scholarly journals Do checklist-induced behavioral changes improve self-confidence in fundoscopic examination?: A mixed-methods study

2020 ◽  
Author(s):  
Daiki Yokokawa ◽  
Kiyoshi Shikino ◽  
Akiko Ikegami ◽  
Tomoko Tsukamoto ◽  
Kazutaka Noda ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Phase 1 ◽  
General Medicine ◽  
Behavioral Changes ◽  
University Hospital ◽  
Theory Approach ◽  
Mixed Methods Design ◽  
Self Confidence ◽  
Two Phases ◽  
Grounded Theory Approach

Abstract Background Fundoscopic exams are conducted during outpatient consultations to assess intracranial disease and complications from chronic diseases. Low level of confidence in these skills which physicians have is one of the causes that Implementation frequency is low. We quantitatively verified increases in exam implementation for patients suggested for fundoscopic exams, as well as improvements in physicians' confidence in the procedures, by introducing a checklist. We also conducted a qualitative analysis in order to clarify the process by which they gain confidence in examination procedures. Methods This study is a before-after study, within an embedded-experimental mixed methods design. Phase 1 spans April to May 2016, April to May 2017, and October to November 2017. Phase 2 spans the two months following each phase 1 period. We sampled 15 physicians in department of general medicine at a university hospital assigned to initial consultation. The introduction of a checklist that verifies whether the fundoscopic exam was implemented. Measures are implementation ratio of the fundoscopic exam to the total number of indication cases, and Visual Analog Scale (VAS) values ​​for the confidence in procedure are measured between the two phases. To analyze, we obtained qualitative data from interviews and used the Modified Grounded Theory Approach. Results We observed significant increases in the implementation ratio (19.2% (29/151 cases) vs. 64.8% (105/162 cases), p<0.001), and in the VAS value for the confidence (1.89mm vs 4.68 mm (p<0.001)) between the two phases. Analysis of the interviews produced five themes from the initial 632 codes, 31 concepts (with <>), and 8 categories. To increase the implementation, it is necessary to reduce the and < Forgetting>, which is preventing by the checklist. The <Lack of successful experiences in detecting abnormalities> leads to a <Lack of confidence>. Repeated executions result in <Successful experiences and confidence building>.Conclusions The intervention increased the implementation ratio, thereby increasing successful experiences and confidence among physicians. The growth of confidence boosted motivations to implement fundoscopic exams.

scholarly journals Do checklist-induced behavioral changes improve self-confidence in fundoscopic examination?: A mixed-methods study

2020 ◽  
Author(s):  
Daiki Yokokawa ◽  
Kiyoshi Shikino ◽  
Akiko Ikegami ◽  
Tomoko Tsukamoto ◽  
Kazutaka Noda ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Phase 1 ◽  
General Medicine ◽  
Behavioral Changes ◽  
Mixed Methods Study ◽  
University Hospital ◽  
Mixed Methods Design ◽  
Self Confidence ◽  
Two Phases ◽  
Fundoscopic Examination

Abstract BackgroundFundoscopic exams are conducted during outpatient consultations to assess intracranial disease and complications from chronic diseases. Low level of confidence in these skills which physicians have is one of the causes that Implementation frequency is low. We quantitatively verified increases in exam implementation for patients suggested for fundoscopic exams, as well as improvements in physicians' confidence in the procedures, by introducing a checklist. We also conducted a qualitative analysis in order to clarify the process by which they gain confidence in examination procedures.MethodsThis study is a before-after study, within an embedded-experimental mixed methods design. Phase 1 spans April to May 2016, April to May 2017, and October to November 2017. Phase 2 spans the two months following each phase 1 period. We sampled 15 physicians in department of general medicine at a university hospital assigned to initial consultation. The introduction of a checklist that verifies whether the fundoscopic exam was implemented. Measures are implementation ratio of the fundoscopic exam to the total number of indication cases, and Visual Analog Scale (VAS) values ​​for the confidence in procedure are measured between the two phases. To analyze, we obtained qualitative data from interviews and used the Modified Grounded Theory Approach.ResultsWe observed significant increases in the implementation ratio (19.2% (29/151 cases) vs. 64.8% (105/162 cases), p<0.001), and in the VAS value for the confidence (1.89mm vs 4.68 mm (p<0.001)) between the two phases. Analysis of the interviews produced five themes from the initial 632 codes, 31 concepts (with <>), and 8 categories. To increase the implementation, it is necessary to reduce the <Lack of confidence> and < Forgetting>, which is preventing by the checklist. The <Lack of successful experiences in detecting abnormalities> leads to a <Lack of confidence>. Repeated executions result in <Successful experiences and confidence building>.ConclusionsThe intervention increased the implementation ratio, thereby increasing successful experiences and confidence among physicians. The growth of confidence boosted motivations to implement fundoscopic exams.

