• Barriers and facilitators to use of non-pharmacological treatments in chronic pain

      Becker, W.C.; Dorflinger, L.; Edmond, S.N. (BioMed Central Ltd., 2017)
      Background: Consensus guidelines recommend multi-modal chronic pain treatment with increased uptake of non-pharmacological pain treatment modalities (NPMs). We aimed to identify the barriers and facilitators to uptake of evidence-based NPMs from the perspectives of patients, nurses and primary care providers (PCPs). Methods: We convened eight separate groups and engaged each in a Nominal Group Technique (NGT) in which participants: (1) created an individual list of barriers (and, in a subsequent round, facilitators) to uptake of NPMs; (2) compiled a group list from the individual lists; and (3) anonymously voted on the top three most important barriers and facilitators. In a separate process, research staff reviewed each group's responses and categorized them based on staff consensus. Results: Overall, 26 patients (14 women) with chronic pain participated; their mean age was 55. Overall, 14 nurses and 12 PCPs participated. Seven healthcare professionals were men and 19 were women; the mean age was 45. We categorized barriers and facilitators as related to access, patient-provider interaction, treatment beliefs and support. Top-ranked patient-reported barriers included high cost, transportation problems and low motivation, while top-ranked facilitators included availability of a wider array of NPMs and a team-based approach that included follow-up. Top-ranked provider-reported barriers included inability to promote NPMs once opioid therapy was started and patient skepticism about efficacy of NPMs, while top-ranked facilitators included promotion of a facility-wide treatment philosophy and increased patient knowledge about risks and benefits of NPMs. Conclusions: In a multi-stakeholder qualitative study using NGT, we found a diverse array of potentially modifiable barriers and facilitators to NPM uptake that may serve as important targets for program development. Copyright 2017 The Author(s).
    • Does antiretroviral therapy packaging matter? Perceptions and preferences of antiretroviral therapy packaging for people living with HIV in northern Tanzania

      Muiruri, C.; Jazowski, S.A.; Ramadhani, H.O. (Dove Medical Press Ltd., 2020)
      Introduction: Despite improvements in treatment (eg, reduction in pill intake), antiretroviral therapy (ART) is dispensed in socially inefficient and uneconomical packaging. To make pills less conspicuous and decrease the risk of being stigmatized, people living with HIV (PLWH) often engage in self-repackaging - the practice of transferring ART from original packaging to alternative containers. This behavior has been associated with ART nonadherence and failure to achieve viral load suppression. While much of the literature on ART packaging has centered around medication adherence, patients stated preferences for ART packaging and packaging attributes that influence the observed ART nonadherence are understudied. Methods: We conducted a qualitative study to elucidate perceptions of ART packaging among PLWH at two large referral hospitals in Northern Tanzania. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed and coded. Results: Of the 16 participants whose data were used in the final analysis, a majority were between 36 and 55 years of age (Mean 45.5 years SD: 11.1), had primary-level education (n=11, 68.8%), were self-employed (n=9, 56.3%), reported that they had self-repacked ART (n=14, 88%), and were taking ART for more than 6 years (n=11, 68.8%). Participants identified three attributes of ART packaging that increased anticipated HIV stigma and prompted self-repackaging, including visual identification, bulkiness, and the rattling noise produced by ART pill bottles. Conclusion: Given the drastic reduction in the number of pills required for HIV treatment, there is an opportunity to not only assess the cost-effectiveness of innovative ART packaging but also evaluate the acceptability of such packaging among PLWH in order to address stigma and improve ART adherence. © 2020 Muiruri et al.
    • Early assessment of the 10-step patient engagement framework for patient-centred outcomes research studies: The first three steps

      Sofolahan-Oladeinde, Y.; Newhouse, R.P.; Lavallee, D.C. (Oxford University Press, 2017)
      Background. A key principle of patient-centred outcomes research (PCOR) is the engagement of patients and other stakeholders in the research process, but the evidence is still emerging on the impact patient engagement has on the research process. A 10-step framework has been developed to provide methodological guidance for patient engagement throughout the research process. However, the utility of the framework for patient engagement has not been tested in actual research studies. Objective. To describe researcher's overall experiences with engaging patients at the beginning of their PCOR research process. Methods. Twelve in-depth interviews were conducted face-to-face and by telephone with PCOR researchers between November 2014 and January 2015 at an Academic Health Center in the eastern USA. All data were audiotaped and transcribed, and NVivo 10 software was used for data analysis. Results. Four major themes emerged (i) the importance of patient engagement and how it provides 'a perspective you can't get unless you talk to the patient'; (ii) the impact of patient engagement; (iii) challenges and barriers of engagement; and (iv) the realities of patient engagement. Conclusions. Researchers' views illustrate the need to re-evaluate patient engagement in PCOR based on current realities. Given the many challenges to engagement that researchers encounter, it may be more productive to redefine the process of patient engagement so that the issues researchers now face are taken into account in future funding announcements, engagement rubrics and methodology frameworks developed.
    • “I’m Doing Everything Right All Over Again”: How Women Manage Exiting Street Prostitution Over Time

      Gesser, Nili; Shdaimah, Corey S. (PubPub, 2021-07-13)
      Exiting the criminalized sale of sex, which we refer to as prostitution, is a complex, recursive process which has been rarely studied longitudinally. Using typical case sampling, we selected two respondents from a two-year ethnographic study of a court-affiliated diversion program in Philadelphia who participated in a total of eight interviews. Saldaña’s (2009) seldom-used longitudinal coding method was applied to conduct a fine-grained analysis of participants’ perceptions of exiting prostitution over time, focusing on participants’ motivations and actions. Respondents managed expectations of others and themselves and their sense of self-worth within a context of changing relationships, structural opportunities, accomplishments and setbacks. Viewed in a longitudinal context, the same relationships and structural hurdles often had a different impact on women’s motivation to exit at different time points. We argue that a longitudinal perspective of the exiting process is critical to avoid erroneous binary classifications of women as either exiters or non-exiters from prostitution, as the exiting process is more complex than what cross-sectional studies have previously revealed. Findings have implications for researchers of prostitution and programs for women exiting prostitution that should structure supports and (dis)incentives in a nonjudgmental fashion in line with this nuanced understanding of exiting over time. This is particularly important in criminal justice settings, where punitive responses have serious short- and long-term consequences.
    • Social capital during the first wave of the covid-19 outbreak: The case of the island of menorca

      Villalonga-Olives, Ester; Kawachi, Ichiro; Hernández-Aguado, Ildefonso (MDPI AG, 2021-12-02)
      The rapidly evolving coronavirus pandemic has drastically altered the economic and social lives of people throughout the world. Our overall goal is to understand the mechanisms through which social capital shaped the community response to the pandemic on the island of Menorca, Spain, which was under a strict lockdown in 2020. Between April and June 2020, we performed qualitative interviews (n = 25) of permanent residents of the island. From the findings, it is evident that social capital is an important resource with the capacity to organize help and support. However, the dark sides of social capital, with lack of social cohesion and lack of trust, also emerged as an important negative issue. We identified sources of tension that were not resolved, as well as important sociodemographic differences that are primary drivers for health inequalities. The investment in social networks and social capital is a long-term need that should consider sociodemographic vulnerability. © 2021 by the authors.