Browsing by Subject "qualitative methods"

Now showing 1 - 5 of 5
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    Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration.
    (J Pers Med, 2016-04-28) Sperber, Nina R; Andrews, Sara M; Voils, Corrine I; Green, Gregory L; Provenzale, Dawn; Knight, Sara
    We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines.
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    Can Results-Free Review Reduce Publication Bias? The Results and Implications of a Pilot Study
    (Comparative Political Studies, 2016-11) Findley, MG; Jensen, NM; Malesky, EJ; Pepinsky, TB
    © 2016, © The Author(s) 2016. In 2015, Comparative Political Studies embarked on a landmark pilot study in research transparency in the social sciences. The editors issued an open call for submissions of manuscripts that contained no mention of their actual results, incentivizing reviewers to evaluate manuscripts based on their theoretical contributions, research designs, and analysis plans. The three papers in this special issue are the result of this process that began with 19 submissions. In this article, we describe the rationale for this pilot, expressly articulating the practices of preregistration and results-free review. We document the process of carrying out the special issue with a discussion of the three accepted papers, and critically evaluate the role of both preregistration and results-free review. Our main conclusions are that results-free review encourages much greater attention to theory and research design, but that it raises thorny problems about how to anticipate and interpret null findings. We also observe that as currently practiced, results-free review has a particular affinity with experimental and cross-case methodologies. Our lack of submissions from scholars using qualitative or interpretivist research suggests limitations to the widespread use of results-free review.
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    Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study.
    (JMIR formative research, 2022-12) Gonzales, Sarah; Okusaga, Olaoluwa O; Reuteman-Fowler, J Corey; Oakes, Megan M; Brown, Jamie N; Moore, Scott; Lewinski, Allison A; Rodriguez, Cristin; Moncayo, Norma; Smith, Valerie A; Malone, Shauna; List, Justine; Cho, Raymond Y; Jeffreys, Amy S; Bosworth, Hayden B

    Background

    Suboptimal medication adherence is a significant problem for patients with serious mental illness. Measuring medication adherence through subjective and objective measures can be challenging, time-consuming, and inaccurate.

    Objective

    The primary purpose of this feasibility and acceptability study was to evaluate the impact of a digital medicine system (DMS) among Veterans (patients) with serious mental illness as compared with treatment as usual (TAU) on medication adherence.

    Methods

    This open-label, 2-site, provider-randomized trial assessed aripiprazole refill adherence in Veterans with schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder. We randomized 26 providers such that their patients either received TAU or DMS for a period of 90 days. Semistructured interviews with patients and providers were used to examine the feasibility and acceptability of using the DMS.

    Results

    We enrolled 46 patients across 2 Veterans Health Administration sites: 21 (46%) in DMS and 25 (54%) in TAU. There was no difference in the proportion of days covered by medication refill over 3 and 6 months (0.82, SD 0.24 and 0.75, SD 0.26 in DMS vs 0.86, SD 0.19 and 0.82, SD 0.21 in TAU, respectively). The DMS arm had 0.85 (SD 0.20) proportion of days covered during the period they were engaged with the DMS (mean 144, SD 100 days). Interviews with patients (n=14) and providers (n=5) elicited themes salient to using the DMS. Patient findings described the positive impact of the DMS on medication adherence, challenges with the DMS patch connectivity and skin irritation, and challenges with the DMS app that affected overall use. Providers described an overall interest in using a DMS as an objective measure to support medication adherence in their patients. However, providers described challenges with the DMS dashboard and integrating DMS data into their workflow, which decreased the usability of the DMS for providers.

    Conclusions

    There was no observed difference in refill rates. Among those who engaged in the DMS arm, the proportion of days covered by refills were relatively high (mean 0.85, SD 0.20). The qualitative analyses highlighted areas for further refinement of the DMS.

    Trial registration

    ClinicalTrials.gov NCT03881449; https://clinicaltrials.gov/ct2/show/NCT03881449.
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    Exploring Communication Ability in Individuals With Angelman Syndrome: Findings From Qualitative Interviews With Caregivers.
    (American journal on intellectual and developmental disabilities, 2023-05) Zigler, Christina K; Lucas, Nicole; McFatrich, Molly; Gordon, Kelly L; Jones, Harrison N; Berent, Allyson; Panagoulias, Jennifer; Evans, Paula; Reeve, Bryce B
    Communication deficits have a substantial impact on quality of life for individuals with Angelman syndrome (AS) and their families, but limited qualitative work exists to support the necessary content of measures aiming to assess communication for these individuals. Following best practices for concept elicitation studies, we conducted individual qualitative interviews with caregivers and clinicians to elicit meaningful aspects of communication for individuals with AS. Caregivers were able to discuss their child's specific communication behaviors within a large number of expressive, receptive, and pragmatic functions via numerous symbolic and non-symbolic modalities. These results aligned well with published literature on communication in AS and will be used to inform the design of a novel caregiver-reported measure. Future studies on communication in individuals with AS should focus on gathering quantitative data from large samples of diverse caregivers, which would allow for estimations of the frequency of specific behaviors across the population.
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    Mandated caregiver training in the Veterans Health Administration: Caregiver inquiry informs national dissemination.
    (The Gerontologist, 2022-11) Sperber, Nina R; Boucher, Nathan; Hughes, Jaime M; Bruening, Rebecca; Zullig, Leah L; Decosimo, Kasey; Tucker, Matthew; Christensen, Leah A; Allen, Kelli D; Hastings, Susan N; Van Houtven, Courtney H

    Background and objectives

    A minority of family caregivers receive training, with implications for their own and their recipient's outcomes. Federal policy has supported implementation and expansion of caregiver training and support. The Department of Veterans Affairs (VA) has developed a national Caregiver Support Program and collaborated with VA health services researchers to explore caregivers' acceptance of an evidence-based training program in preparation for system-wide dissemination.

    Research design and methods

    This approach entailed a convergent mixed-methods design, which involved separate analyses of quantitative and qualitative data. Survey questions based on the Kirkpatrick model for training evaluation measured caregivers' reaction and learning and interview questions elicited caregivers' reports about the value of the program for them.

    Results

    Most caregivers reported satisfaction with the training when responding to survey questions, although qualitative interviews revealed caveats suggesting need to hone the best timing and specific group of caregivers for maximal benefit.

    Discussion and implications

    Our findings indicate that understanding program-user fit may be particularly critical when implementing training for caregivers as they come to the program at different points along their caregiving journey, needing differing types and intensities of support. While a general program may appeal to policymakers aiming to scale caregiver training within a large, heterogeneous system, there may be shortcomings in terms of end-user acceptance and subsequent downstream outcomes such as reach and ultimately program effectiveness. Good, iterative communication flow between program developers and policymakers facilitates this understanding and, in turn, decisions about scaling.