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Self-efficacy (or the belief in one’s ability to effect change) often moderates the relationship between education, interest, and actions in evaluations of training programs that prepare community-based investigators in the clinical and translational sciences workforce. Such evaluations, however, tend to emphasize individual-level attitudes when there are also community- or organizational-level outcomes impacted. Methods: This study uses a novel sequential, explanatory mixed-methods design to explore multiple levels of self-efficacy (or self-awareness of personal growth in leadership) in the Clinical Scholars program, an equity-centered leadership development program for mid- to later-career healthcare professionals. Our design involves: (1) bivariate correlations and confirmatory factor analysis of self-assessed competencies across all program participants to identify emergent combinations of competencies, which informed (2) more nuanced thematic coding of participants’ stories of most significant change in their personal and professional lives, as a result of the program. Results: In unpacking their accounts of personal leadership styles (that aligned with our quantitative analyses of competencies), we found that participants demonstrated multiple competencies simultaneously. Specifically, they employed emotionally intelligent learning and consensus-building dialogue to manage conflict for interpersonal impact. Additionally, they used this combination of skills to unite diverse stakeholders under a shared vision in order to lead and manage organizational change where all colleagues’ contributions were valued. Conclusion: Together, these methods extend our understanding of personal growth in leadership as an outcome of the program in terms of individual- and organizational-level impacts, using representative quantitative self-assessments to categorize rich qualitative descriptions.
Persons with mental illnesses may experience stigma from their immediate family members in addition to other forms of stigma. Using semi-structured interviews, we investigated experiences of familial mental illness stigma among 15 people diagnosed with mental illnesses in a mid-sized city in Canada. We identified five themes that speak to participants’ experiences of familial mental illness stigma and ways to reduce it. The themes include the following: diagnosis as a ‘double-edged sword,’ potential familial isolation, familial stigma as societal stigma localized, stories of acceptance, and confronting potential familial mental illness stigma. Participants’ narratives indicate that familial mental illness stigma is rooted in the broader social or public stigma, which sees its way into familial relations as well. This stigma takes various forms, including relationship bias or unfair treatment, breakdown in romantic relationships, loss of status, verbal and emotional abuse, exclusion from decision-making, and alienation within their immediate and extended families. Familial mental illness stigma experiences negatively impact participant’s psychological well-being and personal empowerment. However, participants also shared ways that family members create supportive environments or actively confront or prevent stigma. Overall, this study has contributed to knowledge on mental illness stigma, particularly familial mental illness stigma from the perspective of participants living with a mental illness in a high-income country. Suggestions for future research include a focus on strategies to prevent ongoing familial mental illness stigma and large-scale studies to explore familial mental illness stigma to understand why families might perpetrate stigma.
This article explores Indigenous perspectives on archaeology in Canada and the United States and the role of archaeologists in engaging with Indigenous communities. As part of our study, we interviewed Indigenous community members about their experiences in archaeology and their thoughts on the discipline. We analyzed each interview thematically to identify patterns of meaning across the dataset and to develop common themes in the interview transcripts. Based on the results of our analysis, we identified six themes in the data: (1) Euro-colonialism damaged and interrupted Indigenous history, and archaeology offers Indigenous community members an opportunity to reconnect with their past; (2) archaeological practices restrict access of Indigenous community members to archaeological information and archaeological materials; (3) cultural resource management (CRM) is outpacing the capacity of Indigenous communities to engage meaningfully with archaeologists; (4) the codification of archaeology through standards, guidelines, and technical report writing limits the goals of the discipline; (5) archaeological methods are inconsistent and based on individual, or company-wide, funding and decision-making; and (6) archaeological software offers a new opportunity for Indigenous communities and archaeologists to collaborate on projects.
