Medication Adherence Changes in Blacks with Diabetes: A Mixed Methods Study

2020 ◽  
Vol 44 (2) ◽  
pp. 257-270 ◽  
Author(s):  
Deepika Rao ◽  
Martha Maurer ◽  
Jodi Meyer ◽  
Jiaying Zhang ◽  
Olayinka O. Shiyanbola
Keyword(s):  
Mixed Methods ◽  
Medication Adherence ◽  
Illness Perceptions ◽  
Qualitative Interviews ◽  
Barriers And Facilitators ◽  
Interpersonal Factors ◽  
Sequential Mixed Methods ◽  
Over Time

Objectives: In this study, we conducted a longitudinal evaluation of changes in medication adherence and the role of psychosocial and interpersonal factors in these changes among Blacks with type 2 diabetes mellitus (T2DM), and determined barriers and facilitators of T2DM medication adherence. Methods: We used an explanatory sequential mixed methods design for a sample of 287 black adult patients with T2DM in Wisconsin. Two surveys quantitatively evaluated changes in medication adherence, psychosocial factors, and interpersonal factors over time. We conducted 10 semi-structured qualitative interviews to explore participants' perceptions of these changes. Data integration of the quantitative and qualitative findings elucidated barriers and facilitators of medication adherence. Results: Increased adherence was significantly correlated with less concerns about medicines (r = -0.31), higher self-efficacy (r = 0.47), lesser depressive symptoms (r = -0.26), and lesser negative illness perceptions (r = -0.26) at both baseline and follow-up. Patient perceptions of adherence changes included adherence motivators, social support, and complex medication regimens. Integration showed that barriers and facilitators both existed in individuals who had an increase or a decrease in adherence over time. Conclusions: Specific beliefs of Blacks towards T2DM medications must be addressed to improve their adherence. Interventions must be tailored using interpersonal factors.

Management of e-resources in academic libraries in Ghana: Copyright implications

IFLA Journal ◽  
2021 ◽  
pp. 034003522110271
Author(s):  
Theresa L Adu ◽  
Thomas B van der Walt
Keyword(s):  
Distance Education ◽  
Mixed Methods ◽  
Distance Learning ◽  
Academic Libraries ◽  
Online Courses ◽  
Qualitative Interviews ◽  
Digital Resources ◽  
Mixed Methods Approach ◽  
Sequential Mixed Methods ◽  
Library Staff

This study investigated the copyright issues surrounding the management of e-resources in academic libraries in Ghana. Forty-seven library staff and head librarians from four academic libraries were engaged using questionnaires and qualitative interviews in a sequential mixed-methods approach to generate data for this study. The findings indicate that in all four institutions copyright issues arose with the provision of distance learning, online courses and e-reserves services. All the respondents stated that they or their colleagues had had faculty ask questions on copyright issues. However, the professional librarians indicated that the library was not consulted and the instructors for online courses or distance education programmes did not cooperate with librarians; rather, the department posting the materials made the decisions on copyright regarding the usage of digital resources for distance learning, online courses or e-reserves. This does not augur well for the management of copyright of e-resources in academic libraries in Ghana.

scholarly journals Mixed-methods evaluation of the NHS Genomic Medicine Service for paediatric rare diseases: study protocol

2021 ◽  
Vol 1 ◽  
pp. 23
Author(s):  
Celine Lewis ◽  
James Buchannan ◽  
Angus Clarke ◽  
Emma Clement ◽  
Bettina Friedrich ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Rare Diseases ◽  
Qualitative Interviews ◽  
Genomic Medicine ◽  
Research Programme ◽  
Early Years ◽  
Genomic Testing ◽  
Medicine Service ◽  
Recommendations For Practice

