Bracketing in qualitative research: Conceptual and practical matters

Perceptions of sleep health among African American mothers regarding their preschool-aged children: A qualitative study to decrease sleep health disparities

OBJECTIVES

African American children are documented as having poor sleep health due to shorter sleep duration, sleep timing, and sleep behaviors compared to White peers, contributing to child health disparities. Identifying cultural-environmental, and societal factors impacting a child's sleep among African American families is essential for developing interventions for this population. This study evaluated holistically why African American children may have poorer sleep health by examining sleep duration, timing, and behaviors. This was assessed by examining sleep-related beliefs, barriers, and facilitators to sleep schedules and routines. We also explored parental ideas for a sleep intervention.

METHODS

African American mothers of preschool-aged children (2-5years) were recruited using local partnerships and social media. Individual semistructured interviews were conducted by phone. Interviews were transcribed, coded, and analyzed thematically using grounded-theory.

RESULTS

Eighteen African American mothers completed the study. Five themes related to sleep emerged: The importance of adequate nighttime sleep, the influence of family and friends on parental sleep practices, the relationship between environmental and home dynamics on child sleep duration, the impact of acute and chronic societal-level stressors on family sleep health, and considerations for culturally tailored interventions to improve child sleep health.

CONCLUSIONS

Good sleep health was important among African American mothers. Cultural-environmental and societal factors significantly impact children's sleep health. Clinicians and researchers should be aware of financial resources and home dynamics leading to challenges with adequate sleep health when developing or adapting sleep interventions. Identifying cultural-environmental, and societal factors must be considered for targeted efforts to improve sleep health in African American children.

"Us big boys gotta find a way that works": A qualitative study of casual sexual experiences among larger-bodied, White and Latino sexual minority men

Compared to their heterosexual counterparts, sexual minority men (SMM) are more likely to report that their own body image negatively impacts their sex lives, are more vulnerable to weight stigma, and more frequently experience size-based discrimination. Additionally, in comparison to heterosexual men, SMM report higher levels of anti-fat bias, both directed at themselves and intimate partners. Given this literature, we qualitatively examined how nine larger-bodied SMM (Mage = 37.89, SD = 12.42) experience and navigate weight stigma when seeking out casual sex. Our analytic process revealed four primary themes: Building a Gate, Letting Partners Past the Gate, Joy Inside the Gate, and When the Gate Fails. The gate refers to the protection that participants employed to avoid negative, unsafe, or fatphobic sexual encounters. Participants shared that they were aware of weight stigma within their own community, and many assumed (or were explicitly told) that their bodies were undesirable to potential partners. Further, participants readily delineated between fat attraction and fat fetishization, whereby the latter was universally framed as negative and degrading. These findings highlight the complex experience of engaging in casual sex for larger-bodied SMM and identify strategies these men use to protect themselves from body shame and weight stigma.

Motivations for and experiences of childbirth abroad amongst Nigerian women: A qualitative study

Birth tourism, the practice of a woman travelling out of her country of residence to another country to give birth, is common globally. Despite this, there is limited literature on the motivations and experiences of women who gave birth abroad. This study aims to address this gap by seeking to understand the motivations for and experiences of childbirth abroad among Nigerian women. Using purposive and snowball sampling, 27 Nigerian women who had children abroad were recruited via social media platforms. In-depth interviews were conducted remotely, audio-recorded, transcribed, and analysed thematically. Braun and Clarke's six-step thematic analysis was used, which included data familiarisation, code generation, searching for themes, reviewing themes, defining themes, and producing the report. We found that motivations for seeking childbirth abroad varied based on the mother's desires for their children, needs, and circumstances. These motivations were formed at different times before and after pregnancy and evolved over time. The experience of childbirth abroad is mostly good. However, there are also bad experiences, with some women feeling like they were treated differently because they were "self-paying" patients, "black", or not country residents. The cost of care is deemed exorbitant, but most pay their bills. Support of loved ones around childbirth abroad was considered crucial, although not always available. Through it all, realising the expected and collateral benefits of childbirth abroad made it all worth it. In conclusion, motivation for childbirth abroad varies and evolves. While globalisation, broken health systems, and ongoing sustained economic challenges in Nigeria and similar settings continue to motivate women to seek childbirth abroad, their experiences of childbirth abroad suggest that though it might be greener on the other side, it is not necessarily dark green. Systems are needed to elevate their voices in the public discourse and safeguard them from bad experiences of childbirth abroad.

"I want my son to die before I do": A phenomenological study on the views of mothers with disabled children about death after the 6 February 2023 earthquakes in Türkiye

In this study, it was aimed to investigate the experiences of mothers with disabled children directly affected by the 6 February 2023 earthquakes in Türkiye regarding the concept of death in the context of social representations. The interpretive phenomenological analysis method, which is a qualitative research method, was used in the study. The content of semi-structured interviews held with 23 mothers was analyzed according to the analysis guidelines of Smith and Osborn. As a result of the analyses, four themes representing the views of the participants on the concept of death, which were "the perception of death, individual factors affecting the perception of death, environmental factors affecting the perception of death, and methods of coping with death anxiety," as well as fifteen categories under these themes, were revealed. The results of this study present the experiences and needs of mothers with disabled children after the aforementioned earthquakes, their needs in this process, their views about death, and their coping resources within a cultural framework. According to the results, the existing needs and death anxiety of mothers with disabled children have become more prominent after the earthquakes.

"You always think the worst …" Family members' experiences during the COVID-19 emergency: A qualitative descriptive study

AIM

The aim of this study was to explore the experiences of family members of patients admitted to the intensive care unit (ICU) for COVID-19 during the first and second waves of the pandemic in Switzerland.

DESIGN

A qualitative descriptive approach was used in this study.

METHODS

Face-to-face in-depth semistructured interviews were used to explore the experiences of family members of surviving COVID-19 patients, who were admitted to the ICU. Interviews were transcribed verbatim and wereanalysed using Braun and Clarke thematic analysis. In our context, family visits were prohibited during the first and second waves of the pandemic.

FINDINGS

Fifteen family members participated. Interviews were conducted between October 2020 and March 2021. Data analysis identified three main themes: (i) becoming a pillar of support for all; (ii) dealing with uncertainty; and (iii) a trajectory of emotions. Five subthemes are reported within these themes. The primary concern was the need for information due to visitation restrictions. This led to stress as many became the main communication source for other family members and friends. Coping strategies to support the ongoing uncertainty included daily routines, work, and prayer. The inability to visit and the lack of information led to a range of conflicting emotions, such as feeling of helplessness, which were countered by the gratitude that their loved ones had survived.

CONCLUSION

This study highlights the profound impact of the COVID-19 pandemic on the family members of ICU patients. It emphasises their struggle for information, adaptation to new roles, and coping mechanisms amidst uncertainty. Although they experienced predominantly negative emotions, the recovery and return of their loved ones triggered a sense of gratitude. This study sheds light on the crucial role of social support. Such findings may have implications for nursing practice in effectively addressing the concerns and priorities of family members in similar emergency situations, thereby improving clinical outcomes.

Moving Towards Acceptance and Values: A Qualitative Study of ACTforIBD Compared to IBD Psychoeducation

The current study explored perspectives of those with inflammatory bowel disease (IBD) and comorbid anxiety and/or depression on a hybrid acceptance and committment therapy (ACT) intervention, compared to an active control. This qualitative study was nested within a randomized controlled trial (RCT) where an experimental group received an 8-week blended delivery ACTforIBD intervention (four sessions telehealth, four sessions pre-recorded self-directed), while an active control group received a psychoeducation program of similar intensity. Semi-structured interviews were conducted post-intervention and at a 3-month follow-up. Themes were interpreted using reflexive thematic analysis. Twenty individuals participated; ten in each condition. Seven themes were constructed, including three shared themes between groups: I Am Worth Advocating For, Present Moment Is My Biggest Ally, and Ambivalence About Self-Directed Modules. Two themes were identified for the ACTforIBD group: Symptoms Are Going to Happen and Moving Toward Values while two themes identified from the ActiveControl group were: Reset and Refresh and It's Ok to Say No. Acceptance and values modules from ACTforIBD were perceived as useful in reducing psychological distress for those with IBD, while the ActiveControl group felt their program affirmed existing effective coping strategies. Access to external resources for self-directed modules and networking may increase engagement with content long term.

