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The Constant Comparative Method of Qualitative Analysis
Abstract
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... The interview transcripts were analyzed using DeDoose. An inductive thematic analysis approach was employed to ensure that all concepts identified were data-driven and not defined a priori, capturing topics crucial to caregivers (29)(30)(31). A coding tree was established prior to the analysis of transcripts to organize how concepts and sub-concepts would be distributed to the three domains of symptoms, symptom impacts, and caregiver impacts (Supplementary Document 2). ...
... A coding tree was established prior to the analysis of transcripts to organize how concepts and sub-concepts would be distributed to the three domains of symptoms, symptom impacts, and caregiver impacts (Supplementary Document 2). Two researchers from the study team coded all of the interviews using a constant comparative method to ensure dependability (31). ...
Introduction
CACNA1A-related Hemiplegic Migraine (HM) is a rare neurological disorder distinguished by paroxysmal episodes of hemiparesis/hemiplegia with and without headache. Clinical features have been widely characterized, yet the impacts of the paroxysmal events on the patient and caregiver have not been thoroughly explored. Disease concept models are formal frameworks used to describe the lived experiences of patients and their families, offering a source for surrogate endpoints for clinical trials.
Methods
We completed 13 semi-structured interviews with caregivers of 12 individuals diagnosed with CACNA1A-related HM. We methodically coded themes, grouping concepts into three domains. We measured the occurrence of concepts throughout all interviews and subgroups stratified by age categories.
Results
Over 11 h of interviews yielded 2,018 references to 27 distinct concepts. Established symptoms such as seizures (87 references; including status epilepticus 27 references), hemiparesis/hemiplegia (24 references), and unconsciousness (17 references) were referenced, as well as previously underreported symptoms such as apneic episodes (32 references), lost ability to eat (13 references), and vascular access challenges (10 references). The symptom impacts were largely medical (294 references), followed by health (101 references), emotional (36 references), daily living (28 references), and social (26 references). Caregiver impacts were the most referenced domain (995 references), with the pivotal effects seen in caregiver requirements (355 references), emotional (245 references), HM treatments (179 references), daily living (148 references), and health support (135 references).
Discussion
CACNA1A-related HM is a complex disorder defined by serious paroxysmal events that affects a broad range of social and clinical domains. We systematically classified symptoms and impacts from HM episodes, creating a disease concept model to help develop surrogate endpoints for future clinical trials, and identified two opportunities to improve patient management, including a written emergency protocol and a transition plan for adolescents approaching adulthood.
... This iterative process facilitated the refinement of existing codes, identified emergent codes, and illuminated potential relationships between codes. 30,32,33 The three coders independently applied the final codebook systematically to each transcript using ATLAS.ti software (Berlin, Germany) such that each transcript was double coded; JKL resolved discrepancies. ...
Background
Gender inequity persists in high-level leadership within academic medicine. Understanding the perspectives of early career women faculty could clarify how to recruit and support women who pursue high-level leadership. This study explored the specific priorities and concerns that may influence the recruitment of women leaders in the future.
Methods
Twenty-five assistant professors (mean: 1.8 years at rank) completed the Early Career Women’s Leadership Program and participated in semi-structured, in-depth interviews in 2023. Data were analyzed using an iterative, thematic constant comparison process informed by constructivist grounded theory.
Results
The authors identified four themes. In theme one, participants described the importance of being seen and valued as a whole person, with consideration of their personal and professional lives. They sought mentorship and leadership positions that supported their work-life integration. In theme two, women balanced an interplay between the individual and the collective when considering themselves as future leaders. From the individual perspective, participants prioritized personal values like humility and compassion when discussing preferred leadership styles. From the collective perspective, they prioritized inclusivity and teamwork. Theme three showed discomfort with the unknown with a desire to fully understand a leadership position and its impact on personal and professional life. Participants wondered about having the authority and resources to realistically make meaningful change and whether they could adequately prepare to lead. The fourth theme was representation mattered. Participants valued having women leaders who have experienced similar challenges as themselves. These leaders inspired participants to believe that they could also achieve and succeed in high-level leadership.
Conclusion
Early career women balanced numerous factors when considering whether to pursue high-level leadership in academic medicine. Understanding women’s priorities and concerns can enable institutions to prepare women faculty to lead and ultimately recruit and retain them in high-level leadership.
... Çalışma kapsamına alınan her şirketten bir katılımcıyla görüşme yapılması, zaman sınırlamasına uyum sağlamak adına tercih edilmiştir Nitel görüşmelerde katılımcı sayısına ilişkin farklı yaklaşımlar olsa da belirli bir sayı üzerinde uzlaşma bulunmamaktadır. Ancak bu araştırmada, bilgi yeterliliğine ulaşmak amacıyla katılımcı sayısının kontrollü bir şekilde sınırlandırılması tercih edilmiştir (Glaser, 1965). Nitekim, literatürde bazı araştırmalar yalnızca 6 görüşme sonrasında dahi anlamlı veri bütünlüğüne ulaşıldığını göstermektedir (Fugard & Potts, 2015). ...
Dijital dönüşümle birlikte öne çıkan yapay zekâ kavramı eğitimden sanata pek çok alanda kullanılmaya başlayarak, hızla popülerlik kazanan önemli bir uygulama ve araştırma alanı olarak kabul edilmeye başlanmıştır. Yapay zekâ sistemlerinin derin öğrenme ve algoritma alt yapısıyla motor üretimlerin ötesinde duygusal davranışlar, karar verme ve yaratıcı fikir üretimi konusundaki yeteneklerinin gelişmesi, görsel sanat ve tasarım alanlarını kapsayarak üretimin doğal bir parçası haline gelmesi düşüncesine yönelik tartışmaların da gündeme gelmesine neden olmuştur. Bu kapsamda özellikle teknolojinin gelişmesiyle paralel olarak dönüşen ve ilerleyen animasyon sektöründe, yapay zekâ ile insan arasındaki iş birliğinin tanımlanması, sınırların belirlenmesi ve yapay zekânın yakın gelecekte animasyon üretimindeki rolünün irdelenmesi gerekliliğini ortaya çıkarmaktadır. Bu çalışmada yapay zekâ tabanlı araçların yaratıcı süreçleri nasıl dönüştürdüğü, animatörlerin rolünü nasıl yeniden tanımladığı ve gelecekte animasyonun nasıl evrilebileceğini ele alınmaktadır. Araştırmanın temel amacı animasyon yapım süreçlerinde aktif olarak yer alan sektör profesyonelleri ile yapay zekânın animasyon üretimine entegrasyonu konusundaki görüşleri çerçevesinde animasyon sektörünün geleceğindeki yapay zekâ teknolojilerinin rolünün ortaya çıkarılmasıdır. Bu kapsamda araştırmada nitel araştırma yöntemlerinden derinlemesine görüşme yöntemine başvurulmuştur. Bulgular yapay zekâya özel olarak geliştirilmiş olan “Yapay Zekâ Cihaz Kullanımı Kabul Modeli” (Artificially Intelligent Device Use Acceptance (AIDUA)) modeli çerçevesinde değerlendirilerek, animasyon sektör profesyonellerinin yapay zekâ uygulamalarını kullanma niyetleri, sosyal etki, hedonik motivasyon, antropomorfizm, algılanan performans ve çaba beklentisi ve duygu boyutlarıyla ele alınmıştır. Araştırmada elde edilen bulgular animasyon sektörüne yapay zekâ uygulamalarının entegre edilmesinin genel anlamda sektör profesyonelleri tarafından kabul gördüğü sonucunu ortaya koyarken, bu dönüşümün nasıl gerçekleşeceği, endişeler ve faydalar çerçevesinde tartışılmıştır.
