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BACKGROUND: A longer duration of untreated psychosis (DUP) is associated with poorer treatment outcomes. Screening for psychosis spectrum disorders in the primary care setting could help support the earlier detection and treatment of individuals in need. However, the acceptability of screening for psychosis in this setting as part of routine care is currently unknown. METHODS: We conducted a qualitative interview study with providers and service users who participated in an early psychosis screening program conducted in an integrated behavioral health primary care (IBH-PC) setting. Interviews were recruited from one of eight WellSpace Federally Qualified Health Center IBH-PC clinics in the Sacramento, CA area. Transcripts of the recorded interviews were analyzed using thematic analysis. RESULTS: In total, 12 providers and eight service users participated in the interviews. Most service user and provider participants were supportive of psychosis screening in an IBH-PC setting, but not as part of the general practitioner consultation due to the brief, non-behavioral health nature of many of the appointments, and the expected low prevalence of psychosis in this population. The support of leadership, adequate training and support, staff turnover, and organizational changes were all seen to impact the successful implementation of the program. Different barriers and facilitators were considered important at each stage of the process from introducing the screening procedures to service users; to determining when, where, and how to screen; and how to effectively manage the referral and post-referral stages. CONCLUSIONS: Despite the additional challenges of screening in an IBH-PC setting relative to secondary mental health services, the process was considered acceptable and feasible to providers and service users. Services that plan to conduct psychosis screening in their clinics need to consider the challenges and their potential solutions to implementation at each stage of the screening process.

Background: Chronic cough, a cough lasting >8 weeks, includes refractory chronic cough (RCC) and unexplained chronic cough (UCC). Patient-reported outcome (PRO) measures are needed to better understand chronic cough impacts that matter most to patients. The 19-item Leicester Cough Questionnaire (LCQ), an existing PRO measure of chronic cough, assesses impacts of cough across physical, psychological, and social domains. However, the content validity of the LCQ evaluating these concepts in patients with RCC/UCC had not been established. Objectives: To evaluate the content validity of the LCQ in patients with RCC/UCC. Design: A cross-sectional, qualitative interview study. Methods: First, previously completed qualitative interview results in adults with RCC/UCC (N = 30) were evaluated and mapped to LCQ concepts. Next, a clinical cough expert reviewed each LCQ item and assessed the salience of its concepts for patients with RCC/UCC. Finally, semistructured interviews—including both concept elicitation and cognitive debriefing—were conducted in adults with RCC/UCC (N = 20) to elicit a comprehensive set of participant experiences and to assess the appropriateness of using the LCQ in this population. Results: Concepts reported in the past and present qualitative interviews were included across all LCQ items, and most impacts reported to be the "most bothersome" were assessed in the LCQ. In the current study, all participants indicated that reduced cough frequency would be an important treatment target. During cognitive debriefing, each LCQ item was endorsed by ⩾70% of participants. Additionally, participants were generally able to understand, recall, and select a response for each LCQ item. All participants and the clinical expert indicated that the LCQ was appropriate and assessed the impacts most relevant to patients with RCC/UCC. Conclusion: Our findings support the content validity of the LCQ and demonstrate that this measure is fit-for-purpose and includes important cough impacts in adults with RCC/UCC. [ABSTRACT FROM AUTHOR]

Adolescents' supportive relationships with nonparental adults are beneficial when they are close and have trust, but few studies explore how adolescents believe closeness and trust unfold over time. I propose a method for prompting adolescents to retrospectively describe the development of abstract components of such relationships by sharing a study that used interviewee‐created graphing to prompt adolescents to move from concrete parts of the relationship to abstract concepts using a tool adolescents would be familiar with from math classes. Analyses using Venn diagrams and matrices suggested adolescents conceptualized closeness and trust differently, however, this was shaped by whether the adult was a part of their family. Reflections on how the proposed graphing method can effectively be used will be discussed. [ABSTRACT FROM AUTHOR]

The issue of grade inflation has been studied in many countries across the globe, yet it remains under-researched in Pakistan. This study aims to understand grade inflation in Pakistani universities by examining the contributing factors and its consequences. The data for this study was collected through in-depth interviews of 20 professors from four (two public and two private sector) universities in the federal capital of Islamabad, Pakistan. The data reveals that the major cause for grade inflation in the selected universities was the competition between public and private universities to recruit students without giving due consideration to merit. Additionally, the culture of hiring untrained candidates as visiting faculty who aspire to be hired in permanent positions was a key contributing factor that led to grade inflation. Other factors include the limitations of the semester system and individualised directed studies. This study recommends the need to monitor and revisit the examination and grading system in Pakistani universities to enhance imparting quality education and to compete at the international level. [ABSTRACT FROM AUTHOR]

Homonormativity refers to the ratification and endorsement of heteronormative institutions and structures into lesbian, gay, bisexual and transgender (LGBT) lives, culture and discourse. While homonormativity is commonly manifested in (relatively) privileged, White, able‐bodied gay men, this paper focuses on lesbian, bisexual and transgender (LBT) women's experiences in Israeli peripheral and rural spaces. As a concept, homonormativity has the potential of reducing lived experiences into a widely criticized category. Instead, we voice the geographical, temporal and gendered potential of homonormative processes to articulate varied ways for leading a queer life under capitalism. Based on 61 qualitative interviews with LBT women living in the Israeli peripheries, we argue that LBT women employ two major homonormative processes of becoming political subjects to negotiate their sexualities in a space fraught with LGBTphobia. These homonormative processes are comprised of assimilation and contestation, revealing a nuanced mode of political subjectivity, shaped by ongoing experiences of LGBTphobia. [ABSTRACT FROM AUTHOR]

Working at night is associated with adverse cardiometabolic health outcomes. However, there are a lack of nutritional intervention studies conducted amongst night workers, subsequently contributing to a lack of evidence‐based guidelines for night workers. The aim of The Eating on the Night Shift study was to understand how night shift workers view working at night in relation to nutritional health and wellbeing, the barriers and enablers to participate in research and what kind of guidance would be useful to them. Semi‐structured qualitative interviews were conducted with a convenience sample (n = 18) of night workers based in England. The interview covered experiences of working night shifts, perceptions about night work and their health, and perceptions of and likely engagement with nutritional research. Interviews were audio recorded and transcribed verbatim. Transcripts were coded using an inductive thematic analysis approach. Of the final sample 13 were female (72%), 39% worked a rotating shift pattern and 78% had worked night shifts for 1 year or more. Four overarching themes were identified: (1) the consequences of night work on health and wellbeing, (2) eating at night means a less healthy diet, (3) working at night has wider knock‐on effects on aspects of lifestyle and wellbeing and (4) nutritional research is perceived as important, but there are barriers to participation. Night workers are aware that working at night can negatively impact their diet as well as their health. Nutritional researchers need to engage with night workers when considering intervention design and implementation as well as in the development of any resultant evidence‐based guidance to ensure its relevance. [ABSTRACT FROM AUTHOR]

