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− Over the last decade, ESG-Agency scholars have increased their use of social and system dynamic theories, participatory and actorness approaches in agency theories, and justice approaches within critical theories.− Qualitative and multiple qualitative methods are the most widely used approaches in research on agency in earth system governance, with very slowly growing methodological pluralism. − In the future, scholars in this field may benefit from the integration of cross-disciplinary and increasingly complex methods in an effort to foster linking of environmental sciences more broadly into environmental governance research.
The goal of this qualitative study was to explore how adolescents with diagnosed depression describe their social relationships with peers, parents and teachers. Several previous findings have revealed the dual role of interpersonal relationships — as a stressor and contributor to different mental disorders, and also as a source of social support for mental health. Previous studies confirmed the value of a qualitative approach in exploring the self-perceived experiences of adolescents. The research group consisted of 28 adolescents, aged 13–17, with a diagnosis of depression. Individual semistructured interviews (Children's Depression Rating Scale Revised; CDRS-R) were applied in this study, which were analysed using thematic analysis. The results have both scientific and practical value, as well as relevance for the development of preventive interventions targeted at well-being and mental health of adolescents.
Smartphone ownership estimates indicate the vast majority of young people are engaging with smartphone devices. The medium offers a promising opportunity for psychologists to connect with young people seeking help to traverse challenges with mental health, behaviour, learning and wellbeing. However, the views of young people using apps alongside face-to-face therapy remain largely unexplored. Given that clients make the single strongest contribution to therapeutic outcomes it is important to consider the perspectives of adolescents in clinical settings. Using semistructured qualitative interviews, the experiences of seven Australian secondary school-aged adolescents (12–18 years) involved in app-integrated therapy were explored. Thematic analysis resulted in the identification of eight key themes: Between-sessions, Introduction, Responsive, Age, Mindfulness-Meditation, Connection, Knowledge, and App features. Recommending apps appears to encourage young people to take ownership of their therapy, affording opportunities for self-reflection and rehearsal of valuable skills. Further research focused on understanding the views of young people utilising apps with therapy is needed to maximise potential therapeutic benefits. Preliminary practice recommendations and future research directions are proposed.
Critical discourses of sustainability challenge modern rhetoric of economic growth and challenge current modes of social development. Yet sustainability discourses are shaped predominantly by the perspectives and interests of middle-class, tertiary-educated urban policy makers or environmentalists, and have insufficiently engaged people beyond these cohorts, even in the advanced capitalist societies where they have originated. This article shares findings from a study that investigated how people who are not strongly engaged with sustainability discourses understand and engage with many of the underlying concerns that animate these discourses from the context of their situated, everyday experiences. This is important information for sustainability educators, because it challenges dominant ideas of what sustainability is and offers new and alternate ways of engaging different groups of people in actions for sustainability. Bourdieu’s concepts of habitus, field and capital were used to inform the research design that employed focus groups and interviews with people from a range of socio-economic and cultural backgrounds and life stages in Tasmania, Australia. The findings provide insight into the ways in which people who are disengaged from discourses of sustainability may be actively engaged in practices of sustainability that may provide practical guidance for environmentalists and policy makers concerning how current discourses of sustainability reflect specific social contexts and experiences.
Relapse prevention strategies based on monitoring of early warning signs (EWS) are advocated for the management of psychosis. However, there has been a lack of research exploring how staff, carers and patients make sense of the utility of EWS, or how these are implemented in context.
To develop a multiperspective theory of how EWS are understood and used, which is grounded in the experiences of mental health staff, carers and patients.
Twenty-five focus groups were held across Glasgow and Melbourne (EMPOWER Trial, ISRCTN: 99559262). Participants comprised 88 mental health staff, 21 patients and 40 carers from UK and Australia (total n = 149). Data were analysed using constructivist grounded theory.
All participants appeared to recognise EWS and acknowledged the importance of responding to EWS to support relapse prevention. However, recognition of and acting on EWS were constructed in a context of uncertainty, which appeared linked to risk appraisals that were dependent on distinct stakeholder roles and experiences. Within current relapse management, a process of weighted decision-making (where one factor was seen as more important than others) described how stakeholders weighed up the risks and consequences of relapse alongside the risks and consequences of intervention and help-seeking.
Mental health staff, carers and patients speak about using EWS within a weighted decision-making process, which is acted out in the context of relationships that exist in current relapse management, rather than an objective response to specific signs and symptoms.
