scholarly journals Healthcare professionals’ perceptions on barriers and facilitators to DMARD use in rheumatoid arthritis

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
M. J. H. Voshaar ◽  
B. J. F. van den Bemt ◽  
M. A. F. J. van de Laar ◽  
A. M. van Dulmen ◽  
J. E. Vriezekolk
Keyword(s):  
Rheumatoid Arthritis ◽  
Healthcare Professionals ◽  
Medication Use ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Healthcare Team ◽  
Management Skills ◽  
Related Factors ◽  
Interview Guide ◽  
Depth Interviews

Abstract Background Disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of rheumatoid arthritis (RA) treatment. However, the full benefits of DMARDs are often not realized because many patients are sub-optimally adherent to their medication. In order to optimize adherence, it is essential that healthcare professionals (HCPs) understand patients’ barriers and facilitators for medication use. Insight in these barriers and facilitators may foster the dialogue about adequate medication use between HCPs and patients. What HCPs perceive as barriers and facilitators has, so far, scarcely been investigated. This study aimed to identify the perceptions of HCPs on patients’ barriers and facilitators that might influence their adherence. Methods This qualitative study was performed using semi structured in-depth interviews with HCPs. An interview guide was used, based on an adjusted version of the Theoretical Domains Framework (TDF). Thematic analysis was conducted to identify factors that influence barriers and facilitators to DMARD use according to HCPs. Results Fifteen HCPs (5 rheumatologists, 5 nurses and 5 pharmacists) were interviewed. They mentioned a variety of factors that, according to their perceptions, influence DMARD adherence in patients with RA. Besides therapy-related factors, such as (onset of) medication effectiveness and side-effects, most variation was found within patient-related factors and reflected patients’ beliefs, ways of coping, and (self-management) skills toward medication and their condition. In addition, factors related to the condition (e.g., level of disease activity), healthcare team and system (e.g., trust in HCP), and social and economic context (e.g. support, work shifts) were reported. Conclusions This study provided insights in HCPs’ perceptions of the barriers and facilitators to DMARD use patients with RA. Most factors that were mentioned were patient-related and potentially modifiable. When physicians understand patients’ perceptions on medication use, adherence to DMARDs can probably be optimized in patients with RA leading to more effectiveness of treatment outcomes.

scholarly journals Barriers and facilitators to implementing clinical imaging guidelines by healthcare professionals using theoretical domains framework: a mixed-methods systematic review protocol

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 20210004
Author(s):  
Harriet Nalubega Kisembo ◽  
Ritah Nassanga ◽  
Faith Ameda Ameda ◽  
Moses Ocan ◽  
Alison A Kinengyere ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Systematic Reviews ◽  
Financial Incentives ◽  
Healthcare Professionals ◽  
Information Source ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Clinical Imaging

Objectives: To identify, categorize, and develop an aggregated synthesis of evidence using the theoretical domains framework (TDF) on barriers and facilitators that influence implementation of clinical imaging guidelines (CIGs) by healthcare professionals (HCPs) in diagnostic imaging Methods: The protocol will be guided by the Joanna Briggs Institute Reviewers’ Manual 2014. Methodology for JBI Mixed Methods Systematic Reviews and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P). Information source will include databases (MEDLINE, EMBASE and The Cochrane Library), internet search (https://www.google.com/scholar), experts’ opinion, professional societies/organizations websites and government bodies strategies/recommendations, and reference lists of included studies. Articles of any study design published in English from 1990 to date, having investigated factors operating as barriers and/or facilitators to the implementation CIGs by HCPs will be eligible. Selecting, appraising, and extracting data from the included studies will be independently performed by at least two reviewers using validated tools and Rayyan – Systematic Review web application. Disagreements will be resolved by consensus and a third reviewer as a tie breaker. The aggregated studies will be synthesized using thematic analysis guided by TDF. Results: Identified barriers will be defined a priori and mapped into 7 TDF domains including knowledge, awareness, effectiveness, time, litigationand financial incentives Conclusion: The results will provide an insight into a theory-based approach to predict behavior-related determinants for implementing CIGs and develop strategies/interventions to target the elicited behaviors. Recommendations will be made if the level of evidence is sufficient Advances in knowledge: Resource-constrained settings that are in the process of adopting CIGs may opt for this strategy to predict in advance likely impediments to achieving the goal of CIG implementation and develop tailored interventions during the planning phase. Systematic review Registration: PROSPERO ID = CRD42020136372 (https://www.crd.york.ac.uk/PROSPERO).

