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PubMed1996

Screening for cutaneous melanoma by skin self-examination.

BACKGROUND: Although some evidence indicates that early detection protects against the development of lethal melanoma, no randomized clinical trials have been conducted to measure the efficacy of early detection (or screening) in preventing death from this disease. Since melanoma incidence in the United States is relatively rare, a randomized clinical trial to test the efficacy of screening would be extremely expensive. PURPOSE: As an alternative to a randomized clinical trial, we conducted a population-based, case-control study to investigate whether early detection through skin self-examination (SSE) is associated with a decreased risk of lethal melanoma (includes the presence of advanced disease with distant metastases in addition to death from melanoma). METHODS: SSE (conducting a careful, deliberate, and purposeful examination of the skin) was assessed in all subjects by use of a structured questionnaire and personal interviews. The major exposure variable, SSE, was defined following focus-group interviews with melanoma patients and healthy control subjects. The final study population consisted of 1199 Caucasian residents of the state of Connecticut enrolled from January 15, 1987, through May 15, 1989; 650 individuals were newly diagnosed with cutaneous melanoma, and the remaining 549 individuals were age- and sex-frequency matched control subjects from the general population. During the study interviews, nevi on the arms and backs of subjects were counted. In 5 years of follow-up (through March 1994), 110 lethal cases of melanoma were identified. The study design allowed separate estimation of the impact of SSE on reduced melanoma incidence (primary prevention) and survival among incident cases (secondary prevention). Odds ratios (ORs) were used to measure the associations between SSE and melanoma and between SSE and lethal melanoma. RESULTS: SSE, practiced by only 15% of all subjects, was associated with a reduced risk of melanoma incidence (adjusted OR = 0.66; 95% confidence interval [CI] = 0.44-0.99; comparing case patients with control subjects). The data indicated further that SSE may reduce the risk of advanced disease among melanoma patients (unadjusted risk ratio = 0.58; 95% CI = 0.31-1.11); however, longer follow-up is required to confirm this latter estimate. If both estimates are correct, they suggest, in combination, that SSE may reduce mortality from melanoma by 63% (adjusted OR = 0.37; 95% CI = 0.16-0.84; comparing lethal cases with general population controls). CONCLUSIONS AND IMPLICATIONS: SSE may provide a useful and inexpensive screening method to reduce the incidence of melanoma. SSE may also reduce the development of advanced disease. The results of this study need to be replicated before strategies to increase the practice of SSE are further developed and promoted.

Adult↗

PubMed2006

The views of undergraduate nursing students on caring for patients with HIV/AIDS.

A qualitative, exploratory and descriptive study was conducted with the purpose of exploring and describing the views of undergraduate nursing students on caring for HIV/AIDS patients. The study population consisted of BCur III nursing students studying at the Medical University of Southern Africa (Medunsa). Participants were purposively selected. Focus group interviews were used as a data collection instrument. Guided by a group moderator and responding to a central research question, participants shared their views about caring for HIV/AIDS patients. Tesch's qualitative method of data analysis, as described by Cresswell (1994:155), was used to analyse the data. Caring for HIV/AIDS patients evoked emotions such as fear, anger and frustration among undergraduate nursing students. Students expressed needs such as the acquisition of knowledge and a reduction in the stigmatisation of patients with HIV/ AIDS, while the data analysis revealed demands such as more intensive clinical accompaniment by lecturers and antiretroviral therapy delivery by government. Suggested solutions included student participation in HIV/AIDS prevention campaigns and the upholding of patients' rights. Curriculum innovation was recommended to improve students' knowledge of HIV/AIDS and to ensure the provision of quality care for these patients.

Anger↗

PubMed2001

A qualitative study of patients' views on anxiety and depression.

