Assessing the Potential for Integrating Routine Data Collection on Complementary Feeding to Child Health Visits: A Mixed-Methods Study

There is no routine data collection in the UK on infant dietary diversity during the transition to solid foods, and health visitors (HVs) (nurses or midwives with specialist training in children and family health) have the potential to play a key role in nutrition surveillance. We aimed to assess items for inclusion in routine data collection, their suitability for collecting informative data, and acceptability among HVs. A mixed-methods study was undertaken using: (i) an online survey testing potential questionnaire items among parents/caregivers, (ii) questionnaire redevelopment in collaboration with community staff, and (iii) a survey pilot by HVs followed by qualitative data collection. Preliminary online questionnaires (n = 122) were collected to identify useful items on dietary diversity. Items on repeated exposure to foods, aversive feeding behaviors, flavor categories, and sugar intake were selected to correspond to nutrition recommendations, and be compatible with electronic records via tablet. HVs surveyed 187 parents of infants aged 12 months. Semi-structured interviews indicated that HVs found the questionnaire comparable with standard nutrition conversations, which prompted helpful discussions, but questions on eating behavior did not prompt such useful discussions and, in some cases, caused confusion about what was ‘normal.’ Lack of time among HVs, internet connectivity issues, and fear of losing rapport with parents were barriers to completing electronic questionnaires, with 91% submitted by paper. Routine nutrition data collection via child health records seems feasible and could inform quality improvement projects.

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Development of a tool for identifying and addressing prioritised determinants of quality improvement projects led by healthcare professionals: a mixed-methods study

10.21203/rs.2.24055/v2 ◽

2020 ◽

Author(s):

Anne van Tuijl ◽

Hub C. Wollersheim ◽

Cornelia R.M.G. Fluit ◽

Petra. J. van Gurp ◽

Hiske Calsbeek

Keyword(s):

Quality Improvement ◽

Mixed Methods ◽

Online Survey ◽

Healthcare Professionals ◽

Learning By Doing ◽

Mixed Methods Study ◽

Quality Improvement Initiative ◽

Structured Interviews ◽

Priority Score ◽

A Priority

Abstract Background: Several frameworks have been developed to identify essential determinants for healthcare improvement. These frameworks aim to be comprehensive, leading to the creation of long lists of determinants that are not prioritised based on being experienced as most important. Furthermore, most existing frameworks do not describe the methods or actions used to identify and address the determinants, limiting their practical value. The aim of this study is to describe the development of a tool with prioritised facilitators and barriers supplemented with methods to identify and address each determinant. The tool can be used by those performing quality improvement initiatives in healthcare practice. Methods: A mixed-methods study design was used to develop the tool. First, an online survey was used to ask healthcare professionals about the determinants they experienced as most facilitating and most hindering during the performance of their quality improvement initiative . A priority score was calculated for every named determinant, and those with a priority score ≥ 20 were incorporated into the tool. Semi-structured interviews with implementation experts were performed to gain insight on how to analyse and address the determinants in our tool Results: The 25 healthcare professionals in this study experienced 64 facilitators and 66 barriers when performing their improvement initiatives. Of these, 12 facilitators and nine barriers were incorporated into the tool. Sufficient support from management of the department was identified as the most important facilitator, while having limited time to perform the initiative was considered the most important barrier. The interviews with 16 experts in implementation science led to various inputs for identifying and addressing each determinant. Important themes included maintaining adequate communication with stakeholders, keeping the initiative at a manageable size, learning by doing and being able to influence determinants. Conclusions: This paper describes the development of a tool with prioritized determinants for performing quality improvement initiatives with suggestions for analysing and addressing these determinants. The tool is developed for those engaged in quality improvement initiatives in practice, so in this ways it helps to bridging the research to practice gap of determinants frameworks. More research is needed to validate and develop the tool further.

