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A growing number of researchers are trying to provide explanations for continuity and change in drug policy in different contexts. Such research predominantly falls in the pluralist realm of public policy where various actors compete to have their policy proposals accepted. Using a critical framework called Policy Constellations (PC), developed by Stevens and Zampini, this paper attempts to explain reactions of the British Government to Novel Psychoactive Substances (NPS) between 2008 – 2016. Qualitative data comes from in-depth interviews with stakeholders (N = 15), including NGO workers, a former Home Secretary, drugs ministers, governmental advisors, a former senior police officer, former Deputy Drug Coordinator, and a former Advisory Council for the Misuse of Drugs (ACMD) member. Two 'constellations' competed in British NPS policy setting. The PC framework illustrates power imbalances between these competing stakeholders. Abstinence orientated actors (the conservative constellation) enjoyed strategic advantages and media power which allowed them to create a favourable policy setting. These advantages were not enjoyed by the liberal constellation who struggled to access the policy setting and influence policy developments. The prohibitive nature of the policy used to counter NPS can be explained with the domination of actors whose values align with the conservative constellation. [ABSTRACT FROM AUTHOR]

Despite a sound policy framework, the right of learners with disabilities in South Africa to inclusive and equitable quality education is not being met. A key reason hindering the realisation of this right is that there are very few teacher education programs focused on supporting learners with disabilities. Acknowledging the urgency of teacher education, in this paper we draw on qualitative data from 109 teacher participants and 39 course facilitators of a series of disability inclusion-focused teacher education short courses in the Western Cape province of South Africa. Based on their experience of the courses, we consider how teachers can be empowered to meet the diverse needs of their learners within an inclusive framework. Findings highlight that professional and personal growth facilitated a more empathic understanding of learners and the opportunity to collaborate with others, enabling teachers to find creative ways of solving problems faced in their workplaces. To support teachers in meeting the needs of their learners, teacher training should facilitate active reflection on the role they play in shaping the lives of their learners, and prepare teachers to respond to challenges strategically, taking advantage of the resources available to them within and beyond their school environment. [ABSTRACT FROM AUTHOR]

Sexual revictimization can have a negative impact on many facets of women's wellbeing, yet limited evidence exists regarding specific interventions that support healing and the reduction of further revictimization. This paper will explore regional and rural women's experience of a group-based empowerment program, the Shark Cage program, in Victoria, Australia. The "Shark Cage" program aims to address revictimization by empowering women and girls to build personal boundaries and assertiveness within the context of gender equality and human rights. Data were collected via participant observations across the 8-week program, in combination with semi-structured interviews with participants (N = 11) pre and post intervention. All participants had access to therapeutic support outside of the program. Findings indicate that the program fostered connections among women with shared experiences of sexual revictimization, reducing feelings of isolation. Participants detailed the benefit of developing and practicing skills in reducing revictimization, such as assertiveness and boundary setting. Program learning and recovery was embedded within a network of embodied emotions, social connections, cultural norms and place-based relations that influenced how participants recovery could be understood, processed and addressed. [ABSTRACT FROM AUTHOR]

This paper authentically represents the voices of non-verbal children with cerebral palsy using a case study design. Policy suggests that children should have the right to play and leisure opportunities, however non-verbal children with cerebral palsy have fewer choices. Additionally, children with communication, learning and mobility limitations are usually excluded from research. The aim of this research was to capture the voices of non-verbal children by exploring their well-being impact in terms of their experiences and choices about their level of participation in recreational activities. A qualitative case series study included interviews, observations, photographs and diaries. Where possible, the diaries were completed by both caregivers and children. Data were analysed thematically, and the lens of positioning theory applied. Seven children aged nine to sixteen years participated. The findings showed how equipment, people and environments enabled or hindered the children's participation. The children also advocated as champions for their own well-being. Positioning theory was applied across the data and was adapted offering a way to better understand the children's well-being responses. The findings demonstrate how these children were able to self-advocate, demonstrating their well-being by their intentional behaviours from their level of participation in a recreational activity. The voices of non-ambulant and non-verbal children are underrepresented in the literature. This study offers an innovative approach to highlight their voices using visual data. The images project the narrative about their choices for participation in recreational activities. The proposed kaleidoscope of well-being offers a way to demonstrate the fluctuations in their emotional responses from their participation. Choices for participation in recreational activities remains limited for non-ambulant and non-verbal children with cerebral palsy. Designers and policy makers should consider how equipment and environments can be adapted or created to increase the choices for non-ambulant and non-verbal children with cerebral palsy. Practitioners in health and social care should consider how to listen to the voices of non-verbal and non-ambulant children with cerebral palsy and their parents/guardians and work towards jointly setting participation goals to affirm their strengths. [ABSTRACT FROM AUTHOR]