Pulses are a healthy, sustainable, low cost food, but consumption levels are low for a variety of reasons, including practical and cooking concerns. This work aimed to explore barriers and facilitators towards pulse consumption and increasing consumption, and the potential value of cooking suggestions and recipes for changing these perceptions. Two qualitative studies were undertaken. In Study 1, 21 participants (10 males, 11 females, of a range of ages, cooking responsibilities, and experiences with pulses) were interviewed both before and after receiving cooking suggestions and recipes. In Study 2, 12 participants (2 males, 10 females, as above) were interviewed once after trying recipes. Interviews were audio-recorded, transcribed, and analysed using thematic analysis. Seven themes described barriers and facilitators towards pulse consumption: ‘Enjoyment and Sensory properties’; ‘Benefits and Recommendations’; ‘Practical Concerns’; ‘Cooking Concerns’; ‘Compatibility with current diet’; ‘Personal Influences’; and ‘External Influences’. Some similar themes also referred to increasing consumption: ‘Willingness’; ‘Awareness, Knowledge of Benefits’; ‘Knowledge of Cooking and Practical Concerns’; and ‘Compatibility with current diet’. Cooking suggestions and recipe use resulted in themes on ‘Awareness’; ‘Willingness, Trying New Things’; ‘Small Changes’; and facilitators associated with ‘Enjoyment, Sensory Properties, Practical Concerns, Benefits’ and ‘Knowledge, Cooking Ideas and Confidence, Incorporation, Cooking Solutions’. Barriers related to ‘Risk and Preconceptions’; ‘Awareness, but’ inaction and additional considerations were also found. Our findings demonstrate a positive role for pulse consumption for increased experience, familiarity, and confidence with preparing, cooking, and consuming these healthy and sustainable foods.
Advancements in medicine and science have enabled more and more people to live longer with a chronic medical condition, namely cancer. Nevertheless, the palliative care (PC) approach continues to be introduced and incorporated later in the lives of patients and families dealing with such conditions. Thus, the need for individuals to care for this population in our society is increasing, giving rise to the so-called “informal caregivers.” The present study intends to examine the main obstacles faced by informal caregivers taking care of a cancer patient receiving PC based on what health professionals working in these settings perceive and write down. To achieve this goal, the written files of 2 Portuguese palliative care institutions were analyzed.
Methods
An inductive thematic analysis was conducted, focusing on the contact between health professionals and family caregivers and based on the notes taken by health professionals.
Results
Three main overarching themes were identified: (1) burden, (2) intra-family impact of the illness, and (3) network vulnerabilities. Included in this are the emphasis on the role of the family and social support, the high levels of psychological morbidity and caregiver burden present over this period, and a great need for information about the illness.
Significance of results
This study provided a broader awareness regarding the daily struggle experienced by family caregivers, particularly those who juggle between “roles.” It is vital to understand the scope of the obstacles experienced by caregivers during the terminal phase of their loved one’s illness, given how important it is to address the family’s needs. Future studies and practitioners should consider these observations and topics when considering new approaches for this population, as they ought to be quite focused and short in time in order to meet people’s needs.
The present study aimed to identify the factors that prohibit or enable breast cancer survivors from adopting a healthy lifestyle, as well as to record patients’ suggestions towards developing a weight-loss lifestyle intervention. Twenty-three breast cancer survivors participated in four online, semi-structured focus groups in Greece. All discussions were video-recorded and transcribed verbatim. Participants were 50⋅5 ± 7⋅4 years old with a current mean BMI of 29⋅1 ± 3⋅4 kg/m2. Four main themes emerged from thematic analysis: (1) dietary and lifestyle practices, (2) the effects of cancer on body weight, (3) the impact of cancer on psychology, and (4) the effect of the environment on body weight. Lack of information from healthcare professionals and lack of time were the main barriers to body weight management, whereas the main facilitators were support from their social environment, along with a comfortable physical environment, and the facility of technology. Participants suggested that an effective weight-loss lifestyle intervention should include psychological and social support, guidance and education, collaboration, flexible recommendations, personalised goals, and a follow-up plan. The needs of breast cancer survivors need to be considered when designing weight-loss lifestyle interventions. A personalised approach may prove more effective in promoting a healthy lifestyle and improving patients’ care.