Background: A new nationally commissioned NHS England Genomic Medicine Service (GMS) was recently established to deliver genomic testing with equity of access for patients affected by rare diseases and cancer. The overarching aim of this research is to evaluate the implementation of the GMS during its early years, identify barriers and enablers to successful implementation, and provide recommendations for practice. The focus will be on the use of genomic testing for paediatric rare diseases. Methods: This will be a four-year mixed-methods research programme using clinic observations, interviews and surveys. Study 1 consists of qualitative interviews with designers/implementers of the GMS in Year 1 of the research programme, along with documentary analysis to understand the intended outcomes for the Service. These will be revisited in Year 4 to compare intended outcomes with what happened in practice, and to identify barriers and facilitators that were encountered along the way. Study 2 consists of clinic observations (pre-test counselling and results disclosure) to examine the interaction between health professionals and parents, along with follow-up interviews with both after each observation. Study 3 consists of a longitudinal survey with parents at two timepoints (time of testing and 12 months post-results) along with follow-up interviews, to examine parent-reported experiences and outcomes. Study 4 consists of qualitative interviews and a cross-sectional survey with medical specialists to identify preparedness, facilitators and challenges to mainstreaming genomic testing. The use of theory-based and pre-specified constructs will help generalise the findings and enable integration across the various sub-studies.   Dissemination: We will disseminate our results to policymakers as findings emerge, so any suggested changes to service provision can be considered in a timely manner. A workshop with key stakeholders will be held in Year 4 to develop and agree a set of recommendations for practice.

scholarly journals Finding the Balance Between Collaboration and Autonomy Among School Nurses in Interactions With Schools

2020 ◽  
pp. 105984052091892
Author(s):  
Arnfinn Helleve ◽  
Unni Vere Midthassel ◽  
Roger Andre Federici
Keyword(s):  
Qualitative Interviews ◽  
School Nurses ◽  
Barriers And Facilitators ◽  
Personal Relationships ◽  
School Staff ◽  
National Guidelines ◽  
Personnel Recruitment ◽  
Personal Relations ◽  
Negative Impacts ◽  
Over Time

In Norway, new national guidelines for school service emphasize the importance of establishing structured collaboration with schools. Nevertheless, few studies have explored the characteristics of such collaboration. The purpose of the present study is to explore how principals, teachers, and school nurses collaborate and to identify barriers and facilitators of structured collaboration. The study is based on 46 qualitative interviews conducted in five Norwegian municipalities in 2018 and 2019. The results reveal that school nurses are highly valued among the school staff but collaborations between teachers and school nurses varied both within and between schools, often for arbitrary reasons such as personal relations and office locations at schools. Personal relationships built over time as well as regular meetings, seemed to foster stronger collaboration, while discontinuity in personnel, recruitment difficulties, and sick and maternity leaves were frequently reported factors that seemed to have negative impacts on collaboration.

scholarly journals Barriers and Facilitators of Parent Engagement With Health Promotion in Child Care: A Mixed-Methods Evaluation

2020 ◽  
Vol 47 (6) ◽  
pp. 914-926
Author(s):  
Courtney T. Luecking ◽  
Phillip Dobson ◽  
Dianne S. Ward
Keyword(s):  
Health Promotion ◽  
Mixed Methods ◽  
Organizational Context ◽  
Parent Engagement ◽  
Barriers And Facilitators ◽  
Personal Attributes ◽  
Comparative Case Study ◽  
Healthy Behaviors ◽  
Sequential Mixed Methods ◽  
High Engagement

