Phenomenological Approaches in Psychology and Health Sciences

Awareness of postpartum depression among midwives and pregnant women in Arkhangelsk, Arctic Russia

BACKGROUND

Postpartum depression (PPD) affects approximately 17% of the women worldwide with nearly half of all cases going undetected. More research on maternal mental health, particularly among healthcare professionals and pregnant mothers, could help identify PPD risks and reduce its prevalence.

OBJECTIVE

Given that awareness of PPD is a crucial preventive factor, we studied PPD awareness among midwives and pregnant women in Arkhangelsk, Arctic Russia.

METHODS

A qualitative study was conducted using in-depth semi-structured interviews. Midwives and pregnant women were recruited from the women's clinic of the Arkhangelsk municipal polyclinic. Seven midwives and 12 pregnant mothers were interviewed.

RESULTS

Midwives described limited time for psychological counselling of pregnant women; they reported that their primary focus was on the physiological well-being of women. Pregnant women have expressed a desire for their families to share responsibilities. The participants considered PPD as a mix of psychological and physiological symptoms, and they also highlighted a discrepancy between the expectations of pregnant women and the reality of motherhood. The present study underscored the limited understanding of PPD identification.

CONCLUSIONS

The findings suggest that there is a need for increased awareness among midwives and pregnant women regarding PPD. Prevention programs targeting PPD with a specific emphasis on enhancing maternal mental health knowledge are warranted.

Use of poppers (nitrite inhalants) among young men who have sex with men with HIV: A clinic-based qualitative study

Nitrite inhalants (poppers) are associated with HIV transmission and commonly used among young men who have sex with men (YMSM), a group at increased risk for HIV. Significant research gaps exist in understanding the context in which YMSM use poppers. Qualitative interviews were conducted with 15 YMSM (22-31 years) with HIV to better understand the context in which poppers are used and their impacts on HIV care outcomes, such as care retention and antiretroviral adherence. The Social Ecological Model was applied to understand intrapersonal, interpersonal, community, and system level influences on popper use. Factors influencing popper use included: ubiquity of popper use in sexual settings, introduction to poppers by casual sexual partners, patient-HIV provider communication surrounding poppers, neighborhood, substance use and HIV care systems, and the legal status of poppers. Implications for clinical care, public health, policy, and future research are discussed.

Medical residents' perceptions of group biases in medical decision making: a qualitative study

BACKGROUND

Systematic biases in group decision making (i.e., group biases) may result in suboptimal decisions and potentially harm patients. It is not well known how impaired group decision making in patient care may affect medical training. This study aimed to explore medical residents' experiences and perspectives regarding impaired group decision making and the role of group biases in medical decision making.

METHODS

This study used a qualitative approach with thematic analysis underpinned by a social constructionist epistemology. Semi-structured interviews of medical residents were conducted at a single internal medicine residency program. Residents were initially asked about their experiences with suboptimal medical decision making as a group or team. Then, questions were targeted to several group biases (groupthink, social loafing, escalation of commitment). Interviews were transcribed and transferred to a qualitative data analysis software. Thematic analysis was conducted to generate major themes within the dataset.

RESULTS

Sixteen interviews with residents revealed five major themes: (1) hierarchical influence on group decision making; (2) group decision making under pressure; (3) post-call challenges in decision making; (4) interactions between teamwork and decision making; and (5) personal and cultural influences in group decision making. Subthemes were also identified for each major theme. Most residents were able to recognize groupthink in their past experiences working with medical teams. Residents perceived social loafing or escalation of commitment as less relevant for medical team decision making.

CONCLUSIONS

Our findings provide unique insights into the complexities of group decision making processes in teaching hospitals. Team hierarchy significantly influenced residents' experiences with group decision making-most group decisions were attributed to consultants or senior team members, while lower ranking team members contributed less and perceived fewer opportunities to engage in group decisions. Other factors such as time constraints on decision making, perceived pressures from other staff members, and challenges associated with post-call days were identified as important barriers to optimal group decision making in patient care. Future studies may build upon these findings to enhance our understanding of medical team decision making and develop strategies to improve group decisions, ultimately leading to higher quality patient care and training.

Financial medicine: A multi-dimensional concept moving towards contextually specific working definitions for use in the South African prehospital setting

Introduction

The phenomenon that has been described as Financial Medicine has been occurring within the South African Healthcare sector for at least the last decade. Despite the ongoing effect of this phenomenon, there is no organised body of knowledge or formulated working definitions to guide knowledge sharing and theorisation within this research focus area. The practice of Financial Medicine exerts a deleterious effect on the South African prehospital healthcare system, and represents an area in dire need of focused research efforts. Establishing appropriate working definitions and associated taxonomy is an important first step in supporting further research efforts into this aspect of South African prehospital healthcare systems.

Methods

A qualitative research methodology following a constructivist grounded theory design was used. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity.

Results

A working definition for Financial Medicine is provided. Six new terms are introduced, with associated working definitions, namely Financial Medicine Practices, Treatment-based profiteering, Cost-of-care-aversion, Personal-gain-at-patient-expense, Money-racketeering-in-healthcare, and Impoverishing-healthcare-earning.

Conclusion

The working definitions and suggested taxonomy presented in this article are the first step in formally conceptualising and theorising the phenomenon of Financial Medicine, in order to support further research and collaboration in this space.

Searching for choice and control: Western Australian service provider experiences of health, housing and migration

This research aimed to inform approaches to increase access to secure housing and improve mental health outcomes for migrants from culturally and linguistically diverse backgrounds (hereafter migrants) who are generally invisible in health and social policy and service provision in Western Australia. We used semi-structured, in-depth interviews (n = 11) and interpretative phenomenological analysis to explore service provider experiences and perspectives of issues impacting service provision and the needs of migrants in this context. Five superordinate themes reveal complex experiences for both service providers and the migrants with whom they work. Findings reflect tensions between contemporary notions of choice and control and a social service system that is difficult to navigate, reflects systemic racism and appears to rely heavily on the non-government sector. Insights have important and practical implications for health promotion policy, practice and research. Recommendations include improvements to housing access, provision, funding and policies; addressing service barriers via staff training and more accessible community resources; and co-design and community outreach approaches.

Implementing supplementary breast cancer screening in women with dense breasts: Insights from European radiographers and radiologists

INTRODUCTION

In response to the critical need for enhancing breast cancer screening for women with dense breasts, this study explored the understanding of challenges and requirements for implementing supplementary breast cancer screening for such women among clinical radiographers and radiologists in Europe.

METHOD

Fourteen (14) semi-structured online interviews were conducted with European clinical radiologists (n = 5) and radiographers (n = 9) specializing in breast cancer screening from 8 different countries: Denmark, Finland, Greece, Italy, Malta, the Netherlands, Switzerland, United Kingdom. The interview schedule comprised questions regarding professional background and demographics and 13 key questions divided into six subgroups, namely Supplementary Imaging, Training, Resources and Guidelines, Challenges, Implementing supplementary screening and Women's Perspective. Data analysis followed the six phases of reflexive thematic analysis.

RESULTS

Six significant themes emerged from the data analysis: Understanding and experiences of supplementary imaging for women with dense breasts; Challenges and requirements related to training among clinical radiographers and radiologists; Awareness among radiographers and radiologists of guidelines on imaging women with dense breasts; Challenges to implement supplementary screening; Predictors of Implementing Supplementary screening; Views of radiologists and radiographers on women's perception towards supplementary screening.