Older adults who age at home independently are often celebrated as having anticipated and planned for their care needs in the later stages of life, whereas those who receive assistance from home support services are often stigmatised as dependent and characterised as a ‘drain on the system’. However, this thematic analysis of interview data from 12 home care clients in two Canadian provinces offers evidence that counters the assumption that home care clients are passive recipients of care. Extending Corbin and Strauss' theorisation of how individuals manage chronic conditions alongside Dorothy Smiths' conception of work, we explore how home care clients ‘work’ to receive care as they age in place. Specifically, home care clients not only engage in daily life work, illness work and biographical work, but also advocate for themselves and their workers, co-ordinate and negotiate with members of their caring convoys and networks, and adapt in various ways to navigate personal, relational, structural and policy-level challenges. We suggest that work done by older adults who are ageing in place be addressed, acknowledged and incorporated into care planning and operational policy development to challenge both the stigma of dependency and neoliberal narratives of self-sufficiency.
Previous research has revealed that stigma is not restricted to people with mental health problems but extends to the professionals involved in their care and treatment. Unlike other artistic manifestations, the study of the depictions of psychiatry in popular music is still a less-explored topic. This article addresses the subcultural portrayals of the psychiatrist and psychiatric treatments within Spanish popular music. The predominance of negative depictions of mental health professionals as social control agents was a striking finding, given the topicality that characterises punk music. It is suggested that the allegorical role assigned to the psychiatrist in such a specific narrative framework, marked by ideological factors, could potentially explain these findings. In contrast to other cultural manifestations that show a tendency towards more balanced views of psychiatric treatment and practice, the negative representations in Spanish punk songs seem to have evolved little over decades, reflecting outdated views of the psychiatric approach.
In this chapter, we will discuss the “big four” approaches to qualitative analysis – qualitative content analysis, thematic analysis, grounded theory, and discourse analysis – before briefly describing four additional commonly used approaches. Some of these approaches are empirical, either theory-driven or inductive, identifying observable concepts in the data. In others, research is from a social constructionist perspective, incorporating the researcher’s interpretation as an essential part of the analysis. Some methods, such as thematic analysis, can be used for either approach. This epistemological range means that, as with quantitative analyses, it is essential to select the appropriate method for analyzing the data, and the rigorous procedures involved in qualitative methodology must be followed meticulously.
There is wide variation in the problems prioritised by people with psychosis in cognitive behavioural therapy for psychosis (CBTp). While research trials and mental health services have often prioritised reduction in psychiatric symptoms, service users may prioritise issues not directly related to psychosis. This discrepancy suggests potential challenges in treatment outcome research.
Aims:
The present study aimed to examine the types of problems that were recorded on problem lists generated in CBTp trials.
Method:
Problem and goals lists for 110 participants were extracted from CBTp therapy notes. Subsequently, problems were coded into 23 distinct categories by pooling together items that appeared thematically related.
Results:
More than half of participants (59.62%) listed a non-psychosis-related priority problem, and 22.12% did not list any psychosis related problems. Chi-square tests indicated there was no difference between participants from early intervention (EI) and other services in terms of priority problem (χ2 = 0.06, p = .804), but that those from EI were more likely to include any psychosis-related problems in their lists (χ2 = 6.66, p = .010).
Conclusions:
The findings of this study suggest that psychiatric symptom reduction is not the primary goal of CBTp for most service users, particularly those who are not under the care of EI services. The implications for future research and clinical practice are discussed.
The present study sought to investigate the experience of individuals living with their partner with an acquired brain injury (ABI) during the first lock down period of the COVID-19 pandemic.
