Leadership in primary care

Leadership is an important concept for GPs and has its own topic guide in the MRCGP curriculum. Simply put, leadership is about influencing others to take action for change. You may like to start this article by thinking of a few public figures you know, and what makes you think they are ‘good leaders’ – or not. This often highlights the fact that ‘good’ is defined both by how effective leaders are (…‘ he really changed the practice’…); and whether they lead people into actions that help or harm (… ‘ pay went up, but care got worse…’). As GPs, we need to recognise and develop our own leadership skills and be able to help others to do what is needed for effective patient care. This starts with having some definitions and building up through ‘knowing about’ and ‘knowing how’, towards understanding and applying our skills in practice. Leadership can also need action, beyond our own practice and that of our team, to the wider setting of the community, other parts of the workforce, and in the wider ‘macro’ sphere of changing the systems of care. This article will give you a framework for this learning. The article highlights some of the core capabilities of GPs, why you need them, and how you can develop them, linking this in with MRCGP Workplace-Based Assessment (WPBA) requirements. It also aims to show the links between ‘knowing yourself’ and ‘working in organisations’ - as GP leadership is needed at many levels.

Los buenos profesores universitarios, en la voz de padres de familia. Un insumo para el diseño de programas de formación docente con pertinencia social

El objetivo de esta investigación fue describir las percepciones de padres de familia acerca de las características de la enseñanza de los buenos profesores universitarios, consideradas como un insumo para el diseño de programas de formación docente con pertinencia social. Es un estudio cualitativo con indagación naturalista. Participaron 93 padres de familia con hijos universitarios del Estado de Sonora, México. Se empleó una guía de tópicos que respondieron por medio de la técnica de composición escrita y una entrevista semiestructurada. Emergieron categorías de forma inductiva siendo éstas las que presentaron mayor densidad: a) crea clima agradable de confianza, b) explica claramente, c) preparados en su materia y la didáctica, d) enseña de forma entusiasta y práctica y e) apoya a los estudiantes en su aprendizaje. Para validar estas categorías se compararon con estudios de temas similares realizados en universidades ubicadas en los primeros lugares del ranking académico QS Latin América Rankings. Se obtuvieron coincidencias en un 80% de las categorías de las percepciones de padres y de los estudios, lo que valida su voz y abre posibilidades de participación en los procesos de redefinición de políticas y contenidos en los procesos de formación docente The objective of this research was to describe the perceptions of parents about the teaching characteristics of good university professors, considered as a social input for the design of teacher training programs. It is a qualitative study with naturalistic inquiry. 93 parents with university children from the State of Sonora, Mexico participated. A topic guide was used that responded through the written composition technique and a semi-structured interview. Inductive categories emerged, these being the ones that presented the highest density: a) creates a pleasant climate of trust, b) explains clearly, c) prepared in their subject and didactics, d) teaches enthusiastically and practically, and e) supports students in their learning. In order to validate these categories, they were compared with studies on similar topics carried out in universities located in the first places of the QS Latin America Rankings academic ranking. Agreements were obtained in 80% of the categories of the perceptions of parents and the studies, which validates their voice and opens possibilities for participation in the processes of redefining policies and contents in the teacher training processes

Knowledge, health beliefs and attitudes towards dementia and dementia risk reduction among descendants of people with dementia: a qualitative study using focus group discussions

Background Individuals with a parental family history of dementia have an increased risk of developing dementia because they share their genes as well as their psychosocial behaviour. Due to this increased risk and their experience with dementia, they may be particularly eager to receive information regarding dementia risk reduction (DRR). This study evaluated the knowledge, beliefs and attitudes towards dementia and DRR among descendants of people with dementia. Method Using a semi-structured topic guide, three focus group discussions were conducted consisting of 12 female (80%) and 3 male (20%) descendants of people with dementia with a mean (± SD) age of 48.8 (± 12) years. Focus group discussions were audio recorded and transcribed. Each transcript was analysed thoroughly, and where appropriate, a code was generated and assigned by two researchers independently. Then, similar codes were grouped together and categorized into themes. Results The items in the topic guide could only be addressed after participants had been given the opportunity to share their experiences of having a parent with dementia. Participants were unaware or uncertain about the possibility of reducing the risk of developing dementia and therefore hesitant to assess their dementia risk without treatment options in sight. Moreover, participants indicated that their general practitioner only gave some information on heritability, not on DRR. Although participants identified a large number of modifiable risk factors as a group during the group discussions, they were eager to receive more information on dementia and DRR. In the end, participants adopted a more positive attitude towards a DRR programme and provided suggestions for the development of future DRR programmes. Conclusions Although the research aim was to evaluate the knowledge, beliefs and attitudes towards dementia and DRR, sharing experiences of having a parent with dementia seemed a prerequisite for considering participants’ own risk of developing dementia and participating in a DRR programme. Knowledge of dementia and DRR was limited. Due to unawareness of the possibility of reducing dementia risk, participants were hesitant about assessing their dementia risk. Group discussions positively changed the perception of dementia risk assessment and participants’ willingness to participate in a DRR programme.