Facilitators and barriers to "Positive Outcomes" from cognitive-behavioral therapy, according to young people: A thematic synthesis

OBJECTIVE

This qualitative review sought to explore how young people (YP) conceptualize positive outcomes from cognitive-behavioral therapy (CBT) and what YP perceive to be the facilitators and barriers to positive outcomes.

METHODS

A systematic literature search was conducted in June 2021 using six online databases. Studies were included if qualitative data were collected from participants who were aged up to 25, had internalizing mental health difficulties, and had received in-person CBT from trained practitioners.

RESULTS

Nineteen studies were included. The Gough Weight of Evidence framework was used to assess methodological and topical quality and relevance. A thematic synthesis identified 34 conceptualizations of positive outcomes, 57 facilitators, and 49 barriers. Descriptive and analytical themes were identified. In line with the review's pragmatic perspective, the latter were worded as practice recommendations: acknowledge YP's perspectives on outcomes, teach tangible CBT techniques, balance autonomy and support, frame CBT as "upskilling," explore nuanced barriers to engagement, and consider the power of group dynamics.

CONCLUSIONS

This review established the range of YP's views about positive outcomes from CBT, as well as facilitators and barriers to achieving these. Findings should prompt CBT practitioners to reflect and consider how their practice might be shaped through reports from YP as experts by experience.

Dropping the mask: It takes two

LAY ABSTRACT

In some situations, autistic people feel pressure to change their social behaviour by camouflaging. In other situations, autistic people feel they don't need to change their social behaviour. Instead, they feel they can socialise in ways that feel authentic or true to themselves. Past research has tended to focus on autistic people's experiences of camouflaging rather than their experiences of authenticity. In this study, we asked autistic people what it is like for them when they can socialise in ways that feel authentic or true to themselves. Autistic people described authentic-feeling socialising as more free, spontaneous and open than camouflaging. In supportive environments, this kind of socialising had more positive and less negative consequences than camouflaging. Autistic people felt that having self-awareness and acceptance of their own social needs and being around autistic and nonautistic people who were accepting and understanding helped them to socialise in authentic-feeling ways. Autistic people also spoke about communication behaviours they felt nonautistic people should use to help overcome misunderstandings and create autism-friendly social environments. These findings suggest it is helpful for autistic people to have access to supportive and accepting social environments in which they feel able to socialise in ways that feel authentic to them. In creating such social environments, it is important to focus on nonautistic people's knowledge and attitude towards autistic people and also their ability to use helpful communication behaviours.

Explaining the practicum experiences of diagnostic radiography undergraduates in Australia and Ethiopia using the theory of human relatedness

INTRODUCTION

Practice learning is critical to the development of clinical skills; hence placements are a major component of all pre-registration radiography programmes. Nonetheless, dissatisfaction with practicum experiences is a common reason why students consider leaving such programmes. Providing effective placements which promote retention may not only require better appreciation of students' clinical reflections, but also a more fundamental understanding of the implicit criteria they use to appraise a practicum. This study applied the theory of human relatedness (THR) to the placement experiences of radiography undergraduates to identify the evaluative mechanisms which may underpin these experiences.

METHODS

A critical realist investigative approach was employed to reanalyse data regarding the practicum experiences of stakeholders involved in undergraduate diagnostic radiography programmes at two universities in Australia and Ethiopia against the eight core THR concepts, namely connectedness, disconnectedness, parallelism, enmeshment, belonging, reciprocity, mutuality, and synchrony.

RESULTS

The findings identified all states of relatedness and processes/social competencies of the THR within the placement experiences of these stakeholders. The degree of positive relatedness a radiography student experiences within a practicum, irrespective of the setting, may affect their clinical performance.

CONCLUSION

The findings support the argument that the THR may reflect an implicit set of criteria stakeholders use to evaluate clinical encounters. Additionally, these results are congruent with earlier investigations regarding the practicum reflections of other undergraduate healthcare students.

IMPLICATIONS FOR PRACTICE

To enhance student placement experiences, it is necessary to recognise the effect a student's sense of relatedness may have on their self-efficacy and proficiency, modifying pre-practicum preparation and assessment arrangements to inhibit disconnectedness and enmeshment, avoid the need for parallelism, and better cultivate connectedness, belonging, reciprocity, mutuality, and synchrony.

"God was with me": A qualitative study of Christian meaning-making among refugees

In this consensual qualitative research study, we investigated the role of refugees' Christian faith in meaning-making coping. High percentages of religiosity in refugee populations support the need to understand the role of religion in their coping processes. Interviews with 20 Christian refugees from 10 African and Asian countries revealed that participants drew heavily from their faith resources to cope with their experiences. Specifically, refugees reported coping practices that included trust in God, prayer, intimacy with God, spiritual surrender, lament, worship, and social support. Although many participants described spiritual struggles, including doubting God, feeling distant from God, and questioning God, most found meaning amid refugee-related suffering and reported perspective shifts, a deepening of faith, seeing suffering as part of God's plan, experiencing a deepened sense of purpose, and growing in the likeness of Christ. Refugees also reported growth through suffering in the form of gratitude, altruism, testimony, and humility. Clinical implications include encouraging the use of religious resources for meaning-making and supporting the resolution of spiritual struggles.

What should inpatient psychological therapies be for? Qualitative views of service users on outcomes

BACKGROUND

There is limited research on what, when and how outcomes should be measured in psychological therapy trials in acute mental health inpatient wards.

OBJECTIVES

This study aimed to consider what outcomes service users think are important to measure.

METHODS

This qualitative study explored the views of 14 participants, who had an inpatient admission within the last year, on outcomes of psychological therapies using semistructured interviews. Data were analysed using thematic analysis from a critical realist perspective with both inductive and deductive coding.

RESULTS

The 126 outcomes that were important to participants were mapped onto an established taxonomy of outcomes across different health areas and the socioecological framework to consider the wider context and help summarise the outcomes. Most of the outcomes were mapped to the intrapersonal and interpersonal level. In addition to the outcome mapping, three themes were constructed from the qualitative data: (1) I am not a problem I am a person, (2) Feeling cared for and loved, (3) What does getting better look like.

CONCLUSIONS

Our results highlight the need for patient-reported outcomes which are cocreated with service users, disseminating research and training on preventing dehumanising experiences, enhancing psychological safety and therapeutic relationships and improving access to psychological therapy.

PATIENT OR PUBLIC CONTRIBUTION

The wider People with Personal Experience Involvement Committee at the University of Bath were consulted which included a focus group during the early planning stages. We also collaborated with a person with personal experience, at every stage of the research. This included developing our research question and aims, protocol, participant documents (e.g., information and debrief forms), advertisement and recruitment strategy, interview topic guide, the codes, the final themes and quotes and reviewing the manuscript. People with lived experience of being admitted to an acute mental health inpatient ward participated in our study.

