Is it feasible to implement an injury surveillance system for amateur boxing events in Australia? A mixed methods study.

BackgroundKnowledge mobilization (KM) is essential to close the longstanding evidence to practice gap in pediatric pain management. Engaging various partners (i.e., those with expertise in a given topic area) in KM is best practice; however, little is known about how different partners engage and collaborate on KM activities. This mixed-methods study aimed to understand what different KM partner groups (i.e., health professionals, researchers, and patient/caregiver partners) perceive as supporting KM activities within pediatric pain management.MethodsThis study used a convergent mixed-methods design. Ten partners from each of the three groups participated in interviews informed by the Consolidated Framework for Implementation Research, where they discussed what impacted KM activities within pediatric pain. Participants then rated and ranked select factors discussed in the interview. Transcripts were analyzed within each group using reflexive thematic analysis. Group-specific themes were then triangulated to identify convergence and divergence among groups. A matrix analysis was then conducted to generate meta-themes to describe overarching concepts. Quantitative data were analyzed using descriptive statistics.ResultsUnique themes were developed within each partner group and further analysis generated four meta-themes: (1) team dynamics; (2) role of leadership; (3) policy influence; (4) social influence. There was full agreement among groups on the meaning of team dynamics. While there was partial agreement on the role of leadership, groups differed on who they described as taking on leadership positions. There was also partial agreement on policy influence, where health professionals and researchers described different institutions as being responsible for providing funding support. Finally, there was partial agreement on social influence, where the role of networks was seen as serving distinct purposes to support KM. Quantitative analyses indicated that partner groups shared similar priorities (e.g., team relationships, communication quality) when it came to supporting KM in pediatric pain.ConclusionsWhile partners share many needs in common, there is also nuance in how they wish to be engaged in KM activities as well as the contexts in which they work. Strategies must be introduced to address these nuances to promote effective engagement in KM to increase the impact of evidence in pediatric pain.

Although the prevalence of dissociative disorders (DDs) is up to 10 percent of the general population, psychiatric-mental health (PMH) registered nurses lack education on how to care for individuals diagnosed with these disorders. Sixty-two PMH nurse educators completed an anonymous online survey about their perceptions of teaching DDs to nursing students. Braun and Clarke's six-phase framework was used to conduct an inductive, reflexive thematic analysis of the data. Three primary themes were identified: lack of resources, differing opinions on the value of teaching DDs, and stigma. Though roughly 75 percent of participants reported that they teach DDs to their nursing students, they endorsed concerning misperceptions about the diagnoses. By failing to properly educate future PMH RNs about DDs, individuals with DDs are at risk of receiving inadequate and inappropriate nursing care and experiencing poor outcomes.


 
 
 Objective: To generate themes on facilitators and barriers for midwifery preceptorship.Methods: Midwifery preceptors in undergraduate education in Canada were invited to participate in
 one of three focus groups. A constructivist paradigm and reflexive thematic analysis approach was used for responses that were transcribed verbatim.
 Results: In September and October 2020, three focus groups took place comprising a total of 16 midwifery preceptors. Participants represented multiple Canadian jurisdictions and had a range of education, midwifery, and precepting experiences. Two primary themes, “the altruism of precepting” and “the lack of autonomy in precepting,” were generated from our analysis of participants’ responses. Preceptors also provided suggestions to better enable their role.
 Discussion/Conclusion: We interpreted a “precepting dilemma” in midwifery clinical teaching such that there are altruistic influences on the role and also an underlying lack of autonomy. Obligations and nurturing elements contributed to midwifery preceptors’ utilitarianism. Exacerbating a lack of sovereignty in precepting were deficits in collaboration and aspects that further marginalized the role. It is imperative for stakeholders of midwifery in Canada to carefully consider how altruism and autonomy of precepting affect the experiential curricula.
 This article has been peer reviewed.
 