Attention to children's emotional health and wellbeing (EHWB) has increased over the last decade due to a decline in children and young people's mental health. COVID-19 escalated this need globally as children were subjected to immediate and drastic changes to their education and daily lives. This paper reports on a UK qualitative study exploring the perceptions of teachers working in primary schools and the level of support they require for children's EHWB. Semi-structured online interviews were conducted with teachers during COVID-19. The findings highlighted four themes of professional support that were required: 1) funding support 2) support with pedagogical responsibilities, 3) external support and 4) home and parental support. Overall, teachers considered there was a lack of provision for their role, with additional pressures placed on them to support children's EHWB. The paper concludes that more resources are required long term to support teachers in a post-COVID-19 education system. [ABSTRACT FROM AUTHOR]

Introduction: Individuals living with Crohn's disease (CD) experience burdensome symptoms. As such, it is important to measure CD symptom severity in clinical research. The goal of this study was to evaluate the content validity, psychometric performance, and score interpretability of a new patient-reported instrument, the Crohn's Symptom Severity (CSS) questionnaire, among adolescents and adults with moderately to severely active CD. Methods: Cognitive debriefing interviews (N = 30; n = 20 adults, n = 10 adolescents) were conducted to evaluate the content validity of the CSS. Additionally, the CSS scores were evaluated for reliability and validity using data from a phase 3 randomized clinical trial of risankizumab (NCT03105128; N = 850). Meaningful within-patient change (MWPC) thresholds were estimated using anchor-based methods. Results: All interview participants (n = 30/30, 100.00%) reported the CSS was easy to complete and most participants (n = 28/29, 96.55%) reported that the CSS was relevant to their experience of CD. Among the clinical trial subjects (N = 850) the following was found for the CSS: mostly acceptable item–total correlations (0.26–0.79); weak to moderate inter-item correlations (r = 0.07–0.57), good internal consistency (Cronbach's α = 0.76–0.87); intraclass correlation coefficients ranged from 0.48 to 0.70, not consistently exceeding the acceptable range for test–retest reliability (0.70); acceptable convergent validity and known-groups results; and demonstrated sensitivity to change. Analyses supported an MWPC estimate of 6–11 points. Conclusions: This study supports use of the CSS for measuring CD symptoms and sleep impact among adolescents and adults aged 16 and older with moderately to severely active CD in clinical research. Trial Registration: NCT03105128 (registration date 4 April 2017). [ABSTRACT FROM AUTHOR]

Self-leadership has traditionally been positioned as an individual-level phenomenon, putting strong emphasis on individuals' responsibility to influence themselves in order to achieve positive outcomes. However, this perspective may oversee that individuals are embedded in a social system, and that self-leadership may be best achieved as a collective endeavour that involves the individual and their interaction with the social environment. The present research thus aims to understand how individuals and their social environment at work (i.e. managers, co-workers) play together in order to enable self-leadership. The question was addressed using an inductive coding approach to qualitative data that stem from 73 semi-structured interviews with job newcomers from one organization in Germany. The findings showed that newcomers' self-led behaviour could be enabled by two key aspects of their social environment (i.e. individualized support for learning; team members acting as partners), which shaped and were shaped by newcomers' internal process of becoming aware of their task and relations-oriented contributions at work. Overall, our findings point to the role that the social environment plays for self-leadership. We discuss the implications for self-leadership theory. MAD statement Self-leadership is of increasing importance in today's complex and rapidly changing work environment. As individuals do not operate in a social vacuum, but are constantly impacted by and are impacting their social environment themselves, it is important to explore how an individual's social environment at work (i.e. their leaders and co-workers) can encourage individual self-leadership. Based on qualitative interviews, we describe the interplay between job newcomer's perceptions of leader and co-worker behaviour, their internal awareness processes, and self-led behaviour. Thereby, we provide specific aspects of how leaders and co-workers can encourage individual self-leadership at work. [ABSTRACT FROM AUTHOR]

Purpose: When mobility deficits persist after stroke or spinal cord injury (SCI), outpatient neurorehabilitation services are required. This study aimed to explore the current practice of German outpatient neurorehabilitation services and identify factors associated to this practice. Methods: This was a qualitative observational study in which semi-structured interviews were conducted with professionals from outpatient neurorehabilitation services and mobility-impaired patients. A qualitative content analysis with a data-driven coding process was used. Results: Three general practitioners, five physical, five occupational, and one speech therapist, one neuropsychologist, two outpatient nurses, one rehabilitation technician, one social worker, two patient advocates (long-term survivors, each stroke and SCI), and 20 patients (10 after stroke, 10 after SCI, all first-ever affected since approximately one year) participated. The reported experiences ranged from high satisfaction to perceived deficits in participation-oriented, evidence-based, and coordinated care. Identified associated factors were: (a) availability of specialised therapists and professional education, (b) outpatient service catalogue, (c) cost coverage, (d) setting rehabilitation goals, and (e) physician as care coordinator. Conclusion: Areas of improvement identified focused on: setting rehabilitation goals towards participation, training therapists on evidence-based treatments and shared decision-making, updating the outpatient service catalogue, and implementing coordination actions. Implementation of these recommendations should be evaluated. IMPLICATIONS FOR REHABILITATION: Professionals need to be trained in setting rehabilitation goals and treatments. The continuing education should be based on current evidence and address interprofessionalism. Academization and continuing education in scientific work for therapists should be advanced. Professionals should educate patients about rehabilitation goals and set rehabilitation goals together, both interprofessional coordinated and with the patient (shared decision-making). Activity and participation should be the central aspects. Rehabilitation clinicians should give instructions to therapists on what to do if rehabilitation goals are not worked on. Rehabilitation clinicians should encourage interprofessional collaboration and information exchange where this is not the case. The exchange of information between outpatient professionals should be promoted through appropriate measures, that is, interprofessional meetings could be introduced. The outpatient service catalogue should be revised regarding evidence-based and participation-oriented treatments and enable appropriate cost coverage. [ABSTRACT FROM AUTHOR]