... We explored the content of BAs and identified naturally occurring themes (inductive approach) through thematic analysis, 19 using Microsoft Word and Excel. Each researcher independently reviewed an initial subset of BAs using an open-coding approach; through iterative discussion, we identified consensus codes and created a joint codebook. ...
Background: Behavioral alerts (BAs) are electronic health record communication tools used to notify clinicians and staff about patient behavioral incidents. Despite their widespread presence, limited research exists on the content and use of BAs.
Methods: This study took place in a large, urban, academic general internal medicine practice. Demographics of patients with BAs were compared with all patients at the practice (N = 27,023). Only patients with active BAs (N = 518) were included in the qualitative analysis. Themes were generated through open and axial coding of BAs’ free-text and thematic analysis to describe the content of BAs.
Results: A total of 518 patients in the practice had BAs (1.9%). Compared with the general practice population, patients with BAs were more likely to be Black (23% vs. 8.5%), have public insurance (77.8% vs. 41.9%), and have a psychiatric (62.5% vs. 30.7%) or substance use-related (36.1% vs. 5.8%) diagnosis. We identified six BA themes: criminalization (behavior described as criminal or necessitating law enforcement), implied overuse (exploitation of medical resources with recommendation for limitation), advocacy (author offers support and defense), coordinating care (logistic details), venting (expression of negativity without a plan), and warning (communication of risk).
Discussion: The wide-ranging content of BAs demonstrates their varied, unstandardized use. The unregulated use of BAs should be reexamined and restructured to avoid negatively impacting patients, particularly given their disproportionate use for historically marginalized populations, including patients who are Black, have public insurance, and those with psychiatric or substance use-related diagnoses.
... It is a process by which the data guide the development of theory, as opposed to applying an existing theory to data (Lincoln and Guba 1985). The theory-building process is not linear (Charmaz 2014) and requires the constant comparative method used through interactive data collection and analysis (Glaser 1965, Glaser and Strauss 1967, Strauss and Corbin 1990. Researchers primarily use qualitative data from interviews or focus groups to inform the formation of the theory (Creswell 2011). ...
... The interview questions were designed to allow teachers to openly describe their experience with integrating CT into each lesson-describing their comfort level with integrating CT and describing challenges that arose, detailing their lesson planning process and rationale as to what specific concept(s) they embedded into the lesson-and to provide examples as to how they were able to identify emergent CT in their students' work process. Interview responses were analyzed using Dedoose software V 9.2.22 and employing an inductive coding system that was refined over time, followed by using a constant comparative approach [29]. Four members of the research team developed a coding scheme that included code name and code examples and included relevant child codes. ...
Few studies of computational thinking (CT) integration in elementary curricula have yet focused on supporting early elementary educators with implementing and assessing their young students’ application of these practices to content area work. This paper summarizes a collaborative research project that engaged researchers, K-second grade teachers, and professional development (PD) providers in implementing a hybrid PD model to answer the following research questions: (1) What kind of PD and guidance do teachers need to identify and support emergent computational thinking development in young students’ language and work process? (2) What kind of PD and guidance do teachers need to identify emergent computational thinking development in young students’ work products? This project employed a mixed-methods research design that included pre- and post-surveys and interviews with teachers to measure and understand how growth in teachers’ confidence, knowledge, and self-efficacy with CT prepared them to identify and support these concepts with young learners. Additionally, analysis was able to identify the key formative assessment strategies these teachers employed to generate insight into students’ understanding and application of CT during problem-solving.
... Qualitative data were analyzed using a constant comparative approach. 15,16 Three coders from South Carolina triple coded a subset (n = 5) of their sample to identify emergent themes within the main impact constructs using NVivo 12. Then open-ended survey responses from 4 states and in-depth interview verbatim transcript data from 1 state were combined into Excel. A coding team composed of members from each state multiple-coded a subset of the sample, using the developed codebook as a flexible a priori codebook. ...
Objective
The study examines: 1) impacts of COVID-19 on the work of Supplemental Nutrition Assistance Program – Education (SNAP-Ed) implementers, 2) facilitators and barriers experienced in making adaptations, and 3) factors that would have helped with preparedness to adapt.
Design, Setting, and Participants
A purposive sample of 181 SNAP-Ed program implementers from across five states completed a survey or interview based on the study aims. Quantitative data was summarized with descriptive statistics and qualitative data was analyzed thematically.
Results
Direct education activities were found to be most impacted during COVID-19 while working to change policies, systems, and environments and indirect education were less impacted. Both positive and negative impacts surfaced. Respondents were most likely to say they were moderately or slightly prepared to make adaptations. Elements of internal organizations, technology, and partners both helped and hindered adapting. Pre-established virtual capacity, formal preparation and planning protocols and procedures, and better and more frequent communication with partners and program leadership would have helped with preparedness.
Conclusion
SNAP-Ed needs assessment and implementation processes should integrate and expand upon the lessons learned in the study to enhance future emergency preparedness among program implementers. Program policy should be updated to allow for implementation flexibility during future emergencies.
... The first author and two assistants inductively analyzed responses to the five open-ended prompts by compiling response texts into a spreadsheet and examining them using a constant comparison method (Glaser, 1965). They read through texts arranged in vertical (i.e., within question) and horizontal (i.e., within subject) arrangements. ...
Research on female video game characters often investigates negative outcomes of playing as stereotyped characters. Yet, video games increasingly offer people opportunities to play as capable, prominent female characters that may be meaningful and promote positive outcomes (e.g., feelings of empowerment). This manuscript shares the results of a mixed methods survey of individuals ( N = 751) recruited via online forums who recalled their experiences playing as female game characters. We analyzed qualitative response data using a traditional, top-down approach to identify themes. We focus our analysis and discussion on the results of a human-derived analysis, which indicated both positive and negative dimensions of experiences that participants found meaningful. Participants reported that taking on the role of a female character was often very important to them, but the reason for this significance varied across players. Often, these reasons involved their own gender identities and the context in which the gameplay occurred (e.g., online multiplayer). We consider findings as evidence of eudaimonic media effects.
