Achieving trustworthiness in qualitative research: A pan-paradigmatic perspective

Applying Kumpfer's resilience framework to understand the social adaptation process of the trailing parents in China

BACKGROUND

Trailing parents, a distinct group emerging from China's rapid social change and urbanization, are experiencing migration in old age, posing challenges for their social adaptation. Existing research has mainly focused on the hardships faced by this group, but few studies have focused on how they cope with change and achieve some degree of successful social adaptation. This study aimed to understand the coping and social adaptation process of trailing parents in China.

METHODS

This study used a qualitative research approach. A total of 24 trailing parents were invited to participate in a semi-structured interview and share their experiences and efforts to cope with the many challenges. Kumpfer's resilience framework was used as the theoretical framework for the study design, data collection, and data analysis.

RESULTS

This study identified several intra-family and community stressors that trailing parents may face when moving to a new environment and uncovered five key resilience characteristics that may be triggered or fostered in the presence of these stressors, including physical fitness, psychological stability, open-mindedness, learning ability, and nurturing hobbies. Individuals with resilience traits have been observed to engage in positive cognitive processing and transform the new environment. Consistent with Kumpfer's resilience framework, this study revealed the dynamics of the stressors faced by trailing parents in the new environments, the role of resilience characteristics, and the critical influence of social support in shaping the interplay between the individual and the environment that enabled them to adapt positively.

CONCLUSIONS

This study highlights the importance of fostering resilience traits and leveraging positive coping mechanisms to facilitate a smoother adaptation process for trailing parents. Meanwhile, there is an urgent need to focus on creating opportunities that strengthen their social support networks.

Canadian politicians' rhetoric on Twitter/X: Analysing prejudice and inclusion towards Muslims using structural topic modelling and rhetorical analysis

We analysed tweets from five English-speaking Canadian political parties in the year leading up to the 2019 federal election to explore both prejudicial and inclusive rhetoric in relation to Muslim identities on social media. We used structural topic modelling to understand what topics were discussed before moving to a rhetorical approach to analyse how topics were discussed. We identified 10 topics. Seven talked about Muslim groups in primarily inclusive ways, including depicting the positive contributions to Canadian society, creating ideological space for Muslim religious practices and invoking superordinate identities with victims of hate crimes to cultivate solidarity. However, the effectiveness of inclusive rhetoric was sometimes questioned due to omitting the subgroup-specific prejudice faced by Muslims. Prejudicial rhetoric occurred in three of the topics due to the nativist populist PPC party depicting Muslims as a threat to Canadian values, as hostile to people from other religious faiths, and depicting 'elites' in society as concealing the 'true' information concerning Muslims. The study contributes to understanding how politicians attempt to cultivate minority inclusion/exclusion in multicultural contexts through social media, as well as understanding the rhetoric of nativist populism in Canada and its similarities to other Global North contexts.

"Definitely a Dark Time:" professional and ethical issues in post-acute care physical therapy during the COVID-19 pandemic

BACKGROUND

Disproportionate effects of the SARS-CoV-2 (COVID-19) pandemic on older adults in post-acute care settings created many professional and ethical challenges for patients and healthcare providers.

OBJECTIVE

The purpose of this study was to examine the professional and ethical issues of physical therapists (PTs) and physical therapist assistants (PTAs) in providing facility-based post-acute care in residential settings (skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals) during the COVID-19 pandemic.

METHODS

A qualitative descriptive research design was used to explore professional and ethical issues during the COVID-19 pandemic. PTs and PTAs described their experiences during semi-structured interviews conducted virtually. Interview data was analyzed with reflexive thematic analysis.

RESULTS

Thematic analysis produced 4 themes: facility-wide battle against infection and death, doing the best you can to provide care amidst COVID-19 constraints, promoting ethical good and doing the right thing, and a dark intense time.

CONCLUSIONS

Professional and ethical constraints on providing care faced by PTs and PTAs during the COVID-19 pandemic can inform current and future clinical practice. Although some of the challenges faced by PTs and PTAs were unique to COVID-19, many problems represent preexisting systemic and organizational issues that were exacerbated by the pandemic.

'Misdiagnosed and Misunderstood': Insights into Rarer Forms of Dementia through a Stepwise Approach to Co-Constructed Research Poetry

This study investigated co-constructed research poetry as a way to understand the lived experiences of people affected by rarer dementia and as a means to use poetry to convey those experiences to healthcare professionals. Using mixed methods, 71 people living with rarer dementia and care-partners (stakeholders) contributed to co-constructing 27 poems with professional poets; stakeholders' verbatim words were analysed with descriptive qualitative analysis. Stakeholders were also surveyed and interviewed about their participation. Healthcare professionals (n = 93) were surveyed to elicit their responses to learning through poetry and its acceptability as a learning tool. Poems conveyed a shared narrative of different aspects of lived experience, often owing to atypical symptoms, misunderstandings by professionals, lack of support pathways, and a continuous struggle to adapt. Stakeholder surveys indicated it was a valuable experience to both co-create and respond to the poems, whilst group interviews revealed people's experiences of the research poetry were characterised by reflection on lived experience, curiosity and exploration. Healthcare professionals' responses reinforced poetry's capacity to stimulate cognitive and affective learning specific to rare dementia support and prompt both empathy and critical thinking in practice. As the largest poetry-based study that we are aware of, this novel accessible approach of creating group poems yielded substantial information about the experiences and needs of those affected by rarer dementia and how poetry can contribute to healthcare education and training.

Navigating work and life- a qualitative exploration of managers' and employees' views of return-to-work after sick leave due to common mental disorders

BACKGROUND

Incorporating multiple perspectives and contexts in knowledge mobilisation for return-to-work after sick leave due to common mental disorders can promote interprofessional and organisational strategies for facilitating the return-to-work process. This study aimed to explore the facilitators of and barriers to return-to-work after common mental disorders. This exploration considered the perspectives of employees and managers and the realms of work and private life.

METHODS

A qualitative approach was used with data from 27 semi-structured telephone interviews. The strategic sample consisted of employees who returned to work after sick leave due to common mental disorders (n = 17) and managers responsible for their return-to-work process (n = 10). Thematic analysis conducted in a six-step process was used to generate themes in the interview data.

RESULTS

The analysis generated three main themes with subthemes, illustrating experiences of barriers to and facilitators of return-to-work positioned in the employees' private and work contexts: (1) Getting along: managing personal difficulties in everyday life; (2) Belonging: experiencing social connectedness and support in work and private life; and (3) Organisational support: fostering a supportive work environment. The results contribute to a comprehensive understanding of the return-to-work process, including the challenges individuals face at work and in private life.

CONCLUSIONS

The study suggests that return-to-work after sick leave due to CMDs is a dynamic and ongoing process embedded in social, organisational, and societal environments. The results highlight avenues for an interprofessional approach and organisational learning to support employees and managers, including space for the employee to recover during the workday.

TRIAL REGISTRATION

This study recruited employees from a two-armed cluster-randomised controlled trial evaluating a problem-solving intervention for reducing sick leave among employees sick-listed due to common mental disorders (reg. NCT3346395).

"Systems seem to get in the way": a qualitative study exploring experiences of accessing and receiving support among informal caregivers of people living with chronic kidney disease

BACKGROUND

The well-being of informal caregivers of people living with chronic kidney disease is influenced by their experiences with support, however, few studies have focused on exploring these experiences. This study aimed to explore informal caregivers' experiences accessing and receiving support while caring for someone living with chronic kidney disease.

