Exploration of sedentary behaviour among general practitioners: protocol for a mixed methods study

Background: Many general practitioners (GPs) are sedentary for most of their working day. Levels of sedentary behaviour may have been exacerbated by increased use of telemedicine in light of the COVID-19 pandemic, as this is traditionally performed while sitting down. Excessive sedentary behaviour is associated with many adverse health outcomes and increased all-cause mortality. This study will gain quantitative data on levels of sedentary behaviour among GPs and general practice specialty trainees (GPSTs), to identify to what extent general practice is a sedentary occupation, as well as qualitative data regarding the barriers and facilitators to reducing sedentary behaviour in the general practice setting.Methods: The study follows a sequential, mixed-methods model. The first stage will involve the dissemination of a questionnaire survey, where participants self-estimate their sedentary behaviour on a working day and on a non-working day. The second stage will use thigh-worn accelerometers and a sleep/work log to obtain objective data regarding sedentary behaviour among a purposive subset of participants who responded to the questionnaire. The third stage will involve semi-structured interviews with a purposive subset of accelerometer study participants, analysed with the application of a theoretical framework regarding the acceptability of healthcare interventions.Conclusions: This paper outlines a protocol for a sequential, mixed-methods study exploring sedentary behaviour among GPs and GPSTs. Findings of this study will shed light on the new ways of working as a result of the COVID-19 pandemic, which will be relevant to clinicians working in similar primary care settings throughout the world.Trial Registration: ClinicalTrials.gov Identifier: NCT04556695. Date of registration: 21st September 2020.

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General Practitioners’ Attitudes toward Municipal Initiatives to Improve Antibiotic Prescribing—A Mixed-Methods Study

Antibiotics ◽

10.3390/antibiotics8030120 ◽

2019 ◽

Vol 8 (3) ◽

pp. 120 ◽

Cited By ~ 3

Author(s):

Marthe Sunde ◽

Marthe Marie Nygaard ◽

Sigurd Høye

Keyword(s):

General Practice ◽

Quality Improvement ◽

Mixed Methods ◽

General Practitioners ◽

Treatment Guidelines ◽

National Level ◽

Medical Officer ◽

Mixed Methods Study ◽

Antibiotic Prescribing ◽

E Mail

Antimicrobial stewardship (AMS) interventions directed at general practitioners (GPs) contribute to an improved antibiotic prescribing. However, it is challenging to implement and maintain such interventions at a national level. Involving the municipalities’ Chief Medical Officer (MCMO) in quality improvement activities may simplify the implementation and maintenance, but may also be perceived challenging for the GPs. In the ENORM (Educational intervention in NORwegian Municipalities for antibiotic treatment in line with guidelines) study, MCMOs acted as facilitators of an AMS intervention for GPs. We explored GPs’ views on their own antibiotic prescribing, and their views on MCMO involvement in improving antibiotic prescribing in general practice. This is a mixed-methods study combining quantitative and qualitative data from two data sources: e-mail interviews with 15 GPs prior to the ENORM intervention, and online-form answers to closed and open-ended questions from 132 GPs participating in the ENORM intervention. The interviews and open-ended responses were analyzed using systematic text condensation. Many GPs admitted to occasionally prescribing antibiotics without medical indication, mainly due to pressure from patients. Too liberal treatment guidelines were also seen as a reason for overtreatment. The MCMO was considered a suitable and acceptable facilitator of quality improvement activities in general practice, and their involvement was regarded as unproblematic (scale 0 (very problematic) to 10 (not problematic at all): mean 8.2, median 10). GPs acknowledge the need and possibility to improve their own antibiotic prescribing, and in doing so, they welcome engagement from the municipality. MCMOs should be involved in quality improvement and AMS in general practice.

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Engagement with and delivery of the ‘parkrun practice initiative’ in general practice: a mixed methods study

British Journal of General Practice ◽

10.3399/bjgp20x710453 ◽

2020 ◽

Vol 70 (697) ◽

pp. e573-e580

Author(s):

Joanna Fleming ◽

Carol Bryce ◽

Joanne Parsons ◽

Chrissie Wellington ◽

Jeremy Dale

Keyword(s):

