Search Results (175)

Background: Exposure-based cognitive behavioral therapy (Ex-CBT) is widely seen as the gold-standard treatment for anxiety and obsessive-compulsive disorder (OCD). Yet, minoritized youth are underrepresented in efficacy studies, raising questions about the applicability of Ex-CBT to minoritized youth. Effectiveness data suggest systematic adaptation of Ex-CBT to address youth culture and context is likely needed, and many clinicians make adaptations and augmentations in practice. However, research on the specific strategies clinicians use to address their youth clients’ culture and context within anxiety and OCD treatment is lacking. In the current study, we assess practice-based adaptations, augmentations, and process-based approaches utilized when delivering treatment to youth for OCD and anxiety in public mental health clinics. Methods: We conducted qualitative interviews with 16 clinicians from both specialty anxiety and general mental health clinics serving youth with anxiety or OCD in the public mental health system. Participating clinicians had a mean age of 32.19 (SD = 5.87) and 69% of therapists identified as female; 69% identified as White, 25% identified as Asian, and 6% as Black or African American. In qualitative interviews, clinicians shared how they addressed clients’ culture and context (e.g., social identities, stressors and strengths related to social identities and lived environment). Thematic analysis identified the strategies clinicians employed to address culture and context. Results: Clinicians reported incorporating culture and context through process-based approaches (e.g., building trust gradually, considering clients’ social identity stressors, engaging in self-awareness to facilitate cultural responsiveness) and through culturally adapting and augmenting treatment to promote person-centered care. Core strategies included proactive and ongoing assessment of clients’ cultural and contextual factors, adapting exposures and augmenting Ex-CBT with strategies such as case management and discussion of cultural context, and taking a systems-informed approach to care. Conclusions: Examining practice-based adaptations, augmentations, and process-based approaches to treatment for minoritized youth with OCD or anxiety can inform efforts to understand what comprises person-centered culturally responsive Ex-CBT. Empirical testing of identified strategies is a needed area of future research. Full article

Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusions: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity. Full article

This paper aims to discuss the transition of new graduate nurses into the workforce, the preparation provided to equip them through the novice–beginner stage, and the theory–practice conundrum. Background: In Australia, new graduate transition programs have been in existence since the 1990s. While there is widespread acknowledgment that this period is pivotal for new graduate nurses entering the profession, there is a lack of consensus on the definition of best practice to achieve optimal preparation for new graduate nurses transitioning into the workforce. Methods: This discussion paper integrates the nursing literature on this topic with the extensive professional experiences of the authors, who are currently working as clinicians in metropolitan hospitals and hold academic positions at universities. Their insights are informed by the literature sourced from peer-reviewed English language journals, including reviews, empirical studies, and national and international reports. Discussion: Recruiting and retaining nurses presents a multifaceted challenge that requires the development of effective tools and strategies to build a sustainable workforce. Both the literature and the authors’ experiences highlight several key factors influencing the preparedness of new graduates. These factors include workplace culture, the demands placed on new graduates, and the support, education, and training they receive. The perspectives shared in this article offer valuable discussion points that can deepen our understanding of the current issues and contribute to the development of more effective solutions. Full article

Background/Objectives: End-of-life (EOL) HIV cure research, which studies HIV persistence through pre- and post-mortem tissue collection, has focused primarily on people living with HIV (PLWH) with a prognosis of six months or less. However, the perspectives of long-term survivors (LTS) diagnosed before the advent of effective antiretroviral treatment (ART) remain underexplored. Understanding their motivations and concerns about EOL cure research is essential for creating inclusive and ethical research frameworks. Methods: Between 2023 and 2024, we conducted in-depth qualitative interviews with 16 PLWH aged 60 and older from diverse backgrounds across the United States, recruited through community-based organizations and HIV networks. We used inductive thematic analysis to explore LTS’ perspectives on EOL HIV research. Results: Participants included cisgender men (56.25%) and women (43.75%) with diverse racial identities. While participants supported EOL HIV cure research, their willingness to participate varied, influenced by awareness, logistics, and ethical concerns. Altruism-motivated participation, but misconceptions about procedures and concerns over bodily integrity represented potential barriers. Some viewed blood draws and leukaphereses as routine, while others expressed hesitancy with biopsies and post-mortem tissue retrieval. HIV stigma, historical mistrust, and cultural beliefs also played a role in willingness to participate. LTS emphasized the need for decentralized research sites, travel support, and financial safeguards. Conclusions: To include LTS in EOL HIV cure research, a community-driven approach is needed, focusing on clear communication, ethical considerations, logistical support, and linkages to EOL care. Addressing misconceptions and building trust, particularly within groups traditionally underrepresented in research, is essential to expanding participation. Full article