CONCLUSION

The interviews with radiographers and radiologists provided valuable insights into the challenges and potential strategies for implementing supplementary breast cancer screening. These challenges included patient and staff related challenges. Implementing multifaceted solutions such as Artificial Intelligence integration, specialized training and resource investment can address these challenges and promote the successful implementation of supplementary screening. Further research and collaboration are needed to refine and implement these strategies effectively.

IMPLICATIONS FOR PRACTICE

This study highlights the urgent need for specialized training programs and dedicated resources to enhance supplementary breast cancer screening for women with dense breasts in Europe. These resources include advanced imaging technologies, such as MRI or ultrasound, and specialized software for image analysis. Moreover, further research is imperative to refine screening protocols and evaluate their efficacy and cost-effectiveness, based on the findings of this study.

Identity change of late-deafened adults after receiving cochlear implants

PURPOSE

The aim of this research was to understand how adults reconceptualise their identity when experiencing hearing loss as an adult, and how their identity might change with a cochlear implant.

MATERIALS AND METHODS

Using an online survey administered through cochlear implant social media groups, with follow-up semi-structured interviews, participants answered questions about their hearing loss and cochlear implant experiences. Forty-four people answered the survey and 16 participated in an in-depth interview. All were older than 18 years, once had heard, became deafened in adulthood and had at least one cochlear implant.

RESULTS

The decision to have a cochlear implant often meant acknowledging they were no longer a hearing person. After having an implant four themes emerged. (1) Some participants maintained a hearing identity through hearing loss and after cochlear implantation, while others returned to their hearing identity. (2) Others acknowledged a confused identity, neither deaf nor hearing. In unexpected findings, (3) during the progression of hearing loss, some participants had identified as hearing but could not hear, however after implantation, they became deaf people who could hear. (4) Furthermore, after implantation, some participants identified as disabled when they had not done so when less able to hear.

CONCLUSION

Given the prevalence of hearing loss in later life, it is important to understand the way these adults understand their identity through the progression of hearing loss and after becoming cochlear implant recipients. The belief people have of themselves impacts healthcare choices and affects their commitment to ongoing rehabilitation.

'There is still a part of me that would love to be the old me again', how do adolescents and young adults (AYA) experience cancer-related bodily changes: a phenomenological interview study

PURPOSE

Due to the increase in both cancer incidence and overall survival rates, more adolescents and young adults (AYAs) have to live with the effects that their cancer diagnosis and following treatments have on their bodies. This qualitative phenomenological study aimed to gain more insight into the way AYAs experience these effects and how they respond to these effects.

METHODS

Semi-structured interviews with a sample of 11 AYAs with an age range of 25-41 years at the time of the interview, who were diagnosed with different types of cancer, were conducted. Participants were recruited via social media and patient associations until data saturation was reached. A topic guide with open-ended questions about lived experiences was used. Interpretative phenomenological analysis (IPA) was performed to analyse the transcripts.

RESULTS

We identified six Group Experiential Themes based on different ways AYAs experience their bodies: (1) self-conscious body, (2) vulnerable body, (3) adapting to the body, (4) uncontrollable body, (5) remembering the body and (6) shared bodies.

CONCLUSION

This study offers in-depth insight into the bodily experiences of AYAs after cancer and how they respond to these changes from a phenomenological point of view.

IMPLICATIONS FOR CANCER SURVIVORS

This knowledge could be beneficial to provide more guidance for AYAs during and after their illness, by focussing on personalised psychological (after)care.

"I Feel Like I Have Lost Part Of My Identity" - A Qualitative Study Exploring The Impact Of Chronic Ankle Instability

Introduction

Lateral ankle sprain is the most common ankle injury and up to 40% of those who sustain a lateral ankle sprain will develop chronic ankle instability (CAI). The aim of this study was to explore the thoughts and expectations of CAI-patients concerning their condition and expectations of care in an orthopedic setting. .

Study Design

Qualitative study.

Methods

Nine semi-structured one-to-one interviews were conducted with CAI-patients who were referred to an orthopedic setting. Interviews were recorded, transcribed, and analyzed using systematic text condensation with an inductive goal free approach. .

Results

Seven themes emerged. The themes were Injury history and symptoms (Lateral ankle sprain during sport, pain and instability), Information from health professional (conflicting information about management and prognosis), Management (mental and physical challenges), Expectation and hope (explanation of symptoms, prognosis and imaging to provide clarification of condition), Activity and participation (restriction in sport and daily life and feelings of uncertainty), Support (support from family/friends) and Identity (low ability to participate in sport and social life result in loss of identity). .

Conclusion

The impact of CAI exceeds an experience of pain and instability. Patients experienced loss of identity, having to manage uncertainty regarding their diagnosis and prognosis and had hopes of being able to explain their condition. .

Level of Evidence

Not applicable.

"Giving Me the Self-Confidence to Tackle It": Mothers' Experiences Participating In The Engaged Eaters Program, A Caregiver-Mediated Feeding Intervention

The purpose of this study was to understand caregivers' experience of participating in a caregiver-mediated in-home feeding intervention, the Engaged Eaters Program, for their young autistic child. This qualitative study utilized a thematic approach to analyze post-intervention semi-structured interviews with thirteen mothers of autistic children between the ages of 2 to 7 years after they participated in the intervention. Interview questions focused on the child and family experience, what worked well, what could be improved, and how the intervention integrated into family routines. Four major themes were identified: In-Home Intervention, Parent Skill and Knowledge, Increased Social Participation, and Parent Responsibilities and Challenges. Sub-themes provided descriptions of learning practical tools to support their child, increasing self-efficacy, and impacts on family life. Mothers described an increase in tangible skills that were easily practiced in the home environment that improved their confidence and self-efficacy in feeding their children. They also described how participation did require more work and time commitment for them beyond their regular responsibilities. The caregiver experience is essential to understand for intervention effectiveness while simultaneously addressing child, caregiver, and family needs. By focusing on the mothers' experiences, individualized needs, and self-efficacy, we were able to better understand how integrating an intervention into the family context and daily routines may be beneficial for the whole family.

A qualitative study assessing the barriers and facilitators to physical activity in adults with hearing loss

OBJECTIVES

Growing epidemiological evidence has shown hearing loss is associated with physical inactivity. Currently, there is a dearth in evidence investigating why this occurs. This study aimed to investigate the barriers and facilitators to physical activity in middle-aged and older adults with hearing loss.

DESIGN

Individual semi-structured qualitative interviews.

METHODS

A phenomenological approach was taken. Ten adults (≥40 years) were interviewed via videoconferencing. The interview schedule was underpinned by the capability, opportunity, motivation and behaviour (COM-B) model. Reflexive thematic analysis was used to generate themes, which were subsequently mapped onto the COM-B model and behaviour change wheel.

RESULTS

Nine hearing loss specific themes were generated, which included the following barriers to physical activity: mental fatigue, interaction with the environment (acoustically challenging environments, difficulties with hearing aids when physically active) and social interactions (perceived stigma). Environmental modifications (digital capabilities of hearing aids), social support (hearing loss-only groups) and hearing loss self-efficacy were reported to facilitate physical activity.

CONCLUSIONS

Middle-aged and older adults with hearing loss experience hearing-specific barriers to physical activity, which has a deleterious impact on their overall health and well-being. Interventions and public health programmes need to be tailored to account for these additional barriers. Further research is necessary to test potential behaviour change techniques.