Why Do Canadians Travel Abroad for Cosmetic Surgery? A Qualitative Analysis on Motivations for Cosmetic Surgery Tourism

Background: Canadians are increasingly engaging in medial tourism. The purpose of this study was to review Canadians’ experiences with travelling abroad for cosmetic surgery, including primary motivations for seeking care outside of Canada. Methods: A qualitative analysis was conducted using semistructured interviews following a pre-determined topic guide. People who had undergone cosmetic surgery outside of Canada were interviewed. The interviews were transcribed and coded to determine motivational themes. Patients were recruited until thematic saturation was achieved. Results: Thematic saturation was achieved after recruitment of 11 patients. The most common motivational themes identified in this study for seeking cosmetic surgery outside of Canada included cost, post-operative care provided, marketing/customer service, and word-of-mouth. Member checking and theory triangulation were validation techniques used to verify identified themes. Mexico was the most common location for cosmetic tourism. The most common procedures were breast augmentation, mastopexy, and abdominoplasty. Participants gathered pre- and post-operative information primarily through pamphlets and contact with surgeons’ offices. Follow-up was only available for half of the participants in this study, and only 5 of the participants felt that they had received informed consent. Conclusions: The majority of participants engaged in cosmetic tourism due to cost reasons and the level of post-operative care provided.

Psychosocial barriers and facilitators for a successful return to work following injury within firefighters

Objective The aim was to explore firefighter’s experiences during their recovery from injury. Focused specifically on exploring perceived psychosocial barriers and facilitators firefighters faced during recovery and return to work. Methods Semi-structured interviews were used to provide an in-depth understanding of the firefighter’s experiences. The semi-structured interviews were informed by a topic guide. The topic guide focused on five main themes, (1) overall experience of returning to operational duties following an injury, (2) perceived barriers experienced during their return to work, (3) perceived facilitators experienced during their return to work, (4) confidence in participating in physical activity following injury and (5) where they felt areas of improvement could be made with the return to work process. Thematic analysis of the data collected was undertaken using The Framework Method. Results Two main themes were sought after transcription: barriers and facilitators. From these, nine subthemes were identified (1) communication, (2) confidence in physical activity participation, (3) modified duties, (4) physiotherapy, (5) return to operational duties, (6) support, (7) inconsistency, (8) use of station gyms, (9) detachment from the watch. Conclusions Consideration should be made for the consistency of procedures followed during an individual’s return to work following an injury. Further research is needed to understand if the themes identified in this study are the same for other fire services. Further research is also needed to understand how the findings may be best implemented within the fire service.

Knowledge, Beliefs and Attitudes Towards Dementia and Dementia Risk Reduction Among Descendants of People with Dementia: A Qualitative Study Using Focus Group Discussions

Background Individuals with a parental family history of dementia have an increased risk of developing dementia because they share their genes as well as their psychosocial behaviour. Due to this increased risk and their experience with dementia, they may be particularly eager to receive information regarding dementia risk reduction (DRR). This study evaluated the knowledge, beliefs and attitudes towards dementia and DRR among descendants of people with dementia.Method Using a semi-structured topic guide, three focus group discussions were conducted consisting of 12 female (80%) and 3 male (20%) descendants of people with dementia with a mean age of 48.8 ± 12.0 years. Focus group discussions were audio recorded and transcribed. Each transcript was analysed thoroughly, and where appropriate, a code was generated and assigned by two researchers independently. Then, similar codes were grouped together and categorized into themes.Results The items in the topic guide could only be addressed after participants had been given the opportunity to share their experiences of having a parent with dementia. Participants were unaware or uncertain about the possibility of reducing the risk of developing dementia and therefore hesitant to assess their dementia risk without treatment options in sight. Moreover, participants indicated that their general practitioner only gave some information on heritability, not on DRR. Although participants identified a large number of modifiable risk factors as a group during the group discussions, they were eager to receive more information on dementia and DRR. In the end, participants adopted a more positive attitude towards a DRR program and provided suggestions for the development of future DRR programs.Conclusions Although the research aim was to evaluate the knowledge, beliefs and attitudes towards dementia and DRR, sharing experiences of having a parent with dementia seemed a prerequisite for considering participants’ own risk of developing dementia and participating in a DRR program. Knowledge of dementia and DRR was limited. Due to unawareness of the possibility of reducing dementia risk, participants were hesitant about assessing their dementia risk. Group discussions positively changed the perception of dementia risk assessment and participants’ willingness to participate in a DRR program.

