabilitation interventions for children with severe malaria-related disability should consider patient– or caregiver–reported outcomes (components of disability). [ABSTRACT FROM AUTHOR]

Introduction: Although current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision‐making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth. Methods: We conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty‐five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi‐structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care. Results: Of 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision‐making (n = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt "backed into a corner" and "forced into homebirth," perceiving a lack of access to safe and respectful care in the hospital system. Conclusion: Some service users believe that home birth is their only option when they cannot access hospital‐based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk. [ABSTRACT FROM AUTHOR]

This article examines the methodological choices made for a research study into Health Systems Leadership. Reflections on key learnings are provided as a way of offering insight for researchers navigating these decisions for the first time. Embarking on qualitative research to effect change is purposeful but challenging; choosing the most appropriate methodology and methods can often be confounding and stressful for new researchers. This article explores the decision to use Interpretive Descriptive methodology with an Appreciative Inquiry lens and makes visible decision junctures in the development of this research. Literature provides a wealth of expert guidance and excellent insights into research methodology and methods. However, very little expounds on the learnings of those who have gone before and what their insights and learnings may be. Research into allied health clinicians and their journey into health systems leadership roles provides an opportunity to reflect on an applied research journey. [ABSTRACT FROM AUTHOR]

Despite growing engagement with researchers' positionalities and applications of reflexivity, considerations for researchers' identities and experiences as parents remain under-developed. In particular, reflections about conducting research in the presence of one's family continue to be a marginal topic in discussions about research methods, ethics and fieldwork. More recently, a small body of literature on the family dimensions of conducting fieldwork has begun to emerge. Most of this existing work relates specifically to the discipline of anthropology, and is often focused specifically on the experiences of mothers and motherhood. Significantly less has been written, however, about the experiences of fathers conducting fieldwork, and related questions about parenting, masculinity and field research. This article intends to counter these tendencies, by reflecting on my experiences of conducting field research in northern Uganda in the company of my wife and my two young children. I reflect on the practical and logistics aspects of this, and specifically on the methodological and ethical components of accompanied fieldwork, and the ways in which my family's presence in the field impacted upon the knowledge production and research process. I specifically argue that conducting accompanied fieldwork carries immediate implications for researcher positionalities and relationalities with interlocutors. I specifically reflect on how my identity as a father shaped how I was perceived by my research participants, and how it enabled me to build new and different relationships with my interlocutors – thereby contributing to debates about positionality and reflexivity. Such transparent reflections, I hope, will be of interest for others embarking on field research within the presence of their families in the future, and seek to contribute towards a process of raising awareness, facilitating exchanges within the academy and increasing institutional support for accompanied fieldwork. [ABSTRACT FROM AUTHOR]

Background: Diabetes distress is commonly seen in adults with pre-existing diabetes and is associated with worsened glycemic management and self-management practices. While a majority of women report increased stress during pregnancy, it is unknown how women with type 1 or type 2 diabetes experience diabetes distress during this unique and transitional time. Purpose: This study aimed to understand the experiences and perceptions of diabetes distress in women with pre-existing diabetes during pregnancy. Methods: A qualitative study using an interpretive description approach was conducted. In-depth, one to one interviewing was used to capture rich descriptions of the pregnancy experience. Nested, stratified, and theoretical sampling was used to recruit 18 participants with type 1 and type 2 diabetes from the quantitative strand of this mixed methods study. Constant comparative analysis was used to inductively analyze the data and develop themes. Findings: Four themes, each with several subthemes, emerged under the main finding of "Diabetes Distress": 1) Worry for Baby's Health – "What's this going to do to the baby?"' 2) Feeling Overwhelmed with Diabetes Management—"It just seemed unattainable"; 3) Living with Diabetes – "There's no way out" and 4) Cycle of Diabetes Distress. Conclusions: The findings from this study identify the sources and experiences of diabetes distress during pregnancy in women with pre-existing diabetes. Diabetes distress often presents as cyclical and multifaceted during pregnancy, with elements of fear for the unborn baby, difficulties with diabetes management, and having negative lived experiences of diabetes. Further work is needed to develop appropriate screening tools for pregnancy and interventions to mitigate diabetes distress. Diabetes educators are well-positioned provide emotional support and person-centred self-management education to individuals with diabetes. [ABSTRACT FROM AUTHOR]