scholarly journals An Exploration of Barriers Women Face in Balancing Motherhood and Education in Kenya

2016 ◽  
Vol 2 (5) ◽  
Author(s):  
Lucy Wanjiku Musili
Keyword(s):  
Time Management ◽  
Multiple Roles ◽  
Management Skills ◽  
Face To Face ◽  
Student Mothers ◽  
Postgraduate Study ◽  
Main Challenge ◽  
Postgraduate Level ◽  
Interview Guide ◽  
Depth Interviews

This study explores barriers women face in balancing motherhood and education in Kenya. Owing to the nature of this study, the research design was mainly qualitative and face-to-face in-depth interviews were conducted by the researcher with 32 female students reported in their role as mothers of child (ren) eighteen years old or younger enrolled for postgraduate study at University of Nairobi using an interview guide. The study has three objectives:1) Evaluate experiences of mothers who study at postgraduate level; 2) Examine how women combine multiple roles of motherhood and education; and 3) Explore challenges that hinder women participation in postgraduate study. These study findings reveals that postgraduate student mothers experience conflict between various commitments like childcare, domestic, work and academic responsibilities. For example they juggled childcare and timetabling issues and, for some, their main challenge was a feeling of guilt for inability to spend quality time with their young families. These women however were able to overcome these difficulties with highly developed organization, time-management skills, family support and by sacrificing sleep and recreating time for their families. The women were strongly motivated by the desire for personal achievement, and the opportunity to create a better future for their families specifically their children. These study findings demonstrated that postgraduate study rewarded women with a sense of freedom, growth, pride and achievement, as well as developing their professional identity. It also provided them with a major opportunity to grow and develop their personal abilities while raising their children..

scholarly journals Improving the way healthcare professionals deliver different news to families during pregnancy or at birth: a qualitative study

2021 ◽  
Vol 22 ◽  
Author(s):  
Esther Mugweni ◽  
Samantha Goodliffe ◽  
Sabrena Jaswal ◽  
Melita Walker ◽  
Angela Emrys-Jones ◽  
...  
Keyword(s):  
Lived Experience ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Psychological Impact ◽  
Theoretical Domains Framework ◽  
Training Programme ◽  
Barriers And Facilitators ◽  
Mental Wellbeing ◽  
Training Intervention ◽  
The Way

Abstract Aim: To explore the lived experience of delivering or receiving news about an unborn or newborn child having a condition associated with a learning disability in order to inform the development of a training intervention for healthcare professionals. We refer to this news as different news. Background: How healthcare professionals deliver different news to parents affects the way they adjust to the situation, the wellbeing of their child and their ongoing engagement with services. This is the first study that examined the lived experience of delivering and receiving different news, in order to inform the development of training for healthcare professionals using the Theoretical Domains Framework version 2. Method: We conducted qualitative interviews with a purposive sample of 9 different parents with the lived experience of receiving different news and 12 healthcare professionals who delivered different news. It was through these descriptions of the lived experience that barriers and facilitators to effectively delivering different news were identified to inform the training programme. Data analysis was guided by Theoretical Domains Framework version 2 to identify these barriers and facilitators as well as the content of a training intervention. Findings: Receiving different news had a significant impact on parents’ emotional and mental wellbeing. They remembered how professionals described their child, the quality of care and emotional support they received. The process had a significant impact on the parent–child relationship and the relationship between the family and healthcare professionals. Delivering different news was challenging for some healthcare professionals due to lack of training. Future training informed by parents’ experiences should equip professionals to demonstrate empathy, compassion, provide a balanced description of conditions and make referrals for further care and support. This can minimise the negative psychological impact of the news, maximise psychological wellbeing of families and reduce the burden on primary care services.

scholarly journals Barriers and facilitators to discontinuing long-term use of benzodiazepine receptor agonists: a qualitative study using the Theoretical Domains Framework