Method:
Semi-structured interviews were conducted with seven partners of individuals who had sustained a range of ABIs. Interviews were transcribed verbatim and thematic analysis was carried out by two of the researchers exploring the unique narratives.
Results:
ABI occurs within a relational framework, which means that it has repercussions not only for the individual but also the entire family system. COVID-19 prevented family systems (living separately) from coming together which negatively impacted them; however, it also slowed life down, with many people working from home with flexible arrangements in place which participants found to be beneficial. Three main themes emerged from the interview data: partner focus, slowing down and support networks. The narratives identified the struggles of having to continue their partner’s rehabilitation when face to face services could not visit the home, the importance of establishing routine, the positives of a slower paced life (due to COVID-19) that enabled them to build stronger relationships with their partners, and the difficulties of being separated from family and loved ones.
Conclusion:
This research suggests that it is imperative to consider individual experiences and choices. Some families benefited from reduced treatment and a slowed pace of life, whilst others may find this overwhelming and burdensome. The study makes recommendations for supporting couples after an ABI during the ongoing pandemic.
While there is a growing body of literature on the wish to die in older patients, there is little research about their will to live. Exploring the subjective will to live (WTL) offers valuable insights into the patients’ resources and motivations, which could help improving geriatric palliative care. The aim of this study was to examine, in long-term care facilities (LTCF), residents’ definitions of and factors influencing their WTL.
Methods
Twenty residents (mean age 85.8 ± 10.3 years, 70% women) of 3 Swiss LTCFs gave informed consent and participated in semi-structured interviews about their WTL. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted to identify recurrent themes (40% double coded).
Results
The majority of residents reported that they had not thought about the WTL. Nevertheless, they had no difficulty in describing it as innate in their lives. They spontaneously mentioned factors that contributed to their WTL, classified into 5 themes: (1) relationships – primarily with family and health professionals, secondarily with other residents; (2) living situation – the LTCF as a necessary place providing care, constant professional presence, and security, yet necessitates inconveniences such as loss of independence; (3) personality factors – positive outlook on life or spirituality; (4) engagement in routines – organized activities and individual daily routines; and (5) health status – primarily related to functional health.
Significance of results
Examining WTL provides important insights into elements that are essential to take into account in planning care and promoting well-being in LTCF residents. The themes identified provide important starting points for improving life in LTCFs.
The Schwartz theory of personal values has been used extensively, and almost exclusively quantitatively, by researchers to increase understanding of the impact of values on human behaviour. While it provides a well-tested methodology and common language, the approach has been limited by its reliance on survey work, in which the researcher asks participants questions of interest, and then correlates these with respondents’ self-reporting of their values. There is limited qualitative work that has drawn on the insights of the Schwartz theory. The main exception is based on a lexicon of values words derived from Schwartz’s work which has been used to identify dominant societal values across time. We are proposing that the Schwartz theory can also be used to analyse values appeals in persuasive speech. Using thematic analysis of an example of political persuasion, we illustrate how Schwartz’s values work can be further adapted for qualitative research.
This paper presents the process considerations contained within the first ever framework for implementing Product Lifecycle Management (PLM) within high-value Engineering-to-Order (ETO) programmes. The scientific contribution of the research is the identification of the process-oriented factors that are instrumental in the successful implementation of PLM within an ETO context. The framework has been developed using a qualitative methodology based on the thematic analysis of 27 semi-structured interviews. The participants were senior personnel from 11 ETO organisations in the United Kingdom, France, Australia, the United States and Canada. The thematic analysis resulted in framework themes described in relation to the process objectives, challenges or enablers, and the contributing elements of the themes were then synthesised to illustrate their interconnectedness in supporting PLM implementation. Validation of the framework using 19 participants selected from seven ETO organisations resulted in 95% agreement with statements that assessed the quality, structure and versatility of the framework. This research contributed to the updated BAE Systems Maritime Naval Ships PLM strategy for the design, build and in-service support for the First of Class new generation Royal Navy vessel for a recent shipbuilding programme.
