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Look on the Bright Side: The Interactional Construction of a Survivor Identity in the Breast Cancer Clinic 看到光明的一面:乳腺癌诊所幸存者身份的互动建构。
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-24 DOI: 10.1111/hex.70482
Stephanie Mace, Susan Speer

Objectives

People with breast cancer are widely encouraged to ‘look on the bright side’ and ‘think positive’ in the face of adversity, and research suggests a positive correlation between patient optimism and health outcomes. However, the promotion of a bright-side disposition has also been criticised because it can be perceived as a moral obligation that implies poor outcomes are a result of individual failure to adopt the correct attitude. In this paper, instead of treating bright-side talk as empirical evidence for a person's mental state, or reporting evidence for or against bright-side thinking, we systematically examine what bright-side talk is doing interactionally, and how it functions in real-time clinical consultations.

Design and Methods

Thirty-three instances of bright sides were identified from a corpus of 73 transcribed video-recordings of clinician-patient consultations (totalling 30+ hours) in a National Health Service breast unit, and analysed using conversation analysis.

Results

Bright sides function as practical, in-the-moment tools to do identity work. Consistently positioned following expressions of dissatisfaction with, or bad news about, treatment outcomes, bright sides manage and deflect potential inferences that patients may be overly upset by, or complaining about the trivialities of what has been lifesaving treatment. Instead, bright sides offer a comparatively ‘upbeat’ counterbalance to the prior negative stance that focuses attention on the ‘bigger picture’ of the patient's survival and its appreciation.

Conclusions

Clinicians and psycho-oncology interventions can usefully deconstruct cultural mandates to ‘look on the bright side’ by encouraging discussion of legitimate patient concerns that may otherwise remain hidden.

目的:人们普遍鼓励乳腺癌患者在面对逆境时要“看到光明的一面”和“积极思考”,研究表明,患者的乐观情绪与健康结果呈正相关。然而,提倡积极的性格也受到了批评,因为它可以被视为一种道德义务,暗示糟糕的结果是个人未能采取正确态度的结果。在这篇论文中,我们没有将乐观谈话作为一个人精神状态的经验证据,也没有报道支持或反对乐观思维的证据,而是系统地研究了乐观谈话在相互作用中的作用,以及它在实时临床咨询中的作用。设计和方法:从国家卫生服务乳腺部门的临床-患者咨询的73个转录视频记录(总计30多个小时)中确定了33个好的方面,并使用对话分析进行了分析。结果:光明面是做身份识别工作的实用、即时工具。在表达对治疗结果的不满或坏消息之后,积极的一面可以管理和转移患者可能过度沮丧的潜在推断,或者抱怨挽救生命的治疗的琐碎。相反,积极的一面提供了一种相对“乐观”的平衡,以抵消之前的消极立场,即把注意力集中在患者生存及其价值的“大局”上。结论:临床医生和心理肿瘤学干预可以有效地解构文化使命,通过鼓励讨论可能被隐藏的合理的患者担忧,“看到光明的一面”。
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引用次数: 0
Fostering Physician-Patient Partnerships: The Importance of Embracing the Ontological and Epistemological Understandings of Knowledge 培养医患伙伴关系:拥抱知识的本体论和认识论理解的重要性。
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-21 DOI: 10.1111/hex.70484
Nicolas Fernandez, Joachim P. Sturmberg

Introduction

Healthcare is becoming substantially complex in part due to greater multimorbidity, climate-related health issues, and problems related to access to care. While patient partnership is widely advocated as a strategy to adapt medical practice to the complexity, significant barriers persist.

Aim

We sought to shed light on the ontological and epistemological ‘tensions' generated by the implementation, sometimes by imposition, of the concept of physician–patient partnership in medical practice.

Methods

This reconceptualization of the distinctive ways of knowing is based on illustrative physician-patient interactions used to contrast the fundamental belief-systems that generate ontological and epistemological tensions impeding physician-patient partnership. We contrast knowledge valued by the prevailing positivist paradigm with the kinds of knowledge patients can contribute to ensure optimal healthcare outcomes.

Findings

Identifying the complementarity of evidence-based and experiential knowledges leads to a paradigmatic shift in how we perceive, interpret, and use data in the clinical setting. The two co-existing but distinct ontologies and epistemologies—neither is inherently superior to the other—are essential for a broader and concrete understanding of illness, its experience and its management.

Conclusion

This exploration into the complex nature of physician-patient partnerships provides insights about avenues for strengthening them and making them fulfil their promise to enhance health care access and outcomes for all.

Patient Contribution

The first author is a kidney transplant recipient (2008) and has been actively involved in patient partnership within health research and medical education since 2010. This paper reflects his accumulated insights and observations regarding the barriers that hinder the development of effective partnerships in health care.