Exploring the interplay between dementia, multiple health conditions and couplehood: A qualitative evidence review and meta-ethnography

Background: On average, people with dementia live with 4.6 additional health conditions. Additionally, two thirds of carers of people with dementia are spouses, and are also likely to live with multimorbidity, given that older age is strongly associated with an increase in health conditions. Consequently, living with dementia and multimorbidity is often a shared experienced as a couple. However, research has not explored how living with both dementia and multimorbidity may impact on couplehood. Method: We conducted a qualitive evidence review using a meta-ethnographic approach, to answer the following question: In what way (if any) does living with dementia and multimorbidity impact on couplehood? No papers were found on couplehood, dementia and multimorbidity, therefore the review consists of a meta-synthesis of couples' experiences of living with dementia in relation to couplehood, with an additional search for any data related to health within the qualitative findings. Findings: Two major reciprocal themes and five subthemes were identified from the 14 study findings. 1. Change and adjustment in the relationship, which included themes around a sense of 'togetherness', change in roles and identity and developing shared coping strategies and 2. Commitment, which was encapsulated by themes on unconditional love and commitment to wedding vows. Health-related findings were limited but included the impact on emotional wellbeing and how other health conditions, rather than dementia, were attributed to a loss in physical sexual intimacy. Conclusion: This review found that couplehood was threatened when dementia symptoms progressed and couples experienced feelings of loss of independence and identity. However, a strong foundation of commitment, love and loyalty to each other developed over the course of the relationship, was the 'glue' that helped couples face dementia together. However, further research is needed to explore couples' experiences of living with both multimorbidity and dementia in relation to couplehood in order to develop holistic, relationship-centred interventions.

Dignity and the Importance of Acknowledgement of Personhood for People With Disability

Exploring the intricate relationship between individual and collective experiences, this study explores dignity from the perspectives of people with disability. Using an extreme citizen science approach, we engaged people with disability as active partners in gathering data through qualitative surveys and focus groups. Framework Analysis was employed to ensure the validity of findings while privileging the voices of people with lived experience of disability. Dignity was contingent on the acknowledgement of personhood and the delivery of human rights. Our research identified five key aspects to maintain and protect dignity: (1) acknowledging personhood; (2) recognising people with disability as decision-makers of their lives; (3) realising the right to access information; (4) maintaining the right to privacy; and (5) eliminating or minimising barriers to accessibility and inclusion. Undignified experiences that resulted from a lack of acknowledgement negatively affected participants' wellbeing, and healthcare settings were identified as particularly challenging environments for dignity. These findings have significant implications for healthcare systems and services within an international and interdisciplinary context. They emphasise the need for adaptable, flexible services, co-designed with people with lived experience of disability. Addressing organisational constraints, resource limitations, and expectations is paramount to ensuring dignity is maintained through the acknowledgement of personhood and safeguarding of human rights.

Perceptions and Experiences of Undergraduate Students Regarding Social Media as a Tool for Government COVID-19-Related Messages: A Qualitative Study in Nottingham, UK

The rise of social media has given way to its use as a form of public health communication. Previous research has shown social media-based interventions to be effective, particularly for university students. Social media was used as a tool for public health messaging during the COVID-19 pandemic; however, there is a lack of information regarding the experiences and perceptions of such messaging and its effectiveness among UK university students. A qualitative study was conducted to explore the perceptions and experiences of public health messaging on social media during the pandemic, as well as the effects of such messaging. Fourteen semi-structured interviews with undergraduate students at the University of Nottingham, UK, were conducted. Five main themes were identified: effects of COVID-19 on university students, use of social media by university students, COVID-19 messaging on social media, effects of public health messaging on social media in compliance with COVID-19 guidelines, and improving public health messaging for the future. This study provides a novel insight into the experiences and perceptions of undergraduate students at a UK university regarding public health messaging on social media during the COVID-19 pandemic.

"God wastes nothing": A consensual qualitative study of coping among Catholic individuals with cancer diagnoses

While religious meaning-making has been extensively studied, emic religious coping remains largely unexplored. This consensual qualitative research study explored Catholic cancer survivors' (N = 22) descriptions of drawing on their religious framework throughout their cancer journeys. Findings revealed distinctive Catholic resources such as the power of blessings, drawing comfort from the saints and sacraments, and "offering up" suffering as a form of spiritual surrender, suggesting the existence of underlying theodicies of divine purpose as well as potential clinical resources. While many participants described spiritual struggles and questions, most found meaning through deepening their faith, helping others, and re-examining their priorities. Exploratory mixed-method analyses suggest that questioning God may promote turning toward faith, while being angry at God is associated with difficulty in doing so. The findings have implications for research, pointing to emic practices that merit further study.

Patients' experiences of cannulation of arteriovenous access for haemodialysis: A qualitative systematic review

INTRODUCTION

Cannulation is an essential part of haemodialysis with arteriovenous access. Patients' experiences of cannulation for haemodialysis are problematic but poorly understood. This review aims to synthesise findings related to patients' experiences of cannulation for haemodialysis from qualitative studies, providing a fuller description of this phenomenon.

METHODS

Eligibility criteria defined the inclusion of studies with a population of patients with end-stage kidney disease on haemodialysis. The phenomena of interest was findings related to patients' experiences of cannulation for haemodialysis and the context was both in-centre and home haemodialysis. MedLine, CINAHL, EMBASE, EMCARE, BNI, PsycInfo and PubMed were last searched between 20/05/2019 and 23/05/2019. The quality of studies was assessed using the using Joanna Briggs Critical Appraisal Checklist for Qualitative Research. Meta-aggregation was used to synthesise findings and CERQual to assess the strength of accumulated findings.

RESULTS

This review included 26 studies. The subject of included studies covered cannulation, pain, experiences of vascular access, experiences of haemodialysis and a research priority setting exercise. From these studies, three themes were meta-aggregated: (1) Cannulation for haemodialysis is an unpleasant, abnormal and unique procedure associated with pain, abnormal appearance, vulnerability and dependency. (2) The necessity of cannulation for haemodialysis emphasises the unpleasantness of the procedure. Success had multiple meanings for patients and patients worry about whether the needle insertion will be successful. (3) Patients survive unpleasant, necessary and repetitive cannulation by learning to tolerate cannulation and exerting control over the procedure. Feeling safe can help them tolerate cannulation better and the cannulator can invoke feeling safe. However, some patients still avoid cannulation, due to its unpleasantness.

CONCLUSIONS

Cannulation is a pervasive procedure that impacts on patients' experiences of haemodialysis. This review illuminates further patients' experiences of cannulation for haemodialysis, indicating how improvements can be made to cannulation.

REGISTRATION

PROSPERO (CRD42019134583).

Change processes during intensive day programme treatment for adolescent anorexia nervosa: a dyadic interview analysis of adolescent and parent views

Background

Day programmes for adolescent anorexia nervosa (AN) can function as an alternative to inpatient admissions and/or an increase in outpatient treatment intensity. Processes of change during treatment for AN are currently poorly understood. This study aimed to explore how adolescents with AN and their parents understood the helpful and unhelpful factors and processes that impacted them during day programme treatment.

Method

A critical realist paradigm was used to qualitatively explore the views of 16 participants. Participants were recruited from the Intensive Treatment Programme (ITP) at the Maudsley Center for Child and Adolescent Eating Disorders (MCCAED) at the end of treatment. Dyadic Interview Analysis (DIA) was used to compare and contrast the narratives of the seven adolescent-parent pairs after two inductive reflexive thematic analyses were conducted for the group of eight adolescents and the group of eight parents separately.

Results

Eight subthemes across three themes were identified: 1) "Like me she didn't feel so alone anymore"-families connect with staff, peers, and each other; 2) "You have to eat because ITP say so"-the programme provides families with containment through its structure and authority; and 3) "I found that I was using the skills I learnt there like in multiple aspects of my life, not just around food"-families take in new ideas and generalize these into their lives. These interconnected themes generated hope and change. However, helpful elements individually could be unhelpful if one or more of the other factors were missing. For example, staff firmness, which participants often found helpful (theme two), could be experienced as harshness when adolescents did not feel related to as individuals (theme one).

