"It's Like the Pieces of a Puzzle That You Know": Research Interviews With People Who Inject Drugs Using the VidaviewTM Life Story Board

Bei dem Life Story Board (LSB) handelt es sich um ein visuelles Tool, das in therapeutischen Kontexten zum Einsatz kommt, um die Lebenswelt zu ko-konsturieren, die die persönlichen, relationalen und zeitlichen Aspekte individueller gelebter Erfahrung umfasst. In unserer Studie zu Drogennutzung und Schadensreduzierung interviewten wir Menschen, die Drogen injizieren unter Einsatz des LSB, um herauszufinden, ob sich hieraus Potenziale für eine verbesserte qualitative Forschung ergeben könnten. In unserem Forschungsteam arbeiteten neben Akademiker*innen auch frühere oder aktuelle Drogenkonsument*innen mit. Interviews wurden von jeweils zwei Personen geführt: eine agierte als Interviewer*in, die andere war für das LSB zuständig.Entlang der Ergebnisse war nachvollziehbar, dass Interviewende und Interviewte in unterschiedlicher Weise mit dem LSB interagierten: Während die Interviewer*innen es nutzten, um sich im Leitfaden zu orientieren, half es den Befragten, die eigene Lebensgeschichte mittels einer Vielzahl an emotionalen und kognitiven Äußerungen zu validieren oder zu unterstreichen. Das LSB erlaubte, sich an spezifische Situationen oder Vorfälle zu erinnern, Perspektiven hinzuzugewinnen und der eigenen Geschichte zusätzlichen Sinn zu verleihen. Insoweit arbeiteten Interviewte und Interviewende unter jeweils unterschiedlichen Vorzeichen mittels des LSB gemeinsam an einer (Re-)Präsentation der jeweiligen Lebensgeschichte.The Life Story Board (LSB) is a visual tool used in therapeutic circumstances to co-construct a lifescape that represents the personal, relational and temporal aspects of a person's lived experiences. We conducted a study of the drug use and harm reduction experiences of people who inject drugs through research interviews using the LSB to determine whether it has the potential to enhance qualitative research. Our team included community researchers who were current or former drug users and academic researchers. Interviews were conducted by two community researchers: an interviewer and a storyboarder who populated the LSB.Results showed that interviewers and participants interacted with the LSB in different ways. The board functioned to situate the interviewers in the interview schedule, whereas participants often used the board as a way to validate or reinforce their life story. Participants expressed a variety of emotional and cognitive responses to the board. Overall, the LSB helped participants focus on their life story to recall specific occasions or incidents and enabled them to gain perspective and make greater sense of their lives. Both participants and interviewers engaged with the LSB in nuanced ways that enabled them to work together to represent the participant's life story

A 'combined framework' approach to developing a patient decision aid: the PANDAs model

Background There is a lack of practical research frameworks to guide the development of patient decision aids [PtDAs]. This paper described how a PtDA was developed using the International Patient Decision Aids (IPDAS) guideline and UK Medical Research Council (UKMRC) frameworks to support patients when making treatment decisions in type 2 diabetes mellitus. Methods This study used mixed methods to develop a PtDA for use in a UK general practice setting. A 10-member expert panel was convened to guide development and patients and clinicians were also interviewed individually using semi-structured interview guides to identify their decisional needs. Current literature was reviewed systematically to determine the best available evidence. The Ottawa Decision Support Framework was used to guide the presentation of the information and value clarification exercise. An iterative draft-review-revise process by the research team and review panel was conducted until the PtDA reached content and format `saturation’. The PtDA was then pilot-tested by users in actual consultations to assess its acceptability and feasibility. The IPDAS and UKMRC frameworks were used throughout to inform the development process. Results The PANDAs PtDA was developed systematically and iteratively. Patients and clinicians highlighted the needs for information, decisional, emotional and social support, which were incorporated into the PtDA. The literature review identified gaps in high quality evidence and variations in patient outcome reporting. The PtDA comprised five components: background of the treatment options; pros and cons of each treatment option; value clarification exercise; support needs; and readiness to decide. Conclusions This study has demonstrated the feasibility of combining the IPDAS and the UKMRC frameworks for the development and evaluation of a PtDA. Future studies should test this model for developing PtDAs across different decisions and healthcare contexts

Essential conditions for the implementation of comprehensive school health to achieve changes in school culture and improvements in health behaviours of students

