Culture of discrimination in healthcare: A grounded theory

BACKGROUND

Discrimination in health care is an international challenge and a serious obstacle to justice and equality in health.

RESEARCH OBJECTIVE

The purpose of this study was to design a grounded theory of discrimination in health care based on the experiences and perceptions of Iranian healthcare providers and patients.

RESEARCH DESIGN

This qualitative study was conducted using by the grounded theory method.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected through semi-structured interviews with 18 healthcare providers including 11 nurses, two physicians, two nurse's assistants, and three patients in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling and analyzed simultaneously using the Corbin and Strauss (2015) approach.

ETHICAL CONSIDERATIONS

The study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1398.023). Also, after explaining the objectives of the study, all the participants completed and signed the written consent form.

FINDINGS

The "culture of discrimination" was the study's core category, reflecting the nature of discrimination in health care. The theory of "culture of discrimination in health care" is the result of five main categories: "individual social stimuli," "culture of discrimination," "unintentional discrimination," "conflict with discrimination," and "dissatisfaction with discriminatory behavior." These categories cover the underlying factors, strategies, and outcomes of the discrimination process in health care.

DISCUSSION

The results of the study showed that nurses and other health care providers experience unintentional discrimination. Unintentional discrimination refers to discriminatory behaviors and practices of health care providers.

CONCLUSION

The theory of culture of discrimination in health care can be used as a practical guide to describe and understand the role of health care providers, especially nurses. Further studies with a quantitative approach to applying this theory in medical settings are recommended.

Clinical nurse adherence to professional ethics: A grounded theory

BACKGROUND

Professional ethics is the regulation and discipline of nurses' daily nursing work. Nurses often encounter various ethical challenges and problems in their clinical work, but there are few studies on nurses' adherence to professional ethics.

RESEARCH AIM

An analysis of nursing adherence to nursing ethics from the perspective of clinical nurses in the Chinese public health system.

RESEARCH DESIGN

This study adopts the grounded theory approach proposed by Strauss and Corbin.

PARTICIPANTS AND RESEARCH CONTEXT

Between July 2021 and January 2022, Clinical nurses were recruited for online video interviews using purposive and theoretical sampling methods in seven hospitals in Beijing, Tianjin, Shanxi, Henan, Guangdong, and Fujian, China. Data analysis was conducted using Strauss and Corbin's coding approach.

ETHICAL CONSIDERATIONS

This study was approved by the Ethics Committee of Sanming First Hospital (MingYiLun 71/2021).

FINDINGS

A total of 27 participants were included. A theoretical model of nursing staff adherence to professional ethics was constructed. The main core was adherence to professional ethics and the other cores were (1) causal conditions: professional ethics code, individual conscience; (2) intervening conditions: personal growth, social support system, matching career compensation, prediction of adverse consequences; (3) action strategies: sticking to professional values, self-regulation, flexible response, post-event improvement; and (4) outcomes: self-harmony, reduced medical disputes.

CONCLUSIONS

This study provides an interpretive understanding of why clinical nurses adhere to professional ethics in China and describes the challenges and issues posed by nurses' use of strategies to cope with ethical adversity. The findings can be used to develop future complex studies.

Adaptation Process of Korean Elderly Women to Foreign Daughters-in-Law in Multicultural Rural Families: A Grounded Theory Method

INTRODUCTION

In South Korea, the number of multicultural families is steadily increasing. The purpose of the study was to examine and identify the process of adaptation of elderly women to foreign daughters-in-law in multicultural families in rural settings.

METHOD

This is a qualitative study and applies a grounded theory method. Data were collected through individual in-depth interviews between February and April 2019, involving 15 elderly women with foreign daughters-in-law, and analyzed employing Corbin and Strauss's grounded theory.

RESULTS

The results are demonstrated through the "Chaotic," "Resistive," "Exploratory," "Transitional," and "Receptive" periods, based on the flow of time.

DISCUSSION

The findings contribute to the practice and intervention of multicultural nursing by examining the adaptation process and providing future direction on the adaptation of elderly women who are part of multicultural families.

Model Construction of Chinese Preservice Physical Education Teachers' Perception of Social Media: A Grounded Theory Approach

(1) Background: Pre-service physical education teachers commonly embrace social media for multiple purposes. However, little is known about their perception of social media, which could affect the appropriate use of social media in their future professional work. This study aims to explore a theoretical model of how pre-service physical education teachers perceive social media in order to provide a basis for educators to guide their appropriate use of social media. (2) Methods: Qualitative data were collected in diverse ways, mainly from interviews. Seventeen Chinese preservice physical education teachers were selected as participants by a purposive sampling technique. The interview questions focused on participants' motivation, expectations, and experiences in social media usage. Grounded theory was used to analyze the data by ROST CM and Nvivo 12. (3) Results: The perception of social media among teachers includes three subsidiary categories made up of 10 sub-categories, 70 concepts, and 307 labels. The three categories are (a) value perception, including the perspective of intelligent function, interaction, and rich information, (b) risk perception, involving psychological risk, information risk and privacy risk and (c) overall perception, like development trends, current status and basic elements. (4) Conclusions: Chinese preservice physical education teachers perceive social media as having similarities and differences compared to other countries. Future research should consider a large sample survey to revise and verify the initial exploration of perception and study diverse groups of teachers' perceptions of social media.

Inheritance and Innovation of Pottery Sculpture Technique in Shiwan, China: A Grounded Study from Cultural Ecology

Ceramics play an important role in human daily life and production practice. Pottery sculpture technique is the core of ceramic making. However, the production process of traditional ceramics is accompanied by high pollution, which has a great impact on human health and the ecological environment. Rapid development of industrialization has exacerbated this consequence. As the "Pottery Capital of Southern China", Foshan has been involved in environmental crises while relying on the ceramic industry to develop. Since the 21st century, Foshan has gradually successfully driven to upgrade the city from industrial to culture-led by carrying out positive innovations in Shiwan pottery sculpture technique. Therefore, based on the theoretical perspective of cultural ecology, this paper selects Shiwan pottery sculpture technique as the object, uses Python (Octopus Collector) to obtain data, and applies grounded theory to generate the ecological evolution model. This study discussed how the Shiwan pottery sculpture technique promotes the harmonious coexistence of human beings, industries, and cities in the new cultural ecological environment of the 21st century by exploring and clarifying the interaction and function of different elements in different stages of evolution. Finally, this study not only makes up for the current lack of research on Shiwan's cultural ecology, but also provides meaningful reference for environmental reform in other industrialized cities.

Recovery-oriented daily care practice for community-based mental health service consumers in Japan: A grounded theory approach

Recovery, which is a non-linear, unique process allowing mental health service consumers to live autonomously, has become a prominent concept. However, adapting recovery-oriented practice to daily care is challenging. We explored recovery-oriented practice among mental health professionals in Japan via semi-structured interviews including nurses, occupational therapists, and psychiatric social workers (17 professionals in total). Data were analysed using grounded theory. Six categories emerged. The core category was 'Continuing to adjust care to meet consumers' needs for their unique lives'. The professionals stated that they practised in accordance with the service consumers' sincere hopes based on an equitable relationship because they believed that this approach would enhance consumers' personal agency, proactive behaviour, and self-choice. Despite negative consequences, the professionals did not view the consumers' choices as 'failures' and instead helped them to find meaning in their experiences. Although the therapeutic relationship tended to be paternalistic, participants described how concrete practices helped build an equitable relationship. In recovery-oriented practice, the provision of support centred on consumer values is important, without imposing own's own values. Care practices should also be aligned with consumers' hopes, needs and goals.

Experiences of families and health professionals along the care continuum for low-birth weight neonates: A constructivist grounded theory study

AIMS

To explore the experiences of health professionals and families concerning supporting low-birth weight (LBW) infants along the continuum of care (CoC) in Ghana with the goal to unveil new strategies to improve the quality of neonatal care.

DESIGN

A constructivist grounded theory.

METHOD

Simultaneous data collection and analysis among health professionals alongside families with LBW infants from September 2020 to April 2021. The study used constructivist grounded theory strategies for data collection and analysis.