Multilayer framework for digital multicomponent platform design for colorectal survivors and carers: a qualitative study

Background

The advent of eHealth services offers the potential to support colorectal cancer (CRC) survivors and their informal caregivers (ICs), yet research into user needs and design requirements remains scant. This exploratory qualitative study addresses this knowledge gap by focusing on the development of a Digital Multicomponent Platform (DMP) designed to provide comprehensive support to these populations.

Aims

The objective of this research is to use qualitative methodologies to identify key user needs and design requirements for eHealth services. It seeks to propose and apply a multi-tiered framework for creating a DMP that encapsulates the needs of CRC survivors and their ICs.

Methods

Skype-based focus groups (FGs) were utilized to gather qualitative data from CRC survivors and ICs. This approach served to elicit crucial themes integral to the design of the DMP. A multi-tiered framework was subsequently developed to integrate user-centered design (UCD) principles and requirements with predetermined outcomes, eHealth services, and IT infrastructure.

Results

The first stage of the analysis identified five crucial themes: (1) the importance of healthcare system interaction via eHealth, (2) interaction between healthcare providers and peers, (3) lifestyle and wellness considerations, (4) platform content and user interface requirements, (5) caregiver support. The second stage analysis applied the multi-tiered framework, to determine the DMP that was conceptualized from these themes, underscores the significance of personalized content, caregiver involvement, and integration with electronic health records (EHRs).

Conclusion

The study offers novel insights into the design and development of digital supportive care interventions for CRC survivors and their caregivers. The results highlight the utility of user-centered design principles, the significance of personalized content and caregiver involvement, and the need for a unified health data platform that promotes communication among patients, healthcare providers, and peers. This multi-tiered framework could serve as a prototype for future eHealth service designs.

Lessons learned about online engagement and implementation of an intuitive eating programme for university employees

Background: Intuitive eating (IE) principles present an evidence-based strategy for improving one's relationship with food while reducing the incidence of weight cycling and health risks associated with chronic dieting and weight regain. Offering online programming provides improved access to education while reducing barriers to programme enrollment but is also associated with high rates of attrition. Aim: To examine the process of programme implementation and identify barriers and facilitators of engagement for an online IE programme for employees at a large Midwestern university. Methods: The web-based programme Finding Peace with Food: An Intuitive Eating Approach consisted of an online community with discussion prompts, 10 weekly modules containing videos, activities, and counsellor interviews and was developed using recognized health behaviour theory and evidence-based practices. Participants were university employees (n = 20). Qualitative data were assessed using a phenomenological approach to discern the themes of barriers and facilitators of programme participation. Participation rates were assessed using descriptive statistics. Results: All participants were Caucasian, 85% were female, and their ages ranged from 26-64. The module-based structure was well received. The primary barriers to participation were time constraints, overwhelming amount of information, and aversion to Flipgrid platform use. The quality and usefulness of the programme information were identified as facilitators of participation. Conclusion: Program participation was influenced by the time frame available to complete the programme modules and participants' ease of use of platform applications.

Definitions of Solitude in Everyday Life

What does it mean to be in solitude? Researchers building this nascent field are learning much about the potential affordances of solitude, but lack an agreed-upon definition or set of definitions. Arriving at that meaning is crucial to forming a solid foundation for studies that use both naturalistic and laboratory designs to explore outcomes of solitude. This study identified themes from semi-structured interviews with adults aged 19 to 80 from diverse backgrounds. We concluded that solitude is a state in which the dominant relationship is with the self. If not physically alone, people in solitude are mentally distanced from others and away from active technology-mediated interactions. Complete solitude involves both physical separation and inner focus, but solitude is best defined through a taxonomy that recognizes physical separation and internal focus as independent, sufficient characteristics. An internal focus benefits from (but is not defined by) balancing solitude with social time, quiet, and choice.

Exploring Patient Advisors' Perceptions of Virtual Care Across Canada: Qualitative Phenomenological Study

BACKGROUND

While virtual care services existed prior to the emergence of COVID-19, the pandemic catalyzed a rapid transition from in-person to virtual care service delivery across the Canadian health care system. Virtual care includes synchronous or asynchronous delivery of health care services through video visits, telephone visits, or secure messaging. Patient advisors are people with patient and caregiving experiences who collaborate within the health care system to share insights and experiences in order to improve health care.

OBJECTIVE

This study aimed to understand patient advisors' perceptions related to virtual care and potential impacts on health care quality.

METHODS

We adopted a phenomenological approach, whereby we interviewed 20 participants who were patient advisors across Canada using a semistructured interview protocol. The protocol was developed by content experts and medical education researchers. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Data collection stopped once thematic saturation was reached. The study was conducted at Queen's University, Kingston, Ontario. We recruited 20 participants from 5 Canadian provinces (17 female participants and 3 male participants).

RESULTS

Six themes were identified: (1) characteristics of effective health care, (2) experiences with virtual care, (3) modality preferences, (4) involvement of others, (5) risks associated with virtual care encounters, and (6) vulnerable populations. Participants reported that high-quality health care included building relationships and treating patients holistically. In general, participants described positive experiences with virtual care during the pandemic, including greater efficiency, increased accessibility, and that virtual care was less stressful and more patient centered. Participants comparing virtual care with in-person care reported that time, scheduling, and content of interactions were similar across modalities. However, participants also shared the perception that certain modalities were more appropriate for specific clinical encounters (eg, prescription renewals and follow-up appointments). Perspectives related to the involvement of family members and medical trainees were positive. Potential risks included miscommunication, privacy concerns, and inaccurate patient assessments. All participants agreed that stakeholders should be proactive in applying strategies to support vulnerable patients. Participants also recommended education for patients and providers to improve virtual care delivery.

CONCLUSIONS

Participant-reported experiences of virtual care encounters were relatively positive. Future work could focus on delivering training and resources for providers and patients. While initial experiences are positive, there is a need for ongoing stakeholder engagement and evaluation to improve patient and caregiver experiences with virtual care.

Going home positive: a qualitative study of the experiences of care for patients with COVID-19 who are not hospitalized

BACKGROUND

Most Canadians diagnosed with COVID-19 have had mild symptoms not requiring hospitalization. We sought to understand the patient experience of care while being isolated at home after testing positive for SARS-CoV-2 infection.

METHODS

We conducted a phenomenologically informed qualitative descriptive study using in-depth semistructured interviews to identify common themes of experience for patients sent home from hospital with a positive COVID-19 diagnosis. Between July and December 2020, we conducted interviews with patients who were followed by the North York General Hospital COVID Follow-Up Clinic. Patients with mild to moderate symptoms were interviewed 4 weeks after their COVID-19 diagnosis. We conducted the interviews and performed a thematic analysis of the data concurrently, in keeping with the iterative process of qualitative methodology.

RESULTS

We conducted interviews with 26 patients. From our analysis, 3 themes were developed regarding participants' overall experience: lack of adequate communication, inconsistency of information from various sources, and the social implications of a COVID-19 diagnosis. The implications of a positive test for SARS-CoV-2 infection are substantial, even when symptoms are mild and patients self-isolate as recommended. Participants noted communication challenges and inconsistent information, leading to exacerbated stress.

INTERPRETATION

Participants shared their experiences of the stigma of testing positive and the frustration of poor communication structures and inconsistent information. Experiencing care during self-isolation at home is an area of increasing importance, and these findings can inform improved support, ensuring access to equitable and safe COVID-19 care for these patients.