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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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Midwives’ experiences of caring for women with antenatal anxiety and depression: A qualitative study with midwifery acupuncturists

New Zealand College of Midwives ◽

10.12784/nzcomjnl57.2021.3.20-26 ◽

2021 ◽

Vol 57 ◽

Author(s):

Lee-Ana Lowe ◽

Debra Betts

Keyword(s):

Mixed Methods ◽

Health Services ◽

Pregnant Women ◽

Online Survey ◽

Maternal Mental Health ◽

Mixed Methods Study ◽

Anxiety And Depression ◽

Structured Interviews ◽

Convenience Sample ◽

Antenatal Anxiety

Background: Pregnant women seek help for a range of physical and emotional pregnancy symptoms from traditional acupuncturists. Whether midwifery acupuncturists in Aotearoa New Zealand (Aotearoa NZ) provide acupuncture for antenatal anxiety and depression (AAD) in practice is currently unknown. Aim: This qualitative arm of a mixed-methods study aimed to explore midwifery acupuncturist experiences of caring for pregnant women with AAD in Aotearoa NZ. The aim of the research was to examine the factors that influence midwifery acupuncturists' perceptions of acupuncture use for AAD. Method: This was a mixed-methods study involving an online survey and in-depth interviews from a convenience sample of Aotearoa NZ midwifery acupuncturists who had completed a Certificate of Midwifery Acupuncture. This paper describes the thematic analysis of the semi-structured interviews. Findings: The eight interviewees were mostly NZ European (n=6) and Lead Maternity Carers (LMCs; n=6) caring for pregnant women in rural and urban locations throughout Aotearoa NZ. The interviews revealed an overarching theme, “helping midwives to navigate the ocean of AAD”, which identified the lack of support participants experienced from current maternity health services for AAD in Aotearoa NZ. Subthemes “Missing the boat during pregnancy” expressed how participants felt no options were available for AAD prevention, while “keeping women afloat with no ship in sight” represented how interviewees tried to keep women in their care stable even though access to maternal mental health services was difficult. Participants felt acupuncture was a useful non-pharmaceutical tool that works; however, they had reservations about “adding acupuncture to the midwifery toolbox”. Conclusion: Aotearoa NZ midwifery acupuncturists were concerned about AAD and the limited conventional options available for women in their care. Acupuncture was viewed as a promising adjunct to usual treatment for AAD. Reservations included adding acupuncture to an already heavy midwifery workload, the cost of acupuncture, and the appropriateness of the treatment.

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Healthcare Providers and Caregivers’ Perspectives on the Quality of Child Health Services in Urban Indonesia: A Mixed-Methods Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158047 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8047

Author(s):

Agus Setiawan ◽

Poppy Fitriyani ◽

Rizkiyani Istifada ◽

Shefaly Shorey

Keyword(s):

Mixed Methods ◽

Child Health ◽

Healthcare Providers ◽

Healthcare Services ◽

Mixed Methods Study ◽

Child Health Services ◽

Structured Interviews ◽

Mortality And Morbidity ◽

Factors Affecting

Although Indonesia’s child mortality rate has decreased in tandem with the global trend, healthcare services can be further improved for children. This study aims to explore the perceptions of healthcare providers and caregivers of children aged below five years to improve child health in urban Indonesia. A mixed-methods study design was adopted. Quantitative data were collected via questionnaires from the caregivers. Qualitative data were collected via semi-structured interviews from the healthcare providers. Analysis of 540 caregiver questionnaires regarding the care provided to their child revealed that the majority of them were very satisfied (46.1%) and satisfied (52.2%) with the care received. Analysis of 12 interviews with healthcare providers derived three major themes: (1) importance of one’s role as a healthcare provider; (2) factors affecting the delivery of healthcare; and (3) the way forward in caring for young children. Although caregivers were very satisfied with the care received for their children, the perception of healthcare providers regarding their responsibility in delivering care to children under five years old provides insights into improving the quality of services for children in Indonesia. Our findings suggest that mortality and morbidity of children aged below five years can be best reduced by optimizing primary and secondary preventive measures.

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Development of a tool for identifying and addressing prioritised determinants of quality improvement initiatives led by healthcare professionals: a mixed-methods study

Implementation Science Communications ◽

10.1186/s43058-020-00082-w ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Anne A. C. van Tuijl ◽

Hub C. Wollersheim ◽

Cornelia R. M. G. Fluit ◽

Petra J. van Gurp ◽

Hiske Calsbeek

Keyword(s):

