scholarly journals A theoretically informed, mixed-methods study of pharmacists’ aspirations and readiness to implement pharmacist prescribing

2021 ◽  
Author(s):  
Derek Stewart ◽  
Abdulrouf Pallivalapila ◽  
Binny Thomas ◽  
Yolande Hanssens ◽  
Wessam El Kassem ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Tertiary Care ◽  
Pharmacy Practice ◽  
Principal Component ◽  
Management Support ◽  
Pharmacist Prescribing ◽  
Facilitators And Barriers ◽  
Physician Resistance ◽  
Inner Setting

AbstractBackground Studies have highlighted advancing clinical pharmacy practice in Qatar. Objective To explore pharmacists’ aspirations and readiness to implement pharmacist prescribing. Setting Hamad Medical Corporation (HMC), the main provider of secondary and tertiary care. Method A sequential explanatory mixed-methods design. Questionnaire items were derived from the Consolidated Framework of Implementation Research (CFIR), in domains of: awareness/support; readiness; implementation; and facilitators and barriers. Following piloting, all pharmacists (n = 554) were invited to participate. Questionnaire data were analysed using descriptive and inferential statistics with principal component analysis of attitudinal items. Focus groups were recorded, transcribed and analysed using the Framework Approach. Main outcome measure Aspirations and readiness to implement pharmacist prescribing. Results The response rate was 62.8% (n = 348), with respondents highly supportive of implementation in Qatar (median 4, scale 0–5, extremely supportive). The majority (64.9%, n = 226) considered themselves ready, particularly those more senior (p < 0.05) and classifying themselves innovative (p < 0.01). Outpatient (72.9%, n = 221 agreeing) and inpatient (71.1%, n = 218 agreeing) HMC settings were those perceived as being most ready. PCA identified 2 components, with ‘personal attributes’ being more positive than ‘prescribing support’. Facilitators were access to records, organizational/management support and the practice environment, with physician resistance and scope of practice as barriers. Focus groups provided explanation, with themes in CFIR domains of innovation characteristics, characteristics of individuals and the inner setting. Conclusion HMC pharmacists largely aspire, and consider themselves ready, to be prescribers with inpatient and outpatient settings most ready. CFIR domains and constructs identified as facilitators and barriers should be focus for implementation.

scholarly journals A theoretically informed, mixed-methods study of pharmacists’ aspirations and readiness to implement pharmacist prescribing

2021 ◽  
Author(s):  
Derek Stewart ◽  
Abdulrouf Pallivalapila ◽  
Binny Thomas ◽  
Yolande Hanssens ◽  
Wessam El Kassem ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Tertiary Care ◽  
Pharmacy Practice ◽  
Principal Component ◽  
Management Support ◽  
Pharmacist Prescribing ◽  
Facilitators And Barriers ◽  
Physician Resistance ◽  
Inner Setting

Abstract Background Studies have highlighted advancing clinical pharmacy practice in Qatar. Objective To explore pharmacists’ aspirations and readiness to implement pharmacist prescribing. Setting Hamad Medical Corporation (HMC), the main provider of secondary and tertiary care.Method A sequential explanatory mixed-methods design. Questionnaire items were derived from the Consolidated Framework of Implementation Research (CFIR), in domains of: awareness/support; readiness; implementation; and facilitators and barriers. Following piloting, all pharmacists (n=554) were invited to participate. Questionnaire data were analysed using descriptive and inferential statistics with principal component analysis (PCA) of attitudinal items. Focus groups were recorded, transcribed and analysed using the Framework Approach. Main outcome measure Aspirations and readiness to implement pharmacist prescribing. Results The response rate was 62.8% (n=348), with respondents highly supportive of implementation in Qatar (median 4, scale 0-5, extremely supportive). The majority (64.9%, n=226) considered themselves ready, particularly those more senior (p<0.05) and classifying themselves innovative (p<0.01). Outpatient (72.9%, n=221 agreeing) and inpatient (71.1%, n=218 agreeing) HMC settings were those perceived as being most ready. PCA identified 2 components, with ‘personal attributes’ being more positive than ‘prescribing support’. Facilitators were access to records, organizational/management support and the practice environment, with physician resistance and scope of practice as barriers. Focus groups provided explanation, with themes in CFIR domains of innovation characteristics, characteristics of individuals and the inner setting. Conclusion HMC pharmacists largely aspire, and consider themselves ready, to be prescribers with inpatient and outpatient settings most ready. CFIR domains and constructs identified as facilitators and barriers should be focus for implementation.