Conclusion

The findings can be conceptualized within recent descriptions regarding the therapeutic change, including epistemic trust and mentalization. Treatment characteristics, such as intensity and containment, as well as illness-specific factors and processes, such as control and collaboration, the role of peer support, and the potential for family members to experience the impact of the adolescent's AN and treatment non-response as traumatic, are equally important to consider.

"It gave her that soft landing": Consumer perspectives on a transitional rehabilitation service for adults with acquired brain injury

Transitional rehabilitation service models for people with acquired brain injury (ABI) may address sub-optimal support for individuals returning home after hospitalization for ABI. This study investigated perspectives of people with ABI and close others who received transitional rehabilitation. A qualitative study involving semi-structured interviews with 10 individuals with ABI and 12 associated close others was conducted as part of a mixed-method evaluation of an Australian transitional rehabilitation service (TRS) pilot project. Thematic analysis based on the Framework method was conducted independently by two researchers. Three broad themes illustrated participants' experience of the TRS: (1) structure after hospital discharge; (2) a "soft landing"; and (3) equipped for community living. Findings suggest that home-based, interdisciplinary transitional rehabilitation after hospital discharge was perceived as an important stage of rehabilitation by participants. Valued features relate to post-hospital rehabilitation structure: a single point of contact to facilitate organization and information exchange, a known discharge destination, and consistent communication; support and therapy within a familiar home environment; and being equipped with relevant knowledge and strategies to manage ongoing challenges. Further research exploring the experiences of individuals with ABI without close family or social support, and research capturing longitudinal outcomes from transitional rehabilitation is recommended.

Resident Physician Perspectives on Mindfulness Education in Residency: A Multispecialty Qualitative Assessment of Clinical Care Impact

Background

Mindfulness training positively influences residents personally and professionally. Routine integration into residency may be impacted by limited understanding of the ways in which mindfulness training enhances clinical care.

Objective

We explored residents' direct experience and personal application of mindfulness in their clinical work following 10 hours of mindfulness training.

Methods

Mindfulness training sessions were facilitated between 2017 and 2019 for 5 groups of residents: pediatrics, ophthalmology, postgraduate year (PGY)-1 anesthesiology, and 2 different years of PGY-1 family medicine residents. Training was integrated into resident protected didactic time and attendance was expected, although not mandated, with the exception of pediatrics, in which the department mandated the training. Qualitative evaluation was conducted using a voluntary, semi-structured, de-identified phone interview within 2 months post-training. Reviewers independently coded the transcripts and then dialogued to reach consensus around emergent themes.

Results

Thirty-six of 72 residents (50%) who participated in the training completed interviews. Themes were similar across specialties. All residents acknowledged the potential usefulness of mindfulness training during residency. Six residents (17%) reported they had not applied the mindfulness training to their daily work by the end of the course. There were 4 emergent themes related to clinical application of mindfulness training: integrating brief moments of mindfulness practice, self-awareness, relational presence with patients, and maintaining perspective during clinical encounters and residency training as a whole.

Conclusions

After completing a 10-hour mindfulness training program, residents reported enhanced perspective-taking and relationship-building with themselves and their patients in clinical settings across medical and procedural specialties.

Rumination Mediates the Relationship Between Childhood Traumas with Cognitive Defusion, Acceptance, and Emotion Regulation: A Qualitative and Quantitative Study

This study examines the intermediary role of rumination in the relationship between childhood traumas in young adults and cognitive defusion, psychological acceptance, and suppression which is one of the emotion regulation strategies. In the quantitative stage of the study formed according to the explanatory sequential design, the intermediary role of rumination by using a structural equation model while in the qualitative stage, the intermediary role of rumination was analyzed through interviews using the interpretive phenomenology design. Personal Information Form, Childhood Trauma Scale, Short Form Ruminative Response Scale, Acceptance and Action Form II, Drexel Defusion Scale, and Emotion Regulation Scale were used in the research. At the end of the research, it was determined that childhood traumas have a negative effect on cognitive defusion and acceptance, while they have a positive effect on suppression. It was seen that rumination has a partial intermediary role in the relationship of childhood traumas with cognitive defusion, acceptance, and suppression. As a result of the qualitative analysis, twelve themes such as "Constantly thinking about the past, not being able to move away from childhood traumas, not being able to forgive their parents, inability to get rid of negative thoughts, living in the past, moving away from a value-driven life, false expression of emotion, suppression of emotions, emotions reflected in behavior, coping with negative emotions and desired emotion regulation" emerged concerning participants' experiences of cognitive defusion, acceptance, and suppression. Although one of the purposes of using AAQ-II in the study was to support discussions about the scale via qualitative results, this was a limitation for the study. Therefore, although a high rate was obtained, it is not possible to infer that childhood traumas and rumination can explain acceptance behaviors. For this, much more quantitative and qualitative studies are needed. Other qualitative research findings are thought to support quantitative research findings.

Exploring Individual Mental Health Issues: A Qualitative Study among Fellowship-Trained Sports Medicine Physicians

The mental health of fellowship-trained sports medicine physicians (FTSMPs) around the United States is a subject that needs additional exploration. Currently, there is little research exploring how FTSMPs address their mental health on a routine basis. Using the theory of secondary trauma stress to help navigate this study, the purpose of this expressive, all-purpose qualitative study is to improve the understanding of FTSMPs' perceptions of their mental health and the kinds of strategies used to manage these issues. This is a general qualitative study. All interviews were conducted via video communication platforms such as Zoom. The final sample included 35 FTSMPs: 25 men and 10 women. Data collection used a semi-structured interview approach. Data analysis was carried out using NVivo 12 qualitative data analysis software. Four themes emerged: mental health matters affect individual daily lives of FTSMPs; FTSMPs correlate mental health struggles with stress and anxiety; FTSMPs experience barricades when seeking support for mental health issues; and FTSMPs have poor mental health support-seeking behaviors. Results highlight openings for hospitals and private practice institutions, including producing a maintainable work-life equilibrium for FTSMPs and offering these FTSMPs access to mental health services. These recommendations may diminish exhaustion amongst several FTSMPs, a product detrimental to patients, providers, and hospitals.

Engineering student experience and self-direction in implementations of blended learning: a cross-institutional analysis

BACKGROUND

Much of researchers' efforts to foster wider implementation of educational innovations in STEM has focused on understanding and facilitating the implementation efforts of faculty. However, student engagement in blended learning and other innovations relies heavily on students' self-directed learning behaviors, implying that students are likely key actors in the implementation process. This paper explores the ways in which engineering students at multiple institutions experience the self-directed selection and implementation of blended learning resources in the context of their own studies. To accomplish this, it adopts a research perspective informed by Actor-Network Theory, allowing students themselves to be perceived as individual actors and implementors rather than a population that is implemented upon.

RESULTS

A thematic analysis was conducted in two parts. First, analysis identified sets of themes unique to the student experience at four participant institutions. Then, a second round of analysis identified and explored a subset of key actors represented in students' reported experiences across all institutions. The findings show clear similarities and differences in students' experiences of blended learning across the four institutions, with many themes echoing or building upon the results of prior research. Distinct institutional traits, the actions of the instructors, the components of the blended learning environment, and the unique needs and preferences of the students themselves all helped to shape students' self-directed learning experiences. Students' engagement decisions and subsequent implementations of blended learning resulted in personally appropriate, perhaps even idiosyncratic, forms of engagement with their innovative learning opportunities.

CONCLUSION

The institutional implementation of blended learning, and perhaps other educational innovations, relies in part on the self-directed decision-making of individual students. This suggests that instructors too hold an additional responsibility: to act as facilitators of their students' implementation processes and as catalysts for growth and change in students' learning behaviors. Developing a greater understanding of students' implementation behaviors could inform the future implementation efforts of faculty and better empower students to succeed in the innovative classroom.

