scholarly journals Codeveloping a multibehavioural mobile phone app to enhance social and emotional well-being and reduce health risks among Aboriginal and Torres Strait Islander women during preconception and pregnancy: a three-phased mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e052545
Author(s):  
Michelle Kennedy ◽  
Ratika Kumar ◽  
Nicole M Ryan ◽  
Jessica Bennett ◽  
Gina La Hera Fuentes ◽  
...  

ObjectiveDescribe the development and pretest of a prototype multibehavioural change app MAMA-EMPOWER.DesignMixed-methods study reporting three phases: (1) contextual enquiry included stakeholder engagement and qualitative interviews with Aboriginal women, (2) value specification included user-workshop with an Aboriginal researcher, community members and experts, (3) codesign with Aboriginal researchers and community members, followed by a pretest of the app with Aboriginal women, and feedback from qualitative interviews and the user-Mobile Application Rating Scale (U-MARS) survey tool.SettingsAboriginal women and communities in urban and regional New South Wales, Australia.ParticipantsPhase 1: interviews, 8 Aboriginal women. Phase 2: workshop, 6 Aboriginal women. Phase 3: app trial, 16 Aboriginal women. U-MARS, 5 Aboriginal women.ResultsPhase 1 interviews revealed three themes: current app use, desired app characteristics and implementation. Phase 2 workshop provided guidance for the user experience. Phase 3 app trial assessed all content areas. The highest ratings were for information (mean score of 3.80 out of 5, SD=0.77) and aesthetics (mean score of 3.87 with SD of 0.74), while functionality, engagement and subjective quality had lower scores. Qualitative interviews revealed the acceptability of the app, however, functionality was problematic.ConclusionsDeveloping a mobile phone app, particularly in an Aboriginal community setting, requires extensive consultation, negotiation and design work. Using a strong theoretical foundation of behavioural change technique’s coupled with the consultative approach has added rigour to this process. Using phone apps to implement behavioural interventions in Aboriginal community settings remains a new area for investigation. In the next iteration of the app, we aim to find better ways to personalise the content to women’s needs, then ensure full functionality before conducting a larger trial. We predict the process of development will be of interest to other health researchers and practitioners.

2020 ◽  
Author(s):  
Michelle Bovill ◽  
Ratika Kumar ◽  
Nicole Ryan ◽  
Jessica Bennett ◽  
Gina La Hera Fuentes ◽  
...  

BACKGROUND Improving the health and wellbeing of Aboriginal women and their babies is a primary focus to address health inequity in Australia. Interventions must be contextualised by the impacts on health that are a direct result of historical oppression, dispossession and ongoing racism since colonisation. Aboriginal women experience compromised social and emotional wellbeing including mental, cultural, spiritual wellbeing. Addressing social and emotional wellbeing coupled with behavioural risk factors would have a high potential to improve the health and wellbeing of mother and child. mHealth has been trialled in Aboriginal communities and appears to be a favourable method of intervention. Building on the requests from Aboriginal women we designed a multi-behavioural mobile phone app. OBJECTIVE This paper describes the development and pre-test of a prototype multi-behavioural change app MAMA-EMPOWER with Aboriginal women and communities in New South Wales, Australia. METHODS Mixed methods study design using the Center for eHealth Research and Disease Management Roadmap for designing eHealth technology’s three phases; phase one-contextual enquiry included stakeholder engagement and qualitative interviews with Aboriginal women, phase two- value specification included user-workshop with an Aboriginal researcher, community members and experts phase 3 co-design with Aboriginal researchers and community members, followed by a pre-test of the app with Aboriginal women, and feedback from qualitative interviews and the user-MARS survey tool. RESULTS Phase 1 conducted informal market interviews to establish community need. Engagement with stakeholders refined digital considerations and behaviour change wheel factors to embed in the app. Interviews with 8 Aboriginal women revealed 3 themes; current app use, desired app characteristics and implementation. Phase 2 workshop with 6 Aboriginal women raised 3 themes; engagement, caution with wording and visual content. Phase 3 engaged 16 Aboriginal women to trial the app on their phones, all content areas were accessed, u-MARS was completed by 5 women, the highest ratings were for information (mean score of 3.80 out of 5, SD=0.77) and aesthetics (mean score of 3.87 with SD of 0.74), while functionality, engagement and subjective quality had lower scores. Qualitative interviews revealed the acceptability of the app, however functionality was problematic. CONCLUSIONS Developing a mobile phone app, particularly in an Aboriginal community setting, requires extensive consultation, negotiation and design work. Using a strong theoretical foundation of behaviour change technique’s coupled with the consultative approach has added rigour to this process. The use of mobile phone apps to implement behavioural interventions in Aboriginal community settings is still a new area for investigation. In the next iteration of the app we aim to find better ways to personalise the content to women’s needs, then ensure full functionality before conducting a larger trial. We predict the process of development will be of interest to other health researchers and practitioners.