General Practice ◽

Mixed Methods ◽

Focus Group ◽

Online Survey ◽

Mixed Methods Study ◽

Structured Interviews ◽

Practice Staff ◽

Health And Wellbeing ◽

Positive Effects ◽

Improve Patient

BackgroundThe parkrun practice initiative, a joint collaboration between parkrun and the Royal College of General Practitioners, was launched to encourage general practices to improve the health and wellbeing of patients and staff through participating in local 5 km parkrun events. Why and how practices engage with the initiative is unknown.AimTo investigate engagement with and delivery of the parkrun practice initiative in general practice.Design and settingMixed methods study conducted from April–July 2019 comprising an online survey of all registered parkrun practices, and interviews and a focus group with practice staff in the West Midlands.MethodThe designated contacts at 780 registered parkrun practices were invited to complete an online survey. A purposive sample of parkrun practice staff and non-registered practice staff took part either in semi-structured interviews or a focus group, with transcripts analysed thematically.ResultsOf the total number of parkrun practices, 306 (39.2%) completed the survey. Sixteen practice staff (from nine parkrun practices and four non-registered practices) took part in either semi-structured interviews (n = 12) or a focus group (n = 4). Key motivators for becoming a parkrun practice were: to improve patient and staff health and wellbeing, and to become more engaged with the community and enhance practice image. Practices most commonly encouraged patients, carers, and staff to take part in parkrun and displayed parkrun flyers and posters. Challenges in implementing activities included lack of time (both personal and during consultations) and getting staff involved. Where staff did engage there were positive effects on morale and participation. Non-registered practices were receptive to the initiative, but had apprehensions about the commitment involved.ConclusionPractices were keen to improve patient and staff health. Addressing time constraints and staff support needs to be considered when implementing the initiative.

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A mixed methods study exploring the views and experiences of internationally qualified midwives in Australia: Research Protocol (Preprint)

10.2196/preprints.13406 ◽

2019 ◽

Author(s):

Mitra Javanmard ◽

Mary Steen ◽

Rachael Vernon ◽

Megan Cooper

Keyword(s):

Mixed Methods ◽

South Australia ◽

Mixed Methods Study ◽

Second Phase ◽

Snowball Sampling ◽

Structured Interviews ◽

Human Research Ethics ◽

Sequential Mixed Methods ◽

Transitional Experiences ◽

Two Phases

BACKGROUND Approximately, 13% of the total Australian midwifery workforce is internationally qualified. Although they play a significant role in the Australian midwifery system, there is limited understanding of their transitional experiences. OBJECTIVE This mixed methods study aims to explore the transitional experiences and perspectives of internationally qualified midwives practising in Australia. METHODS This study uses an explanatory sequential mixed methods design incorporating two phases. The first phase of the study includes an e-survey that will be distributed to internationally qualified midwives in Australia, via the website e-bulletins of the Australian Nursing and Midwifery Federation and Australian College of Midwives. Additionally, potential respondents will be recruited via social media (Twitter, Facebook) and associated snowball sampling. At the end of the e-survey, respondents will be asked whether they are willing to take part in an interview. Data from the e-survey will be statistically analysed. The results of the e-survey and literature review will help to develop a guide for interview questions, with these interviews taking place during the second phase. A nested sample of participants will be created using the same selection criteria as for the e-survey. Semi-structured interviews will provide a deeper insight into the transitional experiences of internationally qualified midwives. Data will then be thematically analysed. RESULTS An integration of the e-survey results and interview findings will be synthesised to explore and better understand the transitional experiences of this group of midwives. The resulting data may potentially be used to formulate recommendations for future recruitment and retention practices, and to aid the Australian midwifery workforce in valuing diversity and fostering a supportive work environment. CONCLUSIONS At the time of writing this protocol, data collection had not yet commenced, however collection was subsequently completed in late 2018 and analysis is currently underway. CLINICALTRIAL This study was approved by the University of South Australia Human Research Ethics Committee (Protocol Number: 0000036397).

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Examining the Transition Networks of Secondary Special Educators: An Explanatory Sequential Mixed Methods Study

Remedial and Special Education ◽

10.1177/07419325211063485 ◽

2021 ◽

pp. 074193252110634

Author(s):

Jennifer L. Bumble ◽

Erik W. Carter ◽

Emily M. Kuntz

Keyword(s):

Mixed Methods ◽

Special Educators ◽

Transition Process ◽

Severe Disabilities ◽

Mixed Methods Study ◽

School Level ◽

Structured Interviews ◽

High School Level ◽

Sequential Mixed Methods ◽

Transition Networks

Successful outcomes for youth with disabilities require collaboration within and beyond the school system. Collaboration ideally includes a range of professionals across school systems, service systems, and communities coming together as part of a “transition network” to support the transition process. Using a quantitative survey of 509 secondary special educators and 25 semi-structured interviews, this explanatory sequential mixed methods study (a) examined the characteristics of transition networks (i.e., the social networks of secondary special educators), (b) identified variables associated with larger networks, and (c) explored educators’ interpretations of these associations. Quantitative analyses indicated that larger networks were associated with working at the high school level, supporting students with moderate/severe disabilities, increased years of experience, and greater knowledge about establishing collaborative partnerships. Interview analyses provided context for the quantitative results. These findings provide a deeper portrait of prevailing transition collaborations and have implications for educators charged with delivering high-quality transition programming.

