scholarly journals Why Women Choose At-Home Abortion via Teleconsultation in France?: A Mixed-Method Study on Drivers of Telemedicine Abortion

2021 ◽  
Author(s):  
Hazal Atay ◽  
Helene Perivier ◽  
Kristina Gemzell-Danielson ◽  
Jean Guilleminot ◽  
Danielle Hassoun ◽  
...  
Keyword(s):  
Mixed Method ◽  
Public Involvement ◽  
Medical Abortion ◽  
Patient And Public Involvement ◽  
Mixed Method Study ◽  
List Type ◽  
Cross Sectional ◽  
Safe Abortion ◽  
Abortion Care ◽  
At Home

AbstractObjectivesIn face of the COVID-19 health emergency, France has allowed medical abortions to be performed by teleconsultation until 9 weeks of gestation. In an attempt to understand the demand and main drivers of telemedicine abortion, we analysed the requests that Women on Web (WoW), an online telemedicine abortion service operating worldwide, received from France throughout 2020.MethodsWe conducted a parallel convergent mixed-method study among 809 consultations received from France at WoW between 1 January and 31 December 2020. We performed a cross-sectional study of data obtained from the WoW consultation survey and a manifest content analysis of anonymised email correspondence of 140 women consulting with WoW helpdesk from France.ResultsWe found that women encounter macro-level, individual-level, and provider-level constraints while trying to access abortion in France. The preferences and needs over secrecy (46.2%), privacy (38.3%), and comfort (34.9%) are among the most frequent reasons for women from France to choose telemedicine abortion through WoW. The COVID-19 pandemic seems to be an important driver for resorting to telemedicine (30.6%). The lockdowns seem to have had an impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.ConclusionsThe demand for at-home medical abortion via teleconsultation increased in France during the lockdowns. However, drivers of telemedicine abortion are multi-dimensional and go beyond the conditions unique to the pandemic. Given the various constraints women continue to encounter in accessing safe abortion, telemedicine can help meet women’s preferences and needs for secrecy, privacy and comfort, while facilitating improved access to and enabling more person-centred abortion care.Tweetable AbstractAt-home abortion via teleconsultation can help meet women’s needs and preferences for privacy, secrecy, and comfort, while facilitating improved access to abortion care in France.Key MessagesThe lockdowns seem to have had an impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.While the COVID-19 pandemic was an important push factor for women to choose telemedicine, the drivers of telemedicine are multidimensional and go beyond conditions unique to the pandemic.Telemedicine can help meet women’s needs and preferences for privacy, secrecy, and comfort, while facilitating access to and enabling more person-centred abortion care in France.Funding InformationThis research was funded by a public grant overseen by the French National Research Agency (ANR) as part of the “Investissements d’Avenir” program LIEPP (ANR-11-LABX-0091, ANR-11-IDEX-0005-02) and the Université de Paris IdEx (ANR-18-IDEX-0001).Patient and public involvement statementThis public policy analysis does not involve patients or the public in the design, or conduct, or reporting, or dissemination plans of this work. However, the service that WoW provides is designed to address the priorities and experiences of people who access the service. Thus, the research questions were informed by the needs of people who rely on WoW to access abortion.Ethics approvalThe study was approved by the Regional Ethics Committee, Karolinska Institutet, Dnr 2009/2072-31/2 and Dnr 2020/05406.

scholarly journals Enablers and Barriers to Online Learning among Medical Students during COVID-19 Pandemic: An Explanatory Mixed-Method Study

2021 ◽  
Vol 13 (11) ◽  
pp. 6086
Author(s):  
Nurhanis Syazni Roslan ◽  
Ahmad Sukari Halim
Keyword(s):  
Online Learning ◽  
Medical Students ◽  
Mixed Method ◽  
Self Regulation ◽  
Development Planning ◽  
Cross Sectional Study ◽  
Mixed Method Study ◽  
Learning Space ◽  
Cross Sectional ◽  
At Home