In Japan, care-giving sons are noted for their high rates of abuse of care recipients. This study revealed, for the first time, the difficulties unique to sons caring for their mothers. All sons used long-term care insurance services. However, they provided care that could not be covered by such public services while harbouring psychological distress. In this study, we interviewed 13 sons living with their older mothers as the primary carer and conducted a thematic analysis focusing on their psychological distress. As part of our study findings, we have identified nine themes during analysis: uncomfortable feelings that cannot be mitigated as a son; feeling of futility in being unrecognised as a carer; fear of losing something important; a strong sense of responsibility for one's mother's life; disappointment in being unable to obtain understanding and co-operation from one's siblings in providing care; irritation and anger towards one's wayward mother; guilt about treatment of one's mother; sense of exhaustion due to demanding care; and experiencing hopelessness and despair. Thus, it is important to understand what psychological distress carers experience and to consider possible approaches for their support. The study findings provide suggestions for long-term care support in regions, such as East Asia, where the numbers of son carers are increasing inevitably owing to declining birth rates and ageing population, as in Japan.
Despite the potential benefits of open communication about possible desires to die for patients receiving palliative care, health professionals tend to avoid such conversations and often interpret desires to die as requests for medical aid in dying. After implementing trainings to foster an open, proactive approach toward desire to die, we requested trained health professionals to lead and document desire to die-conversations with their patients. In this article, we explore how trained health professionals experience an open (proactive) approach to desire to die-conversations with their patients.
Methods
Between April 2018 and March 2020, health professionals recorded their conversation-experiences on documentation sheets by answering seven open questions. A subsample was invited to offer deeper insights through semi-structured qualitative interviews. Interviews and documentation sheets were transcribed verbatim and analyzed thematically, then findings from both sources were compared and synthesized.
Results
Overall, N = 29 trained health professionals documented N = 81 open desire to die-conversations. A subsample of n = 13 health professionals participated in qualitative interviews. Desire to die-conversations after the training were reported as a complex but overall enriching experience, illustrated in seven themes: (1) beneficial (e.g., establishing good rapport) and (2) hindering aspects (e.g., patients’ emotional barriers) of desire to die-conversations, (3) follow-up measures, (4) ways of addressing desire to die, as well as (5) patient reactions to it. The interviews offered space for health professionals to talk about (6) content of desire to die-conversation and (7) (self-)reflection (e.g., on patients’ biographies or own performance).
Significance of results
As part of an open (proactive) approach, desire to die-conversations hold potential for health professionals’ (self-)reflection and a deeper understanding of patient background and needs. They may lead to a strengthened health professional–patient relationship and potentially prevent suicide.
Edited by
Ruth Kircher, Mercator European Research Centre on Multilingualism and Language Learning, and Fryske Akademy, Netherlands,Lena Zipp, Universität Zürich
This chapter shows how semi-structured interviews can contribute to the study of language attitudes. It pays particular attention to how understanding interviews as contextually and socially situated speech events, shaped by the spatial and temporal context in which they take place and the relationship between interviewer(s) and interviewee(s), is crucial for the analysis and interpretation of interview data. It addresses the strengths of using interviews to investigate attitudes (e.g. that they may bring to light new information, new topics, and new dimensions to established knowledge) as well as their limitations (e.g. that participants may say what they believe the interviewer wants to hear or agree with the interviewer’s questions, regardless of their content). Following a discussion of the key practical issues of planning and research design including constructing an interview protocol, choosing the language or variety to use in the interview, and presenting multiple languages or varieties in interview transcripts, it explains how the qualitative data resulting from semi-structured interviews can be analysed thematically. The chapter ends with an illustration of interview methodology on the basis of a case study of attitudes towards Cypriot Greek in London’s Greek Cypriot diaspora.