scholarly journals Novel electronic adherence monitoring devices in children with asthma: a mixed-methods study

2020 ◽  
Vol 7 (1) ◽  
pp. e000589
Author(s):  
Sukeshi Makhecha ◽  
Amy Chan ◽  
Christina Pearce ◽  
Angela Jamalzadeh ◽  
Louise Fleming
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Electronic Monitoring ◽  
Inhaled Corticosteroids ◽  
Tertiary Care ◽  
Ease Of Use ◽  
Advantages And Disadvantages ◽  
Children With Asthma ◽  
Adherence Monitoring ◽  
Monitoring Devices

IntroductionAdherence monitoring to inhaled corticosteroids is an essential component of asthma management. Electronic monitoring devices (EMD) provide objective data on date, time and number of actuations. However, most give no information on inhalation. Novel EMD (NEMD) platforms have the potential to monitor both activation and inhalation.AimTo assess the feasibility of NEMDs, in terms of usability, acceptability to patients and healthcare professionals and accuracy.MethodsThis was an open-label, prospective, mixed-methods, pragmatic randomised study. Children with asthma attending specialist tertiary care were randomised to one of four NEMD: Remote Directly Observed Therapy (R-DOT), Hailie Smartinhaler, INhaler Compliance Assessment device (INCA) and the Rafi-tone App. Following monitoring, participants were invited to focus groups or one-to-one interviews. Usability and acceptability were evaluated using themes identified from the focus groups and interviews. Adherence accuracy was determined using adherence data from each NEMD.ResultsThirty-five children were recruited; 18 (51%), (11 males, median age 13.5 (7–16) years) completed monitoring, 14 (78%) provided feedback. Participants identified various features such as ease of use and minimal effort as desirable criteria for an NEMD. The Hailie and INCA fulfilled these criteria and were able to record both actuation and inhalation. Negative themes included a ‘Big Brother’ effect and costs.ConclusionThere was no ‘one size fits all’, as participants identified advantages and disadvantages for each NEMD. Devices that can easily calculate adherence to activation and inhalation have the potential to have greatest utility in clinical practice. Each NEMD has different functionality and therefore choice of platform should be determined by the needs of the patient and healthcare professional.

scholarly journals Patient and healthcare professional eHealth literacy and needs for systemic sclerosis support: a mixed methods study

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001783
Author(s):  
Agnes Kocher ◽  
Michael Simon ◽  
Andrew A Dwyer ◽  
Catherine Blatter ◽  
Jasmina Bogdanovic ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Systemic Sclerosis ◽  
Focus Groups ◽  
Information And Communication Technologies ◽  
End Users ◽  
Management Support ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Web Based ◽  
Ehealth Literacy