Multiple Mental Health Literacies in a Traditional Temple Site in Kerala: The Intersection Between Beliefs, Spiritual and Healing Regimes

The notion of 'mental health literacy' has been proposed as a way of improving mental health problem recognition, service utilisation and reducing stigma. Yet, the idea embodies a number of medical-model assumptions which are often at odds with diverse communities' spiritual traditions and local belief systems. Twenty participants were recruited to this study consisting of mental health service users (N = 7), family carers (N = 8) and community members (N = 5) in a temple town in Kerala, South India participated in semi-structured interviews exploring the variety of beliefs and practices relating to mental health. Our findings indicate that the issue may be better understood in terms of multiple mental health literacies which people deploy in different circumstances. Even those sceptical of traditional and spiritual approaches are knowledgeable about them, and the traditional practices themselves often involve detailed regimes of activities aimed at effecting an improvement in the person's mood or condition. Therefore, we argue it is appropriate to consider mental health literacy not as a unitary universal phenomenon but instead as a mosaic of different literacies which may be deployed in different settings and in line with different experiences and which may operate in synergy with each other to enable treatment but also facilitate a sense of meaning and purpose in life.

"My Autism is Linked with Everything": at the Crossroads of Autism and Diabetes

Autistic adults experience stark health disparities and difficulties accessing health care. Their realities of managing complex health conditions are unknown. Our research explored the experience of Autistic adults self-managing diabetes. Interviews with Autistic adults with diabetes and their support people were thematically analysed to identify three key themes. The Autistic experience influenced diabetes self-management, including autism-unique challenges and strengths. Participants prioritised avoiding Autistic burnout over diabetes self-management; mitigating the psychosocial pressures of neurotypical systems took precedence. Health professionals often separated autism and diabetes subsequently overlooking key factors impacting diabetes self-management. To better meet the needs of Autistic adults, diabetes care and health management more broadly should be considered within the context of autism, including supports for self-management during Autistic burnout.

A mixed-methods study of race-based stress and trauma affecting Asian Americans during COVID

COVID-19 propelled anti-Asian racism around the world; empirical research has yet to examine the phenomenology of racial trauma affecting Asian communities. Our mixed methods study of 215 Asian participants of 15 ethnicities examined experiences of racism during COVID and resulting psychological sequelae. Through qualitative content analysis, themes emerged of emotional, cognitive, and behavioral changes resulting from these racialized perpetrations, including: internalizing emotions of fear, sadness, and shame; negative alterations in cognitions such as reduced trust and self worth; and behavioral isolation, avoidance, and hypervigilance, in addition to positive coping actions of commitment to racial equity initiatives. We engaged in data triangulation with quantitative Mann-Whitney U tests, finding that those who experienced COVID discrimination had significantly higher racial trauma and PTSD scores compared to those who did not. Our convergent findings provide clinicians with novel ways to assess the ongoing impact of racial trauma and implement appropriate interventions for clients.

Perceived Factors That Facilitate or Prevent the Use of Speech-Generating Devices in Bilingual Individuals With Aphasia

PURPOSE

The aim of this study was to explore practicing speech-language pathologists' (SLPs') perceptions of factors that could facilitate or prevent the use of speech-generating devices (SGDs) in bilingual individuals with aphasia. Specifically, this exploratory study sought to identify the facilitators and barriers to SGD use in individuals with culturally and linguistically diverse backgrounds.

METHOD

An online survey was distributed to SLPs through an e-mail listserv and social media of an augmentative and alternative communication company. This article focused on the results of the survey items related to (a) the presence of bilingual individuals with aphasia on an SLP's caseload, (b) training related to SGD or bilingual aphasia, and (c) barriers and facilitators to SGD use. A thematic analysis was conducted to analyze the barriers and facilitators to SGD use reported by the respondents.

RESULTS

A total of 274 SLPs who met the inclusion criteria had experience in implementing SGD for people with aphasia. Regarding relevant training, our results indicated that very few SLPs received bilingual aphasia intervention training (17.22%) or bilingual SGD training (0.56%) in graduate school. The results from our thematic analysis revealed four major themes of barriers and facilitators to SGD use, including (a) hardware and software, (b) cultural and language content, (c) SLP's cultural and linguistic competency, and (d) resources.

CONCLUSIONS

Practicing SLPs reported several barriers to SGD use in bilinguals with aphasia. Most notably, language barriers for monolingual SLPs were seen as the greatest barrier to language recovery in individuals with aphasia whose primary language is not English. Several other barriers were consistent with previous research, such as financial factors and insurance disparities. The top three most important factors that facilitate SGD use in bilinguals with aphasia, as identified by the respondents, include user-friendly symbol organization, personalized words, and ease of programming.

Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences

BACKGROUND

Mental health recovery involves an integration of clinical and psychosocial frameworks. The recovery journey of individuals diagnosed with schizophrenia and the factors that influence it have been extensively studied. Because the recovery journey is culturally influenced, we examined the recovery process expriences of individuals diagnosed with schizophrenia in China, focusing on the influence of a Confucian-dominated collectivist and family-centred culture.

METHODS

An Interpretive Phenomenological Analysis (IPA) study was conducted; data were gathered through in-depth interviews with 11 individuals with lived experience of schizophrenia.

RESULTS

Four themes were identified in this study: traumatic illness experiences, influence of the family, motives for recovery, and posttraumatic growth, comprising ten subthemes. "For the family" and "relying on oneself" are the main drivers of recovery for individuals with a Chinese cultural background. Some people believe that taking care of themselves is an important way to ease the burden on their families and treat them well. There is a link between 'for the family' and 'relying on oneself.

CONCLUSIONS

Individuals living with schizophrenia in China have undergone significant traumatic experiences and have profound interactions with their families. Post-traumatic growth reflects an increase in the individual's connection to others and individual agency. It also suggests that the individual is not receiving enough support outside of the family. The impact of individual agency and family relationships should be considered in services that promote recovery, and clinic staff should enhance support outside the home to the individuals.

Exploring virtual care clinical experience from non-physician healthcare providers (VCAPE)

COVID-19 has caused an urgent implementation of virtual care (VC). Most research has focused on patient and physician experience with virtual care. Non-physician healthcare providers have played an active role in transitioning to virtual care, yet little is known about their experiences. This study explored their lived experiences in caring for patients virtually. Forty non-physician healthcare providers from local hospitals, community, and home care settings in Kingston, ON, Canada, participated and included nurse practitioners, occupational therapists, physiotherapists, psychologists, registered dietitians, social workers, and speech-language pathologists. Data were collected using semi-structured interviews between February and July 2021 and were analyzed thematically. The study was guided by organizational change theory. Four themes were identified from the data: 1) Quality of care, 2) Resources and training, 3) Healthcare system efficiency, and 4) Health equity and access for patients. Providers suggested that VC increased patient-centredness and had clear benefits for patients. Participants had little to no training in conducting patient care, virtually stating this as a key challenge. They believed that VC increased the efficiency of the healthcare system and was more proactive. Despite concerns regarding inequities across healthcare, participants reported that VC could improve equity as long as patients had access to technology. The study highlights the urgent need to support all healthcare providers in delivering optimal patient-centred care. We should leverage some of the advantages offered by VC to improve the efficiency of healthcare delivery, reduce provider burnout, and increase capacity across organizational systems.