导言:医疗保健正变得相当复杂,部分原因是多病、气候相关的健康问题以及与获得医疗服务有关的问题增多。虽然患者伙伴关系被广泛提倡为使医疗实践适应这种复杂性的一种战略,但仍存在重大障碍。目的:我们试图阐明由实施产生的本体论和认识论的“紧张关系”,有时通过强加,在医疗实践中医患伙伴关系的概念。方法:这种独特的认识方式的重新概念化是基于说明性的医患互动,用于对比产生阻碍医患伙伴关系的本体论和认识论紧张关系的基本信念系统。我们对比知识价值的普遍实证主义范式与知识的种类,患者可以贡献,以确保最佳的医疗保健结果。发现:发现循证知识和经验知识的互补性导致我们如何在临床环境中感知、解释和使用数据的范式转变。这两种共存但又截然不同的本体论和认识论——两者本质上都没有优劣之分——对于更广泛、更具体地理解疾病、疾病的经验和治疗是必不可少的。结论:对医患伙伴关系的复杂性质的探索,为加强医患伙伴关系并使其履行其承诺,提高所有人的医疗服务可及性和结果提供了见解。患者贡献:第一作者是肾移植受者(2008年),自2010年以来一直积极参与健康研究和医学教育中的患者合作。这篇论文反映了他积累的见解和观察关于障碍,阻碍发展有效的伙伴关系在卫生保健。
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引用次数: 0
Conceptualising Essential Oral Health Benefits Baskets: A Thematic Analysis of Public and Expert Perspectives 概念化基本口腔健康益处篮子:公众和专家观点的专题分析。
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-20 DOI: 10.1111/hex.70501
Béatrice Durvy, Lukas Schöner, Tamara Reyes Ojopi, Katharina Achstetter, Reinhard Busse, Katherine Carr, Stefan Listl, Orsolya Németh, Amal Skandrani, Stéphanie Tubert-Jeannin, Chris Vernazza, Juliane Winkelmann, Ruth Waitzberg

Introduction

Despite its importance, oral health (OH) is often excluded from comprehensive public health coverage in Europe, resulting in financial hardship and exacerbating OH inequalities. Defining what ‘essential’ means in OH is a prerequisite for developing a public benefits basket to expand public coverage and financial protection.

Method

This qualitative study explored the population's and experts' perspectives on ‘essential’ OH in Europe. Participants were purposively sampled from eight European countries. Data were collected through 37 focus group discussions (FGDs) gathering 228 participants. As data saturation was reached, data from 21 FGDs were analysed using thematic analysis.

Results

‘Essential’ in OH was perceived as a state of good OH, encompassing both performing basic functions and the psychosocial dimension, which aligns with the WHO definition of good OH. Participants highlighted multiple considerations to define an ‘essential’ OH benefits basket, including services' contributions to improving health, economic criteria, societal values, people-centred care and feasibility. Considering OH as part of a broader health system was seen as crucial.

Conclusion

Findings emphasise the fluid and multidimensional nature of the ‘essential’ concept in OH and highlight the myriad considerations for priority-setting in public coverage. This underscores the importance of first defining what is ‘essential’ in each country's context. This study identifies three key lessons relevant for policy-making. First, people's expectations vary between and within countries but remain realistic, as considerations are similar to those used in other health fields. Second, OH should be better integrated into the general health system. Finally, involving patients and potential patients in the decision-making process is key to (re-)defining an OH benefits basket that responds to the health system's goals.

Public Contribution

OH patients and potential patients were at the centre of this study, informing how to conceptualise ‘essential’ in OH in Europe. This is a concrete example of how public participation mechanisms can support decision-making over the definition of an (OH) benefits basket.

