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Child and family experiences of a whole-systems approach to physical activity in a multiethnic UK city: a citizen science evaluation protocol.Whole-systems approaches are being adopted to tackle physical inactivity. The mechanisms contributing to changes resulting from whole-systems approaches are not fully understood. The voices of children and families that these approaches are designed for need to be heard to understand what is working, for whom, where and in what context. This paper describes the protocol for the children and families' citizen science evaluation of the Join Us: Move, Play (JU:MP) programme, a whole-systems approach to increasing physical activity in children and young people aged 5-14 years in Bradford, UK. The evaluation aims to understand the lived experiences of children and families' relationship with physical activity and participation in the JU:MP programme. The study takes a collaborative and contributory citizen science approach, including focus groups, parent-child dyad interviews and participatory research. Feedback and data will guide changes within this study and the JU:MP programme. We also aim to examine participant experience of citizen science and the suitability of a citizen science approach to evaluate a whole-systems approach. Data will be analysed using framework approach alongside iterative analysis with and by citizen scientists in the collaborative citizen science study. Ethical approval has been granted by the University of Bradford: study one (E891-focus groups as part of the control trial, E982-parent-child dyad interviews) and study two (E992). Results will be published in peer-reviewed journals and summaries will be provided to the participants, through schools or directly. The citizen scientists will provide input to create further dissemination opportunities.
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Fathers providing kangaroo care in neonatal intensive care unitsBackground. Kangaroo care (KC) has been used widely in neonatal care to promote bonding/attachment and neurodevelopment for preterm and term infants. However, current literature suggests that research mainly focuses on infants' and mothers' experiences. The role of fathers in caring for their infant/child is changing and evolving in many countries around the globe. Yet little is known about fathers' experiences of KC in neonatal units. This review, therefore, aims to scope the current evidence of Father-infant KC (Father KC) in Neonatal Intensive Care Units (NICUs). Research question. What impact does KC have upon fathers when their baby is cared for in NIUCs? Search method. A scoping review was conducted and guided by the framework of Arksey and O'Malley (2005). The data sources consisted of Medline, Embase, America Psychological Association (APA) PsycInfo, Emcare, Cochrane Central, Web of Science, Google Scholar and ProQuest. The study inclusion criteria were: (1) studies involving fathers who had experience of KC with their baby whilst in Neonatal Intensive Care Units (NICUs), and other neonatal care settings, such as Special Care Baby Nursery (SCBU), delivery/labour room and postnatal ward; (2) literature published from 2000 to 2020; (3) primary studies including qualitative, quantitative, and mixed methods studies; (4) studies published in English. Results. The total number of studies identified were 13. Seven studies were qualitative and six were quantitative. None were mixed methods. Studies reported several positive KC benefits on fathers, such as reduced stress, promotion of paternal role and enhanced father-infant bond. It was highlighted that KC could be time-consuming for fathers and challenging to practise when balancing work and family life commitments. Conclusion. This review provides evidence that KC practice has health and wellbeing benefits for fathers and infants in NICUs and other relevant neonatal care settings, The findings of this review support the justification to promote Father KC in NICU environments, and guide policies to include father involvement. Implementing Father KC in NICU settings will assist fathers to care and connect with their baby. Further research is needed to explore how to facilitate and evaluate KC education for fathers from diverse backgrounds and cultures.
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Navigating the coronavirus pandemic 2 years on: Experiences of people with dementia from the British IDEAL cohort.People with dementia have been affected in unique ways during the COVID-19 pandemic. It is not known whether the impact of the pandemic has changed with time or with the changes in social restrictions. This study explored how experiences of coping with the effects of the pandemic in the UK changed over time. We conducted semi-structured interviews with people with dementia living in the community in England and Wales who had taken part in a qualitative interview at an earlier stage of the pandemic. We applied framework analysis to identify themes and compared these with interviewees' previous accounts. Nine people aged between 51 and 89 years were interviewed; four were female and five had early onset dementia. We identified three themes: 1. Navigating a changing world: Living with coronavirus; 2. A 'downward spiral': Managing advancing dementia; and 3. Availability, accessibility, and suitability of support. Findings reflect participants' ongoing caution about re-emerging from social restrictions to resume valued activities, and how this led to coping behaviours to minimise the impact on wellbeing in the absence of formal support and services. Despite easing of restrictions across the UK, the negative impact of the coronavirus pandemic on people with dementia continues. Whilst individuals and services have adapted to some of the challenges, there is now an opportunity to rebuild support networks and services to ensure people with dementia are suitably advised, supported and socially engaged to allow them to live as well as possible.