RESULTS

The analysis of 25 interviews resulted in a theoretical model describing 10 themes along the CoC for LBW infants, categorized into health and family systems drivers. In this paper, we focus on the latter. Early bonding and family involvement were empowering. Mothers needed assistance in balancing hope and confidence which enabled them to render special care to their LBW infants. Providing mothers with financial and domestic support as well as creating awareness on newborn health in communities were important.

CONCLUSION

To achieve family involvement, a coordinated CoC must entail key players and be culturally inclusive. It must be applied at all levels in the CoC process in a non-linear faction. This can help LBW infants to thrive and to reach their full developmental potential.

IMPACT

The theoretical model developed shows the importance of family involvement through family systems care for a comprehensive response in addressing needs of health professionals and families with LBW infants and bridging the fragmentations in the neonatal CoC in Ghana. Context-tailored research on family systems care in the neonatal period is necessary to achieve a quality CoC for LBW infants and their families.

PATIENT OR PUBLIC CONTRIBUTION

Caregivers and providers participated by granting in-depth interviews. Care providers further contributed through their feedback on preliminary findings.

A Perceptual Structure of Soundscapes in Urban Public Spaces Using Semantic Coding Based on the Grounded Theory

The definition of 'soundscape' emphasises the perceptual construct of sounds; thus, the mechanism of sound perceptions becomes vital for soundscape evaluations. Using a qualitative approach, this study explored the aspects and processes of sound perceptions and built a perceptual soundscape structure from the insight of sociology. The interview was conducted between January and March 2018, in four urban public spaces. Data reached saturation after 23 participants were interviewed based on the grounded theory approach. Four perceptual aspects of sounds were identified from the semantic coding analysis: sound classification, sound features, psychological reactions, and soundscape preferences. These aspects form a three-level process of perceiving soundscapes: sound classifications, sound appraisals (including sound features and psychological reactions), and finally, judgment (soundscape preferences). Overall, four aspects categorised into three levels of perception make up the soundscape structure. Soundscape preferences are at the most profound level of perception and are informed by the previous three aspects. Soundscape preferences are expressed through descriptive words and narrative 'image'. The 'image' reflects people participating in different activities according to their social background. Social relationships influence soundscape preferences through people's sound requirements for various activities. The perceptual structure of soundscapes may provide guidance for future soundscape research and soundscape questionnaire design.

Tourism destinations and tourist behavior based on community interaction models of film-enabled tourism destinations

The importance of media-induced tourism has increased in the latest decade. The integration and collaboration of film elements is an especially effective pathway for the innovative development and upgrading of the experience of the cultural tourism industry. Existing studies on the mechanism of tourism destinations and cultural tourism development, mainly from the perspective of tourism destinations and tourist experience, have rarely explored the cultural tourism development mechanism from the perspective of interest-related community interaction in the film-enabling context. In this study, we conducted high-frequency word analysis and element category analysis of the online text data of the Japanese animation film Your Name from the angle of interest-related community interaction through utilizing online text analysis and Grounded Theory analysis. Based on the interest-related community interaction, we analyzed the elements of interest-related community interaction in cultural tourism triggered by the film, including tourist hotspots, tourism resources, the tourist experience, sightseeing expectations, tourism evaluation and information dissemination, and formulated the orientation pathway of film-enabling cultural tourism. In this study, we aimed to enrich cultural tourism research and provide a reference point and theoretical support for film-enabling cultural tourism in the Internet era by introducing the concept of interest-related community innovation to the scene of film-enabling cultural tourism.

A Study on Chinese Audience's Receptive Behavior towards Chinese and Western Cultural Hybridity Films Based on Grounded Theory-Taking Disney's Animated Film Turning Red as an Example

For a long time, Chinese audiences have not had a high opinion of hybrid Chinese and Western movies. However, the unanimous praise for Turning Red in China se ems to have reversed this situation. In order to verify whether the attitudinal behavior of Chinese audiences toward the film's hybridization of Chinese and Western cultures has changed, this study collected textual materials reflecting the Chinese audience's receptive attitudes toward the film: Douban reviews, short reviews, questionnaires and Mtime.com reviews. Through a grounded study of 664,312 words, a total of 16 initial categories and four main categories were obtained. Finally, a cognitive-emotional-attitudinal mechanism model was formed to explain the audience's receptive behavior process. The study found that Chinese audiences' positive reception of Turning Red comes more from the fact that the film touches on personal emotions and focuses on a series of issues such as growing up, family, and gender, with intergenerational conflict as the core. The audience achieves self-projection and empathy while watching the film, rather than recognizing the Chinese culture presented therein. On this basis, the research further found that the internal structure of the current cultural hybridity has not changed greatly. The reason audiences do not give a high evaluation of cultural hybridity films lies in the lack of conscious distinction between the hybridity culture and the local culture. At the same time, in terms of cross-cultural creation, we should abandon the blind pursuit of cultural symbols, take root in cultural soil and then pay attention to more specific problems. This study reveals that the key factor affecting the audience's receptive behavior toward cultural hybridity films is not necessarily the performance of local culture, which is of great significance for establishing new evaluation criteria.

Development of trauma team cognition can be explained by "split vision": A grounded theory study

The aim of this study was to explore interaction of interprofessional hospital trauma teams. A theory about how team cognition is developed through a dynamical process was established using grounded theory methodology. Video recordings of in-real-life resuscitations performed in the emergency ward of a Scandinavian mid-size urban hospital were collected and eligible for inclusion using theoretical sampling. By analyzing interactions during seven trauma resuscitations, the theory that trauma teams perform patient assessment and resuscitation by alternating between two process modes, the two main categories "team positioning" and "sensitivity to the patient," was generated. The core category "working with split vision" explicates how the teams interplay between the two modes to coordinate team focus with an emergent mental model of the specific situation. Split vision ensures that deeper aspects of the team, such as culture, knowledge, empathy, and patient needs are absorbed to continuously adapt team positioning and create precision in care for the specific patient.

Living in Stealth: A Grounded Theory Study of Transgender Women's Barriers to HIV-Prevention Services and Interventions

Background and Purpose: HIV infection is a health disparity among transgender women. Despite availability of HIV-prevention interventions and services, many transgender women do not access these interventions and services. The purpose of this study was to identify the process by which barriers may prevent transgender women from receiving HIV-prevention interventions and services and to have participants propose ideas on how to overcome these barriers. Methods: Utilizing a grounded theory approach, 25 in-depth, semistructured interviews were conducted with transgender women aged 20-69 years. After providing written informed consent, participants completed an in-depth individual interview. Interviews were audio-recorded and transcribed verbatim. Categories and subcategories were identified from the data using open, axial, and selective coding. Results: A theory grounded in the data named Living in Stealth emerged that described this central phenomenon that underpinned the other main categories of Encountering Social Barriers and Encountering Structural Barriers. Generating Ideas for Restructuring HIV-Prevention for Transgender Women was the final category in which participants provided ideas to overcome HIV-prevention barriers. Implications: Clinicians and researchers providing HIV-prevention services and interventions for transgender women need awareness of the complex nature of HIV prevention for this subpopulation of women. More research is needed to incorporate findings from this study into HIV-prevention interventions for transgender women.

Psycho-emotional recovery, the meaning of care in the process of providing palliative care to Iranian people with cancer: A grounded theory study

AIM

Despite the significance of palliative care in treating people with cancer, the provision of this type of care in Iran is vague and unorganized. This research intends to explore the meaning of care in the process of providing palliative care to Iranian people with cancer and to develop a theory that would explain the phenomenon.

DESIGN

This is a qualitative study in nature and Corbin and Strauss' Grounded Theory approach was used for data analysis.

METHODS

Data was collected through semi structured interviews that were held with 21 participants who have had experiences in receiving and providing palliative care. The study was conducted in April to December 2019 in palliative care centres of Tehran. Sampling first started purposefully and moved to theoretical once concepts began to emerge from the data. Comparative and continuous data analysis was undertaken using Corbin and Strauss' (Basics of qualitative research: Techniques and procedures for developing grounded theory, Sage, 2015) approach.

