Explore the vast range of titles available.

Physical activity (PA) can improve a range of outcomes following a cancer diagnosis. These include an improvement in experience of side effects of treatment (eg, fatigue) and management of comorbid conditions. PA might also increase survival and reduce recurrence. Digital interventions have shown potential for PA promotion among cancer survivors, but most in a previous review were Web-based, and few studies used mobile apps. There are many PA apps available for general public use, but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis. This study sought posttreatment nonmetastatic breast, prostate, and colorectal cancer survivors' opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention. Each participant was randomly assigned to download 2 of 4 apps (Human, The Walk, The Johnson & Johnson Official 7 Minute Workout, and Gorilla Workout). Participants used each app for 1 week consecutively. In-depth semistructured telephone interviews were then conducted to understand participants' experiences of using the apps and how app-based PA interventions could be developed for cancer survivors. The interviews were analyzed using thematic analysis. Thirty-two participants took part: 50% (16/32) had prostate cancer, 25% (8/32) had breast cancer, and 25% (8/32) had colorectal cancer. Three core themes were identified. The first theme was that multiple factors affect engagement with PA apps and this is highly personalized. Factors affecting engagement included participants' perceptions of (1) the advantages and disadvantages of using apps to support PA, (2) the relevance of the app to the user (eg, in terms of cancer-related factors, their PA goals, the difficulty level of the app, the way in which they interact with their mobile phone, and the extent to which the app fits with their self-identity), (3) the quality of the app (eg, usability, accuracy, quality of production, and scientific evidence-base), and (4) the behavior change techniques used to promote PA. In the second theme, participants recommended that apps that promote walking are most appealing, as walking removes many barriers to PA. Finally, the participants suggested that PA apps should be integrated into cancer care, as they valued guidance and recommendations from health care professionals. This sample of breast, prostate, and colorectal cancer survivors was receptive to the use of apps to promote PA. Although no publicly available PA app was deemed wholly suitable, many suggestions for adaptation and intervention development were provided. The results can inform the development of an app-based PA intervention for cancer survivors. They also highlight the wide-ranging and dynamic influences on engagement with digital interventions, which can be applied to other evaluations of mobile health products in other health conditions and other health behaviors.

Background Choosing a suitable sample size in qualitative research is an area of conceptual debate and practical uncertainty. That sample size principles, guidelines and tools have been developed to enable researchers to set, and justify the acceptability of, their sample size is an indication that the issue constitutes an important marker of the quality of qualitative research. Nevertheless, research shows that sample size sufficiency reporting is often poor, if not absent, across a range of disciplinary fields. Methods A systematic analysis of single-interview-per-participant designs within three health-related journals from the disciplines of psychology, sociology and medicine, over a 15-year period, was conducted to examine whether and how sample sizes were justified and how sample size was characterised and discussed by authors. Data pertinent to sample size were extracted and analysed using qualitative and quantitative analytic techniques. Results Our findings demonstrate that provision of sample size justifications in qualitative health research is limited; is not contingent on the number of interviews; and relates to the journal of publication. Defence of sample size was most frequently supported across all three journals with reference to the principle of saturation and to pragmatic considerations. Qualitative sample sizes were predominantly – and often without justification – characterised as insufficient (i.e., ‘small’) and discussed in the context of study limitations. Sample size insufficiency was seen to threaten the validity and generalizability of studies’ results, with the latter being frequently conceived in nomothetic terms. Conclusions We recommend, firstly, that qualitative health researchers be more transparent about evaluations of their sample size sufficiency, situating these within broader and more encompassing assessments of data adequacy . Secondly, we invite researchers critically to consider how saturation parameters found in prior methodological studies and sample size community norms might best inform, and apply to, their own project and encourage that data adequacy is best appraised with reference to features that are intrinsic to the study at hand. Finally, those reviewing papers have a vital role in supporting and encouraging transparent study-specific reporting.

