Insider and Outsider Perspectives: Reflections on Researcher Identities in Research with Lesbian and Bisexual Women

The circular paradox of including people with severe brain injuries and reduced decisional capacity in research: A feasibility study exploring randomized research, consent-based recruitment biases, and the resultant health inequities

BACKGROUND

People with severe brain injuries (PSBI) and reduced capacity to consent (CTC) frequently develop muscle contractures. Standard care includes prolonged stretch (PS) but there is limited condition-specific evidence from randomized controlled trials (RCTs).

PURPOSE

Identify factors affecting the inclusion of PSBI and reduced CTC in a PS RCT and methodologies more capable of generating condition-specific outcomes.

METHODS

Mixed-method feasibility studies, including a pilot RCT (PSBI, adults with reduced CTC) comparing PS treatments (serial casting and splinting) and focus groups/interviews with physiotherapists involved in PS treatment. Reflexive thematic analysis developed themes.

RESULTS

Two PSBI were included in the pilot RCT with no significant safety concerns or adverse effects. Twelve physiotherapists participated in two focus groups and two interviews. Four themes were identified: 1) complexity of contracture management; 2) burden of decision making; 3) lack of evidence and uncertainty; and 4) challenges to RCT acceptability and feasibility.

CONCLUSIONS

Reduced CTC contributes to the exclusion of PSBI from experimental research, and a circular paradox where poor research inclusion contributes to generalized healthcare and "evidence-biased medicine." Due to the complexity of their condition, simply including PSBI in randomized research is unlikely to create meaningful health outcomes. Improving their care requires a paradigm shift toward pluralistic methods of knowledge generation.

Air rage from the sharp end: cabin crew perspectives on disruptive passenger behaviour in Europe and its impact on occupational safety and well-being

Disruptive passenger behaviour (DPB) incidents spiked during the COVID-19 pandemic period, compromising the safety of commercial flights on a daily basis. This qualitative semi-structured interview study examined the perceived triggering factors and motivations for DPB and the subsequent impact of DPB upon cabin crew well-being and safety. Twenty-four European cabin crew disclosed experiences, subjective observations of perpetrator traits, assessment of DPB development and information regarding their well-being and perceived safety. Thematic analysis revealed that the perceived frequency of DPB had increased, driven by an accumulation of pandemic-related factors - such as enforcing mask wearing amongst intoxicated passengers. DPB was found to decrease resilience and spur maladaptive coping strategies in crew. Suggested enhancements to current DPB mitigation consisted of stricter punishment for DPB as a deterrent, alcohol bans and higher quality training. These findings can inform decision-makers' efforts to support cabin crew well-being and create safer cabin workplaces in the future.

'Show Us a Kiss!': The Everyday Sexual Harassment Experiences of Female Lesbian, Bisexual, and Queer Students

This study explored the experiences of lesbian, bisexual, and queer (LBQ) students' (N = 9, aged 19-24) of sexual harassment via semistructured interviews. Data were analysed using a thematic analysis. Three overarching themes emerged: (a) the paradox of men's unwanted sexual attention, (b) the negative impact on relationships, and (c) the LGBTQ* community as a refuge. The women reported enduring unwanted heteronormative sexual attention, and heterosexist and homophobic harassment which forced some to conceal their sexuality. Support for the LGBTQ* community was central in developing confidence to call-out harassment. The findings call for the inclusion of LBQ-specific messages in sexual violence awareness and prevention interventions.

Solidarity with whom? Minority perspectives on allyship in Danish queer spaces

Social psychological research has witnessed a burgeoning interest in advantaged group allies acting in solidarity with disadvantaged groups to challenge systems of inequality. While solidarity from advantaged group members is often deemed critical for social change, the perceptions of disadvantaged group members regarding ally participation are seldom addressed. This research delved into how LGBTQIA+ individuals in Denmark conceptualize allyship. Through 26 semi-structured interviews with participants and organizers of queer pride events, a thematic analysis identified three themes addressing how allyship materializes, what risks it bears and who it involves. Specifically, we present a three-levelled framework of allyship, which captures practices of allyship on a personal, relational and structural level. Our analysis also reveals the risk of allyship when it is not perceived as genuine and complexities of group boundaries when discussing allyship, shedding light on intersectional challenges within minority communities. These findings illustrate the nuances involved in providing and receiving allyship within and across various social (sub)groups.

Highs, Lows, and Hormones: A Qualitative Metasynthesis of Transgender Individuals' Experiences Undergoing Gender-Affirming Hormone Therapy

Gender Affirming Hormone Therapy (GAHT) is a key therapeutic approach which aims to help trans and gender diverse (or simply "trans") individuals' transition from their sex-presumed-at-birth to their experienced gender identity. Previous reviews have focused on synthesizing quantitative experiences; however, a qualitative lens is important to understand the personal journey of GAHT. This review provides a qualitative meta-synthesis of the experiences of trans people around the world who have undergone GAHT to elicit contextualized understanding of the changes experienced. Systematic searches of eight databases identified an initial 2670 papers, refined to a final 28 papers. Overall, findings suggested that the GAHT journey is unique and elicited a myriad of changes which, whilst challenging at times, were life-changing and brought about positive psychological, physical, and social changes. Other themes explored GAHT not being treated as a fix-all for associated mental health issues, the rules that govern appraisal of physical changes, how privilege and social identity evolve, and the power of affirmation. This work offers important recommendations to improve the care offered to trans people undergoing GAHT. Namely, person-centered support is essential, and peer-navigation may be a useful future direction to explore.

One person, many changes: a socioecological qualitative analysis of the experiences of transfeminine individuals undergoing feminising gender-affirming hormone therapy

Gender-affirming hormone therapy (GAHT) comes with many physical, psychological, and social changes that are often considered in isolation. This research uses a socioecological lens with a sample of 15 Australian transfeminine individuals to investigate the changes experienced during GAHT. Semi-structured interviews were conducted in 2022, with verbatim transcripts analysed using deductive thematic analysis with Bronfenbrenner's Socioecological Model (SEM) as a framework. Analyses revealed two themes intersecting multiple levels of the SEM. Theme 1 contained two sub-themes and broadly encapsulated how interactions with others influenced GAHT experiences. Sub-theme 1 spoke to how stigma creates positive or negative experiences (through the macrosystem, the exosystem, and proximal processes), while sub-theme 2 described how GAHT causes internal changes that promoted stronger interpersonal relationships (person and proximal processes). Theme 2 described how changes occurred over time, with some changes being temporary, and others being delayed (person and time). These themes highlight the interconnected nature of the physical, psychological, and social changes and experiences that can occur during GAHT. Best-practice care for trans people undergoing GAHT needs to be multi-faceted and holistic in order to embed support across different SEM components.

