Gestational diabetes mellitus follow-up in Norwegian primary health care: a qualitative study

BackgroundWomen with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course approach aiming to prevent disease and promote health across generations, the Norwegian GDM guideline recommends follow-up in primary care after delivery, with information on the increased risks, lifestyle counselling, and annual diabetes screening. Few reports exist on Norwegian women’s experiences of GDM follow-up. AimTo elucidate women’s experiences with follow-up of GDM in pregnancy and after delivery, and to explore their attitudes to diabetes risk and motivation for lifestyle changes. Design & settingQualitative study in primary care in the region of Stavanger, Norway. MethodSemi-structured in-depth interviews were conducted 24–30 months after delivery with 14 women aged 28–44 years, with a history of GDM. Data were analysed thematically. ResultsMost women were satisfied with the follow-up during pregnancy; however, only two women were followed-up according to the guideline after delivery. In most encounters with GPs after delivery, GDM was not mentioned. To continue the healthy lifestyle adopted in pregnancy, awareness of future risk was a motivational factor, and the women asked for tailored information on individual risk and improved support. The main themes emerging from the analysis were as follows: stigma and shame; uncertainty; gaining control and finding balance; and a need for support to sustain change. ConclusionWomen experienced a lack of support for GDM in Norwegian primary care after delivery. To maintain a healthy lifestyle, women suggested being given tailored information and improved support.

COVID-19 as a Social Disease: Qualitative Analysis of COVID-19 Prevention Needs, Impact of Control Measures and Community Responses Among Racialized/Ethnic Minorities in Antwerp, Belgium

Background: In high income countries, racialized/ethnic minorities are disproportionally affected by COVID-19. We lack in-depth understanding of these communities’ experiences with and responses to COVID-19 despite the established importance of community involvement in epidemic preparedness. We explored information and prevention needs, coping mechanisms with COVID-19 control measures and their impact on lived experiences among selected racialized/ethnic minority communities.Methods: This qualitative rapid assessment conducted in Antwerp/Belgium used an interpretative and participatory approach. We included migrant communities with geographic origins ranging from Sub-Saharan Africa, North-Africa to the Middle East, Orthodox Jewish communities and community workers working with these groups. Data were collected between May 2020 - May 2021 through key informant-, in-depth interviews and group discussions (N=71). Transcripts were analyzed inductively, adopting a reflexive thematic approach. A community advisory board provided feedback throughout the research process.Results: Participants indicated the need for tailored information in terms of language and timing. At the start of the epidemic, they perceived official public health messages as insufficient to reach all community members. Information sources included non-mainstream (social) media and media from home countries, hampering a nuanced understanding of virus transmission mechanisms and local and national protection measures. Participants felt the measures’ most negative impact on their livelihoods (e.g. loss of income, disruption of social and immigration support). Economic insecurity triggered chronic stress and fears at individual and family level. High degrees of distrust in authorities and anticipated stigma were grounded in previously experienced racial and ethnic discrimination. Community-based initiatives mitigated this impact, ranging from disseminating translated and tailored information, providing individual support, and successfully reaching community members with complex needs (e.g. the elderly, digitally illiterate people, those with small social networks or irregular legal status). Conclusion: Study participants’ narratives showed how coping with and responding to COVID-19 was strongly intertwined with socio-economic and ethnic/racial characteristics, justifying conceptualizing COVID-19 a social disease. At the same time, communities demonstrated resilience in responding to these structural vulnerabilities. From a health equity perspective, we provide concrete policy recommendations grounded in insights into communities’ structural vulnerabilities and resilience.