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Perceptions of students regarding the delivery of sexual and reproductive health education in schools in FijiAdolescent sexual and reproductive health (SRH) remains a challenge globally. High school youths without comprehensive sexuality education (CSE) are more likely to engage in high risk sexual behaviors than their peers in schools with CSE. Fiji continues to have very poor adolescents SRH indicators. This study aimed to gauge the perceptions of students towards the delivery of SRH education in schools in Fiji. A qualitative study design was used to collect data from students in year 11-13 in public secondary schools in Suva, Fiji in 2018. Schools with equal ethnic mix were selected. A semi-structured open-ended questionnaire was used to guide Focus Group Discussions (FGDs). A male research facilitator conducted FGD with males while a female research facilitator facilitated that amongst the females. Data collected was analyzed thematically. Seven FGDs were conducted. A total of 46 students (29 males) participated with the age range from 17-19 years old. Eight themes emerged: current SRH education; students' knowledge on adverse consequences of SRH; sources of SRH information; need for sex education; provision of SRH education in schools; characteristics of teachers of SRH education; age-appropriate incremental sex education; and ideal version of SRH. The study shows that Fijian students desired a lot more from sex education than what is currently offered for sexual decision-making. There is a need for mandatory and comprehensive sex education for young people.
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Predictors of knowledge, attitude, and practice (KAP) towards family planning (FP) among pregnant women in FijiThis study aimed to determine the predictors of Knowledge, Attitude and Practice (KAP) towards Family Planning (FP) among pregnant Fijian women. A cross-sectional study was conducted over two months in 2019 with adult pregnant women attending the Antenatal Clinic (ANC) at Ba Mission Hospital (BMH), Fiji. Data was collected using a self-administrated questionnaire. Statistical analysis included correlation tests and regression analysis in determining predictors of KAP. 240 pregnant women participated in this study with a mean age of 26.02 (± SD = 4.13). The results showed a moderate level of knowledge (mean 14.95, SD ± 3.15), positive attitude (mean 20.56, SD ± 5.68), and good practice (mean 4.97, SD ± 1.73). Linear regression identified that women with more than seven children had a knowledge score of 3.65, lower than null parity (t value = -2.577, p = 0.011). Women aged 20 to 24 had a 6.47 lower attitude score than women aged 18 to 19 (t value = -2.142, p = 0.033). Women in defacto relationships had a 2.12 lower attitude score compared to the married category (t value = -2.128, p = 0.034). Fijian women of Indian descent had a 1.98 lower attitude score than the I Taukei women (t value = -2.639, p = 0.009). Women aged 30-34 had 2.41 lower practice scores than those aged 18-19 (t value = -2.462, p = 0.015). This study found a medium knowledge of FP among pregnant women. These findings support a recommendation for further research to implement effective strategies.
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'Some of my patients only come to renew their prescriptions. They are not interested in any additional advice or support'. Physicians' perceptions on their roles in cardiovascular diseases risk reduction and management in FijiPrimary health care (PHC) physicians' perceptions are vital to understand as they are the first-line health care providers in cardiovascular diseases (CVD) risk assessment and management. This study aims to explore PHC physicians' perceptions on their roles and their perceptions on management and risk reduction approaches on CVD risk reduction and management in Fiji. This is a qualitative study conducted in the Suva Medical area among 7 health centers from 1 August to 31 September, 2021. Purposive sampling was used to recruit physicians who worked in the Suva medical area as PHC physicians with at least 6 months' experience in the Special Outpatients Department clinics. In-depth interview were conducted using a semi-structured questionnaire over the telephone and recorded on a tablet device application. The interview content was then transcribed, and thematic analysis was done. This study included 25 PHC physicians. From the thematic analysis, 2 major themes emerged with 6 subthemes. Theme 1 was CVD management skills with 3 subthemes including education, experience and trainings, beliefs and attitudes of physicians, self-confidence and effectiveness in CVD risk reduction and management. Theme 2 was roles and expectations with 3 subthemes including perceptions of effective treatment, perceptions of physicians' roles and perceptions of patients' expectations. Physicians generally see their role as central and imperative. They perceive to be important and leading toward combating CVDs. Physicians' perceptions on their commitment to prevention and management of CVDs through their skills and knowledge, beliefs and motivation should be acknowledged. It is recommended that the physicians are updated on the current evidence-based medicine. Limitations include results that may not be the reflection of the entire physician and multidisciplinary community and the difficulties in face-to-face interviews due to the coronavirus diseases of 2019 pandemic.