Understanding the experiences of caregivers of HIV-exposed children under five: A phenomenological inquiry

Background

Children born to mothers with HIV require special care from the womb to the postnatal period, and caregivers involved in their care face several challenges.

Objective

This study aimed to explore caregivers' experiences providing care for HIV-exposed children under five.

Methods

This study employed a phenomenological approach. Ten caregivers of HIV-exposed children living in Jakarta, Indonesia, were selected using snowball techniques. Online in-depth interviews were conducted to collect data from September 2021 to July 2022, and thematic analysis using Colaizzi's method was performed for data analysis.

Results

The study involved ten caregivers (nine females and one male) aged between 23 and 42 years. Seven of them were mothers who tested HIV-positive, while one was an adoptive father, one was a mother's sister, and one was an aunt of HIV-exposed children. The majority of them were housewives and had a low educational background. Three themes were generated: (i) disease-transmission foreboding, (ii) prejudice against mothers and children exposed to HIV, and (iii) seeking support.

Conclusion

Caring for HIV-exposed children poses emotional and physical challenges for caregivers, necessitating support from health professionals and peer groups. Nurses play essential roles in improving caregiver well-being and supporting optimal growth and development in HIV-exposed children under five by designing intervention programs. Furthermore, to enhance home-based HIV care in Indonesia, the government must implement social interventions that target families with limited resources.

A supportive text message intervention for individuals living with endometriosis (EndoSMS): Randomized controlled pilot and feasibility trial

Introduction

As a high symptom burden chronic condition, endometriosis is associated with diminished quality of life (QoL) and psychological distress. The EndoSMS text message intervention was developed to inform and support individuals living with endometriosis. The primary aim of this study is to assess the acceptability, feasibility and preliminary efficacy of EndoSMS, to improve endometriosis-specific QoL and reduce psychological distress in a randomised controlled trial, compared with care as usual. We will additionally assess the impact of EndoSMS on self-efficacy for managing endometriosis.

Methodology

A two-arm parallel pilot randomised controlled trial with waitlist control was conducted. Baseline assessments included QoL, psychological distress, self-efficacy, demographic and medical variables. Following baseline survey completion, participants were randomised to either the Intervention (EndoSMS: 3-months of text messaging) or Control condition. At 3-month follow-up, all participants completed an online survey reassessing outcomes, and Intervention participants provided quantitative and qualitative user feedback on EndoSMS.

Results

Data collection commenced on 18 November 2021 and was completed on 30 March 2022. Descriptive statistics will be used to analyse feasibility and acceptability of the intervention. Preliminary efficacy analyses will be conducted using linear mixed models for QoL, psychological distress and self-efficacy outcomes. Subgroup analyses will also be conducted for typically underserved populations (e.g., rural/regional).

Conclusion

This pilot will provide acceptability, feasibility and preliminary efficacy evidence for the impact of a supportive text messaging program for endometriosis. It will contribute to understanding how to optimally support individuals in living with and managing their endometriosis.

Trial Registration

Australian New Zealand Clinical Trials Registry.

Looking at both sides, outcomes of positive workplace relational systems: A phenomenological study

Relational systems are like a gear wheel in organizational processes that keeps employees connected and moving. These relationships are developed and maintained within the work environment for task accomplishment. But these relational systems are originating other outcomes that directly and indirectly affect the organizational process. The present study aimed to explore the outcomes of positive workplace relational systems. Under qualitative phenomenological approach followed a classical content analysis technique employed to analyze the data collected from 20 Bank employees through semi-structured interviews. The data analysis revealed that outcomes of positive relational systems varied depending on the duration and quality of relationships. Organizational culture identified as an important factor that influences the quality of relationships and their outcomes. The data analysis revealed that positive workplace relational systems along with positive behavioral outcomes also develop negative outcomes among employees such as perception of organizational politics. This study argued that outcomes of positive workplace relational systems depend on the perception and need satisfaction of participants. The result highlighted the important areas for individuals and organizations to consider in the context of relationship management, developing interpersonal skills in employees, and encouraging relationship generosity. It will help to enhance the well-being of employees and improve organizational performance.

The Lived Experiences of Spousal Bereavement and Adjustment Among Older Chinese Immigrants in Calgary

Spousal bereavement poses considerable challenges to adults in late life. Some populations, such as older immigrants, may experience heightened negative outcomes as a consequence of spousal bereavement, due to migratory stress and social isolation. Spousal bereavement is culturally embedded as it is related to cultural beliefs and attitudes concerning death and family relationships. However, studies on spousal bereavement or widowhood among older immigrants are extremely limited. This study aims to fill the gap by exploring, via a phenomenological approach, the lived experiences of widowed older Chinese immigrants in Calgary and responding to the question: What are the lived experiences of widowed Chinese older immigrants in coping with their spousal bereavement? With the data drawn from 12 in-depth qualitative interviews, findings were categorized into individual, family, community and societal levels. Study participants experienced long-lasting grief that was private and impacted by their culture and immigration status. Although family and ethno-cultural communities provided various types of supports during participants' widowhood, they did not directly assist them in coping with spousal loss. Most participants did not access social services for bereavement support, more often relying on cultural rituals and faith practices. Findings suggest the need for culturally appropriate bereavement supports and family/community involvement for older immigrant adults who have experienced spousal loss.

Co-design and Development of EndoSMS, a Supportive Text Message Intervention for Individuals Living With Endometriosis: Mixed Methods Study

BACKGROUND

Endometriosis, which affects 1 in 10 people assigned female at birth, is a chronic systemic inflammatory disease with a high symptom burden and adverse socioemotional impacts. There is a need for an accessible, cost-effective, and low-burden intervention to support individuals in managing their endometriosis condition.

OBJECTIVE

This study aimed to co-design and evaluate the acceptability, readability, and quality of a bank of supportive SMS text messages (EndoSMS) for individuals with endometriosis.

METHODS

In phase 1 of this mixed method design, 17 consumer representatives (individuals with endometriosis) participated across three 3-hour web-based (Zoom, Zoom Video Communications, Inc) focus groups. The transcripts were encoded and analyzed thematically. In phase 2, consumer representatives (n=14) and health care professionals (n=9) quantitatively rated the acceptability, readability, and appropriateness of the developed text messages in a web-based survey. All the participants initially completed a background survey assessing sociodemographic and medical factors.

RESULTS

Consumer representatives demonstrated diverse sociodemographic characteristics (Mage=33.29), varying in location (metropolitan vs rural or regional), employment, and relationship and educational statuses. Participants reached a consensus regarding the delivery of 4 SMS text messages per week, delivered randomly throughout the week and in one direction (ie, no reply), with customization for the time of day and use of personal names. Seven main areas of unmet need for which participants required assistance were identified, which subsequently became the topic areas for the developed SMS text messages: emotional health, social support, looking after and caring for your body, patient empowerment, interpersonal issues, general endometriosis information, and physical health. Through a web-based survey, 371 co-designed SMS text messages were highly rated by consumers and health care professionals as clear, useful, and appropriate for individuals with endometriosis. Readability indices (Flesch-Kincaid scale) indicated that the SMS text messages were accessible to individuals with a minimum of 7th grade high school education.

CONCLUSIONS

On the basis of the needs and preferences of a diverse consumer representative group, we co-designed EndoSMS, a supportive SMS text message program for individuals with endometriosis. The initial evaluation of the SMS text messages by consumer representatives and health professionals suggested the high acceptability and suitability of the developed SMS text messages. Future studies should further evaluate the acceptability and effectiveness of EndoSMS in a broader population of individuals with endometriosis.

