A Qualitative Analysis of Factors Impacting Comprehensive Cleft Lip and Palate Care in Ghana

Objective: The objective of this study was to examine practices regarding cleft lip and palate (CLP) among medical professionals and caregivers of children with CLP and to identify barriers and facilitators to comprehensive CLP care at a hospital in West Africa. Design: Qualitative methods used consisted of individual semistructured interviews with caregivers of children with CLP and one focus group with CLP team members. Setting: A majority of the interviews took place in the hospital, with some occurring during home visits. The focus group was conducted in the same hospital. Participants: Forty-five caregivers of children with CLP and 1 adult with CLP completed an interview. Additionally, 2 of the caregivers had CLP and completed an interview from their perspective. The focus group consisted of 13 CLP team members from a comprehensive CLP team in Ghana. Interventions: Interviews consisted of semistructured, open-ended questions, and the focus group relied on a discussion guide. Line-by-line coding was used to identify common themes regarding barriers and facilitators to CLP care. Results: Barriers to CLP care that were consistent across caregiver interviews and the focus group were lack of knowledge regarding CLP, stigma and cultural beliefs surrounding CLP, transportation, financial, and feeding/nutrition issues. Barriers to care identified in the interviews and focus group were similar; however, facilitators to care varied greatly between the 2. Conclusions: Two different qualitative methods provided unique perspectives on barriers and facilitators to CLP care. However, patients and caregivers continue to face substantial barriers to obtaining care.

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Parent’s Experiences During Orthodontic Treatment of Their Children With Cleft Lip and Palate: Phenomenological Study

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620980606 ◽

2020 ◽

pp. 105566562098060

Author(s):

Mohammad Moslem Imani ◽

Amir Jalali ◽

Prichehr Nouri ◽

Amin Golshah

Keyword(s):

Orthodontic Treatment ◽

Cleft Lip ◽

Phenomenological Study ◽

Cleft Lip And Palate ◽

Counseling Services ◽

Treatment Needs ◽

Descriptive Phenomenology ◽

Efficient Treatment ◽

Adverse Experiences ◽

Semistructured Interviews

Objectives: Cleft lip and palate (CLP) is a congenital anomaly that affects not only the patients but also their family members and companions. Identifying the problems encountered by patients with CLP and their families can greatly help clinicians in efficient treatment planning to obviate the treatment needs and promote the quality of life of patients. This study aimed to determine the experiences of the parents of children with CLP undergoing orthodontic treatment. Methods: This study was conducted based on descriptive phenomenology using the Colaizzi’s 7-step analysis method of phenomenological data. The private orthodontic clinics of Kermanshah city were evaluated in this study. The participants included the parents of children with CLP younger than 15 years who had presented to the clinics seeking orthodontic treatment. In-depth semistructured interviews with open-ended questions were used to collect information regarding the experiences of parents in this process. The collected data were analyzed using the Colaizzi’s 7-step analysis. Results: Qualitative analysis of the interviews yielded 271 codes, 18 subthemes, 7 themes, and 3 main themes including fatigue (exhaustion, helplessness, and incompetence), self-reliance (mutual support and empathy), and the need for social support (counseling services and citizenship rights). Conclusion: In general, the results revealed that parents of children with CLP under orthodontic treatment are vulnerable due to their previous adverse experiences in the course of treatment of their children and need support in several physical, psychological, social and spiritual domains.

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Implementation of ultrasound after central venous catheter insertion: A qualitative study in early adopters

The Journal of Vascular Access ◽

10.1177/11297298211053447 ◽

2021 ◽

pp. 112972982110534

Author(s):

Enyo A Ablordeppey ◽

Shannon M Keating ◽

Katherine M Brown ◽

Daniel L Theodoro ◽

Richard T Griffey ◽

...

Keyword(s):

Focus Group ◽

Central Venous Catheter ◽

Qualitative Analysis ◽

Focus Groups ◽

Venous Catheter ◽

Barriers And Facilitators ◽

Central Venous ◽

Focus Group Discussions ◽

Group Discussions ◽

Post Procedure

Background: The adoption rate of point of care ultrasound (POCUS) for the confirmation of central venous catheter (CVC) positioning and exclusion of post procedure pneumothorax is low despite advantages in workflow compared to traditional chest X-ray (CXR). To explore why, we convened focus groups to address barriers and facilitators of implementation for POCUS guided CVC confirmation and de-implementation of post-procedure CXR. Methods: We conducted focus groups with emergency medicine and critical care providers to discuss current practices in POCUS for CVC confirmation. The semi-structured focus group interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach (NVivo software), aiming to identify priority categories that describe the barriers and facilitators of POCUS guided CVC confirmation. Results: The coding dictionary of barriers and facilitators consisted of 21 codes from the focus group discussions. Our qualitative analysis revealed that 12 codes emerged spontaneously (inductively) within the focus group discussions and aligned directly to CFIR constructs. Common barriers included provider influences (e.g. knowledge and beliefs about POCUS for CVC confirmation), external network (e.g. societal guidelines, ancillary staff, and consultants), and inertia (habit or reflexive processes). Common facilitators included ultrasound protocol advantage and champions. Time and provider outcomes (cognitive offload, ownership, and independence) emerged as early barriers but late facilitators. Conclusion: Our qualitative analysis demonstrates real and perceived barriers against implementation of POCUS for CVC position confirmation and pneumothorax exclusion. Our findings discovered organizational and personal constructs that will inform development of multifaceted strategies toward implementation of POCUS after CVC insertion.