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Demystifying case management in Aotearoa New Zealand: A scoping and mapping reviewBackground: Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. Aim: This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). Methods: Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. Results: A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. Conclusions: Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care.
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Developing and validating a school-based screening tool of Fundamental Movement Skills (FUNMOVES) using Rasch analysisA large proportion of children are not able to perform age-appropriate fundamental movement skills (FMS). Thus, it is important to assess FMS so that children needing additional support can be identified in a timely fashion. There is great potential for universal screening of FMS in schools, but research has established that current assessment tools are not fit for purpose. To develop and validate the psychometric properties of a FMS assessment tool designed specifically to meet the demands of universal screening in schools. A working group consisting of academics from developmental psychology, public health and behavioural epidemiology developed an assessment tool (FUNMOVES) based on theory and prior evidence. Over three studies, 814 children aged 4 to 11 years were assessed in school using FUNMOVES. Rasch analysis was used to evaluate structural validity and modifications were then made to FUNMOVES activities after each study based on Rasch results and implementation fidelity. The initial Rasch analysis found numerous psychometric problems including multidimensionality, disordered thresholds, local dependency, and misfitting items. Study 2 showed a unidimensional measure, with acceptable internal consistency and no local dependency, but that did not fit the Rasch model. Performance on a jumping task was misfitting, and there were issues with disordered thresholds (for jumping, hopping and balance tasks). Study 3 revealed a unidimensional assessment tool with good fit to the Rasch model, and no further issues, once jumping and hopping scoring were modified. The finalised version of FUNMOVES (after three iterations) meets standards for accurate measurement, is free and able to assess a whole class in under an hour using resources available in schools. Thus FUNMOVES has the potential to allow schools to efficiently screen FMS to ensure that targeted support can be provided and disability barriers removed.
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Exploring families' acceptance of wearable activity trackers: A mixed-methods studyThe family environment plays a crucial role in child physical activity (PA). Wearable activity trackers (wearables) show potential for increasing children's PA; however, few studies have explored families' acceptance of wearables. This study investigated the acceptability of using wearables in a family setting, aligning experiences with components of the Technology Acceptance Model and Theoretical Domains Framework. Twenty-four families, with children aged 5-9 years, took part in a 5-week study, where all members were provided with a Fitbit Alta HR for 4 weeks. Acceptability was measured using weekly surveys and pre-post-questionnaires. Nineteen families participated in a focus group. Quantitative and qualitative data were integrated using the Pillar Integration Process technique. Pillars reflected (1) external variables impacting wearable use and PA and (2) wearable use, (3) ease of use, (4) usefulness for increasing PA and other health outcomes, (5) attitudes, and (6) intention to use a wearable, including future intervention suggestions. Families found the Fitbit easy to use and acceptable, but use varied, and perceived impact on PA were mixed, with external variables contributing towards this. This study provides insights into how wearables may be integrated into family-based PA interventions and highlights barriers and facilitators of family wearable use.
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Assessing the impacts of creating active schools on organisational culture for physical activityNational and international guidance recommends whole-school approaches to physical activity, but there are few studies assessing their effectiveness, especially at an organisational level. This study assesses the impact of the Creating Active School's (CAS) programme on organisational changes to physical activity provision. In-school CAS leads completed a 77-item questionnaire assessing school-level organisational change. The questionnaire comprised 19 domains aligned with the CAS framework and COM-B model of behaviour change. Wilcoxon Signed Rank Tests assessed the pre-to-nine-month change. >70% of schools (n = 53) pre-CAS had inadequate whole-school physical activity provision. After nine months (n = 32), CAS had a significant positive effect on organisational physical activity. The positive change was observed for: whole-school culture and ethos, teachers and wider school staff, academic lessons, physical education (PE) lessons, commute to/from school and stakeholder behaviour. This study provides preliminary evidence that CAS is a viable model to facilitate system-level change for physical activity in schools located within deprived areas of a multi-ethnic city. To confirm the results, future studies are required which adopt controlled designs combined with a holistic understanding of implementation determinants and underlying mechanisms.