COVID-19 anti-Asian racism and race-based stress: A phenomenological qualitative media analysis

OBJECTIVE

News media has recently been replete with stories of anti-Asian rhetoric and racism related to the COVID-19 pandemic. Empirical literature, however, has yet to systematically analyze and document these experiences and their impact. Our study aimed to examine this phenomenon by analyzing news media coverage published between December 31, 2019-June 30, 2020 on COVID-related anti-Asian incidents.

METHOD

We utilized a phenomenological approach to conduct qualitative content analysis of 84 media articles reporting on coronavirus related anti-Asian incidents. We also present the emerging psychological framework of race-based stress and trauma to conceptualize the psychological impact of these race-based incidents reported in the media.

RESULTS

Qualitative analysis revealed five primary themes: (a) pathologizing cultural practices; (b) alien in one's own land; (c) invalidation of interethnic differences; (d) ascription of diseased status; and (e) duality of frontline hero and virus carrier. We provide examples for each of these themes.

CONCLUSION

These themes document stigmatizing narratives and demonstrate the phenomenology of race-based stress and trauma experienced by Asian individuals during the COVID era. We present potential implications for mental health of Asian individuals during and following the COVID-19 pandemic, as well as recommendations for future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The impact of Confucianism on social and emotional health of Vietnamese adolescents: A phenomenological study

Confucianism has become an educational ideology in Vietnam and blended its philosophy with other religious and spiritual doctrines. The current study explores the impact of Confucianism on social and emotional health (SEH), which focuses on the skill-based aspect of Confucian Vietnamese adolescents. A hermeneutic phenomenological study was chosen as an appropriate approach for collecting and interpreting descriptions of 15 Confucian Vietnamese adolescents to explore how these lived experiences have shaped their current perceptions of SEH. We have labeled the two shared common characteristics in the participants' various SEH experiences, including (1) Authentic perception of Confucian philosophy strengthens the self-esteem; (2) Positive practice of the 5-essential human virtues helps establish and maintain healthy, supportive relationships. The two essences reflected the positive impact of Confucianism on SEH of Vietnamese adolescents. The adolescents' SEH experiences are consistent with Confucian philosophy while at the same time not conflicting with other religious doctrines. The findings of this study have broadened our understanding of the applicability of socio-emotional competence models to promote positive psychological development in adolescents, and the feasible goal-setting in counseling and psychotherapy from different psychological theories about the combination of religious and spiritual practices.

Exploring the perspectives of ‘young adults’ (18–24) who have been in formal care and their experiences of attending a socially prescribed community allotment gardening group

Introduction:

Young adults who have experienced periods of time being ‘in care’ are one of the most socially deprived populations within society, with their needs largely unmet and often not fully understood. Despite the significant attempts to invest in community-based ‘social prescribing’ interventions to address such health inequalities, there is a dearth of understanding regarding how such occupation-based community groups are experienced by this particular population. This UK based qualitative study aimed to explore the experiences of young adult ‘Care Leavers’ regarding their participation in a socially prescribed community gardening group.

Method:

Semi-structured online interviews were conducted with six young care leavers aged between 18 and 24 years who regularly participated in a community gardening group. Interviews were recorded transcribed verbatim and analysed Braun and Clarke’s Thematic Analysis process by two researchers to maximise validity.

Findings:

Four key themes emerged: ‘Social belonging and connection’, ‘A safe space’, ‘Sense of achievement from active engagement’ and ‘The facilitatory aspects of nature’. The findings suggested nature-based co-occupation within a local group, enhanced social capital, self-identity and wellbeing.

Conclusion:

This study supports the emerging scope of using community occupation-based interventions with young adult ‘Care Leavers’ and offers an insight into their particular needs.

Authenticity as Best-Self: The Experiences of Women in Law Enforcement

Law enforcement poses a difficult work environment. Employees’ wellbeing is uniquely taxed in coping with daily violent, aggressive and hostile encounters. These challenges are compounded for women, because law enforcement remains to be a male-dominated occupational context. Yet, many women in law enforcement display resilience and succeed in maintaining a satisfying career. This study explores the experience of being authentic from a best-self perspective, for women with successful careers in the South African police and traffic law enforcement services. Authenticity research substantiates a clear link between feeling authentic and experiencing psychological wellbeing. The theoretical assumption on which the study is based holds that being authentic relates to a sense of best-self and enables constructive coping and adjustment in a challenging work environment. A qualitative study was conducted on a purposive sample of 12 women, comprising 6 police officers and 6 traffic officers from the Western Cape province in South Africa. Data were gathered through narrative interviews focussing on experiences of best-self and were analysed using interpretive phenomenological analysis. During the interviews, participants predominantly described feeling authentic in response to work-related events of a conflictual and challenging nature. Four themes were constructed from the data to describe authenticity from a best-self perspective for women in the study. These themes denote that the participating women in law enforcement, express feeling authentic when they present with a mature sense of self, feel spiritually congruent and grounded, experience self-actualisation in the work–role and realign to a positive way of being. Women should be empowered towards authenticity in their world of work, by helping them to acquire the best-self characteristics needed for developing authenticity.

Using ethics of care as the theoretical lens to understand lived experiences of caregivers of older adults experiencing functional difficulties

The lived experiences of caregivers of older adults in Ghana are not well understood. The purpose of this study was to explore and discuss the lived experiences of these caregivers using the Ethics of Care as a theoretical lens and Interpretative phenomenological analysis as the methodological approach. Ten caregivers in receipt of social welfare services on behalf of older adults were recruited from the Social Welfare Unit at the Komfo Anokye Teaching Hospital (KATH) in southern Ghana. The analysis identified five interrelated themes: 1) committing the Self to caregiving; 2) caregiving impacting the Self; 3) motivating factors to caregiving; 4) caregiving burdens, and 5) thinking about personal affairs. Their experiences demonstrate that caregivers value the caregiving relationship, as posited by Ethics of Care, and tend to care for their health and well-being. Caregivers’ expression of commitment to caring for older adults is mainly influenced by reciprocity, despite internal and external stressors, and desire to fulfil unmet personal needs. Ethics of care offers an understanding of the lived experiences of caregivers of older adults in Ghana. The findings draw attention to the state to develop specific programs to ensure the health, social and financial well-being of older adults’ caregivers.

"Your Body Is Not At All Where You Left It": Adolescent and Young Adult Cancer Survivors' Experiences Transitioning Back Into Physical Activity After Treatment

Physical activity (PA) can help manage cancer treatment-related side effects and improve well-being following treatment; however, resuming PA after a period of inactivity due to cancer can be challenging. The purpose of this study was to explore adolescents and young adults (AYAs) experiences transitioning back into PA after a period of inactivity due to cancer treatment. Twelve previously active AYAs (M_age = 30 ± 5.8 years) were purposefully sampled and engaged in a semi-structured interview. The following four themes were generated through a reflexive thematic analysis: PA is described as important and valuable; navigating one's appearance and fitness changes after cancer treatment within the PA context; supportive care is essential to successful PA transitions; and juxtaposed environments: fitness facilities, cities, and green spaces. Developing strategies aimed at gradually transitioning into PA should be a priority to improve AYAs' well-being through survivorship.