As a response to an ageing population, and to benefit from senior citizens’ resources and improve their quality of life, European countries are increasingly engaging older volunteers in the old-age sector and care environments. Older Danes’ participation in volunteer work is high; however, nursing home residents and home care recipients are typically not part of these initiatives as volunteers, but as the receivers of volunteer care. We investigate an initiative that engages frail older people as volunteer language teachers for foreigners learning Danish in an endeavour to utilise their resources as volunteers and to engage the language teachers socially. Through participant observations and semi-structured interviews with older volunteers, Danish-language students and care personnel, we explore what constitutes good social relationships in this specific initiative, how these relationships are created and the kind of subject that appears through Elderlearn. We are inspired by the sociology of attachment as we describe how frail older people emerge as engaged subjects by becoming reattached to their life histories, interests, abilities and relational skills. In this regard, good social relationships surpass the immediate volunteer–recipient bond and create a ‘blurry volunteering’ with less distinct divisions of who gives and who receives. This generates constructive relationships created through interlinguistic competences, international consciousness, and use of materials, objects and the local community. We argue that this arrangement reattaches the language teachers to their life histories, thereby enabling the emergence of a different kind of international and engaged old-age subjectivity.
Despite the significant improvement in all components of preparedness in the past decade, there are still gaps between the guidelines and the reality on the ground. The purpose of this study is to explore how Israeli public health and emergency medicine experts perceive the demands for health organization emergency preparedness and the actual practice.
Qualitative phenomenological research. We interviewed 22 Israeli public health and emergency medicine experts face-to-face and conducted a content analysis.
The findings revealed barriers in the following areas: preparation and readiness of hospitals, preparedness and readiness in the community, connection between the community and the hospital, inter-agency coordination and interface, interdisciplinary integration, preparedness resources, postcrisis evaluation, assimilating smart technologies, information accessibility, and communication.
To reduce the gap between theory and practice, retrospective research and evaluation must be included to learn in depth what strategies and resources should be used during a health crisis. Likewise, profiles should be constructed and the community should be segmented in order to design resilience programs and accommodate information to subpopulations.
This study sought to explore main barriers and facilitators to implementing health technology assessment (HTA) in Kuwait from the perspective of key stakeholders.
Semi-structured qualitative interviews were conducted with ten key stakeholders: seven healthcare providers working at various departments of the Kuwaiti Ministry of Health (MOH), and three academics with substantial experience in teaching HTA or related fields. Interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Data were analyzed using an inductive thematic approach.
Participating stakeholders reported several factors that might act as a barrier to building HTA in Kuwait: minimal awareness of HTA, lack of institutional and human capacity, a fragmented healthcare system, poor communication between researchers and policy makers, the country's wealth, politics, as well as data quality, availability, and sharing. Institutionalizing HTA as a politically empowered body, enforcing its recommendation by law, and benefiting from neighboring countries' experiences were suggested as possible ways to move forward.
Studies exploring the unique challenges that high-income developing countries may face in implementing HTA are still scarce. The results of this study are consistent with evidence coming from other developing countries, while also suggesting that the abundance of financial resources in the country is a double-edged sword; it has the potential to facilitate the development of HTA capacity, but also hinders recognizing the need for it.
Light and intermittent smokers (LITS) represent almost 50% of all current smokers. Research is needed to understand smoking motives among adult light smokers.
To explore smoking cues and motivators among a racially diverse sample of adult LITS (≤10 CPD). In addition, we explored differences between native (always smoked ≤10), and converted (former heavier) LITS.
We used purposive sampling to recruit participants who were native and converted LITS and to include equal numbers of African Americans, Whites and Latinos. We coded and analyzed transcripts using a stage approach to identify themes.
Four main themes emerged that may be unique to light smokers and suggests potential strategies for intervention: (1) smoking in response to cues and control, (2) identifying as a smoker, (3) concern about health consequences, and (4) other priorities influencing smoking. There were some differences among smoking cues and motivators by race and ethnicity, and differences between native and converted LITS.
Overall, LITS reported drivers of smoking that were unrelated to symptoms of nicotine withdrawal. Even when experiencing salient cues, our LITS cohort expressed the ability to assert control over smoking by abstaining when situational contexts made smoking inconvenient.
Asia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients’ autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.
Guided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals’ attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.
The extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.
Significance of results
Healthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities.
Health professionals are key stakeholders who potentially have important roles in preventing unintentional child home injuries. This study aimed to identify facilitators and barriers to the prevention of unintentional child home injuries perceived by health professionals.