This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Rehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement. The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations. Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process. Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run. [ABSTRACT FROM AUTHOR]

A growing body of conceptual evidence over the last decade has increased our understanding of parents' experiences of having an infant with complex congenital heart disease. These concepts include parents' feelings of uncertainty, fear, excitement, and mastery. However, little is known about parents' experiences, confidence, and knowledge acquisition during transition from hospital to home with their infant after the first stage of complex cardiac surgery. A theoretical framework to assess, plan and implement child and family centered care would assist children's cardiac nurses responsible for parental education, discharge planning and coordination. To explore parents' experiences of the transition from hospital to home with their infant, following the first stage of cardiac surgery. A prospective mixed methods longitudinal design. Semi-structured interviews were undertaken, including administration of the Maternal Confidence Questionnaire at four timepoints: before discharge following stage one cardiac surgery (T0), 2 weeks' post discharge (T1), 8 weeks' post discharge (T2) and after stage two surgery (T3). Qualitative data were thematically analyzed. Descriptive statistics were used to characterize the sample and non-parametric repeated measures analysis of variance was used to analyze changes over time in maternal confidence scores. Sixteen parents of 12 infants participated. Four "patterns of transition experience" emerged, the fourth "Mastery", is discussed in this paper. Mastery can be contextualized in terms of the parents' journeys of knowledge construction, gaining confidence and reflection. Learning was dynamic and transformational, but successful learning and acquisition of knowledge was also dependent upon the parents' ability to absorb, integrate and adjust at any given time. Confidence at T0 was significantly lower than at T1 (p =.011), T2 (p =.018) and T3 (p =.012). There were no significant differences between scores at T1, T2 and T3. Liminality, as a concept, described the between and betwixt time that parents experienced as they were preparing for discharge from hospital; excitement to be going home balanced with the fear of being alone and confidence in looking after their fragile infant. Parents of infants with complex congenital heart disease obtain knowledge, confidence, and mastery dependent upon their transition experience and their personal journey through pre-liminal, liminal, and post-liminal phases of discharge from hospital to home. A conceptual framework "Parenting through Transitions – hospital to home" emerged that could assist in structuring assessment of parents' knowledge and support needs within a coordinated discharge process. Identifying individualized support would promote adaptation and adjustment during transition from the pre to post liminal phase, following their infant's first stage of complex cardiac surgery. Parents learning was dynamic and transformational, learning opportunities overlapped transitional phases of their infant's journey, but successful learning and acquisition of knowledge was also dependent upon the parents' ability to absorb, integrate and adjust at any given time. The transition from hospital to home and traversing the physical boundary of leaving the hospital for the first time with their infant (liminal phase), was loaded with emotionally traumatic experiences that could not be separated from the transition that was being explored within this study. Adjusting to the new situation, developing confidence over time, and becoming comfortable as they mastered new skills, demonstrated that some of these parents could pass through that liminal space to mastery of a new normal (post-liminal phase), which encompassed competence, integration, and comfort. [ABSTRACT FROM AUTHOR]