Trans broken arm syndrome: A mixed-methods exploration of gender-related medical misattribution and invasive questioning

RATIONALE

Gender-related medical misattribution and invasive questioning (GRMMIQ), colloquially known as "trans broken arm syndrome," is a form of medical discrimination faced by transgender and gender diverse (TGD) patients wherein a provider incorrectly assumes that a medical condition results from a patient's gender identity or medical transition. This phenomenon may take one of two forms: (1) the incorrect and explicit misattribution of gender identity or medical transition as being the cause of an acute complaint, or (2) invasive and unnecessary questions regarding a patient's gender identity or gender transition status.

OBJECTIVE

Using mixed-methods procedures, this study aims to explore the incidence, some common correlates, and manifestations of GRMMIQ.

METHODS

American TGD participants (N = 147), recruited through an online recruitment platform, completed questions assessing their experiences in the healthcare system including lifetime incidence of GRMMIQ, outness to healthcare providers, and additional experiences of gender-related discrimination in a medical setting. Participants who indicated experiences of GRMMIQ were asked open-ended questions about one such experience.

RESULTS

Nearly one-third of participants reported experiencing GRMMIQ. Experiences were associated with outness to acute care providers and other types of gender-related discrimination in healthcare settings. Analysis of qualitative data revealed four primary themes: (1) assumptions of disordered thinking and being, (2) hyperfocus on aspects of medical transition, (3) cultural ignorance and incompetence, and (4) dismissiveness of the patient.

CONCLUSION

Together, these results enhance the understanding of an underexplored aspect of medical discrimination faced by TGD individuals while highlighting commonalities across different experiences.

Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa

Exclusive breastfeeding (EBF) is not a norm in many communities in South Africa despite the World Health Organizations' recommendations for EBF in the first six months of infant's life. Thus, South Africa continues to observe suboptimal and poor practices of EBF. The purpose of the study was to explore the experiences of mothers who are HIV-positive and negative on EBF and examine the extent to which initiation and sustenance of EBF is influenced by cultural beliefs, societal norms, and family norms and practices in Mpumalanga Province. Three focus group discussions and twelve in-depth interviews were conducted among thirty mothers who were purposively selected during their visits to the facilities for childcare services. Interviews were audiotaped, transcribed verbatim, and transcripts were analysed through thematic analysis using NVivo version 10. Mothers were aged between 18 and 42 years, most were unemployed and were living in poor sociodemographic backgrounds in extended family households. We found evidence of factors that influence the decision to EBF and mix feed infants among mothers. Traditional and cultural beliefs and norms that exist within their communities informed decisions mothers took to EBF. These beliefs existed alongside mothers' opinions on breastfeeding (BF) and HIV infection, as well as the fears of harming the baby through HIV infection, leading to early cessation of BF. Mothers were also advised by family members, friends, and even some healthcare workers to use traditional medicines while BF. The association of EBF with sagging breasts and weight loss as well as discomfort with public BF are personal beliefs that influenced initiation and early cessation of EBF. Breastfeeding messages ought to be context specific to improve the knowledge, understanding, acceptance and practice of EBF among HIV-positive and negative mothers. Culturally appropriate counselling messages that address the known cultural practices of the populations affected are essential to changing the beliefs and norms of the communities including extended families of EBF mothers.

Exploration of barriers to screening for domestic violence in the perinatal period using an ecological framework

AIMS

To explore Australian healthcare providers' perspectives on factors that influence disclosure and domestic violence screening through the lens of Heise's (1998) integrated ecological framework.

DESIGN

This paper reports the findings that were part of a sequential mixed methods study with survey data informing interview questions. Participants for interviews were recruited after expressing an interest after completing surveys, as well as via snowball sampling.

METHODS

Semi-structured interviews were undertaken in 2017 with 12 practicing healthcare providers delivering care to women in the perinatal period in Greater Western Sydney, NSW, Australia. Data were analysed using Braun and Clarke's (2006) six-step thematic approach.

FINDINGS

The findings were framed within Heise's integrated ecological framework under four main themes. The main themes were 'Ontogenic: Factors preventing women from disclosing'; 'Microsystem: Factors preventing healthcare providers from asking'; 'Exosystem: Organizational structures not conducive to screening'; and 'Macrosystem: Cultural attitudes and socioeconomic influences affecting screening'.

CONCLUSION

Organizational policies are needed for better systems of reminding healthcare providers to enquire for domestic and family violence and mandating this within their practices. Mandatory domestic and family violence education and training that is suitable for the time constraints and learning needs of the healthcare provider is recommended for all healthcare providers caring for perinatal women. Further research is needed in addressing culturally specific barriers for healthcare providers to enquire about domestic and family violence in a culturally appropriate way.

PUBLIC AND PATIENT ENGAGEMENT AND INVOLVEMENT IN RESEARCH (PPEI)

No Patient or Public Contribution was embedded into the research reported in this paper as this research was specifically exploring healthcare providers' perspectives on domestic violence screening within their own practice experience.

"Don't Promise Something You can't Deliver:" Caregivers' Advice for Improving Services to Adolescents and Young Adults with Autism

Approximately 50,000 youths with autism spectrum disorders (ASD) exit U.S. high schools yearly to enter adult systems of care, many of whom remain dependent on family for day-to-day care and service system navigation. As part of a larger study, 174 family caregivers for adolescents or young adults with ASD were asked what advice they would give service providers about how to improve services for youth with ASD. Reflexive thematic analysis identified a framework of five directives: (1) provide a roadmap to services; (2) improve service access; (3) fill gaps to address unmet needs; (4) educate themselves, their families, and society about autism; and (5) operate from a relationship-building paradigm with families. Education, health, and social service providers, as well as policymakers, can use these directives to better assist youth with ASD and their families in the transition to adulthood.

Critical realist exploration of long-term outcomes, impacts and skill development from an Australian Rural Research Capacity Building Programme: a qualitative study

OBJECTIVES

Research capacity building programmes usually only examine short-term outcomes, following up participants after 1 or 2 years. Capacity building in health research requires a long-term view to understand the influence and impact of capacity building endeavours. This study examined long-term outcomes for individuals regarding the maintenance and use of research skills and the conduct of real-world research in a rural area. We also explored the changes individuals had seen in their career, work team or organisation as a result of this training.

DESIGN

A qualitative study underpinned by critical realism and based on interviews and focus groups with graduates of the Rural Research Capacity Building Programme (RRCBP), a researcher development programme that has been delivered since 2006.

SETTING

Rural and remote areas of New South Wales, Australia.

PARTICIPANTS

22 graduates of the RRCBP from the 2006 to 2015 cohorts (20 female, 2 male). All were experienced rural-based health workers at the time of training.

RESULTS

Focus groups and interviews yielded three themes about capacity building outcomes: (1) developed research capable individuals; (2) embedded research capability into teams and (3) real-world research that makes a difference within an organisation.

CONCLUSIONS

Research training improved graduates' skill, experience, confidence and employability. Research capable individuals enabled others, enhancing team research capacity and raising the profile of research within their organisation.Training in research, alongside tangible organisational support for research activity, creates real-world impacts for policy and clinical practice. Providing ongoing opportunities for researchers to undertake research would enhance return on investment and assist with retention of experienced staff.

The impact of public responses toward healthcare workers on their work engagement and well-being during the Covid-19 pandemic

INTRODUCTION/CONTEXT

Healthcare workers (HCWs) play an important role in fighting against the COVID-19 pandemic. However, they have been exposed to mixed public responses more significantly during the COVID-19 pandemic, which have potentially affected their work and life.

AIM

We aim to study what public responses toward HCWs existed, how and why such public responses impacted HCW's work engagement and well-being, and how Human Resource (HR) professionals navigate these impacts. These understandings are important for improving HCWs' work and life quality.