BACKGROUND: In the management of patients with anxiety and depression in general practice, the emphasis has been on improving detection and appropriate use of drug therapies by health professionals. Patients' own perceptions of their problems and what services they would prefer have not often been sought. AIM: To explore patient perspectives in relation to their healthcare needs in anxiety and depression. DESIGN OF STUDY: Semi-structured individual and focus group interviews. SETTING: A total of 27 patients from an urban four-partner group general practice who were identified as having anxiety and depression by a practice population questionnaire survey. METHOD: All interviews were transcribed and the major themes were summarised using grounded theory analysis. RESULTS: Patients seek many different ways of coping with their problems but view their general practice as a focal point for help. Their experiences are dominated by the struggle to control unwelcome and intrusive thoughts and to live in a hostile and threatening world. They also have distinct preferences regarding their health needs and there is universal scepticism about drug therapies. CONCLUSION: Patients describe personal and professional barriers to seeking help and have particular views on the treatment options. This perspective contrasts with the current professional emphasis on detection and drug use. This view is therefore central to informing the debate on management of neurotic disorders in primary care and on improving the care of these patients.

Adolescent↗

PubMed2002

Active sick leave for patients with back pain: all the players onside, but still no action.

STUDY DESIGN: Semistructured interviews, group discussions, and a mailed survey. OBJECTIVE: To identify barriers to the use of active sick leave (ASL) and to design an intervention to improve the use of ASL by patients with low back pain. SUMMARY OF BACKGROUND DATA: ASL was introduced in Norway in 1993 to encourage people on sick leave to return to modified work. With ASL the National Insurance Administration (NIA) pays 100% of wages, thereby allowing the employer to engage a substitute worker at no extra cost, in addition to the worker on ASL. Arranging ASL requires cooperation between the general practitioner (GP), employer, local NIA staff, and the patient, which may explain why ASL was used in less than 1% of the eligible sick leave cases in 1995, despite strong support from all players. METHODS: The authors conducted five in-depth interviews at a workplace where ASL was successfully implemented. Questionnaires were sent to 89 GPs, 102 workplace representatives, and 22 local NIA officers in three counties. Five patients with back pain who had used ASL were interviewed in a focus group, and 10 patients with back pain who had not used ASL were interviewed using a structured guide. Five workplaces participated in a dialogue conference. Data collection and analysis were iterative, and new data were constantly compared with the previously analyzed materials. RESULTS: About 80% of the GPs, employers, and NIA officers believed ASL is effective in reducing long-term sick leave. Among the barriers identified were lack of information, lack of time, and work flow barriers such as poor communication and coordination of activities between the players required to carry out ASL. Two strategies were designed to improve the workflow between them. A passive implementation strategy was designed to require a minimum amount of economic and administrative support. It included targeted information, clinical guidelines for low back pain, a reminder to GPs in the sick leave form, and a standardized agreement. A proactive strategy included the same four elements plus a kick-off continuing education seminar for GPs and a trained resource person to facilitate the use of ASL. CONCLUSIONS: Having all the players onside may be essential, but it is not sufficient to bring about action in workplace strategies for patients with low back pain. If early return to modified work is effective, implementing it may require interventions targeted at identified barriers.

Communication↗

PubMed2002

Assessing practice of student nurses: methods, preparation of assessors and student views.

AIMS: To describe the methods of measuring progress in achieving competence of preregistration nursing and midwifery students used by institutions of higher and further education in Scotland and to describe the philosophy and approaches to competence assessment in each institution. BACKGROUND: Institutions of higher and further education in Scotland operate a variety of schemes to assess the clinical practice of student nurses. These are based on different philosophies and practices and this raises the question of which are valid and reliable. METHODS: All institutions in Scotland providing validated Diploma of Higher Education programmes for preregistration nursing and midwifery participated in this study. Data were collected by postal questionnaire, review of programme documentation and supplemented with interviews with key stakeholders. The directors of the 13 programmes (seven nursing and six midwifery programmes) were surveyed and also 12 group interviews with students (six nursing and six midwifery student groups) from seven institutions. Students from all four branches were represented and 72 students (36 nurses and 36 midwives) were interviewed. RESULTS: Four key findings were identified and related to competence assessment methods, preparation of practice assessors, consequences of failure to meet expected level of outcome and students' views. CONCLUSIONS: There has been a change in theoretical frameworks of assessment instruments used since the 1992 programmes commenced and only a limited number of approaches to clinical assessment are used in Scotland. Students' views suggested that they had little confidence in methods of clinical competence assessment and there was no formal validity and reliability testing within institutions. A lack of consistency in the training of student assessors in the clinical areas was identified. Some of these issues may be resolved with the development of a national instrument for competence assessment.