2020 ◽  
Vol 37 (3) ◽  
pp. 333-360
Author(s):  
Nahal Khabbazbashi ◽  
Evelina D. Galaczi

This mixed methods study examined holistic, analytic, and part marking models (MMs) in terms of their measurement properties and impact on candidate CEFR classifications in a semi-direct online speaking test. Speaking performances of 240 candidates were first marked holistically and by part (phase 1). On the basis of phase 1 findings—which suggested stronger measurement properties for the part MM—phase 2 focused on a comparison of part and analytic MMs. Speaking performances of 400 candidates were rated analytically and by part during that phase. Raters provided open comments on their marking experiences. Results suggested a significant impact of MM; approximately 30% and 50% of candidates in phases 1 and 2 respectively were awarded different (adjacent) CEFR levels depending on the choice of MM used to assign scores. There was a trend of higher CEFR levels with the holistic MM and lower CEFR levels with the part MM. Although strong correlations were found between all pairings of MMs, further analyses revealed important differences. The part MM was shown to display superior measurement qualities particularly in allowing raters to make finer distinctions between different speaking ability levels. These findings have implications for the scoring validity of speaking tests.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Olga Szafran ◽  
Wayne Woloschuk ◽  
Jacqueline M. I. Torti ◽  
Maria F. Palacios Mackay

Abstract Background The importance of wellbeing of family medicine residents is recognized in accreditation requirements which call for a supportive and respectful learning environment; however, concerns exist about learner mistreatment in the medical environment. The purpose of this study was to to describe family medicine graduates’ perceived experience with intimidation, harassment and discrimination (IHD) during residency training. Methods A mixed-methods study was conducted on a cohort of family medicine graduates who completed residency training during 2006–2011. Phase 1, the quantitative component, consisted of a retrospective survey of 651 graduates. Phase 2, the qualitative component, was comprised of 11 qualitative interviews. Both the survey and the interviews addressed graduates’ experience with IHD with respect to frequency and type, setting, perpetrator, perceived basis for IHD, and the effect of the IHD. Results The response rate to the survey was 47.2%, with 44.7% of respondents indicating that they experienced some form of mistreatment/IHD during residency training, and 69.9% noting that it occurred more than once. The primary sources of IHD were specialist physicians (75.7%), hospital nurses (47.8%), and family physicians (33.8%). Inappropriate verbal comments were the most frequent type of IHD (86.8%). Graduates perceived the basis of the IHD to be abuse of power (69.1%), personality conflict (36.8%), and family medicine as a career choice (30.1%), which interview participants also described. A significantly greater proportion IMGs than CMGs perceived the basis of IHD to be culture/ethnicity (47.2% vs 10.5%, respectively). The vast majority (77.3%) of graduates reported that the IHD experience had a negative effect on them, consisting of decreased self-esteem and confidence, increased anxiety, and sleep problems. As trainees, they felt angry, threatened, demoralized, discouraged, manipulated, and powerless. Some developed depression or burnout, took medication, or underwent counselling. Conclusions IHD continued to be prevalent during family medicine residency training, with it occurring most frequently in the hospital setting and specialty rotations. Educational institutions must work with hospital administrators to address issues of mistreatment in the workplace. Residency training programs and the medical establishment need to be cognizant that the effects of IHD are far-reaching and must continuously work to eradicate it.


BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e028476
Author(s):  
Charles Shey Wiysonge ◽  
Phetole Walter Mahasha ◽  
Duduzile Edith Ndwandwe ◽  
Ntombenhle Ngcobo ◽  
Karen Grimmer ◽  
...  