The importance of dignity and choice for people assessed as having intellectual disabilities

2020 ◽  
pp. 174462952090520
Author(s):  
Savra Anne Frounfelker ◽  
Anne Bartone
Keyword(s):  
New York ◽  
Day Treatment ◽  
Comparative Method ◽  
Theory Approach ◽  
Group Settings ◽  
Self Confidence ◽  
Constant Comparative Method ◽  
Day Habilitation ◽  
Grounded Theory Approach

Individuals assessed as having an intellectual disability often spend a significant amount of time in day treatment/day habilitation programs after they graduate from school. The quality of these programs varies widely and is not federally legislated. The purpose of the current study is both to explore factors that lead to higher satisfaction for participants in these programs and to better understand what participants want in a program. Using a grounded theory approach, researchers interviewed 25 participants, staff, and family members in focus group settings to collect qualitative data. Interviews focused on what worked and what could be improved at a program located in Western New York. Using the constant comparative method, themes emerged from the data that pointed to the importance of dignity and choice in a day program to facilitate empowerment, higher levels of satisfaction and self-confidence.

scholarly journals The Flipped Classroom Is Effective for Medical Students to Improve Deep Tendon Reflex Examination Skills: A Mixed-Method Study

2021 ◽  
Author(s):  
Shun Uchida ◽  
Kiyoshi Shikino ◽  
Kosuke Ishizuka ◽  
Yosuke Yamauchi ◽  
Yasutaka Yanagita ◽  
...  
Keyword(s):  
Medical Students ◽  
Flipped Classroom ◽  
Deep Tendon Reflex ◽  
Intervention Group ◽  
General Medicine ◽  
Likert Scale ◽  
University Hospital ◽  
Control Group ◽  
Self Confidence ◽  
Before And After

Abstract Background: Deep tendon reflexes (DTR) are a prerequisite skill in clinical clerkships. However, many medical students are not confident in their technique and need to be effectively trained. We evaluated the effectiveness of a flipped classroom for teaching DTR skills. Methods: We recruited 83 fifth-year medical students who participated in a clinical clerkship at the Department of General Medicine, Chiba University Hospital, from November 2018 to July 2019. They were allocated to the flipped classroom technique (intervention group, n=39) or the traditional technique instruction group (control group, n=44). Before procedural teaching, while the intervention group learned about DTR by e-learning, the control group did so face-to-face. A 5-point Likert scale was used to evaluate self-confidence in DTR examination before and after the procedural teaching (1=no confidence, 5=confidence). We evaluated the mastery of techniques after procedural teaching using the Direct Observation of Procedural Skills (DOPS). Unpaired t-test was used to analyze the results of the 5-point Likert scale and DOPS. We assessed self-confidence in DTR examination before and after procedural teaching using a free description questionnaire in the two groups. Additionally, in the intervention group, focus group interviews (FGI) (7 groups, n=39) were conducted to assess the effectiveness of the flipped classroom after procedural teaching.Results: Pre-test self-confidence in the DTR examination was significantly higher in the intervention group than in the control group (2.8 vs. 2.3, P=0.005). Post-test self-confidence in the DTR examination was not significantly different between the two groups (3.9 vs. 4.1, P=0.31), and so was mastery (4.3 vs. 4.1, P=0.68). The questionnaires before the procedural teaching revealed themes common to the two groups, including “lack of knowledge” and “lack of self-confidence.” Themes about prior learning, including “acquisition of knowledge” and “promoting understanding,” were specific in the intervention group. The FGI revealed themes including “application of knowledge,” “improvement in DTR technique,” and “increased self-confidence.” Conclusions: Teaching DTR skills to medical students in flipped classrooms improves readiness for learning and increases self-confidence in performing the procedure at a point before procedural teaching.

scholarly journals Do Checklist-Induced Behavioral Changes Improve Self-Confidence in Fundoscopic Examination? A Mixed-Methods Study