"Where Is My Place?" A Qualitative Study of Gay Men's Experiences of Social Support, Relationships and Community in Relation to Psychological Wellbeing and Distress

This study aimed to understand young gay men's experiences of social support, relationships, community networks, talking about psychological distress, and their impact on distress and wellbeing. Eight verbatim transcriptions from semi-structured interviews with gay men aged 18-35 years were analyzed using Interpretative Phenomenological Analysis. Three super-ordinate themes were developed; 1) Growing up gay in a straight world: Developmental traumas, regarding men's experiences of homophobic abuse and exclusion and the internalized impact on their identities and identity concealment. 2) Belonging and not belonging within LGBTQ+ communities, encompassing men's varied experiences of LGBTQ+ communities and the corresponding impacts upon their wellbeing. 3) Relational responses to rejection, describing how men made sense of and managed their relationships within the context of the developmental traumas they had experienced growing up as gay men. These findings illuminate the psychological impact of experiencing multiple developmental traumas related to one's identity as a gay man, and how this influences lifelong relational behavior; and how experiences of social support, relationships and LGBTQ+ communities influence men's mental health. They provide a strong rationale for psychological interventions to acknowledge and address gay men's unique and adverse social experiences within their relationships, communities and societies.

Qualitative interview study of rheumatology patients' experiences of COVID-19 shielding to explore the physical and psychological impact and identify associated support needs

OBJECTIVE

Many clinically extremely vulnerable rheumatology patients have only recently ceased shielding from COVID-19, while some continue to minimise in-person contact. The objective of this study was to understand the impact of shielding and associated support needs in patients with rheumatic conditions and to understand how rheumatology teams can meet these needs both currently and in future pandemics.

DESIGN, PARTICIPANTS AND SETTING

The study was conducted in the Southwest of England using a case-study design. The participants were 15 patients with rheumatic conditions who were advised to shield and/or chose to shield at any time during the COVID-19 pandemic.

METHODS

Qualitative data collected via telephone and online semi-structured interviews and analysed using reflexive thematic analysis.

RESULTS

Fifteen interviews were conducted. Three main themes represent the data:'Just shove them over there in the corner' captures changes in patients' self-perception. They felt different to most other people, vulnerable and left behind. The initial sense of shock was followed by a sense of loss as changes became long term.'A long and lonely road' captures patients' psychological isolation due to a perceived lack of understanding and support. This included having to prove their health status and justify their shielding behaviours, which impacted their relationships. At times, they felt abandoned by their healthcare providers.'You can't just flip a switch' captures the difficulty of getting back to pre-pandemic normal after shielding. Patients did not recognise themselves physically and mentally. They wanted to collaborate with health professionals and identified the need for specific guidance to support their recovery.

CONCLUSION

Patients are dealing with lasting physical and mental effects from shielding and consequences of delayed healthcare. Health professionals need time and resources to ask about patients' well-being, identify their health needs and refer/signpost to appropriate sources of support.

'The illness isn't the end of the road'-Patient perspectives on the initiation of and early participation in a multi-disease, community-based exercise programme

BACKGROUND

Exercise is the cornerstone of cardiac rehabilitation (CR). Hospital-based CR exercise programmes are a routine part of clinical care and are typically 6-12 weeks in duration. Following completion, physical activity levels of patients decline. Multi-disease, community-based exercise programmes (MCEP) are an efficient model that could play an important role in the long-term maintenance of positive health behaviours in individuals with cardiovascular disease (CVD) following their medically supervised programme.

AIM

To explore patients experiences of the initiation and early participation in a MCEP programme and the dimensions that facilitate and hinder physical activity engagement.

METHODS

Individuals with established CVD who had completed hospital-based CR were referred to a MCEP. The programme consisted of twice weekly group exercise classes supervised by clinical exercise professionals. Those that completed (n = 31) an initial 10 weeks of the programme were invited to attend a focus group to discuss their experience. Focus groups were transcribed and analysed using reflexive thematic analysis.

RESULTS

Twenty-four (63% male, 65.5±6.12yrs) patients attended one of four focus groups. The main themes identified were 'Moving from fear to confidence', 'Drivers of engagement,' and 'Challenges to keeping it (exercise) up'.

CONCLUSION

Participation in a MCEP by individuals with CVD could be viewed as a double-edged sword. Whilst the programme clearly provided an important transition from the clinical to the community setting, there were signs it may breed dependency and not effectively promote independent exercise. Another novel finding was the use of social comparison that provided favourable valuations of performance and increased exercise confidence.

Exploring Aromanticism Through an Online Qualitative Investigation With the Aromantic Community: "Freeing, Alienating, and Utterly Fantastic"

Objective

To explore what aromanticism is, common misconceptions about this identity, and the experiences people have connecting with an aromantic identity.

Methods

An online, international open-ended survey with a convenience sample of aromantic individuals (N = 1642) analyzed with thematic analysis.

Results

To identify as aromantic involves a spectrum of experiences with romance commonly tied to experiencing stigma. Connecting with an aromantic identity allows for a greater understanding of the self and a connection to a community.

Conclusions

Future research is needed to explore the experiences and perspectives of this community to gather better understanding of their needs and how to prevent/limit stigmatizing experiences.

Looping Disruption: A Relational Mechanism Enhancing Treatment Readiness among Individuals Convicted of Sexual Offending?