IntroductionDespite the unparalleled success of immunisation in the control of vaccine preventable diseases, immunisation coverage in South Africa remains suboptimal. While many evidence-based interventions have successfully improved vaccination coverage in other countries, they are not necessarily appropriate to the immunisation needs, barriers and facilitators of South Africa. The aim of this research is to investigate barriers and facilitators to optimal vaccination uptake, and develop contextualised strategies and implementation plans to increase childhood and adolescent vaccination coverage in South Africa.MethodsThe study will employ a mixed-methods research design. It will be conducted over three iterative phases and use the Adopt, Contextualise or Adapt (ACA) model as an overarching conceptual framework. Phase 1 will identify, and develop a sampling frame of, immunisation stakeholders involved in the design, planning and implementation of childhood and human papillomavirus immunisation programmes in South Africa. Phase 2 will identify the main barriers and facilitators to, and solutions for, increasing vaccination coverage. This phase will comprise exploratory qualitative research with stakeholders and a review of existing systematic reviews on interventions for improving vaccination coverage. Using the findings from Phase 2 and the ACA model, Phase 3 will develop a set of proposed interventions and implementation action plans for improving immunisation coverage in South Africa. These plans will be discussed, revised and finalised through a series of participatory stakeholder workshops and an online questionnaire, conducted as part of Phase 3.EthicsEthical approval was obtained from the South African Medical Research Council (EC018-11/2018). No risks to participants are expected. Various steps will be taken to ensure the anonymity and confidentiality of participants.DisseminationThe study findings will be shared at stakeholder workshops, the website of Cochrane South Africa and academic publications and conferences.


2019 ◽  
Author(s):  
Astrid Karnoe ◽  
Lars Kayser ◽  
Lasse Skovgaard

BACKGROUND Digital data collection has the potential to reduce participant burden in research projects that require extensive registrations from participants. To achieve this, a digital data collection tool needs to address potential barriers and motivations for participation. OBJECTIVE This study aimed to identify factors that may affect motivation for participation and adoption of a digital data collection tool in a research project on nutrition and multiple sclerosis (MS). METHODS The study was designed as a sequential mixed methods study with 3 phases. In phase 1, 15 semistructured interviews were conducted in a Danish population of individuals with MS. Interview guide frameworks were based on dimensions from the electronic health literacy framework and the Health Education Impact Questionnaire. Data from phase 1 were analyzed in a content analysis, and findings were used to inform the survey design in phase 2 that validates the results from the content analysis in a larger population. The survey consisted of 14 items, and it was sent to 1000 individuals with MS (response rate 42.5%). In phase 3, participants in 3 focus group interviews discussed how findings from phases 1 and 2 might affect motivation for participation and adoption of the digital tool. RESULTS The following 3 categories related to barriers and incentives for participation were identified in the content analysis of the 15 individual interviews: (1) life with MS, (2) use of technology, and (3) participation and incentives. Phase 1 findings were tested in phase 2’s survey in a larger population (n=1000). The majority of participants were comfortable using smartphone technologies and participated actively on social media platforms. MS symptoms did cause limitations in the use of Web pages and apps when the given pages had screen clutter, too many colors, or too small buttons. Life with MS meant that most participants had to ration their energy levels. Support from family and friends was important to participants, but support could also come in the form of physical aids (walking aids and similar) and digital aids (reminders, calendar functions, and medication management). Factors that could discourage participation were particularly related to the time it would take every day. The biggest motivations for participation were to contribute to research in MS, to learn more about one’s own MS and what affects it, and to be able to exchange experiences with other people with MS. CONCLUSIONS MS causes limitations that put demands on tools developed for digital data collection. A digital data collection tool can increase chances of high adoption rates, but it needs to be supplemented with a clear and simple project design and continuous communication with participants. Motivational factors should be considered in both study design and the development of a digital data collection tool for research.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24132-e24132
Author(s):  
Nazima Jaffer Dharsee ◽  
Beatrice W Addai ◽  
Lisa Murray ◽  
Amanda Shewbridge ◽  
Maria Aresu ◽  
...  