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The use of wearable activity trackers in schools to promote child and adolescent physical activity: A descriptive content analysis of school staff's perspectivesThe school environment is an ideal setting for promoting physical activity (PA). Wearable activity trackers (wearables) have previously been implemented, in research, as intervention tools within the school-environment. However, the large-scale use and acceptance of wearables, in schools, is unknown. This study distributed a cross-sectional survey to school staff to investigate the prevalence of child and adolescent wearable use in schools, including when and how they are used, and school staff's willingness to use them in the future (as implemented by school staff). This survey consisted of between 13 and 22 items, including closed-ended and open-ended questions. Closed-ended responses were displayed descriptively (wearable prevalence and characteristics), and open-ended qualitative responses were categorised using descriptive content analysis (how wearables are used). 1087 school staff provided valid responses. Of those, 896 (82.4%) had never used a wearable as a teaching or support tool for their students, and 120 (11%) currently used- and 71 (6.5%) had previously used- a wearable as a teaching or support tool for their students. When wearables were used, school staff implemented their use regularly and during physical education lessons or throughout the entire school day. Wearables were used to monitor or increase student's PA levels, or for student and staff educational purposes (e.g., academic learning, movement breaks). Most school staff were willing to use a wearable as a teaching or support tool to promote student's PA, and/or learning about PA, in the future. This study is the first study to explore the widescale use and acceptance of children and adolescents using wearables in the school-setting. Findings may inform the development of future school-based interventions and public health initiatives for physical activity promotion, using wearables.
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Living with dementia during the COVID-19 pandemic: insights into identity from the IDEAL cohortThe continuing COVID-19 pandemic and social restrictions have impacted on the cognitive decline and mental health of people with dementia. Social isolation and loss of activities due to social restrictions may also have implications as to sense of identity for people with dementia. As part of the INCLUDE (Identifying and Mitigating the Individual and Dyadic Impact of COVID-19 and Life Under Physical Distancing on People with Dementia and Carers) component of the IDEAL (Improving the Experience of Dementia and Enhancing Active Life) cohort study, the overall aim of this subtle realist qualitative study was to explore the perspectives of people with dementia on living through the COVID-19 pandemic within the context of the ‘post-vaccine’ period and the national lockdowns in England and Wales; and to determine perceived challenges to and facilitators of ‘living well’ during the COVID-19 pandemic and beyond as restrictions were eased. In addition, the study findings are considered in relation to understandings of identity in dementia which the broader accounts of living through the pandemic have highlighted. Seven people with mild-to-moderate dementia were interviewed and themes were derived using framework analysis. Themes suggest interviewees' stoic acceptance of the pandemic and social restrictions but also fear of decline related to the temporality of their condition as well as loss of self-confidence to re-engage with the world. Interviewees managed threats to social identity by striving to maintain social and emotional connections, where the importance of a shared, social identity, particularly for people with young-onset dementia, was also apparent. Unlike in previous studies during the pandemic, the relevance of occupation for identity was observed, where maintaining previous or new activities or occupations was important to facilitate identity as well as to keep a sense of purpose. Therefore, as well as supporting people with dementia as the pandemic eases, future research into occupation and identity in dementia is of potential value.
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The impact of dementia education on student paramedics preparedness to care, knowledge, confidence, and attitudes towards dementia: an analytic surveyBackground: Paramedics play a vital role in the emergency health care of people living with dementia. People with dementia often have complex needs, posing challenges for paramedics. Paramedics often lack the confidence and skills to assess people with dementia appropriately and receive little, if any, dementia education. Aims: To evaluate the impact of dementia education on student paramedics preparedness to care, knowledge, confidence, and attitudes towards dementia. Methods: A 6-hour education programme on dementia was developed, implemented, and evaluated. A pre-test-post-test design using self-completion validated questionnaires was used to evaluate first year undergraduate student paramedics knowledge, confidence, and attitudes, towards dementia, as well as their preparedness to care for people with dementia. Results: Forty-three paramedic students attended the education programme with forty-one fully completed questionnaires being collected pre-training and thirty-two post-training. Students reported feeling significantly more preparedness to care for people with dementia after the education session (p
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Organizational preventative strategies undertaken by dental clinics in Fiji during COVID-19 Pandemic: A qualitative studyAim: This research aims to determine the organizational preventative strategies implemented by dental clinics in Fiji during the COVID-19 pandemic. Methods: This qualitative study was conducted amongst Dental Officers (Dos) and Dental Managers (DMs) who were working at government dental clinics, private dental clinics, and the School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji. A semi-structured open-ended questionnaire was used for data collection through in-depth interviews via zoom. A manual thematic analysis of the data was conducted. Results: Thirty Dos and 17 DMs participated in this study. 16 themes emerged from data analysis: Major Strategies implemented, Staff perception about strategies in place, Triaging and Screening, Hand hygiene, Waiting room changes, Operational Capacity, Universal precautions, Personal Protective Equipment (PPEs), Disinfection and decontamination protocols, Ventilation, Sterilization, Pre-procedural mouth rinse, Waste management, Vaccination status, Bubbles and Adaptation of Protocols. The Dos were generally satisfied with the strategies implemented by the DMs. The DMs along with other Dos had used various guidance documents to devise tailor-made ones suited for dental clinics in Fiji. Conclusion: Various strategies were adopted from several guidelines and tailor-made Standard Operating Procedures (SOPs) for each workplaces were developed by the various DMs. The majority of Dos were in favor of and satisfied with the protocols in place. Future research can be conducted in other divisions and include other health care professionals as well apart from just Dos and DMs.