RESULTS

Main concerns of care providers in providing palliative care was to reduce the affliction and anxiety of patients by understanding the difficult state of patient and psycho-emotional recovery was identified as the core category, which was performed via three critical strategies: building emotional connection, reinforcing positive mindset and having a core value in care.

Easier, but not easy: Testing a grounded theory of breastfeeding experiences among women with larger birthweight infants

OBJECTIVE

Grounded Theory has previously been used to explore breastfeeding practices amongst average birthweight infants and these working hypotheses can be 'tested' in new contexts. A pre-existing Grounded Theory was applied to the context of women who gave birth to larger birthweight infants (≥4,000 g) to understand whether perceptions and practices of infant feeding were distinct.

DESIGN

A nested qualitative study analysed data from N = 10 women with a larger birthweight infant (≥4,000 g). Face-to-face, semi-structured interviews were audio-recorded and transcribed verbatim. Grounded Theory methodology was used to analyse data.

RESULTS

A pre-existing Grounded Theory of breastfeeding experiences derived from women with average birthweight infants did not hold true among women with larger birthweight infants. An alternative Grounded Theory was therefore proposed comprised of three discrete themes: Infant Ability to Breastfeed; Attenuating Maternal Concerns; and Reality of Breastfeeding.

CONCLUSIONS

Larger infant birthweight is potentially a protective factor against breastfeeding latch and lactation difficulties. It is associated with alleviating maternal concerns, helping to reduce disparities between expectations of breastfeeding and reality, but does not alleviate the demands breastfeeding places on women. Healthcare professionals help to attenuate women's concerns, however the support needs for women with larger birthweight infants may not differ from existing care recommendations.

Interactions between children, parents and nurses during postoperative pain management: A grounded theory study

AIM

To explore the interactions between children, parents and nurses during postoperative pain management.

BACKGROUND

Despite the growing evidence relating to postoperative pain management in children and relevant practice guidelines, children still experience moderate to severe pain after surgery. One factor could be related to the relatively unexplored child-parent-nurse interaction.

DESIGN

A qualitative constructivist grounded theory methodology.

METHODS

Data were collected from a paediatric hospital in the United Kingdom. Ten children aged between 6 and 11 years old who had undergone surgery, 11 parents and 10 nurses participated. Methods included face-to-face semi-structured interviews. Data were analysed using constant comparison technique, memos and constructivist grounded theory coding levels. The COREQ guidelines were followed for reporting.

FINDINGS

Three concepts emerged from data, "Parents as a communicator for child-nurse interaction", "Parents' emotional turmoil in child-nurse interaction", and "Parents' actions in child-nurse interaction" which constructed the substantive theory of child-parent-nurse interaction during postoperative pain management: "Facilitating or Inhibiting Interactions: Parental Influence on Postoperative Pain Management". The findings highlight an absence of a three-way interaction between children, parents and nurses and a dyadic interaction process between children and nurses was not apparent. Instead, child-parent-nurse interactions were constructed around two dyads of child-parent and parent-nurse interactions with child-nurse interaction constructed via parents. Parents, as a communicator, influenced the entire postoperative pain management processes between children, parents and nurses by facilitating or inhibiting the interaction processes.

CONCLUSIONS

This study identifies potentially important evidence about the unique position parents hold between their child and nurses as a central pivotal communicator during children's postoperative pain management.

RELEVANCE TO CLINICAL PRACTICES

This study may help to explain how and why postoperative pain management remains suboptimal. The substantive theory could support improvements in the management of postoperative pain through a much wider recognition of parents' central pivotal communicator role and the complexity of these child-nurse interactions.

A constructivist grounded theory exploration of Mindfulness for Healthcare Professional students

BACKGROUND AND PURPOSE

To better understand the effects of an intervention, Mindfulness for Healthcare Professional (MIHP), and how it may improve healthcare professional student (HCP) functioning, a constructivist grounded theory exploration was conducted.

MATERIALS AND METHODS

Ten participants with the lowest or highest changes on quantitative measures of burnout and perceived stress at the end of MIHP were interviewed at a long-term follow-up. A theoretical framework was developed from the resultant themes to describe the mechanisms by which MIHP had effects on work-relevant functioning.

RESULTS

Three overarching themes emerged as mechanisms of change both from their presence in those participants reporting an improvement in stress and their missingness from those participants who reported no change: developing a mindfulness practice, integrating practice into daily life, and enhanced awareness. These mechanisms led to optimized work-relevant functioning: 1) emotional competencies, including nonjudgement, emotion regulation, and burnout prevention; and 2) patient-centered care, including improved listening, patience, and efficiency at work.

CONCLUSION

The resultant framework is discussed in the context of previous literature on MIHP and mindfulness theory more broadly. Implications for future disseminations of MIHP encourage the use of group interventions with emphasis on developing at-home practice and informal mindfulness integrated into daily work.

Surviving Child Abuse in People With Mental Illness: A Grounded Theory Approach

The aim of this qualitative study was to examine the process of surviving child abuse in people with a mental illness in order to develop an explanatory theory. The study utilized the grounded theory approach. Seventeen community-dwelling adults with a mental illness who had experienced child abuse were interviewed. For the in-depth interview, the lifeline interview method was used. Data were collected from July 14, 2019, to February 28, 2020. The constant comparative method was used for analysis, to identify similarities and differences between different statements, and similar phenomena or theories were compared and analyzed continuously. The central phenomena were "losing oneself" and "in a precarious state." Participants used "expressing," "standing on one's own feet," and "avoiding" as coping strategies. Observed outcomes were "making life work for them" and "living with others." The core category was "losing myself, embracing myself as someone in a precarious state, and being reborn as the master of my life." Positive religious coping, having a supportive network, and emotional or physical distance from difficult situations played a major role in surviving participants' experiences of child abuse and being victimized because of their mental illness. Our findings provide a theoretical basis for understanding people with mental illness who have survived child abuse, and suggest that opportunities for sharing their stories, facilitating self-reliance, and avoiding the causes of their difficulties all play a role in their healing process. Based on this study, it is expected that clinical experts and policy developers will be able to formulate evidence-based interventions and policies.

Understanding COVID-19 Risk Perceptions and Precautionary Behaviors in Black Chicagoans: A Grounded Theory Approach

OBJECTIVES

To determine whether actual community-level risk for COVID-19 in the Black community influenced individual perceptions of community-level and personal risk and how self-assessment of personal risk was reflected in the adoption of COVID-19 precautionary behaviors.

METHODS

Semistructured interviews were conducted with 20 Black Chicago adults from February to July 2021. A grounded theory approach was used for the qualitative analysis and initial, focused, and theoretical coding were performed.

RESULTS

We developed a grounded model consisting of four major themes: (a) Pre-Existing Health Conditions; (b) Presence of COVID-19 Infection in Participant Social Network; (c) COVID-19-Related Information, Participant Trust, and Perceived Personal Risk; and (d) Perceived Higher Burden of COVID-19 in the Black Community.

CONCLUSIONS

Higher perceptions of personal risk were shaped by pre-existing health conditions and experiences with COVID-19 in one's social network but were not influenced by perceived higher burden of COVID-19 in the Black community.

POLICY IMPLICATIONS

Black adults' perceptions of their individual risk and precautionary behaviors were not congruent with public health data and recommendations. Therefore, COVID-19 messaging and mitigation should be informed by local community engagement and transparent communication.

What motivates rural teachers to retain? A study on Chinese rural teachers' turnover from grounded theory and FsQCA

This research is aim at a deeper understanding of factors that leading Chinese rural teachers' (CRTs) turnover in their profession. The study regarded in-service CRTs (n = 408) as the participants, adopted the semi-structured interview and an online questionnaire to collect the data, and used grounded theory and FsQCA to analysis the data based. We have found that (A) welfare allowance, emotional support, and working environment can be substituted equivalently to increase CRTs' retention intention while professional identity regarded as the core condition; (B) career development is neglected for two reasons: one is CRTs compensated for inadequate social support by self-improvement; another is CRTs adapted themselves to accept professional stagnation; (C) the CRTs will have a strong intention to retain but lack enthusiasm for teaching because lack professional identity when the external environment is favorable. This study clarified the complicated causal relationships between CRTs' retention intention and its factors, contributed to the practical development of CRTs workforce.