Many convicted individuals do not enter or complete treatment programs in prisons, which limits effective rehabilitation and prevention of recidivism. Treatment readiness is suggested to be an important construct when addressing this problem. Nevertheless, the underlying processes (e.g., how readiness factors interact) are not well studied, and even less is known regarding readiness in the sub-population of individuals convicted of sexual offenses. This paper aims to open up the "black box" and explore psychosocial and context-specific processes behind treatment readiness from the vantage point of the individuals' lived experiences. In-depth interviews were conducted with 19 adult men convicted of sexual offenses in Swedish prisons, treatment participants (N = 13) as well as non-participants (N = 6). The thematic analysis illustrates readiness obstacles in terms of unintended antagonistic forces in the correctional system operating in the opposite direction of rehabilitative objectives. Nonetheless, a hypothesized relational mechanism, looping disruption, initiated by a non-punitive and supportive response (from prison staff, therapists, close ones, or inmates) to the convicted individual's negative behaviors or emotions, appeared to reverse such negative, punitive loops, contributing to the mobilization of treatment readiness. Implications for theory, policy, and practice are discussed.

A Qualitative Study of Risk and Protective Factors for Resilience in Survivors of Sex Trafficking

This study explored risk and protective factors for resilience in survivors of sex trafficking from the survivors' perspectives. In-depth interviews were conducted with 16 participants recruited from survivor-led advocacy agencies and social service agencies that provide trafficking-specific services. Two overarching themes emerged from data analysis: (a) deep connections to self and others facilitate resilience and (b) detrimental "help" threatens survivors' resilience. Our findings suggest that it may be important for service providers to assist survivors build healthy relationships with themselves and others to promote survivors' resilience. Further, our results highlight the importance of offering more inclusive, survivor-centered, and trauma-informed services.

Narratives of holistic mental health recovery in New Zealand Defence Force personnel

Research on military mental health recovery has tended to focus on therapy outcomes while backgrounding the role of diverse healing influences. The New Zealand Defence Force (NZDF) is a bicultural military integrated with Māori customs and cultural perspectives on holistic health and wellbeing. This study used narrative analysis to examine the semi-structured interviews of 21 active duty NZDF personnel who had accessed mental healthcare to understand what factors contributed to their return to wellness. Narratives described an orientation toward recovery as a process, where many interrelated wellbeing and social factors together supported the return to health. Culturally available Māori wellbeing metaphors were adopted as heuristics by service members in their storying of growth and healing. Findings are considered in terms of how wellbeing and recovery are conceptualized and promoted within militaries with diverse cultures. Discussion focuses on how narratives within military institutions can promote resilience and support service member recovery from mental distress.

Not Just Checklists and Rainbows: Exploring Canadian Dietitians' Beliefs, Values, and Knowledge of Transgender Nutritional Care

Purpose

Many transgender (short form: trans) people are experiencing disparities within Canadian health care systems, including nutritional and dietetic health care systems. This research explores the views, beliefs, and experiences of Canadian dietitians about trans nutritional care and seeks to understand how dietitians can better address the nutritional needs of trans individuals.

Methods

Semistructured online interviews were conducted with 16 Canadian dietitians. Interviews were transcribed and the data were analyzed thematically.

Results

Three main themes were created; (1) There's an Unjust System, (2) We've Come a Long Way, and (3) Not Just Checklists and Rainbows. The participants explored the historic nature of the Canadian dietetic profession and noted the connection between cis-normativity and the erasure of trans identities. They also explored how dietitians could better address the health needs of trans people, including moving beyond the acknowledgement of trans identities to changing the way gender is viewed in the profession.

Conclusion

The dietetic profession must move beyond surface-level activities and rethink gender. Recommendations include adding trans-focused care training into the profession, creating safer spaces for trans individuals, advocacy and allyship, and recruiting trans people to the profession.

Usability of a wearable device for home-based upper limb telerehabilitation in persons with stroke: A mixed-methods study

Background

The use of wearable technology offers a promising home-based self-directed option for upper limb training. Although product usability is a crucial aspect of users' acceptance of a wearable device, usability studies in wearable devices are rare, with most studies focusing primarily on clinical validity.

Objective

This study aimed to explore the usability of a wristwatch device called "Smart reminder" for home-based upper limb telerehabilitation for persons with stroke.

Methods

Eleven stroke participants used the proposed wristwatch for at least two weeks and underwent a home-based telerehabilitation program. A mixed-methods design was used to explore the usability of the wristwatch. Quantitative data were collected through the System Usability Scale (SUS) questionnaire, and the participants' rate of therapy compliance (gathered from the device) was reported descriptively. In addition, qualitative data were collected through semi-structured interviews with the participants and were analyzed using thematic analysis.

Results

The results demonstrated that the usability of the proposed wristwatch and telerehabilitation system was rated highly by the participants, with a high SUS mean score of 84.3 (12.3) and high therapy compliance rate (mean  =  91%). Qualitatively, all participants reported positive experiences with the wristwatch and indicated keenness to use it again. Participants reported physical improvements and felt motivated to exercise after using the wristwatch. They found the device easy and convenient and appreciated the remote monitoring function. Meanwhile, they highlighted critical considerations for the design of the device and program, including technical support, a wearable design of the device, graded exercise content according to ability, and flexibility in exercise schedules. Finally, they suggested that an interim review with the therapist on their progress might help them continue using the wristwatch.

Conclusions

This study's results supported the proposed wearable device's usability and showed strong acceptance by the participants for using it as a home-based upper limb telerehabilitation intervention.

Who carries the baby? How lesbian couples in the Netherlands choose birth motherhood

Objective

The purpose of the study is to contribute to an understanding of the cultural and normative meaning of birth motherhood and how lesbian couples decide who carries the child.

Background

The decision of who carries the child is central in lesbian family-making, carrying consequences for life after birth. Even so, it has been relatively overlooked in research. Drawing from the sociology of personal life and Park's (2013) conceptualization of monomaternalism, we study how informants consider and decide birth motherhood.

Method

Semistructured interviews with both partners in 21 pregnant lesbian couples in the Netherlands were thematically analyzed.

Results

The meaning of birth motherhood was ambivalent, linked to femininity, socially recognized motherhood, and biogenetic imaginaries. In couples where both wanted to carry, age, which carried different symbolic meanings, was a powerful tiebreaker.