导言:尽管口腔健康(OH)很重要,但在欧洲,它经常被排除在全面的公共卫生覆盖之外,导致财政困难并加剧了OH的不平等。定义OH中“基本”的含义是制定公共福利篮子以扩大公共覆盖和财务保护的先决条件。方法:本定性研究探讨了欧洲人口和专家对“必需”OH的看法。参与者特意从八个欧洲国家中取样。通过37个焦点小组讨论(fgd)收集了228名参与者的数据。当数据达到饱和时,使用专题分析对21个fgd的数据进行分析。结果:OH中的“必需”被认为是一种良好OH状态,包括执行基本功能和心理社会维度,这与世卫组织对良好OH的定义一致。与会者强调了确定“基本”保健福利篮子的多重考虑,包括服务对改善健康的贡献、经济标准、社会价值观、以人为本的护理和可行性。考虑将OH作为更广泛的卫生系统的一部分是至关重要的。结论:研究结果强调了OH中“基本”概念的流动性和多维性,并强调了在公共覆盖中确定优先事项的无数考虑因素。这强调了首先在每个国家的背景下定义什么是“必要的”的重要性。这项研究确定了与决策相关的三个关键经验教训。首先,人们的期望在国家之间和国家内部有所不同,但仍然是现实的,因为考虑因素与其他卫生领域使用的因素相似。第二,门诊应更好地纳入一般卫生系统。最后,让患者和潜在患者参与决策过程是(重新)定义符合卫生系统目标的OH福利篮子的关键。公众贡献:OH患者和潜在患者是本研究的中心,告知如何概念化OH在欧洲的“必要”。这是公众参与机制如何支持(OH)福利篮子定义决策的一个具体例子。
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引用次数: 0
A Qualitative Evaluation Exploring Co-Production of Falls Management in Care Homes 探索养老院跌倒管理合作生产的定性评价。
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-19 DOI: 10.1111/hex.70500
Fran Hallam-Bowles, Alice Kilby, Adam Gordon, Stephen Timmons, Pip Logan, Lindsay Rees, Will Lawry, CHAFFINCH stakeholder group, Katie Robinson
<div> <section> <h3> Background</h3> <p>Co-production approaches are increasingly used in research but are rarely evaluated in care home settings. This study explored factors influencing key principles of co-production in a series of workshops around falls management in care homes.</p> </section> <section> <h3> Methods</h3> <p>Stakeholders (care home residents and relatives, care home staff, and health and social care staff) participating in co-production workshops as part of a research study were invited to take part in this qualitative evaluation. The workshops were developing a model to implement falls training in care homes as part of a systemic action research study. Non-participant observations of workshops explored stakeholder interactions. Stakeholders participated in reflection meetings about their experiences of co-production. Framework analysis mapped key themes to the National Institute for Health and Care Research's (NIHR) principles of co-production.</p> </section> <section> <h3> Results</h3> <p>Nine themes were identified. Sharing power was affected by two themes: opportunities to challenge dominant voices, resulting from the influence of the research team and separate stakeholder groups, and integrating a disjointed system. Including all perspectives and skills was influenced by two themes: involvement of key stakeholders and a flexible approach. Respecting and valuing knowledge was impacted by two themes: respecting and utilising expertise and experience, and confidence. Two themes relating to reciprocity were identified: benefits and potential harms. One theme related to building and maintaining relationships: team dynamics.</p> </section> <section> <h3> Conclusions</h3> <p>Co-production in this context is complex and affected by multiple factors. Separate stakeholder groups, a flexible approach and recognising different experiences and expertise facilitated co-production in line with its key principles. Potential reputational risks, confidence levels and limited involvement of residents, relatives and care home staff in a variety of roles were identified as barriers. Future studies in care homes should consider organisational power dynamics and create safe spaces, providing opportunities for inclusive participation.</p> </section> <section> <h3> Patient and Public Contribution</h3> <p>A collaborator group, including a patient and public involvement and engagement (PPIE) advisor and health and social care professionals, contribute
背景:合作生产方法越来越多地用于研究,但很少在养老院环境中进行评估。本研究探讨了影响养老院跌倒管理的一系列工作坊中共同生产的关键原则的因素。方法:邀请利益相关者(护理院居民和亲属、护理院工作人员、卫生和社会护理工作人员)参加作为研究研究一部分的联合生产讲习班,参与这一定性评估。作为系统行动研究的一部分,讲习班正在开发一种在养老院实施跌倒培训的模式。研讨会的非参与者观察探讨了利益相关者的相互作用。利益相关者参加了关于他们合作制作经验的反思会议。框架分析将关键主题映射到国家卫生和保健研究所(NIHR)的合作生产原则。结果:确定了9个主题。权力分享受到两个主题的影响:挑战主导声音的机会,来自于研究团队和独立的利益相关者群体的影响,以及整合一个脱节的系统。包括所有观点和技能受到两个主题的影响:关键利益攸关方的参与和灵活的做法。尊重和重视知识受到两个主题的影响:尊重和利用专业知识和经验,以及信心。确定了与互惠有关的两个主题:利益和潜在危害。与建立和维持关系有关的一个主题是:团队动力。结论:这种情况下的合作制作是复杂的,受多种因素的影响。不同的利益相关者群体、灵活的方法和认识到不同的经验和专业知识,促进了符合其关键原则的合作生产。潜在的声誉风险、信心水平和居民、亲属和护理院工作人员在各种角色中的有限参与被确定为障碍。未来对护理院的研究应考虑组织权力动力学,创造安全空间,提供包容性参与的机会。患者和公众贡献:包括患者和公众参与和参与(PPIE)顾问以及卫生和社会保健专业人员在内的一个合作小组对研究方法、研究结果的介绍和作者身份做出了贡献。护理院的居民告知了联合生产车间的设计。
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引用次数: 0
Experiencing Socioeconomic Deprivation as a Carer in the United Kingdom: A Qualitative Study 英国照护者经历社会经济剥夺:一项定性研究。
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-19 DOI: 10.1111/hex.70502
Megan Armstrong, Alma Jeri-Wahrhaftig, Abi Woodward, Danielle Nimmons, Carolyn A. Chew-Graham, Joanne Protheroe, Fiona Stevenson, Nathan Davies, Kate Walters