Building synergies is seen as an effective strategy to address and decrease existing fragmentation in health systems of low-and middle-income countries (LMICs). To that end, different programmes, such as the Sector Wide Approach, have been adopted to increase health system synergies. Despite these efforts, fragmentation remains an enduring problem, hampering health system performance in LMICs. This study is part of the Lancet Commission on synergies between Universal Health Coverage, Health Security, and Health Promotion; we aimed to document synergising strategies adopted by Rwanda. Data for this paper came from a qualitative study including in-depth interviews of 15 key informants and a document review. A thematic analysis embracing deductive and inductive approaches was used to analyse the data. We found that Rwanda adopted three main strategies to increase health system synergies: (1) alignment of health programmes with national health policies and strategies, (2) increased coordination across national health institutions, and (3) effective monitoring and evaluation frameworks. Achieving synergies in a low-resource country is challenging but not impossible. To meet the target of global health agendas such as the Sustainable Development Goals and the prevention of future global pandemics, efforts to increase health system synergies in LMICs need to be strengthened. [ABSTRACT FROM AUTHOR]

Understanding Twitter by individuals and organizations to raise awareness and give voice to the disability community provides important insight into digital discourse around disability. This study examines #disability tweets shared during National Disability Employment Awareness Month in October 2018. Sourced and cleaned, English language tweets (n = 12,963) were analyzed through a mixed-methods approach. As the title of this paper, a tweet from our dataset, suggests, Twitter discourse reflects disability activism and culture as it exists globally. This work highlights important methodological considerations for differentiating the ways individuals and organizations utilize Twitter and highlights the importance of qualitative analysis in this regard. [ABSTRACT FROM AUTHOR]

Adolescence is a time of particular risk for violence perpetrated by parents, teachers, peers and intimate partners. Social norms that condone violent discipline, promote masculinities focused on violence, and support gender inequality play an important role in perpetuating violence. However, little is known about the relationship between inequitable gender norms and children's experiences of violence from parents or other adults in the household. Utilising data from the Gender and Adolescence: Global Evidence (GAGE) study, this paper explores how adolescent and household attitudes and community-level gender norms influence experiences of violence among young adolescents (aged 10–12) in Ethiopia. Our results show that community norms, rather than adolescent and household attitudes, are significantly associated with experiences of household violence. This result holds for boys and girls, and in rural areas. In urban areas, however, adolescent attitudes were more influential than community norms, perhaps indicating less cohesive communities. Overall, these findings suggest that violence prevention programming should prioritise shifting community norms, particularly in rural areas, in order to promote adolescent girls' and boys' right to bodily integrity. [ABSTRACT FROM AUTHOR]

Social work is a practice-based profession with social justice as a core value and ethical principle. Social work programs incorporate social justice into both the explicit and implicit curricula. However, there has been a longstanding divide in how to address social justice at systemic levels while fostering socially just and competent practice. The aim of this qualitative study was to examine how MSW students describe their learning about social justice and social work practice. To explore this area of inquiry, we conducted three focus groups (N = 16) with current MSW students or recent MSW graduates from Canadian social work programs. Participants described the following five themes that either facilitated or created barriers in their learning about social justice and social work practice: 1) reflection on practice, 2) negotiating discomfort, uncertainty, and safety, 3) learning from lived experiences, 4) learning how to embody social justice in practice, and 5) receiving support, supervision, and coaching. We discuss the implications for social work education and practice. [ABSTRACT FROM AUTHOR]

While the field of recovery science has burgeoned over the past two decades, little research has considered the experiences of university students in recovery from addiction, particularly in Canada. Addressing this gap, using a recovery capital framework, 16 qualitative interviews were conducted to explore students' meanings, experiences, and barriers/facilitators to recovery from problematic substance use and/or behaviors. Reflexive thematic analysis revealed three main themes: 1. multiple recovery pathways and identities; 2. stigma and disclosure; and 3. proximity to campus community and resources. Recommendations to create more recovery-friendly campuses are provided. [ABSTRACT FROM AUTHOR]

