Local politico-administrative perspectives on quality improvement based on national registry data in Sweden : a qualitative study using the Consolidated Framework for Implementation Research.

Background. Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results. The politicians and administrators perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions. The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

Negotiating collective and individual agency : a qualitative study of young women's reproductive health in rural India

The societal changes in India and the available variety of reproductive health services call for evidence to inform health systems how to satisfy young women's reproductive health needs. Inspired by Foucault's power idiom and Bandura's agency framework, we explore young women's opportunities to practice reproductive agency in the context of collective social expectations. We carried out in-depth interviews with 19 young women in rural Rajasthan. Our findings highlight how changes in notions of agency across generations enable young women's reproductive intentions and desires, and call for effective means of reproductive control. However, the taboo around sex without the intention to reproduce made contraceptive use unfeasible. Instead, abortions were the preferred method for reproductive control. In conclusion, safe abortion is key, along with the need to address the taboo around sex to enable use of "modern" contraception. This approach could prevent unintended pregnancies and expand young women's agency.

Struggling with daily life and enduring pain : a qualitative study of women's experiences with pelvic girdle pain during pregnancy

Background. Few studies have investigated the experiences of living with pelvic girdle pain (PGP) and its impact on pregnant women’s lives. To address this gap in knowledge, this study investigates the experiences of women living with PGP during pregnancy. Methods. A purposive sample, of nine pregnant women with diagnosed PGP, were interviewed about their experiences. Interviews were recorded, transcribed to text and analysed using a Grounded Theory approach. Results. The core category that evolved from the analysis of experiences of living with PGP in pregnancy was “struggling with daily life and enduring pain”. Three properties addressing the actions caused by PGP were identified: i) grasping the incomprehensible; ii) balancing support and dependence and iii) managing the losses. These experiences expressed by the informants constitute a basis for the consequences of PGP: iv) enduring pain; v) being a burden; vi) calculating the risks and the experiences of the informants as vii) abdicating as a mother. Finally, the informants’ experiences of the consequences regarding the current pregnancy and any potential future pregnancies is presented in viii) paying the price and reconsidering the future. A conceptual model of the actions and consequences experienced by the pregnant informants living with PGP is presented. Conclusions. PGP during pregnancy greatly affects the informant’s experiences of her pregnancy, her roles in relationships, and her social context. For informants with young children, PGP negatively affects the role of being a mother, a situation that further strains the experience. As the constant pain disturbs most aspects of the lives of the informants, improvements in the treatment of PGP is of importance as to increase the quality of life. This pregnancy-related condition is prevalent and must be considered a major public health concern during pregnancy.

'Ultrasound is an invaluable third eye, but it can't see everything' : a qualitative study with obstetricians in Australia

Background: Obstetric ultrasound has come to play a significant role in obstetrics since its introduction in clinical care. Today, most pregnant women in the developed world are exposed to obstetric ultrasound examinations, and there is no doubt that the advantages of obstetric ultrasound technique have led to improvements in pregnancy outcomes. However, at the same time, the increasing use has also raised many ethical challenges. This study aimed to explore obstetricians' experiences of the significance of obstetric ultrasound for clinical management of complicated pregnancy and their perceptions of expectant parents' experiences. Methods: A qualitative study was undertaken in November 2012 as part of the CROss-Country Ultrasound Study (CROCUS). Semi-structured individual interviews were held with 14 obstetricians working at two large hospitals in Victoria, Australia. Transcribed data underwent qualitative content analysis. Results: An overall theme emerged during the analyses, 'Obstetric ultrasound - a third eye', reflecting the significance and meaning of ultrasound in pregnancy, and the importance of the additional information that ultrasound offers clinicians managing the surveillance of a pregnant woman and her fetus. This theme was built on four categories: I:'Everyday-tool' for pregnancy surveillance, II: Significance for managing complicated pregnancy, III: Differing perspectives on obstetric ultrasound, and IV: Counselling as a balancing act. In summary, the obstetricians viewed obstetric ultrasound as an invaluable tool in their everyday practice. More importantly however, the findings emphasise some of the clinical dilemmas that occur due to its use: the obstetricians' and expectant parents' differing perspectives and expectations of obstetric ultrasound examinations, the challenges of uncertain ultrasound findings, and how this information was conveyed and balanced by obstetricians in counselling expectant parents. Conclusions: This study highlights a range of previously rarely acknowledged clinical dilemmas that obstetricians face in relation to the use of obstetric ultrasound. Despite being a tool of considerable significance in the surveillance of pregnancy, there are limitations and uncertainties that arise with its use that make counselling expectant parents challenging. Research is needed which further investigates the effects and experiences of the continuing worldwide rapid technical advances in surveillance of pregnancies.