METHODS

Informal caregivers of people living with chronic kidney disease (n = 13) in the United Kingdom were primarily recruited via community organisations and social media adverts to participate in semi-structured interviews. Interviews explored support needs, experiences of receiving support from different groups (e.g. healthcare professionals, family/friends), and barriers and facilitators to accessing support. Support was understood as including emotional, practical, and informational support. Data were analysed using reflexive thematic analysis.

RESULTS

Three themes were generated: (1) "Systems seem to get in the way" - challenges within support systems, illustrating the challenges informal caregivers encountered when navigating complex support systems; (2) Relying on yourself, describing how informal caregivers leveraged their existing skills and networks to access support independently, while recognising the limitations of having to rely on yourself to find support; and (3) Support systems can "take the pressure off", showing how support systems were able to help informal caregivers cope with the challenges they experienced if certain conditions were met.

CONCLUSIONS

In response to the challenges informal caregivers experienced when seeking support, improvements are needed to better consider informal caregiver needs within healthcare systems, and to develop interventions tailored to informal caregiver needs and context. Within the healthcare system, informal caregivers may benefit from system navigation support and better integration within healthcare teams to ensure their informational support needs are met. New interventions developed to support informal caregivers should fit within their existing support systems and incorporate the qualities of support, such as empathy, that were valued. Additionally, use of an equity framework and user-centered design approaches during intervention development could help ensure interventions are accessible and acceptable.

Potential Implementers' Perspectives on the Development and Implementation of an e-Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease: Qualitative Interview Study

BACKGROUND

e-Mental health interventions can improve access to mental health support for caregivers of people living with chronic kidney disease (CKD). However, implementation challenges often prevent effective interventions from being put into practice. To develop an e-mental health intervention for caregivers of people living with CKD that is optimized for future implementation, it is important to engage professionals that may endorse or deliver the intervention (ie, potential implementers) during intervention development.

OBJECTIVE

This study aims to explore the perspectives of potential implementers working in kidney care, in mental health care, or at nonprofit organizations regarding the design and implementation of an e-mental health intervention for caregivers of people living with CKD.

METHODS

Potential implementers (N=18) were recruited via National Health Service Trusts, email, and social media advertisements to participate in semistructured video interviews. Interview questions were informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive analysis approach using the CFIR, with inductive coding applied to relevant data not captured by the framework.

RESULTS

A total of 29 generic categories, related to 17 CFIR constructs, were identified. The perceived fit between the intervention and implementation context (ie, existing service delivery models and work routines) and existing social networks among potential implementers were perceived as important factors in enhancing implementation potential. However, a need for capacity building among potential implementers to create systems to support the identification and referral of caregivers to an e-mental health intervention was identified. Equity concerns were raised regarding the intervention, highlighting the importance of incorporating an equity lens during intervention design to enhance accessibility and adoption.

CONCLUSIONS

Potential implementers provided valuable insights into key design and implementation factors to help inform the development of an e-mental health intervention for caregivers of people living with CKD. Incorporating their feedback can help ensure the intervention is acceptable and inform the selection of future implementation strategies to enhance the implementation potential of the intervention. Potential implementers should continue to be engaged throughout intervention development.

Stigma manifestations in cardiomyopathy care impact outcomes for black patients: a qualitative study

INTRODUCTION

Inequities in clinical care may contribute to racial disparities observed in studies of heart disease morbidity and cardiogenetic testing outcomes. There is a lack of research aimed at understanding the complexity of those inequities, but stigma likely contributes. This qualitative exploratory study helps close that gap in the literature by describing intersectional stigma manifestations perceived by the Black cardiomyopathy patient population at one academic medical center.

METHODS

Qualitative interviews were conducted with 14 Black cardiomyopathy patients. Interviews aimed to elicit patients' experiences with discrimination related to diagnosis, symptoms, genetic testing, knowledge of genetic results, genetic counseling, providers' actions, and providers' communication. The interview guide was informed by The Health Stigma and Discrimination Framework. Data were also collected about participant demographics, type of cardiomyopathy, age of diagnosis, documentation of relevant family history, and completion of genetic counseling and/or genetic testing.

RESULTS

More than half of participants reported intersectional stigma manifestations related to their race, age, and/or weight while receiving care from cardiologists, nurse practitioners, genetic counselors, or clinical support staff. Stigma manifestations included physical roughness during patient care, withholding diagnostically-relevant information from the patient, impersonal care, coercion, and use of offensive stereotyped language by providers. These stigma manifestations impacted access to care, uptake of genetic testing, timeline to diagnosis, patient emotion, patient-provider trust, and adherence to medical recommendations.

CONCLUSIONS

This study provides nuanced qualitative descriptions of stigma manifestations that affect patient and clinical outcomes in cardiology care and genetic services in one medical center in the Southeastern United States. The results of this study suggest that provider bias and stigma manifestations have an adverse effect on cardiogenetic and clinical outcomes among Black cardiomyopathy patients. Clinical interventions are suggested to assist health professionals in providing culturally-competent and respectful care. These results help inform patient-provider communication, clinical policies, and evidence-based practice in cardiology care and genetics. Continued study of this topic across more institutions and with a larger sample size is needed to confirm the generalizability of the conclusions.

Artificial intelligence in language instruction: impact on English learning achievement, L2 motivation, and self-regulated learning

Introduction

This mixed methods study examines the effects of AI-mediated language instruction on English learning achievement, L2 motivation, and self-regulated learning among English as a Foreign Language (EFL) learners. It addresses the increasing interest in AI-driven educational technologies and their potential to revolutionize language instruction.

Methods

Two intact classes, consisting of a total of 60 university students, participated in this study. The experimental group received AI-mediated instruction, while the control group received traditional language instruction. Pre-tests and post-tests were administered to evaluate English learning achievement across various domains, including grammar, vocabulary, reading comprehension, and writing skills. Additionally, self-report questionnaires were employed to assess L2 motivation and self-regulated learning.

Results

Quantitative analysis revealed that the experimental group achieved significantly higher English learning outcomes in all assessed areas compared to the control group. Furthermore, they exhibited greater L2 motivation and more extensive utilization of self-regulated learning strategies. These results suggest that AI-mediated instruction positively impacts English learning achievement, L2 motivation, and self-regulated learning.

Discussion

Qualitative analysis of semi-structured interviews with 14 students from the experimental group shed light on the transformative effects of the AI platform. It was found to enhance engagement and offer personalized learning experiences, ultimately boosting motivation and fostering self-regulated learning. These findings emphasize the potential of AI-mediated language instruction to improve language learning outcomes, motivate learners, and promote autonomy.

Conclusion

This study contributes to evidence-based language pedagogy, offering valuable insights to educators and researchers interested in incorporating AI-powered platforms into language classrooms. The results support the notion that AI-mediated language instruction holds promise in revolutionizing language learning, and it highlights the positive impact of AI-driven educational technologies in the realm of language education.

You only get one brain: adult reflections on coping and recovery after traumatic brain injury in adolescence

BACKGROUND

TBI during adolescence can result in significant acute symptoms that can persist into adulthood. This research analyzed retrospective qualitative accounts of young adults who had sustained a TBI in adolescence to explore coping and recovery processes specific to this developmental stage.