Background

Informal carers compose approximately 7% of the UK population and, through their unpaid care, they make important contributions to society and the health care industry. Being an informal carer is higher in people experiencing socioeconomic deprivation; however, no qualitative research has explored the impact of this on the ability to provide care for those with long-term conditions.

Aim

To explore the experiences and challenges of being a carer whilst experiencing socioeconomic deprivation.

Methods

Semi-structured one-to-one interviews with adults experiencing socioeconomic deprivation (n = 12) living in London and Sheffield, United Kingdom. Participants were recruited through social media and community channels. Data were managed in NVivo and analysed using reflexive thematic analysis.

Results

Three analytical themes were developed: (1) Economic insecurity including insecure housing and challenges with financial welfare leading to sacrificing the necessities such as healthy food, water and heating; (2) social and structural barriers such as a lack of opportunities for social mobility due to care impacting employment and educational attainment, as well as area-based barriers and feeling unheard by professionals; (3) the emotional challenges and rewards of being a carer such as managing people with poor mental well-being exacerbated by their socioeconomic situation, whilst finding their caring role meaningful.

Conclusion

Carers experiencing socioeconomic deprivation face additional challenges and barriers in their ability to provide care such as more emotional work, making sacrifices of necessities due to financial constraints and feeling unheard. Policy changes are needed to better support this population financially and to enable social mobility, as well as development of interventions and support resources for carers to use to feel empowered and to maintain good well-being.

背景:非正规护理人员约占英国人口的7%,通过无偿护理,他们为社会和医疗保健行业做出了重要贡献。在经历社会经济剥夺的人群中,成为非正式照顾者的可能性更高;然而,尚无定性研究探讨这对长期患病患者提供护理的能力的影响。目的:探讨在经历社会经济剥夺的情况下,作为一名护工的经历和挑战。方法:对生活在英国伦敦和谢菲尔德的经历社会经济剥夺的成年人(n = 12)进行半结构化的一对一访谈。参与者是通过社交媒体和社区渠道招募的。数据在NVivo中进行管理,并使用反身主题分析进行分析。结果:提出了三个分析主题:(1)经济不安全,包括住房不安全和经济福利挑战,导致牺牲健康食品、水和供暖等必需品;(2)社会和结构障碍,如由于护理影响就业和受教育程度而缺乏社会流动机会,以及基于区域的障碍和专业人员闻所未闻的感觉;(3)作为照顾者的情感挑战和回报,如管理心理健康状况不佳的人,会因其社会经济状况而加剧,同时发现他们的照顾角色有意义。结论:经历社会经济剥夺的护理人员在提供护理能力方面面临额外的挑战和障碍,例如更多的情感工作,由于经济拮据而牺牲必需品和感觉被忽视。需要改变政策,以更好地在财政上支持这一人口,促进社会流动,并为护理人员开发干预措施和支持资源,使他们感到有能力并保持良好的福祉。
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引用次数: 0
Development and Validation of a Patient Classification System for Rehabilitation Hospitals Based on Patient and Stakeholders Engagement: A Study Protocol 基于患者和利益相关者参与的康复医院患者分类系统的开发和验证:一项研究方案。
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-18 DOI: 10.1111/hex.70505
Shima Shirozhan, Kian Norouzi Tabrizi, Mahdieh Motie, Rouhollah Mirshafiee, Hasan Mohammadi, Amin Ajalli

Introduction

Patient Classification Systems (PCS) are essential for managing resources and staffing in hospitals. However, existing systems are predominantly nursing-centric and fail to capture the interdisciplinary nature and complexity of care in rehabilitation settings, leading to inaccuracies in workload assessment and resource allocation. This study aims to develop and validate a novel, context-specific PCS for rehabilitation hospitals through a participatory approach that actively engages patients and stakeholders.

