ABSTRACT Objective The aim of this study was to evaluate the acceptability and feasibility of a Parent Peer support programme in rural and remote Queensland to support parents and improve mental wellbeing, and to describe programme co‐design and implementation. Setting Central Queensland. Participants Parent Peers and project stakeholders involved in the co‐design, development, and implementation of a rural and remote Parent Peer support programme. Design A mixed‐methods study using online surveys and interviews explored the co‐design, implementation, and perceptions of a Peer Support programme for parents in four rural and remote Queensland communities and a Parent Peer training programme. Seven Parent Peers and 13 stakeholders provided perspectives on the co‐design process and the implementation of the Parent Peer programme. Parent Peers also provided feedback on the Peer Support training modules. Descriptive statistics and thematic and summative content analysis were used to analyse and describe quantitative and qualitative data. Results Two themes were identified, including ‘Connection and Collaboration’, which identified the collaborative, co‑design process as crucial for the successful development, implementation, and sustainability of the programme; and ‘An Evolving Role’, which acknowledged the importance of the evolving and adaptable nature of the role to ensure tailored and responsive strategies for individual communities. Training was acceptable and engaging for Parent Peers, providing them with valuable education and support as they began their role. Conclusion The co‐designed Parent Peer programme was feasible, acceptable, and strongly supported by participants. The Parent Peer role needed to be flexible and adaptable to meet changing and unique community needs. The Parent Peer model could be widely implemented in rural and remote communities across Australia to improve parent support and wellbeing. Patient or Public Contribution An iterative consultative co‐design process was systematically followed throughout. Organisational healthcare professionals,individuals with lived experience, parents, early education specialists, and community stakeholders were actively involved in the design, development, and implementation of the Parent Peer project.
ABSTRACT Background The co‐occurrence of diabetes and tuberculosis (TB) worsens outcomes for both conditions, increasing mortality risk and treatment failure. Despite the need for integrated care for the two conditions, evidence on feasible and context‐specific implementation strategies remains limited. This study explored the implementation potential of contextually designed implementation strategies to integrate diabetes within TB care in Pakistan, using the Optimised TB and Diabetes (Opt‐TBD) package. Methods This qualitative case study was conducted from October 2023 to June 2024, across four TB facilities representing primary, secondary and tertiary levels of care in Pakistan. Using a qualitative design, we conducted in‐depth interviews with TB patients with comorbid diabetes ( n = 12) at 3 and 6 months after implementation, while healthcare providers ( n = 6) were interviewed towards the end of the implementation period. We applied the Consolidated Framework for Implementation Research (CFIR) alongside Proctor's implementation outcomes framework to explore implementation processes and six implementation outcomes: acceptability, appropriateness, feasibility, adoption, penetration and sustainability. Results Several contextually tailored implementation strategies, including structured staff training, standardised screening protocols and strengthened referral mechanisms, were employed to integrate diabetes care within routine TB services. Overall, the intervention aligned well with existing TB workflows, provided that adequate resources, clearly defined referral pathways and ongoing staff training were ensured. Despite logistical challenges—such as delays in obtaining HbA1c test results and patient privacy concerns—healthcare providers reported adopting diabetes screening and counselling practices beyond the initial study participants. Strong leadership engagement and consistent programmatic support facilitated early implementation; however, sustaining these efforts long‐term will require securing dedicated financial resources and formal integration into policy frameworks. Conclusion This qualitative study indicates promising implementation potential for integrating the Opt‐TBD care package within routine TB services in Pakistan. Participants generally perceived the package as acceptable and workable within routine TB services, while laboratory delays, referral challenges and dependence on external financing remained important barriers to wider implementation. These findings informed refinement of the Opt‐TBD package and the subsequent broader RE‐AIM evaluation. Lived Experience or Public Contribution To develop a more inclusive and contextually relevant integrated TB–diabetes care pathway, we gathered input from both service providers and service users, including patients with TB–diabetes multimorbidity. The Opt‐TBD care package was co‐designed with relevant stakeholders, and this qualitative study was undertaken to capture the experiences and insights of patients and healthcare providers during implementation. Participation was sought across different genders, age groups, provinces and levels of care to ensure a broad range of perspectives. This approach helped ensure that the views of those directly affected by and involved in service delivery informed the refinement of the care package and its implementation strategies.