Stakeholders perspective of, and experience with contact tracing for COVID-19 in Ghana: A qualitative study among contact tracers, supervisors, and contacts

Background Ghana confirmed the first two cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) infection on 12th March 2020. Following this, the government introduced routine and enhanced contact tracing to identify, quarantine, and test contacts for COVID-19. This study, therefore, intends to document the experiences of contact tracers, their supervisors, during COVID-19 containment in Ghana. Methods Purposive sampling was used to select twenty-seven (27) participants; sixteen contact tracers, six supervisors, and five contacts of COVID-19 cases for an in-depth interview using a topic guide. These interviews were conducted on a phone or face-to-face basis whilst maintaining physical distancing protocol. All these were recorded and transcribed verbatim. Then, QSR NVivo 12 was used to analyse the data thematically. Results Contact tracers were selected based on their professional background and surveillance experience with other infectious diseases. They were trained before the first confirmed cases of COVID-19 in the country and before deployment. Deployment of contact tracers was in pairs to monitor contacts daily through physical visits or over the phone. Their activities included educating contacts about the condition, filling the symptoms diary, and providing psychological support. Contacts for COVID-19 were identified through case investigation, and their monitoring is done once a day despite the twice-daily requirement. Wherever a case was confirmed, enhanced contact tracing within a 2km radius was done. Furthermore, it was reported that some contacts were not adhering to the self-quarantine. In addition to this, other challenges included; unstable provision of PPEs and remuneration, refusal of some contact to test, delays in receiving test results, and poor coordination of the whole process. Conclusions The study concludes that contact tracing was generally perceived to be helpful in COVID-19 containment in Ghana. However, adhering to self-quarantine protocol had many challenges for both contact tracers and the contacts. Improving coordination and quick release of test results to contacts is necessary for COVID-19 containment. Lastly, the supply of Personal Protection Equipment and motivation needs to be addressed to help position the country well for effective contact tracing.

Understanding patterns of adherence to COVID-19 mitigation measures: a qualitative interview study

Background Evidence highlights the disproportionate impact of measures that have been introduced to reduce the spread of coronavirus on individuals from Black, Asian and minority ethnic (BAME) communities, and among those on a low income. An understanding of barriers to adherence in these populations is needed. In this qualitative study, we examined the patterns of adherence to mitigation measures and reasons underpinning these behaviors. Methods Semi-structured interviews were conducted with 20 participants from BAME and low-income White backgrounds. The topic guide was designed to explore how individuals are adhering to social distancing and self-isolation during the pandemic and to explore the reasons underpinning this behavior. Results We identified three categories of adherence to lockdown measures: (i) caution-motivated super-adherence (ii) risk-adapted partial-adherence and (iii) necessity-driven partial-adherence. Decisions about adherence considered potential for exposure to the virus, ability to reduce risk through use of protective measures and perceived importance of/need for the behavior. Conclusions This research highlights a need for a more nuanced understanding of adherence to lockdown measures. Provision of practical and financial support could reduce the number of people who have to engage in necessity-driven partial-adherence. More evidence is required on population level risks of people adopting risk-adapted partial-adherence.

Exploring Frontline Employees’ Motivations to Engage in value Cocreation: A Context of Non-Fuel Retailing

In the context of non-fuel retailing, the goal of this study is to find out what motivates frontline employees to participate in value cocreation activities with consumers. According to this study, frontline employees participate in value cocreation activities to attain the expected or perceived value they desire. Through the conduction of six interviews in Malaysia's automotive sector, this study used an exploratory technique to investigate the underlying characteristics of frontline employees' motives. Semi structured interviews were done with the use of a topic guide, but the researchers were not confined in their frame of reference, allowing them to explore for clarification and confirmation. The results of the interviews were examined using an idiographic technique and then compared using cross-case analysis. Professional identity, financial benefits, career progression opportunities, and workplace recognition are all motivators for frontline employees to cocreate value. Due to variances in the employees' past expectations, these reasons may change across different service situations. Managers may begin measuring and managing service interactions between frontline personnel and customers by understanding their motives to cocreate value.

Disclosing a Diagnosis in the Workplace: Perspective of People With Multiple Sclerosis

Background: Early withdrawal from the workforce is associated with a diagnosis of multiple sclerosis (MS), with employment retention rates also lower than in the general population. Despite legal requirements, equality in the workplace for people with MS has not been achieved. Disclosure of multiple sclerosis at work is essential for the implementation of accommodations enabling employment retention. Method: An interpretive descriptive study explored participants’ decision to disclose or not disclose their diagnosis of multiple sclerosis and the implications this had on work participation and working relationships. Semistructured interviews were used to collect data from 6 participants. Results: Three themes were identified, using a reflective approach to analysis, from the data: (a) Accommodations; (b) Workplace Relationships; and (c) Balancing Work and Home Life. Participants had mixed experiences of disclosing their diagnosis. Findings supported the implementation of workplace accommodations including physical, cognitive, and structural supports. Concealment of MS was associated with fear of workplace stigmatisation. Conclusion: Disclosure is multidimensional and subjective. It is based on personal, systematic, and social factors. This study was limited by the small number of participants and not including stakeholders in the creation of the topic guide. The results are important for those involved in supporting people with multiple sclerosis to remain in the workplace.