Methods

This mixed-methods study protocol comprises three sequential stages. First, a systematic scoping review following Arksey and O'Malley's framework will identify key PCS components from existing evidence. Second, structured expert panel sessions employing a modified Delphi technique will develop a consensus-based preliminary framework. Third, the developed PCS will undergo rigorous validation through pilot implementation, assessing inter-rater reliability using Cohen's Kappa and criterion validity against established tools, including the Functional Independence Measure (FIM) and Barthel Index, with explicit sample size calculation and reliability criteria.

Conclusion

The study will generate a validated PCS specifically designed for rehabilitation hospital settings through systematic integration of evidence and stakeholder insights. The resulting tool is expected to enhance workload measurement accuracy, promote equitable resource distribution, and ultimately improve both care quality and operational efficiency in rehabilitation contexts.

Patient or Public Contribution

Stakeholders, including patients, their families, administrators, and multidisciplinary clinical staff, have been engaged from the initial conception of the study. They contributed to defining the research objectives, formulating the scoping review questions, and are integral participants in the co-design and validation stages, ensuring the resulting system is relevant and applicable to real-world practice.

简介:患者分类系统(PCS)是必不可少的管理资源和人员配备在医院。然而,现有系统主要以护理为中心,未能捕捉到康复环境中护理的跨学科性质和复杂性,导致工作量评估和资源分配不准确。本研究旨在通过积极吸引患者和利益相关者参与的参与式方法,为康复医院开发和验证一种新颖的、针对具体情况的PCS。方法:该混合方法研究方案包括三个连续阶段。首先,根据Arksey和O'Malley的框架进行系统的范围审查,将从现有证据中确定关键的PCS组件。其次,采用改进的德尔菲技术的结构化专家小组会议将制定基于共识的初步框架。第三,开发的PCS将通过试点实施进行严格的验证,使用Cohen's Kappa和标准效度对既定工具(包括功能独立性测量(FIM)和Barthel指数)评估评分者之间的可靠性,并具有明确的样本量计算和可靠性标准。结论:通过系统整合证据和利益相关者的见解,本研究将产生一个专门为康复医院设计的有效的PCS。由此产生的工具有望提高工作量测量的准确性,促进公平的资源分配,并最终提高康复环境中的护理质量和业务效率。患者或公众贡献:利益相关者,包括患者、家属、管理人员和多学科临床工作人员,从研究的最初概念开始就参与其中。他们为定义研究目标、制定范围审查问题做出了贡献,并且是共同设计和验证阶段不可或缺的参与者,确保最终系统与现实世界的实践相关并适用。
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引用次数: 0
People With Non-Communicable Diseases Using Ayurveda: A UK-Based Qualitative Study 非传染性疾病患者使用阿育吠陀:一项基于英国的定性研究。
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-18 DOI: 10.1111/hex.70494
Patricia Egwumba, Kaushik Chattopadhyay, Laura Nellums, Manpreet Bains

Introduction

Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in the United Kingdom, placing significant pressure on the National Health Service (NHS). Despite the growing popularity of Ayurveda for managing NCDs, little is known about its use among people with these conditions in the United Kingdom. This study explored the experiences and perspectives of people with NCDs who use Ayurveda to manage their conditions in the United Kingdom.

Methods

Twenty qualitative semi-structured interviews were conducted with UK-based adults with NCDs. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Findings

Three key themes were identified. First, participants chose Ayurveda due to its alignment with personal values like natural, holistic healing and dissatisfaction with Western medicine, particularly side effects and impersonal care. Second, they reported positive experiences with Ayurvedic treatment, including personalised consultations, diverse treatment options and improved health outcomes. Third, participants highlighted challenges in sustaining Ayurvedic care, such as concerns over product safety, difficulty following complex regimens, limited medicine availability and financial barriers—especially since treatments are not covered by the NHS.

Conclusion

People living with NCDs described Ayurveda as a more natural and philosophically congruent healing system, reflecting their cultural and personal perspectives. Despite structural and financial challenges, they considered it a relevant option for managing their conditions. These findings suggest that Ayurveda continues to hold significance as a complementary approach to NCD management in the United Kingdom.

