The Importance of Patient Expectations: A Mixed-Methods Study of U.S. Psychiatrists

Objective: To examine how psychiatrists think about and modulate non-specific factors (e.g., hope, expectations) in clinical practice.Methods: U.S. psychiatrists were recruited for two studies assessing attitudes and behaviors related to non-specific factors. Study 1 entailed remote qualitative focus groups (k = 7) with n = 26 participants (36.0% female). Study 2 was a quantitative survey with n = 346 respondents (34.0% female) designed to assess the generalizability of focus group findings.Results: Four themes were identified in Study 1 that were used to inform the survey (Study 2): (1) Expectations (2) Hope, (3) Placebo Effect, and (4) Aesthetic Features. Nearly all surveyed psychiatrists (92.2%) considered patient expectations at least “most of the time” when interacting with a patient. Focus groups revealed that psychiatrists often attempt to balance optimism and realism to improve outcomes. A majority of survey respondents believed office design and physician attire could at least somewhat influence expectations (72.5 and 77.3%, respectively) and even outcomes (51.5 and 58.7%, respectively). Focus group psychiatrists described how physical features may be used as therapeutic tools.Conclusions: Psychiatrists are highly mindful of patient expectations. Although there is variability in the perceived importance of expectations, hope, the placebo effect, and aesthetic features, many utilize these factors in clinical practice.

Perspectives of pharmacists in general practice from qualitative focus groups with patients during a pilot study

BackgroundUtilising skill mix in general practice is proposed as a solution to the demand-supply issue. Pharmacists can play an important role in this context leading to an increase in training and funding for independent prescriber roles. A role for Pharmacists in General Practice was funded, piloted and evaluated by NHSE from 2015.AimWhat is the patient perspective of pharmacists in patient facing roles in general practice in the UK?Design & SettingFocus group interviews exploring patient perspectives on the pharmacist role.Method33 patients, five focus group interviews (January-December 2016). Data was iteratively analysed using the one sheet of paper technique.ResultsWhile public are aware of the primary care crisis, they are less well informed about potential solutions. Data showed patients primarily sought access to a clinician over expressing a preference for any type of clinician. Low awareness was shown about the role and there was initial confusion about pharmacist’s roles. Acceptability levels were high.Pharmacists add value and provide an expert medication focused service which can have a positive impact on medicines use.Patients reported benefit from longer appointments, feeling they weren’t rushed, and that all their conditions were being considered holistically. They trusted pharmacists as experts in medication and trust was consolidated over time. Regular coaching from a pharmacist could lead to improved patient self-monitoring and self-care.Conclusion (implications)Pharmacists can add value to the general practice team and this is recognised by patients.

Feeling Terrified?

This Element presents original research into how young people interact with violent extremist material, including terrorist propaganda, when online. It explores a series of emotional and behavioural responses that challenge assumptions that terror or trauma are the primary emotional responses to these online environments. It situates young people's emotional responses within a social framework, revealing them to have a relatively sophisticated relationship with violent extremism on social media that challenges simplistic concerns about processes of radicalisation. The Element draws on four years of research, including quantitative surveys and qualitative focus groups with young people, and presents a unique perspective drawn from young people's experiences.

Facilitators and Barriers to the Implementation of the Primary Care Asthma Paediatric Pathway: A Qualitative Analysis

ObjectiveThe Primary Care Asthma Paediatric Pathway (PCAPP) included an EMR embedded pathway that provided an evidence-based approach to paediatric asthma management. The aim of this qualitative study was to use a theory-based approach to understand the facilitators and barriers that impacted the implementation of the PCAPP in primary care.Methodsa randomized cluster-controlled design was implemented in 22 primary care practices in Alberta, Canada with half receiving the PCAPP intervention and the other half receiving usual care. Following the implementation of the complex intervention, a purposeful sample of intervention sites were selected to participate in qualitative focus groups to assess the barriers and facilitators to the implementation.ResultsOur qualitative findings are organized into three themes using the core constructs of the normalization process theory (NPT): (1) facilitators of implementation, (2) barriers to implementation, and (3) proposed mitigation strategies. Participants were positive about the pathway, and felt it served as a reminder of optimal paediatric guideline-based asthma management, a streamlined pathway multi-faceted approach to suggest evidence-based care, and an EMR-based targeted collection of tools and resources. Barriers included a generally low priority for the primary care teams, and, in accordance, clinicians suggested they had few children with asthma in their practices. The pathway was not integrated into clinic flow and there was not a specific process to ensure the pathway was used. Sites without project champions also struggled more with implementation. Despite these barriers, clinicians identified clear mitigation strategies to improve uptake including developing a reminder system within the EMR and creating a work-flow that incorporated the pathway.ConclusionOur study demonstrated the applicability of the NPT in the implementation of an evidence-based pathway for primary care. This study demonstrated it is important to ensure teams participate in enrolment (establishing buy-in), legitimization (ensuring teams see their role in the pathway) and activation (an ongoing plan for sustainability). Had these components of cognitive participation been addressed more carefully prior to implementation there may have been greater uptake, and ongoing use of the pathway. Trial Registration: This study was registered at clinicaltrials.gov on June 25, 2015; the registration number is: NCT02481037, https://clinicaltrials.gov/ct2/show/NCT02481037?term=andrew+cave&cond=Asthma+in+Children&cntry=CA&city=Edmonton&draw=2&rank=1

School Health Promotion at the Time of COVID-19: An Exploratory Investigation with School Leaders and Teachers

The Coronavirus pandemic has impacted the entire school population’s emotions and the disruption of the organization of the school world. In this context it is important to reflect on the role of health promotion at school. The present study aimed at exploring school leaders’ and teachers’ perspectives and experiences about COVID-19 pandemic and its effects in the school and education system. The first objective was to gather the experience of school leaders regarding the change in school organization, with particular attention to organizational and health promotion aspects. The second was to investigate the perception of health promotion and self-efficacy of teachers in primary, middle and high schools. The research was conducted using qualitative (focus groups for the school leaders) and quantitative methods (questionnaires for the teachers). The findings showed new ways of improving wellbeing at school and implementing health promotion through the sharing of good practice between school leaders. The need for time and space to reflect among school leaders on the educational and didactic aspects of school organization also emerged. Teachers showed a low to medium level of self-efficacy regarding the adoption of strategies in line with health promotion; specificities for each grade and level will be discussed.