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i20-i20
Author(s):  
T Lynch ◽  
C Ryan ◽  
C Cadogan
Keyword(s):  
Systematic Review ◽  
Behaviour Change ◽  
Healthcare Professionals ◽  
Theoretical Domains Framework ◽  
Benzodiazepine Receptor ◽  
Brief Interventions ◽  
Barriers And Facilitators ◽  
Withdrawal Symptoms ◽  
Structured Interviews

Abstract Introduction Long-term use (>3 months) of benzodiazepine receptor agonists (BZRAs) persists in healthcare settings worldwide despite guidelines recommending short-term use (≤4 weeks). Potential harms of long-term BZRA use include dependence and withdrawal symptoms. A systematic review highlighted that brief interventions targeting long-term BZRA use lacked theoretical underpinning and were often poorly described (1). It is advocated that interventions should be systematically developed and reported, use an appropriate theory-base and involve key stakeholders in their development. Semi-structured interviews based on the Theoretical Domains Framework (TDF) can be used to identify patient-level barriers and facilitators that should be targeted by interventions (2). Aim The aim of this study was to explore the views and experiences of individuals who had previously used BZRAs on a long-term basis through semi-structured interviews and to identify key theoretical domains that acted as barriers and facilitators to discontinuing long-term BZRA use. Methods A multi-strand convenience sampling method was used to recruit participants through community pharmacies, general practices and social media (e.g. Twitter, Instagram). Individuals who had successfully discontinued long-term BZRA use were eligible to participate if they were ≥18 years of age, community dwelling and resident in the Republic of Ireland. Individuals with a: cognitive impairment, history of epilepsy, serious mental illness (e.g. prescribed anti-psychotics) or receiving opioid substitution treatment were excluded. Semi-structured interviews were conducted using a TDF-based topic guide (2). Questions covering each TDF domain were used to explore participants’ perceptions of barriers and facilitators to discontinuing long-term BZRA use. Data were recorded and transcribed verbatim. Transcripts were independently checked for accuracy. Data were analysed using the framework method. Interviews continued until data saturation was achieved. Ethical approval was granted by the RCSI Research Ethics Committee. Results Thirteen patients were interviewed (seven female; median age: 43 years; median duration of use: six years). Key barriers to discontinuing BZRA use were identified under the ‘Emotions’ and ‘Reinforcement’ domains. These included participants’ first-hand experience of withdrawal symptoms and resultant fear towards discontinuation of the medication. ‘Intentions’ and ‘Social influences’ were identified as key theoretical domains that facilitated participants in discontinuing BZRA use. For example, participants described having strong intentions to discontinue BZRA use and discussed the positive influence of healthcare professionals such as community pharmacists in supporting them. Conclusion The study findings indicate that individuals who have successfully discontinued long-term BZRA use often have strong intentions to do so, as well as the support of healthcare professionals. However, challenges to discontinuing BZRA use include withdrawal symptoms and negative emotions towards the discontinuation process. The main strength of this study is that it used the TDF to examine barriers and facilitators to discontinuing long-term BZRA use. A notable limitation was that none of the participants were aged ≥65 years which limits the transferability of the findings. Future work will look to examine the views and experiences of current long-term BZRA users, integrate the findings with this study and map key domains to behaviour change techniques to inform the development of an intervention to reduce long-term BZRA use. References 1. Lynch T, Ryan C, Hughes CM, Presseau J, van Allen ZM, Bradley CP, et al. Brief interventions targeting long-term benzodiazepine and Z-drug use in primary care: a systematic review and meta-analysis. Addiction. 2020;115(9):1618–39. 2. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science. 2012;7(1):37.