简介:非传染性疾病(NCDs)是英国发病率和死亡率的主要原因,给国家卫生服务(NHS)带来了巨大压力。尽管阿育吠陀在控制非传染性疾病方面越来越受欢迎,但在英国,人们对它在这些疾病患者中的应用知之甚少。本研究探讨了英国使用阿育吠陀治疗非传染性疾病患者的经验和观点。方法:对英国非传染性疾病成年人进行了20次定性半结构化访谈。采访录音,逐字抄录,并采用专题分析进行分析。研究结果:确定了三个关键主题。首先,参与者选择阿育吠陀是因为它符合个人价值观,比如自然的、整体的治疗,以及对西医的不满,尤其是副作用和客观的护理。其次,他们报告了接受阿育吠陀治疗的积极经历,包括个性化咨询、多样化的治疗选择和改善的健康结果。第三,与会者强调了维持阿育吠陀治疗的挑战,比如对产品安全的担忧,复杂的治疗方案难以遵循,有限的药物供应和财政障碍——特别是因为治疗不在NHS的覆盖范围内。结论:非传染性疾病患者将阿育吠陀描述为一种更自然、更符合哲学的治疗体系,反映了他们的文化和个人观点。尽管面临结构性和财务方面的挑战,但他们认为这是管理他们状况的一个相关选择。这些发现表明,阿育吠陀在英国作为非传染性疾病管理的补充方法继续具有重要意义。
{"title":"People With Non-Communicable Diseases Using Ayurveda: A UK-Based Qualitative Study","authors":"Patricia Egwumba,&nbsp;Kaushik Chattopadhyay,&nbsp;Laura Nellums,&nbsp;Manpreet Bains","doi":"10.1111/hex.70494","DOIUrl":"10.1111/hex.70494","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in the United Kingdom, placing significant pressure on the National Health Service (NHS). Despite the growing popularity of Ayurveda for managing NCDs, little is known about its use among people with these conditions in the United Kingdom. This study explored the experiences and perspectives of people with NCDs who use Ayurveda to manage their conditions in the United Kingdom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty qualitative semi-structured interviews were conducted with UK-based adults with NCDs. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Three key themes were identified. First, participants chose Ayurveda due to its alignment with personal values like natural, holistic healing and dissatisfaction with Western medicine, particularly side effects and impersonal care. Second, they reported positive experiences with Ayurvedic treatment, including personalised consultations, diverse treatment options and improved health outcomes. Third, participants highlighted challenges in sustaining Ayurvedic care, such as concerns over product safety, difficulty following complex regimens, limited medicine availability and financial barriers—especially since treatments are not covered by the NHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>People living with NCDs described Ayurveda as a more natural and philosophically congruent healing system, reflecting their cultural and personal perspectives. Despite structural and financial challenges, they considered it a relevant option for managing their conditions. These findings suggest that Ayurveda continues to hold significance as a complementary approach to NCD management in the United Kingdom.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12627756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
‘A Forever Imprint on Me…I Couldn't Be There When He Needed Me the Most’: Care Partner Experiences of Patient Safety During Covid-19 Restrictions “在我身上留下了永远的印记……当他最需要我的时候,我不能在他身边”:Covid-19限制期间患者安全的护理伙伴经历
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-18 DOI: 10.1111/hex.70496
Kayley Perfetto, Kim Sears, Jane O'Hara, Lenora Duhn
<div> <section> <h3> Background</h3> <p>It is believed that engaging care partners (CPs) in patient safety is a potential strategy to ensure patients' well-being during hospital admissions. When present, CPs who feel comfortable can be ‘safety nets’, monitoring and acting to prevent healthcare-related harm. However, there are limitations in evidence about CPs' perspectives regarding and experiences of safety engagement at the direct care level and the implications if they have restricted access, such as during the Covid-19 pandemic.</p> </section> <section> <h3> Objective</h3> <p>To understand CPs' experiences of patient safety when, due to Covid-19 restrictions, they were unable to be present in the hospital during a patient admission.</p> </section> <section> <h3> Methods</h3> <p>A descriptive, exploratory qualitative study was conducted in an acute care hospital in Ontario, Canada, and four Canadian organisations that support CPs. One-to-one semi-structured interviews and reflexive thematic analysis were completed.</p> </section> <section> <h3> Findings</h3> <p>Twelve CPs participated. Overall, they believed hospital restrictions had consequences on patient safety and was troubling for them and their loved ones, as illuminated in the three main themes: <i>Stress Escalates Amid Disrupted, Ineffective Communications Between CPs and Patients/Healthcare Professionals; CPs' Patient Safety Concerns Change and are Heightened in Their Absence From the Bedside, Calling for New Tactics</i>, and <i>Hospital Access Restriction Negatively Impacts CPs' Well-Being, Necessitating Creative Ways to Bolster Their Strength</i>.</p> </section> <section> <h3> Discussion</h3> <p>The findings give insight into CPs' engagement in patient safety at the direct care level and the importance of being present, given the types of contributions they want to make. Communication was paramount, and the scope of their involvement—the nuances of which became more apparent in their absence—affirmed how connected CPs are and need to be within the health team for successful risk reduction. Disconnecting CPs from engaging in safety diminished the patient's protection, and instead of reducing CP fears related to involvement, it escalated newfound worries and stressors.</p> </section> <section> <h3> Conclusion</h3> <p>This study highlights CPs' experiences with patient safety when they c
背景:据信,让护理伙伴(CPs)参与患者安全是一种潜在的策略,以确保患者在住院期间的健康。当在场时,感觉舒适的CPs可以成为“安全网”,监测并采取行动防止与医疗保健相关的伤害。然而,关于CPs对直接护理层面安全参与的看法和经验,以及如果他们的准入受到限制(例如在Covid-19大流行期间),其影响的证据存在局限性。目的:了解由于Covid-19限制,CPs在患者入院期间无法在场时的患者安全体验。方法:在加拿大安大略省的一家急症护理医院和四个支持CPs的加拿大组织中进行了一项描述性、探索性质的研究。完成一对一半结构化访谈和反身性专题分析。结果:12名CPs参与。总体而言,他们认为医院的限制对患者的安全产生了影响,并给他们和他们的亲人带来了麻烦,这在三个主题中得到了说明:CPs与患者/医疗保健专业人员之间中断,无效的沟通中压力升级;CPs的患者安全问题在他们离开床边时发生了变化,并得到了加强,这需要新的策略,医院准入限制对CPs的健康产生了负面影响,需要创造性的方法来增强他们的力量。讨论:研究结果深入了解了CPs在直接护理层面对患者安全的参与,以及考虑到他们想要做出的贡献类型,他们在场的重要性。沟通是最重要的,他们参与的范围——在他们缺席的情况下,其中的细微差别变得更加明显——肯定了CPs是如何在健康团队中相互联系的,并且需要成功地降低风险。切断CP参与安全活动的联系,减少了患者的保护,不仅没有减少CP对参与的恐惧,反而加剧了新发现的担忧和压力源。结论:本研究强调了CPs不能在床边时对患者安全的经验,以及他们在减轻风险方面的关键作用,并且,在对未来公共卫生危机的预期中,以及正在进行的护理方法,质疑禁止和不促进CPs参与床边的风险。患者或公众贡献:12名有参与患者安全生活经历的成年患者CPs参与了本研究。由于Covid-19实施的访客限制,这些CPs在入院期间无法与患者在一起。
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引用次数: 0
Telemedicine and Cultural Competency in Dementia Care: Mapping Stakeholder Roles in Digital Toolkit Development in SSA: A Systematic Review 远程医疗和痴呆症护理中的文化能力:在SSA中绘制数字工具包开发中的利益相关者角色:系统综述。
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-16 DOI: 10.1111/hex.70489
Abiodun Adedeji, Huseyin Dogan, Festus Adedoyin, Michelle Heward