... The first author and two assistants inductively analyzed responses to the five open-ended prompts by compiling response texts into a spreadsheet and examining them using a constant comparison method (Glaser, 1965). They read through texts arranged in vertical (i.e., within question) and horizontal (i.e., within subject) arrangements. ...
Research on female video game characters often investigates negative outcomes of playing as stereotyped characters. Yet, video games increasingly offer people opportunities to play as capable, prominent female characters that may be meaningful and promote positive outcomes (e.g., feelings of empowerment). This manuscript shares the results of a mixed methods survey of individuals (= 751) recruited via online forums who recalled their experiences playing as female game characters. We analyzed qualitative response data using a traditional, top-down approach to identify themes. We focus our analysis and discussion on the results of a human-derived analysis, which indicated both positive and negative dimensions of experiences that participants found meaningful. Participants reported that taking on the role of a female character was often very important to them, but the reason for this significance varied across players. Often, these reasons involved their own gender identities and the context in which the gameplay occurred (e.g., online multiplayer). We consider findings as evidence of eudaimonic media effects.
... This gradually revealed the significance of different categories of enrichment and their relationship to specific settings. In our use of techniques developed over many years of qualitative research, we were conscious both of the danger that longstanding engagement with the field informs our constructions (Charmaz, 2006) and Glaser's (1965) distinction of thematic analysis and the search for an axial code from prior coding, on the grounds that researchers constantly redesign and reintegrate theoretical notions (Glaser, 1965, p. 437). ...
This paper reports a longitudinal study, organized around national surveys and institution-based case studies, of 'enrichment' in post-16 colleges across England and Wales. These institutions transect general and vocational education pathways, whose curricula are organized respectively around subject disciplines and employment skills. Drawing on social justice perspectives and understandings of curriculum theory and cultural reproduction, the study initially analysed enrichment practices positioned as additional to subject-based curricula. However, extending thematic analysis through cross-case comparison, the study uncovered an additional , complementary role of enrichment: in some specialist/general education settings, teacher-led, practice-based extensions of subject curricula, complemented by agentic networking opportunities, facilitated middle-class higher education transitions; vocational enrichment, responding instead to 'learner support' imperatives and socializing young people into employment routines, sustained the normative transitions to work that characterize vocational pathways. These distinctive complementary logics mirror the inequalities of epistemic access identified by curriculum theory, suggesting that these extend beyond formal curricula. On the other hand, some marginal practices, including broader, more critical preparation for adulthood and work, suggest possibilities to advance social justice, transgressing the academic/vocational divide. Whilst unequal societies persistently sustain this divide, activities outside formal curricula may support more agentic and socially just transitions to adult-hood and working life. ARTICLE HISTORY
... Data were reviewed and common themes identified from 113 individual comments. A thematic analysis was completed, and identification of patterns was obtained through Glaser's (1965) constant comparative method. Five major themes emerged: staffing to teach, foundation through education, support of preceptor role, enhanced communication, and acknowledgment of preceptor. ...
Nurse preceptors are essential to the development of new nurses, especially considering the worsening nursing shortage following the pandemic. This study used a mixed methods survey (n=139) to examine the motivation, perceived barriers, and supports for nurse preceptors post-pandemic. Results and implications for
healthcare leaders are discussed.
... The refined coding structure from deductive and inductive approaches was then applied to all interview transcripts. Key themes were identified through an iterative process utilizing a constant comparison method [26]. The final analyses were reviewed by a diverse team comprising physicians, scientists, and patient partners, ensuring multiple perspectives were considered, deepening the understanding of the data, and ensuring internal quality control and rigor. ...
Objectives
Adolescents and young adults (AYAs, 18–39 years) with cancer identifying as racially/ethnically minoritized or 2SLGBTQIA+ (Two‐Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual and “+” referring to other queer identities) have been underrepresented in cancer research. This study explores the aspects of identity that hold significance for these minoritized AYAs and how these facets impact their healthcare experiences.
Methods
Eligible participants comprised English‐speaking AYAs who self‐identified as racially/ethnically minoritized and/or 2SLGBTQIA+, were diagnosed with cancer between the ages of 15–39, currently aged > 18, and had received or were receiving cancer care within Canadian healthcare system. Additionally, four patient partners meeting the same criteria were recruited as research collaborators. Semi‐structured one‐on‐one virtual interviews guided by an interview script were conducted, and qualitative analysis employed a framework approach.
Results
We recruited 23 participants from 4 Canadian provinces (mean age: 28, Range: 20–44); 17 identified as racially/ethnically minoritized, one as sexual/gender minoritized, and five as racially/ethnically and sexually/gender minoritized. Participants emphasized that their culture/ethnicity, religion/spirituality, sexuality, gender, family, career, and being an immigrant are important aspects of their identity, with only one participant recognizing their identity as a “person with cancer”. A cancer diagnosis altered the aspects of identity deemed most significant by participants. Both visible and invisible aspects of identity shaped participants' experiences and influenced their level of trust in the healthcare system.
Conclusion
Racially, ethnically, gender, or sexually minoritized AYAs with cancer place considerable importance on aspects of their identity that are shaped by their respective communities. Recognizing and respecting these identities are paramount for healthcare professionals to deliver safe and inclusive care.
... We looked for instances in which students stated ideas that they recognized in the model, specifically locating discourse concerning The circular conductor was restructured to the shape of a person with a thinking cloud, with particles on the face and in the cloud Electrons (white dots) and blue vertical lines added between the two conducting lines, although they are not part of the model unconventional constructions. We used the constant comparative approach (Glaser, 1965) to iteratively identify the themes identified in students' statements. ...
Does inventing representations in open-ended computational environments contradict the goal of acquiring canonical scientific knowledge? We analyze the computational models of electric conductors that N = 35 eight-grade students built with a NetLogo-based microworld. Students used the microworld to sketch structures that represent models of electric conductors and then observed the resulting electric current. We use data from classroom discourse, computer log files and questionnaires, to identify different ways through which students used the platform, and how their engagement in construction, explains the variance in their learning gains. We found differences in the number and types of models that students constructed in the microworld: while most students built the models that were intended by the instructors, some added unconventional doodling models, that deviated from the intended structures. We found that students who built more models made larger gains in conceptual knowledge about electric current. However, we also found that students who constructed more unconventional models, produced lower learning gains on items that assessed the particle-level mechanism of electrons in conductors. ARTICLE HISTORY
Introduction Advanced cancer poses unique difficulties for patients, caregivers, and health care providers. Prognostic discussions are pivotal in shaping care decisions during this stage. These conversations involve health care professionals conveying disease progression, expected outcomes, and estimated life expectancy. Research consistently underscores the pivotal role of prognostic discussions in advanced cancer care, and most existing research stems from developed countries, necessitating the exploration of experiences within the Indian context.