e24132 Background: The incidence of breast cancer is increasing in low- & middle- income countries (LMICs). Alongside attempts to reduce the disparity in cancer survival between high-income countries (HIC) & LMICs, it is important that survivorship is well understood and managed in an evidence based, resource and culturally sensitive manner. This project aimed to develop knowledge, skills and services concerning living with and beyond breast cancer primary treatment. Methods: This 3-phase study used mixed methods. Phase 1 used participant observation and focus group interviews (FGIs) to scope experience, resources, current practice, and challenges to implementing a recovery package. In Phase 2 nurses used the adapted Holistic Needs Assessment (HNA) with 500 women in Tanzania and Ghana, who were also offered a recovery care plan and treatment summary following their breast cancer primary treatment. Data was entered into a macro database & analysed using descriptive statistics. Phase 3 was the development of a culturally sensitive “Foundations in Cancer Care” training toolkit for nurses. The toolkit was based on a “train the trainer” model and included slides, an existing palliative care toolkit and exercises. The training programme consisted of 5 days teaching covering theory and practice. Data collection included: Initial FGIs to ascertain learning needs, confidence in knowledge & skills, assessed pre & post teaching course, and course evaluation. Data were analysed using descriptive statistics. Results: In Phase 1 six themes were identified concerning experience of breast cancer which included cultural beliefs & practices and access to treatment & support. Phase 2 data from Tanzania showed a similar level of unmet need at the end of treatment to a previous similar published analysis from the UK. Data from Ghana showed a much higher level of unmet need. Evaluation following Phase 3 showed a positive change in nurses’ confidence in their knowledge. Conclusions: This mixed methods three-phase study has documented experience, resources and current practise around breast cancer survivorship in two African centers treating breast cancer. The feasibility of using HNA to identify unmet needs in these women has been demonstrated and needs the identified. Results from the HNA informed a training toolkit which was implemented and positively received and could be adapted for use in other LMICs.


10.2196/13295 ◽  
2019 ◽  
Vol 6 (4) ◽  
pp. e13295 ◽  
Author(s):  
Astrid Karnoe ◽  
Lars Kayser ◽  
Lasse Skovgaard

Background Digital data collection has the potential to reduce participant burden in research projects that require extensive registrations from participants. To achieve this, a digital data collection tool needs to address potential barriers and motivations for participation. Objective This study aimed to identify factors that may affect motivation for participation and adoption of a digital data collection tool in a research project on nutrition and multiple sclerosis (MS). Methods The study was designed as a sequential mixed methods study with 3 phases. In phase 1, 15 semistructured interviews were conducted in a Danish population of individuals with MS. Interview guide frameworks were based on dimensions from the electronic health literacy framework and the Health Education Impact Questionnaire. Data from phase 1 were analyzed in a content analysis, and findings were used to inform the survey design in phase 2 that validates the results from the content analysis in a larger population. The survey consisted of 14 items, and it was sent to 1000 individuals with MS (response rate 42.5%). In phase 3, participants in 3 focus group interviews discussed how findings from phases 1 and 2 might affect motivation for participation and adoption of the digital tool. Results The following 3 categories related to barriers and incentives for participation were identified in the content analysis of the 15 individual interviews: (1) life with MS, (2) use of technology, and (3) participation and incentives. Phase 1 findings were tested in phase 2’s survey in a larger population (n=1000). The majority of participants were comfortable using smartphone technologies and participated actively on social media platforms. MS symptoms did cause limitations in the use of Web pages and apps when the given pages had screen clutter, too many colors, or too small buttons. Life with MS meant that most participants had to ration their energy levels. Support from family and friends was important to participants, but support could also come in the form of physical aids (walking aids and similar) and digital aids (reminders, calendar functions, and medication management). Factors that could discourage participation were particularly related to the time it would take every day. The biggest motivations for participation were to contribute to research in MS, to learn more about one’s own MS and what affects it, and to be able to exchange experiences with other people with MS. Conclusions MS causes limitations that put demands on tools developed for digital data collection. A digital data collection tool can increase chances of high adoption rates, but it needs to be supplemented with a clear and simple project design and continuous communication with participants. Motivational factors should be considered in both study design and the development of a digital data collection tool for research.


BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e050706
Author(s):  
Joanne M Fitzpatrick ◽  
Anne Marie Rafferty ◽  
Shereen Hussein ◽  
Ivanka Ezhova ◽  
Sinead Palmer ◽  
...  