A generic qualitative study involving semi-structured interviews.
The capital city of Iran.
Data for this study were collected through 28 in-depth interviews with health professionals. Purposive sampling was conducted from three areas of Tehran based on their socio-economic development.
Thematic data analysis yielded nine overarching themes: prioritising child home injury, knowledge, the nature of injury and injury prevention, child-related factors, parent-related factors, living environment, cultural issues, resources and management.
Health professionals can potentially be supportive to meet families’ needs. However, further support and resources will be required if they are to fully develop their potential in preventing injuries in the home. The lack of a national action plan was a significant constraint for health professionals.
We explored identity formation among nine gay men who were born between 1946 and 1964. This group of nine was the largest homogeneous sub-group within a larger sample (N = 18). Although participants share similar demographic characteristics, their individual social, personal and narrative identities diverge to represent distinctive embodied selves. Guided by queer and feminist theories, the qualitative analysis identified dominant and counter-narratives that demonstrate the complexity of sexual identity as it evolves over time. All nine men recall being aware of their gay identity as children; however, like many socially constructed labels, their outward identity was more complex and difficult to understand. The findings demonstrate how participants negotiated their sexual identities through decades of social change. As illustrated within each subset of identity (i.e. social, personal and narrative), some participants found themselves breaking ground for a broader gay rights social movement, while others described their experience of being relegated to silence and invisibility for most of their lives. This research contributes to an ongoing discussion concerning the individuality found among lesbian, gay, bisexual and transgender (LGBT) individuals in later life. As the LGBT population becomes more visible, there will be a growing need to understand the individualism that exists within this coalition and affirm their diversifying sexual and gender identities.
The number of people growing older with severe mental illness (SMI) is rising, reflecting societal trends towards an ageing population. Evidence suggests that older people are less likely to seek help, be referred for and receive psychological therapy compared with younger people, but past research has focused on those with mild to moderate mental health needs.
This research aims to identify the specific barriers faced by older people with SMI.
We interviewed 53 participants (22 service users with SMI aged over 50 years, 11 carers of people with SMI, and 20 health care professionals) about their views and experiences of accessing therapy for SMI in later life.
Thematic analysis revealed five themes: organizational and resource issues; myths about therapy and attitudinal barriers; stigma; encouraging access to therapy; and meeting age-specific needs.
Barriers faced by older people with SMI are not only age-related, but also reflect specific issues associated with having a SMI over many years. Improving awareness of the benefits of psychological therapies is important not only for older people with SMI themselves, but also for their carers and staff who work with them.
Our objective was to explore the processes and determinants leading physicians to integrate estimated glomerular filtration rate (eGFR) in their drug prescriptions
Access to patients’ eGFR would allow primary care pharmacists to optimise their role in the procedure of safe prescribing. Some rare physicians actively integrate eGFR in their prescriptions, in a sporadically and uncoordinated manner.
Qualitative study using semi-directed interviews conducted among 12 French physicians who integrated eGFR in their drug prescriptions, (February 2016–April 2017). These voluntary participants were recruited through different means: Twitter®, forums, direct contact and snowball sampling. Data analysis was based on the grounded theory approach, underpinned by a comprehensive perspective of interactionist orientation.
Residency and training, professional experience – including experiences of adverse drug reactions – and the membership in various communities of professionals were key drivers for the integration of eGFR in prescriptions. The theoretical aim was above all safe prescribing in order to reduce adverse drug reactions, with the control by a dispensing pharmacist and/or other healthcare professionals. Nevertheless, none of the physicians had received any feedback from any healthcare professionals. Despite their disappointment, the physicians remained convinced of the interest of integrating eGFR in their prescriptions and would continue to do so. Characteristics associated with integration of eGFR in drug prescriptions belong partly to Roger’s theory of innovations. If a widespread diffusion of this habit takes place, it will be necessary to evaluate its adoption by both physicians and pharmacists.
Psychologists play an important role in the provision of mental health support to young people. Some psychologists are incorporating apps into therapy with young people; however, little is understood about why such incorporation is taking place. Ten semi-structured qualitative interviews exploring why psychologists augment therapy by recommending or using apps alongside therapy were undertaken. Findings suggest that psychologists were prompted to update their therapeutic approach in response to client-initiated discussion of apps. Personal use of apps, higher engagement in therapy, increased access to therapeutic strategies between sessions, and a reduction of the stigma associated with externalising therapeutic strategies were also facilitating factors. Implications for practice such as apps currently complementing structured therapy over unstructured talk therapy, and further research are explored.