Objective The aim of this study is to identify the themes and patterns that emerge from the narratives of patients and caregivers surrounding prognostic discussions.
Materials and Methods Using a qualitative methodology, participants were drawn from the palliative care clinic via a purposive sampling in this prospective qualitative study. Semi-structured interviews were conducted, and thematic analysis was employed to understand patient and caregiver experiences. Ethical considerations were adhered to throughout, obtaining informed consent and ensuring anonymity.
Results Findings from 21 participants revealed five themes shaping prognostic discussions: perception and understanding of prognostic information, emotional impact, decision-making and treatment preferences, communication with providers, and cultural and religious influences. Patients struggled to comprehend complex medical terms, while caregivers played essential roles in aiding understanding. Both groups grappled with intense emotions upon learning of limited life expectancy, impacting decision-making. Effective communication and involvement of caregivers in discussions were pivotal, and cultural and religious beliefs shaped the perspectives on death.
Conclusion This study emphasizes the intricate emotional landscape of patients and caregivers during advanced cancer prognostic discussions. It highlights the need for health care providers to undergo specialized communication training, prioritize shared decision-making, and respect cultural contexts. However, the study's limitations warrant future research for broader generalizability and long-term impact assessment.
The concept of flourishing has garnered interdisciplinary attention, particularly within the realm of workplace research, given its relevance to individuals' daily lives. However, despite its growing importance, defining and measuring workplace flourishing remains challenging, often due to the adoption of generic life‐domain perspectives. This review addresses these challenges by synthesizing literature from work and life domains. We meticulously analyze 118 pertinent articles through an integrative review methodology, uncovering gaps in conceptualization, measurement, determinants, and outcomes of workplace flourishing. Our review introduces a new conceptual lens, focusing on the role of personal project pursuits in shaping flourishing. We also clarify the distinction between flourishing and thriving, providing much‐needed conceptual clarity. Additionally, the review presents an integrative framework that synthesizes determinants and outcomes of flourishing, offering a multitude of avenues for future exploration.
Purpose
Internal corporate venturing is a vehicle for firms to realize strategic and financial goals through entrepreneurial ventures. Prior research presents a strategic process in which individual managers make rational choices based on their formal roles and top-down corporate objectives. Recent work has challenged this by adopting a relational approach using a macro-level perspective highlighting cultural and institutional logics. This study augments and develops this relational approach by contributing a micro-level perspective by focusing on managers engaged in developing ventures in large organizations. The data show how internal corporate venturing (ICV) actors use discursive practices to make sense of their relationship contexts and develop interpretive repertoires to give sense to their decisions and shape their future strategies. The data illustrate how corporate venturing actors make sense of their uncertain experience and develop insider-outsider strategies by balancing three competing interpretive repertories, which form the basis of strategies supporting an entrepreneurial future in an organizational context.
Design/methodology/approach
Forty-two interviews were conducted with ICV actors, including senior directors of corporate venturing units in multinational corporations and their venture project leaders. The authors conducted a micro-level study through an interpretive sensemaking analysis of managers' “talk.” Interviews are considered through three lenses: “functional talk” (why they said it), “interpretive themes” (what they said) and “interpretive repertoires” (how they said it).
Findings
The perceived challenges experienced by the participants through their relationships were identified. Participants emphasized balancing project and organizational role risk in pursuing venture development, leading to a perceived dependent trust relationship between supporters. Three interpretive repertories were identified through which participants positioned their explanations of their relationship contexts in ICV. Participants used these to discursively frame their corporate venturing practices and position their future strategies.
Originality/value
A new framework of corporate venture sensemaking and sensegiving reconfiguration is provided to explain how managers discursively resolve conflicting relationship pressures while maintaining personal positioning. The paper shows how conflicting interpretive repertoires and personal interpretations are generated through a discursive practice comprising sensemaking and sensegiving reconfiguration processes to shape their future strategies. The paper contributes to theory by explicating the relational perspective of ICV at the micro-level and demonstrates how this is influenced by the discursive practices of managers leading the ICV activity.
Due to rapid changes in local, state, national, and worldwide environments, public managers face increasing challenges to fulfilling the purposes of their work. Systemic thinking is one way to support the management of complexity. The purpose of this design-based research project was to design, develop, and formatively assess one-page tools to support the systemic thinking of public managers. The research project was conducted in six phases comprising two cycles. In this chapter we describe a single phase of design-based research and focus on the use of concept maps as a qualitative data visualization tool. Concept maps were developed from data collected during interviews with six instructional designers and eight public managers. Visualizing the qualitative interview data allowed us to perceive aspects of teaching systemic thinking not available solely using traditional data analysis methods. The relevance of visualizing qualitative data stems from what those data provide: a deeper and more human explanation of the phenomena under study. Learning experience design was used as the conceptual framework for this study. Due to the multi-faceted nature of learning experience design, its utility as a conceptual framework was relevant to the bringing together of design thinking and systemic thinking to produce the learning tools and theoretical contributions.
Civil registration establishes legal identity for individuals and related government-issued identification document. Civil registration data are used to generate vital statistics which are an important source of data to policy-makers planning public policies and researchers studying population dynamics. However, many resource-poor countries lack a functioning civil registration and vital statistics (CRVS) system. Learning the factors that affect CRVS can help data users to better understand the context behind these data. The Government of Lao People’s Democratic Republic is in the process of conducting a social and behavior change communication (SBCC) campaign to improve civil registration. In preparation, a qualitative study was conducted to understand the residents’ knowledge, attitudes, practices, facilitating factors, and barriers regarding civil registration. One hundred seven key-informant interviews and 22 focus group discussions were conducted with government and nongovernmental organization employees, development partners, and residents employing semi-structured guides during July-December 2018. Data were analyzed using ATLAS.ti 23 applying the grounded theory and constant comparative analysis methods plus analytic memo writing. Findings show that barriers to civil registration include various costs involved in registering vital events, lack of awareness of civil registration, long distances to registration offices and poor road conditions, perceived lack of benefits, and long, complicated registration procedures. Respondents recommended the SBCC to inform the public about the legal mandate for and benefits of civil registration, and instruction on how to register vital events, using multiple channels, such as television, outreach visits to villages, posters, radio, village chiefs and loudspeakers, brochures, face-to-face meetings, social media, etc.