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Effectiveness and safety of mechanical thrombectomy for acute ischaemic stroke in Latin American countries: A systematic reviewTo describe the use, effectiveness, and safety outcomes of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in Latin American countries. Studies reporting MT outcomes for AIS in Latin America were identified in CINAHL, MEDLINE, Web of Science, SciELO, EMBASE, and LILACS databases. Synthesis was conducted according to effectiveness (recanalization rates) and safety measures (mortality and functional independence at 90 days). Seventeen studies were included, mainly from public and university hospitals. MT utilization varied from 2.6% to 50.1%, while successful recanalization ranged from 63% to 95%. Functional independence 90 days after stroke (a modified Rankin scale score of 0 to 2) was achieved in less than 40% across most studies. Mortality rates were below 30%; studies with posterior circulation strokes reported higher mortality rates. The randomized trial reported better health outcomes for functional independence among patients in the MT group (OR 2.28; 95% CI, 1.41 - 3.69), favoring MT over standard care. The included studies had great methodological heterogeneity due to differences in study design, the MT time window, and stroke location. The only randomized trial showed improved functional independence and lower mortality rates with MT than with standard care. The rest of the studies reported similar findings to available literature. Efforts to improve stroke care are reflected in improved patient outcomes in the region. Future studies should consider standard time window criteria and reduce the risk of bias by including representative samples and comparison groups.
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Designer benzodiazepines gidazepam and desalkygidazepam (bromonordiazepam): What do we know?Designer benzodiazepines are one of the primary new psychoactive substances (NPS) threats around the world, being found in large numbers in post-mortem, driving under the influence of drugs (DUID) and drug facilitated sexual assault (DFSA) cases. Even though when compared to many other NPS types, such as opioids and cathinones, there are relatively few designer benzodiazepines being monitored. Recently a new NPS benzodiazepine has been reported in Europe, the USA and Canada, desalkygidazepam, also known as bromonordiazepam. This substance is a metabolite of the pro-drug gidazepam, a drug licenced for use in Ukraine and Russia under the name Gidazepam IC®. In the paper we review what is currently known about the use, pharmacology and analytical detection of gidazepam, its metabolite desalkygidazepam, and their other possible metabolites.
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Intra and Inter-Rater Reliability of a Novel Isometric Test of Neck Strength.There is no single, universally accepted method of measuring isometric neck strength to inform exercise prescription and injury risk prediction. This study aimed to establish the inter- and intra-rater reliability of a commercially available fixed frame dynamometer in measuring peak isometric neck strength. A convenience sample of male (n = 16) and female (n = 20) university students performed maximal isometric contractions for flexion (Flex), extension (Ext), left- (LSF) and right-side flexion (RSF) in a quadruped position over three sessions. The intra-rater reliability results were good-to-excellent for both males (ICC = 0.83–0.90) and females (ICC = 0.86–0.94) and acceptable (CV < 15%) across all directions for both males and females. The inter-rater reliability results were excellent (ICC = 0.96–0.97) and acceptable (CV < 11.1%) across all directions. Findings demonstrated a significant effect for sex (p ≤ 0.05): males were stronger in all four directions, and a significant effect for direction (p ≤ 0.05): Ext tested stronger (193 N) than Flex (176 N), LSF (130 N) and RSF (125 N). The findings show that the VALD fixed frame dynamometer can reliably assess isometric neck strength and can provides reference values for healthy males and females.