Background Early care and education providers cite lack of parent engagement as a central barrier to promoting healthy behaviors among young children. However, little research exists about factors influencing parent engagement with promoting healthy eating and activity behaviors in the this setting. Aims This study aimed to address this gap by examining low and high parent engagement with the Healthy Me, Healthy We campaign to identify barriers and facilitators of parent engagement with the intervention. Method This comparative case study used an explanatory sequential mixed-methods approach. We created center-level parent engagement scores using process evaluation data from the effectiveness trial of Healthy Me, Healthy We. Recruitment focused on centers with the five lowest and five highest scores. Twenty-eight adults (7 directors, 9 teachers, 12 parents) from seven centers (3 low engagement, 4 high engagement) completed semistructured interviews and the Family and Provider/Teacher Relationship Quality measure. Analytic approaches included descriptive statistical analyses for surveys and a framework-informed thematic analysis for interviews. Results Prominent contrasts between low- and high-engagement groups involved center culture for parent engagement and health promotion, practices for fostering networks and communication within centers, and communication between centers and parents. Personal attributes of providers (e.g., attitudes) also differentially influenced practices for engaging parents. Discussion and Conclusion Organizational characteristics and individual practices can facilitate or impede parent engagement with health promotion efforts. Assessing organizational context, gaining input from all stakeholders, and conducting capacity-building interventions may be critical for laying the foundation for positive relationships that support parent engagement in implementation of health promotion programs and beyond.

scholarly journals Psychological Inflexibility as a Predictor of Sexual Functioning Among Women with Vulvovaginal Pain: A Prospective Investigation

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3596-3602
Author(s):  
Pernilla Maathz ◽  
Ida K Flink ◽  
Linnea Engman ◽  
Johanna Ekdahl
Keyword(s):  
Sexual Functioning ◽  
Functional Disability ◽  
Preliminary Evidence ◽  
Multiple Regression Model ◽  
Pain Severity ◽  
Psychological Inflexibility ◽  
Chronic Pain Conditions ◽  
Over Time

Abstract Objective Persistent vulvovaginal pain affects many women and often has adverse effects on sexual functioning. Psychological inflexibility related to pain is associated with distress and functional disability across different types of chronic pain conditions, but little is known about the role of psychological inflexibility in vulvovaginal pain. The present study examines psychological inflexibility related to pain as a predictor of sexual functioning over time among women with vulvovaginal pain. Methods Questionnaires including measures of psychological inflexibility, pain severity, and sexual functioning were administered to female university students at two points in time. One hundred thirty women with vulvovaginal pain responded to the questionnaire at baseline and at follow-up after 10 months. A multiple regression model was used to explore psychological inflexibility and pain severity as predictors of sexual functioning at follow-up. Results Higher levels of psychological inflexibility and more severe pain at baseline were associated with poorer sexual functioning 10 months later. In analysis adjusting for baseline levels of sexual functioning, psychological inflexibility was the only significant predictor of sexual functioning at follow-up. Conclusions The findings provide preliminary evidence that psychological inflexibility is associated with sexual adjustment over time among women with vulvovaginal pain and point to the relevance of further examinations of the psychological inflexibility model in the context of vulvovaginal pain.

scholarly journals The Role of Gender in Nurse-Resident Interactions: A Mixed-methods Study

2021 ◽  
Vol 22 (4) ◽  
pp. 919-930
Author(s):  
Emily Cleveland Manchanda ◽  
Anita Chary ◽  
Noor Zanial ◽  
Lauren Nadeau ◽  
Jennifer Verstreken ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Patient Care ◽  
Gender Bias ◽  
Clinical Judgment ◽  
Qualitative Interviews ◽  
Mixed Methods Study ◽  
Interprofessional Communication ◽  
Hospital Leadership

Introduction: The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses. Methods: We analyzed qualitative interviews and focus groups with residents and nurses from two hospitals for dominant themes. An electronic survey, developed through an inductive-deductive approach informed by qualitative data, was administered to EM residents and nurses. Quantitative analyses included descriptive statistics and between-group comparisons. Results: Six nurses and 14 residents participated in interviews and focus groups. Key qualitative themes included gender differences in interprofessional communication, specific examples of, and responses to, gender bias. Female nurses perceived female residents as more approachable and collaborative than male residents, while female residents perceived nurses’ questions as doubting their clinical judgment. A total of 134 individuals (32%) completed the survey. Females more frequently perceived interprofessional gender bias (mean 30.9; 95% confidence interval {CI}, 25.6, 36.2; vs 17.6 [95% CI, 10.3, 24.9). Residents reported witnessing interprofessional gender bias more frequently than nurses (58.7 (95% CI, 48.6, 68.7 vs 23.9 (95% CI, 19.4, 28.4). Residents reported that gender bias affected job satisfaction (P = 0.002), patient care (P = 0.001), wellness (P = 0.003), burnout (P = 0.002), and self-doubt (P = 0.017) more frequently than nurses. Conclusion: Perceived interprofessional gender bias negatively impacts personal wellbeing and workplace satisfaction, particularly among female residents. Key institutional stakeholders including residency, nursing, and hospital leadership should invest the resources necessary to develop and integrate evidence-based strategies to improve interprofessional relationships that will ultimately enhance residency training, work climate, and patient care.