METHODS

Thirteen adults (aged 20-25 years; mean 23 years) who sustained a mild (n = 12) or moderate (n = 1) TBI during adolescence (aged 13-17 years at injury), approximately 7.7 years (range = 6.7-8.0 years) prior, participated. Semi-structured individual interviews, analyzed using thematic analysis, explored participants' experiences following their TBIs.

RESULTS

Thematic data analysis produced two key categories of themes relating to recovery processes: (1) Individual factors impacting coping, with themes of learning to cope with difficulties, seeking acceptance and balance, and finding meaning; and (2) Social factors impacting coping, which included themes of feeling included, relying on family, professionals didn't get it, and lacking someone who understands.

CONCLUSIONS

Recovery following TBI sustained during adolescence could be maximized by facilitating greater understanding of specific impacts on young people among clinicians and family, longer term monitoring of symptoms including emotional reactions to symptoms, and the provision of emotional support.

"Don't You Understand That We Are Punishing You for Your Own Good?": Attitudes of Women With Substance Use Disorder to Punitive and Therapeutic Methods in Closed Communities

The growing numbers of women with substance use disorder (SUD) and the resulting establishment of dedicated treatment and rehabilitation services have spawned a rich literature on the etiology of addiction among women, their therapy needs and the effectiveness of the treatments they receive. Nevertheless, very few studies have examined the punitive methods applied to women with SUD as part of their treatment. This study examines the positions of thirteen Israeli women with SUD regarding punishments meted out in closed therapeutic communities (TCs), and their experienced short- and long-term implications. The findings suggest ambivalence toward the harsh treatment and punishment in the communities, and to their negative repercussions for the clients' mental condition after their release. We conclude that the methods of treatment and punishment in these settings must be changed and based on the clients' strengths and empowerment. Punishments should be meted out in a proportional way, and as a last resource.

The pursuit of intimacy: intimate relationship development for women with physical disabilities

Background and purpose

Understanding the barriers and facilitators to intimate relationship development among women with physical disabilities is crucial for promoting positive rehabilitation outcomes. This study investigates these factors using a Consensual Qualitative Research approach.

Methods

The research team utilized Consensual Qualitative Research. Consensual Qualitative Research is widely used in various social services to address limitations inherent limitations of other qualitative methods. Women with various physical disabilities (n=6) were identified and interviewed using a utilized a semi-structured interview. Their attitudes towards intimacy, outcome expectancy, and self-concept of women with physical disabilities were examined. The impact of physical disabilities, including disability stigma, on these factors was also assessed. Data was coded utilizing multiple researcher consensus as well as an auditor to consensually agree upon domains and core ideas while taking into account validity and trustworthiness, as per the methodology chosen.

Results

The study discovered general themes (100% representation) concerning core values and barriers to intimacy, societal barriers to intimate relationships, and hope for future relationships. Typical themes (50-83% representation) included non-romantic intimacy, physical barriers to intimacy, perceived limitations, and negative outcome expectancies. Across the board, the influence of disability limitations, identity, and societal attitudes became evident. The role of rehabilitation professionals in advocating for social skills development and self-confidence enhancement emerged as crucial.

Conclusions

The study illuminated barriers to intimacy among women with physical disabilities, such as societal stigma and self-concept associated with disability. The critical role of rehabilitation professionals in normalizing intimacy discussions and equipping individuals with necessary social skills and self-confidence was underscored. This focus could yield enhanced intimate relationship outcomes and improve the quality of life for women with physical disabilities.

Conceptualizations of wellbeing among nonbinary individuals in the Midwestern United States: a photovoice study

Background: Traditionally, gender has been viewed through an essentialist lens with fixed biology-based traits or polarized gender norms between women and men. As awareness of gender diversity grows, increasingly more people are coming out as nonbinary - or not exclusively a man or woman. Little has been explored regarding experiences unique to nonbinary individuals, particularly beyond a focus on adverse risks and outcomes to understand their wellbeing. This article discusses gendered experiences and the construction of wellbeing among nonbinary individuals. Aim: The purpose of this study was to conceptualize wellbeing as a complex multidimensional phenomenon through nonbinary individuals' perspectives. Methods: A virtual PhotoVoice study was conducted with 17 nonbinary adults in the Midwestern United States who participated in online group discussions and in-depth semi-structured interviews, which were analyzed with thematic analysis. Results: The analysis identified five core dimensions of nonbinary wellbeing: 1) Security, 2) Mental and physical health, 3) Autonomy, 4) Belonging, and 5) Gender positivity. Exemplary definitions of wellbeing are also presented. Discussion: Understanding how nonbinary individuals thrive challenges the framing of gender diverse experiences in adversity and presents a more holistic portrayal that community members and allies can strive toward. This study contributes an intersectional understanding of wellbeing in relation to identities of race, culture, age, disability, neurodiversity, and sociopolitical geographical context. The findings of this study can aid in practice, advocacy, and research to bolster the wellbeing of nonbinary people.

An Interpretative Phenomenological Analysis of the lived experience of sensuality expression among women over 50 years of age in Nigeria

INTRODUCTION

Sensuality, an essential component of sexuality, is the enjoyment, expression, or pursuit of physical and sexual pleasure or satisfaction. Sensuality expression of women over 50 is under-researched and often ignored, making it difficult to have a scientific basis to develop age-appropriate healthy-ageing programmes for this group in Nigeria. An exploratory study was conducted to explore the lived experiences of the expression of sensuality of Nigerian women over 50 and the meaning they attach thereto.

METHODOLOGY

An Interpretative Phenomenological Analysis approach was used to collect and analyze data from 17 female teachers from three public secondary schools in Osun state, Nigeria, to represent a homogenous group of professional women over the age of 50. A semi-structured questionnaire was used to obtain qualitative data that was thematically analyzed.

FINDINGS

Four superordinate themes emerged: 'Self-reinvention to camouflage ageing realities for sensuality expression'; 'Embracing own sensuality'; 'Yearning for old self'; and 'Loss of interest in romantic relationships', with various subordinate themes.

CONCLUSION

These finding provide the basis to develop age-appropriate healthy-ageing programmes for this group, and a baseline for further sexual health research among this group of women in Nigeria, who are often overlooked or considered asexual due to their being beyond the reproductive age.

"I thought I was going to die there:" Socio-political contexts and the plight of undocumented Latinx in the COVID-19 pandemic

Since the beginning of the COVID-19 pandemic, certain U.S. population groups have suffered higher rates of infection and mortality than whites, including Latinx. Public health officials blamed these outcomes on overcrowded housing and work in essential industries prior to the vaccine's availability. We sought to illuminate the lived experience of these factors through a qualitative study of undocumented Latinx immigrant workers in the secondary economy (n ​= ​34). This study focuses on the intersectionality of social locations for undocumented Latinx immigrants living in a relatively affluent suburb and working in the construction and service sectors prior to the pandemic. Their narratives revealed how the pandemic created financial precarity through prolonged periods of unemployment and food insecurity. Workers described worry over unpaid bills, and potentially catastrophic episodes in which they treated severe COVID-19 with home remedies. Long spells of unemployment, food insecurity, inability to pay bills and lack of access to healthcare emerged because of socio-political contexts including the nature of low-wage labor and lack of a safety net.

