The implementation of a smoking cessation and alcohol abstinence intervention for people experiencing homelessness

Abstract In the United States, eighty percent of the adult homeless population smokes cigarettes compared to 15 percent of the general population. In 2017 Power to Quit 2 (PTQ2), a randomized clinical trial, was implemented in two urban homeless shelters in the Upper Midwest to address concurrent smoking cessation and alcohol treatment among people experiencing homelessness. A subset of this study population were interviewed to assess their experiences of study intervention. The objective of this study was to use participants’ experiences with the intervention to inform future implementation efforts of combined smoking cessation and alcohol abstinence interventions, guided by the Consolidated Framework for Implementation Research (CFIR). Methods: Qualitative semi-structured interviews were conducted with 40 PTQ2 participants between 2016–2017 and analyzed in 2019. Interviews were audio-recorded, transcribed, and analyzed using a socially constructivist approach to grounded theory. Findings: Participants described the PTQ2 intervention in positive terms. Participants valued the opportunity to obtain both counseling and nicotine-replacement therapy products (intervention characteristics) and described forming a bond with the PTQ2 staff and reliance on them for emotional support and encouragement (characteristics of individuals). However, the culture of alcohol use and cigarette smoking around the shelter environment presented a serious challenge (outer setting). The study setting and the multiple competing needs of participants were reported as the most challenging barriers to implementation (implementation process). Conclusion: The CFIR was useful in offering specific insights about the implementation context of the PTQ2 intervention, including the impact of the factors in the inner and outer settings of the shelter environment. Participants described a discord in their personal goals of reduction compared with the study goals of complete abstinence, which may pose a challenge to the ways in which success is defined for people experiencing homelessness.

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“We Are Doing These Things So That People Will Not Laugh at Us”: Caregivers’ Attitudes About Dementia and Caregiving in Nigeria

Qualitative Health Research ◽

10.1177/10497323211004105 ◽

2021 ◽

pp. 104973232110041

Author(s):

Candidus C. Nwakasi ◽

Kate de Medeiros ◽

Foluke S. Bosun-Arije

Keyword(s):

The United States ◽

Structured Interviews ◽

Dementia Caregivers ◽

Term Care ◽

Awareness Campaigns ◽

Knowledge Deficit ◽

People With Dementia ◽

Qualitative Descriptive ◽

The Impact

Some Nigerians, in their effort to make sense of dementia symptoms, use descriptions that may stigmatize people with dementia and their families. This qualitative descriptive study focused on the everyday understanding of dementia and the impact of stigma on the caregiving experiences of informal female Nigerian dementia caregivers. Semi-structured interviews were conducted with a purposive sample of 12 adult informal female caregivers in Nigeria and analyzed for themes. Afterward, results were presented to focus groups of 21 adult Nigerians residing in the United States for more contextual insight on the findings. The three major themes were misconceptions about dementia symptoms, caregiving protects against stigmatization, and stigma affects caregiving support. Overall, we argue that knowledge deficit, poor awareness, and traditional spiritual beliefs combine to drive dementia-related stigmatization in Nigeria. Strategies such as culturally appropriate dementia awareness campaigns and formal long-term care policies are urgently needed to help strengthen informal dementia caregiving in Nigeria.

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Understanding Low-value Care and Associated De-implementation Processes: A Qualitative Study of Choosing Wisely Interventions Across Canadian Hospitals

10.21203/rs.3.rs-565514/v1 ◽

2021 ◽

Author(s):

Gillian Parker ◽

Monika Kastner ◽

Karen Born ◽

Nida Shahid ◽

Whitney Berta

Keyword(s):

Process Model ◽

Healthcare Providers ◽

Implementation Process ◽

Choosing Wisely ◽

Structured Interviews ◽

Team Members ◽

Implementation Processes ◽

Healthcare Settings ◽

National Campaigns ◽

The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Results:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

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“Here in the Bible Belt, It’s Predominantly Negative”: Sexual Identity Stigma in the American South, 50 Years After Stonewall

Frontiers in Psychology ◽

10.3389/fpsyg.2021.804064 ◽

2021 ◽

Vol 12 ◽

Author(s):

Joseph J. Frey ◽

William J. Hall ◽

Jeremy T. Goldbach ◽

Paul Lanier

Keyword(s):

