The high needs of youth involved in the child welfare system and the poor long-term outcomes of former foster youth represent a significant systemic challenge. As part of a process to adapt an evidence-based parenting program for a child welfare population, we conducted a series of focus groups with child welfare staff, foster caregivers, and young adults who were involved in the foster system as teens. From these focus groups we learned that, although there is a need for evidence-based parenting programs for families involved in the child welfare setting, one of the significant barriers to program implementation is the lack of meaningful connection between caregivers and youth in their care. We will provide an in-depth discussion on the proposed adaptations to make Staying Connected more relevant for foster families, including the addition of skills training to help overcome some of the barriers to connection. Staying Connected holds the promise of cultivating more supportive home environments that have the capacity to nurture youths’ healthy development, including the avoidance of high-risk behaviors.
We explored the effects of living with multiple sclerosis (MS) on a primary relationship: that between the person with MS and his or her closest confidant. We anticipated that this would enhance understanding of the meaning of psychosocial support from the perspective of people with MS. Using a phenomenological qualitative approach, we interviewed 33 people with MS and the people they identified as providing psychosocial support to them (their confidants). The results were presented to a range of health-care workers in two focus groups to explore their responses. Two additional focus groups were held with the participants with MS to add depth and clarity to the findings. Three major themes emerged from the interviews: 1) People with MS do not want to be defined by their condition and want to live as normal a life as possible. 2) The confidant helps to maintain this sense of normality. 3) Both the person with MS and the confidant value the relationship and together try to manage the realities of living with MS. The findings indicate the need to raise awareness among MS care professionals about the value of the confidant relationship. Training professionals to discuss emotional issues with clients and increasing collaboration with agencies that provide emotional support will facilitate a more holistic approach to care.
Background: The adverse effects of heatwaves on mortality are well recognised. Heatwaves are predicted to become more frequent and severe in coming decades. England’s National Heatwave Plan (NHP) aims to prepare the country for periods of extreme heat and thereby limit adverse health effects. The central aim of this study is to understand how effectively the NHP is disseminated within an acute hospital and to identify any barriers to its use.
Methods: Qualitative data was collected through semi-structured interviews and focus groups with key hospital managers, nurses and healthcare assistants. All participants were recruited from a single hospital in the South East of England. Data were analysed using Framework Analysis.
Results: We conducted two focus groups with frontline clinical staff and five interviews with senior managers, all of whom deemed the NHP a low priority. Hospital managers showed good awareness of the plan, which was lacking amongst frontline staff. Nevertheless front line staff were familiar with the dangers of excess heat and felt that they individualised care accordingly. Communication of information between managers and frontline staff was highlighted as a problem during heatwaves. Additionally, issues with inadequate building stock and equipment limited effective implementation of the plan. Participants were able to suggest novel improvements to the plan.
Conclusions: Increased awareness and improved communication could help better integrate the NHP into the clinical practice of English hospital-based healthcare professionals. Further evaluation of the NHP in acute care trusts and other health care settings is warranted to expand upon these initial findings.
Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.
This study aimed to explore the attitudes and behaviors of Latino mothers around feeding their children. Using qualitative methods, we conducted 4 focus groups in Spanish with 41 Latino mothers of elementary school-age children in San Diego County (CA). Latino mothers’ mean age was 41 years; 90% were foreign-born; 74% had a high school education or less. We explored cultural viewpoints around feeding and cooking and feeding strategies used. Focus groups were analyzed based on a priori and emergent themes. Two themes around feeding emerged, including: 1) feeding attitudes central to the maternal responsibility of having well-fed children; and 2) feeding behaviors that centered on cooking methods, supportive behaviors and reinforcement strategies for “eating well”. These findings increase our understanding of the Latino maternal role to feed children and may help to inform more culturally appropriate research to effectively address nutritional issues and obesity prevention in Latino children.
English as a Second Language programs serve large foreign-born
populations in the US with elevated risks of tuberculosis (TB), yet little is
known about TB perceptions in these settings. Using a community-based
participatory research approach, we elicited perceptions about TB among
immigrant and refugee learners and staff at a diverse adult education center.