As the coronavirus disease 2019 (COVID-19) trajectory remains unknown, online learning (OL) has replaced face-to-face teaching strategies in education institutions. Research and training focus on harnessing educators, but less is understood at the students’ ends. This study examines the OL readiness components, self-regulation, enablers, and barriers to OL at home among medical students during the COVID-19 pandemic through an explanatory mixed-method study. We conducted a cross-sectional study with 178 students and an in-depth interview with 10 students from a public medical school in Malaysia. We found that while all students owned at least one learning device, 22.5% of the students did not have a learning space at home. 21.9% students did not have Wi-Fi access, and 11.2% did not receive mobile broadband coverage at home. Despite these barriers, students had a suitable OL self-regulation level. Significantly higher self-regulation was observed among pre-clinical year students, students with higher grades, and students who had designated learning space at home. We found that high-immediacy and low-bandwidth applications such as WhatsApp and Telegram, and YouTube as the most accessible and easiest platforms to navigate in OL. Our qualitative findings yielded a conceptual model of OL enablers at learners, educators, and institution levels. This framework may serve as one of the guides in faculty development planning and policymaking, especially in promoting a more socially inclusive OL.

scholarly journals Arm Based on LEg blood pressures (ABLE-BP): can systolic leg blood pressure measurements predict systolic brachial blood pressure? Protocol for an individual participant data meta-analysis from the INTERPRESS-IPD Collaboration

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e040481
Author(s):  
Sinead T J McDonagh ◽  
James P Sheppard ◽  
Fiona C Warren ◽  
Kate Boddy ◽  
Leon Farmer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Public Involvement ◽  
Meta Analysis ◽  
Patient And Public Involvement ◽  
Prognostic Models ◽  
Individual Participant Data ◽  
Dissemination Strategy ◽  
Cross Sectional ◽  
Individual Participant ◽  
Meta Analyses

IntroductionBlood pressure (BP) is normally measured on the upper arm, and guidelines for the diagnosis and treatment of high BP are based on such measurements. Leg BP measurement can be an alternative when brachial BP measurement is impractical, due to injury or disability. Limited data exist to guide interpretation of leg BP values for hypertension management; study-level systematic review findings suggest that systolic BP (SBP) is 17 mm Hg higher in the leg than the arm. However, uncertainty remains about the applicability of this figure in clinical practice due to substantial heterogeneity.AimsTo examine the relationship between arm and leg SBP, develop and validate a multivariable model predicting arm SBP from leg SBP and investigate the prognostic association between leg SBP and cardiovascular disease and mortality.Methods and analysisIndividual participant data (IPD) meta-analyses using arm and leg SBP measurements for 33 710 individuals from 14 studies within the Inter-arm blood pressure difference IPD (INTERPRESS-IPD) Collaboration. We will explore cross-sectional relationships between arm and leg SBP using hierarchical linear regression with participants nested by study, in multivariable models. Prognostic models will be derived for all-cause and cardiovascular mortality and cardiovascular events.Ethics and disseminationData originate from studies with prior ethical approval and consent, and data sharing agreements are in place—no further approvals are required to undertake the secondary analyses proposed in this protocol. Findings will be published in peer-reviewed journal articles and presented at conferences. A comprehensive dissemination strategy is in place, integrated with patient and public involvement.PROSPERO registration numberCRD42015031227.

An observational study of patient experiences with a direct-to-patient telehealth abortion model in Australia

2021 ◽  
pp. bmjsrh-2021-201259
Author(s):  
Terri-ann Thompson ◽  
Jane W Seymour ◽  
Catriona Melville ◽  
Zara Khan ◽  
Danielle Mazza ◽  
...  
Keyword(s):  
Observational Study ◽  
Access To Care ◽  
Median Time ◽  
Medical Abortion ◽  
Patient Experiences ◽  
Potential Solution ◽  
Abortion Care ◽  
Home Service ◽  
First Contact ◽  
At Home

BackgroundWhile abortion care is widely legal in Australia, access to care is often poor. Many Australians must travel long distances or interstate to access abortion care, while others face stigma when seeking care. Telehealth-at-home medical abortion is a potential solution to these challenges. In this study, we compared the experience of accessing an abortion via telehealth-at-home to accessing care in-clinic.MethodsOver a 20-month period, we surveyed patients who received medical abortion services at Marie Stopes Australia via the telehealth-at-home service or in-clinic. We conducted bivariate analyses to assess differences in reported acceptability and accessibility by delivery model.ResultsIn total, 389 patients were included in the study: 216 who received medical abortion services in-clinic and 173 through the telehealth-at-home service. Telehealth-at-home and in-clinic patients reported similarly high levels of acceptability: satisfaction with the service (82% vs 82%), provider interaction (93% vs 84%), and recommending the service to a friend (73% vs 72%). Only 1% of telehealth-at-home patients reported that they would have preferred to be in the same room as the provider. While median time between discovering the pregnancy to first contact with a clinic was similar between groups, median time from first contact to taking the first abortion medication was 7 days longer for telehealth-at-home patients versus in-clinic patients (14 days (IQR 9–21) vs 7 days (IQR 4–14); p<0.01).ConclusionThe telehealth-at-home medical abortion service has the potential to address some of the challenges with provision of abortion care in Australia.