Mental Health ◽

United States ◽

Health Disparities ◽

Sexual Identity ◽

Minority Stress ◽

The United States ◽

Mental Health Disparities ◽

Structured Interviews ◽

United States South ◽

The Impact

Lesbian, gay, bisexual, and pansexual (LGB+) individuals have disproportionate rates of mental illness. Minority stress and sexual identity stigma are posited as the primary social determinants of LGB+ mental health disparities. Discussions in the literature have questioned the impact of sexual identity stigma in a world increasingly accepting of sexual minorities. Additionally, the LGB+ population in the United States South is often overlooked in American research. This article details a qualitative study exploring experiences related to sexual identity stigma among adults who identify as LGB+ in the United States South. Semi-structured interviews with 16 individuals were analyzed using content analysis. Six thematic categories of stigma emerged from participants’ experiences: (a) navigating an LGB+ identity, (b) social acceptability of an LGB+ identity, (c) expectation of LGB+ stigma, (d) interpersonal discrimination and harassment, (e) structural stigma, and (f) relationship with the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Findings suggest that sexual identity stigma remains a common experience among these Southern United States participants. Further, thematic categories and subcategories primarily aligned with extant theory with one exception: Intracommunity stigma, a form of stigma emanating from the LGBTQ community, emerged as a stigma type not currently accounted for in theoretical foundations underpinning mental health disparities in this population.

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Implementation and normalization process of asynchronous video interviewing practices in the hospitality industry

International Journal of Contemporary Hospitality Management ◽

10.1108/ijchm-07-2016-0402 ◽

2018 ◽

Vol 30 (2) ◽

pp. 685-701 ◽

Cited By ~ 3

Author(s):

Cynthia Mejia ◽

Edwin N. Torres

Keyword(s):

Hospitality Industry ◽

Selection Process ◽

New Technology ◽

Implementation Process ◽

Structured Interviews ◽

Research Attention ◽

Content Type ◽

Recruitment And Selection ◽

The Impact ◽

Normalization Process

Purpose Asynchronous video interviews (AVIs) enable recruiters and job candidates to conduct and review employment interviews at different points in time, promising improved cost and time efficiencies for all users. This research aims to investigate the implementation and normalization process of AVI in the hospitality industry with the unified theory of acceptance and use of technology (UTAUT) and the normalization process theory (NPT) providing theoretical support. Design/methodology/approach Semi-structured interviews have been conducted with hiring managers from three different hospitality companies, which were in different stages of the implementation process. The data have been recorded, transcribed and coded according to the UTAUT and NPT constructs, revealing emergent themes. Findings Five overarching themes emerged: AVI effort and efficiency expectation; augmentation to the interview process; challenges for the applicant; challenges for the recruiter; and issues with applicant interviewing aesthetics. Additional coding and analysis with NPT identified the following in terms of evaluation of the implementation process: participants’ implementation activities showed a tendency to emanate from cognitive participation (relationship work), leading to coherence (sense-making work), followed by collective action (enactment of work/operational work) and finally reflexive monitoring (appraisal work). Practical implications Findings from this research include recommendations for the best practices integrating AVI into the hospitality employee selection process. Originality/value Given the increased demands on the recruitment and selection of talent in the hospitality industry, several organizations have turned to mechanized HR software platforms. The impact of interview modalities and particularly AVI has received limited research attention, thus this study expanded this new stream of literature. Furthermore, this research is among a nascent stream using NPT to evaluate the implementation and normalization of this new technology.

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‘A Nut We Have Officially yet to Crack’: Forcing the Attention of Athletic Departments Toward Sustainability Through Shared Governance

Sustainability ◽

10.3390/su11195198 ◽

2019 ◽

Vol 11 (19) ◽

pp. 5198

Author(s):

Martin Barrett ◽

Kyle S. Bunds ◽

Jonathan M. Casper ◽

Michael B. Edwards ◽

D. Scott Showalter ◽

...

Keyword(s):

Sustainable Development ◽

Intercollegiate Athletics ◽

The United States ◽

Coupled Systems ◽

Structured Interviews ◽

Athletic Departments ◽

The Sustainable Development ◽

Sustainability Governance ◽

The Impact ◽

Office Personnel

In many ways, intercollegiate athletics represents the ‘sustainable’ front porch of higher education. The high-visibility, high-impact nature of elite-level college athletics make athletic departments a central player in the sustainable development journey. However, not all athletic departments respond to this responsibility, nor are all responses uniformly successful. According to national reporting frameworks, an increasing number of universities in the United States are choosing to involve their athletic departments in university-level sustainability governance structures, but the benefits and limitations of this remain unclear. Using the theory of loosely coupled systems, and more specifically, the voice of compensations (which views loose coupling as an unsatisfactory state), the purpose of this paper is to explore perceptions of athletic department engagement in shared sustainability governance, and, thus, a whole-of-institution approach. Semi-structured interviews with sustainability office personnel were conducted and analyzed, and the findings imply that shared sustainability governance has the potential to focus the attention of athletic departments toward sustainability, as well as to reaffirm shared values. Yet, to maximize the impact of athletic departments toward the sustainable development goals of a university, sustainability office personnel suggest the deployment of additional change levers, in a multi-dimensional fashion, as supplementary coupling mechanisms. These would include more rigorous sustainability goals (top-down), continued collaboration on ‘low-hanging fruit’ initiatives (lateral), student-athlete engagement (bottom-up), and the development of an internal sustainability framework (inside-out).

