Pregnant and breastfeeding women's prospective acceptability of two biomedical HIV prevention approaches in Sub Saharan Africa : a multisite qualitative analysis using the theoretical framework of acceptability

HIV infection during pregnancy and breastfeeding has implications for maternal health. Between May- November 2018, we explored prospective acceptability of two novel HIV Pre-exposure Prophylaxis (PrEP) products, oral pills and vaginal rings, through focus group discussions with 65 pregnant and breastfeeding women in Malawi, South Africa, Uganda, Zimbabwe. Qualitative analysis was completed, guided by the Theoretical Framework of Acceptability (TFA). First, a deductive thematic analysis was applied to relevant coded data, into the seven TFA constructs (Affective Attitude; Burden; Ethicality, Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy). Next, an iterative analysis was completed to generate themes within each of the TFA constructs. Women’s positive attitudes towards daily oral PrEP highlighted the familiarity of taking pills, understanding the purpose of taking pills, and the perception that it is an effective method to protect mothers and babies from HIV during pregnancy and breastfeeding. Women emphasized the ease of using the ring given its monthly duration that lowers burden on the user, its discreetness and invisibility once in place. The TFA analysis highlighted how acceptability of both methods could be enhanced by focusing on perceptions of the end users (i.e. the women) and not just the products themselves. This approach provided insights into how to refine the intervention materials and plans for implementation

EmpowerED Adolescent Mental Health: A Pilot Program in Burke County, North Carolina to Improve Education Access and Quality by Utilizing Evidence-Based Mental Health Best Practices

There is a critical link between social determinants of health, particularly educational access and quality, and mental health outcomes among adolescents in rural areas like Burke County, North Carolina. The detrimental impact of adverse childhood experiences (ACEs) on academic performance and mental well-being underscores the need for targeted interventions. The proposed intervention, EmpowerED: Adolescent Mental Health Program, has a mission to redesign the existing system by utilizing mental health education resources to strengthen scholastic achievement of students from underprivileged populations (i.e., low socioeconomic areas). Organized as a pilot after-school program at Liberty Middle School, it seeks to mitigate the effects of ACEs and improve overall educational experiences for economically disadvantaged adolescents. The goal is to foster systemic change by demonstrating how mental health and well-being can enhance educational quality and positively influence health outcomes; therefore, contributing to a healthier future for Burke County residents.Master of Public Healt

Inconsistent relationship between depth of sedation and intensive care outcome: systematic review and meta-analysis

Purpose: To determine the effect of depth of sedation on intensive care mortality, duration of mechanical ventilation, and other clinically important outcomes. Methods: We searched MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO from 2000 - 2020. Randomised controlled trials and cohort studies that examined the effect of sedation depth were included. Two reviewers independently screened, selected articles, extracted data and appraised quality. Data on study design, population, setting, patient characteristics, study interventions, depth of sedation and relevant outcomes were extracted. Quality was assessed using Critical Appraisal Skills Programme tools. Results: We included data from 26 studies (n=7865 patients): 8 RCTs and 18 cohort studies. Heterogeneity of studies was substantial. There was no significant effect of lighter sedation on intensive care mortality. Lighter sedation did not affect duration of mechanical ventilation in RCTs (mean difference [MD]: -1.44 days [95% CI -3.79 to 0.91]) but did in cohort studies (MD: -1.54 days [95% CI -2.68 to -0.39]). No statistically significant benefit of lighter sedation was identified in RCTs. In cohort studies lighter sedation improved time to extubation, intensive care and hospital length of stay and Ventilator Associated Pneumonia. We found no significant effects for hospital mortality, delirium or adverse events. Conclusion: Evidence of benefit from lighter sedation is limited, with inconsistency between observational and randomised studies. Positive effects were mainly limited to low quality evidence from observational studies, which could be attributable to bias and confounding factors

Increasing awareness of gynaecological cancer symptoms: a GP perspective.

In the UK there has been an effort, through the National Awareness and Early Diagnosis Initiative (NAEDI), to increase early stage diagnoses and ultimately cancer survival. Encouraging early symptom presentation through awareness-raising activities in primary care is one method to achieve this goal. Understanding GPs' views about this type of activity, however, is crucial prior to implementation

Acceptability of restrictions in the COVID-19 pandemic: a population-based survey in Denmark and Sweden

