Background: In the Netherlands, general practitioners (GPs) play a key role in provider-initiated HIV testing, but opportunities for timely diagnosis are regularly missed. We implemented an educational intervention to improve HIV testing by GPs from 2015 to 2020, and observed a 7% increase in testing in an evaluation using laboratory data. The objective for the current study was to gain a deeper understanding of whether and how practices and perceptions of GPs’ HIV/sexually transmitted infection (STI) testing behaviour changed following the intervention. Methods: We performed a mixed-methods study using questionnaires and semi-structured interviews to assess self-reported changes in HIV/STI testing by participating GPs. Questionnaires were completed by participants at the end of the final educational sessions from 2017 through 2020, and participating GPs were interviewed from January through March 2020. Questionnaire data were analysed descriptively, and open question responses were categorised thematically. Interview data were analysed following thematic analysis methods. Results: In total, 101/103 participants completed questionnaires. Of 65 participants that were included in analyses on the self-reported effect of the programme, forty-seven (72%) reported it had changed their HIV/STI testing, including improved STI consultations, adherence to the STI consultation guideline, more proactive HIV testing, and more extragenital STI testing. Patients’ risk factors, patients’ requests and costs were most important in selecting STI tests ordered. Eight participants were interviewed and 15 themes on improved testing were identified, including improved HIV risk-assessment, more proactive testing for HIV/STI, more focus on HIV indicator conditions and extragenital STI testing, and tools to address HIV during consultations. However, several persistent barriers for optimal HIV/STI testing by GPs were identified, including HIV-related stigma and low perceived risk. Conclusions: Most GPs reported improved HIV/STI knowledge, attitude and testing, but there was a discrepancy between reported changes in HIV testing and observed increases using laboratory data. Our findings highlight challenges in implementation of effective interventions, and in their evaluation. Lessons learned from this intervention may inform follow-up initiatives to keep GPs actively engaged in HIV testing and care, on our way to zero new HIV infections.
E-Exercise is an effective 12-week blended intervention consisting of around five face-to-face physiotherapy sessions and a web-based application for patients with hip/knee osteoarthritis. In order to facilitate effective implementation of e-Exercise, this study aims to identify physiotherapists' experiences and determinants related to the usage of e-Exercise. Methods: An explanatory sequential mixed methods design embedded in a randomized controlled trial comparing e-Exercise with usual physiotherapy in patients with hip/knee osteoarthritis. Usage of e-Exercise was based on recruitment rates of 123 physiotherapists allocated to e-Exercise and objective web-based application usage data. Experiences and determinants related to e-Exercise usage were investigated with a questionnaire and clarified with semi-structured interviews. Results: Of the 123 physiotherapists allocated to e-Exercise, 54 recruited more than one eligible patient, of whom 10 physiotherapists continued using e-Exercise after the study period. Physiotherapists had mixed experiences with e-Exercise. Determinants related to intervention usage were appropriateness, added value, time, workload, professional autonomy, environmental factors, and financial consequences. Physiotherapists recommended to improve the ability to tailor e-Exercise to the individual needs of the patient patients' individual needs. Discussion: Determinants related to the usage of e-Exercise provided valuable information for the implementation of e-Exercise on broader scale. Most importantly, the flexibility of e-Exercise needs to be improved. Next, there is a need for education on how to integrate an online program within physiotherapy
Purpose Worry is an intuitive sense that goes beyond logical reasoning and is valuable in situations where patients’ conditions are rapidly changing or when objective data may not fully capture the complexity of a patient’s situation. Nurse anesthetists’ subjective reasons for worry are quite vague as they are valued inconsistently and not accurately expressed. This study aimed to identify factors playing a role in the emergence of worry during anesthesia practice to clarify its concept. Design Mixed-methods design consisting of quantitative online surveys followed by qualitative focus group interviews including Dutch nurse anesthetists. Methods Both quantitative and qualitative thematic analyses were performed, followed by data and methodological triangulation to enhance the validity and credibility of findings and mitigate the presence of bias. Findings Surveys (N = 102) were analyzed, and 14 nurse anesthetists participated in the focus group interviews. A total of 89% of the survey respondents reported that at least once have had the feeling of worry, of which 92% use worry during clinical anesthesia practice. Worry was mentioned to be a vital element during anesthesia practice that makes it possible to take precautionary actions to change the anesthetic care plan in a changing situation or patient deterioration. Conclusions While a clear definition of worry could not be given, it is a valuable element of anesthesia practice as it serves as a catalyst for critical thinking, problem-solving, clinical reasoning, and decision-making. Use of the feeling of worry alongside technological systems to make an informed decision is crucial. Technology has significantly improved the ability of health care providers to detect and respond to patient deterioration promptly, but it is crucial for nurse anesthetists to use their feeling of worry or intuition alongside technological systems and evidence-based practice to ensure quick assessments or judgments based on experience, knowledge, and observations in clinical practice.
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Vanuit het werkveld bereiken Fontys Sporthogeschool (FSH) regelmatig vragen voor effectievere ondersteuning bij docentprofessionalisering van docenten Lichamelijke Opvoeding (LO). Deze zijn geconcretiseerd naar enkele breed gedeelde praktijk-vraagstellingen. Een innovatieve en veelbelovende methode voor docentprofessionalisering is Lesson Study (LS). Bij LS werken docenten samen aan het ontwerpen, uitvoeren en onderzoeken van een les. Deze aanpak voldoet aan kenmerken voor effectieve docentprofessionalisering zoals omschreven in de wetenschappelijke literatuur. Het is echter nog niet bekend of LS daadwerkelijk effectief is. Het consortium bestaande uit FSH, Universiteit Gent, Universiteit Utrecht, en de Academische Opleidingsscholen West-Brabant, Brabant Noord-Oost, Tilburg en Den Bosch, is daarom gekomen tot de volgende onderzoeksvragen: 1) Wat zijn de effecten van een workshop ‘motivationeel klimaat’ gevolgd door een begeleide lesson study op de vijf niveaus van doorwerking van Guskey (2000), in vergelijking met alleen een workshop? 2) Welke belemmeringen en succesfactoren kunnen er geïdentificeerd worden met betrekking tot het zelfstandig toepassen van de methode lesson study door docenten LO? 3) Hoe waarderen docenten LO en hun leidinggevenden de opbrengsten van de methode lesson study ten opzichte van de tijdsinvestering die deze vergt? In het onderzoek is sprake van een mixed-methods aanpak. De effecten (vraag 1) worden kwantitatief gemeten aan de hand van de niveaus van Guskey (2000) en vergeleken met een controlegroep van scholen die alleen een workshop krijgen. Vraag 2 en 3 worden kwalitatief onderzocht via focusgroepgesprekken (docenten) en semi-gestructureerde interviews (leidinggevenden). De opbrengsten van dit project zijn kennis met betrekking tot de effectiviteit en bruikbaarheid van LS voor docentprofessionalisering bij LO. Deze kennis wordt verspreid met nationale en internationale publicaties en presentaties. Voor het werkveld wordt tevens een symposium georganiseerd. De kennis zal niet alleen indalen in de lerarenopleiding LO van Fontys Sporthogeschool, maar LS zal bij gebleken effectiviteit ook in worden gezet als werkvorm voor LO-studenten die stagelopen.