The aim was to explore patients' early experiences of symptoms after hemithyroidectomy and how these symptoms influenced their daily lives. An inductive explorative qualitative research design was performed. Sixteen patients from two hospitals were interviewed between two-three weeks after the surgery. All the patients experienced compression symptoms before the surgery. The study was analyzed with conventional manifest content analysis. The inductive analysis yielded two main categories and one subcategory. The two main categories were: Early postoperative symptoms that caused disadvantage in daily life and Early postoperative symptoms and coping strategies. The subcategory was: Early postoperative experiences of concerns about the future. Key points: 1. Patients experienced early postoperative symptoms that affected their lives in multiple levels, making them develop coping strategies and awaking concerns about remaining symptoms in the future. 2. The effect of hemithyroidectomy influenced patients' daily life in the early postoperative phase considerably. 3. The study shows that tailored preoperative patient information is important. The findings may guide professionals to tailored preoperative information to optimize the care for this patient group. [ABSTRACT FROM AUTHOR]

Background: Hereditary Angioedema (HAE) due to C1-inhibitor deficiency (C1INH) is a rare condition, clinically characterised by recurrent swelling. The unpredictability of attacks affects the patients' quality of life (QoL). HAE patients and their families have vast unmet physical, psychological, and social needs. A human-centred design (HCD) approach to describing the needs of different user types is to utilise personas, a data-driven narrative tool for communicating user archetypes that capture the individuals' attitudes, goals, and behaviours. The aim of this study was to create and analyse personas based on HAE patients' and their caregivers' interviews. Semi-structured interviews were conducted through anthropological conversations with patients, patient-caregivers (double role of patient and caregiver), and non-affected caregivers. Qualitative and quantitative insights from analyses formed the basis to create personas. Results: We enrolled 17 subjects: 15 patients (6 of them were patient-caregivers) and 2 non-affected caregivers. The mean age of participants was 50.3 ± 14.4 years. Eight patients were on treatment with prophylactic therapy. The mean percentage score of Angioedema Quality of Life (AE-QoL) for HAE patients was 19.8 ± 12.0. Six personas were identified describing the participants' personal history, disease management, and needs: four personas referred to patients, one to patient-caregivers, and one non-affected caregiver personas were identified. Across patient personas, the most expressed needs were psychological support and better awareness amongst healthcare professionals. Caregivers, on their side, desired better information about the disease, including the latest therapies, and higher awareness within the community. Conclusion: A Human Centred Innovative Approach Based on Persona extends beyond the physical symptoms to encompass the psychological and social aspects of the individual's well-being also including the family in the evaluation. [ABSTRACT FROM AUTHOR]

Objectives: To explore how to reach immigrant women through community agencies to raise awareness of the role of physical activity (PA) in reducing cancer risk. Study design: Qualitative description. Methods: We conducted semi-structured telephone interviews with immigrant women and community agency managers to discuss the ideal design of an education session on PA and cancer risk, and identified themes using content analysis. Results: Participants included 22 women (6 African or Caribbean Black, 4 Chinese, 3 Filipino, 5 Indian, 4 Pakistani) and 16 agency managers from across Canada. Women were not familiar with Canada's PA guidelines, and few were aware that PA reduces the risk of cancer. All expressed interest in education about PA and cancer. Diverse women and managers expressed similar preferences for education session design including content (e.g. PA amount/type), format (e.g. in person preferred but virtual more practical), personnel (external expert plus agency staff), cultural tailoring (e.g. translated supplemental take home information) and reinforcing (e.g. follow-up with participants) strategies. Women and managers identified few barriers to participating in education sessions, chiefly, that women lacked time due to work and family responsibilities; and noted several enablers of participation (e.g. emphasize social aspect, provide gift cards or recreation centre passes). Conclusions: We generated insight on the ideal characteristics of a community-based education session that could raise awareness among immigrant women of the importance of PA in reducing cancer risk. Further research is needed to assess the feasibility and impact of PA education sessions designed based on these findings. [ABSTRACT FROM AUTHOR]

Background: Disparities in cervical cancer screening rates among marginalized groups is a driver of inequalities in cervical cancer. Self‐sampling for human papillomavirus (HPV) testing is a newly emerging alternative to clinician‐performed testing to screen for cervical cancer, and has high potential to reduce screening barriers in under‐screened and marginalized groups. We study the acceptability in of HPV self‐sampling and informational materials among Black/African American, Hispanic/Spanish speaking, American Indian/Alaska Native and transgender/nonbinary populations. Methods: We conducted qualitative interviews with patients, ages 30–65, who were Black/African American, Hispanic, American Indian, and/or transgender/nonbinary individuals assigned female at birth. Telephone interviews were conducted in English or Spanish. Patients did not complete the test, rather were asked about the attractiveness, comprehensibility, and acceptability of the HPV self‐test, instructions, and messaging. Results: Among 23 completed interviews (5 American Indian/Alaska Native, 7 Hispanic [2 bilingual, 5 Spanish‐speaking], 5 Black/African American, and 6 transgender/nonbinary), patients from all groups thought the test was straightforward and convenient, and they would complete the test at home or in clinic. The transgender/nonbinary patients preferred at‐home testing. American Indian and transgender/nonbinary patients liked that the test might avoid pain, discomfort, and invasiveness. All patients liked the letter and instructions. All groups had specific suggestions for making the materials more culturally acceptable. Conclusions: The HPV self‐test and the instructions and materials for use were acceptable for a diverse group of patients. Tailored outreach and messaging should be considered to reduce screening disparities among groups that have been historically underserved by the medical system. [ABSTRACT FROM AUTHOR]

The study is devoted to investigating the turnover intentions of international academics at Japanese universities. Semi-structured interviews were conducted with 40 full-time international academics in Japan. The interview data were coded and analyzed through an inductive process based on a four-stage procedure. The study suggests that although many international academics perceived themselves as tokenized symbols, stimulated by the determinants ranging in the dimensions of ease of movement, internal environmental factors, and external environmental factors, the majority of international academics were more inclined to remain in Japan. The study fills in the research gap regarding international academics' turnover intentions, it also challenges and enriches Matier's (1990) claim, highlighting that only when faculty members perceived ease of mobility and high internal and external environmental benefits, would they terminate their employment. Implications for policymakers, scholars and university administrators are offered for future studies and institutional practices. [ABSTRACT FROM AUTHOR]