IntroductionDenmark and Sweden initially adopted different responses to the COVID-19 pandemic although the two countries share many characteristics. Denmark responded swiftly with many mandatory restrictions. In contrast, Sweden relied on voluntary restrictions and a more “relaxed” response during the first wave of the pandemic. However, increased rates of COVID-19 cases led to a new approach that involved many more mandatory restrictions, thus making Sweden’s response similar to Denmark’s in the second wave of the pandemic.AimThe aim was to investigate and compare the extent to which the populations in Denmark and Sweden considered the COVID-19 restrictions to be acceptable during the first two waves of the pandemic. The study also aimed to identify the characteristics of those who were least accepting of the restrictions in the two countries.Materials and methodsCross-sectional surveys were conducted in Denmark and Sweden in 2021. The study population was sampled from nationally representative web panels in the two countries, consisting of 2,619 individuals from Denmark and 2,633 from Sweden. The questionnaire captured key socio-demographic characteristics. Acceptability was operationalized based on a theoretical framework consisting of seven constructs and one overarching construct.ResultsThe respondents’ age and gender patterns were similar in the two countries. The proportion of respondents in Denmark who agreed with the statements (“agree” alternative) that captured various acceptability constructs was generally higher for the first wave than the second wave of the pandemic. The opposite pattern was seen for Sweden. In Denmark, 66% in the first wave and 50% in the second wave were accepting of the restrictions. The corresponding figures for Sweden was 42% (first wave) and 47% (second wave). Low acceptance of the restrictions, defined as the 25% with the lowest total score on the seven acceptability statements, was associated with younger age, male gender and lower education levels.ConclusionRespondents in Sweden were more accepting of the restrictions in the second wave, when the country used many mandatory restrictions. In contrast, respondents in Denmark were more accepting of the restrictions in the first wave than in the second wave, implying an increased weariness to comply with the restrictions over time. There were considerable socio-demographic differences between those who expressed low acceptance of the restrictions and the others in both countries, suggesting the importance of tailoring communication about the pandemic to different segments of the population

Acceptability of healthcare interventions : an overview of reviews and development of a theoretical framework

Abstract Background It is increasingly acknowledged that \u2018acceptability\u2019 should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients. Methods Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators. Results From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Conclusion Despite frequent claims that healthcare interventions have assessed acceptability, it is evident that acceptability research could be more robust. The proposed definition of acceptability and the TFA can inform assessment tools and evaluations of the acceptability of new or existing interventions

Numerical Analysis of the Combined Influence of Accelerated Crucible Rotation and Dynamic Crucible Translation on Liquid Phase Diffusion Growth of SiGe

The effects of accelerated crucible rotation technique (ACRT) and dynamic translation on liquid phase diffusion (LPD) growth of SixGe1−x single crystals have been separately investigated numerically in earlier works and were found to have a very positive impact on the LPD growth process. Building upon these findings, in this paper, we study the consequences of imposing both ACRT and dynamic translation on this growth technique. Time-dependent, axisymmetric numerical simulations using moving grid approach have been carried out using finite volume code Ansys Fluent. Crucible translation effect is simulated using dynamic thermal boundary condition. Results are compared to the case in which this growth system is subjected to ACRT only. It is predicted that by combining ACRT with dynamic pulling, excellent axial compositional uniformity can be achieved and growth rate can be improved substantially without significantly compromising on the benefits of employing ACRT. The results show that it is advantageous to utilize the combination of ACRT and dynamic translation during LPD growth rather than using them independently for producing relatively uniform composition SixGe1−x single crystals in a shorter span of time

Application of a theoretical framework to assess intervention acceptability : a semi-structured interview study

Background: The importance of considering acceptability of healthcare interventions has been recognised. However there is little guidance on how to assess acceptability. Previous research has treated acceptability as a simple construct, assessed uni-dimensionally. Such an approach restricts the potential to identify variation, and to discriminate between interventions with high versus low levels of acceptability. The purpose of this study was to compare the use of a multi-construct theoretical framework with a more general approach, to investigate acceptability. Methods: Eleven healthcare professionals (HCPs) completed semi-structured interviews about the acceptability of two interventions. The first was an audit-and-feedback intervention (i.e. summary of clinical performance provided to HCPs) relating to blood transfusion practice. The second was an online toolkit to support hospital staff to respond to the feedback (e.g. by prompting action planning). Questions within the topic guide framed acceptability as 1) a global construct (i.e. one question about acceptability in general); 2) a multi-component construct (seven questions about acceptability), based on a recently-developed theoretical framework of acceptability (TFA). Transcripts were analysed using framework analysis. Findings: When answering the global question, participants (a) spontaneously referred to several constructs in the TFA, and (b) reported that both interventions were acceptable. Based on responses to the set of questions based on the TFA, participants reported more varied assessments of acceptability. Discussion: Investigating acceptability as a multi-component construct resulted in greater level of discrimination between levels of acceptability. The TFA could be applied to explore acceptability of healthcare interventions more widely