Patients' Perceptions of Exercise-Based Cardiac Telerehabilitation after a Myocardial Infarction-A Qualitative Study

To be able to design telerehabilitation programs targeting the needs and preferences of end-users, patients' in-depth perspectives are needed. To date, such studies are lacking and, therefore, the aim of the present study was to describe patients' perceptions of performing exercise-based cardiac telerehabilitation after a myocardial infarction (MI). Individual semi-structured interviews were performed with 15 patients (3 women, median age 69 years) after an MI who had participated in exercise-based cardiac telerehabilitation for three months. The interviews were transcribed verbatim and analyzed with inductive content analysis. An overall theme was defined as "Cardiac telerehabilitation-a new alternative for exercising that is easily accessible and up to date". Four categories, including "The important role of a physical therapist with expert knowledge", "Prerequisites playing an important role in the willingness to participate", "Making exercise accessible and adjustable" and "Inspiring future exercise", and 15 subcategories were identified. Understanding the patient's perspective is an important key to further improving and successfully implementing exercise-based cardiac telerehabilitation, as an alternative or adjunct to traditional, centre-based programs. The findings can serve to improve patient-physiotherapist interactions and to inform important aspects related to exercise, technology and a sense of security from an exercise-based cardiac telerehabilitation program.

Developing effective health coaches: Experience gained in a clinical trial of a health coach intervention

OBJECTIVE

To identify the characteristics of an effective health coach and describe how these characteristics can be developed.

METHODS

A qualitative descriptive design was used to obtain insights from a convenience, homogenous sample of health coaches, social workers, and research staff members collaborating as members of a team providing a health coaching telehealth intervention for lay caregivers. Individual interviews were analyzed using thematic analysis.

RESULTS

The 11 study participants interviewed were predominately married (75 %), female (92 %) and Caucasian (83 %). Ages ranged from 27 to 66 with an average age of 42 years. The sample was highly educated, with five having attained a terminal degree (PhD or DNP). The participants described three themes of characteristics that contributed to the success of health coaches: personal characteristics, professional characteristics, and program characteristics.

CONCLUSIONS

These characteristics expand what is known about attributes that contribute to successful health coaching. Most can be trained or used in developing programs and interventions.

PRACTICE IMPLICATIONS

Our findings suggest that many of the core skills of an effective health coach can be developed through individual training, program design, and peer support. Innate personal characteristics such as trustworthiness, integrity, and compassion are hard to influence but can be identified in the hiring process.

Qualitative multi-centered study: Trustworthiness of the three-level model (3-LM) Part 1

The 3-Level Model (3-LM) is proposed as a guide or heuristic for observing and describing patient change. Used since 2011 in the context of the International Psychoanalytic Association (IPA), its trustworthiness as a model still needs to be studied. OBJECTIVES AND METHODS: This study aimed to assess the trustworthiness of the 3-LM by comparing the output of three groups of IPA-certified analysts (Europe, North America and South America). The comparison was made using process and outcome measures as analytical tools. This objective was divided into specific objectives presented in two articles. Each group belonged to a different geographical region of the IPA. They all worked on the same clinical case and their output was analysed using the same structured qualitative methodology. To analyse levels 1 and 3 of the model, the Consensual Qualitative Research (CQR) method was used. For level 2, the Operationalised Psychodynamic Diagnosis (OPD-2) was used. RESULTS AND DISCUSSION: There was a predominance of convergence between each of the groups for each of the levels analysed, with some points of divergence. The implications of these results for the trustworthiness of the model, clinical practice, training and research in psychoanalysis are discussed.

Adjusting to a new reality: Consensual qualitative research on therapists' experiences with teletherapy

OBJECTIVE

In the wake of the COVID-19 pandemic, the use of teletherapy has become more pervasive than ever. Many therapists faced this move to a remote setting with little experience or training. We aimed to qualitatively examine therapists' subjective experience of providing teletherapy, including changes in technique, the therapeutic relationship, and the therapeutic process.

METHODS

Thirty-one psychotherapists participated in semistructured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method.

RESULTS

Therapists typically reported a change in the therapeutic relationship in terms of an increased sense of disconnection as well as shifts in various aspects of the relational dynamics, and they also typically experienced differences in the therapy process due to changes in patient and therapist engagement in the therapeutic work. Additionally, some therapists also reported that they became more active and directive in sessions, took a more informal, personal, or relaxed approach to interacting with patients, and while the emotional connection changed and they missed the energy and intimacy of in-person sessions, the relationship in telesessions felt more authentic and human for some, and teletherapy also provided a way to discuss new dimensions in the process.

CONCLUSION

Overall, these results suggest great variability in therapists' subjective experiences with teletherapy, and present teletherapy as a distinct therapy format in many aspects. Further process-level research and subsequent training is needed to better equip therapists to navigate teletherapy's challenges and harness its unique opportunities.

Relational coding: Enhancing the transparency and trustworthiness of grounded theory research

Grounded theory practitioners are undoubtedly familiar with critiques of their research which problematise its lack of transparency and, subsequently, trustworthiness. While the literature on grounded theory already benefits from numerous varying guides on ‘how to do grounded theory’, comparatively less instruction exists around how to do it clearly and convincingly. One of the elements of the grounded theory methodology (GT) which appears to be impacted most by confusion around transparent writeup is coding, naturally leading to the theoretical outputs thereof suffering from questionable trustworthiness. Through the course of my own postgraduate research, I developed a tool which not only makes coding more transparent to the reader, but to the researcher themselves. This tool, Relational Coding, highlights the relationships between codes which form the foundation of theory, and reveals them more obviously to the reader and researcher alike. Rather than ‘a how to guide to GT’, this is a ‘how to show you have actually done GT’ tool. This allows for stronger arguments to be built from the theory which this methodology builds due to the trustworthiness inspired by enhanced transparency. Here I demonstrate its usefulness and applicability, as well as key shortcomings which may be addressed by fellow grounded theory enthusiasts as the tool is inherently organic and modifiable.

Exploring reasons for sick leave due to common mental disorders from the perspective of employees and managers – what has gender got to do with it?

Purpose

The purpose of this study was to explore the employee and the managerial experience of reasons for sick leave due to CMDs in relation to work and private life, through the lens of a transactional perspective of everyday life occupation and gender norms.

Methods

Semi-structured interviews were conducted with 17 employees on sick leave due to CMDs and 11 managers. By using transactional and gender perspectives in a reflexive thematic analysis, themes were generated in a constant comparative process.

Findings

Four themes were identified: a) struggling to keep up with work pressure and worker norms; b) struggling with insecurity in an unsupportive work environment; c) managing private responsibilities through flexible work schedules, and d) managing emotions alongside unfavourable working conditions.

Conclusion

Sick leave due to CMDs was understood as related to experiences of accumulated events situated in different social, cultural, and societal contexts of everyday life. Practices and policies should encourage an open dialogue about work and private life and health between employees and managers. To build healthy and sustainable work environments practices should also aim for increased awareness of social norms. A better understanding may facilitate the identification of situations in work and private life that are problematic for the employee.

Convenient consumption: a critical qualitative inquiry into the gambling practices of younger women in Australia

There are a range of stereotypes and assumptions associated with women's gambling behaviours. While researchers have demonstrated that the practices associated with women's gambling are changing and becoming increasingly normalized, there is a limited understanding of how younger women ascribe meanings to these practices. This study explored the gambling practices of younger women. Forty-one women (20-40 years) participated in qualitative telephone interviews. Participants were asked open-ended questions about personal engagement in gambling, including experiences of gambling, gambling engagement, and experiences with different gambling products and environments. Data interpretation was guided by reflexive thematic analysis. Three themes were constructed from the data: (i) gambling infrastructures, including both products and the embedding of gambling in community environments, contributed to the convenient and regular consumption of gambling, with gambling easy to access and engage with; (ii) social networks and intergenerational gambling practices impacted the perceived social value and competencies related to gambling; and (iii) technology facilitated new gambling practices, routinizing gambling behaviours through automation and building perceived competencies with a range of gambling products. Gambling regulation and public health responses to gambling often focus on either individual behaviours or product characteristics. This study suggests that this focus is too narrow and excludes important influences on younger women's gambling practices, which include the infrastructure that supports the provision and consumption of gambling products. Public health research, policy and practice must consider the full range of determinants that may contribute to the initiation and continuation of gambling in younger women.