scholarly journals Factors that impact implementation of mentorship programs in nursing academia: A sequential-explanatory mixed methods study

2017 ◽  
Vol 7 (10) ◽  
pp. 1 ◽  
Author(s):  
Lorelli Nowell ◽  
Deborah White ◽  
Karen Benzies ◽  
Patricia Rosenau
Keyword(s):  
Mixed Methods ◽  
Nursing Faculty ◽  
Qualitative Interviews ◽  
Nursing Schools ◽  
Barriers And Facilitators ◽  
Current State ◽  
Schools Of Nursing ◽  
Explanatory Mixed Methods ◽  
Mentorship Programs ◽  
Sequential Explanatory

Objective: Nursing education institutions globally have called for mentorship to help address the nursing faculty shortage; however, little is known about the current state of mentorship or the barriers and facilitators for implementing mentorship programs in Canadian nursing schools. The objective of this study is to identify the current state of mentorship in Canadian nursing academia and explore factors that impact implementation of mentorship programs.Methods: A sequential-explanatory mixed methods design with 2 phases: (1) cross sectional survey of nursing faculty to identify the current state of mentorship in Canadian schools of nursing and explore facilitators and barriers to implementing mentorship programs; and, (2) qualitative interviews about nursing faculty member’s experiences with mentorship.  Integration occurred when selecting phase 2 participants based on phase 1 results. A web-based survey was developed based on a review of literature; surveys were collected between September 2015 and March 2016 from 935 nursing faculty members.  Survey participants (n = 48) were purposively sampled for maximum variation to participate in qualitative interviews, and data were analyzed thematically.Results: The majority of Canadian nursing schools lack formal mentorship programs with existing mentorship programs varying in scope and components. Factors influencing mentorship program implementation include: mentorship training and guidelines; quality of the mentoring relationships; choice and availability of mentors; organizational support; time and competing priorities; culture of the institution; and evaluation of mentorship outcomes.Conclusions: Our results confirm lack of formalized mentorship programs in Canadian schools of nursing. In developing mentorship programs, academic leaders need to consider multiple barriers and facilitators to ensure success.

scholarly journals Men With a “Woman’s Disease”: Stigmatization of Male Breast Cancer Patients—A Mixed Methods Analysis

2018 ◽  
Vol 12 (6) ◽  
pp. 2194-2207 ◽  
Author(s):  
Evamarie Midding ◽  
Sarah Maria Halbach ◽  
Christoph Kowalski ◽  
Rainer Weber ◽  
Rachel Würstlein ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mixed Methods ◽  
Male Breast Cancer ◽  
Qualitative Interviews ◽  
Male Breast ◽  
Breast Cancer Patients ◽  
Mixed Methods Design ◽  
Work Related ◽  
Care Systems

Male breast cancer (MBC) is rare and known as a typical woman’s disease. This study is part of the N-MALE project (Male breast cancer: patient’s needs in prevention, diagnosis, treatment, rehabilitation and follow-up-care) and aims to investigate how MBC patients (MBCP) feel about suffering from a “woman’s disease,” what character the stigmatization has, and how it can be prospectively reduced. Therefore, a mixed methods design is applied including data of N = 27 qualitative interviews with MBCP and quantitative data of N = 100 MBCP. Findings identify a diverse picture, as stigmatization varies between contexts and patients: Most stigmatization concentrates on sexual stigmatization and ignorance of MBC and mostly occurs in cancer care systems and work-related contexts. The level of stigmatization varies with age and amount of treatment methods received, as reported within the created typology of different MBCP stigma types. To prospectively reduce stigmatization in MBCP, more publicity of MBC is needed, as well as gender-neutral communication and information material.

