Researching and learning through time and space: Reflections from the QMiP virtual conference 2021

[Extract] THE COVID-19 PANDEMIC has significantly impacted and changed how academic and research events, such as workshops and conferences, are typically conducted. The shift to having these events online has enabled academics and researchers to remain connected while being kept updated on the various developments in their respective fields and disciplines. As a PhD candidate in Singapore, this transition to online platforms has enabled me to attend a plethora of qualitative research workshops and conferences that would have otherwise been out of reach for me due to the time and costs involved participating in such events in person

"Making do with things we cannot change": an interpretive phenomenological analysis of relationship resilience among gay men in Singapore

Despite evolving social and political attitudes, many countries, including Singapore, still do not recognize couples in same-sex relationships. Much remains to be understood about the processes and strategies that help these couples maintain their relationships, especially in Asian societies. This study explored the ways in which gay men in intimate relationships safeguarded their relationships and remained resilient in Singapore. Semi-structured interviews were conducted with nine gay men in long-term relationships. The data were analyzed using interpretive phenomenological analysis. The analysis generated three superordinate themes, a) Making do with things we cannot change, b) Remaining resilient through social and financial capital, and c) Our love is stronger than the challenges we face. The emergent themes pointed to the ways in which participants coped with or shielded themselves against socio-political stressors that negatively impacted their relationships in the Singapore context. While some participants sought solace in families of choice, many learned to accept socio-political situations beyond their control. Most participants made do with implicit recognition as they were unwilling to disrupt social harmony. Others used their financial security to overcome structural barriers such as obtaining legal elements of heterosexual marriage. Findings may further current understanding of the ways in which gay couples remain resilient despite the relational challenges in different cultural contexts

Determinants of antibiotic prescribing for upper respiratory tract infections in an emergency department with good primary care access: a qualitative analysis

Upper respiratory tract infections (URTIs) account for substantial attendances at emergency departments (EDs). There is a need to elucidate determinants of antibiotic prescribing in time-strapped EDs – popular choices for primary care despite highly accessible primary care clinics. Semi-structured in-depth interviews were conducted with purposively sampled physicians (n = 9) in an adult ED in Singapore. All interviews were analysed using thematic analysis and further interpreted using the Social Ecological Model to explain prescribing determinants. Themes included: (1) reliance on clinical knowledge and judgement, (2) patient-related factors, (3) patient–physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness. The physicians relied strongly on their clinical knowledge and judgement in managing URTI cases and seldom interfered with their peers’ clinical decisions. Despite departmental norms of not prescribing antibiotics for URTIs, physicians would prescribe antibiotics when faced with uncertainty in patients’ diagnoses, treating immunocompromised or older patients with comorbidities, and for patients demanding antibiotics, especially under time constraints. Participants had a preference for antibiotic prescribing guidelines based on local epidemiology, but viewed hospital policies on prescribing as a hindrance to clinical judgement. Participants highlighted the need for more public education and awareness on the appropriate use of antibiotics and management of URTIs. Organisational practice norms strongly influenced antibiotic prescribing decisions by physicians, who can be swayed by time pressures and patient demands. Clinical decision support tools, hospital guidelines and patient education targeting at individual, interpersonal and community levels could reduce unnecessary antibiotic use

Differences in psychosocial determinants of hand hygiene between health care professional groups: insights from a mixed-methods analysis

Background: Good hand hygiene (HH) prevents health care-associated infections. We compared psychosocial and organizational factors associated with HH compliance and perceived need for improvement among physicians, nurses, and allied health professionals (AHPs). Methods: We conducted a mixed-methods study in a 1,600-bed adult tertiary-care hospital in Singapore. Seven focus group discussions were conducted and data were analyzed using thematic analysis. The subsequent cross-sectional survey involved 1,064 staff members. Principal components analysis was performed to derive the latent factor structure that was applied in multivariable analyses. Results: All staff members acknowledged that HH was an integral part of their work, but were noncompliant due to competing priorities. Physicians were forgetful but appreciated reminders. Nurses were intrinsically motivated for HH. After adjusting for gender, staff category, seniority, and dermatitis history, having positive knowledge-attitudes-behaviors (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.23-1.69), personal motivators-enablers (OR, 1.60; 95% CI, 1.38-1.86), and emotional motivators (OR, 1.62; 95% CI 1.40-1.88) were positively associated with good HH compliance. Women (OR, 3.91; 95% CI, 1.37-11.11), seniors (OR, 2.88; 95% CI, 1.08-7.68), nurses (OR, 4.05; 95% CI, 1.51-10.87), and staff with personal motivators-enablers for HH (OR, 1.60; 95% CI, 1.08-2.37) were more likely to perceive a need for improvement. Conclusions: Factors influencing self-reported HH differed between health care professional groups. Group-specific interventions are needed to improve compliance