Cognitive behaviour therapy for psychosis (CBTp) should be offered to patients receiving psychiatric inpatient care, yet very little is known about patients' perspectives on this. The aim of this study was to examine patients' experiences of a CBTp‐informed intervention delivered in inpatient settings. We recruited 10 participants from the intervention arm of a randomised controlled trial examining the feasibility and acceptability of a CBTp‐informed intervention for psychiatric inpatient settings. We undertook semistructured interviews examining their experiences of the intervention and analysed them using thematic analysis. The study was conducted in partnership with a coproduction group of key stakeholders (people with lived experience, family and carers, and clinicians). The intervention was found helpful by almost all participants, and all participants would recommend it to others in similar situations to themselves. The results demonstrated that participants valued the therapist's professionalism and emphasised the importance of the therapeutic relationship. Participants highlighted the importance of the therapy focusing on navigating admission and developing skills to manage the crisis experience so they could return to their normal lives. Participants described challenges to having psychological therapy in the acute crisis context including therapy interruptions and ongoing distressing experiences of psychosis. The study demonstrated the importance of prioritising the therapeutic relationship, that therapy was a valued process to navigate admission and discharge, but that some environmental and patient‐level challenges were present. Further research is needed to explore inpatients' experiences of psychological interventions in this setting. Trial Registration: ISRCTN trial registry: ISRCTN59055607 [ABSTRACT FROM AUTHOR]

Over the past decade, there has been a strong focus on studying individuals' responses to stigmatisation, discrimination and racism, while the question of how individuals recognise and make sense of an exclusionary event, has been largely side-lined. To fill in this gap, this study leverages an affect-theoretically informed reformulation of Essed's (1991, Understanding Everyday Racism: An Interdisciplinary Theory. London: Sage) classic concept of 'comprehension of racism' to investigate how individuals understand and make sense of experiences of ethnoracial exclusion. Empirically, the article analyses 419 experiences/incidents of ethnoracial exclusion reported in 66 semi-structured interviews with highly educated, second and 1.75 generation immigrants representing three 'groups' of Germans who (may) experience exclusion due to their migrant background: Germans of Polish migrant background, Black Germans and Germans of Turkish migrant background. The study identifies three modes by which interviewees talked about exclusionary experiences/incidents: (1) by normalisation (interpreting an experience/incident as 'normal'), (2) by categorisation (identifying an experience/incident as, e.g. 'racist', 'discriminatory', or 'disadvantaging') or (3) by indicating feelings of unease. For each of the three modes, the article outlines the role of affects and emotions in interviewees' narratives, provides insight into the types of experiences/incidents for which the modes were used and highlights differences between the three groups of respondents. [ABSTRACT FROM AUTHOR]

This qualitative study consisted of in-depth, retrospective interviews with participants over the age of 18 who experienced child sexual abuse. Through narrative analysis, study findings shed light on three overall findings: the perception of memories, the perception of grooming, and the perception of the lived lives of child sexual abuse survivors. Findings suggest that the narratives elicited from the participants included current views but also past experiences and anticipation about the future, including individual and societal levels of meaning. These narratives are furthermore entangled and inexorably linked – temporally, culturally, generationally, materially, and emotionally – and the results are thus presented from a holistic perspective. Study findings help explain the complex dimensions concerning the lived experiences of child sexual abuse. As such, this research speaks to the field of social and health care practitioners working with children and families facing the complex phenomenon of child sexual abuse. [ABSTRACT FROM AUTHOR]

Introduction/Aims: To better understand the disease burden faced by individuals with Duchenne muscular dystrophy (DMD) of all ages and elucidate potential targets for therapeutics, this study determined the prevalence and relative importance of symptoms experienced by individuals with DMD and identified factors associated with a higher disease burden. Methods: We conducted qualitative interviews with individuals with DMD and caregivers of individuals with DMD to identify potential symptoms of importance to those living with DMD. We subsequently performed a cross‐sectional study to assess which symptoms have the highest prevalence and importance in DMD and to determine which factors are associated with a higher disease burden. Results: Thirty‐nine individuals, aged 11 years and above, provided 3262 quotes regarding the symptomatic burden of DMD. Two hundred participants (87 individuals with DMD and 113 caregivers) participated in a subsequent cross‐sectional study. Individuals with DMD identified limitations with mobility or walking (100%), inability to do activities (98.9%), trouble getting around (97.6%), and leg weakness (97.6%) as the most prevalent and life altering symptomatic themes in DMD. The symptomatic themes with the highest prevalence, as reported by caregivers on behalf of those with DMD for whom they care, were limitations with mobility or walking (90.3%), leg weakness (89.2%), and emotional issues (79.6%). Steroid/glucocorticoid use (e.g., prednisone or deflazacort) was associated with a lower level of disease burden in DMD. Discussion: There are many symptomatic themes that contribute to disease burden in individuals with DMD. These symptoms are identified by both individuals with DMD and their caregivers and have a variable level of importance and prevalence in the DMD population. [ABSTRACT FROM AUTHOR]

Introduction: Strong patient interest in the use of medicinal cannabis to treat various clinical indications has sparked global legislative changes. Practitioners are vital in implementing regulatory changes and facilitating patient access to medicinal cannabis, however, little is currently known about the factors influencing practitioners' uptake. Recent rapid increases in practitioner applications to prescribe medicinal cannabis in Australia provides a unique backdrop to examine the current factors influencing prescribing behaviours. This qualitative study examined Australian practitioners' perspectives on prescribing medicinal cannabis to provide a comprehensive exploration of the potential factors influencing uptake in clinical practice. Methods: Seventeen semi‐structured interviews were conducted with Australian health‐care practitioners. Transcripts were analysed using the Framework approach to thematic analysis and cross‐mapped to appropriate domains of the Theoretical Domains Framework. Results: We identified four themes related to the barriers and facilitators to prescribing medicinal cannabis: (i) clinical capabilities needed to prescribe; (ii) prescribing an unapproved therapeutic good; (iii) negative attitudes towards prescribers in the medical community; and (iv) divergent beliefs about clinical utility. Discussion and Conclusions: Practitioners face multiple pervasive barriers to prescribing medicinal cannabis. Beliefs about clinical utility appear to be highly influential in shaping prescribing behaviours. Moreover, our findings suggest that a medicinal cannabis 'specialisation' has emerged within the Australian medical community. Findings demonstrate that a range of complex and multifaceted factors influence practitioners' medicinal cannabis prescribing behaviours. We highlight several considerations for policy and practice to support safe and appropriate patient access to medicinal cannabis in this emerging area of clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Limitations in physical functioning are common in patients with late-stage chronic kidney disease (CKD) and can greatly affect their lives. Using patient interviews, this study reports experiences associated with physical functioning limitations for patients with late-stage CKD. Methods: A preliminary conceptual model on concepts relevant to physical functioning limitations in patients with CKD was developed using data from a targeted literature review (patients with CKD stages IV–V) and previous interviews (patients with CKD stages IIIa–IIIb). The preliminary conceptual model informed a semi-structured interview guide designed to capture experiences of physical functioning limitations in patients with CKD. Patients with CKD stages IV–V who were not receiving dialysis were interviewed; their responses were used to develop a comprehensive conceptual model summarizing their experiences associated with physical functioning limitations. Results: A total of 25 patients with CKD stage IV (n = 19) or V (n = 6) were interviewed. Based on patient responses, the reported concepts were grouped into one of six categories: physical functioning limitations/difficulties, behavioural impacts, activity participation restrictions, symptoms attributed to physical functioning limitations, impacts on sleep and emotional functioning impacts related to physical functioning limitations. Twenty-three patients reported concepts associated with physical functioning limitations, most frequently 'walking up and down stairs' (83%) and 'walking distances' (74%). All 23 patients also reported behavioural impacts, including 'need to rest/subsequent periods of rest' (100%) and 'participation in fewer activities' (91%). As well as summarizing the reported concepts, the comprehensive conceptual model shows how concepts may relate to one another; for example, challenging symptoms or difficulty completing tasks can lead to changes in patient behaviour such as purposely reducing or avoiding activities. Conclusions: This study found that patients with late-stage CKD not receiving dialysis who experience physical functioning limitations report a range of impacts on their daily lives. The comprehensive conceptual model summarizes the concepts reported and the relationships between them, providing a holistic understanding of how patients with late-stage CKD are affected by physical functioning limitations. Infographic available for this article. Infographic: [ABSTRACT FROM AUTHOR]