Autism research and services have historically focused on individuals with a formal autism diagnosis. However, activists and self-advocates in the United States recognize that there are financial and clinical barriers impeding access to formal diagnostic evaluations for autism. Research also suggests that groups on the margins of autism, specifically those who are not White, young, or assigned male at birth, receive later diagnoses, if diagnosed at all. In particular, individuals who are autistic and LGTBQ+ are likely to not be afforded opportunities to be assessed and diagnosed. We conducted interviews with 65 queer and transgender autistic adults who either self-identified as autistic or had a formal autism diagnosis about their experiences with and perceptions of autism diagnosis. We found that participants derived a sense of meaning and affirmation from their autistic diagnosis and/or identity, faced significant barriers and deterrents to diagnosis, and experienced invalidation as both a barrier to and product of diagnosis. We argue that self-identified autistic individuals provide valuable context and data for many of the social processes and preferences reported by autistic people. We offer recommendations for research and services, specifically that many should not require formal autism diagnoses of participants.
Lay abstract
Most autism research and services focus on individuals with formal autism diagnoses. However, autism activists and self-advocates have raised awareness about the challenges that can prevent individuals from seeking or getting an autism diagnosis. We interviewed 65 queer and transgender adults who either self-identified as autistic without a formal diagnosis or who had a formal autism diagnosis. We found that participants made meaning of their autistic diagnosis and/or identity and found affirmation in this, faced significant barriers and deterrents to getting diagnosed, and experienced invalidation as both a barrier to and product of diagnosis. Due to the challenges that individuals face in getting a diagnosis, we recommend that researchers and advocates consider including self-identified autistic individuals in research and services.
Steeped in the AsianCrit theoretical framework, the current study examined how anti-Asian hate impacted the mental health of Asian and diasporic Asian doctoral women in STEM. Findings highlight the need for faculty to challenge institutional norms that perpetuate the erasure of the toll that anti-Asian hate levied on Asian doctoral women in STEM.
Background
People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization.
Objective
This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI.
Methods
This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ≥18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments.
Results
This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027.
Conclusions
We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders.
Trial Registration
ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509
International Registered Report Identifier (IRRID)
DERR1-10.2196/64575
Introduction
The concept of the commercial determinants of health (CDH) is used to study the actions of commercial entities and the political and economic systems, structures, and norms that enable these actions and ultimately influence population health and health inequity. The aim of this study was to develop a typology that describes the diverse set of activities through which commercial entities influence population health and health equity across industries.
Methods
We conducted a scoping review to identify articles using CDH terms (n = 116) published prior to September 13, 2022 that discuss corporate activities that can influence population health and health equity across 16 industries. We used the qualitative constant comparative method to inductively code descriptions and examples of corporate activities within these articles, arrange the activities into descriptive domains, and generate an overarching typology.
Results
The resulting Corporate Influences on Population Health (HEALTH-CORP) typology identifies 70 corporate activities that can influence health across industries, which are categorized into seven domains of corporate influence (i.e., political practices, preference and perception shaping practices, corporate social responsibility practices, economic practices, products & services, employment practices, and environmental practices). We present a model that situates these domains based on their proximity to health outcomes and identify five population groups (i.e., consumers, workers, disadvantaged groups, vulnerable groups, and local communities) to consider when evaluating corporate health impacts.
Discussion
The HEALTH-CORP typology facilitates an understanding of the diverse set of corporate activities that can influence population health and the population groups affected by these activities. We discuss how the HEALTH-CORP model and typology could be used to support the work of policy makers and civil society actors, as well as provide the conceptual infrastructure for future surveillance efforts to monitor corporate practices that affect health across industries. Finally, we discuss two gaps in the CDH literature that we identified based on our findings: the lack of research on environmental and employment practices and a dearth of scholarship dedicated to investigating corporate practices in low- and middle-income countries. We propose potential avenues to address these gaps (e.g., aligning CDH monitoring with other occupational health monitoring initiatives).
Objectives
System-wide learning for patient safety is a core challenge for the health care sector, despite the prevalence of localised reporting and learning approaches. There is growing interest in how health care services could emulate other safety-critical sectors with the introduction of specialist safety investigation agencies to inform sector-wide safety. This paper reports on a study of the introduction and early operation of one such agency in the English health and care system.
Methods
This was a qualitative interview study carried out between 2019 and 2021 and co-designed through a partnership between University researchers and the Executive Team from the Healthcare Safety Investigation Branch (HSIB) to explore the organisational development of this ‘first of type’ organisation. The study involved interviews with 33 internal and external stakeholders and documentary analysis of HSIB reports.
Results
The study findings highlight the organisational competencies and developmental challenges experienced in the early years of HSIB operations focusing on (i) independence and fit within the wider system; (ii) the selection and scope of investigations; (iii) the methodology and investigation approach; and (iv) the skill and competencies of investigators.
Conclusions
This study offers practical learning to health care decision-makers about the importance of securing independence and integration, about the production of system-wide learning, the standardisation of robust methodologies and the support for a multidisciplinary specialist workforce.
This paper describes the design and evaluation of the O̲rganic chemistry R̲epresentational C̲ompetence A̲ssessment (ORCA). Grounded in Kozma and Russell's representational competence framework, the ORCA measures the learner's ability to interpret , translate , and use six commonly used representations of molecular structure (condensed structures, Lewis structures, skeletal structures, wedge-dash diagrams, Newman projections, and chair conformations). Semi-structured interviews with 38 first-semester organic chemistry learners informed the development of the ORCA items. The ORCA was developed and refined through three pilot administrations involving a total of 3477 first-semester organic chemistry students from multiple institutions. The final version of the ORCA was completed by 1494 students across five institutions. Various analyses provided evidence for the validity and reliability of the data generated by the assessment. Both one-factor and three-factor correlated structures were explored via confirmatory factor analysis. The one-factor model better captured the underlying structure of the data, which suggests that representational competence is better evaluated as a unified construct rather than as distinct, separate skills. The ORCA data reveal that the representational competence skills are interconnected and should consistently be reinforced throughout the organic chemistry course.
While the implementation of English-medium instruction (EMI) in many elite universities is established as common sense, it is fraught with challenges and contradictions. In post-colonial multilingual contexts such as Hong Kong, we argue that EMI is sustained by neoliberal coloniality, whereby its status as an enduring legacy of the hegemonic colonial order is maintained by contemporary neoliberal imperatives. From a stancetaking perspective we examine how members of the public take up stances on EMI on an online forum, in response to an initial thread openly criticising its use on a social work programme at a Hong Kong university. Our analysis of 480 posts shows a range of stances with regard to three recurrent themes, namely practicality, flexibility and fairness. The findings indicate that EMI attracted strong affective rejection from some due to perceived impracticality and inflexibility in its implementation, as well as issues of inclusion in relation to students’ different linguistic repertoires. Conversely, they also reveal deeply entrenched ideologies supporting the use of EMI, most notably for its purported practicality and promised benefits. We conclude by reflecting on the value of stancetaking in understanding ideology and the specific ideological and practical implications of EMI in Hong Kong.