This study aims to photograph, design, and digitally document the surviving residential buildings on the island of Halki (Heybeliada), within the Princes’ Islands. This documentation focuses on the architectural, urban, and historical aspects of Halki, highlighting the significant material evidence of the Greek social and economic presence. It also examines the urban cultural heritage as depicted in Turkish literature of that period to understand how Turkish writers perceived and presented Halki, referencing the Princes’ Islands only for background context. The methodology includes the collection of material from residents through bibliographic and field research conducted on Halki. Based on these findings, a mobile augmented reality (AR) application was developed using the TaleBlazer platform, designed specifically for use on Halki. The application provides a virtual tour with multimedia-supported thematic layers of architectural and historical information. Its usability and learnability were evaluated using a questionnaire completed by students. The results showed high usability, user satisfaction, and perceived value of learning, with the majority of results close to a median score of 4 out of 5. The students identified the occurrence of immersive experience, ease of use, and the emotional stimulation created by the integration of spatial storytelling and multimedia. This paper also shows how the convergence of cultural content (history, architecture, and literature) can enhance interpretations and experiences with mobile AR technologies. Full article

Background: Early Hearing Detection and Intervention (EHDI) programmes must partner effectively with families navigating complex circumstances. Adolescent parents (APs) in Teen Parent Units (TPUs) represent a dynamic group demonstrating resilience as they balance childcare, education, and their own developmental journeys. This study explores their understanding of infant hearing, sources of knowledge, and the development of an effective teaching tool. Methods: A qualitative study was conducted with AP learners at a TPU in Aotearoa, New Zealand. Following a period of relationship-building, three focus groups were held. Data were analysed using content analysis and reflexive thematic analysis. Results: AP learners demonstrated a strong awareness of multisensory interactions. Major sources of knowledge included their relational interactions with people they trusted (midwives and family members), rather than social media. Four key themes emerged in the teaching tool’s development: (1) the effectiveness of multimodal teaching tools, (2) the benefits of peer-supported group learning, (3) the impact of high strain, and (4) the importance of Te Ao Māori (a Māori worldview). Conclusions: This study highlights the importance of culturally grounded health interventions for families navigating complex life circumstances. Group-based learning fostered peer support, hands-on multimodal teaching was effective, and culturally relevant materials and pedagogies enhanced engagement. EHDI programs may more effectively support infants from families navigating complex circumstances by collaborating with trusted support people, integrating with wraparound care networks, utilising safe and familiar settings, and delivering interventions in an engaging and culturally appropriate manner. Full article

Cultural factors shape students’ expectations and perceptions within diverse educational settings. The perceived quality of a Higher Education Institution (HEI) is crucial to its success, with student satisfaction determined mainly by their overall experiences. The concept of Student eXperience (SX) can be analyzed through the lens of Customer eXperience (CX) from a Human–Computer Interaction (HCI) perspective, positioning students as the “customers” of the institution. SX encompasses academic and physical interactions and students’ emotional, social, and psychological responses toward an institution’s systems, products, and services. By accounting for factors such as emotions, socioeconomic status, disabilities, and, importantly, cultural background, SX provides a comprehensive measure of student experiences. Building upon our previous SX model and Hofstede’s national culture model, we have developed a Student eXperience evaluation methodology that serves as a diagnostic tool to assess both student satisfaction and how effectively HEIs serve a diverse student population. This methodology ensures that all students, regardless of their background, are considered in the evaluation process, facilitating the early identification of institutional strengths and weaknesses. Incorporating cultural aspects into the assessment delivers more precise results. Furthermore, our approach supports HEIs in promoting equity, diversity, and inclusion by addressing the needs of minority students and students with disabilities, as well as reducing gender disparities. These objectives align with UNESCO’s Sustainable Development Goals, contributing to fostering an equitable learning environment. By adopting such inclusive evaluation practices, HEIs can enhance the perceived quality of education and their responsiveness to the needs of an increasingly multicultural student body. Full article

(1) Background: Integrating native foods into food systems has shown promising benefits for health, the environment, and the revitalisation of Aboriginal culture. This study aims to explore the benefits, facilitators, and barriers of integrating Australian native foods into the current food system and how traditional knowledge around these foods can be revitalised in a culturally safe way. (2) Methods: This qualitative co-design study involved the following four phases: (I) Relationship building with the communities and cultural training for the research team; (II) Establishment of the Aboriginal Reference Group (ARG) for community involvement and governance; (III) Data collection through interviews and focus groups with participants from two urban Aboriginal communities in Sydney and experts in native foods; and (IV) Collaborative data analysis using both deductive and inductive thematic analysis. (3) Results: We interviewed 22 participants who acknowledged the nutritional, health, cultural, environmental, and economic benefits of Australian native foods. They strongly identified the impact of colonisation and imposed Western culture as root barriers impacting other barriers at the structural, socioeconomic, social, and environmental levels. Participants aspire to achieve food security and sovereignty in a more sustainable food system including native foods. To achieve their aspirations, a framework based on Aboriginal values and principles was developed to guide multicomponent initiatives using native foods. (4) Conclusions: A compassionate food model based on emancipatory community-based and land-based education is essential, connecting ancient and contemporary knowledge to transform the food system. Future research should focus on implementing and evaluating the multicomponent interventions suggested by the participants. Full article