Potential interactions between the pathways to diagnosis of HIV and other STIs and HIV self-testing: insights from a qualitative study of gay, bisexual and other men who have sex with men in Singapore

Objectives: This study draws on qualitative insights on the barriers and facilitators to HIV testing, as well as perceptions of HIV self-testing (HIVST), to propose a framework to understand not only the benefits but also potential knock-on implications of introducing HIVST in the context of other STI testing. Methods: We conducted semistructured, in-depth interviews with 30 gay, bisexual and other men who have sex with men aged 18 and 39 years old in Singapore. Interview topics included barriers and facilitators to HIV and other STI testing, as well as perceptions of HIVST. Interviews were audio-recorded, transcribed, coded and analysed using thematic analysis. Results: For HIV testing, participants cited the perceived risk of acquiring, susceptibility to and symptoms of HIV as internal motivators, while social influence and accessibility of HIV testing services were external motivators. For STI testing, perceived symptoms and partner notification of STI were reported as internal and external motivators, respectively. Availability of bundle tests, starting a new relationship and instances of mandatory testing motivated both simultaneous HIV and other STI testing. The fear of a positive diagnosis and lack of confidentiality were cited as internal and external barriers to HIV testing, respectively, while low perceived severity of other STI and the cost of STI tests were cited as internal and external barriers to other STI testing, respectively. We identified pathways to HIV and other STI testing and discussed how the introduction of HIVST may reduce opportunities for other STI testing. Conclusions: The findings of this study suggest that introducing HIVST might weaken linkages to other STI testing if alternative strategies of promoting other STI testing are not simultaneously implemented. We recommend that future interventions address both the risks of HIV and other STI simultaneously, and that structural interventions promoting HIV and other STI preventions be balanced accordingly

Chemsex among gay, bisexual, and other men who have sex with men in Singapore and the challenges ahead: a qualitative study

Background: Sexualised substance use, or 'chemsex' has been shown to be a major factor driving the syndemic of HIV/AIDS in communities of gay, bisexual, and other men who have sex with men (GBMSM) around the world. However, there is a paucity of research on chemsex among GBMSM in Singapore due to punitive drug laws and the criminalisation of sexual behaviour between men. This qualitative descriptive study is the first to explore perceptions towards, motivators to engaging in, and the barriers to addressing the harms associated with chemsex among GBMSM in Singapore. Methods: We conducted 30 semi-structured in-depth interviews with self-identifying GBMSM between the ages of 18–39 in Singapore following a purposive sampling strategy. Interview topics included participants' perceptions of drug use among GBMSM in Singapore, perceptions towards chemsex, reasons for drug use and chemsex, and recommendations to address the harms associated with chemsex in Singapore. Interviews were audio-recorded, transcribed, coded, and analysed using thematic analysis. Results: Participants reported that it was common to encounter chemsex among GBMSM in Singapore as it could be easily accessed or initiated using social networking phone apps. Enhancement and prolongation of sexual experiences, fear of rejection from sexual partners and peers, and its use as a means of coping with societal rejection were three main reasons cited for engaging in chemsex. The impact of punitive drug laws on disclosure and stigmatisation of GBMSM who use drugs were reported to be key barriers towards addressing chemsex. Participants suggested using gay-specific commercial venues as avenues for awareness and educational campaigns, and social media to reach out to younger GBMSM. Conclusions: This study highlights the complexities behind chemsex use among GBMSM in Singapore, and the range of individual to institutional factors to be addressed. We recommend that community-based organisations and policy-makers find ways to destigmatise discussion of chemsex and provide safe spaces to seek help for drug use

From Acute Infection to Chronic Health Condition: The Role of the Social Sciences on the HIV/AIDS Global Epidemic