scholarly journals Change in Medication Adherence and Beliefs in Medicines Over Time in Older Adults

2015 ◽  
Vol 8 (5) ◽  
pp. 39 ◽  
Author(s):  
Elizabeth Unni ◽  
Olayinka O Shiyanbola ◽  
Karen B Farris
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Adherence Behavior ◽  
Improve Medication Adherence ◽  
Lower Baseline ◽  
Item Scale ◽  
Over Time ◽  
Lower Adherence ◽  
Predictors Of Change

<p><strong>OBJECTIVE:</strong> The temporal component of medication adherence is important while designing interventions to improve medication adherence. Thus, the objective of this study was to determine how medication adherence and beliefs in medicines change over time in older adults.</p> <p><strong>METHODS:</strong> A two-year longitudinal internet-based survey among adults 65+ years was used to collect data on medication adherence (Morisky 4-item scale) and beliefs in medicines (Beliefs about Medicines Questionnaire). Paired t-test and one-way ANOVA determined if a change in beliefs in medicines and medication adherence over time was significant. A multiple linear regression was used to determine the significant predictors of change in medication adherence over time.</p> <p><strong>RESULTS:</strong> 436 respondents answered both baseline and follow-up surveys. Among all respondents, there was no significant change in adherence (0.58 ± 0.84 vs. 0.59 ± 0.84; p &gt; 0.05), necessity beliefs (17.13 ± 4.31 vs. 17.10 ± 4.29; p &gt; 0.05), or concern beliefs (11.70 ± 3.73 vs. 11.68 ± 3.77; p &gt; 0.05) over time. For older adults with lower baseline adherence, there was a statistically significant improvement in adherence (1.45 ± 0.70 vs. 0.99 ± 0.97; p &lt; 0.05); but no change in beliefs in medicines over time. The significant predictors of change in medication adherence over time were baseline adherence and baseline concern beliefs in medicines.</p> <p><strong>CONCLUSION:</strong> With baseline adherence and baseline concern beliefs in medicines playing a significant role in determining change in adherence behavior over time, especially in individuals with lower adherence, it is important to alleviate medication concerns at the beginning of therapy for better adherence.</p>

scholarly journals CERAD practice effects and attrition bias in a dementia prevention trial

2013 ◽  
Vol 25 (7) ◽  
pp. 1115-1123 ◽  
Author(s):  
Melissa Mathews ◽  
Erin Abner ◽  
Allison Caban-Holt ◽  
Richard Kryscio ◽  
Frederick Schmitt
Keyword(s):  
Cognitive Assessment ◽  
Prevention Trial ◽  
Practice Effects ◽  
Cognitive Assessments ◽  
Attrition Bias ◽  
Cognitively Normal ◽  
Dementia Prevention ◽  
Over Time

ABSTRACTBackground:The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) set of tests is frequently used for tracking cognition longitudinally in both clinical and research settings. Repeated cognitive assessments are an important component in measuring such changes; however, practice effects and attrition bias may obscure significant clinical change over time. The current study sought to examine the presence and magnitude of practice effects and the role of attrition bias in a sample of cognitively normal older men enrolled in a prevention trial.Method:Participants were grouped according to whether they completed five years of follow-up (n = 182) or less (n = 126). Practice effects were examined in these participants as a whole (n = 308) and by group.Results:Findings indicate that moderate practice effects exist in both groups on the CERAD T-score and that attrition bias likely does not play a contributing role in improved scores over time.Conclusion:The current study provides additional evidence and support for previous findings that repeated cognitive assessment results in rising test scores in longitudinally collected data and demonstrates that these findings are unlikely to be due to attrition.

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