Faculty development programs (FDPs) are an effective, evidence-based method of promoting knowledge, skills and self-efficacy of faculty. However, implementation and sustainability of curricular capstone projects developed by faculty as part of these programs are rarely reported. Challenges to sustaining programmatic implementation of interprofessional FDP curricular content into academic and clinical settings over time were not found in peer-reviewed literature. To better understand the sustained impact of our geriatrics-focused FDP, we explored barriers and facilitators to implementation and sustainability of capstone projects designed by faculty Scholars in our FDP. Thematic analysis of virtual interviews with 17 Scholars revealed several key factors that impacted the implementation and Dynamic sustainability of curricular projects. Three major themes and sub-themes were identified: Project Implementation (Supportive Factors, Hindering Factors and Filling in Gaps in the Field); Pedagogical Development (Enhancement of Skills and Culture Change); and Sustainability Impact (Project Sustainability, Career Development and Passing the Torch). Results suggest it is important to ensure logistical support, dedicated time, and organizational or institutional support. Implementation of geriatrics-focused FDPs provides an evidence-based approach to sustainability. Further study of the ongoing barriers and facilitators to sustainability is encouraged. [ABSTRACT FROM AUTHOR]

This paper seeks to gain an insight into counselling supervision experiences of Singapore school counsellors (SCs). In-depth, semi-structured interview sessions with 14 SCs were conducted. Their taped interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Positive and negative aspects of their experiences included feeling more connected with other counsellors, experiencing a safe environment for sharing, and having supervision as a source of support and help; and feeling nervous about being judged or assessed, lacking in structure, and not having enough time in supervision. The Integrated Developmental Model (IDM) and Discrimination Model (DM) are discussed here to provide a framework for understanding the experiences of the SCs in group supervision. [ABSTRACT FROM AUTHOR]

In relation to clinical trials, it is far more usual to speak of the community (singular, static) than of publics (multiple, emergent). Rarely defined, the community is commonly taken to be the existing people in a given area, which the trial will engage, mobilise or sensitise to facilitate successful recruitment and retention. Communities are assumed to pre-exist the research, to be timeless, and to be a whole (sometimes consisting of different parts, referred to as stakeholder groups). In this paper, we suggest a conceptual shift from ‘trial community’ to ‘experimental publics’. Using an empirical case study of an HIV prevention trial in Zambia, we draw out the following key points: firstly, publics do not pre-exist research activities but are enacted in concert with them. Secondly, publics are dynamic and transient. And thirdly, experimental publics are situated at the intersection of various forms of inclusion and exclusion, both locally and globally. Our findings emphasise the need to create long-term forms of participation in science, which transcend both the instrumental goals and the individual timelines of specific trials. [ABSTRACT FROM PUBLISHER]

Over the past two decades there has been a growing awareness that sport may not be a positive experience for all children. For example, we know that some children experience sexual abuse in the context of organised sport, and that these offences are often committed by trusted adults, including coaches and club officials. However, less attention has been given to the physical abuse of child athletes. This paper presents a study that explored children's experiences of organised sport, as recounted by young people between the ages of 18 and 25 years in Australia. The study explored the experience of child physical abuse in organised sport including violence, overtraining, and training while injured. A mixed methods research design produced 107 survey responses and 10 in-depth interviews with young adults. Most respondents reported the positive impact that participating in sport had had on their development, but more than a third of the respondents also described experiences of overtraining, being forced to train when injured or of direct physical violence. Drawing upon a thematic analysis of the qualitative data, a conceptual model has been developed and is presented to assist in the understanding of the dynamic of secrecy, which may facilitate ongoing physical harm to children in this context. [ABSTRACT FROM AUTHOR]

Approaches to safety culture assessment may have many limits if supported exclusively by quantitative methods. Based on this, a research team developed a quantitative–qualitative approach to assess the maturity of the safety culture on an oil platform. To that end, the team sought to develop and test a method consisting of an initial ethnographic phase followed by four other distinct phases: definition of homogeneous groups; production of customized questionnaires; quantitative evaluation; and qualitative assessment. The results show the emergence of trends, from pre-defined themes in safety culture to specific levels of maturity for each of the homogeneous groups. At the same time, it was perceived that the maturity level of the groups is defined from the daily work practices developed by each one of them. This experience allowed us to propose a framework for assessing the maturity levels of safety culture for the oil and gas industry. [ABSTRACT FROM AUTHOR]