Clinical Competence↗

PubMed2006

Spiritual care: implications for nurses' professional responsibility.

AIM: This paper aimed to gain insight into the spiritual aspects of nursing care within the context of health care in the Netherlands and to provide recommendations for the development of care in this area and the promotion of the professional expertise of nurses. BACKGROUND: International nursing literature suggests that caregivers are expected to pay attention to spiritual aspects of patient care. In Dutch nursing literature, the spiritual dimension is increasingly becoming a focus of attention. Despite this, there is a lack of empirical data from professional practice in the Netherlands. METHOD: Data were collected by means of focus group interviews. The sample was made up of the specialist fields of cardiology, oncology and neurology and divided into groups of patients, nurses and hospital chaplains. The interviews took place between May and December 2004. Data were qualitatively analysed using the computer programme Kwalitan. RESULTS: Different spiritual themes emerged from the interviews. There were different expectations of the nurse's role with regard to spiritual aspects. The main themes derived from this research can be recognized as aspects of nursing competencies that are reported in the literature. However, the attention to spiritual aspects in the nursing process is not clear cut. It seems to be highly dependent on personal expression and personal commitment. CONCLUSIONS: The study raises questions about the nurse's professional role in spiritual care. The study shows that different factors (personal, cultural and educational) play a role in the fact that spiritual care is not structurally embedded in nursing care. Further research on the impact of that variable is recommended. RELEVANCE TO CLINICAL PRACTICE: Nursing care implies care for the spiritual needs of patients. To provide this care, nurses need to be knowledgeable regarding the content of spiritual care and the personal, professional, cultural and political factors influencing it. They also need to be able to participate in policy and decision-making discussions of spiritual care in clinical nursing practice.

Adult↗

PubMed2002

Participation of African Americans in a smoking cessation trial: a quantitative and qualitative study.

African Americans (AAs) have been considered a hard to reach research population. In a clinical trial of bupropion for smoking cessation, failure to return for randomization was concerning during the initial phase of recruitment. There were three study goals: to review the research on clinical trial participation barriers, to use quantitative analyses to identify differences between randomized (n = 66) and non-randomized (n = 54) participants, and to use focus groups and interviews (2 groups and 2 interviews, 17 participants) to elicit participation barriers and suggestions for participation enhancement. Randomized participants were older (44.1 vs. 37.6; p = 0.0019), predominately female (81.8% vs. 63.0%; p = 0.0201), more likely to have some college (33.3% vs. 16.7%; p = 0.0380), and less likely to be employed full time (32.4% vs. 53.7%; p = 0.0347). Randomized participants reported higher motivation to quit smoking (8.3 vs. 7.3; p = 0.0083) and higher confidence to quit (8.2 vs. 7.3; p = 0.0357). A logistic regression model specified age, gender, and motivation to quit, as predictors of randomization. Focus groups identified transportation, lack of readiness to quit, inadequate reminders, and employment conflicts as barriers to participation. Knowledge of differences between those who return for enrollment and those who do not may be used to increase AA enrollment in clinical trials.

Adult↗

PubMed1996

Ménière's disease: trauma, distress and adaptation studied through focus interview analyses.