Conclusion

Our study shows how the monomaternalist norm shapes conceptualizations of birth motherhood. Desires to experience pregnancy are strong for many. Referring to age can be a way for couples to defuse tension, but it can also be a resource drawn upon to close further negotiations.

Implications

Our study carries implications for policy makers, health care workers, and mothers-to-be. Scholarly, it illuminates the ways in which motherhood, in its various forms, is perceived and recognized.

"A Space Where Queer Is Normalized": The Online World and Fanfictions as Heterotopias for WLW

In the current society, the online and fictional worlds are important spaces for both the identity construction and wellbeing of LGBTQ people. Connecting these spaces are fandoms (and fanfictions), which can operate as places of resistance for marginalized groups. Through the collection of survey data completed by 79 women loving women (WLW), this study therefore asks, in what ways does the online world, particularly in relation to fandoms, open up spaces for WLW. Employing a Foucauldian analysis, findings suggest communities online are crucial for affirmative support, and fanfictions are places where queerness is normalized. As such, through the displacement of time and space, online spaces (and particularly fanfictions) operate as heterotopias that significantly disrupt normative societal discourses. Accordingly, empathetic communities and the normal queer are notably absent from many WLW's physical worlds. However, caution is urged as these results are less clear for women of color.

Sexual Subjectivity in Solo and Partnered Masturbation Experiences Among Emerging Adult Women

This qualitative study aimed to examine the experiences and attitudes toward masturbation among emerging adult women. The study was the first to compare women's solo and partnered masturbation experiences, focusing on how feelings of pleasure, sexual desire, and a sense of empowerment-important markers of women's sexual subjectivity-varied across the two contexts. The sample consisted of 40 women between the ages of 18 and 22 years. The majority of participants identified as Latina (33%) or Black (30%) and were enrolled in community college. Semi-structured interviews about women's masturbation experiences were analyzed using thematic analysis. Women described a multitude of feelings, including pleasure but also awkwardness and guilt. Although women did not describe their masturbation practices as morally wrong, they often alluded to disliking masturbation and preferring it less to partnered sex. Whereas some attitudes and feelings (e.g., awkwardness) arose in the context of both solo and partnered masturbation encounters, others were prevalent only in one (e.g., guilt in the solo encounters). Feelings of pleasure, sexual desire, and empowerment manifested differently in the two contexts. There was more focus on self-knowledge, control, and physical pleasure in the solo encounters and more enjoyment of a partner's desire and intimacy in the partnered encounters. We examine the findings through a feminist lens and consider how race/ethnicity, sexual scripts, and contemporary societal contexts shape women's sexual lives.

The Emotional and Psychological Labor of Insider Qualitative Research Among Systemically Marginalized Groups: Revisiting the Uses of Reflexivity

In response to decades-long exclusionary practices, academic institutions are now recruiting early career researchers (ECRs) from systemically marginalized populations who specialize in equity-related research. As a result, these ECRs are likely to conduct research within their communities on topics that have personal relevance-insider research. Methodological training for insider research places an emphasis on methods, such as reflexivity, to ensure rigor; however, the emotional and psychological impacts of these research methods on the researcher are seldom discussed. Therefore, I use analytic autoethnography to illustrate the embodied impacts of conducting insider research using an example of personal relevance and argue that methodological practices require an embodied reflexivity that centers the researcher and the impacts the research has on them. This paradoxically rewarding and taxing work necessitates changes in methodological training and practice, institutional support, and an openness to innovation when calling for equity, diversity, and inclusion in the academy.

Doubly Marginalized: Addressing the Minority Stressors Experienced by LGBTQ+ Researchers Who Do LGBTQ+ Research

Lesbian, gay, bisexual, transgender, and nonbinary, and queer people (LGBTQ+) experience significantly higher levels of stressors due to discrimination, stigma, and marginalization than do cisgender heterosexual people. These high levels of stressors have impacts on health and well-being as well as career impacts. Limited research suggests that within higher education LGBTQ+ faculty experience bullying, discrimination, and harassment within the workplace. There is also data to suggest that research on marginalized populations is perceived to be less objective and valuable than research on majority populations. Research on the challenges of being a member of a marginalized population who conducts research on the same population suggests potentially negative career and personal impacts. To my knowledge, there has been little to no research on the double marginalization related to being an LGBTQ+ researcher doing research within the LGBTQ+ community. To describe the potential impacts of being an LGBTQ+ researcher who does LGBTQ+ research, I apply the extant literature on marginalized researchers who do research among marginalized populations to LGBTQ+ researchers. I also describe the potential minority stressors that LGBTQ+ researchers may face and how that may impact careers. Finally, I offer multiple recommendations for improvements for our research community and argue that senior faculty, leadership, and mentors can take specific actions to lessen stressors for LGBTQ+ researchers studying LGBTQ-related topics.

Compassionate Discourses: A Qualitative Study Exploring How Compassion Can Transform Healthcare for 2SLGBTQ+ People

Compassion can be seen as a necessary, but often lacking, concept and practice in healthcare. Due to the cis-heteronormative nature of societies, people who identify as Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ+) often experience health disparities and disparities in accessing compassionate healthcare. We aimed to explore the meanings of compassion in healthcare for Canadian 2SLGBTQ+ people. Using a poststructuralist framework, 20 self-identifying 2SLGBTQ+ participants were interviewed. Data was analyzed through discourse analysis. Three main discursive considerations are discussed, including (1) meanings and expectations of compassion in healthcare, (2) compassionate healthcare is not guaranteed, and (3) prescription for care: self-compassion for healing and health. The results provide insights into how compassionate healthcare is framed for 2SLGBTQ+ participants and how compassion is often lacking for them due to discourses of cis-heteronormativity and healthism.