Purpose: Canadian new immigrant families (also known as newcomers) encounter challenges navigating systems when trying to access programmes critical for their children's healthy development. The purpose of this study is to understand how newcomer families find and use early childhood programmes and services from the perspective of families and early childhood educators (ECEs) working within a settlement organization. Methods: Using photovoice methodology, newcomer family members (n = 8) with young children and ECEs (n = 6) participated in a series of virtual workshops to share photos and reflect on their experiences. Results: Participants discussed the systemic barriers that obstructed newcomer families' access to services for young newcomer children. Financial challenges due to unemployment/ underemployment, language and cultural differences were emphasized. Despite these barriers and challenges, participants shared how culturally responsive programmes enhanced their connections to programmes and services. Both groups of participants discussed the critical role of social networks in supporting newcomers to use programmes by helping families become aware of available services and assistance with various processes such as registration. Conclusions: This research illustrates the lived experiences of newcomer families and identifies opportunities to address inequities, improve early childhood programmes, and enhance families' access to programmes and services. [ABSTRACT FROM AUTHOR]

Faculty from diverse disciplines are involved in teaching servicelearning where reflection is an essential component. This qualitative study explores disciplinary differences in understanding reflection and use of reflective pedagogy. We interviewed faculty (N = 24) from 18 departments to examine differences in how they conceive and practice reflective pedagogy in service-learning courses. We found that disciplinary differences are a factor in how faculty conceive and practice reflection. Faculty from health and social care disciplines demonstrated an advantage compared to colleagues from other fields. Further, we found that how faculty conceive reflection is a factor in reflective practice. Conceptualizations of reflection, which are more student-referent or learner-focused, correlate with the more intense and effective practice of reflective pedagogy. [ABSTRACT FROM AUTHOR]

The aims of this study were to explore perceptions of school-based physical therapists (SBPTs) about professional development and effective practice and to create a conceptual framework to help understand how SBPTs become effective practitioners who continue to learn and grow professionally as clinicians in an educational setting. Twenty school-based physical therapists completed a demographic questionnaire and a semi-structured interview. Guiding interview questions focused on SBPTs' perceptions of roles and responsibilities, professional development, barriers, and recommendations. Participants identified roles and personal qualities of effective SBPTs. Three concepts for the process of professional development were developed: educational context and culture, barriers to effective practice, and strategies for professional development. The development of effective practice for SBPTs is a multifaceted, iterative process involving a unique set of knowledge, skills, and behaviors that allow them to fulfill their roles. The process takes time and effort to understand the self within the educational context and culture, recognize barriers to effective practice, and develop strategies for success. A conceptual framework was developed to assist SBPTs in implementing a plan for professional development that leads to effectively providing services to students and functioning as essential members of the educational team. [ABSTRACT FROM AUTHOR]

The study's aim was two-fold: (1) to explore the experiences and perceptions of industry, academic, and research professionals concerning technologies used within aged care; and (2) to identify needs-led priorities for the future development and application of technologies within aged care. Global population ageing requires a recalibration of aged care policies, systems, and services to promote and support healthy ageing. It is expected that technology will play an important role in this regard. This study qualitatively assessed the landscape of technology use in aged care from the perspective of industry, academic, and research professionals. A purposefully designed cross-sectional survey collecting experiences, perspectives, and barriers about technology through open responses. Using convenience sampling, thirty-five participants completed an online survey between April and October 2020. A descriptive qualitative content analysis approach was used to analyse the written responses. Reporting of findings followed the EQUATOR's Standards for Reporting Qualitative Research checklist. Four themes were identified that characterised the use of technologies within aged care: (1) User Perceptions and Attitudes: wariness and reluctance to technology; (2) Systemic Issues within Aged Care: Under-resourced with opportunities for innovation; (3) Technology-Related Barriers: Equity, costs, privacy, integration, and interoperability and (4) Research Priorities: Co-design and integration of technology. The existing technology does not meet the needs of older people, aged care personnel and the system in general, which prevents its successful implementation and uptake. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is associated with medical and psychosocial challenges. SCD in adulthood is characterized by increased morbidity and mortality, vulnerability, inadequate self-management preparation, and limited social support. This study evaluated the implementation of a virtual support group during the COVID-19 pandemic using an intervention parameters framework evaluation. Participants included six adults living with SCD. Content analysis was conducted for each of the six intervention parameters, and satisfaction scores were summarized. Participants positively evaluated all intervention parameters of the virtual support group. Findings confirmed that a community-engaged intervention supports self-management and establishes key social networks for adult participants. [ABSTRACT FROM AUTHOR]