Residency applications via virtual-interview could potentially mitigate the extensive cost and time required for customary in-person interviews. We outline the perception of medical students and residents on the use of virtual-interview for residency applications in lieu of in-person interviews. We obtained 1824 responses from medical students and residents through an online questionnaire between March2019-Feb2020 in Texas-United States. The survey had 11 statements (five in favor of in-person interviews and 6 in favor of virtual interviews) that respondents could rank on a 5-point Likert scale. All statements' scores were summed based on the response given by each participant to create a total score between 11 and 55. The perception of the two groups was analyzed using an independent sample T-test and ANOVA. We received a total of 1711 responses from medical students and 113 from medical residents. Respondents were more female (82.2% of medical students and 47.8% of residents), with a mean age of 22.87±3.42 years old for medical students and 28.72±4.35 years old for residents. Both groups preferred in-person interviews; however, the residents were significantly more in favor (P = 0.03). Both groups agree that virtual-interviews should be as an option, though this was considerably higher in the medical students (P = 0.001). In the multivariate analysis, \"travel distance\" and \"type of medical school\" had a significant impact on choosing the virtual-interviews in both groups (p<0.01). In-person interviews are favored by both medical students and residents compared to virtual-interview services in normal circumstances. However, both groups agree that programs should offer the option of having virtual-interviews as an available choice. Distance to an interview location and the type of medical school were the factors that had a significant impact on perception of using virtual-interviews. Knowing about the applicants' attitude toward residency interviews and the national circumstances are essential when preparing the interview guides. Our findings are limited by the small sample size and the low response rate. Further extensive studies are warranted to better understand the perception of residency applicants toward virtual-interviews to improve the interview process in the United States.

An interview is considered the gold standard method of assessing global functional outcomes in clinical trials among patients with acute traumatic brain injury (TBI). However, several multicenter clinical trials have used questionnaires completed by a patient or caregiver to assess the primary end point. To examine agreement between interview and questionnaire formats for assessing TBI outcomes and to consider whether an interview has advantages. This cohort study used data from patients enrolled in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project from December 2014 to December 2017. Data were analyzed from December 2020 to April 2021. Included patients were aged 16 years or older with TBI and a clinical indication for computed tomography imaging. Outcome assessments were completed using both an interview and a questionnaire at follow-up 3 and 6 months after injury. Traumatic brain injury of all severities. Ratings on the Glasgow Outcome Scale-Extended (GOSE) administered as a structured interview rated by an investigator and as a questionnaire completed by patients or caregivers and scored centrally were compared, and the strength of agreement was evaluated using weighted κ statistics. Secondary outcomes included comparison of different sections of the GOSE assessments and the association of GOSE ratings with baseline factors and patient-reported mental health, health-related quality of life, and TBI symptoms. Among the 3691 eligible individuals in the CENTER-TBI study, both GOSE assessment formats (interview and questionnaire) were completed by 994 individuals (26.9%) at 3 months after TBI (654 [65.8%] male; median age, 53 years [IQR, 33-66 years]) and 628 (17.0%) at 6 months (409 [65.1%] male; median age, 51 years [IQR, 31-64 years]). Outcomes of the 2 assessment methods agreed well at both 3 months (weighted κ, 0.77; 95% CI, 0.73-0.80) and 6 months (weighted κ, 0.82; 95% CI, 0.78-0.86). Furthermore, item-level agreement between the 2 methods was good for sections regarding independence in everyday activities (κ, 0.70-0.79 across both time points) and moderate for sections regarding subjective aspects of functioning such as relationships and symptoms (κ, 0.41-0.51 across both time points). Compared with questionnaires, interviews recorded more problems with work (294 [30.5%] vs 233 [24.2%] at 3 months and 161 [26.8%] vs 136 [22.7%] at 6 months), fewer limitations in social and leisure activities (330 [33.8%] vs 431 [44.1%] at 3 months and 179 [29.7%] vs 219 [36.4%] at 6 months), and more symptoms (524 [53.6%] vs 324 [33.1%] at 3 months and 291 [48.4%] vs 179 [29.8%] at 6 months). Interviewers sometimes assigned an overall rating based on judgment rather than interview scoring rules, particularly for patients with potentially unfavorable TBI outcomes. However, for both formats, correlations with baseline factors (ρ, -0.13 to 0.42) and patient-reported outcomes (ρ, 0.29 to 0.65) were similar in strength. In this cohort study, GOSE ratings obtained by questionnaire and interview methods were in good agreement. The similarity of associations of the ratings obtained by both GOSE methods with baseline factors and other TBI outcome measures suggests that despite some apparent differences, the core information collected by both interviews and questionnaires was similar. The findings support the use of questionnaires in studies in which this form of contact may offer substantial practical advantages compared with interviews.

