UNASSIGNED: This study aimed to explore healthcare providers\' perceptions of support provision for people who have experienced stroke.
UNASSIGNED: A qualitative descriptive study was conducted. Snowball sampling was used to recruit Australian healthcare workers providing care to people with stroke. Semi-structured one-on-one interviews were audiotaped and transcribed. An inductive thematic analysis of all transcripts was undertaken by two authors.
UNASSIGNED: Fourteen participants who worked across the care continuum in three Australian states were interviewed. Responses fit into three overarching themes: (1) attitudes to supports; (2) availability and accessibility of supports; and (3) awareness of supports. These themes encompassed perceptions of the support options available for people with stroke and the factors affecting support provision decision making among healthcare providers.
UNASSIGNED: The healthcare providers in this study thought people with stroke would benefit from a greater range of available supports. Supports should take into account the diverse experiences and acute and long-term needs of people with stroke, as well as be accessible to people from all cultural, linguistic, and socioeconomic backgrounds. Healthcare providers and people who have experienced stroke may benefit from a roadmap for post-stroke support that clearly outlines where responsibility lies for support provision.
Healthcare providers across the care continuum feel that current post-stroke supports and services do not adequately serve the diversity of experiences and needs of stroke survivors.Stroke survivors who do not attend rehabilitation, including those with “mild” stroke or who do not fit within limb-focused rehabilitation services, may be missing out on key post-stroke information and support.The development of a roadmap for post stroke support that identifies minimum support provisions and where responsibility lies for provision could benefit healthcare providers, stroke survivors and their carers.

UNASSIGNED: Autistic people face many barriers to receiving an autism diagnosis. Often, they may be misdiagnosed with borderline personality disorder instead. For our study, we interviewed 10 autistic adults who had previously been diagnosed with borderline personality disorder. This helped us to better understand their experiences. They explained how borderline personality disorder is quite stigmatised and may suggest that people are to blame for their differences in behaviour. They found the treatments they had to try for borderline personality disorder to be harmful. For example, these treatments promoted \'masking\'. Previous research showed that masking can be harmful for autistic people, linking it to risk of suicide. This diagnosis also led to healthcare professionals neglecting them and discounting their beliefs. Once they were diagnosed with borderline personality disorder, it was hard to access an autism assessment. When they did receive their autism diagnoses, this was much more positive. This diagnosis was validating. It also improved their mental health, as they were no longer expected to mask - their differences were now accepted. They still felt that autism was stigmatised in society. However, this was very different to the stigma around borderline personality disorder. They felt autism stigma was more about their competence as people, whereas borderline personality disorder stigma was about how they were broken and might be harmful to others. This study is important because it allows their stories to be heard by researchers and healthcare professionals alike. Adding their voices helps to humanise them, promoting positive change in mental health services. More research is now needed.

UNASSIGNED: Affordability, lack of public mental healthcare facilities, inadequate insurance coverage, and stigma and discrimination are barriers to mental healthcare utilization in India. There is limited research on these barriers and the factors influencing the use of mental health services.
UNASSIGNED: To explore the barriers to seeking mental healthcare for individuals with severe mental illness and their caregivers in a modified assertive community treatment program.
UNASSIGNED: In a qualitative study using a descriptive thematic analysis, we conducted in-depth interviews with 19 adults, including seven individuals with severe mental illness and twelve caregivers. All the participants had been in the modified assertive community treatment program for at least two years. Using thematic analysis, we identified and grouped codes into subthemes and then clustered into themes.
UNASSIGNED: Three major themes on barriers to seeking mental health services emerged: service-related factors, societal-related factors, and illness-related factors. Service-related factors included affordability, accessibility and geographical disparity, and noncoverage under insurance schemes. Societal-related factors included social stigma and discrimination, lack of mental health service knowledge and seeking other forms of treatment, and poor social support. Illness-related factors included poor insight into the illness and no relief from the symptoms despite medication.
UNASSIGNED: Barriers to seeking mental healthcare can be categorized as service-related, societal-related, and illness-related. Identifying these factors will improve mental health service delivery.

UNASSIGNED: There remains a dearth of knowledge concerning the phenomenology of suicidal thoughts, with research focusing on reasons for feeling suicidal rather than their mental expression. While clinical interviews remain the standard phenomenological approach, such exploration of lived experiences may prove challenging for this sensitive topic. As a complementary alternative, the use of naturally-occurring online data is opportune for capturing elaborations on tabooed phenomena.
UNASSIGNED: In this phenomenological study, we present a thematic analysis on lived experiences of suicidal thoughts as spontaneously reported by non-identified users of a Reddit online board (r/Depression), collecting 668 posts using the search terms \"suicidal ideation,\" \"suicidal thoughts,\" and \"suicide.\" Codes were grouped into descriptive categories summarizing the properties of thoughts, their effects, and their relation to suicide. Then, an interpretative synthesis yielded global themes connecting salient meanings on the experience of suicidal thoughts.
UNASSIGNED: With a long-term and recurring nature, thoughts of suicide appear in the form of vivid imagery and daydreaming\'s, initially bringing relief to adverse feelings but eventually becoming conditioned and all-consuming. Rather than a wonderment, they are experienced as intrusive thoughts by people struggling to make meaning of their occurrence. When conciliating the presence of unwanted thoughts, users express intricate relations to wishing or not to die, as well as varying perceptions of control over actions or fear of suicidal behavior.
UNASSIGNED: With an innovative application of big qualitative data into phenomenological analysis, this study contributes to an initial characterization of suicidal thoughts, uncovering findings that are not contemplated into current conceptualizations of suicidality. The analysis is limited by a restricted context of posts and unknown demographics, and further research with clinical interviews is warranted for in-depth exploration of suicidal thoughts.