 

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study was co-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM), now recommissioned as NIHR Applied Research Collaboration East Midlands (ARC EM) and Leicestershire Partnership NHS Trust - Raising Health Charitable Funds Award and supported by the NIHR Leicester Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Background Heart Failure (HF) is associated with a considerable burden of disability that includes frequent hospitalisation and high risk of mortality. Despite advances in HF treatment, many patients continue to experience symptoms and will die from progressive HF, often exacerbated by the presence of co-morbidities, such as obstructive sleep apnea (OSA). Despite the high prevalence of OSA in chronic HF and the association with the development and progression of chronic HF, OSA remains largely under diagnosed and under treated. Purpose To explore factors associated with the diagnosis and treatment of OSA in CHF. Methods A convergent parallel mixed methods research design was utilised. Quantitative methods included a systematic review and meta-analysis, diagnostic validation study and a survey study, whilst semi-structured interviews and reflexive thematic analysis was utilised for the qualitative component. Data collection and data analysis were conducted simultaneously with the integration of the findings in the discussion. Results The systematic review and meta-analysis showed that the STOP-Bang screening questionnaire had a high sensitivity to detect OSA in the sleep clinic and surgical populations but lacked adequate specificity. The diagnostic validation study indicated a high sensitivity of the STOP-Bang questionnaire, but due to differences in prevalence, risk of selection bias and spectrum effect, validation in a sleep clinic population is unlikely to reflect the true performance of the STOP-Bang questionnaire in a stable CHF population. The survey study demonstrated a knowledge deficit in the diagnosis and treatment of OSA, and variable practice among HF clinicians in the UK. Findings from the qualitative component identified several key barriers and enablers across the OSA diagnostic pathway from both patients’ and clinicians’ accounts. Conclusion Due to a lack of typical OSA symptoms, there is currently no real evidence of cardiovascular hospitalisation and mortality benefit for OSA treatment in CHF. This contributed to a paucity of guidance on the management of OSA in CHF clinical guidelines. Due to a lack of typical OSA symptoms, screening questionnaires that rely on patient symptoms may be less effective. Although clinicians felt that OSA was an important clinical condition, findings demonstrated a disconnect between the stated level of clinical importance and clinicians’ actual level of knowledge. The current absence of evidence to support the treatment of OSA in CHF and paucity of CHF guidelines to inform the management of OSA in CHF, are likely to contribute to clinicians not prioritising the recognition and treatment of OSA in CHF.

Clinical research in emergency and critical care is vital, but recruitment and consent are complex. Research may be conducted without prior consent when patients are critically ill, and interventions are time critical. Some patients may die before research participation can be discussed with relatives, leaving the bereaved unaware of their involvement. This study explored potential communication strategies for informing bereaved relatives when a patient has died following enrolment into an emergency or critical care study without prior consent. A mixed-methods study using a telephone survey and semi-structured interviews conducted simultaneously. The survey was conducted within a National Health Service Trust in North West England with relatives of deceased study participants. Semi-structured interviews were conducted with bereaved relatives and research and clinical staff across the UK, and medical examiner (ME)/ME officers based in England and Wales. Quantitative data were analysed descriptively, and qualitative data were analysed using reflexive thematic analysis. Data were synthesised using a constant comparison approach. 11 bereaved relatives completed the survey. 53 individuals (21 research and clinical staff, 18 relatives and 14 MEs/officers) participated in semi-structured interviews. Although many trials do not include a process for notifying bereaved relatives about research participation, most relatives valued the opportunity to learn about their family member's participation, emphasising the importance of transparency and trust. However, some raised concerns over the potential burden of automatic disclosure by the ME service. Offering bereaved relatives the option to receive sensitively worded information about research involvement at an appropriate time, soon after death, was recommended. Bereaved relatives should have the choice to be informed about research participation without prior consent. Our findings support the need for transparent and sensitive communication and will contribute to future guidance for the design and conduct of adult emergency and critical care studies.

BackgroundConflict is prevalent across healthcare settings but is especially common in paediatrics, where high emotional stakes and parental expectations often intensify disagreements. Conflict can lead to negative outcomes for hospitals,...