Este trabajo aborda la incertidumbre, foco central del actual debate epistemológico, en una triple concreción sociológica. En primer lugar, concreción temática: la incertidumbre en el ámbito del cambio climático (CC, en adelante). En segundo lugar, se fija en actores concretos: expertos en ese ámbito. Y tercero: concreta una observación empírica, con entrevistas a expertos españoles en CC. Se asume una perspectiva emic, atenta al habla de los expertos sobre sentido, localización y gestión de la incertidumbre climática. Como recoge la sucesión de los distintos informes del IPCC, la incertidumbre ha sido y es asunto central de reflexión en el estudio del CC. Dado que son los expertos los que la definen, clasifican, miden y comunican al resto de la ciudadanía, su estudio debe pasar necesariamente por la indagación de su peculiar relación con la heterogénea comunidad de los expertos. Tras dar cuenta de la relevancia dada a la incertidumbre en los informes del IPCC, se propone una reconstrucción selectiva del debate sobre la experticia y la incertidumbre, presentando algunos resultados de las indagaciones sobre el tema en España, para centrar después la atención en el análisis de las evidencias aportadas por una investigación cualitativa, concluyendo con los principales resultados alcanzados. Uncertainty is one of the central issues in the current epistemological debate. This paper proposes to approach it within the framework of a triple sociological concretion. First, a thematic concretion: uncertainty in the field of climate change. Second, it focuses on specific actors: experts in the field of climate change. And third, it is based on an empirical sociological observation of qualitative interviews with a significant sample of Spanish climate change experts. Thus, an emic perspective is adopted, paying attention to what the experts say about the meaning, location, and management of uncertainty. Uncertainty has been and continues to be a central topic of reflection in the study of climate change, as shown by the succession of different IPCC reports. Since it is the experts who define, classify, measure, and communicate the uncertainty of climate change to the rest of the citizens, its study must necessarily include the observation of the peculiar relationship with the heterogeneous community of experts. This work aims to make a contribution in this respect. After an account of the importance given to uncertainty in the IPCC reports, it proposes a selective reconstruction of the debate on expertise and uncertainty, presenting some of the results of research on the subject in Spain, to then focus attention on the analysis of the evidence provided by recent qualitative research, and to end with some conclusions that identify the main results obtained.

Over the past decade, the protest against so-called 'gender ideology' in Italian schools has witnessed widespread and pervasive mobilisations. Prompted by the directives of anti-gender organisations, grassroots networks activated at the local level have opposed educational programmes related to gender equality, sexuality and the prevention of discrimination against LGBT+ individuals. Through qualitative interviews with Catholic mothers and teachers who participated in the anti-gender conferences in 2015, we adopted a micro-level perspective to interpret their narratives as strategies aimed at defending their ethical and heteronormative educational competence against emerging norms of sexual democracy. The analysis shows how these women position themselves and construct their opposition to gender ideology as a means of asserting social and cultural legitimacy against the perceived risk of symbolic marginalisation in the field of education.

Abstract Objectives To explore how to reach immigrant women through community agencies to raise awareness of the role of physical activity (PA) in reducing cancer risk. Study design Qualitative description. Methods We conducted semi-structured telephone interviews with immigrant women and community agency managers to discuss the ideal design of an education session on PA and cancer risk, and identified themes using content analysis. Results Participants included 22 women (6 African or Caribbean Black, 4 Chinese, 3 Filipino, 5 Indian, 4 Pakistani) and 16 agency managers from across Canada. Women were not familiar with Canada’s PA guidelines, and few were aware that PA reduces the risk of cancer. All expressed interest in education about PA and cancer. Diverse women and managers expressed similar preferences for education session design including content (e.g. PA amount/type), format (e.g. in person preferred but virtual more practical), personnel (external expert plus agency staff), cultural tailoring (e.g. translated supplemental take home information) and reinforcing (e.g. follow-up with participants) strategies. Women and managers identified few barriers to participating in education sessions, chiefly, that women lacked time due to work and family responsibilities; and noted several enablers of participation (e.g. emphasize social aspect, provide gift cards or recreation centre passes). Conclusions We generated insight on the ideal characteristics of a community-based education session that could raise awareness among immigrant women of the importance of PA in reducing cancer risk. Further research is needed to assess the feasibility and impact of PA education sessions designed based on these findings.

Emergency departments (EDs) are overcrowded and linked to an increased risk of mortality and morbidity. Digitalization in EDs has been shown to increase effectiveness, reduce wait times, and improve performance and patient experience. The purpose of this study was to explore ED nurses’ experiences with digitalization in the ED. Interviews were conducted with eight ED nurses in a Norwegian hospital. Data were analyzed using Braun and Clarke’s six-step thematic analysis. Through analysis, three themes were identified, namely (1) consequences for patient safety, (2) influencing communication in the ED, and (3) impacting acute nursing. ED nurses experienced that the digital tools had increased patient safety through accurate documentation and providing a quick overview of the patient. However, digital tools were also seen as a threat to patient safety due to taking focus away from the patient. Digital tools were experienced to have negatively changed the communication both between personnel and between personnel and patients. Also, digital tools impacted the ED nurses’ professional role to a more digitalization-focused approach rather than a patient-oriented approach. These aspects must be included when planning the implementation of new digital tools in EDs in the future.