Women Caring for Husbands Living with Parkinson’s Disease: A Phenomenological Study Protocol

Parkinson’s disease (PD) is an emerging pandemic caused by aging, longevity, and industrialization. Most people diagnosed with PD initially experience mild symptoms, but over time the symptoms become debilitating. Given their intensive care requirement, most married people living with PD receive care from their spouses; most are female caregivers. Because caregiving is hard work with long hours, caregivers experience stress, fatigue, and depression, often leading to exhaustion and burnout. The purpose of this descriptive phenomenological study is to understand the lived experience of women caregivers of husbands living with PD. As part of this study protocol, women caring at home for their husbands diagnosed with PD will be purposely recruited from the Colorado Parkinson Foundation. Semi-structured interviews will be conducted by Zoom© until data saturation is achieved. Colaizzi’s seven-step process will be used to analyze the data in Atlas.ti. Strategies have been incorporated into the study protocol to maximize trustworthiness and to insure methodological rigor. The study will be reported using recommendations from the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research. Findings from this study may guide intervention development to improve the caregiving experience and to inform clinical practice guidelines for health care professionals.

Frontline leadership for implementing clinical guidelines in Norwegian mental health services: a qualitative study

Purpose

The purpose of this study was to explore and interpret how frontline leaders define, experience and rationalise their approaches to the successful implementation of clinical guidelines in mental health care.

Design/methodology/approach

Employing an interpretative phenomenological design, the authors conducted and analysed individual interviews of frontline leaders at 14 psychiatric clinics involved in a national study of implementing evidence-based clinical guidelines in mental health.

Findings

The authors found a broad spectrum of attitudes and attributes, as well as a wide repertoire of strategies for frontline implementation leadership. Three main approaches were revealed, comprising “Curious and welcoming”, “Integrity and setting standards” and “Caring and collegial”.

Research limitations/implications

The study present what experienced frontline leaders emphasise to enable implementation of guidelines, not empirical pieces of evidences for what they in fact do or if these actions lead to implementation. The generalisability to other settings is unknown. Another sample profile, context or organisational level may have impacted the result. The concreteness of the frontline leaders’ considerations, approaches and actions gives important knowledge about frontline leaders leadership across traditional leadership theories.

Originality/value

Existing leadership theories describe different leadership styles, while this study reveals the need for a wide range of approaches to balance the many needs and demands. The complexity of leadership approaches this study found is in line with implementation theories; thus, the present study incorporates implementation science into the leadership literature.

Barriers to managing elder abuse in primary care services: experiences of healthcare providers in Mexico City

The purpose of this study was to analyze the barriers to managing elder abuse from the perspective of primary care health workers in Mexico City. We performed an ethnographic qualitative-descriptive study. Thirty semi-structured interviews were conducted with healthcare providers associated with three health centers located in areas with medium and high levels of poverty. A phenomenological approach was used to identify themes, subthemes and codes. Three main types of barriers were found: 1) institutional framework; 2) professional competency limitations and the dominance of a biomedical vision; and 3) the invisibilization of elder abuse. These barriers, described by healthcare workers, highlight the complexity involved in integrating the treatment of elder abuse into primary care health services. It is necessary to develop public educational and preventive public policies for elder abuse that are coordinated both with support services to treat such cases as well as with programs to strengthen healthcare providers professional competency.

Youths' and Parents' Experiences and Perceived Effects of Internet-Based Cognitive Behavioral Therapy for Anxiety Disorders in Primary Care: Mixed Methods Study

BACKGROUND

Anxiety is common among youths in primary care. Face-to-face treatment has been the first choice for clinicians, but during the COVID-19 pandemic, digital psychological interventions have substantially increased. Few studies have examined young people's interest in internet treatment or the attitudes they and their parents have toward it.

OBJECTIVE

This study aims to investigate adolescents' and parents' attitudes toward and experiences of internet-based cognitive behavioral anxiety treatment in primary care and its presumptive effects.

METHODS

The study used mixed methods, analyzing qualitative data thematically and quantitative data with nonparametric analysis. Participants were 14 adolescents and 14 parents recruited in adolescent primary health care clinics. The adolescents and their parents filled out mental health questionnaires before and after treatment, and were interviewed during ongoing treatment.

RESULTS

The quantitative data indicated that the internet-delivered cognitive behavioral therapy program used in this study was successful in reducing symptoms (χ²₂=8.333; P=.02) and that adolescents' motivation is essential to the treatment outcome (r=0.58; P=.03). The qualitative results show that youths highly value their independence and freedom to organize treatment work on their own terms. The parents expressed uncertainty about their role and how to support their child in treatment. It was important for parents to respect the youths' need for autonomy while also engaging with them in the treatment work.

CONCLUSIONS

Internet treatment in primary care is accepted by both youths and their parents, who need clarification about the difference between their role and the therapist's role. Patient motivation should be considered before treatment, and therapists need to continue to develop the virtual alliance. Finally, primary care should be clearer in informing adolescents and their parents about the possibility of internet treatment.

Twitter Fingers and Echo Chambers: Exploring Expressions and Experiences of Online Racism Using Twitter

Social media sites, such as Twitter, represent a growing setting in which racism and related stress may manifest. The aims of this exploratory qualitative study were to (1) understand the essence of Twitter users' lived experience with and response to content about race and racism on the platform, and (2) explore their perceptions of how discussions about race and racism on Twitter may impact health and well-being. We conducted six focus groups and four interviews with adult Twitter users (n = 27) from Berkeley, California, and Greenville, South Carolina. We managed the data with NVivo and conducted an interpretative phenomenological analysis to identify themes. Participants described Twitter content as displaying both overt and subtle expressions of racism, particularly for Black and Latinx people, and serving as an echo chamber where similar viewpoints are amplified. Participants described how Twitter users may feel emboldened to type offensive tweets based on the perception of anonymity, and that these tweets were sometimes met with community disapproval used to provide a collective calibration to restore the social norms of the online space. Participants perceived harmful mental, emotional, and physical health impacts of exposure to racist content on Twitter. Our participants responded to harmful race-related content through blocking users and following others in order to curate their Twitter feeds, actively engaging in addressing content, and reducing Twitter use. Twitter users reported witnessing racism on the platform and have found ways to protect their mental health and cope with discussions of race and racism in this social media environment.

Ethical Issues in Private Practice: A Phenomenological Investigation of Music Therapy Business Owners

As a music therapy private practice is both a business and a healthcare service, it should adhere to ethical standards from both disciplines. However, this topic has rarely been examined in the music therapy literature. The purpose of this phenomenological study was to explore ethical dilemmas experienced by music therapy business owners (MTBOs) in their private practice and how MTBOs avoid or address ethical dilemmas. Utilizing convenience and snowball sampling techniques, 21 MTBOs in the United States were interviewed using semi-structured interviews. To answer the two areas of inquiry, we identified three themes and 12 subthemes: (1) Ethical issues related to client welfare, (2) Ethical issues related to business relationships and operation, and (3) Strategies to address or avoid ethical dilemmas. MTBOs also shared how they ensure ethical behavior in themselves, with their employees or independent contractors, and when interacting with professionals outside the private practice. These findings provide a better understanding of MTBOs' lived experiences of ethics in their private practice and may benefit other music therapists who are in private practice or are wanting to go into private practice. Limitations and recommendations for further research are provided.