Journey to wellness: A socioecological analysis of veterans in recovery from substance use disorders

Substance use disorders are increasingly prevalent among veterans in the United States. Veterans in recovery face unique challenges, such as high rates of psychiatric comorbidities, difficulties adjusting to civilian life, and inadequate housing and mental health services. While prior research has explored veterans' experiences in recovery, studies have not implemented a multilevel perspective in their analyses. The current qualitative study examined how individual veteran experiences intersect with interpersonal and systemic factors. Semistructured focus groups were conducted with veterans who were former or current residents of recovery homes (N = 20). Thematic analysis was utilized to explore veterans' personal experiences through the CHIME-D framework (connectedness, hope & optimism, identity, meaning in life, empowerment, and difficulties). The data were further analyzed within a socioecological model (intrapersonal, interpersonal, and community). Each component of the CHIME-D framework was salient across all focus groups, with connectedness, empowerment, and difficulties being the most prominent themes that occurred across all socioecological levels. Results suggest that recovery initiatives can effectively assist veterans by promoting empowerment, facilitating social connections, and addressing cooccurring difficulties across multiple socioecological contexts. Additionally, treatment programs should encourage veterans to take on meaningful roles in their communities. Future research should continue to explore veterans' recovery experiences using a socioecological model.

Impact of the COVID-19 Pandemic on Mental Health and Lifestyle in Thai Occupational Therapy Students: A Mixed Method Study

The impacts of the COVID-19 pandemic have led to global reports of hazards to mental health. However, reports regarding lifestyle changes due to the COVID-19 pandemic are lacking. Using a convergent mixed methods design, we conducted individual interviews with twelve occupational therapy students and interpreted the results by content analysis. We completed a survey of Thai Sensory Patterns Assessment (TSPA) concerning perspectives from occupational therapy students (n = 99). They identified two major themes: (i) adaptive responses were consistent with areas of occupation during the COVID-19 pandemic; (ii) multidimensional challenges were related to sensory patterns of purposeful and meaningful activities. The participants reported both positive and negative impacts of the COVID-19 pandemic on their lives. It had both positive and negative effects on the lifestyle of students affected by the COVID-19 pandemic. The positive effect was that most students learned better ways to protect and care for themselves. During the COVID-19 pandemic, occupational therapy students were most concerned about their online learning activities, economic problems, isolation from society, and lifestyle. The negative effects of this include stress, anxiety, loneliness, frustration, boredom, and exhaustion for occupational therapy students. As an impact of the COVID-19 pandemic, occupational therapy students adapted to new lifestyles and experienced mental health issues related to their studies, families, friends, economics, social climate, and future job opportunities. Educators may use the findings of this study to prevent negative impacts on mental health and promote academic achievement in the future, as well as general well-being, efficacy, and empowerment of students in the new normal post-COVID-19 pandemic era.

Advancing virtual primary care for people with opioid use disorder (VPC OUD): a mixed-methods study protocol

INTRODUCTION

The emergence of COVID-19 introduced a dual public health emergency in British Columbia, which was already in the fourth year of its opioid-related overdose crisis. The public health response to COVID-19 must explicitly consider the unique needs of, and impacts on, communities experiencing marginalisation including people with opioid use disorder (PWOUD). The broad move to virtual forms of primary care, for example, may result in changes to healthcare access, delivery of opioid agonist therapies or fluctuations in co-occurring health problems that are prevalent in this population. The goal of this mixed-methods study is to characterise changes to primary care access and patient outcomes following the rapid introduction of virtual care for PWOUD.

METHODS AND ANALYSIS

We will use a fully integrated mixed-methods design comprised of three components: (a) qualitative interviews with family physicians and PWOUD to document experiences with delivering and accessing virtual visits, respectively; (b) quantitative analysis of linked, population-based administrative data to describe the uptake of virtual care, its impact on access to services and downstream outcomes for PWOUD; and (c) facilitated deliberative dialogues to co-create educational resources for family physicians, PWOUD and policymakers that promote equitable access to high-quality virtual primary care for this population.

ETHICS AND DISSEMINATION

Approval for this study has been granted by Research Ethics British Columbia. We will convene PWOUD and family physicians for deliberative dialogues to co-create educational materials and policy recommendations based on our findings. We will also disseminate findings via traditional academic outputs such as conferences and peer-reviewed publications.

Ethical aspects of the coordination of return-to-work among employees on sick leave due to common mental disorders: a qualitative study

PURPOSE

Identify ethical issues that arise in the coordination of return-to-work (RTW) among employees on sick leave due to common mental disorders (CMDs).

MATERIAL AND METHODS

41 semi-structured individual interviews and one focus group interview with stakeholders (n = 46) involved in RTW: employees on sick leave due to CMDs, coordinators and physicians at primary health care centres, managers, representatives of the Swedish social insurance agency and occupational health services. A six-step thematic analysis focused on the ethical values and norms related to autonomy, privacy, resources and organization, and professional values.

RESULTS

Five themes were identified: (1) autonomous decision-making versus the risk of taking over, (2) employee rights versus restrictions to self-determination, (3) respect for employee privacy versus stakeholders' interests, (4) risk of unequal inclusion due to insufficient organizational structure and resources, (5) risk of unequal support due to unclear professional roles and responsibilities.

CONCLUSION

The main ethical issues are the risks of unequal access to and unequal support for the coordination of RTW. For the fair and equal provision of coordination, it is necessary to be transparent on how to prioritize the coordination of RTW for different patient groups, provide clarity about the coordinator's professional role, and facilitate ongoing boundary work between stakeholders. IMPLICATIONS FOR REHABILITATIONUnfair and arbitrary criteria for inclusion to the coordination of RTW implicate risks of unequal access for the employee on sick leave due to CMDs.Unclear professional roles and responsibilities among stakeholders in the coordination of RTW implicate risks of unequal support for the employee on sick leave due to CMDs.Coordination of RTW should be transparently prioritized on policy and organisational levels to secure fair and equal inclusion.The coordinator's professional role should be clearly defined to facilitate boundary work between stakeholders and improve the competence around the coordination of RTW.

Young people in Australia discuss strategies for preventing the normalisation of gambling and reducing gambling harm

Background

The normalisation of gambling for young people has received considerable recent attention in the public health literature, particularly given the proliferation of gambling marketing aligned with sport. A range of studies and reports into the health and wellbeing of young people have recommended that they should be consulted and engaged in developing public health policy and prevention strategies. There are, however, very few opportunities for young people to have a say about gambling issues, with little consideration of their voices in public health recommendations related to gambling. This study aimed to address this gap by documenting young people’s perceptions about strategies that could be used to counter the normalisation of gambling and prevent gambling related harm.

Methods

This study took a critical qualitative inquiry approach, which acknowledges the role of power and social injustice in health issues. Qualitative interviews, using a constructivist approach, were conducted with 54 young people (11–17 years) in Australia. Reflexive thematic analysis was used to interpret the data.