International Medical Graduates' perceptions about residency training experience: a qualitative study

Objectives

To explore International Medical Graduates residents' experiences and perspectives of their residency training program.

Methods

This qualitative study was conducted at a large research-intensive University. Purposeful sampling was used to recruit 14 International medical graduates. The residents recruited for this study were at different levels in their training ranging from Postgraduate year one to five. Residents interviewed represented seven unique specialties. Each trainee was interviewed, and the data were recorded and transcribed verbatim. A thematic analysis framework was used to conduct the data analysis, resulting in the development of study themes.

Results

Our analysis generated six main themes. These themes were related to costly decisions, unspoken expectations, the stigma associated with being an IMG, fears of being an IMG, the strength and resilience of IMGs, and recommen-dations proposed by IMGs for program improvement.

Conclusions

In this study, we wanted to explore international residents' experiences with their programs. The experience of each individual international resident is unique. However, in this study, we were able to provide firsthand perceptions of IMGs from a research-intensive university and identified common themes experienced and perceived by our resi-dents. This study's findings may help educate, reduce stigma, and guide the implementation of effective individu-al and systemic support for these trainees. Which in turn will enhance the overall educational experiences for IMGs trainees. Our study found that themes seem to be recur-ring, hence, an urgency to bring about appropriate chang-es, equitable opportunities, and support for IMGs.

How do online users perceive health risks during public health emergencies? Empirical evidence from China

Background

The global COVID-19 pandemic has posed a major threat to human life and health, and new media technologies have intensified the spread of risk perception.

Purpose

This study aimed to explore the impact of risk information ground on online users' perceived health risks, and further explore the mediating role of psychological distance and the moderating role of self-efficacy.

Methods

A total of 25 Internet users from different provinces in China were interviewed in-depth, NVIVO.11 was used to qualitatively analyze the interview text data and construct a theoretical model. A total of 492 interviewees were recruited in order to complete a scenario questionnaire, SPSS-27 was used to perform orthogonal experiments, generate eight combinatorial scenarios, analyze demographic data, and clean and prepare data for testing hypotheses. SmartPLS 3.0 was used to test the conceptual model using the structural equation model (SEM) of the partial least squares (PLS).

Results

The analysis of the SEM model shows that all planned hypotheses (Information fluency → Information diagnosability, Information extensibility → Information diagnosability, Information diagnosability → Psychological distance, Platform interactivity → Scenario embeddedness, Network connectivity → Scenario embeddedness, Scenario embeddedness → Psychological distance, Psychological distance → Risk perception, Psychological distance → Self-efficacy → Risk perception, Information fluency → Information diagnosability → Psychological distance → Risk perception, Information extensibility → Information diagnosability → Psychological distance → Risk perception, Platform interactivity → Scenario embeddedness → Psychological distance → Risk perception, Network connectivity → Scenario embeddedness → Psychological distance → Risk perception) are confirmed.

Conclusion

This study found that the information ground factors significantly affect online users' perceptions of health risks, psychological distance mediates the effect of information ground factors on risk perception, and self-efficacy negatively moderates the effect of psychological distance on risk perception.

Factors influencing the satisfaction level of college students in China: Literature analysis based on grounded theory

Student satisfaction is an important index for evaluating the quality of higher education and the competitiveness of colleges in China, and most of the current studies on the factors influencing the satisfaction level of colleges students adopt quantitative research methods. A qualitative analysis of 48 literatures on college students' satisfaction was conducted using NVivo12 in this study. We found that the influencing factors of college students' satisfaction in China are composed of seven dimensions: school reputation, school environment, personal improvement, organizational management, logistical support, teaching quality, and charges and subsidies. Among them, teaching quality, school environment, organizational management, and logistical support are the core categories. Furthermore, school reputation, school environment, organizational management, logistical support, teaching quality, and charges and subsidies are external factors, while personal improvement is an internal factor. To improve the satisfaction level of college students, the two dimensions of external and internal factors must be taken into account, with external factors being given more attention. This study not only expands the scope of scenarios to which the grounded theory has been applied, but also provides a reference for other scholars to conduct more in-depth empirical studies on college students' satisfaction in Chinese colleges.

What are women's experiences of seeking to plan a vaginal breech birth? A systematic review and qualitative meta-synthesis

Background

Guidelines for breech management at term emphasise choice and informed decision-making. Despite this, the choice of vaginal breech birth (VBB), is not always available or accessible. We aimed to describe the experiences of women seeking a VBB as reported in primary research and to offer strategies for improving this experience that are grounded in evidence.

Methods

We conducted a systematic review and qualitative meta-synthesis of the results, using grounded theory analysis methods (PROSPERO registration CRD42021262380), with literature published between January 2000 and February 2022. Seven databases were searched. Our review included literature about women with breech presentation, who sought a planned or unplanned VBB. Studies considering only experiences of alternative management (e.g. caesarean, external cephalic version), and those investigating healthcare workers' experiences were excluded. Covidence systematic review software was used for screening and quality assessment. Qualitative data were extracted using NVivo software (20.5.0). Data were analysed through an iterative process based on constant comparison methods, with an iterative and reflexive code generation process. Codes were then arranged into 'categories of experience', which gave rise to over-arching themes.

Results

Our review included 19 studies. We present one overarching theory: 'Women who wish to plan a vaginal breech birth seek connected autonomy'. Our schematic, depicting this theory, includes seven main categories of experience: paternalistic healthcare; emotional turmoil; judgement and self-doubt; mother vs society: refusing to conform; isolated but united by breech; welcomed direction; and supported self-determination and self-efficacy.

Conclusions

Women seeking to plan a VBB feel vulnerable and wish to connect with capable and confident healthcare providers. To meet their needs, services should be designed so that they can connect with clinicians who are willing and able to support their autonomy. Services should also seek to limit their exposure to disrespectful and judgemental interactions with healthcare providers.

The Self-growth Process of Hospice Volunteers in Ningbo, China

Objective: The development process of self-growth among Chinese hospice volunteers is poorly understood. This study aimed to explore and delineate their dynamic progression toward self-growth. Methods: This qualitative study used grounded theory to analyze semi-structured interview data using individual in-depth face-to-face interviews with 15 volunteers at a hospice care center in Ningbo, China, between January 2021 and January 2022. Data analysis was based on the open, axial, and selective coding stages of grounded theory and used the constant comparative method. Results: From the interview data, we extracted 1 core category (Death awakening life), 4 categories, and 19 subcategories that pertained to the process of self-growth. The 4 categories delineated the process of self-growth; respondents progressed through self-salvation, self-reflection, self-healing, and self-transcendence stages. The 19 subcategories are introduced and illustrated with interview extracts. Conclusions: The study findings can inform the development of training projects aimed at improving hospice care volunteer services.

Research on the Cooperative Governance Path of Multiple Stakeholders in Doctor-Patient Disputes under the Environment of Information Asymmetry

The number of doctor-patient conflicts and disputes in China has been increasing recently. In order to solve the current social problems of the tense doctor-patient relationship and frequent medical disputes, this article, based on grounded theory, uses qualitative analysis software to conduct grounded coding on 622 cases of doctor-patient disputes randomly selected by stratification. After successively adopting open, axial, and selective coding, the relationship structure between the causes and development of medical disputes is summarized. Furthermore, this relationship structure can be used to analyze further and discuss the causes of doctor-patient disputes from the perspective of multiple co-governance and the governance framework of doctor-patient disputes. Finally, it reminds us of the need to standardize government's regulatory responsibilities, promote the equal distribution of medical resources, strengthen the communication awareness between doctors and patients, reduce the information asymmetry between doctors and patients, and build a preventive mechanism-oriented multi-subject collaborative governance path to promote the relationship between doctors and patients in China. We provide relevant countermeasures and suggestions for harmonious development and the smooth resolution of doctor-patient conflicts.