Interpretative Phenomenological Analysis of the Lived Experiences of Older Adults Regarding Their Functional Activities in Ghana

Introduction: Research on disability largely draws on epidemiological data, often conducted in more developed countries. To date, there is little research related to older adults in Ghana, Africa. The purpose of this study was to strengthen understanding of how older adults in Ghana perform functional activities, referenced against the World Health Organization’s International Classification of Functioning, Disability and Health (WHO-ICF) framework. Methods: Interpretative phenomenological analysis (IPA) of semistructured interview data was employed as the methodological approach. Using purposive criterion sampling, 8 older adults admitted to Komfo Anokye Teaching Hospital in Ghana, presenting with any identified health condition and/or frailty were recruited. Results: Analysis of interview data identified 5 interrelated themes: (1) feeling anxious, (2) feeling restricted, (3) understanding and admitting difficulty, (4) striving to be healthy and being productive, and (5) managing functional difficulty. These concerns were classified and related to the WHO-ICF, particularly the contextual factors. Discussion: This study examined in detail experiences of older adults performing functional activities. Our study highlights the relevance of the WHO-ICF framework for understanding the health needs of older adults, emphasizing the functional, social, and environmental factors influencing the functional status of older adults. The findings offer unique insight into the health needs of older adults, drawing attention to the implications for policy and care.

Understanding the lived experiences of medical learners in a narrative medicine course: a phenomenological study

BACKGROUND

Reflection and various approaches to foster reflection have been regarded as an indispensable element in enhancing professional practice across different disciplines. With its inherent potential to engage learners in reflection and improvement, narrative medicine has been adopted in various settings. However, the relevance and effectiveness of reflection remains underexplored in the context of narrative medicine, specifically in regard to the concern about variability of learner acceptance and the way learners really make sense of these reflective activities. This study aimed to explore what medical learners experience through narrative medicine and the meanings they ascribe to the phenomenon of this narrative-based learning.

METHODS

Using a transcendental phenomenology approach, twenty medical learners were interviewed about their lived experiences of taking a narrative medicine course during their internal medicine clerkship rotation. Moustakas' phenomenological analysis procedures were applied to review the interview data.

RESULTS

Six themes were identified: feeling hesitation, seeking guidance, shifting roles in narratives, questioning relationships, experiencing transformation, and requesting a safe learning environment. These themes shaped the essence of the phenomenon and illustrated what and how medical learners set out on a reflective journey in narrative medicine. These findings elucidate fundamental elements for educators to consider how narrative approaches can be effectively used to engage learners in reflective learning and practice.

CONCLUSION

Adopting Moustakas' transcendental phenomenology approach, a better understanding about the lived experiences of medical learners regarding learning in narrative medicine was identified. Learner hesitancy should be tackled with care by educators so as to support learners with strategies that address guidance, relationship, and learning environment. In so doing, medical learners can be facilitated to develop reflective capabilities for professional and personal growth.

Placebo From an Enactive Perspective

Due to their complexity and variability, placebo effects remain controversial. We suggest this is also due to a set of problematic assumptions (dualism, reductionism, individualism, passivity). We critically assess current explanations and empirical evidence and propose an alternative theoretical framework—the enactive approach to life and mind—based on recent developments in embodied cognitive science. We review core enactive concepts such as autonomy, agency, and sense-making. Following these ideas, we propose a move from binary distinctions (e.g., conscious vs. non-conscious) to the more workable categories of reflective and pre-reflective activity. We introduce an ontology of individuation, following the work of Gilbert Simondon, that allow us to see placebo interventions not as originating causal chains, but as modulators and triggers in the regulation of tensions between ongoing embodied and interpersonal processes. We describe these interrelated processes involving looping effects through three intertwined dimensions of embodiment: organic, sensorimotor, and intersubjective. Finally, we defend the need to investigate therapeutic interactions in terms of participatory sense-making, going beyond the identification of individual social traits (e.g., empathy, trust) that contribute to placebo effects. We discuss resonances and differences between the enactive proposal, popular explanations such as expectations and conditioning, and other approaches based on meaning responses and phenomenological/ecological ideas.

Psychotic-like experiences? Trajectories and typologies of hallucinations and delusions from early adolescence to early adulthood in a population-based sample of Irish youth

OBJECTIVES

Hallucinations and delusions that occur in the absence of a psychotic disorder are common in children and adolescents. Longitudinal phenomenological studies exploring these experiences are notably lacking. The objective of the current paper was to explore the phenomenology and characteristics of hallucinations and delusions from early adolescence to early adulthood.

METHODS

Participants were 17 young people aged 18-21 years from the general population, all of whom had a history of childhood hallucinations and/or delusions. Longitudinal data on the phenomenological characteristics and attributions of reported hallucinatory and delusional phenomena spanning nine years were explored using content analysis.

RESULTS

Hallucinatory and delusional phenomena were transient for two-thirds of the sample. The remaining one-third reported reoccurring hallucinatory and delusional phenomena into early adulthood. In those, two typologies were identified: (1) Paranormal typology and (2) Pathological typology. The former was characterised by hallucinatory and delusional phenomena that were exclusively grounded in subcultural paranormal or spiritual belief systems and not a source of distress. The latter was characterised by delusion-like beliefs that were enmeshed with individuals' mood states and a source of distress. The perceived source, the subcultural context and how young people appraised and integrated their experiences differentiated the Paranormal and Pathological typologies.

CONCLUSIONS

Not all hallucinatory and delusion-like experiences are psychotic-like in nature. To reliably differentiate between pathological and non-pathological hallucinations and delusions, assessments need to explore factors including the phenomenology of individuals' experiences, how people make sense and appraise them, and the subcultural contexts within which they are experienced.

Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario

PURPOSE

In Ontario, an individual's registered wish for organ donation is legally valid consent following death. Family veto occurs when the deceased donor's substitute decision-maker (SDM) overrides this consent to donate, evoking a legal and ethical conflict. The objective of this study was to examine the experiences of Organ and Tissue Donation Coordinators (OTDCs) working with SDMs who vetoed a deceased donor's consent for organ donation.

METHODS

Qualitative focus groups were conducted with ten OTDCs in Ontario, Canada who reported experience with family veto. An interpretative phenomenological approach informed data analysis. Themes emerged through team consensus and were further refined through collaborative and reflexive engagement.

RESULTS

Four themes emerged regarding family veto: 1) the significance of the OTDC role, 2) emotional distress and the "understandable" family veto, 3) barriers contributing to family veto, and 4) strategies towards a culture of organ donation. Findings highlighted the importance of patient advocacy in the OTDC role, while revealing the emotional distress of experiencing family veto. OTDCs identified timing and healthcare providers' perceived ambivalence toward organ donation as critical barriers to family authorization. Value-positive language, role reframing, and increased education were offered as strategies to address these barriers and reduce family veto.

CONCLUSION

This study highlights important considerations about organ donation authorization processes in Ontario. Findings support practice changes towards reducing family veto and further research nationally. Collaborations with key stakeholders are warranted to align healthcare practices, donation policies, and education initiatives towards a shared goal of increasing organ donation.

"My private theory is that it's all in the head": Understandings of chronic widespread pain among social workers from municipality job centers in Denmark

People with chronic widespread pain (CWP) are often unfit for work, and consequently they are dependent on the municipality job center to receive social support and sickness benefits. The job center's case management is based on a social worker's assessment of the citizen's health condition. This qualitative study investigates social workers' understandings of CWP. Interviews were carried out with 12 social workers. The results showed that the participants predominantly experienced the citizens' illnesses as psychosocially mediated-referring to trauma, or a lack of meaning in the citizens' lives. Only a few participants mentioned possibilities for somatic explanations of CWP.