Abstract Background Personalised Care and Support Planning (PCSP) replaces conventional annual reviews for people with long-term conditions. It is designed to help healthcare professionals (HCPs) and patients engage in conversations as equals and collaboratively plan actions oriented to each patient’s priorities, alongside biomedical concerns. Little is known about how the shift to remote consulting initiated with COVID-19 restrictions has impacted PCSP. Aim To investigate HCPs’ experiences of conducting PCSP conversations remotely and consider implications for the fulfilment of PCSP ambitions as remote consulting continues beyond COVID-19 restrictions. Methods 19 semi-structured interviews with HCPs in England and Scotland; interpretive analysis. Results HCPs’ accounts made clear that COVID-19 restrictions impacted multiple aspects of PCSP delivery, not just the mode of conversation. Broader disruption to general practice systems for gathering and sharing information ahead of PCSP conversations, and moves to ‘wide window’ appointment times, made it harder for patients to be prepared for PCSP conversations. This constrained scope to achieve PCSP ambitions even with the best professional communication skills. Most remote PCSP conversations were conducted by telephone. In the absence of visual communication with patients, it was sometimes harder to achieve the ambitions of PCSP conversations, including to balance patient and professional agendas, fulfil key planning activities, and foster a relational ethos of equal, collaborative partnership. The challenges were particularly severe when working with new patients and people with complex clinical and social problems. Although options for telephone appointments now offer valued flexibility, sustained experience of struggling to achieve PCSP ambitions via remote consulting led some HCPs to lower their standards for judging a “good” PCSP conversation, and to diminished professional satisfaction. Conclusions There are significant challenges to fulfilling the ambitions of PCSP via telephone, especially when preparatory support is limited. This study provides grounds for scepticism about how compatible telephone appointments can be with this person-centred model of working, especially for people who are socially disadvantaged and live with complex health conditions. These threats to the provision of person-centred support for people with long-term conditions warrant careful attention going forward if the PCSP model and its benefits are to be sustained.

Abstract Background Care coordination has been identified as one of five focuses of HealthierSG. Family medicine residents are expected to collaborate with other healthcare professionals for complex patients by the end of residency. However, many residents felt that it was challenging to coordinate care effectively among healthcare stakeholders. However, to date, no qualitative studies have explored these challenges. Therefore, this study aimed to understand the challenges encountered by family medicine residents when coordinating care for complex patients. Methods This was a qualitative descriptive study in which semi structured in-depth interviews were conducted and guided by a topic guide. Total population sampling of 15 third-year family medicine residents in the National Healthcare Group Polyclinics was performed. The interviews were performed over Zoom and were transcribed. Thematic analysis was subsequently performed to analyse the transcripts. Coding was performed iteratively by two independent researchers. Disagreements were adjudicated by a third coder. A coding framework was agreed upon. Potential themes were then independently developed based on the coding framework. Results Six themes emerged from the data, namely, interprofessional communications, accessibility, personal knowledge, time constraints, patient factors and caregiver dissent. Conclusion Challenges faced by family medicine residents are multifaceted. While a few are systemic and pertain to the broader healthcare framework, others, such as issues of unfamiliarity with institutional workflows, community resources, and confidentiality, pertain to the microcosm of residency itself. These are reversible areas for improvement. These challenges can be addressed during planning of residency curricula to better equip family medicine residents with coordinating care for complex patients in the future.

Abstract Background As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation. Methods Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data. Results Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24–96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants’ reported use behavior. Conclusions The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether. Trial registration The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).

Background: In both routine practice contexts and research studies, evidence from standardized self-report symptom measures, administered pre- and posttreatment, is predominantly used to determine whether psychotherapy has been successful. Understanding the nature of unsuccessful psychotherapy requires an ability to evaluate the credibility of outcome data generated by such techniques. An important body of research has identified discrepancies between outcomes assessed through symptom measures and those obtained from other sources. However, not enough is known about the extent to which such paradoxical outcomes exist. Objective: This study analyzes the relationship between outcomes, as assessed by a standardized self-report measure, and as assessed by ratings of young people’s descriptions of change at post-counseling interviews. Methods: Participants were 50 young people (13–16 years old) who had taken part in a trial of up to 10 weeks of school-based humanistic counseling. Our primary standardized measure was the Young Person’s CORE (YP-CORE). To assess young people’s experiences of counseling change, three independent raters scrutinized transcripts of post-counseling interviews, and scored levels of helpfulness on a 1 (Not at all helpful) to 10 (Extremely helpful) scale. Interrater reliabilities were 0.94 (Cronbach’s Alpha) and 0.96 (McDonald’s Omega). Sensitivity analyses were conducted to explore relationships between helpfulness ratings and other outcome measures, i.e., satisfaction with counseling (ESQ) and the Goal-Based-Outcome Tool (GBO), and process measures, i.e., the Working Alliance Inventory (WAI-S) and the Barret Lennard Relationship Inventory (BLRI). Results: Multilevel analysis indicated that helpfulness ratings were not significantly associated with changes in YP-CORE scores. Analyzed categorically, 38% of those showing reliable improvement on the standardized measure were below the median for self-described helpfulness, and 47% of those not showing reliable change were at or above the median for self-described helpfulness. Sensitivity analyses demonstrated closer correlations between helpfulness ratings and other outcome measures (ESQ and GBO), and between helpfulness ratings and process measures (WAI-S and BLRI). Discussion: Our results raise questions about reliance on symptom change outcome measures for defining treatment success and failure, given their disparity with clients’ own descriptions of the helpfulness of therapy. Implications for practice and research are discussed. [ABSTRACT FROM AUTHOR]

Psychotherapy for individuals with psychosis is an effective treatment that promotes recovery in various ways. While there is strong quantitative evidence across modalities, less is known from the patient's perspective. There are many varied forms of psychotherapy, and gaining the patient's perspective can improve understanding of salient elements of psychotherapy and increase engagement, ultimately improving recovery rates. The purpose of this review is to identify and integrate data from published studies of patient perspectives of psychotherapy for psychosis to understand essential elements across approaches, differences between approaches, and how psychotherapy impacts recovery. We aimed to understand further: what are the perceptions about individual psychotherapy from the perspective of individuals with psychosis? The current study was a systematic review using PRISMA guidelines of studies that included qualitative interviews with persons with experiences of psychosis who participated in psychotherapy. All three authors participated in the literature search using Pubmed, APA PsycInfo, and Psychiatry Online. We identified N = 33 studies. Studies included cognitive therapies, acceptance and mindfulness approaches, trauma therapies, metacognitive therapy, and music therapy. All studies reported participants' perceived benefit with the therapeutic relationship as especially salient. Participants described diverse aspects of objective (e.g., symptoms, functioning) and subjective (e.g., self-experience or quality of life) recovery improvements, with perceived mechanisms of change, and with music therapy having some unique benefits. Participants also reported challenges and suggestions for improvement. Study findings highlight the salient aspects of psychotherapy identified by patients that may help therapists to individualize and improve approaches to psychotherapy when working with individuals experiencing psychosis. Overall, findings support the potential for integrative psychotherapy approaches for maximal treatment personalization. [ABSTRACT FROM AUTHOR]