Community partners were trained in focus groups moderation. Ten focus groups
were conducted with 83 learners and staff. Multi-level, team-based qualitative
analysis was conducted to develop themes that informed a model of TB perceptions
among participants. Multiple challenges with TB control and prevention were
identified. There were a variety of mis-perceptions about transmission of TB,
and a lack of knowledge about latent TB. Feelings and perceptions related to TB
included secrecy, shame, fear, and isolation. Barriers to TB testing include low
awareness, lack of knowledge about latent TB, and the practical considerations
of transportation, cost, and work schedule conflicts. Barriers to medication use
include suspicion of generic medications and perceived side effects. We posit
adult education centers with large immigrant and refugee populations as
excellent venues for TB prevention...
Accurate record keeping is an important part of the responsible conduct of research. However, there is very little empirical research on scientific record keeping. No one knows the incidence of serious problems with research records, the types of problems that occur, nor their consequences. In this study, we examined the role of research records in the resolution of misconduct allegations as a useful barometer for the incidence and types of problems that occur with records. We interviewed Research Integrity Officers (RIOs) at 90 major research universities and conducted focus groups with active research faculty. RIOs reported problems with research records in 38% of the 553 investigations they conducted. Severe problems with research records often prevented completion of investigations while problems that are more typical lengthened them by 2 to 3 weeks. Five types of poor record keeping practices accounted for 75% of the problems with incomplete/inadequate records being the most common (30%). The focus groups concurred with the findings from the interviews with RIOs, stressed the importance of the research group leader in setting and maintaining record practices, and offered additional insights. While university officials and faculty members have suspected for many years that there are serious problems with research record keeping...
The purpose of this study was to examine long-term care (LTC) resident and staff perceptions on the decision to use hip protectors and identify the factors that influence attitudes toward hip protector use. Staff (N = 39) and residents (N = 27) at two residential care facilities in British Columbia, Canada were invited to participate in focus groups on fall prevention and hip protector use. A total of 11 focus groups were conducted. Using framework analysis results show that residents and staff shared concerns on aesthetic and comfort issues with hip protectors. Residents also generally felt they did not need, or want to use, hip protectors. However, they also had desire to be cooperative within the LTC environment. Staff underscored their role in advocating for hip protector use and their desire to protect residents from harm. Practice considerations for facilities wishing to promote hip protectors within a patient centered framework are highlighted.
Food allergy (FA) is potentially severe and requires intensive education
to master allergen avoidance and emergency care. There is evidence suggesting
the need for a comprehensive curriculum for food allergic families. This paper
describes the results of focus groups conducted to guide the development of a
curriculum for parents of food allergic children. The focus groups were
conducted using standard methodology with experienced parents of food allergic
children. Participants were parents (n=36) with experience managing FA recruited
from allergy clinics at two academic centers.
The benefits of high-quality father-child relationships for fathers and children alike are well documented. While evidence suggests parenting programs can improve the quality of father-child relationships, few fathers participate in such programs. This qualitative study aims to fill the gap in knowledge on best practices for recruiting urban African American fathers, a group of fathers with unique parenting challenges, to parenting programs. Focus groups were conducted with 29 fathers to gain their perspectives on recruitment strategies. Semi-structured interviews were also conducted with a nationwide sample of 19 fatherhood program providers to learn about their most successful recruitment strategies. Recruitment strategies based on emergent themes from the focus groups and interviews are presented here. Themes included using word-of-mouth recruitment, increasing advertising, targeting advertising specifically to urban African American fathers, providing transportation and incentives, recruiting through the courts, collaborating with other community agencies, and offering parenting programming along with other programming valued by fathers such as employment assistance. Implications for developing strategies for recruiting urban African American fathers to parenting programs are discussed.
Dominicans, one of the fastest growing Hispanic subgroups in New York City (NYC), have a high rate of diabetes. A qualitative study exploring Dominicans’ knowledge, perceptions, and experiences in managing their diabetes was conducted. There were a total of 40 participants who were Spanish speaking Dominicans, 40 to 74 years of age, diagnosed with diabetes and NYC residents. Four focus groups were conducted in Spanish, which were recorded and then transcribed into English. Content analysis was used to analyze the text of the focus groups. Different themes emerged from the data, with apparent gaps in diabetes knowledge and of awareness of risk for diabetes complications.