Utilizing Causal Loop Diagramming to Explore a Research and Evaluation Capacity Building Partnership

The capacity to engage in research, evaluation and evidence-informed decision-making supports effective public health policy and practice. Little is known about partnership-based approaches that aim to build capacity across a system or how to evaluate them. This study examines the impacts of a research and evaluation capacity building partnership called the Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (hereafter, SiREN). SiREN aims to strengthen capacity across a system of clinical and medical services and government and non-government organizations. These organizations are connected through their shared aim of preventing and managing sexually transmissible infections and blood-borne viruses. To examine SiREN, systems concepts and methods were used. Data were collected from SiREN organizational documents (n = 42), a survey tool (n = 104), in-depth interviews (n = 17), a workshop and three meetings with SiREN stakeholders and used to develop two causal loop diagrams. Findings show engagement with SiREN was influenced by a complex interplay of contextual (e.g., organizational capacity) and process (e.g., presence of trusting relationships) factors. SiREN contributed to system level changes, including increased resources for research and evaluation, the development of networks and partnerships that led to more efficient responses to emerging health issues, evidence sharing, and sustainable research and evaluation practice. The use of causal loop diagrams enabled the identification of key leverage points that SiREN can use for continuous improvement or evaluation. The focus on how contextual factors influenced SiREN's ability to create change provides valuable information for researchers, policymakers or practitioners seeking to develop a similar partnership.

Educators' experiences and perspectives of child weight discussions with parents in primary school settings

Background

The role of schools in addressing rising childhood obesity levels has been acknowledged, and numerous diet- and physical activity-related interventions exist. Aside from formal interventions, opportunistic parent-educator conversations about child weight can arise, particularly in primary school settings, yet little is known about how useful these are. This study aimed to understand the utility of child weight related conversations with parents through exploring educators’ experiences and perspectives.

Methods

This qualitative study consisted of semi-structured interviews conducted with primary school teaching staff in the United Kingdom (N = 23), recruited through purposive and subsequent snowball sampling. Interviews were audio-recorded, transcribed, and analysed using thematic analysis.

Results

Participants identified opportunities and need for child weight discussions in schools. However, conversations were prevented by the indirect and sensitive nature of conversations, and educators’ professional identity beliefs. Using pre-existing face-to-face opportunities, good parent-teacher relationships and holistic approaches to child health and wellbeing were reported as important in optimising these conversations.

Conclusions

Whilst educator-parent child weight discussions are necessary, discussions are highly challenging, with contradictory views on responsibility sometimes resulting in avoidance. Educators’ roles should be clarified, and communication training tailored to increase teacher confidence and skills. Current social distancing will likely reduce opportunistic encounters, highlighting a need to further improve communication routes.

Critical factors that affect the functioning of a research and evaluation capacity building partnership: A causal loop diagram

Introduction

Public health policy and practice is strengthened by the application of quality evidence to decision making. However, there is limited understanding of how initiatives that support the generation and use of evidence in public health are operationalised. This study examines factors that support the internal functioning of a partnership, the Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN). SiREN aims to build research and evaluation capacity and increase evidence-informed decision making in a public health context.

Methods

This study was informed by systems concepts. It developed a causal loop diagram, a type of qualitative system model that illustrated the factors that influence the internal operation of SiREN. The causal loop diagram was developed through an iterative and participatory process with SiREN staff and management (n = 9) via in-depth semi-structured interviews (n = 4), workshops (n = 2), and meetings (n = 6).

Results

Findings identified critical factors that affected the functioning of SiREN. Central to SiREN’s ability to meet its aims was its capacity to adapt within a dynamic system. Adaptation was facilitated by the flow of knowledge between SiREN and system stakeholders and the expertise of the team. SiREN demonstrated credibility and capability, supporting development of new, and strengthening existing, partnerships. This improved SiREN’s ability to be awarded new funding and enhanced its sustainability and growth. SiREN actively balanced divergent stakeholder interests to increase sustainability.

Conclusion

The collaborative development of the diagram facilitated a shared understanding of SiREN. Adaptability was central to SiREN achieving its aims. Monitoring the ability of public health programs to adapt to the needs of the systems in which they work is important to evaluate effectiveness. The detailed analysis of the structure of SiREN and how this affects its operation provide practical insights for those interested in establishing a similar project.

Moving Dietetics Forward with Queer Pedagogy: A Post-Structural Qualitative Study Exploring the Education and Training Experiences of Canadian Dietitians for LGBTQ Care

BACKGROUND

Lesbian, gay, bisexual, trans, and other sexually and gender diverse (LGBTQ) people often experience health disparities and disparities in accessing safe health care. Yet dietetic curriculum and training opportunities for LGBTQ care is limited.

OBJECTIVE

The objective of this research was to explore the perspectives and professional training experiences within LGBTQ-focused topics of Canadian dietitians in order to inform future curriculum and pedagogy.

DESIGN

This research is framed within poststructuralist philosophies. Semi-structured qualitative interviews were conducted.

PARTICIPANTS/SETTING

To be eligible, participants needed to be dietitians within Canada who had an interest in discussing gender and sexual diversity within the profession. Although the research call was open to all Canadian dietitians who wanted to discuss gender and sexual diversity within the profession, only dietitians who self-identified as allies to LGBTQ groups ended up participating in this project. Of the sixteen dietitians who participated, eleven participants self-identified as members of LGBTQ groups and five self-identified as straight. All participants took part in online interviews done in private locations of their choosing from September 2020 to January 2021.

ANALYSIS

A systematic thematic analysis was conducted.

RESULTS

Three themes, including 1) Understanding the ethics of dietetic education, 2) Recognizing the cis- and hetero-normativity of dietetic education, and 3) Moving forward with queer pedagogy, were noted from the data.

CONCLUSIONS

Participants explored the lack of LGBTQ focus and content during their professional training and believed such gaps were problematic to the caring philosophies of dietetics. Participants offered insights into how dietetic educators can disrupt ingrained cis- hetero-normativity and rigid binary gender norms within dietetics education and curriculum.

Experiences of staff working in a mental health trust during the COVID-19 pandemic and appraisal of staff support services

Purpose

The health and well-being of healthcare staff came into focus during the coronavirus disease-2019 (COVID-19) pandemic as already strained workforces responded to new and additional challenges. Organisational support services made efforts to adapt staff support provision. However, most literature and recommendations are centred on surveys of medical and clinical staff. The present study included staff across clinical and non-clinical workforces within a mental health trust over the course of the COVID-19 pandemic to date, and aimed to understand workforces' access to and experiences of organisational support.

Design/methodology/approach

The current study was a qualitative one using convenience and purposive sampling. Semi-structured individual and group interviews were conducted using a topic guide. Reflexive thematic analysis was used in a phenomenological framework to analyse data.