Design of an early remote coaching program to bridge the gap from hospital discharge to the start of cardiac rehabilitation. (Preprint)

BACKGROUND Remote coaching might potentially be suited for providing information and support to patients with coronary artery disease (CAD) in the vulnerable phase between hospital discharge and the start of cardiac rehabilitation (CR). OBJECTIVE To explore and summarize information- and support needs of patients with CAD, and to develop an early remote coaching program providing tailored information and support. METHODS We used the intervention mapping (IM) approach to develop a remote coaching program. Three consecutive steps were completed in this study: (1) identification of information- and support needs in patients with CAD, using an exploratory literature study and semi-structured interviews; (2) definition of program objectives; (3) selection of theory-based methods and practical intervention strategies. RESULTS Our exploratory literature study (n=42) and semi-structured interviews (n=17) identified that after hospital discharge, patients with CAD report a need for tailored information and support about: CAD itself and the specific treatment procedures, medication and side effects, physical activity, and psychological distress. Based on the preceding steps, we defined the following program objectives: 1. Patients gain knowledge on how CAD and revascularization affects their bodies and health. 2. Patients gain knowledge about medication and side effects and adhere to their treatment plan. 3. Patients know which daily physical activities they can and can’t do safely after hospital discharge and are physically active. 4. Patients know the psychosocial consequences of CAD and know how to discriminate between harmful and harmless body signals. Based on the preceding steps, a remote coaching program was developed with the theory of health behavior change as theoretical framework, and behavioral counseling and video modelling as practical strategies for the program. CONCLUSIONS In this study we present the design of an early remote coaching program based on the needs of patients with CAD. The development of this program constitutes a step in the process of bridging the gap from hospital discharge to start of CR.

An information classification model for public sector organizations in Sweden: a case study of a Swedish municipality

Purpose The purpose of this study is to create an information classification model that is tailored to suit the specific needs of public sector organizations in Sweden. Design/methodology/approach To address the purpose of this research, a case study in a Swedish municipality was conducted. Data was collected through a mixture of techniques such as literature, document and website review. Empirical data was collected through interviews with 11 employees working within 7 different sections of the municipality. Findings This study resulted in an information classification model that is tailored to the specific needs of Swedish municipalities. In addition, a set of steps for tailoring an information classification model to suit a specific public organization are recommended. The findings also indicate that for a successful information classification it is necessary to educate the employees about the basics of information security and classification and create an understandable and unified information security language. Practical implications This study also highlights that to have a tailored information classification model, it is imperative to understand the value of information and what kind of consequences a violation of established information security principles could have through the perspectives of the employees. Originality/value It is the first of its kind in tailoring an information classification model to the specific needs of a Swedish municipality. The model provided by this study can be used as a tool to facilitate a common ground for classifying information within all Swedish municipalities, thereby contributing the first step toward a Swedish municipal model for information classification.

Towards a Robust Electronic Agriculture Platform Development

This study identified that the calls to go back to agriculture has reached high decibels and in response several individuals and institutions have shown inclinations towards these calls. The study also identified that agriculture has become knowledge intensive, such that timely, accurate and specifically tailored information have become critical determinant success factors. To aid those disposed to responding to these calls as well as the requisite critical information needs germane to achieving success, the study looked in the direction of Electronic agriculture (Electronic -Agriculture), an emerging research area. And in specific terms, the study analyzed the requirement specifications incidental to meeting the information needs of the identified challenges. And based on the insights gained, the study modeled and simulated a system whose features and functionalities met the requirements for a desirable conceptual framework for setting up an Electronic -Agriculture platform.

Spinning straw into gold: description of a disruptive rheumatology research platform inspired by the COVID-19 pandemic

Clinical research projects often use traditional methods in which data collection and signing informed consent forms rely on patients’ visits to the research institutes. However, during challenging times when the medical community is in dire need of information, such as the current COVID-19 pandemic, it becomes more urgent to use digital platforms that can rapidly collect data on large numbers of patients. In the current manuscript, we describe a novel digital rheumatology research platform, consisting of almost 5000 patients with autoimmune diseases and healthy controls, that was set up rapidly during the COVID-19 pandemic, but which is sustainable for the future. Using this platform, uniform patient data can be collected via questionnaires and stored in a single database readily available for analysis. In addition, the platform facilitates two-way communication between patients and researchers, so patients become true research partners. Furthermore, blood collection via a finger prick for routine and specific laboratory measurements has been implemented in this large cohort of patients, which may not only be applicable for research settings but also for clinical care. Finally, we discuss the challenges and potential future applications of our platform, including supplying tailored information to selected patient groups and facilitation of patient recruitment for clinical trials.