Quality Improvement ◽

Mixed Methods ◽

Online Survey ◽

Healthcare Professionals ◽

Learning By Doing ◽

Mixed Methods Study ◽

Quality Improvement Initiative ◽

Structured Interviews ◽

Priority Score ◽

A Priority

Abstract Background Several frameworks have been developed to identify essential determinants for healthcare improvement. These frameworks aim to be comprehensive, leading to the creation of long lists of determinants that are not prioritised based on being experienced as most important. Furthermore, most existing frameworks do not describe the methods or actions used to identify and address the determinants, limiting their practical value. The aim of this study is to describe the development of a tool with prioritised facilitators and barriers supplemented with methods to identify and address each determinant. The tool can be used by those performing quality improvement initiatives in healthcare practice. Methods A mixed-methods study design was used to develop the tool. First, an online survey was used to ask healthcare professionals about the determinants they experienced as most facilitating and most hindering during the performance of their quality improvement initiative. A priority score was calculated for every named determinant, and those with a priority score ≥ 20 were incorporated into the tool. Semi-structured interviews with implementation experts were performed to gain insight on how to analyse and address the determinants in our tool. Results The 25 healthcare professionals in this study experienced 64 facilitators and 66 barriers when performing their improvement initiatives. Of these, 12 facilitators and nine barriers were incorporated into the tool. Sufficient support from management of the department was identified as the most important facilitator, while having limited time to perform the initiative was considered the most important barrier. The interviews with 16 experts in implementation science led to various inputs for identifying and addressing each determinant. Important themes included maintaining adequate communication with stakeholders, keeping the initiative at a manageable size, learning by doing and being able to influence determinants. Conclusions This paper describes the development of a tool with prioritised determinants for performing quality improvement initiatives with suggestions for analysing and addressing these determinants. The tool is developed for those engaged in quality improvement initiatives in practice, so in this way it helps in bridging the research to practice gap of determinants frameworks. More research is needed to validate and develop the tool further.

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Development of a tool for identifying and addressing prioritised determinants of quality improvement projects led by healthcare professionals: a mixed-methods study

10.21203/rs.2.24055/v3 ◽

2020 ◽

Author(s):

Anne van Tuijl ◽

Hub C. Wollersheim ◽

Cornelia R.M.G. Fluit ◽

Petra. J. van Gurp ◽

Hiske Calsbeek

Keyword(s):

Quality Improvement ◽

Mixed Methods ◽

Online Survey ◽

Healthcare Professionals ◽

Learning By Doing ◽

Mixed Methods Study ◽

Quality Improvement Initiative ◽

Structured Interviews ◽

Priority Score ◽

A Priority

Abstract Background: Several frameworks have been developed to identify essential determinants for healthcare improvement. These frameworks aim to be comprehensive, leading to the creation of long lists of determinants that are not prioritised based on being experienced as most important. Furthermore, most existing frameworks do not describe the methods or actions used to identify and address the determinants, limiting their practical value. The aim of this study is to describe the development of a tool with prioritised facilitators and barriers supplemented with methods to identify and address each determinant. The tool can be used by those performing quality improvement initiatives in healthcare practice. Methods: A mixed-methods study design was used to develop the tool. First, an online survey was used to ask healthcare professionals about determinants they experienced as most facilitating and most hindering during the performance of their quality improvement initiative. A priority score was calculated for every named determinant, and those with a priority score ≥ 20 were incorporated into the tool. Semi-structured interviews with implementation experts were performed to gain insight on how to analyse and address the determinants in our tool. Results: The 25 healthcare professionals in this study experienced 64 facilitators and 66 barriers when performing their improvement initiatives. Of these, 12 facilitators and nine barriers were incorporated into the tool. Sufficient support from management of the department was identified as the most important facilitator, while having limited time to perform the initiative was considered the most important barrier. The interviews with 16 experts in implementation science led to various inputs for identifying and addressing each determinant. Important themes included maintaining adequate communication with stakeholders, keeping the initiative at a manageable size, learning by doing and being able to influence determinants. Conclusions: This paper describes the development of a tool with prioritized determinants for performing quality improvement initiatives with suggestions for analysing and addressing these determinants. The tool is developed for those engaged in quality improvement initiatives in practice, so in this ways it helps to bridging the research to practice gap of determinants frameworks. More research is needed to validate and develop the tool further.