Drawing upon 152 in-depth qualitative interviews with residents in Austria carried out in the first year of the pandemic, this article discusses how people's experiences with COVID-19 policies reflect and reshape state–citizen relations. Coinciding with a significant government crisis, the first year of COVID-19 in Austria saw pandemic measures justified with reference to a biological, often medical understanding of health that framed disease prevention in terms of transmission reduction, often with reference to metrics such as hospitalisation rates, etc. Instead of using this biomedical frame, our interviewees, however, drew attention to biopsychosocial dimensions of the crisis and problematised the entanglements between economy and health. We call this the emergence of a biosocial notion of citizenship that is attentive to psychological, social and economic dimensions of health. Insights into the biosocial nature of pandemic citizenship open a window of opportunity for addressing long-standing social injustices. [ABSTRACT FROM AUTHOR]

In this article, Turkish mothers' perspectives on sibling relationships are described and analyzed on the basis of 15 qualitative interviews. It is surprising that sibling relationships have received little attention in cultural psychological or sociological research for decades, while other social relationships—such as parent–child relationships, (marital) partner relationships, peer relationships, or hierarchical relationships (e.g., superior–subordinate)—were often studied. The two main goals of the present study are first, to examine Turkish mothers' ethnotheories of sibling relationships between their own offspring and second, to analyze these parental ethnotheories through the lenses of the cultural psychological and sociological concepts of collectivism/individualism and interdependent/independent self-concepts. The interview data for this empirical study was derived from a larger project which focuses on parental ethnotheories more broadly. Problem-centered interview method was used. Eleven of the interviews took place via a digital platform due to the COVID-19 pandemic, while four of the interviews were conducted face-to-face just before pandemic's onset. The Turkish mothers interviewed were from Istanbul and Sinop, a small Turkish city on the coast of the Black Sea. The data was interpreted using the documentary method and relational hermeneutical analysis. The article examines and discusses three topics of sibling relationships, namely hierarchical/equal sibling roles based on birth order, solidarity/sharing, and conflict. We show that all of the mothers interviewed place a high value on connectedness between siblings. With regard to the hierarchical or egalitarian distribution of roles, some of the interviewees differ. [ABSTRACT FROM AUTHOR]

This article reports on a pilot study that examined representational and content diversity in Australian media through semi-structured interviews with experts in the field and secondary documentary analysis of available public reports, news articles and websites. Of the eleven axes of diversity explored in the wider project, this article focuses on ability, ethnicity, religion and class, based on the experience and expertise of the interview participants. The analysis revealed four common themes: (1) the media's tendency to narrowly and predictably portray diverse groups; (2) the lack of diversity in newsrooms and management, and its impact on content and representation; (3) commercial imperatives and (4) the value and impact (or not) of policies. While there are some areas of the media that are seen to be doing a better job, the overwhelming consensus among the participants supported community advocacy and academic literature that finds Australian news media can do better when it comes to diversity, equity and inclusion (DEI). [ABSTRACT FROM AUTHOR]

The study grasps the transformation of agency in the context of mundane production and use of mapping apps. It is asked theoretically and empirically, who produces and maintains Google Maps as cartographic infrastructure and how is this kind of agency being reflected and acted upon from a lifeworld perspective. Firstly, findings are compiled from various interdisciplinary studies on digital cartography, platform capitalism and digital infrastructures. Since these studies focus on agency almost exclusively from a structural perspective, a qualitative study is conducted to explore the use of Google Maps in everyday life. 20 interviews with German users show that digitalization and datafication profoundly change the dynamics of how agency is perceived and reflected. It can be understood as a form of extension of agency because it is deeply rooted in the entanglement of Google Maps' infrastructure and city dwellers everyday practices. [ABSTRACT FROM AUTHOR]

Socializing messages shape individuals' perceptions of professionalism and meaningful work. For individuals in the USA, many anticipatory socialization messages consist of normative notions of work; socializing discourses often draw from dominant ideologies. However, not all workers align their understandings and enactments of work with socializing discourses and/or dominant ideologies. This study draws on 14 interviews with adventure workers (AWs) to examine how socializing messages interplay with their conceptualizations of meaningful work and professionalism, as well as take shape in their work–life management. AWs simultaneously resisted and retooled professionalism depending on the value they associated with work, illuminating ways that professionalism can be a resource and constraint in particular contexts. Our findings illustrate how AWs' perceptions of work–life management, notions of meaningfulness, and enactments of professionalism are co-constituted. We situate our findings alongside work–life scholarship and call for future investigations of the interplay between meaningfulness and professionalism in nonnormative work. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore how the dead human body is socially produced through the practices of those involved in teaching anatomy through cadaveric dissection. The perspectives of anatomists learning to teach offer a novel perspective on the existing literature. The study draws on data from interviews with students and teaching staff involved in practical cadaveric dissection during a UK postgraduate anatomy education programme. Interviews addressed participants' experiences, reflections, and emotional responses during practical dissection of donor bodies. Findings address five areas: anticipation and the 'imagined body', ontology and the latent human, detachment, dissociation, and reconciliation, preparation and intentionality, and gratitude and immortalisation. The findings suggest that during the course of practical dissection sessions, anatomists learn to normalise the transgressive activity of human dissection via processes of reconciliation. The transgressive elements are resolved through the agency of the person once living and through a configuration of the anatomist and the donor body in a network of scientific knowledge, pedagogic practice and personal influence. [ABSTRACT FROM AUTHOR]

Family caregivers are vital to enabling people with dementia to live longer in their own homes. For these caregivers, chatting with clinicians—being listened to empathetically and receiving reassurance—can be seen as not incidental but important to supporting them. This paper considers and identifies the significance of this relational work for family carers by re-examining data originally collected to document caregivers' perspectives on quality in crisis response teams. This reveals that chatting, for family caregivers, comprises three related features: (i) that family caregivers by responding to a person's changing and sometimes challenging needs and behaviors inhabit a precarious equilibrium; (ii) that caregivers greatly appreciate 'chatting' with visiting clinicians; and (iii) that while caregivers appreciate these chats, they can be highly critical of the institutionalized character of a crisis response team's involvement with them. [ABSTRACT FROM AUTHOR]