In order to investigate, in depth, the role of psychological factors in Ménière's disease, i.e. how the patients experience and interpret their symptoms during the process of this illness, a qualitative method "focus group interviews" was used as a study design. The focus group included four subjects; one woman and three men. In addition, semi-structured interviews were performed with each of four more subjects having the disease, three women and one man, in order to guarantee representativity in terms of gender and age. Through the focus interview analyses eight final codes and a number of sub-codes were developed. Results clearly pointed out the significance of the first traumatic attack of the disease as well as early signs; different "psychosomatic" symptoms prior to the attacks. The recognition of fear and phobic reactions in the manifestation of the vertigo attack was considered as an important observation, as attacks often were triggered by distressing thoughts as well as by sensory sensations. Other areas, touched upon for future investigation, were crisis adaptation and illness function.

Adaptation, Psychological↗

PubMed2002

In conversation: high school students talk to students about tobacco use and prevention strategies.

The purpose of this multi-site qualitative study is to explore how adolescents talk about tobacco use. Sixty-six students in four high schools became co-researchers and led focus group interviews with 205 fellow students. From the interviews, the authors develop a story line that reports how adolescents begin smoking, how smoking becomes a pervasive influence, how attitudes form about smoking, what it means to be a smoker, and, ultimately, student suggestions for tobacco use prevention. Embedded within this story line are complex questions and contradictions. We explore whether peers really are influential, if the media is important, whether smoking is a matter of personal choice, if schools actually promote tobacco use, and whether adolescents can quit smoking.

Adolescent↗

PubMed1985

Adolescents' reactions to counseling interviews.

Fifty subjects aged 12 to 16 were interviewed according to one of five counseling techniques: Modeling 1, Modeling 2, reflecting, probing, and a control condition; and were seen either individually or in a group. Interviews were 30 minutes for five sessions during which a theme was discussed. It was questioned whether low-intimate or medium-intimate themes would be more facilitative of self-expression. It was hypothesized and confirmed that subjects are stimulated to disclose though the modeling intervention and group conditions. However, the question was asked as to the adolescents' feelings and opinions during these interviews. At the end of the last session all subjects were given a questionnaire probing their reactions. The individual control subjects indicated a nonsignificant technique effect, and likewise disclosure was not facilitated during the interviews. Sixty-eight percent of the subjects seen individually preferred these conditions whereas 92 percent of the group participants were satisfied. The most interesting topic was of low-intimacy value. Statistical analyses of the subjects' quantity of self-expression by techniques, individual and group conditions, and themes corresponded to their reported reactions to these variables. Results were explained in terms of the importance of the interview conditions in meeting the adolescents' developmental needs.

Adolescent↗

PubMed2005

Exploring the social and cultural context of sexual health for young people in Mongolia: implications for health promotion.

Recent political, economic, and cultural changes in Mongolia make its large proportion of young people vulnerable to HIV infection. While there had been only two clinical cases of HIV in Mongolia by the year 2000, the incidence of sexually transmitted infections (STIs) is on the rise, especially among people aged 15-24. Little is known about the social and cultural context in which the sexual knowledge, attitudes, and behaviour of Mongolian young people are created and negotiated. This context must be better understood in order to promote safer sex practices. This study employed qualitative research methods to explore and describe the social and cultural context in which sexual behaviour is negotiated among secondary school students in Ulaanbaatar, Mongolia. Students and teachers from two schools in Ulaanbaatar and health professionals were selected by purposeful sampling to participate in six semi-structured focus group interviews in autumn 2000. Thematic content analysis was conducted on the focus group transcripts. Seven themes were extracted including embarrassment, lack of knowledge, concepts of sex, perceptions of condoms, gender roles, peer norms, and the influence of drinking on sexual activity. Results presented are the first description of the social and cultural context of sexual health and highlight the combined impact of these themes on safer sex practices in Mongolia. These findings are not generalizable, but their agreement with the Mongolian and the international literature indicates that they may be transferable. Implications for STI and HIV/AIDS prevention efforts and further research in Mongolia are discussed.