Purpose of the Study: The CONNECT intervention is designed to improve staff connections, communication, and use of multiple perspectives for problem solving. This analysis compared staff descriptions of the learning climate, use of social constructivist learning processes, and outcomes in nursing facilities receiving CONNECT with facilities receiving a falls education program alone. Design and Methods: Qualitative evaluation of a randomized controlled trial was done using a focus group design. Facilities (n = 8) were randomized to a falls education program alone (control) or CONNECT followed by FALLS (intervention). A total of 77 staff participated in 16 focus groups using a structured interview protocol. Transcripts were analyzed using framework analysis, and summaries for each domain were compared between intervention and control facilities. Results: Notable differences in descriptions of the learning climate included greater learner empowerment, appreciation of the role of all disciplines, and seeking diverse viewpoints in the intervention group. Greater use of social constructivist learning processes was evidenced by the intervention group as they described greater identification of communication weaknesses, improvement in communication frequency and quality...
Introduction. The relevance of home care training is not questioned. However, there are no reported learning models to teach in this setting. Aims. To develop and evaluate a learning model to teach home care to medical students. Methods. Stage 1: Learning Model Design. Tutors teaching home care and a sample of medical students were invited to focus groups analyzed according to the grounded theory. Later, the researchers designed the learning model, which was approved by all participants. Stage 2: Learning Assessment. All students in their family medicine internship at Pontificia Universidad Catolica de Chile were invited to participate in a nonrandomized before-and-after pilot trial, assessing changes in their perception towards home care and satisfaction with the learning model. Results. Stage 1: Six tutors and eight students participated in the focus groups. The learning model includes activities before, during, and after the visits. Stage 2: 105 students (88.2%) participated. We observed improvement in all home care training domains (P ? 0.001) and a high satisfaction with the model. Students with previous home visit experiences and who participated with nurses and social workers reported more learning. Conclusions. We report an effective learning model to train medical students in home care. Limitations and recommendations for future studies are discussed.
Young adults are at risk for weight gain in the transition to independent adulthood; 2-year college students are at greater risk and understudied relative to 4-year students. This project conducted formative research for a randomized controlled weight gain prevention trial among 2-year college students, to ensure appropriateness of content and delivery of a curriculum originally developed for 4-year college students. Data were collected from community college students, faculty, and staff from October 2009 to August 2011. Work included focus groups and key informant interviews, curriculum pilot testing, and social network and support website beta testing. Based on focus groups and interviews, program content, course delivery modes, and communication channels were adjusted to meet population interests and preferences. The course was delivered successfully in pilot testing, and the website was received well by beta testers. Formative work successfully guided program adaptations to address population needs.
Heat waves can be lethal and routinely prompt public warnings about the dangers of heat. With climate change, extreme heat events will become more frequent and intense. However, little is known about public awareness of heat warnings or behaviors during hot weather. Awareness of heat warnings, prevention behaviors, and air conditioning (AC) prevalence and use in New York City were assessed using quantitative and qualitative methods. A random sample telephone survey was conducted in September 2011 among 719 adults and follow-up focus groups were held in winter 2012 among seniors and potential senior caregivers. During summer 2011, 79 % of adults heard or saw a heat warning. Of the 24 % who were seniors or in fair or poor health, 34 % did not own AC or never/rarely used it on hot days. Of this subgroup, 30 % were unaware of warnings, and 49 % stay home during hot weather. Reasons for not using AC during hot weather include disliking AC (29 %), not feeling hot (19 %), and a preference for fans (18 %). Seniors in the focus groups did not perceive themselves to be at risk, and often did not identify AC as an important health protection strategy. While heat warnings are received by most New Yorkers, AC cost, risk perception problems...
Due to advances in treatment, persons living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) are living longer, but with aging, immune deficits, and lifestyle factors, they are at increased risk for cancer. This challenges community-based AIDS service organizations (ASOs) to address the growing cancer needs of persons living with HIV/AIDS (PLWHA). Community-based participatory research was applied to engage ASOs in exploring their capacities and needs for integrating cancer-focused programming into their services. Focus groups were conducted with a community advisory board (CAB) representing 10 community-based organizations serving PLWHA. Three 90-minute, serial focus groups were conducted with a mean number of seven participants. Topics explored CAB members’ organizational capacities and needs in cancer prevention, detection, treatment, and survivorship. Transcript analyses identified six themes: (a) agencies have limited experience with cancer-focused programs, which were not framed as cancer specific; (b) agencies need resources and collaborative partnerships to effectively incorporate cancer services; (c) staff and clients must be educated about the relevance of cancer to HIV/AIDS; (d) agencies want to know about linkages between HIV/AIDS and cancer; (e) cancer care providers should be culturally competent; and (f) agencies see opportunities to improve their services through research participation but are wary. Agency capacities were strong in relationships with clients and cultural competency...