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Cycling Without Age Program: The Impact for Residents in Long-Term Care

Western Journal of Nursing Research ◽

10.1177/0193945919885130 ◽

2019 ◽

Vol 42 (9) ◽

pp. 728-735 ◽

Cited By ~ 1

Author(s):

Paula McNiel ◽

Judith Westphal

Keyword(s):

Lived Experience ◽

Long Term Care ◽

Care Facility ◽

The United States ◽

Structured Interviews ◽

Term Care ◽

Long Term Care Facility ◽

Centered Care ◽

The Impact

Long-term care facilities seek ways to enhance the quality of life for residents. Cycling Without Age (CWA), a new international cycling program, is gaining momentum for older adults. This study explored resident riders’ and trishaw pilots’ lived experience of their participation in the CWA program using a qualitative approach at a long-term care facility in the United States. Researchers conducted 27 face-to-face, semi-structured interviews with riders and pilots. For resident riders, the three themes identified included (a) breath of fresh air; (b) wave, chat, and remember; and (c) sit back and relax. Two themes were identified for the pilots: (a) change in frame of mind, and (b) mental and physical rewards. CWA can be as a new strategy for person-centered care. The CWA program provides nursing an opportunity to advocate, recommend, and obtain an order for residents to participate in the program.

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Implementing a Care Pathway for Complex Chronic Patients from a Nursing Perspective: A Qualitative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126324 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6324

Author(s):

Rosario Fernández-Peña ◽

Carmen Ortego-Maté ◽

Francisco José Amo-Setién ◽

Tamara Silió-García ◽

Antoni Casasempere-Satorres ◽

...

Keyword(s):

Care Pathway ◽

Implementation Process ◽

Decisive Role ◽

Structured Interviews ◽

Chronic Patients ◽

Levels Of Care ◽

Professional Health ◽

Communication And Coordination ◽

Evaluation And Monitoring ◽

The Impact

A care pathway constitutes a complex care strategy for decision-making and the organization of processes in the care of complex chronic patients, avoiding the fragmentation of care. Health professionals play a decisive role in the implementation, development, and evaluation of care pathways. This study sought to explore nurses’ opinions on the care pathway for complex chronic patients three years after its implementation. The study participants were thirteen nurses with different roles who were involved in the care pathway. Thematic content analysis of the semi-structured interviews resulted in four major themes: (a) the strengths of the route; (b) the impact of the route on caregivers; (c) the weaknesses of the route; and (d) the future of the route. Overall, the pathway was positively valued for the benefits it provides to patients, the caregiver, and the administration of professional health care. Participants voiced their concerns regarding: communication and coordination difficulties among professionals across the different levels of care, the need for improved teamwork and consensus among professionals at the same center, and human and material resources. The ongoing evaluation and monitoring of facilitators and barriers is necessary throughout the implementation process, to ensure continuity and quality of care in the health system.

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A realist evaluation of the implementation of open visiting in an acute care setting for older people

BMC Health Services Research ◽

10.1186/s12913-019-4653-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Helen Hurst ◽

Jane Griffiths ◽

Carrie Hunt ◽

Ellen Martinez

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Qualitative Interviews ◽

Hospital Setting ◽

Implementation Process ◽

Positive Culture ◽

Routine Data ◽

Realist Evaluation ◽

Barriers To Implementation ◽

The Impact

Abstract Background Open visiting refers to the principle of unrestricted visiting hours in the hospital setting to enable relatives, families and carers to visit at any time. There has been recognition that open visiting supports the principle of patient and family supported care and improves communication. Despite this there has been difficulty in implementing open visiting and barriers identified. The aims of this study were therefore to evaluate the implementation of open visiting, the barriers to implementation, sustainability and the impact of open visiting on communication between health care professionals, families and carers. Methods The study was conducted on two large acute wards for the older person. Realist evaluation methods were used to understand ‘what works well, how, for whom and to what extent.’ Mixed methods were employed including qualitative interviews and descriptive analyses of routine data sets. Following the methodology of realist evaluation, programme theories were identified a long with the context, mechanisms and outcomes of implementation, to better understand the implementation process. Results The results of this study identified some key findings, demonstrating that open visiting does improve communication and can help to build trusting relationships between families/carers and health care professionals (HCP). Barriers to implementation were based on the belief that it would impinge on routines within the ward setting. To achieve the principles of patient and family/carer centred care, the key mechanisms are the confidence and skills of individual nurses and health care assistants to engage with relatives/carers, whilst retaining a sense of control, particularly when care is being delivered to other patients. Conclusion In summary, open visiting creates a positive culture which fosters better relationships between families/carers and HCPs. Involving families/carers as partners in care does not happen automatically in an environment where open visiting is the policy, but requires engagement with staff to encourage and support relatives/carers.