Mental health concerns among doctorate (PhD) nursing students may impact program retention, especially among underrepresented racial-/ethnic-minoritized (UREM) students. Understanding mental health concerns among UREM PhD students is necessary to develop retention strategies. We conducted a qualitative secondary data analysis of a descriptive study with focus groups and individual semi-structured interviews. Participants identified as actively enrolled UREM in PhD nursing programs. Conventional content analysis was utilized. Mental health informed retention through the following themes: PhD program pressure and expectations, help-seeking barriers, personal motivations to succeed, and it takes a village: fostering peer support. Implications for nursing faculty are discussed. [ABSTRACT FROM AUTHOR]

To explore health professionals' acceptance of the guidelines for acute whiplash associated disorders (WAD), and to identify barriers and facilitators to adherence. Qualitative descriptive study involving focus group discussions among health professionals who treat people with WAD in primary and secondary care settings in New South Wales and Queensland, Australia. Twenty-eight health professionals (physiotherapists = 19; chiropractors = 6; osteopaths = 3) participated in six semi-structured focus group discussions that were held in independent offices in Sydney and Brisbane, Australia between September and December 2015. Discussions were audio recorded and verbatim, de-identified transcripts produced. Thematic analysis was conducted using an inductive approach to identify commonly held beliefs. Acceptance of guideline recommendations appeared to be influenced by factors related to the guideline itself, practitioner and practice characteristics, and patient-related factors. Specifically, acceptance was hindered by conflicting belief systems, ambiguity in guideline recommendations, and patient characteristics and expectations. Practitioners demonstrated a positive attitude towards the use of the guidelines in general; however, in some cases, acceptance of key recommendations appeared selective. Future guideline revision and implementation might focus on explaining the underlying principles of the guidelines, providing more detailed recommendations, and involving strategies that challenge inconsistent beliefs and promote informed decision-making. Selective acceptance of guideline recommendations in favour of those not requiring practice change may present a challenge for the implementation of evidence-based practice in the management of whiplash. Participants demonstrated variable, sometimes polar attitudes to guideline key messages and recommendations. Guideline developers need to focus more strongly on changing practitioner beliefs and attitudes, as well as better explaining the underlying principles of the guidelines, and providing more detailed recommendations. [ABSTRACT FROM AUTHOR]

Objective: Despite increasing efforts to improve housing stability, research has largely defined housing stability in a narrow sense and heavily relied on objective measures, such as housing types and housing duration. The present study constructed a conceptual framework for a subjective housing stability definition from the perspectives of individuals with co-occurring mental health and substance use disorders and their behavioral health service providers. Methods: Following the principles of grounded theory, we collected and analyzed qualitative data through semistructured interviews with 24 individuals with serious mental illness and substance use problems and three focus groups with 22 behavioral health service providers. Results: We developed a conceptual framework with two domains of subjective housing stability: functional stability and experiential stability. The functional stability domain includes four theoretical concepts: meeting basic needs, housing quality, housing affordability, and housing permanence. The experiential stability domain includes four theoretical concepts: autonomy and independence, connectedness, safety, and supportiveness. Conclusions: The conceptual framework can inform future research, practices, and policies to move beyond focusing on merely providing housing to consider the diverse and underlying needs in improving housing stability and well-being among those experiencing or at risk of housing instability. [ABSTRACT FROM AUTHOR]