Background

Dementia is a growing concern in Sub-Saharan Africa (SSA), particularly Nigeria, where care is hindered by weak infrastructure, stigma, and limited culturally responsive services. Telemedicine offers promise but faces adoption challenges in low-resource settings.

Objective

To evaluate digital interventions for dementia care in SSA and examine how culturally tailored telemedicine is shaped by stakeholder input, it may reduce caregiver burden and improve care delivery.

Methods

Following PRISMA guidelines, 1650 records were screened: across PubMed, Scopus, PsycINFO, and Google Scholar; 20 studies met inclusion criteria. Thematic analysis identified trends across intervention types, populations, and barriers.

Results

Five core themes emerged: barriers to care (30%), telemedicine opportunities (25%), stakeholder involvement (23%), cultural influences (20%) and technological feasibility (17%). Mobile health tools showed potential when culturally adapted. However, poor infrastructure, digital literacy and traditional beliefs constrained adoption. Engaging caregivers, clinicians and community leaders improved solution relevance and uptake.

Conclusions

Culturally informed, co-designed telemedicine models can strengthen dementia care delivery in SSA, stakeholder-driven digital models may serve as a scalable blueprint for other low-resource contexts.

Patient or Public Contribution

This review incorporated studies that engaged patients, informal caregivers, clinicians, policymakers and community leaders in the codesign and implementation of digital dementia care tools. Their lived experiences and cultural insights informed the development of interventions that are not only technologically feasible but also socially and “culturally appropriate”.