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Implementing seating guidelines into clinical practice and policy: A critical reflection and novel theoryIntroduction: A significant proportion of healthcare that is delivered is wasteful, harmful and not evidence based. There are many wound care related guidelines, but their implementation in practice is variable. The Society of Tissue Viability (SoTV) published updated seating guidelines in 2017, but there is a lack of theoretical and conceptual clarity about how these guidelines are being utilised to inform clinical practice. Therefore, the aim of this paper is to generate a theory that can be used to incorporate the SoTV seating guidelines into policy and clinical practice. Methods: We critically reflected on data from an evaluation study utilising systems-thinking approach, informed by implementation and safety science using wider literature as well as our expertise to generate a guideline implementation theory. Discussion: Factors that facilitate or hinder the incorporation of the SoTV guidelines into policy and practice were characterised. We conceptualised the implementation of these guidelines into policy and practice into a Translation or Implementation into Policy or Practice (TIPP) theory with distinct stages, that we called liminal spaces. Knowledge of the guidelines, and the agency or authority to effect change, are key factors in the translation of these guidelines into clinical practice. Conclusion: Our theory is that there are liminal spaces in the implementation trajectory of these guidelines into practice, which have their own characteristics. This theory provides a framework that can be used to underpin guidelines strategies to embed skin and wound care guidelines into policy and clinical practice in order to improve patient care.
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Perceptions of public health nursing Team Leaders (TLs) and Team Supervisors (TSs) on nurse's development in FijiNurse team leaders are responsible for contributing to managing the quality of service delivery and facility output of their nurses to ensure there is a high quality of care delivered by the health system. This study aimed to explore the perceptions of public health nursing Team Leaders (TLs) and public health nursing Team Supervisors (TSs) on nurses' development in Fiji. A qualitative study was used to gather information using in-depth phone interviews among TLs and TSs comprising Chief Midwifery Nursing Officer (CMNO), Director of Nursing (DON), Sub-divisional Nursing Managers (SDNMs), acting SDNMs and Nursing Manager (NM) at Central health division in Fiji. The data was collected through semi-structured open-ended questionnaires and were audio recorded. The data was analyzed using manual thematic analysis process. The study comprised of 26 participants, which included 10 TSs and 16 TLs. Four themes were identified for the results amongst TSs and TLs: ethical development; professional development; psychological development; and recommendations. However, nine sub- themes were identified for TSs and eight sub-themes were identified for the result amongst TLs. This study highlighted that TLs and TSs elaborated on the need for the ethical, professional, psychological development, nursing development and also on the importance of policies and guidelines. Professional ethics should be integrated into the Continuous Profession Development (CPD) points that are used to renew yearly nursing licenses as well as exposing the need for having competencies on professional ethics in nurses' logbooks. Further research is needed to determine the in-depth barriers.
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"Once you get cancer you die. There is no way to get saved from cancer." A qualitative exploration of patients' perceptions towards cancer in FijiUnderstanding patients' perspective to get an insight into cancer, and how best the public health systems can battle with this disease is the way forward in this current world. This study aimed to explore patients' knowledge about common cancers, barriers to assessing cancer information and cancer preventative approaches in Fiji. The study used a qualitative method approach that was conducted among patients who attended Special Outpatients (SOPD) at the four selected health centres in Lautoka Subdivision, Fiji from 1st March to 30th April 2021. A semi-structured open-ended questionnaire was used to guide in-depth interviews. These audio recordings were transcribed and analysed using thematic analysis. All interview transcripts were read and similar words and phrases were assigned numbers which were grouped together to identify themes and sub themes. Twenty-eight patients took part in the in-depth interview and the responses were grouped into four themes including; cancer knowledge, diagnosis of cancer in a close friend/family, barriers of communication and optimizing cancer awareness. Patients' awareness about common cancers and cancer risk factors was low. Many barriers for cancer screening were highlighted including stigmatization, fear, worry, death, lack of information, herbal medicine use, lack of resources and delay in diagnosis. Awareness strategies highlighted by participants included community outreach programs, house to house visits, opportunistic screening, engagement of community health care workers and the concept of a cancer hub centre. It is evident that there is a range of views from patients towards cancer and it is important to understand these perceptions to better guide public health interventions concerning cancer. This puts more focus on the need to invest more in information, education, and communication material for public campaigns that target a variety of people for a wider reach.