Exploring Modes, Strategies, and Psychosocial Consequences of Cyberbullying Perpetration and Victimization Among University Students

2020 ◽  
Vol 34 (4) ◽  
pp. 787-817 ◽  
Author(s):  
Hira Kanwal ◽  
Humaira Jami
Keyword(s):  
University Students ◽  
Social Networking Sites ◽  
Psychological Impact ◽  
Social Consequences ◽  
Cyber Victimization ◽  
Psychological Consequences ◽  
Negative Consequences ◽  
Psychosocial Consequences ◽  
Interview Guide ◽  
Depth Interviews

The purpose of the study was to explore modes, strategies, and consequences of cyberbullying perpetration and victimization among university students. In-depth interviews of 14 volunteer university students (8 male and 6 female) were conducted who volunteered to participate in the study in which 10 participants were “cybervictims” whereas 4 were “cyberbully-victim”. Interview guide was used for conducting unstructured interviews. Thematic analysis of the interviews revealed different experiences in cyberspace with respect to gender and role (cybervictim and cyberbully-victim) in experiencing cyberbullying and cyber-victimization. Three themes emerged that is psychological consequences (emotional, behavioral, and cognitive), social consequences (family and peers), and change in lifestyle (online, offline, and academic). Facebook was found to be the most prevalent mode of cyberbullying. The cyberbully-victim participants derived more happiness while bullying and had revengeful attitude; whereas, cybervictims experienced more depression, increased family surveillance, social isolation, and became aware of negative consequences of social networking sites, became more vigilant and conscious in cyberspace. Moreover, the consequences reported by cyberbully-victim were distrust on security settings, low academic achievement, and their peers learnt from their cyberspace experience. Perception of cyber-victimization was different across gender and its psychological impact was more pronounced for girls than boys. The results and implications were discussed in Pakistani context.

Barriers to Female Condom Use among Undergraduate Health Science Students

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Bongekile T. Dlamini ◽  
Mduduzi Colani Shongwe
Keyword(s):  
Undergraduate Students ◽  
Female Condom ◽  
Sexual Pleasure ◽  
Health Science ◽  
Science Students ◽  
Tertiary Institution ◽  
Health Science Students ◽  
Inadequate Knowledge ◽  
Interview Guide ◽  
Depth Interviews

The female condom (FC), also known as the femidom, has been on the market since 1993, however, its use remains limited in many parts of southern Africa, including in Eswatini (formerly Swaziland). There is a dearth of literature on the reasons for the limited use of the FC, especially from the perspective of health science students who would otherwise be expected to be knowledgeable about and have favourable attitudes to it. The aim of this study was to explore and describe the barriers to FC use among undergraduate health science students at a selected tertiary institution in Eswatini. A qualitative, exploratory descriptive study was conducted among nine conveniently sampled, unmarried undergraduate students at a selected tertiary institution in the Hhohho region in Mbabane, Eswatini. Responses to an unstructured interview guide, using in-depth interviews were analysed thematically following Creswell’s steps of qualitative data analysis. Five themes emerged from the data: (1) inadequate knowledge about the FC, (2) the FC hinders sexual pleasure, (3) insertion of the FC is time-consuming and uncomfortable, (4) the FC is bigger than the vagina, and (5) fear of being labelled “promiscuous”. Generally, the participants stated that they did not use the FC because of societal myths. Therefore, there is a need to strengthen health education campaigns for the femidom to clear the myths and misconceptions that limit its use.

The Science and Art of Interviewing

2020 ◽  
Author(s):  
Kathleen Gerson ◽  
Sarah Damaske
Keyword(s):  
Social Research ◽  
Research Question ◽  
Research Process ◽  
Social Contexts ◽  
Science And Art ◽  
The Social ◽  
Interview Guide ◽  
Hidden Patterns ◽  
User Friendly ◽  
Depth Interviews

Qualitative interviewing is one of the most widely used methods in social research, but it is arguably the least well understood. To address that gap, this book offers a theoretically rigorous, empirically rich, and user-friendly set of strategies for conceiving and conducting interview-based research. Much more than a how-to manual, the book shows why depth interviewing is an indispensable method for discovering and explaining the social world—shedding light on the hidden patterns and dynamics that take place within institutions, social contexts, relationships, and individual experiences. It offers a step-by-step guide through every stage in the research process, from initially formulating a question to developing arguments and presenting the results. To do this, the book shows how to develop a research question, decide on and find an appropriate sample, construct an interview guide, conduct probing and theoretically focused interviews, and systematically analyze the complex material that depth interviews provide—all in the service of finding and presenting important new empirical discoveries and theoretical insights. The book also lays out the ever-present but rarely discussed challenges that interviewers routinely encounter and then presents grounded, thoughtful ways to respond to them. By addressing the most heated debates about the scientific status of qualitative methods, the book demonstrates how depth interviewing makes unique and essential contributions to the research enterprise. With an emphasis on the integral relationship between carefully crafted research and theory building, the book offers a compelling vision for what the “interviewing imagination” can and should be.