背景:痴呆症在撒哈拉以南非洲(SSA)日益受到关注,尤其是尼日利亚,那里的护理受到基础设施薄弱、污名化和文化响应服务有限的阻碍。远程医疗提供了希望,但在资源匮乏的环境中面临着采用挑战。目的:评估SSA痴呆症护理的数字干预措施,并研究利益相关者的投入如何塑造文化量身定制的远程医疗,它可能会减轻护理人员的负担并改善护理服务。方法:遵循PRISMA指南,筛选1650条记录:PubMed、Scopus、PsycINFO和谷歌Scholar;20项研究符合纳入标准。专题分析确定了干预类型、人群和障碍之间的趋势。结果:出现了五个核心主题:护理障碍(30%)、远程医疗机会(25%)、利益相关者参与(23%)、文化影响(20%)和技术可行性(17%)。移动保健工具在适应文化时显示出潜力。然而,落后的基础设施、数字素养和传统信仰限制了采用。让护理人员、临床医生和社区领导人参与进来,提高了解决方案的相关性和吸收率。结论:文化知情、共同设计的远程医疗模型可以加强SSA的痴呆症护理服务,利益相关者驱动的数字模型可以作为其他低资源环境的可扩展蓝图。患者或公众贡献:本综述纳入了患者、非正式护理人员、临床医生、政策制定者和社区领导人共同设计和实施数字化痴呆症护理工具的研究。他们的生活经验和文化见解为制定干预措施提供了信息,这些干预措施不仅在技术上可行,而且在社会和“文化上适当”。
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引用次数: 0
Public and Patient Involvement in Artificial Intelligence and Big Data Healthcare Research: An Exploration of Issues and Challenges Within the AI-Multiply Project 公众和患者参与人工智能和大数据医疗研究:AI-Multiply项目中的问题和挑战探索。
IF 3.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-14 DOI: 10.1111/hex.70490
Alexandra Thompson, Victoria Bartle, Elizabeth A. Remfry, Duncan J. Reynolds, Michael R. Barnes, Nick J. Reynolds, Barbara Hanratty

Background

Public and patient involvement and engagement (PPIE) is intended to shape research priorities and improve relevance and impact. However, implementing PPIE in complex fields such as artificial intelligence (AI) and big data health research presents specific challenges. This study explores the issues and barriers to meaningful PPIE using the AI-Multiply project as a case example.

Methods

AI-Multiply is a large, interdisciplinary UK-based research project using AI and routine health data to investigate trajectories of multiple long-term conditions and polypharmacy. PPIE was embedded across all five work packages. We used a mixed-methods approach, drawing on CUBE framework surveys, PPIE feedback forms and impact logs to evaluate involvement. Data were analysed thematically using a ‘follow-a-thread’ approach to identify key issues across sources.

Results

Three themes were identified: (1) differing priorities—public contributors prioritised person-centred outcomes, while researchers focused on data-driven healthcare metrics, often constrained by data availability; (2) movement on both sides—both researchers and contributors expressed early apprehension, but mutual trust and integration developed over time; and (3) the importance of established guidance—many issues raised echoed longstanding PPIE guidance on clarity, feedback and facilitation.

Conclusion

While AI and data-specific challenges exist, many PPIE issues in this context relate to applying existing good practice in complex projects. Strong PPIE leadership, early expectation-setting and consistent facilitation are critical for success. Findings will inform the development of practical tools to support involvement in data-driven research.

Patient or Public Contribution

Public contributors with lived experience of multiple long-term conditions contributed to the interpretation of data and co-authored this manuscript.

背景:公众和患者参与和参与(PPIE)旨在确定研究重点,提高相关性和影响。然而,在人工智能(AI)和大数据健康研究等复杂领域实施PPIE面临着具体的挑战。本研究以AI-Multiply项目为例,探讨了有意义的PPIE的问题和障碍。方法:AI- multiply是一个基于英国的大型跨学科研究项目,使用AI和常规健康数据来调查多种长期条件和多种药物的轨迹。PPIE嵌入在所有五个工作包中。我们使用混合方法,利用CUBE框架调查、PPIE反馈表格和影响日志来评估参与情况。使用“跟随一个线程”的方法对数据进行主题分析,以确定各个来源的关键问题。结果:确定了三个主题:(1)不同的优先事项-公共贡献者优先考虑以人为中心的结果,而研究人员则侧重于数据驱动的医疗保健指标,通常受到数据可用性的限制;(2)双方的运动——研究者和贡献者都表达了早期的担忧,但随着时间的推移,相互信任和融合逐渐发展;(3)既定指导的重要性——提出的许多问题与长期以来PPIE关于清晰度、反馈和便利的指导意见相呼应。结论:虽然存在人工智能和特定数据的挑战,但在这种情况下,许多PPIE问题与在复杂项目中应用现有的良好实践有关。PPIE强有力的领导、早期的期望设定和持续的促进是成功的关键。研究结果将为开发实用工具提供信息,以支持参与数据驱动的研究。患者或公众贡献者:具有多种长期疾病生活经验的公众贡献者对数据的解释做出了贡献,并共同撰写了本文。
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Health Expectations
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