2020 ◽  
Vol Volume 13 ◽  
pp. 1219-1228
Author(s):  
Daiki Yokokawa ◽  
Kiyoshi Shikino ◽  
Akiko Ikegami ◽  
Tomoko Tsukamoto ◽  
Kazutaka Noda ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Behavioral Changes ◽  
Mixed Methods Study ◽  
Self Confidence ◽  
Fundoscopic Examination

scholarly journals An integrative counselling program to promote active ageing for older people in Thai nursing homes: an intervention mixed methods design

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jantana Juthavantana ◽  
Nanchatsan Sakunpong ◽  
Ujsara Prasertsin ◽  
Monthira Charupheng ◽  
Sheibon Hassakama Lau
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Nursing Homes ◽  
Older People ◽  
Phase 1 ◽  
The Elderly ◽  
Active Ageing ◽  
Phase 2 ◽  
Mixed Methods Design ◽  
Counselling Program

Abstract Background Active ageing has been a rapidly developing field of study in light of the growing population of older people. Acknowledgement of the lack of a counselling program to promote active ageing for the older people in nursing homes led to the development of this study which aims to investigate active ageing of the Thai elderly in a nursing home in addition to promoting active ageing for them through integrative counselling. Methods The study was conducted in a nursing home in Samut Prakan province, Thailand. The integrative counselling program referred to appropriate literature along with implementation of the Satir Model and Motivational Interviewing techniques. An intervention mixed methods design was applied in the study, which consisted of two phases. Phase 1 involved an investigation of the concept of active ageing, based on the context of older people in nursing homes by way of in-depth interviews, involving 5 participants. Phase 2 comprised of an investigation of the effects of an integrative counselling program to promote active ageing for older people in the same nursing home. There was a total of 16 participants in phase 2 which were divided equally into experimental and control groups respectively. Results Phase 1 of the study showcased qualitative results of the progress of active ageing development in older people that resulted in 4 sub-themes (Health development, spiritual development, active engagement and psychosocial support). Two parameters were used to analyze the results in phase 2. The quantitative results showed that the active ageing score of participants in the experimental arm increased significantly after enrollment (p < 0.05). Furthermore, the experimental group had a higher overall active ageing score in comparison to the control group. Qualitative results of phase 2 elicited factors promoting active ageing in the elderly which included activities, group facilitator and group atmosphere. Both quantitative and qualitative results of phase 2 proved to be significant, showing that the program managed to develop active ageing in participants. Conclusion Psychologists and multidisciplinary teams looking after older people in nursing homes are able to use this integrative counselling program for development of active ageing in the elderly population.

“The Health Education Juggler”

2014 ◽  
Vol 114 (5) ◽  
pp. 398-412 ◽  
Author(s):  
Gitte Engelund ◽  
Ulla Møller Hansen ◽  
Ingrid Willaing
Keyword(s):  
Patient Education ◽  
Health Education ◽  
Second Phase ◽  
Theory Approach ◽  
Comprehensive Model ◽  
Content Type ◽  
Analyse Data ◽  
Two Phases ◽  
Grounded Theory Approach ◽  
Practical Implications

Purpose – The purpose of this paper is to explore educator competencies and roles needed to perform participatory patient education, and develop a comprehensive model describing this. Design/methodology/approach – Data collection in the qualitative study proceeded through two phases. In the first phase, 28 educators were involved in exploring educator competencies needed to perform participatory, group-based patient education. The paper used qualitative methods: dialogue workshops, interviews and observations. In the second phase, 310 educators were involved in saturating and validating the insights from phase one using workshop techniques such as brainstorming, reflection exercises and the story-dialogue method. A grounded theory approach was used to analyse data. Findings – A model called “The Health Education Juggler” was developed comprising four educator roles necessary to perform participatory patient education: the Embracer, the Facilitator, the Translator and the Initiator. The validity of the model was confirmed in phase two by educators and showed fit, grab, relevance, workability and modifiability. Practical implications – The model provides a tool that can be used to support the focus on “juggling” skills in educators: the switching between different educator roles when performing participatory, group-based patient education. The model is useful as an analytical tool for reflection and supervision, as well as for observation and evaluation of participatory, group-based patient education. Originality/value – The study proposes a comprehensive model consisting of four equally important roles for educators performing participatory, group-based patient education.

scholarly journals ‘Cold bedrooms’ and other cooling facilities in UK children’s hospices, how they are used and why they are offered: A mixed methods study