Young migrants in sub-Saharan Africa are particularly vulnerable to HIV-acquisition. Despite this, they are consistently under-served by services, with low uptake and engagement. We adopted a community-based participatory research approach to conduct longitudinal qualitative research among 78 young migrants in South Africa and Uganda. Using repeat in-depth interviews and participatory workshops we sought to identify their specific support needs, and to collaboratively design an intervention appropriate for delivery in their local contexts. Applying a protection-risk conceptual framework, we developed a harm reduction intervention which aims to foster protective factors, and thereby nurture resilience, for youth 'on the move' within high-risk settings. Specifically, by establishing peer supporter networks, offering a 'drop-in' resource centre, and by identifying local adult champions to enable a supportive local environment. Creating this supportive edifice, through an accessible and cohesive peer support network underpinned by effective training, supervision and remuneration, was considered pivotal to nurture solidarity and potentially resilience. This practical example offers insights into how researchers may facilitate the co-design of acceptable, sustainable interventions. [ABSTRACT FROM AUTHOR]

The Framework Convention on Tobacco Control (FCTC) requires countries to develop and implement multi-sectoral tobacco control strategies, including policies and legislation. Zambia, potentially faced by a rising problem of tobacco smoking, signed the FCTC in 2008 but has been unable to enact a tobacco policy for over a decade. This study explores the role of 'principled engagement', a key element of the theoretical framework for collaborative governance, in Zambia's delayed success to develop a comprehensive tobacco control policy. This was a qualitative case study of key stakeholders in the collaborative process of trying to develop a tobacco policy in Zambia. Participan-ts were sampled from across various sectors, including government departments and civil society, comprising anti-tobacco activists and researchers. A total of 27 key informant interviews were undertaken. We supplemented the interview data with a document review of relevant policies and legislation. Data were analysed using thematic analysis. Several factors hindered efforts to attain principled engagement, including the adverse legal and socioeconomic environment in which the collaborative regime evolves; poor planning of meetings and frequent changes in tobacco focal point persons; lack of active and meaningful participation; and communication challenges among the key stakeholders. These collaborative dynamics, coupled with the opposition to tobacco control efforts from within some government departments, revealed the inadequacy of the current collaborative governance regime to facilitate enactment of a comprehensive tobacco control policy in Zambia. Efforts to develop a comprehensive tobacco control policy in Zambia will require addressing challenges such as disagreements, communication, and leadership at engagement level across interested sectors. We further argue that principled engagement has a greater role to play in unlocking these efforts and should therefore be embraced by those entrusted to lead the process to develop tobacco policy in Zambia. [ABSTRACT FROM AUTHOR]

Participatory approaches are increasingly popular in public health, but remain little used to address adolescent health issues. However, adolescent participation in research has enormous potential for identifying solutions to health issues that concern them. In Senegal, a youth-led participatory action research (YPAR) project was implemented in four communities where teams of adolescents were trained to conduct a research project and identify solutions to address adolescent sexual and reproductive health and rights (ASRHR) issues. This article presents the results of the project evaluation, which aimed to explore the potential of YPAR to address ASRHR issues and inform future YPAR projects. Observations and interviews were carried out during results dissemination meetings in each of the communities. The evaluation of the project demonstrated the potential of YPAR to identify relevant solutions, while promoting positive and meaningful adolescent participation. Despite some difficulties, such as community resistance, the youth researchers were able to successfully complete their research project, while developing their confidence and self-esteem. The adolescents were convinced that they could act as agents of positive social change. This project has shown that it is possible and relevant to involve adolescents in research projects, and that this approach has significant potential in global health. [ABSTRACT FROM AUTHOR]

