scholarly journals Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ridhaa Remtulla ◽  
Arwa Hagana ◽  
Nour Houbby ◽  
Kajal Ruparell ◽  
Nivaran Aojula ◽  
...  
Keyword(s):  
Primary Care ◽  
Interpersonal Relationships ◽  
Psychological Safety ◽  
Multidisciplinary Teams ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Authoritarian Leadership ◽  
Shared Beliefs ◽  
Primary Care Teams ◽  
Facilitators And Barriers

Abstract Background Psychological safety is the concept by which individuals feel comfortable expressing themselves in a work environment, without fear of embarrassment or criticism from others. Psychological safety in healthcare is associated with improved patient safety outcomes, enhanced physician engagement and fostering a creative learning environment. Therefore, it is important to establish the key levers which can act as facilitators or barriers to establishing psychological safety. Existing literature on psychological safety in healthcare teams has focused on secondary care, primarily from an individual profession perspective. In light of the increased focus on multidisciplinary work in primary care and the need for team-based studies, given that psychological safety is a team-based construct, this study sought to investigate the facilitators and barriers to psychological safety in primary care multidisciplinary teams. Methods A mono-method qualitative research design was chosen for this study. Healthcare professionals from four primary care teams (n = 20) were recruited using snowball sampling. Data collection was through semi-structured interviews. Thematic analysis was used to generate findings. Results Three meta themes surfaced: shared beliefs, facilitators and barriers to psychological safety. The shared beliefs offered insights into the teams’ background functioning, providing important context to the facilitators and barriers of psychological safety specific to each team. Four barriers to psychological safety were identified: hierarchy, perceived lack of knowledge, personality and authoritarian leadership. Eight facilitators surfaced: leader and leader inclusiveness, open culture, vocal personality, support in silos, boundary spanner, chairing meetings, strong interpersonal relationships and small groups. Conclusion This study emphasises that factors influencing psychological safety can be individualistic, team-based or organisational. Although previous literature has largely focused on the role of leaders in promoting psychological safety, safe environments can be created by all team members. Members can facilitate psychological safety in instances where positive leadership behaviours are lacking - for example, strengthening interpersonal relationships, finding support in silos or rotating the chairperson in team meetings. It is anticipated that these findings will encourage practices to reflect on their team dynamics and adopt strategies to ensure every member’s voice is heard.

Facilitators and barriers for promoting healthy eating among primary care patients: results of a qualitative study among practice nurses

2021 ◽  
Author(s):  
Geertruida J Groenendijk-van Woudenbergh ◽  
Marlies C van Hell-Cromwijk ◽  
Ytje J J van der Veen ◽  
Hylkje F Algra ◽  
Willemieke Kroeze
Keyword(s):  
Primary Care ◽  
Communication Skills ◽  
Healthy Eating ◽  
Patient Encounter ◽  
Structured Interviews ◽  
Good Communication ◽  
Practice Nurses ◽  
Professional Characteristics ◽  
Primary Care Patients ◽  
Facilitators And Barriers

Abstract Background Practice nurses have an important role in promoting healthy eating to prevent or delay long-term complications from chronic lifestyle-related diseases. Objective To identify the facilitators and barriers encountered by practice nurses at a professional level when promoting healthy eating among patients. Methods Face-to-face semi-structured interviews were conducted with 21 Dutch practice nurses. Data were recorded, transcribed and analysed using inductive thematic analysis. Results Two main themes were determined: professional characteristics and professional–patient encounter. Professional characteristics included good communication skills and experience facilitated the successful promotion of healthy eating, while a lack of communication skills and lack of knowledge about diet were perceived as barriers. The most frequently identified facilitators for professional–patient encounter included ensuring a personal connection with patients, creating food awareness, focussing on small changes, adopting a tailored approach, motivating and arranging extra consultations. Barriers included lack of skills to raise the topic, lack of persistence, inability to find a common understanding, lack of competence in handling patients’ own choices and underuse of existing educational materials. Conclusions Further research using the identified facilitators and barriers for promoting healthy eating in primary care patients with chronic diseases could assist in the development of future training programmes for practice nurses.

scholarly journals COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

2021 ◽  
Vol 18 (16) ◽  
pp. 8689
Author(s):  
Claire Norman ◽  
Josephine M. Wildman ◽  
Sarah Sowden
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Care Staff ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Social Prescribing ◽  
Qualitative Interview Study ◽  
The Impact ◽  
Primary Care Staff ◽  
Deprived Areas

COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

Learning from the introduction of ‘skill-mix’ changes in general practice: a qualitative process evaluation

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696701
Author(s):  
Pauline Nelson ◽  
Anne-Marie Martindale ◽  
Anne McBride ◽  
Damian Hodgson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Process Evaluation ◽  
Unintended Consequences ◽  
Active Management ◽  
Early Adopter ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Skill Mix ◽  
Qualitative Process Evaluation