Background/Objectives: Physiotherapists face significant challenges in managing chronic pain; a complex condition best addressed through a biopsychosocial (BPS) approach. Although substantial evidence exists globally, research specific to Spain remains limited. This study explores the experiences and challenges Spanish physiotherapists encounter in integrating BPS elements across public and private healthcare settings. Methods: Semi-structured interviews with 12 experienced physiotherapists were conducted, using a qualitative approach with purposive sampling and reflexive thematic analysis. The analysis, grounded in a constructivist/interpretivist framework, allowed themes to emerge naturally from the data, supported by relevant quotes. Results: Three primary themes were identified: (1) challenges in implementing the BPS approach, including patient resistance and limited training; (2) facilitators for adopting the BPS model, such as multidisciplinary support and positive patient outcomes; and (3) emotional and psychological aspects of the physiotherapists. The findings highlight the complexities of chronic pain management in physiotherapy, emphasizing the need for enhanced psychological training, integrated multidisciplinary care, early diagnosis, and effective family involvement. These insights are critical for improving both patient care and physiotherapist well-being. Conclusions: This study provides valuable guidance for future strategies, focusing on educational enhancements, multidisciplinary collaboration, healthcare policy reform, and emotional support for physiotherapists within the Spanish healthcare context.

Improved self-esteem and body image, as well as reduced experiences of weight stigma are important patient-reported obesity treatment outcomes. However, more knowledge is needed about how individuals who have undergone metabolic and bariatric surgery (MBS) perceive themselves and their bodies and use different coping strategies in relation to body image and self-esteem long-term after MBS. In this qualitative study body image, self-esteem, weight stigma and coping strategies were explored among 18 individuals who underwent MBS more than 10 years ago when interviewed. Using reflexive thematic analysis, two primary themes were identified: 'Experiences of living with a stigmatised body' and 'Coping with weight stigma, body image and self-esteem', and eight sub-themes. Findings capture frequent experiences of weight stigma before bariatric surgery, the need for coping with stigma and body dissatisfaction before and after MBS, and how different coping strategies are related to participants' perceptions of their bodies and self-concepts. More adaptive coping strategies, such as confrontation and cognitive restructuring may facilitate more positive body image outcomes, than more ruminative and avoidant strategies. Understanding adaptive coping strategies can be useful to develop interventions to reduce negative consequences of weight stigma on body image and self-esteem.

Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.

Introduction: Gamification, the use of game elements in non-game contexts, has shown promise in enhancing engagement and motivation in educational settings. In military trauma training, simulations incorporating game elements can replicate austere conditions, providing a safe environment for medics to practise essential skills. Despite this potential, the literature remains inconsistent, with controversies likely arising from a lack of understanding of how game elements and their combinations work. This systematic review aims to examine the use of game elements in the design of military trauma simulations and to evaluate the outcomes reported. Methods: We systematically searched multiple databases, screening 1,168 abstracts and narrowing them down to 630 after removing duplicates. A total of 34 studies met our inclusion criteria. Two reviewers independently extracted data using a structured form. We coded game elements based on established gamification frameworks and assessed study quality using MERSQI and Côté and Turgeon’s tool. A reflexive thematic analysis was conducted to understand the motivations—both deliberate and unintentional—behind the use of these game elements in the included studies. Results: The reflexive thematic analysis identified five themes: Recognizing the World; Believing and Feeling; Play by Choice; Varying Challenges; and Keep on Playing. The game elements most frequently used were plot, scoring, time pressure, avatars, and imposed choice. Multimedia was commonly used to enhance immersion. Conclusion: The reflexive thematic analysis revealed that game elements in military trauma simulations are often motivated by the need to create realism, facilitate immersion, empower learner agency, promote variation, and sustain motivation. While some elements were included intentionally, many were integrated without a deliberate gamification strategy. Our results suggest that simulations could benefit from a more intentional approach to gamification, making them more flexible and engaging in supporting military trauma training.