Adolescent↗

PubMed2000

Value of admission interviews in selecting of undergraduate nursing students.

METHODS: The attrition of students in the undergraduate nursing program was evaluated. The value of the admission interview and its preferred nature were assessed by questionnaires filled by candidates and faculty. FINDINGS: It was found that although interviewing was only partially effective in screening potential drop-outs, including those who left the programme on non-academic grounds, without interviews the attrition rate increased. Personal interviews accounted for a somewhat lower attrition rate than the unanimously preferred group interviews. CONCLUSION: The process of choosing candidates to nursing programmes requires new thinking, as high attrition rates are not prevented by interviews. More research into the proper mechanism of student selection is needed.

Adult↗

PubMed2005

Nurses' moral agency in negotiating parental participation in care.

The purpose of this study was to investigate the issues for nurses in facilitating parental participation in the care of the hospitalized child. A qualitative study informed by grounded theory was undertaken. Nine nurses were recruited from an acute, high-dependency, 23-bed paediatric cardiac/renal unit in Melbourne, Australia. Data collection involved individual semistructured interviews, hospital policies related to family-centred care and a focus group interview. Constant comparative analysis was undertaken to develop an understanding of the data collected in the context of the nurses' experiences and the environment in which they work. Moral agency was identified as the central phenomenon of the study. Causal conditions related to this included the child's best interests, disputes about care and nurses' expectations. These causal conditions were seen to potentially lead to moral distress for the nurses. The coping mechanisms and strategies that affected moral agency have been identified.

Child↗

PubMed2000

Group action planning as a support strategy for Hispanic families: parent and professional perspectives.

Focus group interviews were conducted to obtain participants' preliminary reactions to the responsiveness of group action planning, a person-centered planning approach, as a support strategy for Hispanic families of individuals with disabilities. Focus group participants were 38 Hispanic parents of youth/young adults with developmental disabilities and 22 professionals who provided support services to Hispanic youth/young adults with developmental disabilities and their families. Both constituency groups identified advantages and disadvantages of group action planning. We focus our key recommendations on the implications of this information for education and human service systems as well as directions for future research.

Adolescent↗

PubMed1996

Focus groups: collecting aggregate-level data to understand community health phenomena.

Focus-group method is an apt strategy for studying community health phenomena at the aggregate level. Not only can its use facilitate the inclusion of segments of the population who have been underserved by previous research, but it can generate a depth of understanding about public health problems, community strengths, and potential interventions that have local meaning and utility. Advantages and potential uses of focus groups are explored, as well as purposes and processes of focus-group interviewing, strategies for analysis, methodological limitations, and implications for practice and policy. The author presents investigatory examples to illustrate how focus-group method expands on the possibilities of individual interviewing to explore community interpretations and understand the health needs and experiences of an aggregate.

Adult↗

PubMed1985

Cholinergic REM induction response: separation of anxiety and depression.

Five groups of subjects underwent EEG sleep recordings, arecoline rapid eye movement (REM) induction response testing, and Schedule for Affective Disorders and Schizophrenia (SADS) interview. Group I: 20 patients with primary major depressive disorder (MDD) (endogenous) without any coexisting anxiety disorder; Group II: 19 primary MDD (endogenous) patients with secondary panic, GAD, or phobic disorders; Group III: 18 patients with primary anxiety disorder without coexisting MDD; Group IV: 14 patients with primary anxiety plus secondary MDD; Group V: 26 normal controls. Modified Research Diagnostic Criteria (RDC) were used for diagnosis, based on the SADS interview. There was considerable overlap of SADS scaled scores between patient groups, which is consistent with a heterogeneous clinical presentation of depressive and anxiety states. REM latency was significantly shorter in patients with primary MDD (without anxiety) as compared with that in patients with primary anxiety (no MDD) and normals. Arecoline REM induction response time was significantly shorter in both primary affective groups (I and II) as compared with primary anxiety (no MDD) patients and normal controls. REM latency and arecoline REM induction time was not significantly different between the primary anxiety groups (III and IV) and normals. The study highlights the use of biological markers in differentiating between clinical syndromes confounded by mixed or overlapping phenomenology.