Can humming caregivers´ facilitate feeding during mealtime situations with persons with dementia? A qualitative study

Background. ‘Music Therapeutic Caregiving’, defined as when caregivers’ sing for or together with persons with dementia care situations, has been shown to facilitate the caring situation, and enhance positive and decrease negative expressions in persons with dementia. No studies about singing during mealtimes have been conducted, and this project was designed to elucidate this. However, since previous studies have shown that there is a risk that persons with dementia will start to sing along with the caregiver, the caregiver in this study hummed such that the person with dementia did not sing instead of eat. Aim. To describe professional caregivers’ experiences of humming during meal time while feeding persons with dementia. Method. An intervention with caregivers humming was implemented during lunch time. Focus group interviews were conducted to fetch the caregivers experiences. Qualitative content analysis was used to analyse the interviews. Results. The caregivers described that humming disseminated relaxation and joy, and awakened memories about the songs hummed which encouraged the persons with the dementia to join in the songs. They also described that humming seemed to make the persons with dementia associate with mealtime and could make them eat more. However it also revealed suspiciousness and agitation from the persons with dementia. Conclusion. Humming during mealtime revealed mainly positive as well as some negative influences. More and larger studies are needed to be able to draw general conclusions.

Healthcare providers balancing norms and practice : challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study

BACKGROUND: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.

A qualitative study of the internationalization of born-global technology start-ups in Brazil

O fenômeno das empresas born globals e a internacionalização de empresas brasileiras de base tecnológica são tópicos recentes na literatura acadêmica, devido também ao fenômeno ser recente. Não existem muitos estudados feitos com foco no mercado brasileiro, e os poucos que foram feitos, possuem um viés quantitativo. Esse estudo, entretanto, tem como objetivo analisar startups de maneira qualitativa. Uma extensa revisão de literatura foi desenvolvida a fim de melhor analisar as fundações nas quais o estudo seria desenvolvido, revisando os métodos de internacionalização, empreendedorismo no Brasil, e o fenômeno born global no geral. Entrevistas foram conduzidas com empreendedores no Brasil, que passaram pelo processo de internacionalização de seus modelos de negócios, a fim de reunir introspecções a respeito das peculiaridades do mercado brasileiro. Foram também analisados os fatores de escalabilidade de modelos de negócios dependentes de tecnologia, motivadores para a internacionalização, critério de seleção de mercados, programas governamentais, e o papel das startups brasileiras em uma perspectiva global.

An evaluation of the Business Model Canvas by technology-oriented startups in Brazil : a qualitative study about the usage of the tool by Brazilian entrepreneurs

The following paper was conducted with the support of several entrepreneurs and startups from Brazil. The aim of the research was to find out which impact the Business Model Canvas, further abbreviated as BMC, has on technology-oriented startups in Brazil. The first step of the study was identify some general concepts of entrepreneurship, as well as the conditions and environment of the country. Afterwards, it was focused on defining and comparing different business model tools and concepts to the BMC. After the literature review and meeting with several professionals in the area of entrepreneurship and startups, a questionnaire was formulated in order to conduct the qualitative study and identify the main impact of the tool. The questionnaire was answered by ten startups. In order to check the validity and credibility of the research outcomes, theory and investigator triangulation was used. As a result, the usage of the BMC could be evaluated by obtaining the outcomes and the theory, which showed that Brazilian tech startups are using Osterwalder’s model for the reason of idea creation and testing, validating and pivoting their business model. Interestingly, the research revealed that the entrepreneurs are using the tool often not in the traditional way of printing it, but rather applying it as a thinking approach. Besides, the entrepreneurs are focusing mostly on developing a strong Value Proposition, Customer Segment and sustainable Revenue Streams, while afterwards the remaining building blocks are built. Moreover, the research showed that the startups are using also other concepts, such as the Customer Development Process or Build-Measure-Learn Feedback Loop. These methodologies are often applied together with the BMC and helps to identify the most sustainable components of the business idea. Keywords: Business

The analysis of foreign market entry strategies on the basis of different cultural backgrounds and environments: a qualitative study characterising the differences and similarities of Brazilian and European firms

Moving into a new and foreign market can be challenging, especially when such market has a different culture and working environment in comparison to the home market. Thus, it is of utter importance to adjust a company’s strategy to the new market conditions. Currently, there are no concrete guidelines of what aspects are most important when moving from a developing market such as Brazil into a more sophisticated market like Europe, or vice versa. The present study will examine two companies from the same industry, but with different cultural backgrounds and its strategic similarities and differences for operating in multiple international markets. The data was collected via semi-structured interviews with the Chief Executive Officers (CEOs’) from both companies, using an interview guideline that is based on three different theoretical frameworks. The aim is to give recommendations to these two industries of how to efficiently use existing theoretical frameworks and which aspects are most significant when moving into a new market while keeping in mind a company’s size and background.