scholarly journals Advancing clinical leadership to improve the implementation of evidence-based practice in surgery: a longitudinal mixed-method study protocol

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Amy Grove ◽  
Aileen Clarke ◽  
Graeme Currie ◽  
Andy Metcalfe ◽  
Catherine Pope ◽  
...  
Keyword(s):  
Social Network ◽  
Social Network Analysis ◽  
Network Analysis ◽  
Mixed Method ◽  
Qualitative Data ◽  
Mixed Method Study ◽  
Evidence Based ◽  
Theory Approach ◽  
Cross Sectional ◽  
Clinical Leadership

Abstract Background Clinical leadership is fundamental in facilitating service improvements in healthcare. Few studies have attempted to understand or model the different approaches to leadership which are used when promoting the uptake and implementation of evidence-based interventions. This research aims to uncover and explain how distributed clinical leadership can be developed and improved to enhance the use of evidence in practice. In doing so, this study examines implementation leadership in orthopaedic surgery to explain leadership as a collective endeavour which cannot be separated from the organisational context. Methods A mixed-method study consisting of longitudinal and cross-sectional interviews and an embedded social network analysis will be performed in six NHS hospitals. A social network analysis will be undertaken in each hospital to uncover the organisational networks, the focal leadership actors and information flows in each organisation. This will be followed by a series of repeated semi-structured interviews, conducted over 4 years, with orthopaedic surgeons and their professional networks. These longitudinal interviews will be supplemented by cross-sectional interviews with the national established surgical leaders. All qualitative data will be analysed using a constructivist grounded theory approach and integrated with the quantitative data. The participant narratives will enrich the social network to uncover the leadership configurations which exist, and how different configurations of leadership are functioning in practice to influence implementation processes and outcomes. Discussion The study findings will facilitate understanding about how and why different configurations of leadership develop and under what organisational conditions and circumstances they are able to flourish. The study will guide the development of leadership interventions that are grounded in the data and aimed at advancing leadership for service improvement in orthopaedics. The strength of the study lies in the combination of multi-component, multi-site, multi-agent methods to examine leadership processes in surgery. The findings may be limited by the practical challenges of longitudinal qualitative data collection, such as ensuring participant retention, which need to be balanced against the theoretical and empirical insights generated through this comprehensive exploration of leadership across and within a range of healthcare organisations.

Creating public value in the care at home sector: a mixed-method study about expectations of primary stakeholders using a social exchange perspective

2020 ◽  
Vol 34 (7) ◽  
pp. 807-828
Author(s):  
Sascha Kraus-Hoogeveen ◽  
Pascale Peters ◽  
Els Van der Pool ◽  
Beatrice Van der Heijden
Keyword(s):  
Social Exchange ◽  
Value Creation ◽  
Mixed Method ◽  
Empirical Work ◽  
Mixed Method Study ◽  
Care Providers ◽  
Public Value ◽  
Content Type ◽  
Care At Home ◽  
At Home

PurposeThis mixed-method study aims to contribute to the scholarly debate by outlining an individual-level theoretical framework for public value creation and evaluation that builds upon a social exchange perspective. It provides insights into the normative frames of primary stakeholders in the Dutch care at home sector, that is professionals, managers, clients and informal care providers.Design/methodology/approachA mixed-method design comprising a customized survey among 349 stakeholders, preceded by 31 in-depth interviews was used.FindingsThis empirical work shows differences and similarities in the stakeholders' normative frames revealed via three dimensions of expectations regarding the process of care delivery: personal contact, impact of rules and procedures and communication.Social implicationsThese differences in interpretation have implications for the measurement and evaluation of public value creation.Originality/valueBy statistically and methodologically exploring the different expectations' scales that are developed, we intend to work toward a measure for public value creation, which can be used in future empirical work.

scholarly journals Family planning practices of women working in the Cambodian garment industry: a qualitative study