Findings

35 staff, broadly representative of the trust workforce, were recruited. Six global themes summarised the experiences of staff in relation to work practices, personal well-being and support access over the first year of the COVID-19 pandemic: COVID-19 disease, interpersonal relationships, individual considerations, change, working environment and support.

Practical implications

The findings from the study have implications for organisational support provisions for healthcare workers and the dissemination of these services.

Originality/value

Acknowledging the multi-various experiences of different workforces within National Healthcare Service organisations and how these change over time will facilitate innovative changes to staff support provision.

Prejudice in ‘inclusive’ spaces: Cisgenderist collusion in the interview context

Feminist reflexivity aims to (re)consider and challenge power differentials that exist in the research process. This activity is well represented in, for example, research into heterosexism. In this article we expand feminist reflexive practice in relation to cisgenderism through a (re)examination of interview transcripts conducted by a cisgender researcher on the topic of cisgenderism in media representations of trans and intersex sportspeople. Drawing on interviews with 18 cisgender and trans and non-binary participants, we analyse three forms of researcher collusion in cisgenderism, namely: 1) perpetuating cisgenderism in the selection of media materials; 2) assuming trans women are the referent; and 3) disunifying assumptions about trans sportspeople. This reflexive analysis is discussed with regard to how analytical insights can be generated into the operation and functioning of prejudice. In so doing, we further the conception of prejudice as a ubiquitous and latent activity in research practices.

To see, meet and adapt - an interview study about physiotherapists' pedagogical approach to dementia

Background

Physiotherapists need to use pedagogical approaches and strategies in their work. However, there is no previous definition of what a pedagogical approach in physiotherapy means neither in general nor specifically to dementia. The purpose of this study was therefore to gain greater insight into physiotherapists’ pedagogical approach to dementia by investigating physiotherapists’ views and working methods in contact with older people with dementia, relatives, and nursing staff in elderly care.

Methods

This was a qualitative study with an inductive approach. Semi-structured individual interviews were conducted with 15 physiotherapists with experience of working with older people with dementia in elderly care. The interviews were analyzed with qualitative content analysis.

Results

The term “pedagogical approach” could sometimes be experienced as “vague” or “hard to grasp”. Our research nonetheless identified one overarching theme To see, meet and adapt which is based on insights from the interviews grouped in to five categories. This theme can be seen as an expression of the physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff. It captures the participants’ desire to always see the person in front of them, meet them where they are and adapt their own way of working accordingly. Creating a trusting relationship was described as important and made it easier for the participants to adapt their working methods. The participants’ adaptations could apply to the way they communicated with people with dementia, and how they organized tutoring/education of relatives and nursing staff to maximize learning. Learning through experience and reflection was described as a key to advancing the pedagogical approach and the participants experienced their own learning as constantly ongoing.

Conclusions

This study provides increased understanding into physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff in elderly care and shows that learning through experience and reflection can contribute to the development of the pedagogical approach. Thus, opportunity for reflection should be accommodated in the physiotherapists’ work. The importance of more pedagogical education for physiotherapists both in bachelor and master level were also highlighted. Increasing mobility and physical activity in older people with dementia is important since physical inactivity and sedentary behavior is common. Future research may be directed at further exploring physiotherapists’ pedagogical approach in tutoring/education of nursing staff, with the aim of increasing physical activity among older people with dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02697-7.

Critical Reflection and Cognitive Empowerment among Youth Involved in Community Organizing

Through youth organizing initiatives, young people conduct research into social issues and build power to address these issues. This study examines the developmental interplay between the cognitive components of two of the most influential civic developmental constructs—critical consciousness and psychological empowerment—through analysis of interviews with 19 current and former participants in a youth organizing initiative in San Bernardino, CA, all of whom identify as Latinx. Most participants clearly articulated viewpoints consonant with the cognitive components of critical consciousness and psychological empowerment, but these were much more pronounced among those who had been involved for longer periods of time. Findings provide insights into distinctions and crosscurrents between critical reflection and cognitive empowerment, and into the settings and processes leading to their development. Cycles of action and reflection can support the simultaneous development of critical reflection and cognitive empowerment.

Champions of Social Procurement in the Australian Construction Industry: Evolving Roles and Motivations

There has been a recent proliferation of social procurement policies in Australia that target the construction industry. This is mirrored in many other countries, and the nascent research in this area shows that these policies are being implemented by an emerging group of largely undefined professionals who are often forced to create their own roles in institutional vacuums with little organisational legitimacy and support. By mobilising theories of how organisational champions diffuse innovations in other fields of practice, this paper contributes new insights into the evolving nature of these newly emerging roles and the motivations which drive these professionals to overcome the institutional inertia they invariably face. The results of semi-structured interviews, with fifteen social procurement champions working in the Australian construction industry, indicate that social procurement champions come from a wide range of professional backgrounds and bring diverse social capital to their roles. Linked by a shared sense of social consciousness, these champions challenge traditional institutional norms, practices, supply chain relationships, and traditional narratives about the concepts of value in construction. We conclude that, until normative standards develop around social procurement in the construction industry, its successful implementation will depend on external institutional pressures and the practical demonstration of what is possible in practice within the performative constraints of traditional project objectives.

Fertility health information seeking among sexual minority women

OBJECTIVE

To qualitatively explore and describe fertility information-seeking experiences of sexual minority women (SMW) couples using assisted reproduction.

DESIGN

Qualitative thematic analysis of 30 semistructured, in-depth individual and dyadic interviews with SMW couples.

SETTING

Video conferencing.

PATIENT(S)

Twenty self-identified lesbian, bisexual, and queer women comprising 10 same-sex cisfemale couples (10 gestational and 10 nongestational partners) using assisted reproduction technology in the United States.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

We describe how SMW came to learn about ways to achieve pregnancy through information seeking, acquisition, appraisal, and use.