Results

Five overall strategies were constructed from the data. 1) Reducing the accessibility and availability of gambling products; 2) Changing gambling infrastructure to help reduce the risks associated with gambling engagement; 3) Untangling the relationship between gambling and sport; 4) Restrictions on advertising; and 5) Counter-framing in commercial messages about gambling.

Conclusions

This study demonstrates that young people have important insights and provide recommendations for addressing factors that may contribute to the normalisation of gambling, including strategies to prevent gambling related harm. Young people hold similar views to public health experts about strategies aimed at de-normalising gambling in their local communities and have strong opinions about the need for gambling to be removed from sport.

Evaluating a motivational and psycho-educational self-help intervention for athletes with mild eating disorder symptoms: A mixed methods feasibility study

OBJECTIVE

The primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho-Educational Self-Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED-A). A mixed-methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED-A in reducing athletes' eating disorder symptoms.

METHOD

Thirty-five athletes were recruited. Participation involved completing MOPED-A over a 6-week period and completing self-report measures at baseline (T1), post-intervention (T2) and 4-week follow-up (T3). A subsample (n = 15) completed an interview at T2.

RESULTS

Retention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED-A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3.

CONCLUSIONS

The MOPED-A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted.

Young men's perceptions about the risks associated with sports betting: a critical qualitative inquiry

BACKGROUND

Gambling is an inherently risky activity. New technologies have led to the development of new, online forms of gambling such as sports betting, with round the clock availability and accessibility. While young men have been identified as a group that may be particularly vulnerable to the harms associated with these new online products, few studies have qualitatively explored young men's perceptions of the risks associated with these products. Using concepts associated with the sociology of risk, this paper sought to explore the range of factors that may influence how 18-24 year old young Australian men conceptualise the risks associated with sports betting.

METHODS

Using a critical qualitative inquiry approach, in-depth interviews were conducted with sixteen participants in Victoria, Australia, who engaged in sports betting at least monthly. The data interpreted for this study included questions relating to awareness of gambling, the contexts associated with early gambling experiences; the factors that influenced current gambling behaviours, and why they engaged in gambling. A reflexive approach to thematic analysis was used to interpreted themes from the data.

RESULTS

Four key themes were constructed from the data relating to the factors that influenced risk perceptions. These included: 1) 'The role of early experiences', including exposure to gambling advertising in sport, and the gambling behaviours of social networks; 2) 'The influence of peer rivalry and competition', in which sports betting was used to form connections within and across peer groups; 3) 'The normalisation of gambling', including the embedding of gambling in everyday activities; and 4) 'The influence of perceptions of knowledge, skill, and control', including the belief that they could engage in responsible behaviours and stop gambling if they needed to.

CONCLUSION

This study indicated that a range of factors may influence how young men conceptualise the risks and benefits associated with sports betting. Current public health strategies for gambling that focus on individual determinants and responsibility paradigms must be broadened to target the social and commercial factors that influence young men's attitudes towards, and engagement in sports betting.

Evaluation of the acceptability of patient-reported outcome measures in women following pelvic floor procedures

PURPOSE

Patient-reported outcome measures (PROMs) are valuable tools in evaluating the outcomes of surgical treatment health-related quality of life (HRQoL) of women with stress urinary incontinence (SUI) and may be incorporated into related clinical quality registries. The aim of this study was to assess the feasibility and acceptability of incorporating PROMs into the Australian Pelvic Floor Procedure Registry (APFPR).

METHODS

Semi-structured qualitative interviews were conducted with women with SUI (N = 12) and their managing clinicians (N = 11) in Victoria, Australia. Interview topics covered content and face validity, appropriateness, and acceptability of three incontinence-specific, two pain, one anxiety and depression, one sexual function and one patient global impression of improvement instruments identified through the literature to determine their suitability and acceptability for the APFPR. We analysed interview data into topics using conventional content analysis.

RESULTS

Study participants agreed that PROMs were needed for the APFPR. Both participant groups suggested that some of the instruments were ambiguous, therefore only three instruments (one incontinence-specific, sexual function and patient global impression of improvement) will be included in the APFPR. Both clinicians and women agreed it would be appropriate to answer PROMs at baseline and then at 6- and 12-month postsurgically. Email, phone call and mail-out of the instruments were the preferred options for administration.

CONCLUSION

Most women and clinicians supported the feasibility of incorporating PROMs in the APFPR. Participants believed the PROMs would demonstrate useful aggregate HRQoL data and have potential for use in individual care.

Health locus of control in cancer patient and oncologist decision-making: An exploratory qualitative study

Objective

To investigate how cancer patients’ and family members’ perspective and health locus of control are presented in clinical encounter decision-making.

Methods

Semi-structured in-depth interviews were carried out with 16 cancer patients and 6 family members living in Israel (n = 22). Interviews were transcribed verbatim, and data were analyzed using thematic analysis.

Results

Following the health locus of control model, the findings were divided into an external and internal locus of control themes, and we added a theme regarding shared decision-making. Internal locus of control sub-themes included asking for a second opinion, negotiating with the doctor, asking questions, looking for information, and fighting for their rights. External locus of control sub-themes included powerful others, oncologists, and fate. The dominant approach of most of the interviewees was an external locus of control. Women demonstrated more external locus of control than men. On the direct question of who should decide on treatment—the doctor, the patient, or both jointly—the answers ranged from only the doctor (n = 8) to together (n = 7) to only the patient (n = 8).

Conclusions

This study provides insights into different aspects of locus of control in the clinical encounter involving cancer patients. The findings reflect the need to devote comprehensive attention to cancer patients’ perceptions and experiences in the clinical encounter. A patient-centered care approach and a personalized framework for decision-making in cancer care are essential to achieving better treatment outcomes. Further research can engage in the development and validation of an up-to-date health locus of control questionnaire for cancer patients based on the findings of this study.

Conducting In-Depth Interviews via Mobile Phone with Persons with Common Mental Disorders and Multimorbidity: The Challenges and Advantages as Experienced by Participants and Researchers

Qualitative interviews are generally conducted in person. As the coronavirus pandemic (COVID-19) prevents in-person interviews, methodological studies which investigate the use of the telephone for persons with different illness experiences are needed. The aim was to explore experiences of the use of telephone during semi-structured research interviews, from the perspective of participants and researchers. Data were collected from mobile phone interviews with 32 individuals who had common mental disorders or multimorbidity which were analyzed thematically, as well as field notes reflecting researchers’ experiences. The findings reveal several advantages of conducting interviews using mobile phones: flexibility, balanced anonymity and power relations, as well as a positive effect on self-disclosure and emotional display (leading to less emotional work and social responsibility). Challenges included the loss of human encounter, intense listening, and worries about technology, as well as sounds or disturbances in the environment. However, the positive aspects of not seeing each other were regarded as more important. In addition, we present some strategies before, during, and after conducting telephone interviews. Telephone interviews can be a valuable first option for data collection, allowing more individuals to be given a fair opportunity to share their experiences.

You Only Get One Brain: Adult Reflections on the Long-Term Impacts of Traumatic Brain Injury in Adolescence

Background:

This research adds to scarce literature regarding adolescent experiences of traumatic brain injury (TBI). Retrospective accounts of young adults who had sustained a TBI in adolescence were analysed to explore the perceived impact this had on their lives and forming identities during this important developmental stage.