Despite advancements in spinal muscular atrophy (SMA) management, evaluating outcomes in adults remains difficult. Standard motor scales often show floor/ceiling effects and fail to capture patient-relevant constructs. This creates a disconnect between clinical measurements and the lived experience of adults with SMA, particularly in regulatory contexts requiring demonstrable benefit. This qualitative study explored the evaluation priorities, expectations, and preferences of adults with SMA and the corresponding assessment challenges faced by healthcare practitioners (HCPs). Semi-structured interviews with 18 adults with SMA (types 1b-3) and 31 multidisciplinary HCPs from 14 specialized French centers were conducted. Data were analyzed using reflexive thematic analysis and triangulation. Adults with SMA found standard assessments burdensome, fatiguing, and lack relevance. Their primary goal was maintaining an acceptable life balance, a dynamic equilibrium between their disease state and an adapted environment. This balance hinged on preserving specific keystone abilities (e.g., joystick control, independent transfers), which are highly individualized and critical for social participation. Patients prioritized the assessment of these specific abilities. HCPs corroborated the limitations of standard tools (insensitivity, confounding factors) and logistical constraints. In response, HCPs have developed numerous "home-made," non-validated assessments and used personalized tools to capture meaningful changes, especially in severely affected patients. A discrepancy exists between current standardized SMA assessments and patients priorities. It highlights a need for outcome measures that align with patients' priorities, particularly "keystone abilities." HCPs' innovative approaches offer a promising direction for future assessment development, advocating for a shift towards individualized, holistic evaluation in SMA care.

Physical activity (PA), including active travel (AT), is related to healthy adolescent development and wellbeing, however, behavior rates are low. Simultaneously, adolescent screen use, and engagement in social media platforms (SMP) is very high. The aim of this mixed methods study was to explore the relationship between peer engagement and SMP and adolescent AT and PA. We employed an exploratory sequential design that included integration of results of qualitative interviews with 25 adolescent-parent dyads and quantitative data from a cross-sectional survey in a representative sample of Hebrew-speaking adolescents in secondary schools across Israel ( n = 2,911). Reflexive thematic analysis was employed for the qualitative study; constructs identified served as the basis for development of a quantitative data collection instrument. Correlation and linear regression analyses were conducted to investigate associations between key quantitative analysis variables. The integrated analysis primarily identified convergence between datasets expressed in narrative weaving and joint displays. We found that AT with peers is a social activity; AT and PA are an opportunity for peer-to-peer communication without screens; and SMP are utilized to promote AT and PA. Interventions that emphasize these key constructs as well as use of SMP may increase adolescent AT and PA behaviors.

IntroductionEating disorders (EDs) are potentially life-threatening conditions characterized by persistent eating- and body-related disturbances that negatively impact nutritional intake, psychological well-being, and physical health. While psychological therapies remain the primary treatment for patients with EDs, music-based interventions (MBIs) show significant promise for addressing symptoms in clinical practice. However, little is known about the methods employed in these interventions or their effectiveness in addressing or improving ED outcomes.MethodsFollowing PRISMA-ScR guidelines, we conducted a scoping review of the literature. Eight electronic databases were systematically queried from inception to May 2025 for studies evaluating MBIs in patients engaged in ED treatment. Data regarding study design, sample characteristics, intervention components, and primary outcomes were extracted and analysed utilising either reflexive thematic analysis or descriptive statistics. The quality of intervention reporting was additionally examined utilising the established MBI reporting guidelines.ResultsOf the 114 articles screened, 21 met inclusion criteria. The final sample comprised 10 case studies, 6 qualitative studies, 4 quantitative studies, and 1 mixed methods study, with all but one conducted in high-income countries. Settings included inpatient (n = 12), outpatient (n = 7), and combined (n = 2) ED programs. Most MBIs involved music therapy (n = 18), while others incorporated vibroacoustic therapy (n = 1), background music during mealtimes (n = 1), and group singing (n = 1). Delivery formats encompassed individual (n = 14), group (n = 5), and hybrid (n = 1) sessions, or were not indicated. Qualitative synthesis identified seven themes reflecting symptom management, self-development, and treatment engagement. Quantitative studies reported improvements in anxiety, mood, ED symptoms and increased food eaten and weight gain. However, robust conclusions were limited by small sample sizes, a lack of control group, non-randomisation, or another intervention being implemented with the MBI. Overall, reporting of MBI components was inconsistent, with a mean completeness of 45–100%.DiscussionTo our knowledge, this is the largest scoping review to map the breadth and depth of studies assessing MBIs in ED treatment. Preliminary evidence supports positive psychological and behavioural outcomes for patients with EDs. However, conclusions are limited by lack of methodological rigor, variable outcome measures, and inconsistent reporting of intervention components or theoretical framework. The complex and multifaceted nature of EDs and high rates of comorbidities and trauma histories further complicates interpretations. To advance research and clinical application of MBIs in ED care, standardized approaches to intervention design and reporting are needed, as well as randomised controlled studies clearly testing MBIs against other interventions.

