Table 4 Illustrative quotes
Quote Number | Quote |
|---|---|
Intervention Characteristics | |
Q1 | “we do not want to commit to anything extra than just the standard treatment” – Parent of Child with Cancer [87] |
Q2 | ‘It would be really nice if there was more pediatric evidence that one could actually rely on’ – Family physician [55] |
Q3 | “it would provide us with information that we may not be getting. Especially when the dynamics – when there’s a parent in the room and there’s a child – you might be getting… what’s important to the parent as opposed to what’s important to the child. [PROMs] may help highlight them to us” – Healthcare practitioner [91] |
Q4 | “Very few of us use it [the FOCUS], at all really. It doesn’t drive our therapies it doesn’t drive our strategies we will recommend, it doesn’t really drive anything we do at this point so, so then is really is, it becomes administrative’ – Speech-Language Pathologist [93] |
Q5 | “The other thing that was very helpful is getting our institution to actually provide institutional support specifically getting the Smart Form built into our EMR. I thought that was critical…”—Pediatric primary care clinician [57] |
Q6 | “the tool [developed and validated in the USA and implemented in Malawi without further validation] should include questions that are specifically for Malawi that are culture specific”—Psychosocial Counsellor Mentor [108] |
Q7 | “I found it easy to use and really helpful” – Adolescent with Chronic Pain [94] |
Q8 | “From the parents’ side is it’s too long. And unfortunately, the reading skills of our families is not, you know, up to speed to what’s there [...]” – Pediatric Attending [67] |
Q9 | “they tore out the pages or crossed it [items of a sensitive nature] out and just threw it [the PCOM] away” – Child Health Centre Nurse [100] |
Q10 | “My daughter usually says ‘Oh no, not again’ when she is handed the paper format. She loved using the tablet format. It is much more user friendly for kids/ teens.” – Parent/Caregiver of child with rheumatological condition [98] |
Q11 | “I think that... it will just be energy spent trying to get measures rather than trying to connect with the patient.” – Plastic surgeon [70] |
Outer Setting | |
Q12 | ‘If there are resources to refer them to, sure. But I don’t want to screen for something I can’t get services for.’ – Family Physician [55] |
Q13 | “it should not be introduced by an NGO because if it is being introduced by an NGO the health providers will consider it as an NGO thing. So, this should be incorporated into the main system of the government. The clinicians at government level need to incorporate this” – Medical Technician Mentor [108] |
Inner Setting | |
Q14 | “I think it is important that everybody’s sharing the same tool.” – Oncologist [103] |
Q15 | “I think it is really helpful just to see a bit of background information about them [the families] without necessarily having to go in and find that we’re all asking the same questions” – Child Life Therapist [103] |
Q16 | “Well, I think the downside is maybe just the burden and the work involved in making everything very systematic” – Orthodontist [70] |
Q17 | “... the parents fill it in themselves … I just kind of leave it with the families. I just take a few minutes to explain that, you know, it’s just three pages, it’s just a way for me to get to know you and your family. So for me it’s pretty minimal and even the scoring doesn’t take all that long really.” – Health and Social Care Professional [60] |
Q18 | “I think once healthcare team members see … that there are results that we can use out of this, I think certainly our practitioners would be very interested in this.” – Health and Social Care Professional [60] |
Q19 | “Implementation of new things usually is accommodated when there is an incentive attached to it, from experience that’s what I have seen” – Adolescent District Coordinator Mentor [108] |
Q20 | ‘…we don’t get paid enough and that’s what it comes down to, reimbursement. You should get decent reimbursement for the time that it takes …’ – primary care physician [55] |
Q21 | “As management we do support because when any new program comes, there is a management meeting, and we call general staff meeting explaining that we have this program…… Since management here receives programs well and it gives the program well to the service providers, the service providers also takes the initiative well and implement it.” – Deputy Clinic Manager Mentor [108] |
Q22 | “I don’t think that we’re appropriately staffed for successful child wellness screening…I think it should be people who have—are a little bit more consistent in work schedules so that they come to work reliably. Um, and that they have better organizational skills and better communication skills.” – Implementation Lead [67] |
Q23 | “Space is inadequate. The health providers would want to do some activities but where would they sit? The issues of HIV are sensitive, and you can’t just sit anywhere?” – Health Surveillance Mentor [108] |
Q24 | “It’s still a challenge to figure out how to gather the data and enter it live with the client.” – Child Mental Health Professional [65] |
Q25 | “We do put a reminder in our booking. So the therapist does have to remember that [to input the reminder into the booking system]. But in the booking, we set a reminder to booking. It’s noted and it comes up on the day’s log sheet. So when they walk into a session, it says the time the date, and the FOCUS. And so she [the SLP] knows they [the family] need to have the FOCUS done.” Speech-Language Pathologist [93] |
Individual Characteristics | |
Q26 | “unexpected responses [to the PCOM not elicited through standard history taking] significantly influenced patient management decisions” – Cardiologist [69] |
Q27 | “[If asked to complete PROMs] I’d feel annoyed… I feel it’s easier to talk about the things” – Child receiving solid organ transplant [91] |
Q28 | “I did worry, cos I thought … when I read through the questions, I thought he had to do it, all of them, and I thought, ‘Oh, my God, he's really slow.’” – Parent [78] |
Q29 | “With this you are working together with parents … you are encouraging the parents to have their own assessment with their child and see where they are before they come and see you.” – Health Professional [78] |
Q30 | “I think it is not always necessary to complete the KLIK questionnaires” – Child [89, 90] |
Q31 | “The clinician often does not discuss the KLIK ePROfile” – Parent [89, 90] |
Q32 | “too many other things on our mind [to complete the PCOM” – Parent of Child with Cancer [87] |
Q33 | “I mean, my child’s an introvert. So, I think sometimes [disclosing] is really uncomfortable for [them]” – Caregiver of Child with Solid Organ Transplant [91] |
Process | |
Q34 | “There are multiple steps where the screening process can sometimes not go well and so then we have to go back and fix it. So, we’ll go in and they wouldn’t have gotten the screen, so we have to get the screen. And then they wouldn’t have given the MA [Medical Assistant] the screen to score and we have to do that. And then, that’s just going outside the room after the visit has started and finding the appropriate person, and so that can be really inefficient.” – Pediatric Primary Care Clinician [57] |
Q35 | “this to me was sold to me ‘this is what you do now’” – Health Professional [78] |
Q36 | “First thing that we did was myself and the medical director, we went to the nursing leadership and we went to the administrative leadership in the clinic…we're all one team and we all kind of have our own tiers of leadership and we said, ‘You know, we are going to be doing this project. Do we get buy-in from you all to move forward with this project?’…that was kind of like the jumping point for going into the QI project.” – Pediatric Primary Care Clinician [57] |
Q37 | “I feel like we had a strong internal champion who kept us on task in a way that was not intrusive, but very supportive.” – Clinician [65] |
Q38 | “I think the biggest thing that helped was actually having a multidisciplinary team sort of as the champion for it in the clinic…by having one of your peers be a represented champion, that sort of got the other peers.” – Pediatric Primary Care Clinician [57] |
Q39 | “[External Change Agent] was very good about sharing resources that maybe she and one of the other sites came up with and having that accessible to other sites to use as kind of a framework to start with.” – Clinician [65] |
Q40 | “Parents think there is a lot to fill in and have often forgotten to fill it in and bring it with them” – Nurse [100] |
Patient Needs and Resources | |
Q41 | “[A patient] would feel like their voice is being heard and they’re actually having a chance to say what they think and what they feel because you don’t always have a chance to do that in clinic” – Healthcare Professional [91] |