Caesarean section (CS) rates are rising in urban hospitals in Nepal. However, the reasons behind these rising rates are poorly understood. Therefore, this study explores factors contributing to rising CS rates in two urban hospitals as well as strategies to make rational use of CS. This cross-sectional mixed-methods study was conducted in 2021 in two hospitals, one public hospital and one private one in Kathmandu. The quantitative part included a record-based study of 661 births (private hospital = 276 and public hospital = 385) for the fiscal year 2018/19. The qualitative part included semi-structured interviews with 14 health professionals (doctors, nurses & midwives) and five key informants from relevant organisations and four focus group discussions with pregnant women in antenatal clinics in two hospitals. Quantitative data were analysed using SPSS v28. Qualitative data were organised through NVivo v12 and thematically analysed. The overall CS rate was high (50.2%). The CS rate in the private hospital was almost double than that in the public hospital (68.5% vs. 37.1%). Previous CS was the leading indication for performing CS. Non-medical indications were maternal request (2.7%) and CS for non-specified reasons (5.7%). The odds of CS were significantly higher in the private hospital; women aged 25 years and above; having four or more antenatal clinic visits; breech presentation; urban residency; high caste; gestational age 37-40 weeks; spontaneous labour and no labour. Robson group 5 (13.9%) was the largest contributor to overall CS rate, followed by group 1 (13.4%), 2 (8.8%), 3 (4.4%) and 6 (2.9%). Similarly, the risk of undergoing CS was high in Robson groups 2, 5, 6, 7 and 9. The qualitative analysis yielded five key themes affecting rising rates: (1) medical factors (repeated CS, complicated referral cases and breech presentation); (2) socio-demographic factors (advanced age mother, precious baby and defensive CS); (3) financial factors (income for private hospitals); (4) non-medical factors (maternal request); and (5) health service-related factors (lack of awareness/midwives/resources, urban centralised health facilities and lack of appropriate policies and protocols). Four main strategies were identified to stem the rise of CS rates: (1) provide adequate resources to support care in labour and birth (midwives/trained staff & birthing centres); (2) raise awareness on risks and benefits mode of childbirth (antenatal education/counselling and public awareness); (3) reform CS policies/protocols; and (4) promote physiological birth. The high CS rate in the private hospital reflects the medicalisation of childbirth, a public health issue which needs to be urgently addressed for the health benefits of both mother and baby. Multiple factors affecting rising CS rates were identified in urban hospitals. This study provides insights into factors affecting the rising CS rate and suggests that multiple strategies are required to stem the rise of CS rates and to make rational use of CS in urban hospitals.

Information accessibility is a pivotal factor influencing farmers’ adoption of Agricultural Green Production Technologies (AGPT). However, the widespread issue of information poverty presents a significant obstacle to this adoption process, thereby hindering the progression towards sustainable agricultural development. To address this information deficit, farmers have begun to utilize the Internet and participate in government-led onsite assembly training programs to acquire the necessary knowledge. Yet there is still a lack of research evidence on the effectiveness and comparative advantages of internet and offline training. This study explores the impact of various information access channels on farmers’ adoption of green production technologies in agriculture, focusing on a sample of 731 family farms located in Sichuan Province. The issue of endogeneity was addressed using the Conditional Mixed Process Estimation Method. The sample underwent a t-test and heterogeneity analysis. The findings revealed that both internet-based information access and participation in training significantly bolstered farmers’ adoption of AGPT, with the former proving to be more effective. Notably, heterogeneity was observed among farmers, differentiated by age and the number of village cadres within their family units.

Background We aimed to assess the feasibility of using multiple technologies to recruit and conduct cognitive interviews among young people across the United States to test items measuring sexual and reproductive empowerment. We sought to understand whether these methods could achieve a diverse sample of participants. With more researchers turning to approaches that maintain social distancing in the context of COVID-19, it has become more pressing to refine these remote research methods. Methods We used several online sites to recruit for and conduct cognitive testing of survey items. To recruit potential participants we advertised the study on the free online bulletin board, Craigslist, and the free online social network, Reddit. Interested participants completed an online Qualtrics screening form. To maximize diversity, we purposefully selected individuals to invite for participation. We used the video meeting platform, Zoom, to conduct the cognitive interviews. The interviewer opened a document with the items to be tested, shared the screen with the participant, and gave them control of the mouse and keyboard. After the participant self-administered the survey, the interviewer asked about interpretation and comprehension. After completion of the interviews we sent participants a follow-up survey about their impressions of the research methods and technologies used. We describe the processes, the advantages and disadvantages, and offer recommendations for researchers. Results We recruited and interviewed 30 young people from a range of regions, gender identities, sexual orientations, ages, education, and experiences with sexual activity. These methods allowed us to recruit a purposefully selected diverse sample in terms of race/ethnicity and region. It also may have offered potential participants a feeling of safety and anonymity leading to greater participation from gay, lesbian, and transgender people who would not have agreed to participate in-person. Conducting the interviews using video chat may also have facilitated the inclusion of individuals who would not volunteer for in-person meetings. Disadvantages of video interviewing included participant challenges to finding a private space for the interview and problems with electronic devices. Conclusions Online technologies can be used to achieve a diverse sample of research participants, contributing to research findings that better respond to young people’s unique identities and situations.