BackgroundMultimorbidity, the coexistence of 2 or more chronic conditions, is associated with poor well-being. Health coaching apps offer cost-effective and accessible support. However, there is a lack of evidence of the impact of health coaching apps on individuals with multimorbidity.ObjectiveThis study aimed to assess the impact and acceptability of a health coaching app (the Holly Health [HH] app) on the subjective well-being (SWB) of adults with multimorbidity.MethodsThis study used an explanatory-sequential mixed methods design, with quantitative secondary data analysis in the first phase and qualitative interviews in the second phase. In the quantitative phase (n=565), pre- and post-SWB (Office for National Statistics' 4 personal well-being questions [ONS4]) scores from existing app users with multimorbidity were analyzed using Bayesian growth curve modeling to assess the impact of HH. In the qualitative phase (n=22), data were collected via semistructured interviews and analyzed using reflexive thematic analysis. Mechanisms of action that supported SWB were categorized using the Multi-Level Leisure Mechanisms Framework.ResultsThere was a significant increase in life satisfaction (Coef.=0.71, 95% highest density interval [HDI] 0.52‐0.89), worthwhileness (Coef.=0.62, 95% HDI 0.43‐0.81), and happiness (Coef.=0.74, 95% HDI 0.54‐0.92) and a decrease in anxiety (Coef.=−0.50, 95% HDI −0.74 to −0.25) before and after using the HH app. Overall, 8 acceptable app features activated 5 mechanisms of action, including behavioral, psychological, and social mechanisms. Three additional factors influenced the acceptability of the health coaching app: type of chronic condition, availability of time, and the use of other support tools.ConclusionsThe study demonstrates that health coaching apps could be effective and acceptable support tools for individuals with multimorbidity. This study contributes to understanding why health coaching apps support SWB and could be used to inform the development of future digital health interventions in multimorbidity.

BackgroundLaboratory biosafety should be a priority in all healthcare institutions. In traditional laboratory safety teaching students typically receive knowledge passively from their teachers without active involvement. The combination of experiential learning and mobile learning may provide students with greater engagement, retention, and application of knowledge. To address this issue, we developed and conducted a convergent mixed methods study to assess the feasibility and usability of a WeChat mini program (WMP) named WeMed for laboratory biosafety education for medical laboratory students at Guangzhou Medical University (GMU).MethodsThe study was conducted between November 2022 and October 2023 among second-year undergraduate students at GMU. It involved the concurrent collection, analysis, and interpretation of both qualitative and quantitative data to assess feasibility and usability. In the quantitative strand, two evaluations were conducted via online surveys from students (n = 67) after a four-week study period. The System Usability Scale (SUS) was used to evaluate usability, while self-developed questions were used to assess feasibility. Additionally, a knowledge test was administered 6 months after the program completion. In the qualitative strand, fourteen semi-structured interviews were conducted, whereby a reflexive thematic analysis was utilized to analyze the interview data.ResultsThe overall SUS score is adequate (M = 68.17, SD = 14.39). The acceptability of the WeMed program is in the marginal high range. Most students agreed that WeMed was useful for learning biosafety knowledge and skills (13/14, 93%), while 79% (11/14) agreed it was easy to use and they intended to continue using it. After 6 months, a significant difference in the knowledge test scores was observed between the WeMed group (n = 67; 2nd year students) and the traditional training group (n = 90; 3rd year students). However, the results should be interpreted cautiously due to the absence of a pretest.ConclusionThe combination of experiential learning and mobile learning with WMP is a feasible tool for providing laboratory biosafety knowledge and skills. Ongoing improvements should be made in order to increase long-term acceptance.