“No one did a thing about it:” Adults’ beliefs about the effects of poor eating disorder education in U.S. public schooling

Introduction. Educational policies in the United States addressing eating disorders are lacking, despite noted increases in risk factors such as body dissatisfaction that occur throughout students' education. Similarly, there seems to be no available scientific information on the potential effects of this lack of education. Therefore, the aim of this study was to examine the type, amount, and frequency of information regarding eating disorders that college students recalled receiving throughout their educational careers. Methods. The sample consisted of 43 participants, mostly female, from a tri-college area in the Midwestern U.S. Ten qualitative focus groups were conducted in order to assess a wide range of eating disorder topics, including education about eating disorders. The four education-related codes generated using thematic analysis by the researchers were: When participants learned about eating disorders, when they wish they learned, what they learned, and what they wish they learned. Results. The majority of participants indicated only receiving occasional information in a health class if at all, and this often did not occur until mid-to-late adolescence, which is problematic as the risk factors for eating disorders would have begun years earlier. Most information centered on simplistic definitions of Anorexia Nervosa and Bulimia Nervosa. Participants said that education should be more in depth than simple definitions, and noted that this information should begin early in elementary school (ages 6-10). Participants also stated that they wished they had known more of the warning signs and how to seek help, as well as how to approach and help someone else. Conclusions. This study shows how the U.S. education system may fail to inform youths about the risks for and consequences of eating disorders, potentially leaving them vulnerable to developing unhealthy habits. The data provide suggestions for future educational efforts, namely that information should start in schools in early childhood, as information later in their educational careers may be too late. Keywords: Education, eating disorders, prevention, public policy

Rural students’ transition in and through a semi-urban university: Experiences from the National University of Lesotho

This paper reports on the findings of a study carried out at the National University of Lesotho (NUL). The paper explored the influence of ‘rurality’ on students who originate from the rural areas of Lesotho and analysed their transition at the NUL. The spatial geographic theory and narrative inquiry were adopted, and qualitative focus groups were utilised to collect data. The students were given an opportunity to conceptualise ‘rurality’ and narrate their stories about growing up and earlier schooling, as well as their learning experiences at the NUL. The findings revealed that rural students’ educational trajectories are indeed filled with numerous challenges, mainly due to deprivation and limited exposure to technology in their earlier lives. The main recommendation made by the paper is that the concerned stakeholders ought to be mindful of the needs of all prospective higher education students, including those from rural backgrounds, and intervene accordingly.

Acceptability and feasibility of strategies to promote healthy dietary choices in UK secondary school canteens: a qualitative study

Objective To explore the acceptability and feasibility of choice architecture strategies for dietary change in UK secondary school canteens from the perspectives of pupils, school staff and catering providers through qualitative focus groups and interviews. Results Three focus groups with adolescents (n = 15; mean age 13.7 years; standard deviation 1.9) and eight interviews with school staff and caterers recruited from one school and catering provider in Coventry UK were undertaken. The most acceptable choice architecture strategies for intervening to drive healthy dietary choices are those that make use of proximity and positioning, on the basis that convenience was one of the main drivers for food/drink selections. Acknowledging adolescents’ desire for autonomy and for food to be familiar and predictable was considered important in enhancing acceptability. Challenges to the feasibility of nudge strategies included concerns about behavioural issues, increased food waste, and a decline in uptake of canteen purchases. The design of food choice architecture interventions for secondary school settings should consider the specific characteristics of this age group and setting to ensure successful implementation.

Asylum seekers’ and refugees’ experiences of accessing health care: a qualitative study

BackgroundAsylum seekers and refugees often experience poor health in host countries. The United Nations High Commissioner for Refugees requires hosts to ensure these sanctuary seekers have access to basic health care.AimTo identify barriers and facilitators that affect access to health care by asylum seekers and refugees in Wales.Design & settingParticipatory research approach using qualitative focus groups across Wales, which hosts 10,000 refugees..MethodEight focus groups with asylum seekers, refugees and support workers and volunteers.(n=57)ResultsSpecialist NHS-funded services and grant-aided Non-Governmental Organisations (NGOs) facilitate access to health care, including primary care. Most asylum seekers and refugees understand the role of general practice in providing and coordinating care but are unaware of services out of hours. Reported barriers include: language difficulties, health literacy, unrecognised needs, and the cost of travel to appointments. Participants recognise the importance of mental health, but were disappointed by the state of mental health care. Some fear seeking support for mental health from their GP, but few are aware they have the right to move practice if they were unhappy. Written information about health care is not as accessible to refugees as to asylum seekers. While some participants read such material before consulting, others struggle to access information when in need. Few participants are aware of health prevention services. Even when they know about services like smoking cessation, these services’ difficulty in accommodating asylum seekers and refugees is a barrier.ConclusionMain barriers are: availability of interpreters; knowledge about entitlements; and access to specialist services.