Abstract Background An integrative cooperation of different healthcare professional is a key component for high quality health services. With an aging population and many with long-term conditions, more health tasks and follow-up care are being transferred to primary care and locally where people live. Interprofessional collaboration among providers of different professional designations will be of increasing importance to optimizing primary care capacity in years to come. There is a call for further exploration of models of interprofessional collaboration that might be applicable in Norwegian primary care. The aim of this study was to explore experiences of interprofessional collaboration between primary care physicians and nurses working in primary care by applying an intervention for people with type 2 diabetes. Specifically, this study was designed to strengthen and gain deeper insight into interprofessional collaboration between primary care physicians and nurses in primary care settings. Methods We applied Interpretive Description as a research strategy. The participants within this study were primary care physicians and nurses from four different primary care practices in the western and eastern parts of Norway. We used semi-structured telephone interviews for collecting the data between January and September 2021. Results The analysis revealed two key features of the primary care physicians and the nurses experience with interprofessional collaboration in primary care practices. The first involved managing the influence of discrepancies in their expectations of IPC and the second involved becoming aware of the competence they developed that allowed for better complementarity consultation. Conclusions This study indicates that interprofessional collaboration in primary care practice requires that primary care physicians and nurses clarify their expectations and, in turn, determine how flexible they can become in changing their usual primary care practices. Moreover, findings reveal that nurses and primary care physicians had discrepancies in expectations of how interprofessional collaboration should be carried out in primary care practice. However, both the nurses and primary care physicians appreciated the blending of complementary competencies and skills that facilitated a more collaborative care practice. They experienced that this interprofessional collaboration represented an essential quality improvement in the primary care services. Trial registration The trial is registered 03/09/2019 in ClinicalTrials.gov (ID: NCT04076384).

Medical Assistance in Dying (MAID) legislation has evolved rapidly in Canada with significant impacts on nursing practice. The purpose of this paper is to describe evolving complexities in legislative context and practice standards that influence the experiences nurse practitioners and registered nurses have with MAID. Qualitative interviews were conducted with 25 registered nurses and 10 nurse practitioners from diverse contexts across Canada. Participants described their practices and considerations when discussing MAID as part of advance care planning; their use of, and challenges with, waivers of consent; their practice considerations in negotiating the complexities of clients for whom death is not reasonably foreseeable; and their moral wrestling with the inclusion of MAID for persons whose sole underlying medical condition is mental illness. Findings illustrate the moral complexities inherent in the evolving legislation and the importance of robust health and social care systems to the legal and ethical implementation of MAID in Canada. [ABSTRACT FROM AUTHOR]