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Primary prevention in general practice – views of German general practitioners: a mixed-methods study

BMC Family Practice ◽

10.1186/1471-2296-15-103 ◽

2014 ◽

Vol 15 (1) ◽

Cited By ~ 10

Author(s):

Christine Holmberg ◽

Giselle Sarganas ◽

Nadine Mittring ◽

Vittoria Braun ◽

Lorena Dini ◽

...

Keyword(s):

General Practice ◽

Mixed Methods ◽

Primary Prevention ◽

General Practitioners ◽

Mixed Methods Study

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A mixed methods study on medicines information needs and challenges in New Zealand general practice

BMC Family Practice ◽

10.1186/s12875-021-01451-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Chloë Campbell ◽

Rhiannon Braund ◽

Caroline Morris

Keyword(s):

General Practice ◽

Mixed Methods ◽

New Zealand ◽

Side Effects ◽

General Practitioners ◽

Information Needs ◽

Qualitative Data ◽

Mixed Methods Study ◽

Information Support ◽

Medicines Information

Abstract Background Medicines are central to healthcare in aging populations with chronic multi-morbidity. Their safe and effective use relies on a large and constantly increasing knowledge base. Despite the current era of unprecedented access to information, there is evidence that unmet information needs remain an issue in clinical practice. Unmet medicines information needs may contribute to sub-optimal use of medicines and patient harm. Little is known about medicines information needs in the primary care setting. The aim of this study was to investigate the nature of medicines information needs in routine general practice and understand the challenges and influences on the information-seeking behaviour of general practitioners. Methods A mixed methods study involving 18 New Zealand general practitioner participants was undertaken. Quantitative data were collected to characterize the medicines information needs arising during 642 consultations conducted by the participants. Qualitative data regarding participant views on their medicines information needs, resources used, challenges to meeting the needs and potential solutions were collected by semi-structured interview. Integration occurred by comparison of results from each method. Results Of 642 consultations, 11% (n = 73/642) featured at least one medicines information need. The needs spanned 14 different categories with dosing the most frequent (26%) followed by side effects (15%) and drug interactions (14%). Two main themes describing the nature of general practitioners’ medicines information needs were identified from the qualitative data: a ‘common core’ related to medicine dose, side effects and interactions and a ‘perplexing periphery’. Challenges in the perplexing periphery were the variation in information needs, complexity, ‘known unknowns’ and ‘unknown unknowns’. Key factors affecting general practitioners’ strategies for meeting medicines information needs were trust in a resource, presence of the patient, how the information was presented, scarcity of time, awareness of the existence of a resource, and its accessibility. Conclusions General practitioners face challenges in meeting wide-ranging medicines information needs in patients with increasingly complex care needs. Recognising the challenges and factors that influence resource use in practice can inform optimisation of medicines information support resources. Resources for general practitioners must take into account the complexity and time constraints of real-world practice. An individually responsive approach involving greater collaboration with pharmacists and specialist medicines information support services may provide a potential solution.

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‘Motivational work’: a qualitative study of preventive health dialogues in general practice

BMC Family Practice ◽

10.1186/s12875-020-01249-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Marie Broholm-Jørgensen ◽

Siff Monrad Langkilde ◽

Tine Tjørnhøj-Thomsen ◽

Pia Vivian Pedersen

Keyword(s):

General Practice ◽

General Practitioners ◽

Support System ◽

Preventive Intervention ◽

Digital Health ◽

Clinical Encounter ◽

Preventive Health ◽

Structured Interviews ◽

General Practices ◽

Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

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Risk perception on the labour ward: A mixed methods study

Journal of Patient Safety and Risk Management ◽

10.1177/25160435211002428 ◽

2021 ◽

Vol 26 (2) ◽

pp. 56-63

Author(s):

Claire McCarthy ◽

Sarah Meaney ◽

Marie Rochford ◽

Keelin O’Donoghue

Keyword(s):