Analysis of network public opinion on COVID-19 epidemic based on the WSR theory

Objective

To obtain the influencing factors of public opinion reactions and to construct a basic framework of the factors causing the occurrence of online public opinion in the epidemic area.

Methods

The hot news comments on microblogs during the epidemic in Shanghai were collected and analyzed with qualitative analysis, grounded theory, and the "Wuli-Shili-Renli" (WSR) methodology as an auxiliary method.

Results

(1) Three core categories of the Wuli system, the Shili system, and the Renli system, 15 main categories, and 86 categories that influence the development of network public opinion are obtained. (2) WSR Elements Framework Of Network Public Opinion (WSR-EFONPO) is established. (3) The WSR-EFONPO is explained.

Conclusion

The framework of factors for the occurrence of network public opinion is proposed, and the development process of network public opinion under COVID-19 is sorted out, which is of great theoretical value in guiding the public in the epidemic area to form reasonable behavior.

Dehumanization in female victims of intimate partner violence

BACKGROUND

Dehumanization is a psychological construct meaning denying a person's humanity. The present study has investigated the process of dehumanization in female victims of intimate partner violence using the grounded theory approach.

METHODS

For this purpose, 130 women in Tehran were selected through the convenience sampling method, and after completion of the Revised Conflict Tactics Scales (CTS2), 60 female victims were identified. In-depth interviews started with these women, and the data reached theoretical saturation by interviewing ten victims.

RESULTS

The data analysis shows the role of dehumanization in the experiences of female victims of intimate partner violence in the form of two models. The first model showed that from the victim's perspective, dehumanization plays a crucial role in intimate partner violence. The second model showed that dehumanization was experienced by these women and is involved in developing strategies in their response to the violence. The combination of these two models showed that dehumanization and violence in the context of domestic violence have a reciprocal relationship, forming a cycle between cognitions, emotions, and negative behaviors between couples.

CONCLUSIONS

Data analysis demonstrated that dehumanization might have a role in experiencing intimate partner violence and contribute to IPV recurrence.

Multiple Concurrent Causal Relationships and Multiple Governance Pathways for Non-Pharmaceutical Intervention Policies in Pandemics: A Fuzzy Set Qualitative Comparative Analysis Based on 102 Countries and Regions

The global outbreak of COVID-19 has been wreaking havoc on all aspects of human societies. In addition to pharmaceutical interventions, non-pharmaceutical intervention policies have been proven to be crucial in slowing down the spread of the virus and reducing the impact of the outbreak on economic development, daily life, and social stability. However, no studies have focused on which non-pharmaceutical intervention policies are more effective; this is the focus of our study. We used data samples from 102 countries and regions around the world and selected seven categories of related policies, including work and school suspensions, assembly restrictions, movement restrictions, home isolation, international population movement restrictions, income subsidies, and testing and screening as the condition variables. A susceptible-exposed-infected-quarantined-recovered (SEIQR) model considering non-pharmaceutical intervention policies and latency with infectiousness was constructed to calculate the epidemic transmission rate as the outcome variable, and a fuzzy set qualitative comparative analysis (fsQCA) method was applied to explore the multiple concurrent causal relationships and multiple governance paths of non-pharmaceutical intervention policies for epidemics from the configuration perspective. We found a total of four non-pharmaceutical intervention policy pathways. Among them, L1 was highly suppressive, L2 was moderately suppressive, and L3 was externally suppressive. The results also showed that individual non-pharmaceutical intervention policy could not effectively suppress the spread of the pandemic. Moreover, three specific non-pharmaceutical intervention policies, including work stoppage and school closure, testing and screening, and economic subsidies, had a universal effect in the policies grouping for effective control of the pandemic transmission.

Finding family resilience in adversity: A grounded theory of families with children diagnosed with leukaemia

AIMS AND OBJECTIVES

To develop a conceptual framework that explores the process of building family resilience among Chinese families with children diagnosed with leukaemia.

BACKGROUND

The diagnosis of childhood leukaemia has a devastating effect on the family. Nonetheless, some families were able to positively respond to the crisis. The process through which Chinese families bounce back has received little attention.

DESIGN

Grounded theory.

METHODS

This study used purposive and theoretical sampling to select 16 parents who agreed to participate in semistructured interviews after children were diagnosed with leukaemia. Data collection and analysis occurred simultaneously. Data were analysed through a process of open, axial and selective coding. The COREQ checklist was followed for reporting.

RESULTS

A core category of 'finding family resilience in adversity' was generated. The core category was underpinned by a transition process between two fluid stages: (a) Disrupting the family system, informed by subcategories of negative emotional disturbances and challenges of the diagnosis and treatment journey; (b) Cultivating resilience in families, informed by subcategories of increasing positive attitudes; establishing new family routines; activating good support systems; and practising open family communication.

CONCLUSIONS

The transition process from the disruption of the family system to the cultivation of family resilience is perceived as a complex family dynamic in response to childhood leukaemia. Our findings can form the basis for further research about resilience-based family interventions that promote family well-being during the early stages of a childhood leukaemia diagnosis.

RELEVANCE TO CLINICAL PRACTICE

It is necessary for healthcare professionals to provide essential support for families to face the challenges of diagnosis and treatment to facilitate the successful transition to family resilience. By understanding the dynamic process of developing family resilience, healthcare professionals are able to focus on these families to provide holistic care that satisfies the specific demands of family members.

'The only way out': how self-care is conceptualized by Black women

OBJECTIVE

Discrimination in the lives of Black women often leads to maladaptive coping strategies that negatively influence health. Self-care encompasses practices that promote well-being; however, little is known about how Black women conceptualize and practice self-care.

DESIGN

This article reports qualitative findings from 10 semi-structured interviews conducted with 10 Black women subject-matter experts (SMEs) from throughout the US. There were eight individual interviews with SMEs who provided self-care services/content to other Black women and two group interviews with SME organizations that provided self-care and other wellness programs to Black women. This approach utilized both expert and personal lived experiences of SMEs.

RESULTS

Using the constant comparison analysis method, there was saturation with four concepts that describe the role of structural racism and sexism on the health outcomes of Black women, and the potential for self-care to mediate the negative relationship of these stressors on health. SME practices of self-care overlapped, comprising a 5-part theory of self-care.

CONCLUSION

Ultimately, self-care may help to combat the impact of structural influences on the health of Black women. Using self-care as a healthier approach to coping with stress can aid in the reduction of health disparities.

Early Stage Risk Identification and Governance of Major Emerging Infectious Diseases: A Double-Case Study Based on the Chinese Context

Purpose

Based on the Chinese context, this study uses severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) outbreaks as examples to identify the risk factors that lead to the major emerging infectious diseases outbreak, and put forward risk governance strategies to improve China's biosecurity risk prevention and control capabilities.

Material and Methods

This study combines grounded theory and WSR methodology, and utilizes the NVivo 12.0 qualitative analysis software to identify the risk factors that led to the major emerging infectious diseases outbreak. The research data was sourced from 168 publicly available official documents, which are highly authoritative and reliable.

Results

This study identified 10 categories of Wuli risk factors, 6 categories of logical Shili risk factors, and 8 categories of human Renli risk factors that contributed to the outbreak of major emerging infectious diseases. These risk factors were distributed across the early stages of the outbreak, and have different mechanisms of action at the macro and micro levels.

Conclusion

This study identified the risk factors that lead to the outbreak of major emerging infectious disease, and discovered the mechanism of the outbreak at the macro and micro levels. At the macro level, Wuli risk factors are the forefront antecedents that lead to the outbreak of the crisis, Renli factors are the intermediate regulatory factors, and Shili risk factors are the back-end posterior factors. At the micro level, there are risk coupling, risk superposition, and risk resonance interactions among various risk factors, leading to the outbreak of the crisis. Based on these interactive relationships, this study proposes risk governance strategies that are helpful for policymakers in dealing with similar crises in the future.