ObjectivesWe engaged patients with systemic sclerosis (SSc) and healthcare professionals to assess electronic health (eHealth) literacy and needs relating to web-based support using internet-based information and communication technologies (ICT).MethodsWe employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional survey in patients (n=101) and professionals (n=47). Next, we conducted three focus groups with patients, family members and professionals (n=17).ResultsOf patients, 89.1% used ICT at least weekly for private communication. Patients reported relatively high comprehension of eHealth information (x¯ =6.7, 95% CI: 6.2 to 7.3, range 1–10), yet were less confident evaluating information reliability (x¯ =5.8, 95% CI: 5.1 to 6.4) and finding eHealth apps (x¯ =4.8, 95% CI: 4.2 to 5.4). Patients and professionals reported little experience with web-based self-management support. Focus groups revealed ‘considering non-ICT-accessible groups’ and ‘fitting patients’ and professionals’ technology’ as crucial for acceptability. In relation to understanding/appraising eHealth, participants highlighted that general SSc information is not tailored to individual’s disease course. Recommendations included ‘providing timely, understandable and safe information’ and ‘empowering end-users in ICT and health decision-making skills’. Professionals expressed concerns about lacking resources. Patients were concerned about data security and person-centredness. Key eHealth drivers included ‘addressing end-user perceptions’ and ‘putting people at the centre of technology’.ConclusionsPatients and professionals need education/training to support uptake of eHealth resources. Key elements include guiding patients to timely/reliable information and using eHealth to optimise patient–provider communication. Design that is responsive to end-users’ needs and considers individuals with limited eHealth literacy and/or ICT access appears to be critical for acceptability.

The Development of an Online Tobacco Tracker Tool to Crowdsource Campus Environmental Reports for Smoke and Tobacco Free College Policies: A Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Sabrina F. Loureiro ◽  
Kim M. Pulvers ◽  
Melissa M. Gosdin ◽  
Keavagh R. Clift ◽  
Myra J. Rice ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Positive Reinforcement ◽  
The United States ◽  
College Campuses ◽  
Policy Enforcement ◽  
Sequential Mixed Methods ◽  
Effective Policy ◽  
Online Tracking ◽  
One Year

BACKGROUND College campuses in the United States have begun implementing Smoke and Tobacco-Free policies to discourage the use of tobacco. Smoke and Tobacco-Free policies, however, are contingent upon effective policy enforcement. OBJECTIVE To develop an empirically-derived online tracking tool (Tracker) for crowdsourcing campus environmental reports of tobacco use and waste to support smoke and tobacco-free college policies. METHODS An exploratory sequential mixed methods approach was utilized to inform the development and evaluation of the Tracker. In October 2018, three focus groups across two California universities were conducted and themes were analyzed, guiding Tracker development. After one year of implementation, users were asked in April 2020 to complete a survey about their experience. RESULTS In the focus groups, two major themes emerged: barriers and facilitators to tool utilization. Further Tracker development was guided by focus group input to address these barriers (e.g. information, policing, and logistical concerns) and facilitators (e.g. environmental motivators, positive reinforcement). Amongst 1,163 Tracker reports, those who completed the user survey (n=316) reported the top motivations to using the tool were having a cleaner environment (79%) and health concerns (69%). CONCLUSIONS Environmental concerns, a motivator which emerged in focus groups, shaped the Tracker’s development and was cited by the majority of users surveyed as a top motivator for utilization.

scholarly journals An intervention to decrease burnout and increase retention of early career nurses: a mixed methods study of acceptability and feasibility

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Judy Brook ◽  
Leanne M. Aitken ◽  
Julie-Ann MacLaren ◽  
Debra Salmon
Keyword(s):  
Mixed Methods ◽  
Nursing Students ◽  
Focus Groups ◽  
Academic Staff ◽  
Skills Training ◽  
Early Career ◽  
Mixed Methods Study ◽  
Healthcare Organisation ◽  
Structured Interviews ◽  
Over Time

Abstract Aims To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre. Background Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses. Methods This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention. Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoretical Framework of Acceptability. Wilcoxon Signed Ranks test was used to assess change in acceptability over time. Qualitative data from semi-structured interviews, focus groups and field notes were thematically analysed, adhering to COREQ guidelines. Data were collected February to December 2019. Results One hundred and five questionnaires, 12 interviews with students and 2 focus groups engaging 7 academic staff were completed. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Student nurses perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Challenges related to the practice environment and academic assessment pressures. Reported benefits align with known protective factors against burnout and leaving the profession. Conclusion Planning is needed to embed the intervention into curricula and maximise relationships with placement partners. Evaluating acceptability and feasibility offers new knowledge about the value of the intervention for increasing retention and decreasing burnout for early career nurses. Wider implementation is both feasible and recommended by participants.