Type 2 diabetes accounts for over 90% of all diabetes cases and is caused by a combination of behavioral risk factors. It is currently a serious health issue, particularly among women of reproductive age, as it is associated with reproductive disorders. Preventing it requires knowledge, but there is limited data on behavioral risk factors in Ethiopia. To assess knowledge of the behavioral risks of type 2 diabetes mellitus and its associated factors among women of reproductive age. A community-based cross-sectional study was conducted, with all women in the town serving as the source population. A multistage sampling method was utilized to recruit kebeles, and a systematic random technique was employed to select households at every 13th interval. We completed interview questionnaires for 623 samples. The crude odds ratio was calculated using a bivariate logistic model, and multivariate analysis was performed to control for confounding and identify associated factors among model-fitting variables using an adjusted odds ratio (AOR). The knowledge of behavioral risk factors (BRF) among women of reproductive age (WRA) is 47.0% [95% CI, 43.5-50.9], and significant associations were found with the following factors: average family income of between 3000 and 5000 Ethiopian Birr(ETH) 1.81 [95% CI, 1.03-3.18], > = 5001 ETH 1.93 [95% CI, 1.02-3.68], diabetes mellitus (DM) in the friend or relatives 4.03 [95% CI, 1.56-10.46], family history of DM 9.47 [95% CI, 4.74-18.90], source of information: health workers 1.87 [95% CI, 1.04-3.34] and friend or relatives 1.65 [95% CI, 1.04-2.62]. Knowledge of behavioral risk factors for type 2 diabetes was poor among study participants. Factors such as family income, diabetes mellitus (DM) in friends or relatives, family history of DM, and sources of information were strongly associated with good knowledge. It is essential to emphasize health education about behavioral risk factors for women.

We conducted an explanatory, sequential mixed-methods study to measure variation in the use of imaging and physical therapy (PT) for acute low back pain (LBP) and to identify implementation determinants that might explain variation in use across 22 EDs and 27 urgent cares in urban and rural locations within a community-based health system. We described the patient population and measured concordance with LBP guideline recommendations on imaging and PT referral from January–June 2023. We conducted key informant interviews with physicians and advanced practice providers (APPs), n = 30, from these 49 sites between July – September 2023 and performed content analysis to identify implementation determinants to guideline concordance. From January–June 30, 2023, 1047 Intermountain Health employed or affiliated physicians and APPs at the 22 adult EDs and 27 adult UCs cared for 8047 patient encounters involving acute LBP with no red flags. 29% of acute LBP patient encounters included an imaging order (ED: 43%; UC: 18%) and 5% included a PT order (ED: 7%; UC: 4%). 17 ED and 13 UC physicians and APPs participated in semi-structured interviews. Their patient encounters represent 6% of the overall study population (ED: 5%; UC: 7%) with order rates and patient population characteristics similar to the full study population. ED and UC clinicians were generally familiar with LBP guideline recommendations but varied significantly in their knowledge and beliefs of the appropriate application of guidelines in evaluation and treatment plans. Guideline concordance for use of imaging and PT varied substantially across physicians and advance practice providers providing care at EDs and UC centers within a community-based health system. Implementation strategies that address barriers identified by this study, including varied understanding of the PT discipline, complex workflows for placing PT referrals, the medico-legal assurance that imaging provides, and the lack of feedback loops in ED and UC centers should be tested in future hybrid implementation-effectiveness trials to increase concordance to LBP guidelines and minimize harm related to overuse of imaging and underuse of conservative first-line treatment approaches.

To understand the perceptions of patients and primary care physicians as well as barriers to and facilitators of engaging with a safety-net program for patients with hypercholesterolemia. A cross-sectional telephone survey of patients and qualitative interviews with PCPs. Patients' reasons for adherence or nonadherence to statins and completion of laboratory tests and their perceptions of the safety-net program were ascertained. PCPs were asked to describe their familiarity with the safety-net program and perceived patient barriers to filling a new statin prescription and completing laboratory tests. Among 59 participating patients, 86% did and 14% did not fill their statin. Patients reported statin adherence because their doctor prescribed it (100%), to lower cholesterol (94%), and to prevent a heart attack/stroke (51%). Reasons for nonadherence included wanting to try lifestyle modification (63%), general medication concerns (50%), and fear of adverse events (38%). Among patients filling their prescription, 94% completed a follow-up lipid panel. Among 14 PCPs interviewed, 8 were aware of the safety-net program. PCPs cited in-basket volume and lack of an automated reminder system as common barriers to following up with patients with high low-density lipoprotein cholesterol levels. PCPs perceived (1) patients' fear of statins and (2) forgetfulness as the main reasons for not filling their prescriptions and not completing lipid panels, respectively. PCPs suggested that more frequent patient and provider reminders could improve prescription fills and laboratory test completions. Interventions focused on improving patients' knowledge of statins and educating PCPs about outreach programs may facilitate patient-provider communication and improve statin adherence.