Online health community-An empirical analysis based on grounded theory and entropy weight TOPSIS method to evaluate the service quality

Introduction

With the enhancement of people's health awareness and the impact of the coronavirus pandemic in recent years, people's demand for online health information continues to expand, and online health communities (OHCs) have developed rapidly. However, the service quality of OHCs is uneven, and problems such as content quality, privacy disclosure are increasingly prominent. It's of great significance to establish normalized OHC service quality evaluation standards and develop effective evaluation tools and methods for the improvement of OHC service quality.

Material and Methods

Based on the grounded theory, the raw materials obtained from semi-structured interviews were coded in three stages to construct a service quality evaluation system for OHC. Through empirical analysis, the rationality and effectiveness of the evaluation system were verified. Then six representative Chinese OHCs were selected and their service quality was evaluated by the entropy weight TOPSIS method.

Results

The service quality evaluation system of OHC was constructed which includes 4 first-level indicators and 16 second-level indicators. The weights of the first-level indicators from large to small are content quality, emotional experience quality, interaction quality and function quality. Among the second-level indicator weights, the top three are perceived cost reasonableness, content professionalism and effectiveness of interactive content.

Conclusions

The indicator system is reasonable and effective and the evaluation method has strong applicability and operability. This study will provide theoretical guidance for community platform operators and relevant departments to design effective evaluation mechanism of OHC service quality, offering a reference for decisions and policymakers.

"You've Got to Do Something": Developing Occupational Therapists' Role in End-of-Life Care

Occupational therapists support the occupational participation of people who are dying yet remain underutilized in end-of-life care. The purpose of this article was to explore how occupational therapists develop their role in end-of-life care to provide strategies to address underutilization. Using a grounded-theory method, semi-structured interviews were conducted with 21 occupational therapists. Three themes emerged which demonstrate participants' role development process. Participants' experiences with dying (Close Experience of Loss) often instilled the importance of end-of-life care. Led by these convictions (Willing to Do It), participants developed skills for end-of-life care. Reflecting on their experiences and treatment outcomes (Making a Difference), participants self-validated their role. The Model of Occupational Therapists' Role Development in End-of-Life Care captured this process. Personal experiences and critical self-reflection may provide an adaptive means to drive role development and appropriately increase end-of-life care occupational therapy utilization.

Roadblocks and resilience: A qualitative study of the impact of pediatric tuberculosis on Tanzanian households and solutions from caregivers

Distinct from quantifying the economic sequelae of tuberculosis (TB) in adults, data are scarce regarding lived experiences of youth and their caregivers seeking and sustaining TB treatment in low income communities. Children ages 4-17 diagnosed with TB and their caregivers were recruited from rural and semi-urban northern Tanzania. Using a grounded theory approach, a qualitative interview guide was developed, informed by exploratory research. Twenty-four interviews were conducted in Kiswahili, audio-recorded and analyzed for emerging and consistent themes. Dominant themes found were socioemotional impacts of TB on households, including adverse effects on work productivity, and facilitators and obstacles to TB care, including general financial hardship and transportation challenges. The median percentage of household monthly income spent to attend a TB clinic visit was 34% (minimum: 1%, maximum: 220%). The most common solutions identified by caregivers to mitigate adverse impacts were transportation assistance and nutrition supplementation. To end TB, healthcare systems must acknowledge the total financial burden shouldered by low wealth families seeking pediatric TB care, provide consultations and medications locally, and increase access to TB-specific communal funds to mitigate burdens such as inadequate nutrition.Trial registration: planned sub-study of the registered prospective study, NCT05283967.Trial registration: ClinicalTrials.gov identifier: NCT05283967.

Experiences of Home-living Vulnerable Older Adults with Clinical Depression during the COVID-19 Pandemic: A Qualitative Study

OBJECTIVES

Little is known about the diversity of older adults' experiences during the COVID-19 pandemic. We therefore investigated the pandemic experiences of home-living vulnerable older adults with depression, an understudied subpopulation.

METHODS

We conducted unstructured interviews with N= 20 older (60+ years) adults with clinical depression receiving care in their homes in June and again in December 2020. Interviews were coded according to the grounded theory approach.

RESULTS

We identified eight themes. Participants described feeling disconnected before and during the pandemic, which they attributed to their physical impairments and old age. Their social relations with family, medical providers, and caregivers helped them feel connected. Participants did not feel significantly impacted by the COVID-19 pandemic, but they missed social and physical contact. During the pandemic, isolation was normalized. Participants therefore experienced loneliness due to their isolation, but also a sense of togetherness with the rest of society. Isolation within the home was re-framed as cocooning, which provided a sense of autonomy. Participants nevertheless expressed resignation.

CONCLUSIONS

Home-living vulnerable older adults with depression experienced loneliness but also a degree of relief during the pandemic.

CLINICAL IMPLICATIONS

Positively re-framing isolation and the stability of formal caregiving helped participants endure feeling disconnected during the pandemic.

Emergency Nurses' Competency in the Emergency Department Context: A Qualitative Study

Background

The availability of clear emergency nurses' competencies is critical for safe and effective emergency health care services. The study regarding emergency nurses' competencies remained virtually limited.

Purpose

This study aimed to explore the emergency nurses' competencies in the clinical emergency department (ED) context as needed by society.

Methods

This qualitative study involved focus group discussions in six groups of 54 participants from three EDs. The data were analysed using grounded theory approach including the constant comparative, interpretations, and coding procedures; initial coding, focused coding and categories.

Results

This study revealed 8 core competencies of emergency nurses: Shifting the nursing practice, Caring for acute critical patients, Communicating and coordinating, Covering disaster nursing roles, Reflecting on the ethical and legal standards, Researching competency, Teaching competencies and Leadership competencies. The interconnection of the 8 core competencies has resulted in 2 concepts of extending the ED nursing practice and demanding the advanced ED nursing role.

Conclusion

The finding reflected the community needs of nurses who work in ED settings and the need for competency development of emergency nurses.

The concept, influence, and mechanism of human work interruptions based on the grounded theory

With the development of mobile communication technology and the transformation of work methods and modes, work interruptions have become ubiquitous challenges for employees in the workplace. Less attention has been paid to work interruptions in China, especially the research on human work interruptions, which is different from virtual work interruptions. The present study carried out an in-depth interview with 29 employees. Based on the grounded theory method, a psychological and behavioral mechanism model of employees facing human work interruptions, namely, the "human work interruptions-cognitive appraisals-affective responses-behavioral changes" model, was constructed. It is found that (1) cognitive appraisals are the causes of different affective responses and behavioral changes of human work interruptions; (2) cognitive appraisals are feedback behaviors that refer to the reappraisals of the effectiveness and appropriateness of individuals' affective responses and behavioral changes; and (3) personal traits and environmental characteristics at work influence the affective responses and behavioral changes of human work interruptions at the individual and organizational level. The model constructed in this study further extends the interruption theory and provides implications on how to process human work interruptions in human resource management practice.

A study of the factors which influence digital transformation in Kibs companies

Eighteen interviews were used in this research to inductively conceptualize the factors that influence digital transformation (DT) in Kibs companies that provide multidisciplinary Knowledge Intensive Business Services. Two main groups were identified: factors of DT and use in the new digital environment. Using the findings obtained, a comparison was made with the existing literature and the most relevant aspects of DT as a disruptive phenomenon which can generate intra-organizational competitive advantage are exposed.

Objective

To identify the factors of innovation-oriented organizational management, generated by the collaboration of the professional grouping of Kibs companies through the systematization of knowledge, which serve to conceptually delimit the DT phenomenon. Ultimately, it is expected to establish recommendations for this type of companies based on providing services with high knowledge value that strive to digitally transform their businesses.

Originality

the paper contributes to advancing the conceptual understanding of DT through the study of Kibs companies, which remain understudied. Likewise, there is no known study that analyzes the factors that give rise to DT in a professional grouping of small Kibs companies. It is clear that this union of small companies generates a strong internal capacity for knowledge absorption, through daily interactions with clients and public administrations, which favors the process of implementing certain technological and strategic components that are beneficial for the development of professional activity and increases the propensity to innovate.