Background
Neonates undergoing emergency abdominal surgery frequently require a stoma; closing this stoma with a second operation is an essential part of recovery. Timing of closure varies. Optimal timing is unclear and would be best resolved through a randomised controlled trial; such a trial is likely to be challenging.
Aim
To determine if it is feasible to conduct a clinical trial comparing ‘early’ versus ‘late’ stoma closure in neonates.
Design
Mixed methods comprising three parallel workstreams incorporating: a clinician survey, prospective observational cohort study, parent interviews, focus groups, database analyses and consensus meeting.
Setting
Specialist neonatal surgical centres across the United Kingdom.
Participants and data sources
Neonatologists, neonatal surgeons, neonatal dietitians and neonatal nurses who care for neonates with stomas. Neonates with recent stoma, their parents and the clinicians looking after them. Three existing, overlapping clinical databases.
Results
One hundred and sixty-six professionals from all 27 neonatal surgical centres completed the survey: 6 weeks was the most common target time for stoma closure across clinical scenarios, although there was wide variation. Timing of closure was influenced by nutrition, growth and stoma complications.
The prospective cohort study enrolled 56 infants from 8 centres. Infants were mostly preterm with necrotising enterocolitis or intestinal perforation. Clinicians identified extreme preterm gestation and clinical conditions as reasons for not randomising babies into a hypothetical trial comparing early and late stoma closure. Parents and healthcare professionals identified that comparator arms needed more clinical flexibility in relation to timing of stoma closure.
Analysis of existing databases revealed wide variation in current timing of stoma closure in neonates and identified approximately 300 eligible infants for a trial per annum in the United Kingdom.
Conclusions
A trial of ‘early’ compared to ‘late’ stoma closure in neonates is feasible and is important to families and health professionals. The population of eligible babies in the United Kingdom is sufficient for such a trial. Challenges centre around lack of equipoise in certain scenarios, specifically: extremely preterm infants; infants waiting too long for stoma closure in the ‘late’ comparator; and logistical issues in closing a stoma at a trial-allocated time. These challenges are addressable by incorporating flexibility based on gestation at birth, communicating that both trial arms are standard practice and valid treatment options, and providing resources, for example, for operating lists.
Future work
We recommend the following population, intervention, comparator and outcome as a starting point to inform future trial design. Population: neonates with stomas (excluding those with a fixed treatment pathway). Intervention: stoma closure at 6 weeks and after 32 weeks post conceptual age. Comparator: expectant management with stoma closure undertaken when the clinical team determines is best for the infant. Primary outcomes: weight gain/growth or length of hospital stay.
Study registration
This study is registered as IRAS Project ID 278331, REC Reference 20/LO/1227.
Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128617) and is published in full in Health Technology Assessment ; Vol. 28, No. 71. See the NIHR Funding and Awards website for further award information.
Entrepreneurs in their 50s and beyond face significant identity shifts and well-being challenges as they transition out of the businesses they have built. Grounded in Super’s career-development framework and utilizing the Eisenhardt Method for case study analysis, this research explores the entrepreneurial exit process during the maturity and decline stages. With an average business tenure of 11 years, these entrepreneurs encounter emotional and practical hurdles, such as health concerns, financial pressures, and shifting priorities. The study highlights valuing identity diversification and social support in easing the transition, revealing that financial success alone does not guarantee positive post-exit well-being. Gender differences show women prioritize sustainability and family, while men focus on growth and professional identity. These insights underscore the need for early exit planning and holistic support for successful entrepreneurial succession and retirement strategies.
JEL CLASSIFICATION: L26: Entrepreneurship; D91: Intertemporal Household Choice; Life Cycle Models and Saving; M14: Corporate Culture; Diversity; Social Responsibility; J14: Economics of the Elderly; Economics of the Handicapped; Non-labor Market Discrimination; I31: General Welfare, Well-being
Background
Consumer involvement in healthcare service organisation and policy development is recognised globally as a vital strategy in improving the quality and patient-centredness of care. There are significant gaps in knowledge about consumer involvement in practice, including consumers’ engagement in the process of enhancing cancer services. This study aimed to explore consumers’ perspectives on their involvement in cancer service improvement.
Methods
Cancer consumer representatives were recruited through Victorian Integrated Cancer Services, Australia. Eligible consumers were, or had been, a member of a health service improvement-related committee or project and attended at least one meeting with health professionals. Semi-structured qualitative interviews were conducted online and transcribed verbatim. Data were analysed using inductive thematic analysis.
Results
Six experienced consumer representatives were interviewed. Perspectives on their involvement in improving cancer services were categorised into three major topics. The first addressed personal aspects of involvement, in which participants described personal motivations (e.g., having lived experience of cancer themselves or in their family), challenges encountered in committee involvement, experiences of received support in their role as a consumer representative, concerns about narrow representation, and their evolving identity as a consumer representative. The second discussed practical contributions made by consumer representatives to improve systems and services. Participants detailed their active engagement with committees and consumer-led projects, contributing both their cancer experiences and general or professional skills. The third topic focused on directions for improving consumer involvement in the health system. Suggestions highlighted widening consumer representation to include often marginalised voices to inform decision-making at local committee and health system levels.
Conclusions
This study enhances the real-world understanding of the role that consumer representatives play in improving cancer health services. The strategies suggested in our research provide the opportunity to enhance consumer involvement and pave the way for more effective cancer service planning and implementation across diverse healthcare settings.
Background
Serious Illness Conversations (SICs) are not consistently integrated into existing inpatient workflows.
Objective
We assessed the implementation of multiple interventions aimed at encouraging SICs with hospitalized patients.
Methods
We used the Consolidated Framework for Implementation Research to identify determinants for conducting SICs by interviewing providers and the Expert Recommendations for Implementing Change to develop a list of interventions. Adult patient encounters with a Readmission Risk Score (RRS) > 28% admitted to a general medicine service from January 2019 to October 2021 and without standardized SIC documentation in the prior year were included. A multivariable segmented logistic regression model, suitable for an interrupted time series analysis, was used to assess changes in the odds of standardized SIC documentation.
Results
Barriers included those associated with the COVID‐19 pandemic, such as extreme census. Facilitators included the presence of the Speaking About Goals and Expectations program and palliative care consultations. Key interventions included patient identification via the existing Quality and Safety Dashboard (QSD), weekly emails, in‐person outreach, and training for faculty and trainees. There was no significant change in the odds of standardized SIC documentation despite interventions (change in temporal trend odds ratio (OR) 1.16, 95% Confidence Interval (CI) 0.98–1.39).
Conclusion
The lack of significant change in standardized SIC documentation may be attributed to insufficient or ineffective interventions and COVID‐19‐related challenges. Although patient identification is a known barrier to SICs, this issue was minimized with the use of the QSD and RRS. Further research is needed to enhance the implementation of SICs in inpatient settings.