2021 ◽  
pp. 026921632098433
Author(s):  
Julia Hackett ◽  
Bryony Beresford
Keyword(s):  
Mixed Methods ◽  
The Body ◽  
Mixed Methods Study ◽  
Routine Practice ◽  
Mixed Methods Design ◽  
Support Intervention ◽  
Telephone Interviews ◽  
Explanatory Mixed Methods ◽  
Two Phases ◽  
Changes Over Time

Background: The death of a child is acutely distressing. Evidence on the benefits and value to parents of spending time with their dead child have now been integrated into routine practice and is regarded as a bereavement support intervention. UK children’s hospices have a tradition of using ‘cooling facilities’ (cold bedrooms, cooled blanket/mattress) to extend this period of time by slowing deterioration of the body. Aims: To describe: (1) type and use of cooling facilities in UK children’s hospices, policies and practices regarding their use, and any changes over time. (2) Director of care’s views on the purpose of cooling facilities and the rationale for hospice-specific practices. Methods: An explanatory mixed-methods design consisting two phases: a crosssectional survey of directors of care of UK children’s hospices ( n = 52) followed by semi-structured telephone interviews with a sub-sample of respondents. Survey data were analysed using descriptive statistics and interview data using directed content analysis. Results: 41/52 hospices completed the survey and 13 directors of care were interviewed. All hospices had cooling facilities. Some offered use of portable cooling facilities at home, though take-up appears low. Hospices differed in approaches to managing care and duration of use. Views on whether parents should observe deterioration informed the latter. Directors of care believed they provide families with time to say ‘goodbye’ and process their loss. Challenges for staff were reported.

scholarly journals Identifying Positive Adaptive Pathways in Low-Income Families in Singapore: Protocol for Sequential, Longitudinal Mixed-Methods Design (Preprint)

2018 ◽  
Author(s):  
Esther Chor Leng Goh ◽  
Wan Har Chong ◽  
Jayashree Mohanty ◽  
Evelyn Chung Ning Law ◽  
Chin-Ying Stephen Hsu ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Home Environment ◽  
Low Income ◽  
Child Outcomes ◽  
Phase 1 ◽  
Financial Stress ◽  
Relational Theory ◽  
Mixed Methods Design ◽  
The Social ◽  
Low Income Families

BACKGROUND This study aims to examine the adaptive process of children and mothers from multistressed low-income families in Singapore. It aims to bridge the knowledge gap left by existing poverty studies, which are predominately risk focused. Through a sequential longitudinal mixed-methods design, we will differentiate children and mothers who demonstrate varied social, developmental, and mental health trajectories of outcomes. Through utilizing the Latent Growth Curve Model (LGCM), we aim to detect the development and changes of the positive Family Agency and adaptive capacities of these families over time. The construct of Family Agency is underpinned by the theoretical guidance from the Social Relational Theory, which examines child agency, parent agency, relational agency, and the interactions among these members. It is hypothesized that positive Family Agency within low-income families may lead to better outcomes. The key research questions include whether the extent of positive Family Agency mediates the relationship among financial stress, resource utilization, home environment, and parental stress. OBJECTIVE The study elucidates the Family Agency construct through interviews with mother-child dyads. It also aims to understand how financial stress and resources are differentially related to home environment, parent stress, and parent and child outcomes. METHODS In phase 1, 60 mother-child dyads from families receiving government financial assistance and with children aged between 7 and 12 years will be recruited. In-depth interviews will be conducted separately with mothers and children. On the basis of 120 interviews, a measurement for the construct of Family Agency will be developed and will be pilot tested. In phase 2a, a longitudinal survey will be conducted over 3 time points from 800 mother-child dyads. The 3 waves of survey results will be analyzed by LGCM to identify the trajectories of adaptation pathways of these low-income families. In addition, 10 focus groups with up to 15 participants in each will be conducted to validate the LGCM results. RESULTS This project is funded by the Social Science Research Thematic Grant (Singapore). The recruitment of 60 mother-child dyads has been achieved. Data collection will commence once the amendment to the protocol has been approved by the Institutional Review Board. Analysis of phase 1 data will be completed by the end of the first quarter of 2019, and the first set of results is expected to be submitted for publication by the second quarter of 2019. Phase 2 implementation will commence in the second quarter of 2019, and the project end date is in May 2021. CONCLUSIONS Findings from this study can potentially inform social policy and programs as it refines the understanding of low-income families by distinguishing trajectories of adaptive capacities so that policies and interventions can be targeted in enhancing the adaptive pathways of low-income families with children. INTERNATIONAL REGISTERED REPOR PRR1-10.2196/11629

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