Methodology

qualitative content was analysed using a grounded theory methodology including interviews with experts and the managers of the Kibs companies in the professional sector to obtain a solid basis that can be used to identify the most relevant factors of DT.

Findings/results

as DT is a multidimensional phenomenon of individual companies, this study presents a conceptual framework for the term with the strategic requirements of the market, organizations, public institutions and technological infrastructures of the professional sector. By considering the disruptive factors of digital development in this macroenvironment, conclusions can be made about the basic principles and effects of DT.

Factors Affecting Road Tunnel Construction Accidents in China Based on Grounded Theory and DEMATEL

Despite the continuous progress of tunnel construction technology and safety management technology, road tunnel construction safety still faces many challenges in China, such as how to ensure the effective management and safety control of people and materials, how to ensure the implementation of technology and program implementation, risk assessment of construction site environmental information, etc. Exploring the causes of tunnel construction accidents and understanding the properties of the factors and their interrelationships can effectively control the sources of risk and contribute to the safety control of tunnel construction. Therefore, we have collected 30 formal accident investigation reports from the government safety supervision and management department from 2005 to 2021, including detailed investigation and accident analysis. Based on grounded theory, a qualitative research method to generalize experience through direct observation, abstraction, and analysis of data, we use Nvivo11 software to analyze reports and obtain 6 selective codes, 16 spindle codes, and 43 open codes. In addition, we construct a theoretical model of tunnel construction accident influencing factors, which passed the saturation test. The Decision-Making Trial and Evaluation Laboratory (DEMATEL) model is used to analyze the influencing mechanism and interaction relationships of these factors. The two dimensions of influence degree and centrality are used to determine the critical influencing factors of tunnel construction accidents in mountainous areas. They are security awareness and professionalism. According to the cause degree, the influencing factors are divided into cause and result factors. Finally, the basis and suggestions for reducing construction accidents are presented.

Eight-Element Communication Model for Internet Health Rumors: A New Exploration of Lasswell's "5W Communication Model"

(1) Background: Rumors are a special type of information. Based on the classic theory of the communication of information, the "5W" communication model, this article aims to build a new model and thus explains the generation and communication of Internet health rumors. (2) Methods: The authors selected 50 Internet health rumors, which were widely spread in widely used websites and social media in China, then grounded theory is used to perform the qualitative analysis of the Internet health rumors. (3) Results: Three Core Concepts are abstracted after qualitative analysis. An internal dynamic mutual assistance mechanism of the communication of rumors is built and illustrated. Based on Lasswell's "5W" communication model, the authors develop an eight-element communication model for Internet health rumors to illustrate the generation and communication of Internet health rumors. (4) Conclusions: By removing one or several elements of this new model, the chain of the communication of Internet health rumors could be cut off, which is valuable information for the government or websites to manage communication of Internet health rumors.

Before allyship: A model of integrating awareness of a privileged social identity

Introduction

Although the American Psychological Association encourages clinical psychologists to recognize and understand the experience of social privilege both within themselves and the individuals and communities they serve, there is a dearth of research in the field to guide this pursuit. According to the available literature, an essential barrier to social privilege integration is its implicit and covert nature that prevents consistent consciousness due to hegemonic forces.

Methods

This study explored the process, from initial social privilege awareness to the moment of the study, through individual interviews. A social-constructivist, grounded theory approach was utilized as it was aligned with the understudied phenomena oriented around social justice.

Results

The result is a developmental model of social privilege integration that explicates accumulated exposures to privilege, the resultant threat to and protection of personal identity, and the conducive factors that lead to reconciliation.

Discussion

Implications of this theoretical model include the importance of a developmental perspective to cultivate an understanding of individual prejudice attitudes and discriminatory behaviors, as well as a roadmap toward equitable change. This model may be used by clinical psychologists across multiple settings in response to the most recent APA multicultural guidelines.

The ward round: friend or foe in postgraduate training? A grounded theory study of residents' perspectives

The ward round has traditionally been a learning activity in medical education. Apart from education, ward rounds have multiple roles including patient care and communication. Some studies have described the ward round as an ideal place to learn patient management while others reported that little learning happens on rounds due to lack of time and patient volume. This study aimed to develop a deeper understanding of ward round learning from the perspective of postgraduate trainees. A constructivist grounded theory approach was used and data was collected during focus group discussions. Data were analyzed by initial coding, then grouped into focused codes and development of a theoretical framework by the process of constant comparison. Six categories evolved which contributed to the framework. Postgraduate trainees perceive the ward round as an important space where they use different learning activities to acquire knowledge, attitude and skills required of a specialist doctor. They progress from novices to experts under supervision of faculty who lead ward rounds. The round can achieve its full learning potential if planned and organized well but can become a missed opportunity if the learning environment is unfriendly. Patient- and learner-related barriers exist that hinder ward round learning. The framework explains how ward round learning occurs in postgraduate medical education from a trainee perspective. The findings can guide interventions to improve the learning experience. Studies comparing perspectives of teachers to those of learners are needed to further understand the complex learning milieu of the ward round.

Impact of social pediatrics rotation on residents' understanding of social determinants of health

Social Pediatrics is the newest mandatory rotation in the General Pediatrics residency program at the University of Alberta. Evaluation of the residents include a written reflective assignment, asking them to identify assets and disparities that have influenced the health of a child encountered on the rotation. While there are many published papers on reflective writing , few papers are found in the area of how social determinants of health (SDoH) impact an individual's overall health. This study examines the question: how has exploring SDoH during the Social Pediatrics rotation led to changes in residents' awareness of their own practice of pediatrics? Grounded theory was used to analyse 35 reflections from residents who had submitted them as a mandatory assignment at the end of their rotation. In addition, 10 semi-structured telephone interviews were conducted to further understand residents' perceptions. Interviews were transcribed verbatim and analysis of the reflections and interviews was guided by grounded theory using open, axial, and selective coding. Analyses of written reflections revealed the following categories: 1) judgment/bias, 2) systemic challenges, 3) advocacy, and 4) a sense that everyone is doing their best. Interview data reinforced overlapping categories of bias, systemic challenges and advocacy in addition to two new categories: 1) increased exposure and knowledge of specific disadvantaged populations, and 2) understanding impact of SDoH on overall health.Categories that were generated highlight the importance of residents' education regarding the role of SDoH on overall health and management plans. They became aware of structural determinants of health working with health-care professionals who were advocates for the communities they worked with. Analysis of residents' written reflection assignments and follow-up interviews revealed the value of reflective practice in physician development and reinforced the benefit of fostering experiences not typically encountered in traditional clinical learning environments.

Contextual factors influencing patients' experiences of acute deterioration and medical emergency team (MET) encounter: A grounded theory study

AIM

This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter.

BACKGROUND

Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high-quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective.

DESIGN

Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter.

METHODS

Using a semi-structured interview guide, in-depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12-month period from 2018 to 2019. Interview data were analysed using grounded theory processes.

FINDINGS

Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional-patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health-seeking behaviour and health status.

CONCLUSION

Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors.

IMPACT

The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration.

Combating with Compassion Fatigue: The Perspective of Family Caregivers of People with Schizophrenia

PURPOSE

The purpose of this study was to explore the coping processes used by family caregivers of individuals with schizophrenia to deal with compassion fatigue (CF).

METHODS

Grounded theory was used in this study. For recruitment, purposive and theoretical samplings were used to recruit participants. Data were collected from 29 family caregivers through in-depth interviews and field notes. Data were analyzed using constant and comparative methods.

RESULTS

The study revealed a core process for dealing with CF as "Combating with compassion fatigue" that comprised three dynamic phases: strengthening attachment with the care recipient to increase willpower, learning how to deal with the illness, and self-empowerment to fight to the physical and mental fatigue.

CONCLUSIONS

Family caregivers of people with a diagnosis of schizophrenia use various strategies to fight to CF. These combine the past experiences of strategies that work and new approaches. Our research will allow mental health professionals to provide basic strategies to family caregivers of people with a diagnosis of schizophrenia to help them to cope with CF.