Background and aims
Involuntary civil commitment (ICC) is a legal process by which people are compulsorily admitted to substance use treatment. This study explored views about and promotion of ICC procedures for substance use disorders among public health‐public safety post‐overdose outreach programs and their outreach team members in Massachusetts, USA.
Design
In this mixed‐methods study, survey data were collected from post‐overdose outreach programs in 2019, and semi‐structured interviews were conducted with outreach team members in 2019 and 2020.
Setting
Massachusetts, USA.
Participants
We received 138 survey responses and conducted 38 interviews with post‐overdose outreach team members (law enforcement officers, recovery coaches, social workers and harm reductionists) who were majority male (57%) and white (66%).
Measurements
We used the survey instrument to categorize programs as more (discussed ICC at 50% or more of outreach encounters) or less ICC focused (discussed ICC at less than 50% of outreach encounters) and to identify program characteristics that corresponded with each categorization. Semi‐structured interviews explored staff perceptions of ICC effectiveness.
Findings
Among 138 programs, 36% ( n = 50) discussed ICC at 50% or more of outreach encounters. Discussing ICC at a majority of visits was positively associated with abstinence‐only program philosophies (36% v. 6%, P < 0.001) and collaborating with drug courts (60% v. 30%, P < 0.001), but negatively associated with naloxone distribution (48% v. 75%, P < 0.001) and referring to syringe service programs (26% v. 65%, P < 0.001). Qualitative interviews identified three themes: 1) some programs viewed ICC as a first line tool to engage overdose survivors in treatment; 2) other programs considered ICC a last resort, skeptical of its benefits and concerned about potential harms; 3) families commonly initiated discussions about ICC, reportedly out of desperation.
Conclusions
Promotion of involuntary civil commitment (ICC) appears to vary widely across post‐overdose outreach programs in Massachusetts, USA, with approaches ranging from seeing it as a first step to treatment to being a tool of last resort. Demand for ICC among family members may relate to inadequate access to voluntary treatment. Family interest in ICC appears to be driven by inadequate availability of treatment and other services. ICC at post‐overdose outreach visits should be limited, if used at all.
Objectives
The Bronchiolitis Endotracheal Surfactant Study (BESS) is a randomised controlled trial to determine the efficacy of endo-tracheal surfactant therapy for critically ill infants with bronchiolitis. To explore acceptability of BESS, including approach to consent within a limited time frame, we explored parent and staff experiences of trial involvement in the first two bronchiolitis seasons to inform subsequent trial conduct.
Design
A mixed-method embedded study involving a site staff survey, questionnaires and interviews with parents approached about BESS.
Setting
Fourteen UK paediatric intensive care units.
Participants
Of the 179 parents of children approached to take part in BESS, 75 parents (of 69 children) took part in the embedded study. Of these, 55/69 (78%) completed a questionnaire, and 15/69 (21%) were interviewed. Thirty-eight staff completed a questionnaire.
Results
Parents and staff found the trial acceptable. All constructs of the Adapted Theoretical Framework of Acceptability were met. Parents viewed surfactant as being low risk and hoped their child’s participation would help others in the future. Although parents supported research without prior consent in studies of time critical interventions, they believed there was sufficient time to consider this trial. Parents recommended that prospective informed consent should continue to be sought for BESS. Many felt that the time between the consent process and intervention being administered took too long and should be ‘streamlined’ to avoid delays in administration of trial interventions. Staff described how the training and trial processes worked well, yet patients were missed due to lack of staff to deliver the intervention, particularly at weekends.
Conclusion
Parents and staff supported BESS trial and highlighted aspects of the protocol, which should be refined, including a streamlined informed consent process. Findings will be useful to inform proportionate approaches to consent in future paediatric trials where there is a short timeframe for consent discussions.
Trial registration number
ISRCTN11746266.
Beginning teachers benefit from preparation emphasizing supporting students with diverse needs and developing deeper understandings of algebraic connections. Our study aims to explore how instructors in secondary preparation programs and mathematics preservice teachers (M-PSTs) conceptualize and enact algebraic connections in required courses. Our dataset comprises instructor interviews and course materials from 48 courses across five universities, and 10 focus group interviews involving 37 M-PSTs. Employing constant comparison method, we analyzed data by creating a coding system for algebraic connections. Our findings highlight varying perspectives of M-PSTs and instructors related to encounters with algebraic connections, emphasis of algebraic connection types by both groups, and types emphasized as main objectives of courses in five secondary mathematics teacher education programs. We describe nine algebraic connection themes that were identified in this investigation. We discuss emergent implications for curriculum development, instructional practices, and foundational algebraic concepts in teacher preparation programs.
Among those for whom there were heightened concerns regarding the pivot to online learning during the COVID-19 pandemic were neurodiverse youth. Despite the preponderance of research into online learning during the pandemic, relatively few studies have directly observed the experiences of neurodiverse youth. We present findings from a longitudinal study in which we qualitatively analyzed using an idiographic approach the nearly 2,000 minutes of video recordings of 9 neurodiverse youth learning digital art design via the Zoom platform. The themes we developed from the patterns observed suggest how online learning may both enable and inhibit neurodiverse students’ syncing their communication with ongoing conversations with others, achieving intersubjectivity (shared understanding) with others, coping with frustration, and personal disclosures for building rapport with others. Notably, we observed evidence suggestive of benefits and detriments of online learning for each neurodiverse youth. We discuss implications for the design and implementation of online learning opportunities for neurodiverse youth.
Das Kapitel stellt die morphologische Medienanalyse als komparative Methode vor, mit der sich einzelne Medienangebote, Medienrepertoires und der Wandel medialer Formen vergleichend untersuchen lassen. Im Beitrag wird das analytische Potenzial anhand der Untersuchung journalistischer Inhalte medienspezifisch konturiert und methodologisch als primär qualitatives Verfahren konkretisiert. Auf eine einführende interdisziplinäre Einbettung des Ansatzes folgt eine knappe Skizze des theoretischen Hintergrunds sowie die Vorstellung der für die Fallanalysen festgelegten Basiskategorien. Anschließend wird das Verfahren anhand der beispielhaften Analyse populärjournalistischer Medienangebote illustriert. Der Beitrag schließt mit einer Zusammenfassung zentraler Charakteristika und Potenziale der Methode.
Motivated by the prevalence of an aging population and the associated increase in chronic diseases, coupled with rising medical expenditure, the Korean government initiated a pilot project in Pyeongchang-gun, Gangwon-do, a rural area, to implement a “smart online-to-offline (O2O) digital health care model” aimed at managing and preventing chronic diseases. However, there is limited understanding regarding perspectives and levels of preparedness for digital health among stakeholders at various levels. In-depth focus group interviews were conducted with elderly and non-elderly community members, health care providers, and staff members at Pyeongchang Health and Medical Center. The study found the presence of both positive and negative perceptions and a lack of preparedness across different levels. At the end-user level, it was observed that community members, especially the elderly, have low levels of health and digital literacy, compounded by limited access to social support. At the health care provider level, there was uncertainty about the acceptance of the digital health program. At the area level, the need to bolster health staff members and enhance their capacity was observed. Recommendations include: customizing the design of the online and offline service components by considering end-user factors (such as age, occupation, and household type) that may contribute to disparities in health; establishing a platform for providers to share their experiences to facilitate the effective incorporation of digital health into their practices; and preparing an appropriate provider payment mechanism.