Mixed Methods ◽

Lived Experience ◽

Healthcare Providers ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Daily Basis ◽

Mixed Methods Study ◽

Structured Interviews ◽

Staff Support ◽

Staff Wellbeing

Healthcare providers commonly experience risky situations in the provision of maternity care, and there has been increased focus on the lived experience in recent years. We aimed to assess opinions on, understanding of and behaviours of risk on the LW by conducting a mixed methods study. Staff working in a LW setting completed a descriptive questionnaire-based study, followed by qualitative structured interviews. Statistical analysis was performed with SPSS on quantitative data and thematic analysis performed on qualitative data. Nearly two thirds of staff (64%; 73/114) completed the questionnaire, with 56.2% (n = 47) experiencing risk on a daily basis. Experiencing risk evoked feelings of apprehension (68.4%; n = 50) and worry (60.2%; n = 44) which was echoed in the qualitative work. Structured clinical assessment was utilised in risky situations, and staff described “ going on autopilot” to manage these situations. A large number of respondents reflected on their provision of care following an adverse event (87.7%; n = 64). Debriefing was mentioned as an important practice following such events by all respondents. This study describes the negative terminology prevailing in emergency obstetric care. These experiences can have a profound impact on staff. Risk reduction strategies and the provision of increased staff support and training are crucial to improve staff wellbeing in stressful scenarios.

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Nurses’ educational needs when dealing with aggression from patients and their families: a mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2020-041711 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041711

Author(s):

Kana Sato ◽

Yoshimi Kodama

Keyword(s):

Mixed Methods ◽

Nursing Students ◽

Phase I ◽

Phase Ii ◽

Mixed Methods Study ◽

Self Awareness ◽

Two Phase ◽

Sequential Mixed Methods ◽

Nursing Professionals ◽

Educational Contents

ObjectivesTo explore the type of education needed for nurses when dealing with aggression from patients and their families.DesignA two-phase sequential mixed-methods study.SettingThis study was conducted in Japan, with phase I from March to November 2016 and phase II in November 2018.Main outcome measuresThe challenges faced by nurses when dealing with incidents of aggression from the neutral perspective of neither nurse nor patient/family and perceptions of the educational contents developed in this study. Descriptive analyses were used to examine the data retrieved from both phases.ParticipantsPhase I entailed semistructured interviews among 11 neutral-party participants who observed aggressive incidents between nurses and patients/families. Phase II consisted of a web survey conducted among 102 nursing students and 308 nursing professionals.ResultsPhase I resulted in the identification of the following five main educational components: understanding the mechanisms of anger and aggression, maintaining self-awareness, observant listening, managing the self-impression, and communicating based on specific disease characteristics. Each component was related to improved communication through self-awareness. The results of phase II indicated that participants positively perceived these educational contents as likely to be effective for dealing with aggression from patients/families.ConclusionsThis study clarified the type of education needed for nurses when dealing with aggression based on multiple viewpoints. Specifically, neutral-party interviews revealed that communication should be improved through self-awareness. A subsequent survey among nurses and nursing students showed that the identified educational contents were positively received.

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An intervention to decrease burnout and increase retention of early career nurses: a mixed methods study of acceptability and feasibility

BMC Nursing ◽

10.1186/s12912-020-00524-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Judy Brook ◽

Leanne M. Aitken ◽

Julie-Ann MacLaren ◽

Debra Salmon

Keyword(s):

Mixed Methods ◽

Nursing Students ◽

Focus Groups ◽

Academic Staff ◽

Skills Training ◽

Early Career ◽

Mixed Methods Study ◽

Healthcare Organisation ◽

Structured Interviews ◽

Over Time

Abstract Aims To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre. Background Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses. Methods This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention. Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoretical Framework of Acceptability. Wilcoxon Signed Ranks test was used to assess change in acceptability over time. Qualitative data from semi-structured interviews, focus groups and field notes were thematically analysed, adhering to COREQ guidelines. Data were collected February to December 2019. Results One hundred and five questionnaires, 12 interviews with students and 2 focus groups engaging 7 academic staff were completed. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Student nurses perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Challenges related to the practice environment and academic assessment pressures. Reported benefits align with known protective factors against burnout and leaving the profession. Conclusion Planning is needed to embed the intervention into curricula and maximise relationships with placement partners. Evaluating acceptability and feasibility offers new knowledge about the value of the intervention for increasing retention and decreasing burnout for early career nurses. Wider implementation is both feasible and recommended by participants.

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