2020 ◽  
Author(s):  
Chisato Masuda ◽  
Elisa Oreglia ◽  
Ly Sokhey ◽  
Megan McLaren ◽  
Caroline Free ◽  
...  
Keyword(s):  
Family Planning ◽  
Side Effects ◽  
Medical Abortion ◽  
Garment Industry ◽  
Safe Abortion ◽  
Modern Contraception ◽  
Abortion Care ◽  
Garment Factories ◽  
Comprehensive Abortion Care ◽  
Post Abortion

Abstract Background: Women working in Cambodian garment factories have unmet needs for family planning (contraception and safe abortion) services, because of their background and living conditions. This study describes their experiences regarding abortion and contraception as part of a larger project to develop an intervention to support comprehensive post-abortion care.Methods: We conducted semi-structured interviews with women seeking abortion services at private health facilities. In addition, we interviewed the private providers of abortion and contraception services surrounding garment factories. Interviews lasted up to 60 minutes and were conducted in Khmer and later translated into English. A thematic analysis was undertaken, with medical abortion experiences coded according to the Cambodia comprehensive abortion care protocol.Results: We interviewed 16 women and 13 providers between August and November 2018. Most women reported being married and had at least one child. Among factory workers the major reported reasons for abortion were birth spacing and financial constraints. Family, friends, or co-workers were the major information resources regarding abortion and contraception, and their positive or negative experiences strongly influenced women’s attitude towards both. Medical abortion pills were not always provided with adequate instructions. Half of the participants had a manual vacuum aspiration procedure performed after medical abortion. While women knew the side effects of medical abortion, many did not know the adverse warning signs and the signs of abortion completion. Only three women started post abortion family planning, as most of the women expressed fear and hesitation due to concerns about side effects of modern contraception. Fear of infertility was particularly reported among young women without children. Conclusion: This research shows that in this setting not all women are receiving comprehensive abortion care and contraceptive counselling. Provision of accurate and adequate information about abortion methods and modern contraception was the dominant shortfall in abortion care. Future work to address this gap could involve the development of appropriate interventions and informative tools for women in the Cambodian garment industry such as through existing client contact-centres or social media, including creation of videos or posts on topics that come from clients questions.

PP22  An exploration of the facilitators and barriers to paramedics’ assessment and treatment of pain in paediatric patients following trauma (EX-PAT)

2020 ◽  
Vol 37 (10) ◽  
pp. e10.3-e11
Author(s):  
Barry Handyside ◽  
Helen Pocock ◽  
Charles Deakin
Keyword(s):  
Public Involvement ◽  
Patient And Public Involvement ◽  
Barriers And Facilitators ◽  
Prehospital Emergency Care ◽  
Structured Interviews ◽  
Cross Sectional ◽  
South Central ◽  
Paediatric Patients ◽  
Facilitators And Barriers ◽  
The Uk

BackgroundA cross-sectional service evaluation within South Central Ambulance Service (SCAS) revealed deficiencies in the assessment and management of paediatric patients’ pain resulting from trauma. This suggested a need for further work to identify facilitators and barriers to pain assessment and management amongst this patient group. Studies looking into the barriers and facilitators to paramedics’ assessment and management of paediatrics in pain have been conducted internationally and not solely in traumatic events. These studies are not transferable to the UK setting due to prehospital emergency care differences within these countries.MethodsThis study will utilise qualitative research methods.The study population will be qualified paramedics. In-depth semi structured interviews will be conducted using a guide developed from previous studies and refined at patient and public involvement events. The expected numbers of participants will be 12–15 but will continue to the point of data saturation. Thematic analysis of data will be performed using an open coding technique guided by Braun and Clarke’s six step framework. Once complete member checking will take place with each participant.ResultsIt is anticipated that both positive and negative aspects of paramedics’ role during these incidents will be identified. Previous literature has identified support from colleagues, interaction with parents, and the ability to alleviate pain as facilitators. Barriers have included current educational practices, lack of exposure, guidelines, the prehospital environment, difficulty in assessing young children and difficulty in providing pain relief. It is therefore likely that these themes may emerge but identification of UK-specific barriers and facilitators is anticipated.ConclusionsWith no previous study of this nature conducted before in the UK this could valuably inform the education and teaching provision of ambulance services and universities as well as a platform for policy makers and guideline producers to enhance the tools available to paramedics.

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