Background: Medical anthropology is a subfield that examines the various factors influencing health, disease, illness, and sickness. Cardiovascular disease (CVD) encompasses a range of disorders affecting the heart, arteries, and veins. Patients with CVD face significant, unique health challenges, including functional decline, repeated hospitalizations, and psychological and social issues, which contribute to a global decline in health and escalate health system costs. Medical anthropologists have explored this extensive category of diseases in numerous ways, including cross-cultural studies that enhance our understanding of these conditions. Therefore, building on these preliminary insights, this article posed the following research question: How does medical anthropology enhance our understanding, prevention, and management of cardiovascular diseases through cultural, social, and behavioral lenses? Methods: This study examined the research question through a narrative literature review. Results: The literature analysis revealed connections between medical anthropology and specific CVDs: heart disease, hypertension, arterial disease, venous disease, and wound care. Conclusions: The findings from the literature analysis indicate what could be described as the cultural “blood ties” between medical anthropology and cardiovascular disease. In this manner, in the spirit of integration, inter-, and transdisciplinarity, it is increasingly necessary to incorporate mixed-method approaches drawing from both the anthropological and medical fields to better deliver tailored care. Full article

Background: Medical errors are common, and in particular, medication errors are one of the leading causes of morbidity and mortality in healthcare. Nurses must disclose errors to build trust and ensure patient safety despite communication barriers and fear of reprisals. Truthful documentation and better collaboration can improve patient outcomes. Aim: The aim of this study was to assess barriers to error disclosure among nurses in the Kingdom of Saudi Arabia. Methods: A descriptive cross-sectional survey was conducted in the months of June and August 2024 using a convenience sample of 255 nurses at King Fahad Hospital (KFH), Hofuf. A self-administered questionnaire that contained socio-demographic questions, as well as the Barriers to Error Disclosure Assessment (BEDA) tool, was deployed. Results: The majority of the sample were female (92.2%) and Bachelor’s degree holders (80.8%) who had 1–5 or 6–10 years of experience, representing 45.5% and 29.0% of the sample, respectively. When medical errors occur, only 18% of the nurses disclosed them to patients and their families, and 34.5% of the respondents disclosed medical errors to another team of healthcare professionals. The types of barriers to error disclosure were identified as relating to confidence and knowledge barriers, institutional barriers, psychological barriers, and financial concern barriers. The overall barrier score had an average of 63%. The barriers with the highest scores were those relating to psychological barriers (68.2%), followed by institutional barriers (66.5%) and financial concern barriers (64.5%). Conclusions: Targeted interventions are required for addressing the identified specific needs to support healthcare providers, specifically nurses. New regulations and policy changes are crucial for training programs implementation, enhancing safety culture, and tackling job-related insecurities to minimize barriers to error disclosure and ultimately provide better patient care quality. Further investigations may include a different approach, and it is recommended to provide deeper insights into nurse experiences. Full article

Historically, inequities in mathematics education have resulted in mathematics classrooms that do not support all students, and particularly students from marginalized backgrounds. Efforts to transform mathematics classrooms to be culturally responsive, sustaining, and justice-oriented have met limited success at scale. It may be that supporting teachers to develop more equitable teaching practices would benefit from a more incremental improvement approach. This article considers how school-based mathematics coaches can support teachers to make incremental shifts toward more equitable instruction. We describe a coaching model designed to include elements of incremental improvement, in which coaches and teachers analyze video against a set of rubrics that delineate equitable teaching practices. Using established routines and structures, coaches and teachers work together to identify and enact small, actionable changes that build toward more ambitious equity-oriented practices. Drawing on pilot data, we articulate how the coaching model both reflects and builds on an improvement approach to professional learning. We argue that while incremental shifts may be insufficient to fully address systemic inequities, they can serve as a meaningful bridge toward larger changes. We conclude with considerations for engaging in equity-oriented incremental improvement work. Full article