IntroductionOlder people living in residential and nursing care homes often have complex needs and are at high risk of poor health outcomes and mortality, especially if they contract COVID-19. Care homes use infection prevention and control measures such as social distancing and isolating residents to protect them from COVID-19. The care home sector has stated that implementing social distancing and isolation when caring for residents is a significant challenge. This paper presents the protocol of a mixed-methods study to explore and understand the real-life experiences of implementing social distancing and isolation of residents in care homes for older people from the perspective of residents, families/friends and staff working in and with care homes. The study aims to develop a toolkit of resources for health and care delivery now and for future outbreaks of infectious diseases.Methods and analysisThe study will be conducted in three phases. Phase 1 is a rapid review of evidence to collate knowledge on the mechanisms and measures used by care homes and long-term facilities to socially distance and isolate older people or control the spread of other infectious and contagious diseases. The review results will contribute to participant interviews in phase 2 and toolkit development in phase 3. Phase 2 will involve case studies with six care homes in England, involving the conduct of individual interviews with residents, families and friends, and staff, collection of care home policies and protocols related to social distancing and isolation for residents, and routinely collected care home data. A focus group with a purposive sample of external key informants will also be conducted. Phase 3, synthesising findings from phases 1 and 2, will inform the codesign of a toolkit of resources for residents, families/friends and care homes.Ethics and disseminationThe study has been approved by Coventry and Warwick Research Ethics Committee (20/WM/0318). To maximise impact, we will work closely with the Study Committees and the Patient and Public Involvement group to ensure the findings reach key stakeholders, including residents, families/friends, care homes, commissioners and organisations representing care home providers. We will disseminate the study outputs in peer-reviewed and professional journals, at professional conferences and via other knowledge transfer activities with the care home sector, and resident and carer organisations. The toolkit comprising evidence-informed guidance and resources and a mosaic film will be hosted on a project webpage.Registration detailsThis project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (Project reference NIHR132541). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.PROSPERO registration numberCRD42021226734.


JMIR Cancer ◽  
10.2196/26911 ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e26911
Author(s):  
Yuki Kataoka ◽  
Tomoyasu Takemura ◽  
Munehiko Sasajima ◽  
Naoki Katoh

Background Chatbots are artificial intelligence–driven programs that interact with people. The applications of this technology include the collection and delivery of information, generation of and responding to inquiries, collection of end user feedback, and the delivery of personalized health and medical information to patients through cellphone- and web-based platforms. However, no chatbots have been developed for patients with lung cancer and their caregivers. Objective This study aimed to develop and evaluate the early feasibility of a chatbot designed to improve the knowledge of symptom management among patients with lung cancer in Japan and their caregivers. Methods We conducted a sequential mixed methods study that included a web-based anonymized questionnaire survey administered to physicians and paramedics from June to July 2019 (phase 1). Two physicians conducted a content analysis of the questionnaire to curate frequently asked questions (FAQs; phase 2). Based on these FAQs, we developed and integrated a chatbot into a social network service (phase 3). The physicians and paramedics involved in phase I then tested this chatbot (α test; phase 4). Thereafter, patients with lung cancer and their caregivers tested this chatbot (β test; phase 5). Results We obtained 246 questions from 15 health care providers in phase 1. We curated 91 FAQs and their corresponding responses in phase 2. In total, 11 patients and 1 caregiver participated in the β test in phase 5. The participants were asked 60 questions, 8 (13%) of which did not match the appropriate categories. After the β test, 7 (64%) participants responded to the postexperimental questionnaire. The mean satisfaction score was 2.7 (SD 0.5) points out of 5. Conclusions Medical staff providing care to patients with lung cancer can use the categories specified in this chatbot to educate patients on how they can manage their symptoms. Further studies are required to improve chatbots in terms of interaction with patients.


2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Abdul Hasan Saragih

This classroom research was conducted on the autocad instructions to the first grade of mechinary class of SMK Negeri 1 Stabat aiming at : (1) improving the student’ archievementon autocad instructional to the student of mechinary architecture class of SMK Negeri 1 Stabat, (2) applying Quantum Learning Model to the students of mechinary class of SMK Negeri 1 Stabat, arising the positive response to autocad subject by applying Quantum Learning Model of the students of mechinary class of SMK Negeri 1 Stabat. The result shows that (1) by applying quantum learning model, the students’ achievement improves significantly. The improvement ofthe achievement of the 34 students is very satisfactory; on the first phase, 27 students passed (70.59%), 10 students failed (29.41%). On the second phase 27 students (79.41%) passed and 7 students (20.59%) failed. On the third phase 30 students (88.24%) passed and 4 students (11.76%) failed. The application of quantum learning model in SMK Negeri 1 Stabat proved satisfying. This was visible from the activeness of the students from phase 1 to 3. The activeness average of the students was 74.31% on phase 1,81.35% on phase 2, and 83.63% on phase 3. (3) The application of the quantum learning model on teaching autocad was very positively welcome by the students of mechinary class of SMK Negeri 1 Stabat. On phase 1 the improvement was 81.53% . It improved to 86.15% on phase 3. Therefore, The improvement ofstudent’ response can be categorized good.


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