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An investigation of the barriers and facilitators of adherence in relation to amendable risk factors in the primary prevention of cleft lip and palate

International Journal of Mental Health & Psychiatry ◽

10.4172/2471-4372-c1-009 ◽

2018 ◽

Vol 04 ◽

Author(s):

Dalia Bajabir ◽

Peter Mossey ◽

Nicola Innes ◽

Steve MacGillivray

Keyword(s):

Risk Factors ◽

Primary Prevention ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Barriers And Facilitators

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MOTHERS' EXPERIENCES WHEN THEIR INFANTS WERE DIAGNOSED WITH CLEFT LIPS ANDIOR PALATES

Health SA Gesondheid ◽

10.4102/hsag.v7i2.644 ◽

2002 ◽

Vol 7 (2) ◽

pp. 12 ◽

Cited By ~ 1

Author(s):

Liezel Ter Poorten ◽

Brenda Louw

Keyword(s):

Emotional Support ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Team Approach ◽

Structured Interviews ◽

Team Members ◽

Postnatal Diagnosis ◽

Information Interaction ◽

Parental Preferences ◽

Mothers Experiences

Traditionally the diagnosis of cleft lip and palate was made at birth or soon thereafter, but modem technology has led to the identification of cleft lip prenatally The aim of this study was to describe 16 mothers' experiences of pre- and postnatal diagnosis of their infants' cleft lip and palate, and to develop clinical guidelines for craniofacial team members, to meet parental expectations and needs in both pre- and postnatal periods. In order to provide the best possible care to each affected child and the most effective support to each mother, it is of the utmost importance that craniofacial teams have guidelines to assist them in developing a more accountable, effective and sensitive service to these mothers. An exploratory, descriptive quantitative survey research design was selected to describe mothers' reactions to and perceptions of the pre- and postnatal diagnosis. Scheduled structured interviews were used as a data collecting technique. The results indicated that, irrespective of the time of diagnosis, the mothers required support that included emotional support, information, interaction with other parents of children with clefts, and a team approach. This study emphasised the importance of understanding parental preferences in order to enhance the team approach and also highlighted the need for further research.

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Barriers and facilitators to implementing telehealth services during the COVID-19 pandemic: A qualitative analysis of interviews with cystic fibrosis care team members

Journal of Cystic Fibrosis ◽

10.1016/j.jcf.2021.09.004 ◽

2021 ◽

Vol 20 ◽

pp. 23-28

Author(s):

Aricca D. Van Citters ◽

Olivia Dieni ◽

Peter Scalia ◽

Christopher Dowd ◽

Kathryn A. Sabadosa ◽

...

Keyword(s):

Cystic Fibrosis ◽

Qualitative Analysis ◽

Care Team ◽

Barriers And Facilitators ◽

Team Members

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A Qualitative Dual-Site Analysis of The Pharmacist Discharge Care (PHARM-DC) Intervention Using The CFIR Framework

10.21203/rs.3.rs-1038161/v1 ◽

2021 ◽

Author(s):

Logan Thomas Murry ◽

Korey Kennelty ◽

Michelle Keller ◽

Joshua Pevnick ◽

Jeffrey Schnipper

Keyword(s):

Focus Group ◽

Qualitative Analysis ◽

Hospital Readmissions ◽

Emergency Department Visits ◽

Transitions Of Care ◽

Structured Interviews ◽

Administrative Roles ◽

Team Members ◽

Discharge Care ◽

Study Team

Abstract Introduction: Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Consolidated Framework for Implementation Research (CFIR) framework to evaluate pharmacist perceptions of the PHARM-DC intervention.Methods: Intervention pharmacists and pharmacy administrators were purposively recruited by study team members located within each participating institution. Study team members located within each institution coordinated with two study authors unaffiliated with the institutions implementing the intervention to conduct interviews and focus groups remotely via telecommunication software. Interviews were recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Qualitative analysis was performed using an iterative process to identify “a priori” constructs based on CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation) and to create overarching themes as identified during coding.Results: In total, ten semi-structured interviews and one focus group were completed across both hospitals. At Site A, six interviews were conducted with intervention pharmacists and pharmacists in administrative roles. Also at Site A, one focus group comprised of five intervention pharmacists was conducted. At Site B, interviews were conducted with four intervention pharmacists and pharmacists in administrative roles. Three overarching themes were identified: PHARM-DC and Institutional Context, Importance of PHARM-DC Adaptability, and Recommendations for PHARM-DC Improvement and Sustainability. Increasing pharmacist support for technical tasks and navigating pharmacist-patient language barriers were important to intervention implementation and delivery. Identifying cost-savings and quantifying outcomes as a result of the intervention were particularly important when considering how to sustain and expand the PHARM-DC intervention.Conclusion: The PHARM-DC intervention can successfully be implemented at two institutions with considerable variations in TOC initiatives, resources, and staffing. Future implementation of PHARM-DC interventions should consider the themes identified, including an examination of institution-specific contextual factors such as the roles that pharmacy technicians may play in TOC interventions, the importance of intervention adaptability to account for patient needs and institutional resources, and pharmacist recommendations for intervention improvement and sustainability.

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Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig5-2019-0005 ◽

2019 ◽

Vol 4 (5) ◽

pp. 878-892

Author(s):

Joseph A. Napoli ◽

Linda D. Vallino

Keyword(s):

Systematic Review ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

A Priori ◽

Sufficient Evidence ◽

Obstructive Sleep ◽

Before And After ◽

Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

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