METHODS

We adopted a mixed approach including both quantitative and qualitative methods to investigate how the public responses impact HCWs' work engagement and well-being and how human resource management (HRM) shall intervene. Our quantitative study enables us to collect and analyze a large amount of public responses toward HCWs from the social media platform during the COVID-19 pandemic globally, and uncover the sentiments and topics of these pubic responses via big data and AI technologies. Our qualitative study allows us to understand how and why these public responses impact HCWs' work engagement and well-being via interviews and further identify how HR professionals shall navigate these impacts.

RESULTS

The sentiment analysis showed that 55.9% of the discussions toward HCWs were positive, 27.2% were neutral, and 16.9% were negative. The topic modeling analysis indicated that the commonly identified topics were related to fear (the negative responses) and gratitude (the positive responses). The interviews with 18 HCWs revealed that HCWs' work engagement and well-being were decreased by negative public responses through experiencing tension or disappointment due to social and physical ostracism, rejection, discrimination, and criticism. On the other hand, positive public responses in terms of encouragement, recognition, and tangible donations increased their work engagement and well-being. The analysis also suggested that occupational calling served as a mechanism that explained why public responses had such impacts on HCWs. The interview results also highlighted the significance of HRM in bridging positive public responses toward HCWs and revealed problems with communication from HRM during the pandemic. This research provides practical implications about how to improve HCWs work engagement and well-being during the pandemic via public and HRM efforts.

Stakeholder views on mindfulness for youth at risk for psychosis

Interventions incorporating mindfulness for youth identified to be at risk for psychosis show promise for symptom management yet to be addressed by other approaches. Important questions remain as to how to safely and effectively implement these interventions with this cohort. The aim of this research was to collaboratively identify with stakeholders of such interventions, namely youth at risk for psychosis, and practitioners with experience working with youth at risk for psychosis - attitudes towards mindfulness and potential intervention adaptations to ensure the safety, uptake, and effectiveness of mindfulness interventions used with youth at risk for psychosis. Consolidated criteria for reporting qualitative studies were adopted. Eight practitioners and six at risk for psychosis individuals were interviewed. Both groups identified significant potential benefits of mindfulness, for stress and relaxation, managing difficult thoughts and emotions, increasing positive emotions, improving functioning, and patient empowerment within treatment participation. Stakeholders identified the helpfulness of including compassion-based practices, emphasizing experiential and concrete material, shorter and guided exercises, the targeting of anxiety and attenuated psychotic symptomology, and making the goals or intent of practice youth relevant. Significant barriers were identified - poor functioning and low motivation, high self-criticism, concurrent medication and substance use, and perceptions of mindfulness that may impact uptake (e.g. it requires relaxation to work). Formulation of and research into comprehensive clinical guidelines will help ensure the safe and effective use of future mindfulness and compassion-based practices with at risk for psychosis individuals.

Job autonomy and work-life conflict: A conceptual analysis of teachers’ wellbeing during COVID-19 pandemic

With the shift toward online environments due to COVID-19 pandemic, particularly for educational sector, employees’ performance has been affected by an array of different factors. Personal aspects as well as organizational focus on individuals’ wellbeing are the main focus of this study through inclusion of job autonomy and work-life conflict alongside other factors, such as informational support that can aid academic staff regarding their wellbeing during times of crisis. In response to the effects of COVID-19 on employees, this study aims to provide tangible data to protect university teachers during crises and establish key points that can improve their wellbeing. For this purpose, we used interviews to provide in-depth understanding of the subject. A total of 16 teachers as interviewees have provided qualitative data that was analyzed with MAXQDA (thematic network approach). This study highlights the importance of work-life conflict and vitality of job autonomy on academic staffs’ performance and overall wellbeing through a conceptual analysis. We emphasize the role of organizations in maintaining a work environment where university teachers’ wellbeing is prioritized and various elements such as training and support are used to help stabilizing work-life balance. The current findings can be beneficial for both scholars and decision-makers in schools and universities to enhance elements of remote work for their staff.

Insights into the challenges and facilitators to physical activity among brooklyn teens enroled in a weight management programme

Purpose

A qualitative study was carried out to explore obese adolescents' understanding of physical activity, perceptions of the ideal body type and to identify facilitators of and barriers to physical activity.

Methods

Twenty‐two adolescents 12–18 years of age and 14 of their parents were recruited from an obesity intervention programme in Brooklyn, New York, from June to November 2017. Data were collected using focus groups and individual semi‐structured interviews, followed by interpretative phenomenological analysis of the transcripts.

Results

The adolescents wanted to ‘lose some weight’, but not to be ‘thin’ or ‘look hungry’. Most females desired a ‘slim‐thick’ figure, which was ‘a flat stomach with big thighs, and curvy’. Fun and support from parents, peers and programme staff facilitated achieving their physical activity goals. Barriers included low self‐efficacy, inactive families, fear of neighbourhood gangs and crime and perceptions that the parks were small and overcrowded, with limited physical activity options for adolescents.

Conclusion

These findings highlight the need to consider local norms concerning body image when designing obesity interventions. To effectively reduce childhood obesity in New York City, policy should prioritize the promotion of public safety, improvement of neighbourhood parks and increase options for physical activity.

Patient or Public Contribution

The voices and narratives of patients and their families informed this study.

Exploring clinician perceptions of a care pathway for the management of shoulder pain: a qualitative study

BACKGROUND

Clinical care pathways may be useful tools to improve the quality of healthcare by facilitating the translation of evidence into practice. Our study is situated within a larger project, whereby end-users co-developed a care pathway for the management of shoulder pain. In this study, we explored end-user perceptions of the usefulness and practicality of implementing a care pathway to manage shoulder pain. We also solicited feedback for the pathway's improvement.

METHODS

We conducted a qualitative study using a transcendental phenomenological approach seen through a constructivist lens. Clinicians recorded themselves interacting with the care pathway while working through a clinical case. Clinicians described their thoughts and movements aloud as they completed the activity. Second, we conducted individual semi-structured interviews to discuss the usefulness and practicality of pathway implementation. Interview transcripts were coded independently by reviewers. Transcript codes and associated quotes were grouped into themes. Themes were sequenced and linked creating a 'web' of thematic connections. Summary statements were developed to synthesize the overall essence of the phenomena.

RESULTS

Nine clinicians participated. Participants included eight chiropractors and one medical physician. We found that clinicians believed the care pathway could be useful at various levels, including education (students, interns), for early career clinicians, for engaging patients, facilitating interprofessional communication, and as a reminder of information for certain, less familiar conditions. When discussing the practicality of implementing the care pathway into practice settings, clinicians expressed that agreement with the care pathway and its recommendations may influence its acceptability among clinicians. Additionally, integrating recommendations into practice may be a skill requirement included into clinical training. Clinicians described the importance of opinion leaders in the acceptability of new evidence. Various difficulties with the replicability of interventions into clinical care was also discussed. In general, clinicians suggested the layout of the care pathway was manageable, and there was sufficient information for clinical decision-making. Clinicians also made several recommendations for improvement.

CONCLUSIONS

End-user involvement and collaboration provides tangible instruction to improve care pathways themselves, their implementation strategies and helps to support and strengthen future research for overcoming individual, systemic and contextual barriers.

Analyzing a sport for development program’s logic model by using key actors’ perceptions: The case of Pour 3 Points organization in Montreal

Introduction

More work is needed on measuring the impact of Sport for Development (SFD) organization and on the managerial structures and processes for change. The purpose of the current study was to analyze the logic model (LM) of a SFD program in Canada that provides training for high school coaches in low socioeconomic communities in Montreal.

Methods

Key actors (i.e., coaches, program administrators, school directors, and sport coordinators; N = 22) were interviewed about their perceptions of the different components of the organization’s LM, namely the program’s context, the initial problem it addressed, its needs, objectives, input, output, and impacts.

