Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study

BackgroundPrimary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees’ preparation for, or experiences and perceptions of, them.AimTo understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations.Design & settingA mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees.MethodA cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis.ResultsThe survey response was 16% (n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence (R2 = 0.71, P<0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations.ConclusionThis project sheds light on GP trainees’ current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies.

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Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2019-034023 ◽

2020 ◽

Vol 10 (3) ◽

pp. e034023 ◽

Cited By ~ 2

Author(s):

Calum T McHale ◽

Anita H Laidlaw ◽

Joanne E Cecil

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Weight Management ◽

Primary Care Patient ◽

Overweight And Obesity ◽

Shared Responsibility ◽

Mixed Methods Study ◽

Structured Interviews ◽

Related Factors ◽

Cross Sectional

ObjectiveTo understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland.SettingSeven National Health Service (NHS) Scotland primary care centres.ParticipantsA total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated.Design and methodologyA cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives.Results(1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors.ConclusionsIncongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.

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How spirituality is understood and taught in New Zealand medical schools

Palliative & Supportive Care ◽

10.1017/s147895151300062x ◽

2013 ◽

Vol 13 (1) ◽

pp. 53-58 ◽

Cited By ~ 3

Author(s):

D. Lambie ◽

R. Egan ◽

S. Walker ◽

R. MacLeod

Keyword(s):

Medical Education ◽

New Zealand ◽

Health Outcomes ◽

Medical Schools ◽

Mixed Methods Study ◽

Shared Understanding ◽

Structured Interviews ◽

Cross Sectional ◽

Electronic Survey ◽

School Of Medicine

AbstractObjectives:The objective of this research was to explore how spirituality is currently understood and taught in New Zealand Medical Schools.Methods:A mixed methods study was carried out involving interviews (n = 14) and a survey (n = 73). The first stage of the study involved recorded semi-structured interviews of people involved in curriculum development from the Dunedin School of Medicine (n = 14); which then informed a cross-sectional self-reported electronic survey (n = 73).Results:The results indicate that spirituality is regarded by many involved in medical education in New Zealand as an important part of healthcare that may be taught in medical schools, but also that there is little consensus among this group as to what the topic is about.Significance of results:These findings provide a basis for further discussion about including spirituality in medical curricula, and in particular indicate a need to develop a shared understanding of what ‘spirituality’ means and how it can be taught appropriately. As a highly secular country, these New Zealand findings are significant for medical education in other secular Western countries. Addressing spirituality with patients has been shown to positively impact a range of health outcomes, but how spirituality is taught in medical schools is still developing across the globe.

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Understanding the learning needs of London-based GP trainees in conducting telephone consultations

British Journal of General Practice ◽

10.3399/bjgp19x703457 ◽

2019 ◽

Vol 69 (suppl 1) ◽

pp. bjgp19X703457

Author(s):

Umar Chaudhry ◽

Judith Ibison ◽

Tess Harris ◽

Imran Rafi ◽

Miles Johnston ◽

...

Keyword(s):

Clinical Information ◽

Learning Needs ◽

Assessment Practices ◽

Structured Interviews ◽

Cross Sectional ◽

Negative Experiences ◽

North Central ◽

Out Of Hours ◽

Use Of Technology ◽

Observation Tools

BackgroundTelehealth care and telephone consultations are increasingly used in primary care for daily triage, patient reviews, and providing clinical information; however little is known about the perceptions of GP trainees.AimTo investigate the knowledge and skills of GP trainees in conducting telephone consultations; evaluate their current experiences and learning needs; and identify future training considerations based on feedback received.MethodUsing a mixed-methods approach, a cross-sectional quantitative survey of North Central and East London (NCEL) GP trainees was initially performed. This was followed-up by qualitative semi-structured interviews, which allowed deeper exploration of themes.ResultsIn total 100 trainees responded to the survey, and eight proceeded with interviews. Trainees were least confident in independently undertaking more complex aspects of telephone consulting, and there was a positive correlation between training received and confidence to work independently. Despite positive and negative experiences, trainees felt that there were gaps in their training and significant differences in overall confidence, supervision and feedback among different training grades and between in-hours and out-of-hours practice. Future considerations included curricular promotion, increased trainer-trainee observations using audio-clinical observation tools or simulated practice, and consideration of formal training.ConclusionThis project has shed light on the current learning, feedback, and assessment practices of GP trainees in conducting telephone consultations. Further evaluation will provide a helpful guide to various stakeholders, foresee any challenges and inform a wider debate among postgraduate learners regarding their training for the use of technology in healthcare.

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Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

British Journal of General Practice ◽

10.3399/bjgp18x697349 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697349

Author(s):

Anna Lalonde ◽

Emma Teasdale ◽

Ingrid Muller ◽

Joanne Chalmers ◽

Peter Smart ◽

...

Keyword(s):

Mixed Methods ◽

Information Needs ◽

Qualitative Data ◽

Information Provision ◽

Mixed Methods Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Face To Face ◽

Patient Information Needs ◽

History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

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Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

International Journal for Equity in Health ◽

10.1186/s12939-020-01327-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Christophe Millien ◽

Anatole Manzi ◽

Arlene M. Katz ◽

Hannah Gilbert ◽

Mary C. Smith Fawzi ◽

...

Keyword(s):

Risk Factors ◽

Mixed Methods ◽

Black Women ◽

Uterine Fibroids ◽

Mixed Methods Study ◽

University Hospital ◽

Gynecologic Surgery ◽

Cross Sectional ◽

Women's Lives

Abstract Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

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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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The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

BMJ Open ◽

10.1136/bmjopen-2020-040268 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040268

Author(s):

Danielle Ashworth ◽

Pankhuri Sharma ◽

Sergio A Silverio ◽

Simi Khan ◽

Nishtha Kathuria ◽

...

Keyword(s):

Mixed Methods ◽

Preterm Birth ◽

Pregnant Women ◽

Barriers And Facilitators ◽

Rural India ◽

Structured Interviews ◽

Framework Analysis ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Thematic Framework

IntroductionIndia has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.MethodsA pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.ResultsBefore training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.ConclusionThis study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

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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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