Refinement and Psychometric Properties of the Self-Efficacy for Sleep Hygiene Inventory

2020 ◽  
pp. 019394592094097
Author(s):  
Christine S. Gipson ◽  
Jenifer M. Chilton ◽  
Eric Stocks
Keyword(s):  
Young Adults ◽  
Focus Groups ◽  
Self Efficacy ◽  
Psychometric Testing ◽  
Principal Component ◽  
Sleep Hygiene ◽  
Total Sample ◽  
The Self ◽  
Reliable Measure ◽  
Electronic Survey

The purpose of this study was to determine key concepts of self-efficacy for sleep hygiene among young adults/college students and sleep experts, and to refine the Self-Efficacy for Sleep Hygiene Inventory. The Self-Efficacy for Sleep Hygiene Inventory was revised using input from young adult focus groups and experts. Information from focus groups informed instrument revision. The revised instrument was distributed using an electronic survey to young adults age 18–26 years for a total sample of 296. A principal component analysis with Varimax Orthogonal Rotation was conducted resulting in a three-factor solution. Cronbach’s alphas were: .85 for Behaviors to Adopt (nine items), .79 for Manage Mindset and Environment (eight items), .70 for Behaviors to Avoid (eight items), and .88 for the inventory (twenty-five items). Initial psychometric testing of the Self-Efficacy for Sleep Hygiene Inventory-Revised indicates that it is a reliable measure of self-efficacy for sleep hygiene in young adults age 18–26 years.

Impact of Engaging Students in Health Survey Data Analysis and as Full Partners in School Change: Results From a Mixed Methods Study

2021 ◽  
pp. 152483992110484
Author(s):  
Helen M. Beattie ◽  
Courtney A. FitzGerald ◽  
Sharon N. Koller ◽  
Karen S. Scott ◽  
Bernice Raveche Garnett ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Focus Groups ◽  
Risk Behavior ◽  
Youth Development ◽  
School Change ◽  
Well Being ◽  
Youth Risk Behavior Survey ◽  
Youth Risk Behavior ◽  
Health And Well Being

Young people demand and deserve participation in shaping the health and well-being of their community. Getting to Y: Youth Bring Meaning to the Youth Risk Behavior Survey (GTY) is a positive youth development initiative, whereby students analyze local youth health data and create change. This article adds definitive evidence to support the theoretical foundations of GTY expounded by Garnett et al. (2019). A mixed methods convergent study design, collecting quantitative data from pre- and postintervention surveys and qualitative data from focus groups, was enacted during the 2018–2019 school year. Survey participants were 256 students attending 20 Vermont middle/high schools. Surveys measured self-efficacy, health literacy, civic engagement, resiliency, and knowledge. Focus groups with 50 students solicited open-ended feedback. Wilcoxon signed-rank tests determined student-level change over time. Focus group transcripts were coded using grounded theory and a priori codes from the survey. Statistically significant improvements were seen in average scores from pre- to postintervention surveys in all five domains and differences in effect by gender. Results from the focus group complement the quantitative findings. Participation in GTY positively affected youth participant’s understanding of their own health and well-being and increased agency to take action on behalf of themselves and their community. As the Youth Risk Behavior Survey is available nationwide, GTY is poised for replication to critically engage youth with relevant data to inform social change.

scholarly journals Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study

2020 ◽  
Vol 8 (15) ◽  
pp. 1-256
Author(s):  
Alicia O’Cathain ◽  
Emma Knowles ◽  
Jaqui Long ◽  
Janice Connell ◽  
Lindsey Bishop-Edwards ◽  
...  
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
General Practitioner ◽  
Health Service ◽  
Health Services ◽  
Focus Groups ◽  
Emergency Departments ◽  
Help Seeking ◽  
Mixed Methods Study ◽  
Coping Capacity

Background There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use. Objectives To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives. Design This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking. Results From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice. Limitations Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service. Conclusions Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered. Future work There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions. Study registration This study is registered as PROSPERO CRD42017056273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

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