Background and Objectives
Despite advances in treatment and outcomes for paediatric heart failure, both physical and psychosocial comorbidities remain notable among this patient population. We aimed to qualitatively describe the psychosocial experiences of adolescent and young adults with heart failure and their caregivers’ perceptions, with specific focus on personal challenges, worries, coping skills, and resilience.
Methods
Structured, in-depth interviews were performed with 16 adolescent and young adults with heart failure and 14 of their caregivers. Interviews were recorded and transcribed. Content analysis was performed, and themes were generated. Transcripts were coded by independent reviewers.
Results
Ten (63%) adolescent and young adults with heart failure identified as male and six (37.5%) patients self-identified with a racial or ethnic minority group. Adolescent and young adults with heart failure generally perceived their overall illness experience more positively and less burdensome than their caregivers. Some adolescent and young adults noted specific worries related to surgeries, admissions, major complications, death, and prognostic/treatment uncertainty, while caregivers perceived their adolescent and young adult’s greatest worries to be around major complications and death. Adolescent and young adults and their caregivers were able to define and reflect on adolescent and young adult experiences of resilience, with many adolescent and young adults expressing a sense of optimism and gratitude as it relates to their medical journey.
Conclusions
This study is the first of its kind to qualitatively describe the psychosocial experiences of a racially and socioeconomically diverse sample of adolescent and young adults with heart failure, as well as their caregivers’ perceptions of patient experiences. Findings underscore the importance of identifying distress and fostering resilient processes and outcomes in young people with advanced heart disease.
Introduction
Virtual patients (VPs) are increasingly used in health professions education. How learners engage with VPs and the relationship between engagement and authenticity is not well understood. We explored learners' perceptions of VP education to gain an understanding of the characteristics promoting meaningful engagement in learning, including perceived authenticity.
Methods
Using a constructivist grounded theory approach, we conducted interviews and focus groups with 11 students from 2 Canadian Physician Assistant programs, where VP learning was implemented to supplement clinical education during the COVID-19 pandemic. We explored trainee perspectives on the use of VPs as an educational modality. Data were iteratively collected and descriptively analyzed thematically using a constant comparison approach until theoretical sufficiency was reached.
Results
We identified 3 groups of factors influencing these students' VP learning experiences: (1) technical factors related to the VP platform influenced the perceived authenticity of the patient interactions; (2) individual factors of learners' attitudes influenced their engagement and motivation; and (3) contextual factors related to the learning environment influenced the acceptability and perceived value of the learning experience. Overall, the psychological authenticity of the learning platform and students' motivation for self-directed learning were perceived as most important for students' learning experiences.
Conclusions
Implementing VP learning as a supplement to clinical education should be done with consideration of factors that enhance the psychological authenticity of the learning platform, promote learner engagement and accountability, and encourage acceptability of the learning modality through curricular placement and messaging.
Within a changing research and media landscape, misconceptions and misinformation about microorganisms and microbiomes can arise, necessitating improvements in science communication practices through insights in public perceptions of the microbial world. Yet, little is known about public perceptions of microorganisms and microbiomes, making it difficult to develop tailored messaging. Here we perform an inductive thematic analysis with interviews and surveys from thirty adults across the United States to identify key factors to enhance microbial science communication efforts. Together, our results underscore the importance of 1) recognizing the existing and desired future knowledge of an audience, 2) aligning with broader socio-scientific issues that resonate with people in relevant channels using social networks, 3) fostering collaboration between microbiologists, social scientists, and communicators to improve messaging, and 4) appealing to people’s values and emotions to establish meaningful connections. This study concludes that non-microbial interests, such as an interest in health and wellness, may lead to acquisition of microbial knowledge and that people want scientists to share microbial messages preferably on platforms like social media. Additionally, we identified confusion about microbial terms and a desire to understand human-centric benefits of microorganisms and microbiomes. We suggest that microbiologists partner with science communicators to develop microbial messaging, capitalizing on connections to non-microbial interests and appealing to people’s microbial worldview.
Despite the reality that advocates frequently expend significant resources to pass symbolic policies, this policy design has often been neglected by policy studies scholarship. We combine policy design and policy feedback theory to examine this oft overlooked policy design in practice using the case of California's human right to water law (Assembly Bill 685, or AB 685). Through semi‐structured interviews, archival research, and document analysis, we reveal how grassroots advocates deliberately and effectively pursued AB 685 to build power across the water justice movement and catalyze narrative change about drinking water access, while also building state responsiveness on the topic. These interpretive policy feedback effects then accelerated the policy's resource effects through formal policy changes in funding allocations, administrative structures, and regulatory systems. Collectively, feedbacks from AB 685 have transformed the sociopolitics of drinking water access. Contrary to prevailing wisdom, the policy's ambiguity proved key to building the broad coalition necessary to accomplish these changes, and it facilitated work across policy venues and governance scales through time, which is critical to enacting transformational change. Based on these findings, we argue that symbolic policies merit attention as a potentially advantageous policy design for social movements seeking social change and transformation.
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For sequential and especially historical prediction the principal components are simple persistence, the continuation of orderly trends, recapitulated experience, and planning. But even in combination, these components are inadequate for predicting changes in the rate of change, changes in direction, and large-scale alterations typified by revolutions. The multiplier effects of innovations, leading to accelerated change and to thresholds of radical transformation, provide a major basis for predicting discontinuous change. Finally, the ubiquity of social tensions is a necessary but quite insufficient condition for revolution; other necessary conditions include a centralized polity, considerable urbanization, and effective internal communications. Polarization, a harbinger of revolution, results from a widespread relative or absolute deterioration of economic well-being or political rights, and the failure of elites to make timely concessions.
Comparative sociological studies attempt to develop concepts and generalizations at a level between "pure theory" and descriptive area studies. They help to elucidate the time-and-space limitations of sociological concepts that have less than universal applicability and to uncover the generalizations hidden in many "composite concepts." Positively, they can help us develop typologies of social actions and structures and assess their characteristic range of variation. These contributions are exemplified on the basis of classic comparative studies and of the author's studies of the "political community."
However,this tendency may have to be suppressedin favor of the purpose of the first ap-proach, but in the second approach andthe approach to be presented here, it isused purposefully as an analytic strategy
- Robert K Merton