Background: An integrative cooperation of different healthcare professional is a key component for high quality health services. With an aging population and many with long-term conditions, more health tasks and follow-up care are being transferred to primary care and locally where people live. Interprofessional collaboration among providers of different professional designations will be of increasing importance to optimizing primary care capacity in years to come. There is a call for further exploration of models of interprofessional collaboration that might be applicable in Norwegian primary care. The aim of this study was to explore experiences of interprofessional collaboration between primary care physicians and nurses working in primary care by applying an intervention for people with type 2 diabetes. Specifically, this study was designed to strengthen and gain deeper insight into interprofessional collaboration between primary care physicians and nurses in primary care settings. Methods: We applied Interpretive Description as a research strategy. The participants within this study were primary care physicians and nurses from four different primary care practices in the western and eastern parts of Norway. We used semi-structured telephone interviews for collecting the data between January and September 2021. Results: The analysis revealed two key features of the primary care physicians and the nurses experience with interprofessional collaboration in primary care practices. The first involved managing the influence of discrepancies in their expectations of IPC and the second involved becoming aware of the competence they developed that allowed for better complementarity consultation. Conclusions: This study indicates that interprofessional collaboration in primary care practice requires that primary care physicians and nurses clarify their expectations and, in turn, determine how flexible they can become in changing their usual primary care practices. Moreover, findings reveal that nurses and primary care physicians had discrepancies in expectations of how interprofessional collaboration should be carried out in primary care practice. However, both the nurses and primary care physicians appreciated the blending of complementary competencies and skills that facilitated a more collaborative care practice. They experienced that this interprofessional collaboration represented an essential quality improvement in the primary care services. Trial registration: The trial is registered 03/09/2019 in ClinicalTrials.gov (ID: NCT04076384). [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a critical priority in research, policy, academia and advocacy organizations. PPI in dementia research is gaining momentum. However, these efforts are missing in international projects aimed at those living with advanced dementia in long‐term care (LTC) homes. Additional complexities can arise in enacting PPI within the context of integration of a palliative approach to care and experiences around end‐of‐life in (EOL) dementia. The mySupport study involved implementing the Family Carer Decision Support (FCDS) intervention for care partners of those living with advanced dementia in LTC in six countries. Research Design and Objective: An interpretive description study was conducted to explore the perspectives of international researchers from six countries on engaging people with lived experiences of dementia and EOL care in research processes. The findings from this study informed the development of a PPI strategy and a subsequent toolkit for the FCDS intervention. Findings: Thirty‐eight interviews were completed with project researchers: 12 from the United Kingdom, 8 from Canada, 7 from Ireland, 4 each from Italy and The Netherlands and 3 from the Czech Republic. Four broad themes describe international researchers' perspectives on advancing methods of engagement for people with lived experiences of dementia and EOL in international PPI activities: (1) Groundwork to engage in research; (2) planning for research activities is key; (3) focus on meaningful engagement and (4) having foresight for practical issues shaping PPI. Discussion and Implications: International projects that involve PPI can present many sources of challenges. The findings in this study highlight important considerations for foundational work for incorporating PPI in international projects. Learning from world leaders and those with lived experiences in various regions can be insightful and help share tools and resources. Patient or Public Contribution: PPI was envisioned as a critical part of conducting the mySupport study. The findings from this study informed the development of a PPI strategy and an international Strategic Guiding Council that included family carers of those living with advanced dementia in LTC homes in six countries. This manuscript focused on the perspectives of researchers on their engagement with people with lived experiences of dementia and EOL. The perspectives of persons with lived experiences on engaging in the mySupport research study will be reported in a forthcoming manuscript. [ABSTRACT FROM AUTHOR]

This study explored the experience of adolescents with brain injuries and their caregivers who participated in the Program for the Education and Enrichment of Relational Skills (PEERS®) in Australia. Twenty-seven adolescents and 31 caregivers, who completed the PEERS® intervention as part of an RCT, contributed to focus groups following the 14-week program. Semi-structed interviews guided focus groups. An interpretive description methodology was used to understand participants' experiences in the program and suggestions for improvements. Thematic analysis led to the development of five themes. "Challenging families and meeting expectations" explored the challenge and worth of participating. "Learnt new skills" highlighted skills and strategies gained and methods used to achieve these. "Connecting, belonging and understanding that's our normal" represented the value placed on the group experience. "Confidence in knowing and doing" reflected the changes in everyday social experiences and "Where to from here?" provided many suggestions for adaptation to improve practice. After taking part in the PEERS® social skills group intervention, most adolescents with brain injury and their caregivers perceived improvement in their social participation and had suggestions for improving the group experience. Some adolescents didn't enjoy the program. Offering adolescents with brain injury and their caregivers the opportunity to participate in a group social skills intervention is an important part of paediatric rehabilitation. Participants of group social skills interventions are likely to perceive improvements in their everyday social functioning following completion. Considering strategies to enhance engagement in the group is expected to be important for outcomes. Participants of group social skills programs may need additional support and adjustments to balance the demands of the intervention with other everyday family and school tasks and requirements. [ABSTRACT FROM AUTHOR]

Psychiatric genetic counseling (pGC) has been demonstrated to have meaningful positive outcomes for people with psychiatric conditions and their families. However, it is not widely accessed, and clinical genetics services tend to receive few referrals for these indications. Little research has evaluated psychiatrists' perceptions of and experience with interfacing with pGC. Therefore, we invited Ontario‐based psychiatrists to participate in a study in which they first watched a simulated pGC session (representative of typical practice: the patient had depression with no exceptionally dense family history of psychiatric conditions, no genetic testing is provided, and no family‐based risk assessment is performed), then completed zoom‐based qualitative semi‐structured interviews. Interviews were recorded, transcribed verbatim and checked for accuracy. Using interpretive description to analyze interviews with 12 psychiatrists (data collection was stopped at this point, as theoretical sufficiency was achieved), we generated two theoretical models: the first described the decision‐making pathway psychiatrists currently follow when determining whether and how to address genetics with a patient; the second described psychiatrists' ideas for integrating pGC into care models for the future. Our data shed light on how to facilitate the delivery of pGC for people with psychiatric conditions and their families. [ABSTRACT FROM AUTHOR]