Edited by
Ruth Kircher, Mercator European Research Centre on Multilingualism and Language Learning, and Fryske Akademy, Netherlands,Lena Zipp, Universität Zürich
This chapter examines the significance of attitudinal research in understanding the dynamics of language contact situations in multilingual societies from a cross-disciplinary perspective. This chapter provides practical guidance for the study of language attitudes and ideologies in multilingual communities by discussing issues relating to research planning and design (e.g. identifying which languages are to be explored, whose language attitudes are to be examined in the community), as well as data analysis and interpretation (e.g. quantitative data collected through questionnaires or matched-guise techniques, or qualitative data through interviews or ethnographies). Other important considerations for attitudinal research in multilingual communities are also covered (e.g. the mismatch between positive attitudes towards a language or languages and language use, or links between language policies and language attitudes in language revitalisation projects). The main points made in the chapter are illustrated by means of two case studies. The first relates to language attitudes in multilingual classrooms and the second focuses on language attitudes and ideologies amongst new speakers of minority languages with a focus on Galician in the Autonomous Community of Galicia in north-western Spain.
Videoconferencing therapy (VT) has been an emerging medium of psychological therapy, and during the COVID-19 pandemic there has been substantial growth in its usage as a result of home working. However, there is a paucity of research into client and clinician perceptions of VT. This study sought to assess client and staff experiences of VT. This mixed methods study produced both quantitative and qualitative data. Seven clients who had previously received VT and 11 psychotherapists who had previously delivered VT were recruited from two NHS sites. Clients and psychotherapists took part in qualitative interviews which were analysed using thematic analysis. Quantitative surveys were developed based on themes generated from the interviews and were completed by 172 clients and 117 psychotherapists. These were analysed using simple percentages. VT often exceeded client and psychotherapist expectations and overall experiences of VT were generally positive, although there were mixed findings regarding the therapeutic alliance. Several barriers to VT were cited, such as IT issues, and challenges identified in conducting behavioural experiments, and potential exclusion of certain populations were also cited. The medium of VT was received well by both clients and clinicians, with advantages around convenience seemingly outweighing losses in quality of therapeutic relationship. Future research should focus on overcoming barriers to accessing VT in populations prone to digital exclusion. NHS services not currently employing VT may wish to reconsider their stance, expanding choice of therapy delivery and improving accessibility.
Key learning aims
(1) To gain insight into client and clinician experiences of VT during the COVID-19 pandemic.
(2) To assess the acceptability and feasibility of VT within two NHS short-term psychological support services.
(3) To identify barriers and facilitators to the implementation of VT within two NHS short-term psychological support services.
Sleep is vital for health and wellbeing across the lifecourse. Ethnic differences have been observed with regards to the prevalence and predictors of self-reported sleep problems. An understanding of sleep experiences with ageing and across ethnicities is required to better support older people. Open-ended interviews were conducted with 23 people living in Aotearoa/New Zealand aged 61–92 years (12 Māori and 11 non-Māori) concerning current sleep status, changes over their lifecourse and personal strategies for supporting good sleep. Participants typically expressed satisfaction with current sleep (usually pertaining to duration) or feelings that sleep was compromised (usually pertaining to waking function). Comparisons to a socially perceived ‘ideal’ sleep were common, with sleep transitions presented as a gradual and accepted part of ageing. Participants resisted medicalising sleep disruptions in older age. While participants were aware of ways to enhance their sleep, many acknowledged engaging in practices that undermined it. Unique insights from some Māori participants indicated that sleep disruptions were not so readily pathologised compared to Western views and that sleeplessness could provide opportunity for cultural or spiritual connection. Common narratives underpinning the themes were: ‘You don't need as much sleep when you're older’, ‘Sleep just fits in’ and ‘Having the time of my life’. Findings provide personal experiences and cultural interpretations relating to sleep and ageing. This provides the foundation for future participatory research to co-design sleep health messages which are meaningful for ageing well across ethnicities.