Findings

Findings reveal the participants perceived the program as being successful by all key actors. Participants had similar understandings regarding the targeted problem and context, but their views differed regarding their understanding of the program’s activities. In addition, the key actors addressed issues of the structure and impacts of the SFD program and made suggestions to improve the program, including clarifying its objectives, reinforcing internal communication, and building stronger partnerships with the partner schools.

Conclusions

Findings from the present study provide recommendations to help improve the organization’s LM. In addition, these findings can help researchers and SFD administrators reinforce essential organizational program structures and activities for better management, evaluation, and improved impact on communities.

Yoga complements cognitive behaviour therapy as an adjunct treatment for anxiety and depression: Qualitative findings from a mixed-methods study

OBJECTIVES

Cognitive behaviour therapy (CBT) is recommended for treating anxiety and depression, demonstrating good efficacy and moderate rates of engagement. To further improve outcomes and access to evidence-based treatments, researchers have sought to enhance CBT protocols with mindfulness-based approaches, such as yoga. This study aimed to examine whether yoga is an acceptable and complementary adjunct to CBT through exploring the lived experiences of adults with anxiety and depression who engaged in an adjunct therapeutic yoga programme alongside group CBT.

DESIGN

Single-group qualitative design with post-intervention and follow-up timepoints.

METHODS

Thirty-six adults with anxiety and depression self-selected into a therapeutic yoga programme as an adjunct to group CBT. Qualitative interviews were conducted with 27 participants immediately after the eight-week programme and again three months later. Thematic analysis was used to identify common themes from the lived experiences.

RESULTS

Three primary themes, with nine subthemes, were identified which reflect the experiences of the combined therapies, the complementary elements, and process of engagement over time. The adjunct yoga programme was highly acceptable to adults with anxiety and depression, enhancing engagement and perceived outcomes. Yoga was identified as providing a unique combination of elements that complemented processes of CBT, such as behavioural activation and thought disputation. Yoga practices represented mental health self-management tools that are accessible and available as relapse prevention strategies.

CONCLUSIONS

Therapeutic yoga warrants consideration as an adjunct treatment for anxiety and depression as it offers unique and complementary elements to CBT and can enhance engagement and perceived clinical outcomes.

PRACTITIONER POINTS

Adults with anxiety and depression experienced a therapeutic yoga programme as a suitable and appealing adjunct that enhanced engagement with psychological treatment. Yoga offers a unique combination of elements, including a values system, body-based mindfulness practices, and breathing techniques, that complement CBT processes, such as behavioural activation, awareness of maladaptive patterns, and thought disputation. A therapeutic yoga programme provides adults with anxiety and depression with an accessible and sustainable mental health self-management tool. Therapeutic yoga can be considered for integration to models of mental health service provision to enhance engagement and clinical outcomes for adults with anxiety and depression.

Tangible Experiences of Grace: A Qualitative Investigation of Divine Grace in Roman Catholics

According to Catholic theology, God offers a gift of love, known as divine grace, to all of humanity. This gift of divine grace is the gift of redemption and forgiveness of sins from God that is offered to everyone who decides to acknowledge and accept it. Grace is central to the lived experience of many Christians. This qualitative study examined how Catholics perceive and experience divine grace using interviews that assessed perceptions of divine grace in 29 practicing adult Catholics. A grounded theory analysis resulted in themes indicating that these Catholics view God's divine grace as a tangible gift that is undeserved though continuously offered. The participants' experience of God's grace is not just an abstract theological concept but an embodied aspect of religious life with which believers can interact in many powerful ways. Three characteristics of God's divine grace (i.e., salvific grace, cooperation through free will, primacy of conscience and the afterlife) and three mechanisms to experiencing God's grace (i.e., sacraments, prayer and meditation, saints) are presented.

Digital Storytelling as a Reflective Tool in Occupational Therapy Curriculum

With a shift in moving towards the 4th industrial revolution, digital storytelling has been identified as a novel way of facilitating teaching and learning. This paper will be aimed at offering an understanding of the experience and perspective of occupational therapy students in using digital storytelling as a reflective tool as an assignment as part of their undergraduate and masters occupational therapy curriculum at a university in South Africa. A descriptive qualitative study was undertaken, and five participants were purposively recruited. Individual semistructured interviews were conducted as well as a focus group with participants. An inductive analysis revealed two themes: Reflections on relevance within the occupational therapy curriculum and Is technology the new direction? The findings conclude that digital storytelling as a medium to showcase reflections on identifying formation was an innovative and novel way of documenting the reflective experiences of occupational therapy students.

Exploring clinicians' experiences and perceptions of end-user roles in knowledge development: a qualitative study

Background

End-user involvement in developing evidence-based tools for clinical practice may result in increased uptake and improved patient outcomes. Understanding end-user experiences and perceptions about the co-production of knowledge is useful to further the science of integrated knowledge translation (iKT) – a strategy for accelerating the uptake and impact of research. Our study had two main objectives: (1) explore end-user (clinician) experiences of co-producing an evidence-based practice tool; and (2) describe end-user perceptions in knowledge development.

Methods

We used a qualitative study design. We conducted semi-structured interviews with clinicians and used a transcendental phenomenological approach to analyze themes/phenomena. In addition, we explored the interrelated themes between the thematic maps of each objective.

Results

Four themes emerged from clinicians’ experiences in co-producing the practice tool: ease/convenience of participating, need for support and encouragement, understanding the value of participating, and individual skillsets yield meaningful contributions. Stakeholder roles in knowledge tool development and improving dissemination of evidence and knowledge tools were themes that related to clinician perceptions in knowledge development. The review of interrelated thematic maps depicts an intertwined relationship between stakeholders and dissemination.

Conclusions

End-users provide invaluable insight and perspective into the development of evidence-based clinical tools. Exploring the experiences and perceptions of end-users may support future research endeavours involving iKT, such as the co-production of clinical resources, potentially improving uptake and patient health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06955-7.

From dreams to reality: a phenomenological study of the psychological contracts of ex-military personnel in the Australian Defence Force

Current recruitment and retention issues within the armed forces draw links with breach of the psychological contract – the dynamics of the employee–employer relationship. Compared with civilian contexts, a military position is unique, however, there is a dearth of conceptual investigation regarding the lived experiences of military personnel, particularly with respect to how such contracts form. This paper combined a phenomenological approach with the critical decision method to investigate the lived experiences informing contract formation and contract trajectory of ex-military personnel. Lived experiences pointed to the formulation of ‘fuzzy’ contracts, impressions from defence force recruitment, specific tipping points around organisational commitment, and large differences between the fidelity of the idealised and actualised self/job. Seven superordinate themes are elicited that trace the formation and trajectory of the contract. A schematised account of findings is developed to provide avenues to investigate how beliefs form in a military contract context and their outcomes.

'From Expert to Novice', Perceptions of General Ward Nurses on Deployment to Outbreak Intensive Care Units during the COVID-19 Pandemic: A Qualitative Descriptive Study

AIMS AND OBJECTIVES

This study aimed to explore the perceived preparedness and psychosocial well-being of general ward nurses prior to their deployment into the outbreak intensive care units (ICUs) during the COVID-19 pandemic.

BACKGROUND

With the surge in COVID-19 cases requiring ICU care, non-ICU nurses maybe deployed into the ICUs. Having experienced through SARS, hospitals in Singapore instituted upskilling programs to secure general ward nurses' competency in providing critical care nursing. However, no studies have explored the perceptions of general ward nurses on deployment into the ICUs during the COVID-19 pandemic.

DESIGN

Qualitative descriptive study.

METHODS

The study was conducted at Singapore's epicentre of COVID-19 management. Five focus groups were conducted following purposive sampling of 30 general ward nurses identified for outbreak ICU deployment. Focus groups were audio-recorded, transcribed verbatim and data thematically analysed. This study was conducted and reported in accordance with the COREQ checklist.