Methods:

Thirteen adults (aged 20–25 years; mean 23 years) who sustained a mild or moderate TBI during adolescence (i.e. aged 13–17 years at injury), approximately 7.7 years (range = 6.7–8.0 years) prior, participated in the research. Semi-structured individual interviews, analysed using thematic analysis, explored participants’ experiences following their TBIs.

Results:

Thematic analysis of interview data produced two categories of themes: (1) Impacts on Important Areas of Life, which included: schoolwork suffered, career opportunities became limited, struggling with work and missing out socially; and (2) Impacts on Identity: with themes including feeling ‘stupid’, feeling self-conscious, loss of social identity and being dependent.

Conclusions:

TBI sustained during adolescence can have broad impacts on important areas of life and on developing identity.

In Service of the Society? Medical Associations as Agents of Social Change-Implications for Health Policy and Education in Israel

This study aims to explore what medical associations in Israel do to promote public health, what values underpin their activities, and how their actions can be interpreted. For this purpose, an analysis of both individual and organizational levels was applied in an effort to yield a more nuanced understanding of the relationship between society and the medical profession. In-depth interviews with senior physicians were conducted, combined with a review of policy and public initiatives of medical associations between 2008 and 2018. The findings of this study reveal that medical associations engage in a range of social and policy initiatives designed to promote public health, but, at the same time, they tend to construct socially related health issues as medical problems in a manner that fits their sectorial agendas. This may reflect organized medicine’s efforts to extend its dominance over society through the application of the biomedical model to social issues. It is necessary to integrate biosocial training with medical education to ensure that future physicians are equipped with the skills needed to implement social medicine.

You only get one brain. Adult reflections on acute and ongoing symptom experiences after traumatic brain injury in adolescence

BACKGROUND

This research adds to the scarce literature regarding adolescent experiences of traumatic brain injury (TBI). It uses a qualitative methodology to explore the symptoms experienced after sustaining a TBI at this unique stage of development including their persistence into adulthood.

METHODS

Thirteen adults (aged 20-25 years; mean 23 years) who sustained a mild-moderate TBI during adolescence (aged 13-17 years at injury), approximately 7.7 years (range = 6.7-8.0 years) prior, participated in the research. Semi-structured individual interviews, analyzed using thematic analysis, explored participants' experiences surrounding and following their TBIs.

RESULTS

TBI during adolescence can result in significant acute symptoms, particularly headaches, fatigue, and difficulties in thinking. Participants' descriptions of the extent and impact of these symptoms reflected feelings of frustration and often anxiety and/or depression. Difficulties could persist for years post-TBI and sometimes had not resolved at all.

CONCLUSIONS

Even mild TBI during adolescence can result in significant acute and ongoing symptoms, which can contribute to emotional distress in the long term.

The development and practice of authentic leadership: a cultural lens

Purpose

Despite increasing interest and scholarship on authentic leadership, definitions of the construct remain contested. In addition, limited research exists on its enactment in practice and its sustainability in a global context. The purpose of this study was to explore the practice of authentic leadership and understand more about how it is cultivated and sustained.

Design/methodology/approach

To address these issues, an international sample of leaders nominated by peers as exemplifying authenticity in their leadership was interviewed. This study used consensual qualitative research (CQR; Hill, 2012; Hill et al., 1997), a team-based, exploratory methodology, to conduct data analysis.

Findings

This study describes the results of the analysis, highlighting leaders’ beliefs, values and behaviors; their leadership development and the barriers and supportive factors they experienced as leaders. The findings from this exploratory analysis across all cases, including subgroups, may help contextualize the complexity of authentic and sustainable leadership and provide better understanding of authentic leadership development.

Research limitations/implications

Additional research on social identities and training in leadership are critical. The results of this study suggest new directions in studying the development of authentic leaders as well as in researching the experiences of organizations and team members.

Practical implications

This study provides insight and direction for individuals and organizations seeking to better understand the practice of authentic leadership, its development and how it can be sustained over time and across contexts and social identities.

Originality/value

This exploratory approach involving interviews with leaders around the globe provides information about the direct lived experiences of leaders identified as authentic by their peers. This study further highlights the leaders’ critical leadership beliefs and practices, as well as ways in which they cultivated and learned to sustain their leadership practices. This study also sheds light on ways in which experiences might differ across gendered and cultural contexts.

Rural Healthcare Enterprises in the Vortex of COVID-19: The Impact of Public Policies on the Internal and External Environment

The public policies implemented in order to contain the spread of COVID-19 in the community have created issues both in the internal and the external environments of the Greek rural healthcare enterprises. This study aimed to investigate the full extent of the issues (internal and external) caused by the public policies. Regarding the external factors, we examined the state, the local authorities, the financial institutions, the social stakeholders and the citizens. Regarding the internal factors, we focused on turnover, liquidity, working conditions, internal changes related to patient care and the implementation of protective measures. A qualitative research was conducted among twelve rural healthcare business owners in the form of semi-structured interviews. The research was conducted in the fall of 2020 during the second phase of COVID-19. The research showed that these enterprises were severely impacted by the government’s public policies. Local authorities were not involved due to lack of competence. The business owners were unwilling to support their enterprises via bank lending. During the first phase of COVID-19, citizens postponed nonessential medical examinations, causing a reduction in these enterprises’ turnover. As a result, in the following periods, these enterprises faced liquidity problems. However, they developed social objectives and implemented protective measures for their employees and patients. The present study contributes to the mapping of the factors affecting the internal and external environments of rural healthcare enterprises along with the public policies developed in times of prolonged crisis. These kinds of data are crucial to the business world and government officials voting on social policies. One cannot rule out the possibility of a new financial or health crisis; the findings of this study can prove to be a useful tool in the process of decision making.

Return to work and sick leave patterns following a work injury among young adults: a study protocol of a Swedish multimodal study

INTRODUCTION

There is a lack of studies that focus exclusively on return to work (RTW) and sick leave patterns following a work injury among young adults. This study aims to close the gap by contributing with knowledge regarding young adults' sick leave pattern after a work injury and their experience of RTW after a work injury in Sweden.

METHODS AND ANALYSIS

The present study is a multimodal study, which will use Swedish national register data and qualitative data collection by photovoice. Injuries classified as work injuries according to the Swedish injury classification were included. Registry data will be retrieved from the Swedish National-based registers of Swedish Information System on Occupational Accidents and Work-related diseases, the Swedish Social Insurance Agency's database MicroData for Analysis of Social Insurance and the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies. Persons who have registered a work injury at the Swedish Work Environment Authority in 2012 will be included. Sick leave patterns will be analysed using group-based trajectory models and multivariate analyses to explore how sick leave patterns have developed over 5 years. Subsequently, a participatory approach using photovoice method will be conducted to explore young adults' perceptions of barriers and facilitators in RTW after a work injury. Results from the photovoice group sessions will be analysed using a grounded theoretical approach.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the Ethical Review Board (case number 2019/028-6) in Sweden. Results of the study will be disseminated through peer-reviewed journals, print and media presentation, conferences and via reports to the funding agency.