Social entrepreneurship practices and social change In Brazil: a qualitative study in three non-governmental organizations

Social Entrepreneurship (SE) has attracted growing interest from a wide variety of actors over the last 30 years, especially due to a general agreement that it could be an important tool for tackling many of the world’s social ills. In the academic sphere, this growing interest did not translate into a matured field of study. Quite the opposite, a quick look at this literature makes it evident that: SE has been consistently subjected to numerous theoretical discussions and disagreements, especially over the definition of the concept of SE which is often based on a taken-for-granted notion of social change; it has been more systematically investigated in restricted contexts, often leaving aside so called developing/emerging countries like Brazil and especially lacking in-depth qualitative studies; SE literature lags behind SE practices and few studies focus on how SE actually occurs in a daily and bottom-up manner. In order to address such gaps, this thesis examines how social entrepreneurship practices accomplish social change in the context of Brazil. In this investigation I conducted an inductive practice-based, qualitative/ethnographic study in three Non-Governmental Organizations (NGOs) located in different cities in the Brazilian state of São Paulo. Data collection lasted from February 2014 until March 2015 and was mainly done through participant observations and through in-depth unstructured conversations with research participants. Secondary data and documents were also collected whenever available. The participants of this study included a variety of the studied organizations’ stakeholders: two founders, volunteers, employees, donors and beneficiaries. Observation data was kept in fieldnotes, conversations were recorded whenever possible and were later transcribed. Data was analyzed through an iterative thematic analysis. Through this I identified eight recurrent themes in the data: (1) structure; (2) relationship with other organizational actors (sub-themes: relationship with state, relationship with businesses and relationship with other NGOs); (3) beliefs, spirituality and moral authority; (4) social position of participants, (5) stakeholders’ mobilization and participation; (6) feelings; (7) social purpose; and (8) social change. These findings were later discussed under the lens of practice theory, and in this discussion I argue and show that, in the context studied: (a) even though SE embraces a wide variety of different social purposes, they are intertwined with a common notion of social change based on a general understanding and aspiration for social equality; (b) this social change is accomplished in a processual and ongoing manner as stakeholders from antagonistic social groups felt compelled to and participated in SE practices. In answering the proposed research question the contributions of this thesis are: (i) the elaboration a working definition for SE based on its relationship with social change; (ii) providing in-depth empirical evidence which accounts for and explains this relationship; (iii) characterizing SE in the Brazilian context and reflecting upon its transferability to other contexts. This thesis also makes a methodological contribution, for it demonstrates how thematic analysis can be used in practice-based studies.

The South Omaha Community Scholarship Program: A Qualitative Study of Persistence of Hispanic Students at Bellevue University

The purpose of this case study was to determine the impact of the South Omaha Community Scholarship Program on the persistence of the Hispanic students who participated. Previous research on Hispanic student persistence has focused on the reasons why students do not persist and more recent research has been conducted on programs and retention efforts, colleges and universities are implementing on their campuses. This study researched a specific program, The South Omaha Community Scholarship Program, designed to provide financial, academic and other needed resources to help Hispanic students persist to graduation. The researcher believes this study was important because it provided an overview of how the South Omaha Community Scholarship Program is affecting students both on campus and in their community. Eight interviews were conducted, with eligible students, in person. Students eligible for the study were current students or recent graduates of the South Omaha Community Scholarship Program and had attained at least junior or senior status as of the fall of 2009, as defined by Bellevue University. Research questions were based on the four components of the program and the affect the program had on the student’s life, outside of Bellevue University. The four components of the program were: financial aid, academic advising, the scholarship aid, and the Professional Enrichment Program. The results of the study were broken into five components with an additional section that provided other themes that were derived from the interviews. The five components were: (a) financial aid counseling, (b) academic advising, (c) scholarship aid, (d) Professional Enrichment Program, and (e) the South Omaha Community Scholarship Program beyond Bellevue University. Other themes that were derived from the interviews were: class format, deciding on a college, higher education class, campus resources, and a sense of community on-campus. The research found that the scholarship, provided by the South Omaha Community Scholarship Program, was the primary motivating factor for students to attend Bellevue University and persist in college. The interviewed students also commented on how the scholarship had given them the opportunity to attend college, even though that opportunity had seemed out of reach. The interviewed students also commented on their academic advising experience, campus resources, and feeling a sense of community on-campus as other campus related areas that were affected by the South Omaha Community Scholarship Program. Finally, students provided examples of how the South Omaha Community Scholarship Program impacted their connection to their South Omaha community through volunteer and employment opportunities. Adviser: Richard Hoover