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Aim: The study aimed to describe the various ways in which Italian midwives reconcile their profession's philosophical views about labor with the use of epidural analgesia in clinical practice. Design: Interpretive description. Methods: A purposeful sample of 41 midwives and 12 midwifery students participated in the study. Information about their perceptions and experiences of the use of epidural analgesia and how this practice aligns with their professional values were explored through in-depth interviews (n = 10 focus groups; n = 1 one-to-one interview). The constant comparative method was used to analyze the data. Results: With respect to aligning midwifery care with the administration of epidural analgesia, two midwifery positions were identified: the midwife that acted "in harmony" and the "disoriented midwife", defined by three dimensions: 1) the midwife's conception of her professional role; 2) the woman's attitude towards labor and; 3) the midwife's relationship and comfort with other professionals in the labor room. Conclusion: The results of this research highlight how difficult it can be for a midwife to reconcile a specific philosophical view of labor with the use of epidural analgesia. These findings can provide useful insights to help midwives in the challenging task of combining epidural analgesia with their philosophical view of labor to offer a better birth experience to women.

This article explores the use of the phenomenological approach in the learning experiences of homosexual learners in schools. We conducted the research at a time when studies in education rarely use Heidegger's phenomenological approach to explore educational phenomena. The question is: what are the lessons that can be learnt from the use of Heidegger's phenomenological approach in exploring the learning experiences of homosexual learners in rural secondary schools of South Africa? The study used a phenomenological design in a number of selected secondary schools in Mpumalanga Province, South Africa. We generated data through semi-structured interviews and documents. We purposively selected six learners to participate in the study. Data were analysed by using a thematic approach. The approach helped us to reveal that homosexual learners were discriminated against by their teachers and were subjected to isolation from other learners due to religious beliefs, cultural norms, and traditional practices. The article argues that the use of the Heidegger's phenomenological approach is more appropriate in unravelling nuances related to beliefs, cultural practices, and traditions that may hamper effective teaching and learning than the use of other designs such as surveys. The implication of this is that Heidegger's phenomenological approach is helpful in conducting studies on the lived experiences of people who are discriminated in society, focusing on their well-being, support and care for their future. It also has the potential to contribute immensely towards policy formulation related to inclusive teaching and learning using learners' voices based on their lived experiences. [ABSTRACT FROM AUTHOR]

Reflecting on my experiences as an Annishinaabe student researcher within this wisdom-seeking journey highlights the personal and professional impacts of personal engagement in a relational approach when engaging head as well as heart in a learning journey incorporating reflexivity and wholistic traditional Indigenous perspectives in a Two-Eyed Seeing approach. Leading to cocreating culturally connected health awareness film media resources for liver wellness related to hepatitis C. [ABSTRACT FROM AUTHOR]

Purpose: Despite the susceptibility to the experience of mental distress during adolescence, this population often demonstrate poor help-seeking behaviours. Efforts have been made by schools to address adolescents' knowledge around mental health; less focus has been given to addressing their knowledge of mental health services and avenues for help-seeking. This study aimed to explore adolescents' views of mental health services education. Methods: An interpretive descriptive design was adopted. Thirty adolescents from Ireland participated in individual interviews. Data were analysed using content analysis. Two themes were identified: Recognizing Gaps in Knowledge about Mental Health Service Education, and Enhancing Mental Health Service Education for Young People. Participants reported gaps in their knowledge about mental health services and were uncertain how to access help. Current strategies (e.g., print media) were considered tokenistic and ineffective; instead, multimedia (film/TV) approaches were recommended. Results: Two themes were identified: Recognizing Gaps in Knowledge about Mental HealthService Education, and Enhancing Mental Health Service Education for YoungPeople. Participants reported gaps in their knowledge about mental healthservices and were uncertain how to access help. Current strategies (e.g., print media) were considered tokenistic and ineffective; instead, multimedia (film/TV) approaches were recommended. Conclusions: Current mental health education programmes need to expand their focus beyond social/emotional well-being, providing adolescents with the knowledge they need to access appropriate supports. Considering traditional print media was viewed as ineffective, while film/TV had an influence on perceptions of mental health services, a multimedia approach to education may be an effective way of engaging this population. [ABSTRACT FROM AUTHOR]

