Addressing Challenges When Applying GRADE to Public Health Guidelines: A Scoping Review Protocol and Pilot Analysis

This is a protocol for a scoping review that aims to determine how guideline authors using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach have addressed previously identified challenges related to public health. The Joanna Briggs Institute (JBI) methodology for scoping reviews will be followed. We will search and screen titles of guidelines for all languages published in 2013–2021 in: the GIN library, BIGG database, Epistemonikos GRADE guidelines repository, GRADEpro Database, MAGICapp, NICE and WHO websites. Two reviewers will independently screen full texts of the documents identified. The following information will be extracted: methods used for identifying different stakeholders and incorporating their perspectives; methods for identification and prioritization of non-health outcomes; methods for determining thresholds for decision-making; methods for incorporating and grading evidence from non-randomized studies; methods for addressing concerns with conditional recommendations in public health; methods for reaching consensus; additional methodological concerns; and any modifications made to GRADE. A combination of directed content analysis and descriptive statistics will be used for data analysis, and the findings presented narratively in a tabular and graphical form. In this protocol, we present the pilot results from 13 identified eligible guidelines issued between January and August 2021. We will publish the full review results when they become available.

Do pharmacy practice standards effectively describe behaviour? Reviewing practice standards using a behavioural specificity framework

Background Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is important that they describe behaviours explicitly so they can be interpreted, enacted and measured with ease. The AACTT framework specifies behaviour in terms of the: Action to be performed, Actor who performs the action, Context where the action occurs, Target who the action is performed with/for and Time when the action is performed (AACTT). It provides the most up to date framework for specifying behaviours and is particularly relevant to complex behavioural problems that involve sequences of behaviours performed by different people. Behavioural specificity within pharmacy practice standards has not been explored. Aim To determine if behaviours described in the Professional Practice Standards for Australian Pharmacists specify Action, Actor, Context, Target and Time. Methods Two researchers independently reviewed the scope and structure of the practice standards and one extracted action statements (behaviours) verbatim. Through an iterative process, the researchers modified and developed the existing AACTT definitions to operationalise them for application to review of the action statements in the practice standards. The operational definitions, decision criteria and curated examples were combined in a codebook. The definitions were consistently applied through a directed content analysis approach to evaluate all extracted action statements by one researcher. For consistency 20% was independently checked for agreement by a second researcher. Results A novel codebook to apply AACTT criteria to evaluate practice standards was developed. Application of this codebook identified 768 independent behaviours. Of these, 300 (39%) described at least one discrete observable action, none specified an actor, 25 (3%) specified context, 131 (17%) specified target and 88 (11%) specified time. Conclusion(s) The behaviours detailed in practice standards for Australian pharmacists do not consistently specify behaviours in terms of Action, Actor, Context, Target and Time. Developers in the pharmacy profession, and beyond, should consider the behavioural specificity of their documents to improve interpretability, usability and adherence to the behaviours detailed. This also has implications for the development and evaluation of interventions to change such behaviours and improve quality of care.

Mahasiswa dan Agen Perubahan pada Puisi “Sajak Pertemuan Mahasiswa” karya WS. Rendra

This article discusses the poem "Sajak Pertemuan Mahasiswa" by W.S. Rendra. The discussion of this poem is motivated by efforts and efforts to apply the concept of poetry structure put forward by Lévi-Strauss. The description of the structure of this poem aims to display the structure of the poem consisting of the outer structure (surface structure) and the inner structure (deep structure). The outer structures that will be discussed are forms of text, diction, and sound, while the inner structures that will be discussed are imagery, compounds, and themes. The method used in this study is descriptive of analytics with a type of qualitative research, namely placing the text of poetry as the object and research data. Data collection techniques are done by identifying, classifying, and recording. Data anlysis is done by meaning direct and directed content. Analysis is done by discussing the structure of poetry consisting of text, diction, and sound, imagery, compounds, and themes. The results showed that the structure of Lévi-Strauss poetry can determine the overall meaning and message of poetry. The use of blank verse, simple diction, dominance of vocal sounds /a/, thought imagery, and metaphorical-rhetorical majas refers to the theme of "openness". This theme can be interpreted very broadly, namely openness to justice, education, employment, income, and livelihood. This openness is tried by students as agents of change and a bridge between the government and the people.