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Designing a smoking cessation intervention for the unique needs of homeless persons: a community-based randomized clinical trial

Clinical Trials ◽

10.1177/1740774511423947 ◽

2011 ◽

Vol 8 (6) ◽

pp. 744-754 ◽

Cited By ~ 31

Author(s):

Kate Goldade ◽

Guy-Lucien Whembolua ◽

Janet Thomas ◽

Sara Eischen ◽

Hongfei Guo ◽

...

Keyword(s):

Clinical Trial ◽

Smoking Cessation ◽

Nicotine Patch ◽

The United States ◽

Homeless Persons ◽

Lessons Learned ◽

Community Advisory Board ◽

Homeless Population ◽

Community Based ◽

Quit Smoking

Background Although smoking prevalence remains strikingly high in homeless populations (~70% and three times the US national average), smoking cessation studies usually exclude homeless persons. Novel evidence-based interventions are needed for this high-risk subpopulation of smokers. Purpose To describe the aims and design of a first-ever smoking cessation clinical trial in the homeless population. The study was a two-group randomized community-based trial that enrolled participants ( n = 430) residing across eight homeless shelters and transitional housing units in Minnesota. The study objective was to test the efficacy of motivational interviewing (MI) for enhancing adherence to nicotine replacement therapy (NRT; nicotine patch) and smoking cessation outcomes. Methods Participants were randomized to one of the two groups: active (8 weeks of NRT + 6 sessions of MI) or control (NRT + standard care). Participants attended six in-person assessment sessions and eight retention visits at a location of their choice over 6 months. Nicotine patch in 2-week doses was administered at four visits over the first 8 weeks of the 26-week trial. The primary outcome was cotinine-verified 7-day point-prevalence abstinence at 6 months. Secondary outcomes included adherence to nicotine patch assessed through direct observation and patch counts. Other outcomes included the mediating and/or moderating effects of comorbid psychiatric and substance abuse disorders. Results Lessons learned from the community-based cessation randomized trial for improving recruitment and retention in a mobile and vulnerable population included: (1) the importance of engaging the perspectives of shelter leadership by forming and convening a Community Advisory Board; (2) locating the study at the shelters for more visibility and easier access for participants; (3) minimizing exclusion criteria to allow enrollment of participants with stable psychiatric comorbid conditions; (4) delaying the baseline visit from the eligibility visit by a week to protect against attrition; and (5) regular and persistent calls to remind participants of upcoming appointments using cell phones and shelter-specific channels of communication. Limitations The study’s limitations include generalizability due to the sample drawn from a single Midwestern city in the United States. Since inclusion criteria encompassed willingness to use NRT patch, all participants were motivated and were ready to quit smoking at the time of enrollment in the study. Findings from the self-select group will be generalizable only to those motivated and ready to quit smoking. High incentives may limit the degree to which the intervention is replicable. Conclusions Lessons learned reflect the need to engage communities in the design and implementation of community-based clinical trials with vulnerable populations.

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Locked Up and Blocked Out: The Digital Divide for Formerly Incarcerated Women in Canada

10.32920/ryerson.14655204.v1 ◽

2021 ◽

Author(s):

Emma L. Reid

Keyword(s):

Digital Divide ◽

The United States ◽

Incarcerated Women ◽

Structured Interviews ◽

Learning And Development ◽

Formerly Incarcerated ◽

Incarcerated Populations ◽

Comparative Content ◽

The Impact ◽

Formerly Incarcerated Women

In Canadian prisons and jails, populations are not able to access the internet, and many other essential technologies. Several research studies have examined the impact of the digital divide on incarcerated populations in the United States and other countries around the world (Barreiro-Gen & Novo-Corti, 2015; Reisdorf & Rikard, 2018). This study will expand on the current research by examining the impact of restrictions to internet access in Canadian prisons on the lives of formerly incarcerated women in Canada and, more specifically, how these restrictions affect their ability to reintegrate into society after the period of incarceration. The methodology of this research will be qualitative, and data will be collected through semi-structured interviews with individuals who have a variety of different experiences with the women’s correctional system in Canada. This study will address major areas of research in the field of study that addresses the digital divide, including the learning and development of digital skills, and how different identities can intersect to impact the way individuals experience the digital divide. Through constant comparative content analysis, this study describes the experience of the digital divide, how it both persists and develops from the time of incarceration to life post-incarceration, and how it can compound other types of barriers faced by women who have been incarcerated in our country.

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