It has been proposed that both positive and negative metacognitive beliefs sustain engagement in post-event processing (PEP). However, it is unknown: (1) whether individuals with social anxiety disorder (SAD) actually derive the benefits from PEP that they expect; (2) if this is not the case, how their positive beliefs are maintained; and (3) if they are aware of the counterproductive effects of PEP, why they still perform PEP.
To explore the phenomenology of the processes involved in PEP from the perspective of SADs, in order to address the research questions above.
Twenty-one participants suffering from SAD received individual semi-structured interviews. Transcripts were analysed using thematic analysis.
Analysis revealed three main themes: (1) ‘Only, safe and useful way to improve myself’: SADs feel the need to improve their social performance, and they believe that PEP is the only, safe, and private way to do so, which is an underlying motive for them to do PEP; (2) ‘It hurts more than helps me’: however, through PEP, they do not seem to obtain the benefit that they expect, or only find a variety of counterproductive outcomes; (3) ‘Better safe than sorry’: they sometimes find makeshift solutions to improve their social performance during PEP, which may maintain their PEP as a form of intermittent reinforcement. They weigh up such costs and benefits, and choose to perform PEP while feeling conflicted about PEP.
The results suggest that: (1) SADs rarely obtain the benefits from PEP that they expect; (2) their positive metacognitive beliefs are maintained by solutions they sometimes find during PEP; and (3) SADs choose to perform PEP while feeling conflicted; while PEP ironically maintains and exacerbates negative self-beliefs/images, it is the only safe and useful way to improve their social performance. These findings support and expand on the theories of PEP.
Disaster health care workers experience much greater stress providing psychological first-aid and suffer from the indirect experience of traumatic events. This study examines how disaster health care workers experience disaster mental health.
Twenty-one disaster health care workers recruited from fire stations, community mental health service centers, and disaster trauma centers in Korea participated in this study. Data were collected via in-depth interviews and qualitatively analyzed according to Colaizzi’s phenomenological approach.
Disaster health care workers’ experiences of disaster mental health can be analyzed according to 4 theme categories: (1) commitment to one’s duty as a disaster health care worker; (2) powerlessness and lack of confidence; (3) incident shock and burnout; and (4) incomplete and inadequate healing.
In order to prevent mental health problems and support the disaster health care workers, it is necessary to develop and provide effective, nationwide psychological first-aid training, as well as disaster trauma recovery programs that are tailored to Korean sociocultural context and use immersive digital health care/education technology.
Cyberbullying presents a new workplace issue with initial research demonstrating strong links to negative outcomes for individuals and organisations across a range of sectors. Yet, detailed accounts of target experiences of cyberbullying remain largely unexamined. To address this crucial research gap, this study explores nurses' experiences of workplace cyberbullying – a profession with high rates of workplace bullying. Adopting a work environment perspective, this paper provides an in-depth examination of eight cases of workplace cyberbullying that emphasise the practical and theoretical complexities associated with this emerging workplace hazard. Specifically, workplace cyberbullying is often experienced within a broader pattern of bullying behaviours, leading to a potentially wider scope of harm for those involved. A new typology of cyberbullying based on the source of perpetration is also presented that contributes to our growing understanding of the issue while extending the knowledge base for the effective management of workplace cyberbullying.
Dissemination of results to research participants is largely missing from the practices of most researchers. Few resources exist that describe best practices for disseminating information to this important stakeholder group.
Four focus groups were conducted with a diverse group of individuals. All participants were part of a Patient-Centered Outcomes Research Institute-funded survey study. Focus groups aimed to identify participants’ preferences about receiving research results and their reactions to three different dissemination platforms.
Four focus groups with 37 participants were conducted, including: (1) adults with one comorbidity, at least a college education, and high socioeconomic status (SES); (2) adults with one comorbidity, less than a college education, and lower SES; (3) adults with low health literacy and/or numeracy; and (4) Black or African American adults. Participants discussed their preferences for research results delivery and how each of the platforms met those preferences. This included information needs as they relate to content and scope, including a desire to receive both individual and aggregate results, and study summaries. Email, paper, and website were all popular avenues of presentation. Some desired a written summary, and others preferred videos or visual graphics. Importantly, participants emphasized the desire for having a choice in the timing, frequency, and types of results.
Research participants prefer to receive research results, including study impact and key findings, disseminated to them in an engaging format that allows choice of when and how the information is presented. The results encourage new standards whereby research participants are considered a critical stakeholder group.