To investigate experiences and reflections on challenges in everyday life of people living with limb-girdle muscular dystrophy (LGMD) and chronic pain in order to improve rehabilitation services. The design for this study was qualitative using the Interpretive Description methodology and the salutogenic theory of Sense of Coherence as the theoretical framework. Four semi-structured focus group interviews were conducted with 19 adults with LGMD from April to May 2021. The interviews were conducted online due to COVID-19. Living with chronic pain and LGMD affected everyday life in terms of the participants' overall Sense of Coherence. Beneficial or unfavorable coping strategies were identified within four interrelated categorical themes: pain management, normality comprehension, affected emotional sentiment and altered identity. Healthcare professionals should acknowledge possible chronic pain secondary to LGMD. Chronic pain appears to be a prevalent problem in people with LGMD with negative impact on everyday life, yet patients with LGMD did not receive sufficient information and necessary tools from health professionals to cope with chronic pain. Thus, adequate pain management appeared to be a difficult and self-taught process. Educating health professionals on how to support patients with LGMD and chronic pain is needed. Health professionals should acknowledge and address the possibility of chronic pain secondary to limb-girdle muscular dystrophy (LGMD) and educate patients in pain management. Physiotherapy, energy management and engagement in meaningful activities may help patients gain some control of pain and limit the consequences of pain on everyday life. Supporting patients to accept pain and to shift focus towards their current capabilities may potentially improve pain management. Educating health professionals on how to support patients with LGMD and chronic pain is needed. [ABSTRACT FROM AUTHOR]

Proximal humerus fractures are common in older adults and optimizing their outcomes following this injury can be challenging. This study explored recovery from the perspective of individuals who experience proximal humerus fracture. We conducted in-depth semi-structured interviews (n = 14) with participants (aged 45 and over) recruited from a hand clinic in London, Ontario using a purposive sampling technique. The exploratory interviews were audio-recorded, transcribed, and analyzed using interpretive description approach. Four themes emerged from the narratives of individuals: challenges of day-to-day activities, coping as you go, recapturing valued life roles, and support matters. Recovery after PHF seems relative to contexts and manifests within numerous scenarios. Based on individuals' narratives, the context produces a mosaic that contributes to unique recovery perception and experience. Awareness of the context emphasizes the complexity inherent in recovery and may guide healthcare professionals' efforts toward care for their patients. Individuals with proximal humerus fracture experience recovery as a personal and dynamic process occurring in their diverse contexts. Healthcare professionals need to recognize the significant impact of context on individuals' physical, emotional, and social life following proximal humerus fracture (PHF). A multidisciplinary treatment plan might be desirable where people with PHF and health care professionals collaborate as a whole. Building a multidisciplinary health team including healthcare professionals, peer support, and case management may remove some barriers and facilitate the transition to recovery. [ABSTRACT FROM AUTHOR]

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

Background: Successful diabetes management requires collaboration between patients and healthcare professionals and should be aligned with an individual's condition and resources. We developed a flexible, individualised, patient‐reported outcome (PRO)‐based telehealth intervention called "DiabetesFlex Care" in which patients completed an annual self‐reported questionnaire from home, one required face‐to‐face appointment, and two optional outpatient consultations. In this study, we investigated patients' experiences using DiabetesFlex Care. Methods: We conducted a qualitative, interpretive descriptive (ID) study based on semi‐structured interviews with a purposeful sample of 36 patients with type 1 diabetes (T1D) who had used DiabetesFlex Care. Recorded audio data were transcribed and analysed inductively using the constant comparative method. Results: DiabetesFlex Care changed participants' perspectives on living with diabetes. Patients became more involved in their own care and found that DiabetesFlex Care helped to make their conversations with healthcare professionals more relevant. Furthermore, participants appreciated the ability to both choose the format of their appointments (face‐to‐face vs. phone call) and cancel unnecessary appointments. Conclusion: DiabetesFlex Care was a flexible and inclusive health service that enabled patients to take more responsibility for their own diabetes management. The questionnaire‐based approach in DiabetesFlex Care can help healthcare professionals systematically account for patients' perspectives and support user involvement and self‐management. By extension, this approach can also help minimise healthcare‐related disruptions in patients' lives. Further studies are needed to determine whether flexible PRO‐based telehealth is an acceptable solution for all patients. [ABSTRACT FROM AUTHOR]