RESULT(S)

Analysis revealed three primary themes. First, uncertainty and information scarcity: SMW have basic knowledge about how to conceive but uncertainty persists due to information scarcity regarding how same-sex couples navigate assisted reproduction. Second, women attempt to collect fragmented information from disparate sources. The participants discussed a mixture of formal and informal, online, textual (books), and in-person seeking, finding, and synthesizing information that ranged from reliable to unreliable and from accurate to inaccurate. Finally, persistent heteronormative communication focused on the needs and conditions of male-female couples who experienced subfertility or infertility, rather than barriers related to social constraints and the absence of gametes that SMW sought to overcome.

CONCLUSION(S)

These findings support and extend existing evidence that has focused primarily on online fertility information seeking. Our findings suggest that shifts in fundamental assumptions about who seeks assisted reproductive support and why, together with improvements in fertility-related health communication, may result in more inclusive care for this population.

Preventing Youth Homelessness through Social Procurement in Construction: A Capability Empowerment Approach

Homelessness is a serious and growing problem in the UK, exacerbated by the COVID-19 crisis. The latest figures estimate that 160,000 households are at risk of the worst forms of homelessness. Employment is widely recognised as being critical to reducing homelessness, yet there has been no research into the role that the construction industry, as a major UK employer, can play in reducing this problem. The aim of this paper is to address this gap in knowledge and contribute to the emerging social procurement debate in construction by exploring the role that construction employment can play in reducing the risk of homelessness. Mobilising Sen’s and Nussbaum’s capabilities empowerment approach, an in-depth case study is presented of a construction employment program in Wales, UK, which was aimed at supporting young people who had experienced or who were at risk of homelessness. Contributing to the emerging social value and social procurement debate in construction and drawing on documentary analysis and interviews with young people who were homeless or at risk of homelessness who went through the program, findings indicate that these young people became empowered in ways which reduced their risk of homelessness. It is concluded that the capabilities empowerment framework is valuable in explaining how employment in the construction industry can reduce the risks of homelessness for disadvantaged youth with a care-experienced background or who were known to the criminal justice system.

Are university health services meeting the needs of transgender college students? A qualitative assessment of a public university

OBJECTIVE

This exploratory study sought to assess transgender college students' experiences accessing primary, gynecological, and/or mental health care through university health services (UHS).

PARTICIPANTS AND METHODS

Individual interviews were conducted with eleven transgender undergraduate students attending a large public university in the United States in Spring 2017.

RESULTS

The structure, organization, and practices of UHS are not adequately meeting transgender college students' health care needs. Students reported being repeatedly misgendered and addressed by the incorrect name by staff at UHS. Some providers asked inappropriate and irrelevant questions about their gender identity during clinical encounters. These and related experiences deterred many participants from returning to UHS for health care services.

CONCLUSION

UHS could improve health care delivery to transgender college students by adopting standardized and inclusive practices consistent with those recommended by The Fenway Institute.

Intuitive eating as a counter-cultural process towards self-actualisation: An interpretative phenomenological analysis of experiences of learning to eat intuitively

This research presents an in-depth idiographic study that illustrates how learning to eat intuitively involves socio-cultural challenges, strategies of resistance and self-actualising processes. Interviews were conducted with eight women who had been practising intuitive eating (IE) for at least 1.5 years. Data was analysed using IPA and four themes were drawn inductively from the data: IE as an ongoing process, perceived judgement of others, strategies of resistance and processes of self-actualisation. Further research is needed to explore experiences of learning to eat intuitively amongst different samples and with different cultures, and to further investigate the relationship between IE and the actualising tendency.

'I just don't think it's that natural': adolescent mothers' constructions of breastfeeding as deviant

Breastfeeding is recognised globally as the optimal method of infant feeding. For Murphy (1999) its nutritional superiority positions breastfeeding as a moral imperative where mothers who formula-feed are open to charges of maternal deviance and must account for their behaviour. We suggest that this moral superiority of breastfeeding is tenuous for mothers from marginalised contexts and competes with discourses which locate breastfeeding, rather than formula feeding, as maternal deviance. We draw on focus group and interview data from 27 adolescent mothers from socio-economically deprived neighbourhoods in three areas of the UK, and five early years professionals working at a Children's Centre in the Northeast of England. We argue that breastfeeding is constructed as deviance at three 'levels' as (i) a deviation from broad social norms about women's bodies, (ii) a deviation from local mothering behaviours and (iii) a transgression within micro-level interpersonal and familial relationships. Given this positioning of breastfeeding as deviant, breastfeeding mothers feel obliged to account for their deviance. In making this argument, we extend and rework Murphy's (1999) framework to encompass diverse experiences of infant feeding. We conclude with reflections on future research directions and potential implications for practice.

Modes of Informed Caring: Perspectives of Health Professionals Who Are Mothers of Adult Children with Schizophrenia

Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource.

Implementation of human resource management functions in selected small manufacturing companies in Ga-Rankuwa industrial area, Gauteng, South Africa

Orientation: Human resource management (HRM) is a fundamental element in the success of any organisation. Research on HRM functions in medium and large organisations has been given much attention. However, few research studies have been conducted in assessing the importance and implementation of HRM functions in small companies.Research purpose: The objective of this study was to investigate the implementation of HRM functions and its perceived importance in small manufacturing companies (SMC), as well as the limitations or barriers to effective HRM implementation in SMCs.The motivation for the study: Human resource management functions play a strategic role in any organisation. Literature studies indicate that relatively little is known about HRM functions in small businesses. This research aimed to contribute to the knowledge of HRM and enhance the understanding and importance of the HRM functions in SMCs.Research approach/design and method: A qualitative research design was followed. A convenience sampling technique was used with eight participants. Data were collected by means of semi-structured interviews.Main findings: The HRM functions of recruitment and orientation, general labour relations, human resource information systems (HRIS), performance management, training and development, and remuneration and benefit were informally implemented and acknowledged as crucial in SMCs. The study further found that a limited budget, lack of resources and capacity, inadequate systems, ineffective employment relationships, lack of knowledge and understanding of HRM functions and business instability negatively affect SMCs to implement all HRM functions within the business and therefore negatively influence the performance of the company.Practical/managerial implications: All managers/owners and employees are aware of all the HRM functions that could enhance the performance and success of their organisation.Contribution/value-add: The study findings will assist SMCs to implement and understand the importance of HRM functions as well as the barriers to effective implementation of HRM functions.