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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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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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Satisfaction with Fertility Preservation Decisions among Adolescent Males with Cancer: A Mixed Methods Study

Cancers ◽

10.3390/cancers13143559 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3559

Author(s):

Charleen I. Theroux ◽

Kylie N. Hill ◽

Anna L. Olsavsky ◽

James L. Klosky ◽

Nicholas D. Yeager ◽

...

Keyword(s):

Mixed Methods ◽

Fertility Preservation ◽

Childhood Cancer Survivors ◽

Mixed Methods Study ◽

Decision Quality ◽

Structured Interviews ◽

Short Term ◽

Male Adolescents ◽

Decisional Satisfaction ◽

Ongoing Support

Half of male childhood cancer survivors experience treatment-related fertility impairment, which can lead to distress. Survivors often regret forgoing fertility preservation (FP), and decisional dissatisfaction is associated with a lower quality of life. This mixed methods study examined short-term FP decisional satisfaction among families of male adolescents newly diagnosed with cancer who received an initial fertility consult and completed an FP values clarification tool. One-two months after the FP decision, thirty-nine families completed the Brief Subjective Decision Quality measure. Decisional satisfaction was compared for participants (mothers, fathers, adolescents) who did and did not attempt to bank. Semi-structured interviews included the following question: How do you/your family feel about the banking decision now/in the future? Decisional quality scores were moderate-high (M = 5.74–6.33 out of 7), with no significant differences between non-attempter (n = 15) and attempter (n = 24) families (adolescents: p = 0.83, d = 0.08; mothers: p = 0.18, d = 0.45; fathers: p = 0.32, d = 0.44). Three qualitative themes emerged among non-attempter families: (1) satisfaction with decision (50% of participants), (2) acceptance of decision (60%), and (3) potential for future regret (40%). Satisfaction with decision was the only theme identified in attempter families (93%). Quantitively, short-term decisional satisfaction was high regardless of the banking attempt. However, the qualitative findings suggest that the experiences of families who did not bank may be more nuanced, as several participants discussed a potential for future regret, highlighting the importance of ongoing support.

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Evaluating the motivation of Red Cross Health volunteers in the COVID-19 pandemic: a mixed-methods study protocol

BMJ Open ◽

10.1136/bmjopen-2020-042579 ◽

2021 ◽

Vol 11 (1) ◽

pp. e042579

Author(s):

Leonardo W Heyerdahl ◽

Muriel Vray ◽

Vincent Leger ◽

Lénaig Le Fouler ◽

Julien Antouly ◽

...

Keyword(s):

Public Health ◽

Mixed Methods ◽

Vulnerable Populations ◽

Health Workers ◽

Mixed Methods Study ◽

Red Cross ◽

Volunteer Motivation ◽

Structured Interviews ◽

Current Crisis ◽

French Red Cross

IntroductionVoluntary organisations provide essential support to vulnerable populations and front-line health responders to the COVID-19 pandemic. The French Red Cross (FRC) is prominent among organisations offering health and support services in the current crisis. Comprised primarily of lay volunteers and some trained health workers, FRC volunteers in the Paris (France) region have faced challenges in adapting to pandemic conditions, working with sick and vulnerable populations, managing limited resources and coping with high demand for their services. Existing studies of volunteers focus on individual, social and organisational determinants of motivation, but attend less to contextual ones. Public health incertitude about the COVID-19 pandemic is an important feature of this pandemic. Whether and how uncertainty interacts with volunteer understandings and experiences of their work and organisational relations to contribute to Red Cross worker motivation is the focus of this investigation.Methods and analysisThis mixed-methods study will investigate volunteer motivation using ethnographic methods and social network listening. Semi-structured interviews and observations will illuminate FRC volunteer work relations, experiences and concerns during the pandemic. A questionnaire targeting a sample of Paris region volunteers will allow quantification of motivation. These findings will iteratively shape and be influenced by a social media (Twitter) analysis of biomedical and public health uncertainties and debates around COVID-19. These tweets provide insight into a French lay public’s interpretations of these debates. We evaluate whether and how socio-political conditions and discourses concerning COVID-19 interact with volunteer experiences, working conditions and organisational relations to influence volunteer motivation. Data collection began on 15 June 2020 and will continue until 15 April 2021.Ethics and disseminationThe protocol has received ethical approval from the Institut Pasteur Institutional Review Board (no 2020-03). We will disseminate findings through peer-reviewed articles, conference presentations and recommendations to the FRC.

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