RESULTS

Three salient themes arose, exemplifying the transition from clinical experts in the general wards to practising novices in the outbreak ICUs. Firstly, 'Into the deep end of the pool' described general ward nurses' feelings of anxiety and stress associated with higher exposure risk and expanded responsibilities to nurse critically ill patients. Secondly, 'Preparing for "war"' illustrated deployed nurses' need for clear communication and essential critical care nursing training. Lastly, 'Call of duty' affirmed the nurses' personal and professional commitment to embrace this transition into the ICUs, and their desire for greater psychosocial support.

CONCLUSION

The study findings highlight that though general ward nurses perceived their impending ICU deployment positively, they require ongoing support to facilitate a smoother transition.

RELEVANCE TO CLINICAL PRACTICE

Findings provided an evidence base to improve the preparedness of general ward nurses deployed into the ICUs during the COVID-19 pandemic within key areas of training, information dissemination and psychosocial resilience.

Effective, sustainable, and transferable physical exercise interventions for fall prevention among older people

INTRODUCTION

Falls among older people are preventable through exercise-based programs. However, scientific evidence must be translated into practice to support professionals who implement such programs.

AIM

This study aimed to identify physical exercise interventions for fall prevention and to determine the best practice for implementing them in local community-dwelling older adults.

METHOD

We used a narrative synthesis method to produce Effective, Sustainable, and Transferable Preventive Interventions. We reviewed guidelines, systematic reviews, and randomized controlled trials (RCT) to find the best evidence supporting physical exercises to prevent falls, followed by discussing the evidence with clinical experts to evaluate the best strategy for implementing them into the local context. These steps resulted in the development of a user manual.

RESULTS

We included two guidelines, one systematic review with a meta-analysis, and one RCT. The developed draft manual includes activities, methods, infrastructural resources, human capital, stakeholders, frequency, and duration of the intervention, information, and educational materials, and implementation models. Our discussion of the intervention with a panel of experts considered resources, barriers, and similar experiences to ensure effectiveness and economic, social, and time sustainability.

CONCLUSION

The developed manual could be implemented in the local context and adapted to the needs of the population while considering available resources.

Midcareer Medical School Research Faculty Perspectives on Vitality and Professionalism During the COVID-19 Pandemic

Importance

As medical faculty have central roles during the COVID-19 pandemic, it is important to study the pandemic's association with the vitality and careers of medical school faculty.

Objective

To examine how the COVID-19 pandemic affected midcareer research faculty in academic medicine.

Design, Setting, and Participants

This qualitative study included medical school faculty who participated in the C-Change Mentoring and Leadership Institute. All US medical school faculty recipients of recent National Institutes of Health (NIH) RO1, RO1-equivalent, and K awards were invited to apply to the institute. The 99 applicants who met inclusion criteria were stratified by degree (MD or MD/PhD vs PhD), gender, and race/ethnicity. Enrollment was offered to applicants randomly selected for 40 spots, demographically balanced by sex, underrepresented in medicine minority (URMM) status, and degree. In April 2020, an inquiry was emailed to faculty enrolled in the institute requesting responses to questions about meaning in work, career choice, and values. A qualitative analysis of narrative data responses, using grounded theory, was undertaken to determine key themes. This study is part of a NIH-funded randomized trial to test the efficacy of a group peer mentoring course for midcareer faculty and study the course's mechanisms of action.

Main Outcomes and Measures

Key themes in data.

Results

Of 40 enrolled participants, 39 responded to the inquiry, for a response rate of 97%. The analytic sample included 39 faculty members; 19 (47%) were women, 20 (53%) identified as URMM, and 20 (53%) had an MD or MD with PhD vs 19 (47%) with PhD degrees. Key themes in the data that emerged describing faculty lived experience of the pandemic included increased meaningfulness of work; professionalism and moral responsibility; enhanced relationships with colleagues; reassertion of career choice; disrupted research; impact on clinical work; attention to health disparities, social justice and advocacy; increased family responsibilities; psychological stress; and focus on leadership.

Conclusions and Relevance

During the pandemic, diverse PhD and physician investigators reported increased meaningfulness in work and professionalism and enhanced relationships, all intrinsic motivators associated with vitality. Working during the pandemic appears to have produced intrinsic rewards positively associated with vitality, in addition to adverse mental health effects. These findings have implications for combatting burnout and retaining investigators in the future.

Apparel Consumption and Embodied Experiences of Gay Men and Transgender Women in India: Variety and Ambivalence, Fit Issues, LGBT-Fashion Brands, and Affordability

The purpose of this study was to explore Indian LGBT individuals' apparel consumption practices and embodied experiences related to fashion, style, and the body. Specifically, our research questions were these: What are Indian LGBT individuals' experiences like when navigating the fashion system, and how do they experience their own embodiment in what they wear and how they appear? A qualitative, phenomenological approach was used to answer the research questions. Three gay men and seven transgender women responded to a solicitation for participation and completed a semistructured interview. In our data analysis, we established four themes that relate to two larger areas of emphasis: embodiment and the fashion system. Regarding embodiment, participants related many experiences with their bodies, including (a) variety and ambivalence with bodily practices and (b) difficulty with clothing fit. The other themes centered around knowledge and desires related to the fashion system. Within the fashion system, participants expressed (a) fashion brand awareness and a need for LGBT-centered brands and (b) affordability as a barrier to clothing purchase. Overall, the essence of fashioning one's body as a transgender woman or gay man in India is that, while there has been a significant amount of gender oppression in India, these participants were interested in and desired gender-neutral or LGBT-focused brands.

Sensory Stimulation of the Foot and Ankle Early Post-stroke: A Pilot and Feasibility Study

Background: Somatosensory stimulation of the lower extremity could improve motor recovery and walking post-stroke. This pilot study investigated the feasibility of a subsequent randomized controlled trial (RCT) to determine whether task-specific gait training is more effective following either (a) intensive hands-on somatosensory stimulation or (b) wearing textured insoles. Objectives: Determine recruitment and attrition rates, adherence to intervention, acceptability and viability of interventions and outcome measures, and estimate variance of outcome data to inform sample size for a subsequent RCT. Methods: Design: randomized, single-blinded, mixed-methods pilot study. Setting: In-patient rehabilitation ward and community. Participants: n = 34, 18+years, 42-112 days following anterior or posterior circulation stroke, able to follow simple commands, able to walk independently pre-stroke, and providing informed consent. Intervention: Twenty 30-min sessions of task-specific gait training (TSGT) (delivered over 6 weeks) in addition to either: (a) 30-60 min mobilization and tactile stimulation (MTS); or (b) unlimited textured insole (TI) wearing. Outcomes: Ankle range of movement (electrogoniometer), touch-pressure sensory thresholds (Semmes Weinstein Monofilaments), motor impairment (Lower Extremity Motricity Index), walking ability and speed (Functional Ambulation Category, 5-m walk test, pressure insoles) and function (modified Rivermead Mobility Index), measured before randomization, post-intervention, and 1-month thereafter (follow-up). Adherence to allocated intervention and actual dose delivered (fidelity) were documented in case report forms and daily diaries. Focus groups further explored acceptability of interventions and study experience. Analysis: Recruitment, attrition, and dose adherence rates were calculated as percentages of possible totals. Thematic analysis of daily diaries and focus group data was undertaken. Standard deviations of outcome measures were calculated and used to inform a sample size calculation. Results: Recruitment, attrition, and adherence rates were 48.57, 5.88, and 96.88%, respectively. Focus groups, daily-diaries and case report forms indicated acceptability of interventions and outcome measures to participants. The 5-m walk was selected as primary outcome measure for a future trial [mean (SD) at end of intervention: 16.86 (11.24) MTS group and 21.56 (13.57) TI group]; sample size calculation indicated 60 participants are required per group. Conclusion: Recruitment, attrition and adherence rates and acceptability of interventions and outcomes justify a subsequent powered RCT of MTS+TSGT compared with TI+TSGT.