Cultural attitudes about medical decision making and filial expectations may lead some surrogates to experience stress and family conflict. Thirteen focus groups with racially and ethnically diverse English- and Spanish-speakers from county and Veterans hospitals, senior centers, and cancer support groups were conducted to describe participants’ experiences making serious or end-of-life decisions for others. Filial expectations and family dynamics related to birth order and surrogate decision making were explored using qualitative, thematic content analysis and overarching themes from focus group transcripts were identified. The mean age of the 69 participants was 69 years ± 14 and 29% were African American, 26% were White, 26% were Asian/Pacific Islander, and 19% were Latino. Seventy percent of participants engaged in unprompted discussions about birth order and family dynamics. Six subthemes were identified within 3 overarching categories of communication, emotion, and conflict: Communication – (1) unspoken expectations and (2) discussion of death as taboo; Emotion – (3) emotional stress and (4) feelings of loneliness; and Conflict – (5) family conflict and (6) potential solutions to prevent conflict. These findings suggest that birth order and family dynamics can have profound effects on surrogate stress and coping. Clinicians should be aware of potential unspoken filial expectations for firstborns and help facilitate communication between the patient...
Objective. To explore general practitioners’ (GPs’) perspectives on public health campaigns to encourage people with the early symptoms of rheumatoid arthritis (RA) to seek medical help rapidly. Design. Nineteen GPs participated in four semi-structured focus groups. Focus groups were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results. GPs recognised the need for the early treatment of RA and identified that facilitating appropriate access to care was important. However, not all held the view that a delay in help seeking was a clinically significant issue. Furthermore, many were concerned that the early symptoms of RA were often non-specific, and that current knowledge about the nature of symptoms at disease onset was inadequate to inform the content of a help-seeking campaign. They argued that a campaign might not be able to specifically target those who need to present urgently. Poorly designed campaigns were suggested to have a negative impact on GPs’ workloads, and would “clog up” the referral pathway for genuine cases of RA. Conclusions. GPs were supportive of strategies to improve access to Rheumatological care and increase public awareness of RA symptoms. However, they have identified important issues that need to be considered in developing a public health campaign that forms part of an overall strategy to reduce time to treatment for patients with new onset RA. This study highlights the value of gaining GPs’ perspectives before launching health promotion campaigns.
Thematic analysis of data from nine exploratory focus groups conducted with 71 middle-aged and older African American men and eight focus groups with 77 key women in their lives revealed how social norms and modeling of physical activity influenced men’s motivation to exercise. Both men and women identified male peers as an important source of ideas, encouragement, and support to initiate and sustain physical activity, yet sedentary peers also could contribute to men being less motivated to be active. The primary difference in men’s and women’s perspectives was that men attributed their decline in activity levels to difficulties in finding time for physical activity, whereas women attributed sedentary lifestyles to an increase in men’s physical illnesses and ailments. Men’s participation in team sports and overall activity levels diminished with age. Peer social support can be critical for interventions to help African American men engage in and sustain physical activity.
Although research involving biospecimens is essential in advancing cancer research, minorities, especially African-Americans, are underrepresented in such research. We conducted a mixed-method (qualitative focus groups among African-Americans and quantitative cross-sectional surveys) study on factors associated with biospecimen knowledge and donation intent in the medically underserved urban communities in Southeast and Southwest Washington, DC. Focus groups were conducted among 41 African-Americans and survey data was available from 302 community residents of different races/ethnicities using convenience sampling. We used logistic regression to model the association between biospecimen knowledge and donation intent with selected sociodemographic variables using survey data. Only 47 % of the participants had knowledge of the different types of biospecimens. In multivariate logistic regression models, male gender, African-American race, and low education levels were significantly associated with lower knowledge about biospecimens. Compared to Whites (79 %), fewer African-Americans (39 %) and Hispanics (57 %) had knowledge of biospecimens but the difference was significant for African-Americans only. Positive intent to donate biospecimens for research was observed among 36 % of the survey respondents. After multivariate adjustment...