scholarly journals FRI0526 THE INCIDENCE, PREVALENCE AND MEDICATION USE OF RHEUMATOID ARTHRITIS AMONG KOREAN WOMEN IN CHILDBEARING YEARS: A NATIONWIDE POPULATION-BASED STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 862.2-863
Author(s):  
M. K. Chung ◽  
J. S. Park ◽  
H. S. Lim ◽  
C. H. Lee ◽  
J. Lee
Keyword(s):  
Rheumatoid Arthritis ◽  
Lupus Erythematosus ◽  
Medication Use ◽  
Population Based ◽  
Korean Women ◽  
Childbearing Age ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Disease Modifying ◽  
Incidence Prevalence

Background:Rheumatoid arthritis (RA) predominantly affects women and has a significant impact on childbearing. Several population-based studies identifying incidence, prevalence, and medication use of RA have been reported, yet epidemiological studies focusing on women with RA in childbearing years are missing.Objectives:We aimed to identify the incidence, prevalence and medication use of RA among Korean women in childbearing years.Methods:From National Health Insurance Service (NHIS) data (2009-2016), containing inpatient and outpatient claim information for approximately 97% of the Korean population, we identified 9,217,139 women aged between 20-44 years. Incidence and prevalence of RA in the specific sociodemographic group of women in childbearing age were analyzed, and the prevalence of medication prescription were compared between women with RA and controls without rheumatic diseases such as RA, systemic lupus erythematosus, and ankylosing spondylitis. Individuals with RA were defined by the presence of International Classification of Disease, 10th revision code, M05. The medication use was defined as receiving > 90days prescriptions of NSAIDs, corticosteroids (CSs), and conventional synthetic (cs) disease modifying antirheumatic drugs (DMARDs) or > 1day prescription of biologic (b) DMARDs.Results:Total 24,590 women with RA were identified. The average incidence of RA during 2011-2016 among women in childbearing years was 24.1/100,000 person-years (PYs) (95% CI 20.91-27.31) with a yearly increase from 20.99/100,000 PYs in 2011 to 28.38/100,000 PYs in 2016. The average prevalence of RA during 2009-2016 among women in childbearing years was 105.2/100,000 PYs (95% CI 99.0-111.5) with a minimum of 95.7/100,000 PYs in 2009 and a maximum of 110.5/100,000 PYs in 2016. There were increasing trends in both incidence and prevalence of RA according to age among women in childbearing years peaking in the age group of 40-44 years. The prescriptions of NSAIDs, CSs, csDMARDs and bDMARDs were more frequent in women with RA than controls (NSAIDs; 94.21% vs 21.79%, CSs; 83.65% vs 4.28%, csDMARDs; 91.23% vs 0.41%, bDMARDs; 0.11% vs 0%, p<0.001).Conclusion:The incidence and prevalence of RA are high among Korean women in childbearing years, and medication use was significantly more frequent in this specific population than controls. High disease burden is imposed upon women in childbearing years.References:[1] Won S, Cho SK, Kim D, Han M, Lee J, Jang EJ, Sung YK, Bae SC: Update on the prevalence and incidence of rheumatoid arthritis in Korea and an analysis of medical care and drug utilization. Rheumatol Int 2018, 38(4):649-656.[2] Smeele HTW, Dolhain R: Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Seminars in arthritis and rheumatism 2019, 49(3s):S32-s35.Table 1.Medication use among women with RA and controls in childbearing age between 20-44 years during 2009-2016Control(n=155,486)RA(n=23,756)n(%)n(%)PNSAIDs33,887(21.79)22,380(94.21)<.0001Steroids6,653(4.28)19,871(83.65)<.0001csDMARDs634(0.41)21,673(91.23)<.0001bDMARDs0(0.00)27(0.11)<.0001RA, rheumatoid arthritis; NSAID, non-steroidal anti-inflammatory drug; cs, conventional synthetic; b, biologic; DMARDs, disease modifying antirheumatic drugsDisclosure of Interests:None declared

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