An obstetric fistula also known as vesico vaginal fistula (VVF), or recto-vaginal fistula (RVF) is an abnormal opening between the urogenital tract and intestinal tract caused by prolonged obstructed labour; when the head of the baby presses on the soft tissues in the pelvis leading to loss of blood flow to the women's bladder, vagina, and rectum. This can cause necrosis of the soft tissues resulting in debilitating fistula formations. This study aimed to uncover North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services. Qualitative, interpretive descriptive methodology underpinned by symbolic interactionism involving face-to-face semi-structured interviews was used to explore North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services. A purposive sample of 15 women who had experienced obstetric fistula at a repair Centre in North-central Nigeria were eligible. Four themes emerged from North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services i) I was left alone in the room ii) Waiting for the one vehicle in the village iii) I never knew about labour until that very day iv) and We kept following the native doctors and sorcerers. The findings from this study highlighted the depth of women's experiences from the devastating complication of childbirth injury in North-central Nigeria. Analysis of insights from women's voices directly affected by obstetric fistula demonstrated that in their views and experiences the themes identified were majorly responsible for their fistula status. Thus women need to raise their collective voices to resist oppressive harmful traditions and demand empowerment opportunities that will improve their social status. Government should improve primary healthcare facilities, train more midwives and subsidise maternal care for antenatal education and birth services spending for childbirth women may result in improved childbirth experiences for women in rural and urban communities. Reproductive women call for increased accessibility to healthcare services and the provision of more midwives to mitigate obstetric fistula in North-central Nigerian communities. [ABSTRACT FROM AUTHOR]

Purpose: To understand adolescents' and their parents' perspectives on 'being active', this study explored the experience of participation in physical activity (PA), the role of long-term participation in PA, and the importance of remaining active for life. Methods: Eight ambulant adolescents with CP (aged 11–16 years, seven male) participated in a high-level mobility programme twice per week for 12 weeks. Guided using interpretive description, adolescents and 12 of their parents were interviewed before, after and nine months following the programme. Thirty-eight interviews were coded, analysed, and interpreted, informed by audit information, reflective journaling, and team discussions. Results: Adolescents and their parents highly value being active now and into adulthood. Sustainable participation in PA requires adolescents and families to navigate complex environments (interpersonal, organisational, community, and policy). Core themes were: 'Just Doing it', 'Getting the Mix Right' (right people, right place, right time), 'Balancing the Continua' and 'Navigating the Systems'. The continua involved balancing intra-personal attributes: 'I will try anything' through to 'I will do it if I want to' and 'It's OK to be different' through to 'It sucks being disabled'. Conclusions: The journey to sustainable participation was complex and dynamic. Experiences of successful journeys are needed to help adolescents with CP "stay on track" to sustainable participation. [ABSTRACT FROM AUTHOR]

Mental health has gained significant recognition and importance as a crucial aspect of overall well-being. An individual's mental health is influenced by the intersection of individual, social, cultural, and systematic sources of stress and resilience. It is important to include subjective conceptualizations of mental health and well-being to develop culturally sensitive approaches to mental health promotion. This qualitative study aimed to understand how urbandwelling women living in Pakistan who are micro-finance loan recipients conceptualize the meaning of mental health. Using interpretive description methodology, data were collected and analyzed through in-depth, semistructured interviews conducted in Urdu with a purposeful sample of 32 women. An inductive approach to content analysis was employed to code and categorize the data. Participants conceptualized mental health as the presence of peace and the absence of tension. Chronic sources of tension included a lack of essential resources, safety, and security in their day-to-day living in Karachi, Pakistan. Implementing policies to address women’s basic needs, including access to education, would be a helpful first step towards mental health promotion for Pakistani women. Integrating concepts that reflect women’s understanding of mental health will also be a useful first step in developing culturally sensitive mental health assessment tools. [ABSTRACT FROM AUTHOR]