Description: Journal of Proteome Research DOI: 10.1021/pr400321x

Description: Analytical Chemistry DOI: 10.1021/ac400982w

Description: Background: Telehealth (TH) and telecare (TC) interventions are increasingly valued for supporting selfcarein ageing populations; however, evaluation studies often report high rates of nonparticipationthat are not well understood. This paper reports from a qualitative study nestedwithin a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD)project. It explores barriers to participation and adoption of TH and TC from the perspectiveof people who declined to participate or withdrew from the trial. Methods: Qualitative semi-structured interviews were conducted with 22 people who declined toparticipate in the trial following explanations of the intervention (n = 19), or who withdrewfrom the intervention arm (n = 3). Participants were recruited from the four trial groups (withdiabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and allcame from the three trial areas (Cornwall, Kent, east London). Observations of home visitswhere the trial and interventions were first explained were also conducted by shadowing 8members of health and social care staff visiting 23 people at home. Field notes were made ofobservational visits and explored alongside interview transcripts to elicit key themes. Results: Barriers to adoption of TH and TC associated with non-participation and withdrawal from thetrial were identified within the following themes: requirements for technical competence andoperation of equipment; threats to identity, independence and self-care; expectations andexperiences of disruption to services. Respondents held concerns that special skills wereneeded to operate equipment but these were often based on misunderstandings. Respondents'views were often explained in terms of potential threats to identity associated with positiveageing and self-reliance, and views that interventions could undermine self-care and coping.Finally, participants were reluctant to risk potentially disruptive changes to existing servicesthat were often highly valued. Conclusions: These findings regarding perceptions of potential disruption of interventions to identity andservices go beyond more common expectations that concerns about privacy and dislike oftechnology deter uptake. These insights have implications for health and social care staffindicating that more detailed information and time for discussion could be valuable especiallyon introduction. It seems especially important for potential recipients to have the opportunityto discuss their expectations and such views might usefully feed back into design andImplementation

Description: Background: Available birth settings have diversified in Canada since the integration of regulated midwifery. Midwives are required to offer eligible women choice of birth place; and 25-30% of midwifery clients plan home births. Canadian provincial health ministries have instituted reimbursement schema and regulatory guidelines to ensure access to midwives in all settings. Evidence from well-designed Canadian cohort studies demonstrate the safety and efficacy of midwife-attended home birth. However, national rates of planned home birth remain low, and many maternity providers do not support choice of birth place. Methods: In this national, mixed-methods study, our team administered a cross-sectional survey, and developed a 17 item Provider Attitudes to Planned Home Birth Scale (PAPHB-m) to assess attitudes towards home birth among maternity providers. We entered care provider type into a linear regression model, with the PAPHB-m score as the outcome variable. Using Students' t tests and ANOVA for categorical variables and correlational analysis (Pearson's r) for continuous variables, we conducted provider-specific bivariate analyses of all socio-demographic, education, and practice variables (n=90) that were in both the midwife and physician surveys. Results: Median favourability scores on the PAPHB-m scale were very low among obstetricians (33.0), moderately low for family physicians (38.0) and very high for midwives (80.0), and 84% of the variance in attitudes could be accounted for by care provider type. Amount of exposure to planned home birth during midwifery or medical education and practice was significantly associated with favourability scores. Concerns about perinatal loss and lawsuits, discomfort with inter-professional consultations, and preference for the familiarity of the hospital correlated with less favourable attitudes to home birth. Among all providers, favourability scores were linked to beliefs about the evidence on safety of home birth, and confidence in their own ability to manage obstetric emergencies at a home birth. Conclusions: Increasing the knowledge base among all maternity providers about planned home birth may increase favourability. Key learning competencies include criteria for birth site selection, management of obstetric emergencies at planned home births, critical appraisal of literature on safety of home birth, and inter-professional communication and collaboration when women are transferred from home to hospital.