The role of positive psychological constructs in diet and eating behavior among people with metabolic syndrome: A qualitative study

Positive Psychological (PP) constructs (e.g., optimism and gratitude) may impact the adherence to healthy behaviors, including diet, though prior studies have shown mixed findings. This qualitative study explored the relationships between PP constructs and dietary behaviors among 21 adults with metabolic syndrome through semi-structured interviews. Directed content analysis led to five themes: eating healthfully leads to PP constructs, PP constructs lead to eating healthfully, eating healthfully prevents negative emotions, healthy behaviors associated with diet, and an upward healthy spiral. Given the close relationship between PP constructs and diet, these may be targeted to improve diet in risk populations through interventions that promote well-being.

What Does “Asymmetric VR” Mean? A Directed Content Analysis of Co-Located Use of VR by Users on Reddit

Technology is often framed in terms of space and time of use, such that a mobile phone is used to either send asynchronous messages or host synchronous conversations with remote others, while a classroom smartboard supports co-located, synchronous learning. As the technology becomes more immersive, the applicability of frameworks such as the time/place matrix becomes less clear. This study attempts to provide clarity by applying the Composite framework for Asymmetric VR (CAVR) to online forum descriptions of the use of immersive virtual reality (VR) in co-located groups. A related framework, Roles of Technology, is also explored; however, the authors argue the framework must be expanded before application of it beyond mobile technology. To better understand one possible solution to co-located VR’s isolation problem, a directed content analysis was conducted, exploring the discussion of co-located and asymmetric VR use on various subreddits. As a result, 11 patterns of co-located use of VR, including 8 which specify asymmetric VR designs, are identified. The researchers update the dimensions of CAVR according to these results, compare CAVR to another nascent framework, and offer suggestions for future work and applicability to practice. This work is intended to help guide future creation and research of asymmetric VR experiences through the deconstruction of existing asymmetric VR experiences to their key parts via the application of CAVR.

Dyads' Perceptions: Recruiting Persons Living With Dementia and Caregivers in a Clinical Trial

Recruiting persons living with dementia (PLWD) and their caregivers (dyads) into research is challenging and costly. The purpose of this study was to better understand factors that influence dyads decisions to enroll in a clinical trial. We used Ajzen’s Theory of Planned Behavior (TPB) to develop a qualitative interview guide and analyze the data with a directed content analysis. We conducted semi-structured telephone interviews with 12 PLWD and 9 caregivers who all enrolled in one clinical trial. Aligning with the TPB we found the following positively influenced enrollment: 1) wanting to learn, in-person meetings with knowledgeable staff, and the money always helps (attitudes toward joining); 2) to support another person (perceived norm); and 3) easy to participate (perceived behavioral control). Flexible scheduling and the study taking place in the home was comfortable and convenient for participants. Findings can inform future recruitment efforts and research studies.

Explaining stress coping behaviors in patients with multiple sclerosis based on the PRECEDE model: a qualitative directed content analysis

Background Stress can be regarded as one of the consequences of Multiple Sclerosis (MS) and a factor in exacerbating or recurring the symptoms resulting from the disease. This study aimed to explain the stress coping behaviors in patients with MS based on the PRECEDE model. Methods This study is a qualitative directed content analysis research based on the PRECEDE model. Data were obtained through in-depth semi-structured interviews with 26 patients with MS, who were selected using a purposive sampling and maximum diversity in terms of gender, age, education, marital status, and employment. Data collection continued until the saturation occurred. Simultaneously, collected data were analyzed using a qualitative directed content analysis method. Results Data analysis led to the identification of 11 sub-categories. Of these, 10 sub-categories were assigned to three categories of predisposing factors (awareness, attitude, self-efficacy, and perceived severity), enabling factors (existence of resources, access to resources, skills of using resources, and educational preferences), and reinforcing factors (social support, important others and behavioral consequences). The social comparison category was a new category identified from the analysis of interviews. Conclusions Based on the results, individual, environmental and social factors play a role in the stress of these patients. Designing programs that lead to their empowerment and improvements in the environmental and social conditions can be effective in controlling stress in these patients. Based on the results, planners can adopt the most appropriate strategies to change these determinants, help reduce stress, and promote the psychological standard of living in these patients.