ABSTRACT Introduction Long COVID is a multi‐system condition that affects an increasing number of individuals. Little is known about the support needs of people living with long COVID in Aotearoa New Zealand. This study aimed to explore the lived experiences and healthcare access challenges of people with long COVID to better inform service design. Methods Co‐design methodology was used, informed by the Stanford Design Thinking process and knowledge mobilisation approaches. Participants were recruited via snowballing, through professional networks and support groups. People with lived experience of long COVID were invited to participate in a 2‐h workshop, facilitated by researchers, conducted between March and September 2024. Participants were asked to create a depiction of their experience of long COVID and describe their creation to the group; descriptions were audio‐recorded, transcribed and thematically analysed. The inclusion of people with lived experience of long COVID as co‐investigators ensured that the study was designed and conducted to forefront their knowledge and experience. Results Eight workshops were conducted, including 30 participants, between March and August 2024. Of these, 25 (83%) were female; of the 25 who provided their age, most were aged 45 to 64 years ( n = 18, 72%), four (16%) were aged 25 to 44 years and three (12%) aged 65 years or older. Five key themes emerged: (i) lack of assistance; (ii) systemic barriers; (iii) absence of long COVID clinics; (iv) financial strain; and (v) low quality of care. A sixth theme identified personal coping strategies. Conclusions Individuals with long COVID in Aotearoa New Zealand face major barriers to care, including inadequate services, financial hardship, and fragmented healthcare pathways. Findings support improved pathways and primary health care education in long COVID. A person‐centred, coordinated, and accessible model of care is needed. Lived Experience or Public Contribution The study was designed with two people with lived experience of long COVID included as co‐investigators, and a further one on the Advisory Board. All participants had lived experience of long COVID.
ABSTRACT Background Management of a degenerative meniscal tear (DMT) or symptoms consistent with early knee osteoarthritis (OA) frequently deviates from international clinical practice guidelines, which recommend education and exercise as first‐line treatments and strongly advise against arthroscopic partial meniscectomy. There is a need for implementation strategies to support the uptake of evidence‐based care. Methods A systematic, four‐step intervention development process was used to guide development of a multi‐faceted implementation intervention targeting both individuals with a DMT or early knee OA and their general practitioners (GPs). The process integrated behavioural theory, stakeholder perspectives and evidence on intervention effectiveness. Target behaviours were identified through a literature review and stakeholder consultation. Previously conducted qualitative interviews with 17 GPs and 11 people with DMT were re‐analysed and mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and enablers to the targeted behaviours. Behaviour change techniques (BCTs) and intervention components were then selected to address these determinants. Stakeholder input was incorporated to enhance acceptability and feasibility. Results The resulting intervention aims to promote guideline‐concordant management of a DMT and early knee OA. A programme theory to guide implementation was developed to describe hypothesised mechanisms of action, and candidate outcome measures were identified to support future evaluation and assess the mediating mechanisms of behaviour change. Conclusion Using a systematic, theory‐informed and stakeholder‐engaged approach, we developed a multi‐faceted intervention to support delivery and uptake of evidence‐based care for DMT and early knee OA. The intervention comprised GP educational workshops and resources to support an ‘enhanced consultation’, alongside referral to an early ‘best practice’ physiotherapy session. Patients received both components. The intervention was designed to be feasible, acceptable and locally relevant, but requires further testing to assess implementation and potential for scale‐up in clinical practice. Lived Experience or Public Contribution Stakeholder contributions played a central role in this study. People with lived experience of degenerative meniscal tears and/or knee OA ( n = 6) and healthcare professional stakeholders ( n = 15) were consulted during group discussions and individual meetings. Stakeholders informed every step of the development process, aiming to ensure the final intervention was feasible, acceptable and adapted to the local context.