Individualized prescribing portraits to reduce inappropriate initiation of opioid analgesics to opioid naïve patients in primary care: Protocol for a randomized controlled trial

Background Opioid analgesics are frequently initiated for chronic and acute pain despite weak evidence of benefit, although prescribing rates of some analgesics decreased in the context of the epidemic. In some populations, up to a quarter of opioid naïve persons prescribed opioids for non-cancer pain develop prescription opioid use disorder (OUD). Audit and feedback interventions rely on constructive use of routinely collected data to align professional behaviours and clinical practice with best evidence. These interventions have been shown to help reduce inappropriate initiation. However, effectiveness and acceptability of individualized "portraits" of physicians' prescribing patterns, to reduce inappropriate initiation of opioid analgesics to opioid naïve persons, have not been evaluated. Methods REDONNA is a mixed-methods randomized study testing the effectiveness of individualized prescribing Portraits to reduce inappropriate initiation of opioid analgesics. This intervention to improve safety of opioid prescribing in primary care in British Columbia (BC), Canada involves mailing individual prescribing portraits to an 'early group' of 2604 family physicians, followed in 6 months by a mailing to 2553 family physicians in the 'delayed group'. Primary outcome is number of new opioid prescriptions initiated in opioid naïve people, measured using administrative data from a centralized medication monitoring database covering all prescription opioids dispensed from BC community pharmacies. Secondary endpoints will compare prescribing impact between the two groups. A qualitative sub-study will examine feasibility among a purposive sample of physicians and patients. Discussion This trial provides important evidence on the intervention's potential to steer policy and practice on inappropriate opioid analgesics initiation. Trial registration: The study was registered prospectively on 30 March 2020 at the ISRCTN Register (https://www.isrctn.com/ISRCTN34246811).

What Can We Learn about Science Teachers’ Technology Use during the COVID-19 Pandemic?

The purpose of this qualitative research was to describe teachers’ experiences in a technology-mediated teaching context during the COVID-19 pandemic. We mainly focused on teachers’ experiences with technology use (change and variety of the use) and their willingness to use technology in teaching. We designed an interview-based study. The participants were Estonian science teachers who voluntarily agreed to share their experiences about teaching in new and—for most of them—unexpected, distanced learning conditions. Based on teachers’ reflections on technology use we could distinguish between three groups in which teachers described different levels of willingness to use technology, change in technology use from pre-COVID to distanced learning, and variety in the use of technology. Our results revealed that the higher teachers’ perceived willingness to use technology, the easier it was for them to overcome potential obstacles and cope with the unexpected distanced learning. The main obstacles there were grouped as external (e.g., issues with internet connection, lack of students’ digital skills) and internal (e.g., teachers’ beliefs about technology use for teaching). I was observed that some obstacles were shared by all teachers (such as limitations on students’ digital skills) whereas others where more prevalent in separate groups. This highlights the importance of understanding and considering the variability in the possible obstacles that emerge in using technology in education for teachers with different levels of experience.

Young people's reflections on the factors contributing to the normalisation of gambling in Australia

OBJECTIVES

To explore young people's perceptions of the factors that may normalise gambling, and their opinions about the messages they see about gambling in their environments.

METHODS

An analysis of qualitative data from a mixed methods study of n=111 young people aged 11-16 years in Victoria, Australia. Questions investigated: i) the normalisation of gambling in sport; ii) the impact of advertising on young people; and iii) potential strategies to alert young people about the risks associated with gambling. An inductive approach was used to analyse the data.

RESULTS

Participants perceived that gambling was a regular and everyday activity and that gambling was becoming normalised in sport. However, some directly challenged this alignment. They were particularly critical that gambling advertising may influence young people's current and future gambling-related attitudes and intentions. Most participants supported public health interventions, including more advertising restrictions.

CONCLUSION

Young people's awareness of gambling and gambling marketing may be increasing their perceptions of the alignment between gambling and sport. Implications for public health: Strategies should be developed to increase young people's awareness of the risks associated with gambling. Young people's voices and views should be considered by policy makers in responding to this new public health issue.

Identifying distinctive traits of healthcare leaders in Israel: in-depth interviews with senior physicians – an exploratory study

Purpose

This paper aims to examine the views of physicians in senior management positions regarding the distinctive characteristics and roles of leaders in the Israeli health-care system and what might be the interactions between management and leadership.

Design/methodology/approach

In total, 13 semi-structured in-depth interviews were conducted with physicians in senior management positions. Interviews were recorded, transcribed and analyzed using the qualitative-phenomenological method.

Findings

Interviewees discerned leaders as exhibiting traits of transformational leadership and managers, as expressing characteristics of transactional leadership. Most interviewees asserted that physicians should act as social leaders promoting public health and equality in health care, beyond their clinical practice. They agreed that physicians should fill most senior positions in the health-care system, provided they undergo appropriate training in management, leadership and interdisciplinary collaboration.

Originality/value

Interviewees revealed gaps between the aspiration to lead, perceptions of physicians as leaders and what occurs in reality: physicians wish to assume leadership roles in the health-care system and emphasize the qualities of transformative leadership, but medical education does not include leadership training. Therefore, there is a need to develop training programs for physicians in management and leadership. There is also a need to integrate physicians from various communities to promote local leadership in the health-care field and to reduce disparities. The consideration of health-care leadership is especially applicable in the context of the Covid-19 pandemic, which has placed the question of leadership within and outside of the medical community in a broader social context.

Processual Validity in Qualitative Research in Healthcare

Knowledge development has been continuously challenging. Qualitative research seems to be promising; however, there are difficulties and complexities involved, one of which is validity. Qualitative research is based on different paradigms, ontologies, theories, and methods, and validity assessment may vary. We argue that processual validity can positively influence qualitative health care research. Processual validity is a methodological construction that involves all research steps, including those before and after data collection and analysis. We selected a processual validity model and two cases to illustrate its use and demonstrate processual validity’s importance and applicability. One case explores the gap between medical education and patients’ needs in primary health care. Other studies focus on health care improvements in hospitals. Our results highlight the benefits of processual validity to ensure the transparency and reliability of the research process and provide evidence of the findings to positively influence thinking and the execution of qualitative research in health care.

Medical Student Involvement in a Human Rights Program: Impact on Student Development and Career Vision

Background:

There is consensus among many medical school deans that exposure to human rights is a necessary component of physician training [78], however little is known about the impact of engagement in human rights programs on students’ personal and professional development [1516171819202122232425262728].

Objective:

This study aimed to examine medical students’ experiences in the Mount Sinai Human Rights Program (MSHRP), their motivations for involvement, and the possible influence of engagement on their professional identities, personal growth, and career choices.

Methods:

Through semi-structured interviews, this qualitative study gathered the experiences of 15 fourth year and recently graduated medical students who participated in the comprehensive training, research, and direct service opportunities provided by the program. Responses were coded using a content analysis approach.

Findings:

The results of this research highlight the motivations behind students’ involvement in a medical human rights program, as well as the challenges they experienced engaging with this work. The study captured students’ perceptions of the role of the program on their personal growth, clinical skills, and career vision. Nearly all the students interviewed indicated they developed important, clinically applicable skills that enhanced their traditional medical education. Students indicated that their participation directly influenced their professional identities and future career directions by reinforcing previous interests in human rights and social justice work, impacting medical specialty and residency program selections and fostering commitment to working with immigrant populations.

Conclusions:

The results of this study indicate that longitudinal involvement with the MSHRP contributed to the acquisition of important clinical skills that were not otherwise attained in students’ early medical education. Findings suggest that there is significant opportunity for clinical and leadership development outside the traditional preclinical and clinical setting, and that exposure to human rights education shapes students’ professional identities and career paths. Finally, the findings highlight the essential role of human rights and social justice in medical education.