Virtues and Character Strengths in Persons with Mild Alzheimer's Disease and Related Dementias

The Values in Action (VIA) framework, from positive psychology, consists of 6 virtues (wisdom, courage, humanity, justice, temperance, and transcendence) which can be broken down into 24 strengths of character (Peterson & Seligman, 2004). Although this framework has been used to understand virtues and strengths in various populations, persons with Alzheimer’s disease and other progressive dementias have been largely excluded from such studies. The aims of our study were to utilize the VIA framework to: 1) examine the expression of virtues and character strengths in a sample of persons diagnosed with probable AD (who were clinically designated as having mild disease based on neuropsychological assessment); and 2) provide implications for further strengths-based research and clinical practice with this population. Twenty-eight older adults, between the ages of 56 and 93 (M = 77.88, SD = 9.88), participated in the study. All had a Clinical Dementia Reacting Scale (CDR) of 1 which suggested mild dementia. The Dimensions of Living with Dementia Interview (DLD; McGee & Carlson, 2013) was utilized for data collection. Interviews lasted approximately 45 minutes per participant. The interviews were professionally transcribed, audit checked, and uploaded to NVivo (2018) for analysis. Directed content analysis (Hsieh & Shannon, 2005) was utilized to extend the VIA framework to this sample. The virtues of wisdom, courage, humanity, temperance, and transcendence were demonstrated. We share how these virtues and corresponding character strengths can assist people with early-stage dementia in adaptation to the disease. Implications for clinical practice and further research are provided.

Barriers to Sustained Implementation of STAR-VA and Strategies to Overcome Them

STAR-VA is an evidence-based, interdisciplinary program helping CLC teams effectively manage DBD. We conducted interviews with 42 key informants involved with STAR-VA implementation in 20 CLCs, guided by a sustainment framework, to understand facilitators and barriers to sustained implementation. We used directed content analysis to identify barriers and mapped them to the CFIR-ERIC Mapping Tool to identify associated implementation strategies. We identified six barriers: 1) staffing issues, 2) lack of written policies, 3) staff buy-in, 4) limited leadership support, 5) exclusion of STAR-VA criteria in performance evaluations, and 6) service line silos. We identified six strategies to overcome these barriers, three strategies most frequently mapped to reported barriers to STAR-VA sustainment: 1) assessing local CLC readiness, facilitators and addressable barriers; 2) identifying and preparing new champions; and 3) altering incentive/allowance structures. The identified strategies can be packaged to further integrate STAR-VA into usual CLC care processes to optimize program sustainability.

Adverse or therapeutic? A mixed-methods study investigating adverse effects of Mindfulness-Based Cognitive Therapy in bipolar disorder

Background Mindfulness-Based Interventions (MBIs) are widely used in clinical and non-clinical populations, but little attention has been given to potential adverse effects (AEs). Aims This study aimed to gain insight in the prevalence and course of AEs during Mindfulness-Based Cognitive Therapy (MBCT) for patients with bipolar disorder (BD). Method The current mixed-methods study was conducted as part of a RCT on (cost-) effectiveness of MBCT in 144 patients with BD (Trial registered on 25th of April 2018, ClinicalTrials.gov, NCT03507647). During MBCT, occurrence of AEs was monitored prospectively, systematically, and actively (n = 72). Patients who reported AEs were invited for semi-structured interviews after completing MBCT (n = 29). Interviews were analysed with directed content analysis, using an existing framework by Lindahl et al. Results AEs were reported by 29 patients, in seven of whom the experiences could not be attributed to MBCT during the interview. AEs were reported most frequently up to week 3 and declined afterwards. Baseline anxiety appeared to be a risk factor for developing AEs. Seven existing domains of AEs were observed: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Influencing factors were subdivided into predisposing, precipitating, perpetuating, and mitigating factors. With hindsight, more than half of patients considered the reported AEs as therapeutic rather than harmful. Conclusions Although the occurrence of AEs in MBCT for patients with BD is not rare, even in this population with severe mental illness they were not serious or had lasting bad effects. In fact, most of them were seen by the patients as being part of a therapeutic process, although some patients only experienced AEs as negative.