What do medical students think about their quality of life? A qualitative study

Background: Medical education can affect medical students' physical and mental health as well as their quality of life. The aim of this study was to assess medical students' perceptions of their quality of life and its relationship with medical education. Methods: First-to sixth-year students from six Brazilian medical schools were interviewed using focus groups to explore what medical student's lives are like, factors related to increases and decreases of their quality of life during medical school, and how they deal with the difficulties in their training. Results: Students reported a variety of difficulties and crises during medical school. Factors that were reported to decrease their quality of life included competition, unprepared teachers, excessive activities, and medical school schedules that demanded exclusive dedication. Contact with pain, death and suffering and harsh social realities influence their quality of life, as well as frustrations with the program and insecurity regarding their professional future. The scarcity of time for studying, leisure activities, relationships, and rest was considered the main factor of influence. Among factors that increase quality of life are good teachers, classes with good didactic approaches, active learning methodologies, contact with patients, and efficient time management. Students also reported that meaningful relationships with family members, friends, or teachers increase their quality of life. Conclusion: Quality of teachers, curricula, healthy lifestyles related to eating habits, sleep, and physical activity modify medical students' quality of life. Lack of time due to medical school obligations was a major impact factor. Students affirm their quality of life is influenced by their medical school experiences, but they also reframe their difficulties, herein represented by their poor quality of life, understood as necessary and inherent to the process of becoming doctors.

Qualitative study of young, adult, and aged wistar rats temporomandibular synovial membrane employing light, scanning, and transmission electron microscopy

The aim of this study was to analyze the rat temporomandibular joint (TMJ) synovial membrane at different ages using light, scanning, and transmission electron microscopy. Under light microscopic analysis, the TMJ structures were observed such as condyle, capsule, disk, the synovial membrane collagen type, and cells distribution. In the scanning electron microscopy, the synovial membrane surface exhibited a smooth aspect in young animals and there was an increase with ageing in the number of folds. The transmission electron microscopic analysis showed more synoviocytes in the synovial layer in the young group and still a great number of vesicles and cisterns dilation of rough endoplasmic reticulum in the aged group. In the three groups, a dense layer of collagen fibers in the synovial layer and cytoplasmic extensions were clearly seen. It was possible to conclude that synovial membrane structures in aged group showed alterations contributing to the decrease in joint lubrication and in the sliding between disk and joint surfaces. These characteristic will reflect in biomechanics of chewing, and may cause the TMJ disorders, currently observed in clinical processes. Microsc. Res. Tech. (c) 2012 Wiley Periodicals, Inc.

Comparing expectations and experiences of care for sexually transmitted infections in general practice: a qualitative study

Background A key aim of England's National Strategy for Sexual Health is to extend high-quality sexual health services in primary care. Objectives To explore the expectations and experiences of men and women who initially presented at their general practice with a suspected sexually transmitted infection in order to identify areas where change could improve service delivery. Methods Semi-structured interviews were carried out in six general practices and two genitourinary medicine (GUM) clinics in Brent primary care trust (London) and Bristol (southwest England). Patients within general practice, and GUM patients who had initially attended general practice were eligible to participate. Interview transcripts were analysed using thematic analysis. Results 49 patients (29 women, 20 men) were interviewed. Patients approaching their GP practice typically expected written referral or in-house care, but this expectation was often not met. Absence of formal referral, lack of information and perceived avoidance of sexual health matters by practitioners were commonly cited as reasons for disappointment. However, a dedicated service within general practice met expectations well. Conclusion Purchasers and providers of all general practice services should ensure that any patient consulting in primary care with a suspected sexually transmitted infection can either receive appropriate care there, or a formal and supported referral to a specialised GUM clinic or primary care service.