The use of immersive interactive mixed reality (I2MR) technologies has been of interest to educators due to the rapid advancement of technology, lowered cost, and increased engagement of the senses. This is particularly attractive in special needs education (SNE) as it can provide a safe space in which students can learn and practice skills needed in the real world. 86 students with diagnosed cognitive disabilities (aged 7–18) and 10 teachers from three schools in Singapore participated in the study. The I2MR was added to the school curriculum for 4–8 months, depending on the school. The efficacy and practicality of I2MR intervention were assessed with qualitative interviews and quantitative surveys being analysed through statistical modelling. We showed improvement in students' mental well-being, academic and social skills as well as a positive effect on teachers' work satisfaction and sense of teacher efficacy. Based on the teachers' feedback, I2MR was helpful for SNE because of its engaging environment, interactive and playful nature leading to higher involvement, facilitation of social skills, calming and relaxation effect, and "sandbox" mode for skills to be practised in a safe space. The I2MR limitations included overstimulation effects on certain students. Also, some activities can be performed more effectively using other tools. Overall, we present data that shows benefits and highlights the practicality of I2MR in SNE and make the argument for their further usage and development. [ABSTRACT FROM AUTHOR]

Emergency departments (EDs) are overcrowded and linked to an increased risk of mortality and morbidity. Digitalization in EDs has been shown to increase effectiveness, reduce wait times, and improve performance and patient experience. The purpose of this study was to explore ED nurses' experiences with digitalization in the ED. Interviews were conducted with eight ED nurses in a Norwegian hospital. Data were analyzed using Braun and Clarke's six-step thematic analysis. Through analysis, three themes were identified, namely (1) consequences for patient safety, (2) influencing communication in the ED, and (3) impacting acute nursing. ED nurses experienced that the digital tools had increased patient safety through accurate documentation and providing a quick overview of the patient. However, digital tools were also seen as a threat to patient safety due to taking focus away from the patient. Digital tools were experienced to have negatively changed the communication both between personnel and between personnel and patients. Also, digital tools impacted the ED nurses' professional role to a more digitalization-focused approach rather than a patient-oriented approach. These aspects must be included when planning the implementation of new digital tools in EDs in the future. [ABSTRACT FROM AUTHOR]

Background: Personalised Care and Support Planning (PCSP) replaces conventional annual reviews for people with long-term conditions. It is designed to help healthcare professionals (HCPs) and patients engage in conversations as equals and collaboratively plan actions oriented to each patient's priorities, alongside biomedical concerns. Little is known about how the shift to remote consulting initiated with COVID-19 restrictions has impacted PCSP. Aim: To investigate HCPs' experiences of conducting PCSP conversations remotely and consider implications for the fulfilment of PCSP ambitions as remote consulting continues beyond COVID-19 restrictions. Methods: 19 semi-structured interviews with HCPs in England and Scotland; interpretive analysis. Results: HCPs' accounts made clear that COVID-19 restrictions impacted multiple aspects of PCSP delivery, not just the mode of conversation. Broader disruption to general practice systems for gathering and sharing information ahead of PCSP conversations, and moves to 'wide window' appointment times, made it harder for patients to be prepared for PCSP conversations. This constrained scope to achieve PCSP ambitions even with the best professional communication skills. Most remote PCSP conversations were conducted by telephone. In the absence of visual communication with patients, it was sometimes harder to achieve the ambitions of PCSP conversations, including to balance patient and professional agendas, fulfil key planning activities, and foster a relational ethos of equal, collaborative partnership. The challenges were particularly severe when working with new patients and people with complex clinical and social problems. Although options for telephone appointments now offer valued flexibility, sustained experience of struggling to achieve PCSP ambitions via remote consulting led some HCPs to lower their standards for judging a "good" PCSP conversation, and to diminished professional satisfaction. Conclusions: There are significant challenges to fulfilling the ambitions of PCSP via telephone, especially when preparatory support is limited. This study provides grounds for scepticism about how compatible telephone appointments can be with this person-centred model of working, especially for people who are socially disadvantaged and live with complex health conditions. These threats to the provision of person-centred support for people with long-term conditions warrant careful attention going forward if the PCSP model and its benefits are to be sustained. [ABSTRACT FROM AUTHOR]

Background: Care coordination has been identified as one of five focuses of HealthierSG. Family medicine residents are expected to collaborate with other healthcare professionals for complex patients by the end of residency. However, many residents felt that it was challenging to coordinate care effectively among healthcare stakeholders. However, to date, no qualitative studies have explored these challenges. Therefore, this study aimed to understand the challenges encountered by family medicine residents when coordinating care for complex patients. Methods: This was a qualitative descriptive study in which semi structured in-depth interviews were conducted and guided by a topic guide. Total population sampling of 15 third-year family medicine residents in the National Healthcare Group Polyclinics was performed. The interviews were performed over Zoom and were transcribed. Thematic analysis was subsequently performed to analyse the transcripts. Coding was performed iteratively by two independent researchers. Disagreements were adjudicated by a third coder. A coding framework was agreed upon. Potential themes were then independently developed based on the coding framework. Results: Six themes emerged from the data, namely, interprofessional communications, accessibility, personal knowledge, time constraints, patient factors and caregiver dissent. Conclusion: Challenges faced by family medicine residents are multifaceted. While a few are systemic and pertain to the broader healthcare framework, others, such as issues of unfamiliarity with institutional workflows, community resources, and confidentiality, pertain to the microcosm of residency itself. These are reversible areas for improvement. These challenges can be addressed during planning of residency curricula to better equip family medicine residents with coordinating care for complex patients in the future. [ABSTRACT FROM AUTHOR]

This article explores the challenges and adaptations we undertook to engage people with different communication needs, specifically those living with motor neurone disease (MND), in qualitative research interviews. While interviewing those in advanced stages of illness has raised ethical concerns, participants continue to report value in contributing to research. We reflect on our experiences of conducting qualitative interviews with people living with MND and provide guidance for researchers facing similar challenges. MND significantly impairs communication abilities, impacting speech, gestures, and facial expressions. Communication aids such as augmented and alternative communication (AAC) devices are often key tools for communication. We draw on two research studies using expanded interview techniques to accommodate these devices and provide space for participants to express their views. Interview methods were modified to cater for participant fatigue, setting and individual communication needs. While acknowledging the limitations, we explore how digital platforms, such as MS Teams and Zoom, enabled online interviews, offering advantages for both participants and researchers. Joint interviews involving participants and family members were found to be crucial, considering the interdependence of experiences in illness. Family members often aided communication and enriched data by providing context. Email interviews were another valuable method, allowing participants time to respond and consider their answers, which was particularly useful for those with limited speech. By incorporating a variety of qualitative methods and adapting approaches, we aimed to create inclusive and meaningful research experiences for individuals with different communication needs, ensuring their voices and experiences were captured effectively. [ABSTRACT FROM AUTHOR]