Background‘Skill-mix’ change (changing mix of staff roles or introducing new ways of working) is increasingly promoted to relieve pressure in general practice teams. As part of a primary care workforce strategy, one locality in Greater Manchester is seeking to integrate three ‘non-medical’ roles – Advanced Practitioners (APs), Physician Associates (PAs) and Clinical Pharmacists (CPs) – to work alongside practice staff.AimA qualitative process evaluation studied the integration of these roles to: establish the aims and priorities of the new services; understand and compare the ways in which the roles are being established with identification of measurable impacts and unintended consequences.MethodA rapid scoping review of the primary care skill-mix literature was conducted to inform the evaluation. Purposive and ‘snowball’ sampling enabled semi-structured interviews (12) and focus groups (2) to be conducted with 27 key individuals (workforce/training leads for the new services; APs/PAs/CPs; GPs/practice managers), before being transcribed, anonymised and analysed thematically with a combination of a priori and grounded codes. Analysis of relevant service/training plans supplemented interview/focus group data.ResultsA number of organisational and operational factors affecting implementation success in early adopter sites were identified including: the intended scope and function of new roles with corresponding implications for measuring impacts; leadership/active management of workforce changes; appropriate training and education; inter-professional tensions; regulatory provisions, and sustainability.ConclusionThere is variation in how the three skill-mix initiatives are being implemented in early adopter sites, with implications for success. Key considerations for introducing skill-mix changes in general practice are being identified.

scholarly journals Barriers and Facilitators to Involvement in Children’s Diabetes Management Among Minority Parents

2020 ◽  
Vol 45 (8) ◽  
pp. 946-956 ◽  
Author(s):  
Ashley M Butler ◽  
Marisa E Hilliard ◽  
Courtney Titus ◽  
Evadne Rodriguez ◽  
Iman Al-Gadi ◽  
...  
Keyword(s):  
African American ◽  
Interpersonal Relationships ◽  
Diabetes Management ◽  
Work Environments ◽  
Latino Parents ◽  
Structured Interviews ◽  
Organizational Planning ◽  
Knowledge Capability ◽  
Facilitators And Barriers

Abstract Objective This study aimed to describe parents’ perceptions of the factors that facilitate or are barriers to their involvement in children’s type 1 diabetes (T1D) management among African American and Latino parents. Methods African American and Latino parents (N = 28) of 5- to 9-year-old children with T1D completed audio-recorded, semi-structured interviews that were transcribed and analyzed using thematic analysis. Themes were identified that aligned with the theoretically-derived Capability–Opportunity–Motivation–Behavior (COM-B) framework. Results Parents described Capability-based facilitators of parent involvement, including positive stress management, religious/spiritual coping, organizational/planning skills, and diabetes knowledge. Capability-based barriers included child and parent distress. Interpersonal relationships, degree of flexibility in work environments, and access to diabetes technologies were both Opportunity-based facilitators and barriers; and Opportunity-based barriers consisted of food insecurity/low financial resources. Parents’ desire for their child to have a “normal” life was described as both a Motivation-based facilitator and barrier. Conclusions African American and Latino families described helpful and unhelpful factors that spanned all aspects of the COM-B model. Reinforcing or targeting families’ unique psychological, interpersonal, and environmental strengths and challenges in multilevel interventions has potential to maximize parental involvement in children’s diabetes management.

scholarly journals Impact of COVID-19 on Migrants’ Access to Primary Care and Implications for Vaccine Roll Out: A National Qualitative Study

2021 ◽  
pp. BJGP.2021.0028
Author(s):  
Felicity Knights ◽  
Jessica Carter ◽  
Anna Deal ◽  
Alison F Crawshaw ◽  
Sally Hayward ◽  
...  
Keyword(s):  
Primary Care ◽  
Digital Health ◽  
Phase 1 ◽  
Vaccine Hesitancy ◽  
Administrative Staff ◽  
Foreign Born ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
The Impact ◽  
Roll Out