Understanding what matters to people with Parkinson\'s and their family is essential to derive relevant clinical outcome measures and guide clinical care. The purpose of this study was to explore what is important to people with Parkinson\'s disease vs. family over time. A qualitative content-analysis of online survey data collected by Parkinson\'s UK was conducted to identify types and frequencies of important symptoms and impacts of Parkinson\'s for people with the disease vs. family of people with Parkinson\'s. Independent T-tests were used to identify significance of between group differences for patients vs. family at < 2, 2-5, 6-10, 11-20, > 20-year durations. ANOVA was used to assess for within group differences by disease duration. We found that symptom priority changed significantly over time with longer disease duration. Tremor was reported less often later on, whereas mobility, dyskinesias, gait and speech/communication symptoms gained priority. In general, patients identified movement-related symptoms (e.g., walking, bradykinesia) as the most bothersome at all durations while family more strongly prioritized the physical and psychosocial impacts of disease (e.g., mobility, safety, interpersonal interactions, independence, and family impact). We conclude that important differences exist between family and patient perspectives of what matters and change over time with longer duration of disease.

BACKGROUND: Bariatric surgery is the most effective treatment for people with obesity. It has been shown that there\'s is a complex psychosocial overlay in the pathophysiology and treatment, which requires specific consideration when delivering care. There is a significant drop out rate for patients accepted on to bariatric programmes in New Zealand, resulting in failure to progress to surgical intervention.
METHODS: We conducted individual, semi-structured interviews with patients who were accepted onto the bariatric surgery programme but did not complete the programme, or receive an operation between 2015 and 2020. Grounded theory methodology was used to create an exploratory framework to identify and describe the themes encountered. An iterative process of thematic analysis and comparison between participants experiences was used to consolidate the shared key barriers. This study aims to explore patients experiences of a bariatric surgery programme to understand barriers and enablers to complete a bariatric programme and receive an operation. Adding to previous qualitative work investigating patients experience of bariatric surgery programmes in New Zealand.
RESULTS: Five themes of barriers that patients face to receiving bariatric surgery were identified. These were preoperative weight loss requirement, experiencing the social stigma of obesity, communication, socioeconomic and geographic barriers, and community support. These five themes often co-exist in patients experiences and combine, to cause patients to disengage with the bariatric service.
CONCLUSIONS: Many factors contribute to eligible patients not receiving bariatric surgery once accepted onto the programme. Specified weight loss goals was the most significant barrier. Community support and online resources were significant enablers. This study should inform changes to bariatric programmes in New Zealand.

OBJECTIVE: The aims of this study were to describe the experiences of nurses in the aftermath of the COVID-19 pandemic and to explore nurses\' current desired support needs.
METHODS: This study used a qualitative descriptive design.
METHODS: This study was conducted in the Southeastern United States at an academic health system encompassing acute care hospitals and outpatient speciality clinics. Thirteen nurses were interviewed in August and September of 2023 in five small groups of two or three nurses. Photovoice was used for data collection and each nurse submitted two photographs. Data were analysed utilising conventional content analysis, with transcripts and photograph analysis occurring concurrently.
RESULTS: Three themes were identified: (1) organisational turmoil, (2) personal traumatisation and transitions and (3) striving for revival and renewal. A conceptual model illustrating the three themes and their relationships was developed to depict study findings.
CONCLUSIONS: Nurses were impacted by organisational factors, such as staffing issues and lack of support, and personally through psychological trauma that has remained challenging. Nurses found revival and renewal in their personal lives, but still desire continued improvement in organisational factors to enhance their well-being in ways not currently being addressed to allow for full recovery. Findings from this study are pertinent for healthcare organisations and leaders to develop organisational changes and mental health solutions to support nurse well-being.
UNASSIGNED: The prioritisation of nurse well-being is critical for the nursing profession and healthcare organisations. Organisational improvements and the implementation of support resources are urgently needed to aid in nurse recovery, nurse retention and to ensure patients receive quality care.
CONCLUSIONS: This study identified nurses\' struggles 3 years after the beginning of the COVID-19 pandemic, highlighting the ongoing need to provide resources and interventions that support nurse well-being. Our findings offer nurses\' descriptions of their experiences and support needs for organisations and healthcare leaders to consider in the future.
UNASSIGNED: Standards for Reporting Qualitative Research (SRQR) Checklist.
UNASSIGNED: No patient or public contribution.

OBJECTIVE: Pathways of transitioning from tobacco smoking to vaping after receiving an e-cigarette-based smoking cessation intervention have been minimally explored.
OBJECTIVE: 1) identify pathways between intervention delivery and final follow-up; 2) describe baseline and post-intervention statistical data in relation to smoking/vaping behaviour of the different pathway groups; 3) explore qualitative participant perspectives contextualising pathway groups.
METHODS: Embedded mixed-methods analysis of data collected for the Cessation of Smoking Trial in the Emergency Department (COSTED) randomised controlled trial.
METHODS: Recruitment from 6 Emergency Departments (5 in England and 1 in Scotland) between January and August 2022.
METHODS: 366 adult smokers who were randomised to receive the COSTED intervention and provided data at 6-month follow-up. Qualitative subsample of 24 participants interviewed after follow-up.
METHODS: Brief smoking cessation advice, provision of an e-cigarette starter kit and referral to the local Stop Smoking Service.
METHODS: Descriptive statistical reporting of identified pathways and smoking/vaping behaviour at baseline and 6-month follow-up. Semi-structured phone/video interviews analysed thematically.
RESULTS: 13.4% (n = 49) of participants quit smoking within 1 month of receiving the intervention, 19.1% (n = 70) quit between 1 and 6 months, 24.9% (n = 91) reduced cigarettes per day (CPD) by at least 50%, and 42.6% did not experience a significant smoking reduction. Approximately a third of participants who quit reported not vaping at follow-up. Reporting dual use was associated with a reduction in CPD. Appoximately a third reported experimenting with a different device to the one provided as part of the intervention. Quitters reported themes of satisfaction with vaping, changes in environment facilitating quitting and motivation to quit.
CONCLUSIONS: Dual use of cigarettes and e-cigarettes can result in a reduction of smoking and may preclude quitting smoking. Sustained e-cigarette use is not always necessary for quitting success. Success depends on personal context as well satisfaction with vaping.

Living at risk of a genetically inherited disease can be a challenging experience causing psychological distress as well as the possibility of the genetic disease leading to physical health problems. Huntington\'s disease (HD) is a genetic, neurodegenerative condition. It causes motor dysfunction, cognitive decline and, during the progression of the disease, different psychological difficulties are common. A total of 12 participants living at risk of HD were interviewed and interpretative phenomenological analysis methodology was used to understand their experiences of maintaining psychological well-being. This resulted in three themes: (1) \"you\'re constantly in limbo\": living in two worlds; (2) \"I have to live, just bloody live\": managing the possibility of a time-limited lifespan; and (3) \"I try and try my hardest to look past the disease\": the exhausting quest to keep living well. The findings indicated a need for improved knowledge within professional settings, such as for family doctors, counselors, and other health professionals, specific strategies that genetic counselors can use to support this group, and provision of accessible support and implementation of systemic interventions that would offer support for psychological coping strategies and communication around well-being to the individual and their family unit. Future research could contribute to the formation of such knowledge and the provision of HD-aligned services to help support the psychological well-being of people living at risk of HD.

BACKGROUND: People living in coastal communities have some of the worst health outcomes in the UK, driven in part by high smoking rates. Deprived coastal communities include socially disadvantaged groups that struggle to access traditional stop smoking services. The study aimed to seek the views of people who smoke living in coastal communities, to assess the optimal smoking cessation intervention for this population. In addition, the Template for Intervention Description Replication (TIDieR) checklist was adapted as an analytical framework for qualitative data to inform intervention design.
METHODS: Current or recent ex-smokers (n = 25) were recruited to participate in qualitative interviews from a range of community locations in a deprived English seaside town. A thematic analysis of the interview data was undertaken adapting the TIDieR framework. This analysis was triangulated with relevant literature and notes from stakeholder meetings and observations to map onto the TIDieR checklist to describe the optimal intervention.
RESULTS: Barriers to quitting smoking in the target population included low motivation to quit, high anxiety/boredom, normalisation of smoking and widespread illicit tobacco use. There was broad support for combining behavioural support, e-cigarettes and financial incentives, with a strong preference for the intervention to be delivered opportunistically and locally within (non-healthcare) community settings, in a non-pressurising manner, ideally by a community worker specially trained to give stop smoking support.
CONCLUSIONS: An intensive community-based smoking cessation intervention was acceptable to the target population. Adapting the TIDieR checklist as a deductive qualitative analytical framework offered a systematic approach to intervention development. Combined with other intervention development activities, this ensured that the intervention design process was transparent and the proposed intervention was well defined. It is recommended that prior to intervention development researchers speak to members of the target population who may give valuable insight into the optimal intervention.