Background/Objectives: The aging population presents significant challenges to healthcare systems, with conditions like dementia severely affecting the quality of life for older adults, especially those in long-term care. Gamification has the potential to motivate older adults to engage in exercise by transforming physical activities into enjoyable experiences. Incorporating gaming elements in cycling exercises can foster a sense of interest and achievement, potentially improving health outcomes. This pilot study aims to explore interdisciplinary staff perspectives on using a digital game to motivate cycling exercise among residents living with dementia in long-term care (LTC). Methods: This study applied a qualitative description design. Using an interpretive description approach, we conducted focus groups with 29 staff members, including recreational therapists, rehabilitation therapists, nurses, care aides, and leadership in an LTC home. The consolidated framework for implementation research (CFIR) guided the data analysis to identify barriers and facilitators to adopting the digital game. Results: Engaging LTC residents living with dementia presents various challenges. Identified potential barriers to implementing the cycling game include cognitive and physical limitations, resistance to change, and intervention complexity. Frontline staff strategies include flexible invitations, social groups, making it fun, and building rapport. Success relies heavily on its cultural and individual relevance, along with strong support from leadership, peers, and family. Conclusions: This pilot study explored staff perspectives on the potential integration of a gamified cycling intervention for older adults with dementia in long-term care settings. Staff emphasized that successful implementation would depend on addressing key barriers and identifying enabling strategies. Based on these findings, practice implications were provided to support effective integration. Further research, including resident input and long-term evaluations, is needed to assess the feasibility, acceptance, and effectiveness of gamification in promoting health outcomes for this population. This study adhered to the COREQ Checklist. Full article

Background: The management of chronic pain is inherently multidisciplinary, requiring collaboration across health and care professions because pain is multidimensional, involving psychological, social, biomedical, cultural, and environmental factors. However, pain education has often focused more on biomedical aspects, limiting the capacity of professionals to deliver integrated, person-centred care. Shifting pain education away from biomedically driven curricula may better prepare graduates for meaningful consultations and biopsychosocial care. Objective: This manuscript reports the development and pilot evaluation of a virtual patient simulation designed to help physiotherapy students develop person-centred pain assessment skills. Methods: We developed and piloted a virtual patient with complex pain scenarios for physiotherapy students. To evaluate the simulation, students completed a self-reported questionnaire assessing their ability, self-confidence in person-centred assessment skills, and their attitudes and beliefs regarding the simulation. Results: Frequency and confidence in person-centred inquiry ranged from 100% to 16.3%, depending on the complexity of information. Inductive thematic analysis revealed four themes: (1) Environmental factors & preferences—students’ preference for the learning environment; (2) Learning experience—including engagement, feedback, discussions, and a ‘safe’ space for building confidence; (3) Professional development—insights into person-centred inquiry, personal biases, and emotional challenges; (4) Limitations—including the desire for more complexity, and technical challenges noted. Conclusions: The development of this virtual patient simulation enabled healthcare students to engage with a multidimensional perspective on pain, fostering skills essential for biopsychosocial pain assessment and patient-centred care. Although designed and piloted with physiotherapy students, this model holds potential for broader application across healthcare disciplines. Full article

Background/Objectives: Shift work has profound effects on the health and dietary habits of registered nurses, especially in Hong Kong, where cultural and systematic barriers can pose a challenge. This study investigated the dietary habits of shift-working nurses in public hospitals, identifying barriers and facilitators to healthy eating using a mixed-methods approach. Methods: Nine subjects (five females and four males: mean = 35.6, SD = 8.4 yrs) filled out a validated food frequency questionnaire and a 3-day dietary record followed by photovoice and semi-structured interview. Results: The findings indicated that all participants reported insufficient dietary fiber intake and eight out of nine exceeded sodium intake recommendations. The key barriers included emotional eating triggered by work stress, inconsistent schedules, limited availability of nutritious foods, and workplace social dynamics. The facilitators included workplace support, positive peer influence, and family involvement in meal planning. Conclusions: This paper focuses on the necessity for health care institutions to create and implement nutritional instructions specific to shift workers, maintain appropriate meal breaks, and build a positive work environment. These interventions may be used to enhance nurses’ eating habits and well-being. Full article

This study examined the link between traditional practices, water stewardship, and cholera outbreaks in three rural Nigerian communities (Enugu, Delta, and Ondo States) in 2020. A sample of 180 participants, representing different socio-economic backgrounds, was surveyed using a mixed-methods approach. Knowledge-based pre-test and post-test measures were employed to assess changes in the understanding of cholera transmission, prevention, and water infrastructure. Chi-square and logistic regression analyses were applied to examine the relationship between socioeconomic status, trust in traditional water sources, and cholera knowledge. Educational seminars were conducted, followed by six months, before administering the post-test to the same population. Key findings revealed that 47% of respondents washed animals in water sources, 42% did not treat their water, and 53% were unaware of cholera-reporting practices. The post-test results showed that 80% of participants could correctly identify cholera symptoms following educational interventions (p < 0.001). Water, sanitation, and hygiene (WaSH) program awareness was significantly associated with reduced cholera incidence (p = 0.005), while certain cultural practices, such as washing slaughtered animals in main water sources, were associated with increased cholera (p < 0.002). This study highlights the need for increased awareness of source water quality, better stewardship, and trust-building efforts to provide culturally appropriate interventions in mitigating these outbreaks. Full article