“Never Say Never?” Heterosexual, Bisexual, and Lesbian Women’s Accounts of Being Childfree

Feminist scholars have identified a “motherhood imperative” in Western cultures, when heterosexual women are understood to both want and to have children. However, social shifts have resulted in a decrease in pronatalism as well as an increase in social recognition of the parenting desires of same-sex parents. Despite a resurgence of interest in childfree identities, research to date has predominantly focused on heterosexual women’s explanations for being childfree and their experiences of marginalization. Our aim in the current study was to explore how childfree heterosexual, lesbian, bisexual, and queer women negotiate their childfree lives and identities in the context of their personal and social relationships within changing cultural contexts. Data from 23 interviews with women in the United Kingdom, who responded to a call for childfree participants, were thematically analyzed. We constructed two themes: (1) Never say never? Negotiating being childfree as ever precarious, which shows how women constructed being childfree as requiring constant revisiting and renegotiating to maintain and (2) An ordinary life: Constructing being childfree as rational and reasonable, in which we identify the rhetorical efforts of participants to establish their being childfree as an ordinary, reasonable, and rational position. We conclude that for these women, childfreedom was constantly in flux and that maintaining a positive childfree identity required considerable identity work in order to manage intimate personal relationships and wider friendships. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index

Potential challenges of using narrative inquiry with at-risk young people

BACKGROUND

Being 'at risk' puts an individual in danger of future negative outcomes. Conducting qualitative research such as narrative inquiry with at-risk individuals may result in challenges for participants and researchers.

AIM

To present an overview of several challenges that arose when conducting narrative research with at-risk young people.

DISCUSSION

The main challenges were disclosure of trauma, existing relationships, insider and outsider perspectives, power relationships, and the emotional safety of participants and researchers.

CONCLUSIONS

It is imperative to identify potential challenges before beginning research and make plans to address them.

IMPLICATION FOR PRACTICE

Researchers can use this article to help plan for challenges that may arise with this kind of research with vulnerable participants.

The adoption of Web 2.0 technologies in academic libraries: A comparative exploration

This paper addresses the adoption and non-adoption of communication methods such as social media and explores the implementation of Web 2.0 technologies and their use in academic libraries. I interviewed 16 library employees from six academic university libraries in the Flanders region of Belgium and in South Africa. I explored five academic university libraries in the urban regions of Flanders and South Africa and one situated in a rural region of South Africa. This article discusses the benefits of using social media as a communication tool to engage with students. The results demonstrate that ‘ease of use’ was portrayed as a beneficial construct and has a positive influence on behavioural intention and use of Web 2.0 technologies. A comparison on the adoption of social media between the two countries indicate that financial resources, infrastructure and management support are crucial determining factors in service delivery.

Using hermeneutic phenomenology and the ethnographic principle of cultural interpretation with Malaysian nurses

BACKGROUND

The interpretive paradigm and hermeneutic phenomenological design are the most popular methods used in international cross-cultural research in healthcare, nurse education and nursing practice. Their inherent appeal is that they help researchers to explore experiences. The ethnographic principle of cultural interpretation can also be used to provide meaning, clarity and insight.

AIM

To examine the use of hermeneutic phenomenology and the ethnographic principle of cultural interpretation in a research study conducted with Malaysian nurses on part-time, transnational, post-registration, top-up nursing degree programmes provided by one Australian and two UK universities.

DISCUSSION

To enable the researcher to undertake international cross-cultural research and illuminate Malaysian nurses' views for the reader, cultural aspects need to be considered, as they will influence the information participants provide. Useful strategies that western researchers can adopt to co-create research texts with interviewees are outlined. The paradigm and research designs used in the study revealed the views and experiences of Malaysian nurses.

CONCLUSION

Hermeneutic phenomenology enabled the exploration of participants' experiences, and the ethnographic principle of cultural interpretation enabled the researcher's reflexivity to provide emic and etic views for the reader.

IMPLICATIONS FOR PRACTICE

This paper adds to the discussion of the paradigms and research designs used for international, cross-cultural research in Asia. It identifies the influence participants' cultural values have on their confidence and level of disclosure with western researchers.

Amidst fury, regret, and remorse: An analysis of university students who were placed in disliked majors

This study is an attempt to uncover the factors leading students to study in the majors they dislike. Using a qualitative design, the study aims to explore the forces that cause students to make career choices against their will, and to investigate their future plans during their struggles with their parents and disliked majors. The study was conducted with 13 first-year university students who studied different majors within a school of education. Since the foci of the study were students who disliked their majors and were placed in teaching departments against their will, a purposive sampling technique was used during the selection of participants, and data were analyzed through the content analysis technique. The study revealed that the students had been placed into disliked majors under the simultaneous influence of either one or several forces, such as parental pressure to keep their children geographically close, perceived employment opportunities, life-time job security given to teachers at public schools, fatigue, and failure to get a high scores to be placed in their preferred choice. The study presents suggestions for educational policy-makers by discussing determinants of teaching career choices, by making specific references to parental influences on their children’s decision-making, and by showing that some teacher candidates are placed in teaching majors by making random choices.

The role of alcohol in identity construction among LGBT people: a qualitative study

Research suggests that alcohol use and misuse are higher among lesbian, gay and bisexual than heterosexual populations, yet the social context of drinking in sexual minority communities has rarely been examined. To explore lesbian, gay, bisexual and transgender (LGBT) people's relationship with alcohol, we conducted seven focus groups (N = 33) with pre-existing groups of friends and work colleagues (18 to 52 years) in Scotland, UK. We identified and analysed patterns in our data using thematic analysis. Respondents perceived heavy drinking as central to the commercial gay scene. Choice of drink and drinking vessel was an important part of identity construction. Respondents discussed the perception that gay men would drink alcopops and cocktails while lesbians would drink pints of beer. Even when stereotypes were dismissed as inaccurate, they were still thought to pressure people to drink 'appropriately'. Respondents who did not identify as male or female, and those who used drag, were particularly aware of their choice of drink as a means to express identity or to challenge people's preconceptions about gender. Researchers developing interventions to reduce alcohol-related harm in sexual minority populations need to take account of the central role of identity construction in LGBT drinking practices.