Adult↗

PubMedDate not supplied

An integrated model of discharge planning for acutely-ill elderly patients.

Prior research has demonstrated that current discharge-related practices present resource-related and ethical problems for all those involved. The purpose of this 9-month qualitative study was to develop a more resource efficient and compassionate discharge planning model for acutely-ill, elderly patients. The focus group interviewing method was used to elicit 99 participants' perceptions of an ideal approach to discharge planning. Focus group participants included professionals from acute-care hospitals and community organizations. Telephone interviews were also completed with 25 patients and 6 family members. Themes identified in the analysis revealed that an ideal approach to discharge planning would incorporate seven elements. According to participants, the approach is ideal because it potentially addresses both resource utilization and ethical issues. Program evaluation of the model is underway in order to determine its effectiveness.

Acute Disease↗

PubMed2003

Development of a Rural Asthma Management Model, RAMM.

INTRODUCTION: The prevalence of asthma in Australia is increasing and places a significant cost burden on the community as well as reducing individuals' quality of life. In the late 1990s, asthma was the sixth National Health Priority in Australia and the prevalence of asthma in the Loddon Mallee region (LMR) of Victoria was approximately 1% higher than the State average. Four LMR local government areas had close to double the State average hospital admission ratios for asthma. AIM: The aim of this project was to develop a Regional Asthma Management Model (RAMM) and strategies for its implementation throughout the LMR, as a tool to implement a major health priority of both the Victorian State and Australian Commonwealth governments: to improve health outcomes for people with asthma. METHODS: A literature review was undertaken to identify best practice in asthma management for use as the basis of questions in workbooks designed to profile and compare current asthma management practice in the LMR. The workbooks were sent to all acute hospitals, community health centres and asthma educators in the LMR. The completed workbooks were returned and respondents elaborated on the workbook data at one of five subregional workshops. A survey was also undertaken to identify the range of asthma management strategies currently used by regional general practitioners (GPs) and to invite their views on ways to improve asthma management in the region. To gain consumer input into the RAMM a semi-structured group interview was held in an urban area and individual interviews were held in two rural areas in the region. A multidisciplinary reference group provided guidance to the project and a documentation design team was convened. RESULTS: Of the 19 workbooks sent to individual acute hospitals, 15 (78.9%) were completed and returned; 13 of 14 workbooks (92.8%) sent to individual community health centres were completed and returned. Fourteen of 15 asthma educators identified in the LMR were employed in the acute hospitals and community health centres that returned the workbooks; one asthma educator worked privately. Of the 215 GP surveys distributed, 38 surveys (17.6%) were returned. The majority of this small sample of GPs supported developing a uniform regional approach to asthma management based on NAC guidelines. Consumers interviewed suggested treating doctors, and/or EDs provide patients and carers with written instructions regarding acute asthma attacks and advice on management strategies for the ensuing 24-48 hours. A regional profile of asthma management practice was produced and compared with identified best practice. Gaps in practice and services were identified and responsive recommendations formulated. The National Asthma Campaign (NAC) guidelines were used as the basis for RAMM documentation, a package which consisted of a Regional Asthma Clinical Pathway and Emergency Department (ED) Package. CONCLUSION: The RAMM developed during the project provides documentation to assist best-practice asthma management by regional EDs and acute hospitals. The methodology and outcomes of the RAMM reflect the geography of the region, with multiple service providers from different locations managing a person with asthma across the primary, secondary and tertiary continuum. The RAMM methodology has the potential to be applied to other diseases and to other rural environments. Although the RAMM was designed for rural areas it could be easily adapted to suit the metropolitan environment. Implementation and evaluation of RAMM documentation is in progress.

Journal Article↗