"My Autism Is My Own": Autistic Identity and Intersectionality in the School Context

Background

School is an important context for identity development across childhood and adolescence. These formative experiences impact adulthood. Minimal research has examined first-person autistic perspectives of how school experiences shape autistic identity as well as other intersecting identities. In this study, we examined the school messages that autistic individuals received and how individuals engaged with these external messages to formulate their identities.

Methods

Ten U.S.-based autistic adolescents and adults ages 15-35 participated in qualitative interviews about their elementary through secondary school experiences, interactions with teachers and peers, and how these shaped their identities. Two interviewees also engaged in three follow-up interviews each for member checking and further data gathering. Using a critical constructivist approach informed by grounded theory, we coded interviews inductively. We ensured the trustworthiness of data through peer debriefing, reflexive journaling, memoing, and member checking.

Results

In the school context, autistic students received stigmatizing messages from teachers and peers regarding their autism. These messages varied in relation to students' other identities, including race and gender. Participants felt that, following autism disclosure, teachers viewed them narrowly through an autism lens. Participants actively resisted these negative messages from teachers and peers by reclaiming their autistic identity. They reframed and redefined their autistic identity, embraced their autism-related strengths, and actively made choices about how, when, and to whom to disclose their autism. Decisions around autism disclosure intersected with decisions to emphasize other identities such as race or mental health, especially when these identities were more visible or more acceptable to others.

Conclusions

The school context conveyed powerful, stigmatizing messages around autism. In response, autistic students actively reclaimed and shaped their identities to prioritize a positive, empowered sense of self. Findings show a need for educators to model positive perceptions of autism, build an inclusive school community, and advocate for autistic representation in schools to facilitate autism-affirming messages.

Resilience amongst Ontario registered practical nurses in long-term care homes during COVID-19: A grounded theory study

AIMS

This study aimed to understand how the personal and professional resilience of Registered Practical Nurses working in long-term care (LTC) homes in Ontario were impacted during the Coronavirus 2019 pandemic.

BACKGROUND

Registered Practical Nurses are primary regulated healthcare providers that have worked in Ontario LTC homes during the COVID-19 pandemic. As frontline workers, they have experienced increased stress secondary to lockdowns, changing Ministry of Health recommendations, social isolation and limited resources. LTC homes experienced almost a third of all COVID-19-related deaths in Ontario. Understanding registered practical nurses' (RPNs) resilience in this context is vital in developing the programs and supports necessary to help nurses become and stay resilient in LTC and across a range of settings.

METHODS

Purposive sampling was used to recruit 40 Registered Practical Nurses working in LTC homes across Ontario for interviews. Charmaz's Grounded theory guided in-depth one-on-one interviews and analyses completed between April to September 2021.

RESULTS

Registered Practical Nurse participants represented 15 (37.5%) private, and 25 (62.5%) public LTC homes across Ontario Local Health Integration Networks. Findings informed two distinct perspectives on resilience, one where nurses were able to maintain resilience and another where they were not. Sustaining and fraying resilience, presented as bimodal processes, was observed in four themes: 'Dynamic Role of the Nurse', 'Preserving Self', 'Banding Together' and 'Sense of Leadership Support'.

CONCLUSION

Resilience was largely drawn from themselves as individuals. Resources to support self-care and work-life balance are needed. Additionally, workplace supports to build capacity for team-based care practices, collegial support in problem-solving and opportunities for 'connecting' with LTC nursing colleagues would be beneficial. Our findings suggest a role for professional development resources in the workplace that could help rebuild this workforce and support RPNs in providing quality care for older adults living in LTC.

PATIENT OR PUBLIC CONTRIBUTION

Our research team included two members of the Registered Practical Nurses Association of Ontario, and these team members contributed to the discussion and design of the study methodology, recruitment, analysis and interpretation. Further, RPNs working in long-term care during the COVID-19 pandemic were the participants in this study and, therefore, contributed to the data. They did not contribute to data analysis or interpretation.

The "Life-World" trip of type 2 diabetes patients with allopathic treatment options: a triangulated qualitative investigation

BACKGROUND

Patients with type 2 diabetes usually start treatment with oral hypoglycaemic medications once they have been diagnosed. They eventually require insulin injections. We looked into the experiences of such patients with allopathic treatment alternatives over the course of their journey.

METHODS

The study was conducted using a qualitative inquiry (phenomenological approach triangulated with modified grounded theory) from July 2019 to January 2020. A total of 24 participants (11 men and 13 women) were recruited purposively and interviewed face-to-face until theoretical saturation was reached. QDA Miner Lite v2.0.9 was used to categorise the data.

RESULTS

The majority of patients had no previous notions regarding their illness. They did not have an emotional reaction to being diagnosed. They were uncomfortable on oral hypoglycaemic agents because of uncontrolled blood glucose and gastrointestinal disturbances, which were thought to be the main causes for medication changes. Initial insulin treatment experiences included fear of injection pain, difficulty self-injecting, and a sense of last resort. Insulin's effectiveness, ease of injection with a little needle, and lack of gastrointestinal discomfort were all key reasons in changing the patients' minds about it. Patients have rigorously adhered to insulin since it was found to improve health and bring life.

CONCLUSION

The "life-world" journey of patients with type 2 diabetes with allopathic treatment options was started to be informed of the "unknown" (diabetes), which leads to the "ugly life" (with oral agents), and bridge to and living with the "terrible" (insulin), which was later found to be effective and perceived as "life."KEY MESSAGESPatients with type 2 diabetes believed that life with oral hypoglycaemic medications was "boring."The major reasons for switching to insulin were "uncontrolled blood sugar levels" and "gastrointestinal disturbances" brought on by oral medications.Insulin first terrified type 2 diabetes patients, but they eventually referred to it as "life."

A global grounded theory exploration of investigators' perspectives on male hormonal contraceptive development and acceptability

While best practices have been proposed on how to engage men in family planning (FP), the limited options of male hormonal contraceptives (MHC) are a barrier to reaching men as clients of FP programs. The lack of alternative MHC is preventing the global health community from providing holistic reproductive healthcare. A qualitative grounded theory study was conducted in 2020 to explore MHC experts' perceptions around the development and theoretical acceptability of MHCs. Individual in-depth interviews were conducted with 15 key informants. The informants cited evidence that there is a demand for MHC. The inability to access this data by the pharmaceutical industry was acknowledged. Many informants expressed concern of the possibility for MHC to increase male power in a predominantly patriarchal world. To most informants, at least for the initial introduction of MHC, fertility sharing is something that will largely happen among couples alone rather than individually. There is proven demand among women and men for MHC, however industries may still be reluctant to invest. Effort is needed by the sexual and reproductive health and rights community to include male engagement in FP and to advocate for the development and use of MHC as a tool for women's empowerment.

Texting in a crisis-using SMS for information and emotional support during COVID-19: A mixed methods research study

In the era of new media, short message service (SMS) is no longer seen as advantageous and it is no longer used very much by the Chinese public. However, as a traditional media, local governments managing public health crises used SMS as a way of meeting the public's need for emotional support during the COVID-19 pandemic. Our study examined 108 SMS texts pushed to phones in Chongqing between January and December 2020, and carried out in-depth interviews with ten interviewees. This mixed research method of descriptive and grounded theory analysis was designed to investigate how SMS was used to communicate prevention guidelines and give emotional support during COVID-19. The results show that Chongqing Municipal Health and Health Commission gained the public's attention with SMS messages consisting of neutral, objective advice, and guidance to reduce people's anxiety and panic. However, with the stabilization of COVID-19, SMS has once again been discarded by users, including the public health sector. The study found that the emotional support offered by SMS was limited to the elderly, a subset of the population considered to be weak users of the internet. SMS has been replaced by other technologies, but along with other media, such as official media and social media, it has shaped the media communication environment and served as an emotional support channel for the public. Undoubtedly,the use of SMS during COVID-19 presents a research opportunity for exploring its capacity for prevention, control and emotional support.