Abstract Background Comprehensive School Health (CSH) is an internationally recognized framework that holistically addresses school health by transforming the school culture. It has been shown to be effective in enhancing health behaviours among students while also improving educational outcomes. Despite this effectiveness, there is a need to focus on how CSH is implemented. Previous studies have attempted to uncover the conditions necessary for successful operationalization, but none have described them in relation to a proven best practice model of implementation that has demonstrated positive changes to school culture and improvements in health behaviours. Methods The purpose of this research was to identify the essential conditions of CSH implementation utilizing secondary analysis of qualitative interview data, incorporating a multitude of stakeholder perspectives. This included inductive content analysis of teacher (n = 45), principal (n = 46), and school health facilitator (n = 34) viewpoints, all of whom were employed within successful CSH project schools in Alberta, Canada between 2008 and 2013. Results Many themes were identified, here called conditions, that were divided into two categories: ‘core conditions’ (students as change agents, school-specific autonomy, demonstrated administrative leadership, dedicated champion to engage school staff, community support, evidence, professional development) and ‘contextual conditions’ (time, funding and project supports, readiness and prior community connectivity). Core conditions were defined as those conditions necessary for CSH to be successfully implemented, whereas contextual conditions had a great degree of influence on the ability for the core conditions to be obtained. Together, and in consideration of already established ‘process conditions’ developed by APPLE Schools (assess, vision, prioritize; develop and implement an action plan; monitor, evaluate, celebrate), these represent the essential conditions of successful CSH implementation. Conclusions Overall, the present research contributes to the evidence-base of CSH implementation, ultimately helping to shape its optimization by providing school communities with a set of understandable essential conditions for CSH implementation. Such research is important as it helps to support and bolster the CSH framework that has been shown to improve the education, health, and well-being of school-aged children

"Sleep is healthy for your body and brain." Use of student-centered photovoice to explore the translation of sleep promotion at school to sleep behavior at home

Study objectives Schools are an important setting to teach and reinforce positive health behaviors such as sleep, however, research that incorporates the student perspective of school-based sleep promotion initiatives is limited. This study explored student's perceptions of sleep behavior (how they understood and valued positive and negative sleep behaviors) and determined if and how students translate school-based sleep promotion to the home. Methods Forty-five grade 4 and 5 children (aged 9-11 years) were purposefully sampled from 3 schools participating in the Alberta Project Promoting healthy Living for Everyone in schools (APPLE) in Edmonton, Canada. Using focused ethnography as the method and photovoice as a data generating strategy, qualitative in-depth information was generated through photo-taking and one-on-one interviews. Data were analyzed in an iterative, cyclical process using latent content analysis techniques. Results Four themes related to students’ perception of sleep behavior within the context of a school-based sleep promotion initiative were identified: sleep is “healthy for your body and brain,” sleep habits are rooted in the home environment, school experiences shape positive sleep habits at home, and students translate sleep promotion home if they think it is useful or would be acceptable to the family. Conclusion and implications School-based sleep promotion interventions that are grounded in the comprehensive school health (CSH) approach hold promise for successfully shaping student sleep behavior. To promote health and academic success in children, future interventions should include home-school partnerships that address child sleep across multiple critical learning environments

Binding and Cleavage of E. coli HUβ by the E. coli Lon Protease

The Escherichia coli Lon protease degrades the E. coli DNA-binding protein HUβ, but not the related protein HUα. Here we show that the Lon protease binds to both HUβ and HUα, but selectively degrades only HUβ in the presence of ATP. Mass spectrometry of HUβ peptide fragments revealed that region K18-G22 is the preferred cleavage site, followed in preference by L36-K37. The preferred cleavage site was further refined to A20-A21 by constructing and testing mutant proteins; Lon degraded HUβ-A20Q and HUβ-A20D more slowly than HUβ. We used optical tweezers to measure the rupture force between HU proteins and Lon; HUα, HUβ, and HUβ-A20D can bind to Lon, and in the presence of ATP, the rupture force between each of these proteins and Lon became weaker. Our results support a mechanism of Lon protease cleavage of HU proteins in at least three stages: binding of Lon with the HU protein (HUβ, HUα, or HUβ-A20D); hydrolysis of ATP by Lon to provide energy to loosen the binding to the HU protein and to allow an induced-fit conformational change; and specific cleavage of only HUβ