Background: The COVID-19 pandemic has prompted considerable changes in delivery of UK primary care, including rapid digitalisation, yet the impact upon marginalised migrant groups is unknown. Aim: To understand the impact of the COVID-19 pandemic on migrants and their access to primary healthcare, and implications for COVID-19 vaccine roll out. Design and Setting: Primary care professionals, administrative staff, and migrants (foreign born; >18 years; <10 years in UK), were recruited in three phases using purposive, convenience and snowball sampling from urban, suburban and rural settings. Methods: In-depth semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis. Results: 64 clinicians were recruited in Phase 1 (25 GPs, 15 nurses, 7 HCAs, 1 Pharmacist); Phase 2 comprised 16 administrative staff; and Phase 3, 17 migrants (88% asylum seekers; 65% female; mean time in UK 4 years). Digitalisation has amplified existing inequalities in access to healthcare for many migrants due to lack of digital literacy and access to technology, compounded by language barriers and challenges building trust. Participants highlighted challenges registering and accessing healthcare due to physical closure of surgeries. Migrants reported specific beliefs around COVID-19 and COVID-19 vaccines, from acceptance to mistrust, often influenced by misinformation. Innovative opportunities suggested included translated digital health advice using text templates and YouTube. Conclusion: Migrants risk digital exclusion and may need targeted support to access services. Solutions are urgently needed to address vaccine hesitancy and barriers to vaccination in marginalised groups (including migrants) to ensure equitable uptake of the COVID-19 vaccine.

scholarly journals Engaging Patients in Primary Care Quality Improvement Initiatives: Facilitators and Barriers

2019 ◽  
Vol 35 (1) ◽  
pp. 52-62
Author(s):  
Nancy Pandhi ◽  
Nora Jacobson ◽  
Madison Crowder ◽  
Andrew Quanbeck ◽  
Mollie Hass ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Patient Engagement ◽  
Patient Activation ◽  
Care Quality ◽  
Effective Strategies ◽  
Primary Care Quality ◽  
Primary Care Teams ◽  
Communication Difficulties ◽  
Facilitators And Barriers

Health care transformation calls for patient engagement in quality improvement (PEQI), yet practice participation remains low. This pilot study of 8 primary care clinics at 7 statewide locations sought to determine the most effective strategies for disseminating a previously successful single-system PEQI intervention. Qualitative data were obtained through site visits, interviews, observations, and journaling. All material pertaining to barriers, recruitment/retention, and implementation was extracted, compared, and categorized. Five teams partially completed the intervention and 3 finished. These 3 teams did not ask for shorter trainings and were assigned a quality improvement (QI) coach. Multiple barriers to recruitment, implementation, and retention were noted at the organizational and clinic/team level, including turnover, shifting priorities, cross-level communication difficulties, lack of QI knowledge, and confusion between patient engagement and patient activation. These findings suggest that QI facilitation and dedicated time can help primary care teams identify and overcome barriers to PEQI.

Facilitators and Barriers to Implementing a Digital Informed Decision Making Tool in Primary Care: A Qualitative Study

2022 ◽  
Vol 13 (01) ◽  
pp. 001-009
Author(s):  
Nicole Puccinelli-Ortega ◽  
Mark Cromo ◽  
Kristie L. Foley ◽  
Mark B. Dignan ◽  
Ajay Dharod ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Decision Aids ◽  
Informed Decision ◽  
Care Practice ◽  
Informed Decision Making ◽  
Structured Interviews ◽  
Clinic Staff ◽  
Facilitators And Barriers

Abstract Background Informed decision aids provide information in the context of the patient's values and improve informed decision making (IDM). To overcome barriers that interfere with IDM, our team developed an innovative iPad-based application (aka “app”) to help patients make informed decisions about colorectal cancer screening. The app assesses patients' eligibility for screening, educates them about their options, and empowers them to request a test via the interactive decision aid. Objective The aim of the study is to explore how informed decision aids can be implemented successfully in primary care clinics, including the facilitators and barriers to implementation; strategies for minimizing barriers; adequacy of draft training materials; and any additional support or training desired by clinics. Design This work deals with a multicenter qualitative study in rural and urban settings. Participants A total of 48 individuals participated including primary care practice managers, clinicians, nurses, and front desk staff. Approach Focus groups and semi-structured interviews, with data analysis were guided by thematic analysis. Key Results Salient emergent themes were time, workflow, patient age, literacy, and electronic health record (EHR) integration. Saving time was important to most participants. Patient flow was a concern for all clinic staff, and they expressed that any slowdown due to patients using the iPad module or perceived additional work to clinic staff would make staff less motivated to use the program. Participants voiced concern about older patients being unwilling or unable to utilize the iPad and patients with low literacy ability being able to read or comprehend the information. Conclusion Integrating new IDM apps into the current clinic workflow with minimal disruptions would increase the probability of long-term adoption and ultimate sustainability. NIH trial registry number R01CA218416-A1.

scholarly journals The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
K. E. Grailey ◽  
E. Murray ◽  
T. Reader ◽  
S. J. Brett
Keyword(s):  
Thematic Analysis ◽  
Healthcare Workers ◽  
Evidence Synthesis ◽  
Psychological Safety ◽  
Structured Interviews ◽  
Situational Context ◽  
Safety Research ◽  
Modifiable Factors ◽  
Wide Range ◽  
Facilitators And Barriers

Abstract Introduction Psychological safety is the shared belief that the team is safe for interpersonal risk taking. Its presence improves innovation and error prevention. This evidence synthesis had 3 objectives: explore the current literature regarding psychological safety, identify methods used in its assessment and investigate for evidence of consequences of a psychologically safe environment. Methods We searched multiple trial registries through December 2018. All studies addressing psychological safety within healthcare workers were included and reviewed for methodological limitations. A thematic analysis approach explored the presence of psychological safety. Content analysis was utilised to evaluate potential consequences. Results We included 62 papers from 19 countries. The thematic analysis demonstrated high and low levels of psychological safety both at the individual level in study participants and across the studies themselves. There was heterogeneity in responses across all studies, limiting generalisable conclusions about the overall presence of psychological safety. A wide range of methods were used. Twenty-five used qualitative methodology, predominantly semi-structured interviews. Thirty quantitative or mixed method studies used surveys. Ten studies inferred that low psychological safety negatively impacted patient safety. Nine demonstrated a significant relationship between psychological safety and team outcomes. The thematic analysis allowed the development of concepts beyond the content of the original studies. This analytical process provided a wealth of information regarding facilitators and barriers to psychological safety and the development of a model demonstrating the influence of situational context. Discussion This evidence synthesis highlights that whilst there is a positive and demonstrable presence of psychological safety within healthcare workers worldwide, there is room for improvement. The variability in methods used demonstrates scope to harmonise this. We draw attention to potential consequences of both high and low psychological safety. We provide novel information about the influence of situational context on an individual’s psychological safety and offer more detail about the facilitators and barriers to psychological safety than seen in previous reviews. There is a risk of participation bias - centres involved in safety research may be more aligned to these ideals. The data in this synthesis are useful for institutions looking to improve psychological safety by providing a framework from which modifiable factors can be identified.

Hubungan Alexithymia dengan Kecanduan Media Sosial pada Remaja di Jakarta Selatan

2020 ◽  
Vol 1 (2) ◽  
pp. 9
Author(s):  
Yunita Mansyah Lestari ◽  
Suzy Yusna Dewi ◽  
Aulia Chairani
Keyword(s):  
Social Media ◽  
Interpersonal Relationships ◽  
P Value ◽  
Snowball Sampling ◽  
Research Subjects ◽  
Chi Square ◽  
Toronto Alexithymia Scale ◽  
Social Media Addiction ◽  
Consecutive Sampling ◽  
Tas 20

ABSTRAK   Alexithymia ditandai dengan ketidakmampuan dalam mengenali dan mengekpresikan emosi serta pemikiran yang berorientasi eksternal sehingga mereka memiliki hubungan interpersonal yang buruk. Remaja dengan alexithymia cenderung menjadi kecanduan media sosial.Penelitian ini bertujuan untuk mengetahui hubungan antara Alexithymia terhadap kecanduan media sosial pada remaja di Jakarta Selatan. Subjek penelitian adalah remaja yang berusia 13-19 tahun dan tinggal di Jakarta selatan. Pengambilan data menggunakan metode consecutive sampling dan snowball sampling dengan menyebar kuesioner menggunakan link googleform. Jumlah subjek penelitian sebanyak 207 orang (41 = laki-laki, 166 = perempuan). Skala yang digunakan adalah Toronto Alexithymia Scale (TAS-20) dan Social Media Disorder (SMD). Analisa data menggunakan metode chi-square pada SPSS 25. Hasil penelitian didapatkan 85 orang mengalami alexithymia, 88 mengalami kecanduan dan 62 orang mengalami alexithymia dan kecanduan media sosial. p-value didapatkan 0,000. Hal ini berarti terdapat hubungan antara Alexithymia dengan Kecanduan Media Sosial pada remaja di Jakarta Selatan. Kata Kunci :Alexithymia, Kecanduan Media Sosial, Remaja     ABSTRACT   Alexithymia is characterized by an inability to recognize and express emotions and have external oriented thoughts so that they have poor interpersonal relationships. Teenagers with alexithymial tend to become addicted to social media. This study aims to determine the relationship between Alexithymia towards social media addiction in adolescents in South Jakarta. The research subjects were adolescents aged 13-19 years and lived in south Jakarta. Retrieval of the data was using consecutive sampling and snowball sampling method by distributing questionnaires using the googleform link. The number of research subjects was 207 people (41 = men, 166 = women). The scale was used is the Toronto Alexithymia Scale (TAS-20) and Social Media Disorder (SMD). Data analysis using the chi-square method in SPSS 25. The results showed that 85 people had alexithymia, 88 were addicted and 62 people had alexithymia and were addicted to social media. p-value obtained is 0,000. This means that there is a relationship between Alexithymia and Social Media Addiction in adolescents in South Jakarta. Keyword : Adolescents, Alexithymia, Social Media Addiction

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