To date, human immunodeficiency virus (HIV) infections remain a global public health issue. While there remains no cure, recent biomedical advances have turned HIV from an acute infection into a manageable, chronic health condition. This transformation has enabled people living with HIV (PLHIV) to lead long, healthy lives. Pivotal to this transformation was the role of the social sciences. The social sciences discipline has generated valuable insights into the behavioral, social, cultural, and political factors that impact the development and implementation of HIV programs and interventions. This chapter will explicate the interpretative and critical role of the social sciences in understanding HIV/AIDS and the ways in which the social sciences will continue to impact this global epidemic. The chapter will begin with a short history of HIV/AIDS and its current global trajectory since it was first detected in the 1980s. Subsequent discussions will center around the issues arising from the biomedicalization of HIV/AIDS and illustrate the ways in which the social sciences have deepened the impact of HIV/AIDS work. These will include how the social sciences have shed light on the facilitators and barriers of HIV prevention, uncovered insights into the lived experiences of PLHIV and HIV care, and interrogated the structural impediments and sociopolitical discourses that influence the local and global ideologies for this chronic health condition. The chapter will close with the authors’ reflections regarding the ways in which the social sciences can continue to value-add to HIV/AIDS work in the future

Establishing The Face And Content Validity Of The Couple Resilience Inventory: Qualitative Insights From Same-Sex Couples In Singapore

The Couple Resilience Inventory (CRI) was first developed by Sanford et al. (2016) to assess and measure the behavioural strategies that heterosexual and same-sex couples use to cope with stressful life events. To date, the CRI has not been adapted or cross-validated in non-Western societies. By cross-validating the CRI, researchers and practitioners could understand the similarities and differences in strategies that couples use in different cultural contexts. A qualitative descriptive study was conducted to establish the face and content validity of the CRI among individuals in same-sex relationships in Singapore. Semi-structured interviews were conducted with sixteen participants who were purposively sampled from Singapores LGBTQ community. Interviews were audio-recorded and transcribed verbatim. Data were analysed using Applied Thematic Analysis. Intercoder agreement and saturation were systematically ascertained. The findings provided insights into the ways in which the items in the CRI are understood and answered in the Singapore context. While many of the inventory items were clear, easy to understand, and applicable to their relationships, participants suggested further changes and elaborations to improve the comprehension and clarity of eight items. Interestingly, two-thirds of the participants interpreted two negative behaviour items as helpful in coping with and remaining resilient against stressful life events. Participants also suggested additional resilience strategies beyond the items listed in the CRI. The study findings generally support the face and content validity of the CRI among same-sex couples in Singapore. However, improvements may be required to ensure the inventory is culturally relevant to same-sex relationships in Singapore

A formative research-guided educational intervention to improve the knowledge and attitudes of seniors towards influenza and pneumococcal vaccinations

Background: Adult influenza and pneumococcal vaccination rates in Singapore are low, and factors influencing knowledge and attitudes of seniors towards influenza, pneumonia and their respective vaccines are not well-known. Our study aims to understand the barriers and facilitators towards getting influenza and pneumococcal vaccinations among seniors in Singapore, and subsequently inform the conduct of a relevant community-based educational intervention, as well as evaluate the intervention outcomes. Methods: We performed a mixed methods study with two components: Firstly, formative research was conducted among community-dwelling seniors, using focus group discussions (FGDs), to understand their knowledge and attitudes towards influenza, pneumonia and their respective vaccines. Next, a quantitative study was conducted to evaluate knowledge of seniors and the effectiveness of an educational intervention. Results: Four FGDs were organised with 32 participants, who were predominantly female, of lower educational background, and residing in government rental flats. Participants had varying levels of knowledge and many misconceptions about influenza, pneumonia and their respective vaccinations, with concerns about side effects and vaccine effectiveness. The formative research results were used to inform a community-based educational intervention for seniors. Our subsequent evaluation included 604 elderly participants, mainly from lower educational and socio-economic strata, who initially demonstrated poor knowledge scores (median score 5 out of 9, IQR 4-5). Following our intervention, median knowledge score improved to 7 (IQR 6-8) (p < .0001). Significant improvements in knowledge scores were observed across genders, age strata, education levels, and housing types. Discussion: Our formative research identified knowledge gaps among community-dwelling seniors which affected their attitudes towards vaccination uptake. Key findings were taken into consideration when implementing the educational intervention. Our community-based intervention was effective in improving knowledge and attitudes, and could be used as a cue to action for short-term behaviour changes

A Nurse-Led Integrated Chronic Care E-Enhanced Atrial Fibrillation (NICE-AF) Clinic in the Community: A Preliminary Evaluation

10.3390/ijerph19084467INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH19