BACKGROUND: Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout.
OBJECTIVE: This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden.
METHODS: In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs.
RESULTS: Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65%; t15=2.430; P=.03; d=0.61 [medium effect size]).
CONCLUSIONS: COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions.

Grandparental care of grandchildren is a prevalent social phenomenon. This study explores the perceptions of health-related quality of life of grandparents caring for their grandchildren. A mixed methods design was developed. In the first phase, participants were interviewed using a baseline questionnaire. The second phase consisted of focus groups with 19 of the 100 participants in the quantitative phase. The scores obtained from the quantitative analysis are in line with the qualitative data; they reflect that grandparent carers who are more involved in the care of their grandchildren have more symptoms of depression and stress and have poorer perceptions of physical health-related quality of life. What may at first appear to be a positive aspect, keeping grandparent carers active, can become negative when it comes to shared care and when the grandparents\' willingness to provide care is abused.

BACKGROUND: Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital.
OBJECTIVE: This study aims to evaluate the implementation of a digitalized discharge management system, the project \"Optimizing instersectoral discharge management\" (SEKMA, derived from the German Sektorübergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate.
METHODS: A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group.
RESULTS: Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: \"optimization potential,\" \"barriers,\" and \"enablers.\" On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37%; eg, electronic discharge letter, providing mobile devices to the hospital\'s social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20).
CONCLUSIONS: This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system.

BACKGROUND: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users\' health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers.
OBJECTIVE: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting.
METHODS: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption.
RESULTS: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process.
CONCLUSIONS: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting.

BACKGROUND: Digital health interventions, such as personalized SMS coaching, are considered affordable and scalable methods to support healthy lifestyle changes. SMS, or texting, is a readily available service to most people in Sweden, and personalized SMS coaching has shown great promise in supporting behavior changes.
OBJECTIVE: This study aims to explore the effectiveness of highly personalized SMS coaching for behavior change according to the Capability, Opportunity, Motivation-Behavior (COM-B) model on a sample of physically inactive adults in a nonprofit fitness organization in Sweden.
METHODS: The study used a mixed methods design in which clients acted as their own controls. The participants were clients (n=28) and fitness consultants (n=12). Three types of data were collected: (1) quantitative data at baseline and after the SMS intervention and the waitlist from the clients, (2) qualitative data from semistructured interviews with the fitness consultants, and (3) pseudonymized texting conversations between the fitness consultants and clients.
RESULTS: Overall, the results showed that personalized SMS coaching was effective in supporting the clients\' behavior changes. The quantitative analysis showed how the clients\' capabilities (Cohen d=0.50), opportunities (Cohen d=0.43), and relationship with the fitness consultants (Cohen d=0.51) improved during the SMS intervention in comparison with baseline. Furthermore, the qualitative analysis revealed how personalized texts added value to existing work methods (eg, increasing continuity and flexibility) and how the relationship between the clients and fitness consultants changed during the intervention, which helped motivate the clients.
CONCLUSIONS: Personalized SMS coaching is an effective method for supporting healthy behavior changes. The human connection that emerged in this study needs to be further explored to fully understand the effectiveness of a digital health intervention.

Telehealth has become widely available to solid organ transplant (SOT) recipients during the COVID-19 pandemic. While evidence suggests that telehealth serves as an acceptable alternative for most SOT recipients, their satisfaction and its context remain unclear. This study used a mixed methods approach to investigate the perspectives of SOT recipients (i.e., liver, kidney, and simultaneous liver-kidney) on the benefits and disadvantages of telehealth. A total of 252 adult SOT recipients completed an online survey that quantitatively assessed telehealth experience and satisfaction. Fifteen of them further shared their perspectives by participating in either a focus group or individual interview. Approximately 70% of online survey participants had previously used telehealth for their transplant care. The quantitative data documented that, while recipients were mostly satisfied with telehealth, especially with its effectiveness and convenience, they were less satisfied with the reliability of navigating the telehealth system. The qualitative data further showed that telehealth could be less effective for SOT recipients who perceived themselves as clinically and/or socially vulnerable, needed urgent care, and were concerned about privacy. These findings suggest that the plan for using telehealth to provide transplant care should prioritize personalization, considering unique needs and preferences of each SOT recipient.

OBJECTIVE: To describe the experiences of nursing students and their mental health as they entered employment during the first wave of the COVID-19 pandemic (May-June 2020).
BACKGROUND: As other healthcare professionals, nursing students who worked during the first COVID-19 wave suffered from dysfunctional mental health symptoms.
METHODS: Sequential, mixed-method, multicentre study.
METHODS: The study population comprised 92 students in the third and fourth year of the Nursing degree at three Spanish universities, who entered employment during the pandemic. Data were collected between May and June 2020. In the quantitative phase, data were collected using an online questionnaire containing both validated anxiety and stress scales. In the qualitative phase, semi-structured interviews were conducted with 18 participants. A descriptive analysis of the quantitative data and a reflexive thematic analysis of the qualitative data were carried out, and analyses were combined. COREQ checklist was used for reporting.
RESULTS: The combined quantitative and qualitative results were organised into five thematic areas: (1) Interruption of clinical placements, (2) Entering employment on a healthcare assistant contract, (3) Preventing contagion, (4) Adapting to the situation and managing emotions, and (5) Lessons learned.
CONCLUSIONS: The students had a positive overall experience of entering employment, as they were able to develop their nursing skills. However, they had an emotional impact in form of stress caused by excessive responsibility, academic uncertainty, lack of personal protective equipment and training in its use, and the possibility of spreading disease to their family members.
CONCLUSIONS: In the current context, changes must be made in study programmes to instruct nursing students to be able to cope with extreme clinical situations, such as pandemics. The programmes should include a more extensive coverage of epidemics and pandemics and management of emotional aspects such as resilience.

From the perspectives of patients and caregivers, the objectives were: identifying which result presentations, describing work productivity loss (WPL) outcomes, are most understandable; measuring which presentations are important to report; and investigating which WPL outcomes are viewed as important alongside clinical trials results.
We used a four phased, sequential mixed methods design, guided by patient-oriented research engaging one patient partner. We conducted think-aloud interviews, in British Columbia/Canada, to review WPL results and our survey measuring the understandability and importance of the results, and importance of each WPL outcome. We surveyed a sample representing working Canadians. The findings were summarized and analyzed using linear and logistic regression. We conducted sub-group analyses; one was gender based. All regressions were conducted using generalized estimating equations.
In our qualitative phases, 20 patients and caregivers were interviewed. Participants recommended for the results to be brief, simple, and represented visually. Then, 118 patients and 120 caregivers were surveyed. The results presented in days or cost yielded the highest understandability and importance to report. All WPL outcomes were identified as important to somewhat important to report by most. The associations indicated that the more understandable the result presentation was, the more likely it was to be rated as important. Age was the only factor significantly associated with selecting days or cost as the most important result.
Presenting WPL results in days and cost, using lay terms and visual supports, were viewed as easiest to understand and most important to report in clinical trials by patients and caregivers. Our findings are supportive of clinical trials standardizing the measurement of WPL to include all of its outcomes (absenteeism, presenteeism, employment status changes and total work productivity loss), in addition to tools assessing the comprehensiveness of WPL results to be provided to patients and caregivers.

Development of an advanced practice nurse (APN) role for nutrition management: A needs assessment using a mixed methods approach Abstract. Background: Nurses are attributed to play a key role in nutrition management. This field has emerged to be a subject of advanced nursing practice. Aim: Conducting a needs assessment on the role profile of an advanced practice nurse (APN) in nutrition management according to the PEPPA framework. Methods: Mixed methods design. In a cross-sectional study on the current practice, the diagnostic accuracy of nurses\' nutrition screening using Nutritional Risk Screening (NRS 2002) compared with independent assessment by a nutrition expert using NRS 2022 was examined. In case of a positive screening result, reasons were determined using an in-depth assessment. In addition, semi-structured, guideline-based interviews were conducted and content-analysed. Results: The identification of patients at risk by nurses\' nutrition screening showed a need for improvement (sensitivity: 56%, specificity: 96%; n = 195). Commonly identified reasons for (risk of) malnutrition (n = 51) were lack of desire to eat/lack of appetite or increased caloric needs due to illness. Development opportunities and expectations for an APN were specified based on the interviews (n = 20). They refer to skill enhancement, support within the interprofessional team in complex treatment cases and a stronger nursing role in nutrition management. Conclusions: Based on the needs assessment, the APN\'s areas of responsibility were identified and assigned to the Hamric model, and implementation strategies could be derived.
Zusammenfassung. Hintergrund: Pflegefachpersonen wird eine Schlüsselrolle im Ernährungsmanagement zugeschrieben. Dieser Bereich wurde als ein Schwerpunkt der Entwicklung einer Advanced Nursing Practice identifiziert. Ziel: Bedarfsanalyse zum Rollenprofil einer Advanced Practice Nurse (APN) entsprechend dem PEPPA-Rahmenmodell. Methodik: Mixed Methods-Design. In einer Querschnittserhebung zum Ist-Stand wurde die diagnostische Genauigkeit des pflegerischen Ernährungsscreenings mittels Nutritional Risk Screening (NRS 2022) im Vergleich zur Einschätzung durch eine Ernährungsexpertin mittels NRS 2022 untersucht. Bei positivem Befund wurden Gründe mithilfe eines vertieften Assessments ermittelt. Ergänzend wurden halbstrukturierte, leitfadengestützte Interviews geführt und inhaltsanalytisch ausgewertet. Ergebnisse: Die Identifikation von Risikopatient_innen im pflegerischen Screening wies Verbesserungsbedarf auf (Sensitivität: 56%, Spezifität: 96%; n = 195). Häufig identifizierte Gründe (des Risikos) einer Mangelernährung (n = 51) waren die fehlende Lust zum Essen/Appetitlosigkeit oder ein krankheitsbedingter erhöhter Bedarf. Entwicklungsmöglichkeiten und Erwartungen an eine APN wurden anhand der Interviews (n = 20) konkretisiert. Sie beziehen sich auf Kompetenzerweiterung, Support im interprofessionellen Team bei komplexen Behandlungsfällen und einer stärkeren pflegerischen Rolle im Ernährungsmanagement. Schlussfolgerungen: Anhand der Bedarfsanalyse konnten Aufgabenbereiche der APN benannt, dem Modell nach Hamric zugeordnet und Umsetzungsstrategien abgeleitet werden.

BACKGROUND: Sexual dysfunction represents a critical aspect of quality of life for adolescent and young adult cancer survivors. Studies have consistently documented that adolescents and young adults report greater psychological and physical morbidity than older survivors and healthy peers, including elevated rates of sexual dysfunction, often accompanied by lower satisfaction with sex life and delays in meeting sexual milestones. Moreover, sexual dysfunction, body image concerns, and fertility status affect their confidence in being both physically and emotionally intimate. Despite this evidence, limited research has investigated the influence of psychosocial and interpersonal factors on sexual health outcomes reported by this group. This constitutes a significant gap in the provision of comprehensive sexual health care for adolescent- and young adult-onset cancer survivors, especially since greater emphasis has been recently placed on the biopsychosocial model of sexuality and dyadic approaches to intervention and treatment. In comparison to other cancer types, the incidence of colorectal cancer (CRC) has been increasing at an alarming rate for the adolescent and young adult group. Patients with early-onset CRC experience elevated rates of sexual dysfunction, psychological distress, and social and physical burden, often resulting from issues with bowel control, incontinence, and body image.
OBJECTIVE: This study uses an explanatory sequential mixed methods approach to (1) characterize sexual function, sexual distress, dyadic coping, infertility-related distress, relationship and mental health outcomes of adolescent and young adult CRC survivors within the first 5 years post diagnosis and their partners; (2) examine the reciprocal influence of sexual function and dyadic coping behaviors on sexual distress; and (3) identify interpersonal or couple characteristics associated with coping with sexual dysfunction and its associated distress.
METHODS: Participating couples (n=60) will complete a quantitative web-based survey investigating sexual function, sexual distress, dyadic coping, infertility-related distress, emotional functioning, relationship satisfaction, and body image (cancer survivors only). A subset of 20 couples will participate in an in-depth dyadic interview with 2 members of the research team to further explore couple-based strategies implemented to cope with cancer-related sexual dysfunction and distress.
RESULTS: The study received institutional review board approval. Recruitment and enrollment of couples began in July 2022.
CONCLUSIONS: Results will provide a deeper understanding of the challenges couples experience as they navigate sexual intimacy after CRC treatment by highlighting the role of interpersonal processes. These findings will inform a dyadic intervention for young couples at risk of greater sexual distress in the aftermath of CRC.
UNASSIGNED: DERR1-10.2196/41831.