For a decade, the Lake Chad Basin (LCB) region, which is at the intersection of four countries and home to ethnic groups in Cameroon, Chad, Niger and Nigeria, has been occupied by Boko Haram. The lax borders and deprivation in the region contributed to the emergence and expansion of Boko Haram's insurgency. While much is known about the human casualties of the invasion, little is known about the accessibility of healthcare for the displaced persons. This qualitative study adopted Penchansky and Thomas' ([1981]. "The Concept of Access: Definition and Relationship to Consumer Satisfaction." Medical Care 19 (2): 127–140) theory of access as its conceptual framework (with the following components: geographical accessibility, availability, financial accessibility, acceptability and accommodation) to explore the experiences of the displaced persons in the LCB with respect to access to healthcare. One-on-one interviews (n = 51) and two focus group discussions (n = 16) were conducted with 67 refugees and internally displaced persons recruited from nine host communities in Nigeria and Cameroon, who shared their perceptions of their healthcare access. The displaced persons faced barriers to their access to the healthcare in the LCB. It was found that for each of the components of the theory of access, the study participants encountered barriers to healthcare access. For example, with regard to financial accessibility (affordability), poverty was identified as the main personal barrier to the displaced persons' healthcare access, and with regard to acceptability, it was communication that was reported to be a barrier. The limitations of the study, the recommendations for future research and the implications of the findings are discussed in detail. [ABSTRACT FROM AUTHOR]

Black Americans face disparate health burdens of diet-related chronic diseases. Black Americans who live in communities with inadequate access to healthy foods are at an even greater risk for disparate health outcomes. Urban agriculture in communities with inadequate access to healthy food can complement the existing traditional food system and can make a difference in the accessibility of fresh fruits and vegetables and subsequently, increase fruit and vegetable consumption. However, integrating urban agriculture into a local food system can be challenging. Community capacity-building efforts have the potential to enhance organizational development and enable collaborations to enhance efforts to incorporate urban agriculture into communities with inadequate food access. This study used Chaskin's relational framework to describe community capacity-building efforts to enhance urban agriculture in predominantly Black communities. We found that strategies for community capacity building in urban agriculture include building on existing resources, community engagement, expanding organizational capacity, identifying threats to community capacity building, and identifying ideal solutions to enhance community capacity-building efforts. Urban farmers, gardeners, and advocates identified these strategies to strengthen local control of the food environment through sustainable urban agriculture. Additional research is needed to further identify community engagement strategies that emphasize sustainability, such as workforce development efforts, building networks for new growers, and strengthening connections between farmers, gardeners, urban agriculture advocates, and community residents. [ABSTRACT FROM AUTHOR]

Aging people in Pakistan are a growing population who face a shortage of old age home facilities. There is critical need to develop state-run old age homes for poor older people but to plan them while identifying protective factors for life satisfaction in currently housed residents. Our sample consists of 139 aging residents from six public sector old age homes across four cities. The qualitative results highlight barriers to life satisfaction and coping strategies of the aging population. Bivariate regression results show that aging residents have higher odds for life satisfaction when they are content with: (i) quality of life overall (AOR 5.99; 95% CI: 2.38–7.06); (ii) health (AOR 2.50; 95% CI: 1.02–4.14); (iii) finances (AOR 1.98; 95% CI: 0.67–3.72); (iv) religious and spiritual associations (AOR 1.90; 95% CI: 0.81–2.45); and (v) opportunities for learning (AOR 1.02; 95% CI: 0.42–2.41). We conclude with four salient social policy recommendations to improve life satisfaction for older populations living in old age homes. [ABSTRACT FROM AUTHOR]

The current study examined the perspectives of homeless youth on their life experiences using Bronfenbrenner's ecological-developmental framework. Fifteen youth (18-24 years) were recruited from the streets and homeless serving agencies in a mid-western city in the US. They participated in a life history interview that covered topics including the lived experiences of youth with their family, school, friends, and children's services, daily struggles, resources, personal strengths, and future hopes. The findings of this study illustrate that several factors such as family issues, feeling alienated at school, association with peers involved in delinquent activities, struggles in children's services, major life events, economic downturn, and cultural ideologies influence homelessness among youth. [ABSTRACT FROM AUTHOR]

Child well-being is particularly relevant to South African social workers given the country's high rates of violence, poverty, inequality, unemployment, HIV/AIDS, and poor schooling outcomes. Guided by a social constructivist theoretical lens, and located within an interpretive qualitative research design, the aim of the study was to determine whether children's drawings and teacher interviews can differentiate qualitatively between children with positive well-being and those with compromised well-being. Children aged 6–8 years whose parents/caregivers were recipients of Child Support Grants (CSGs) were asked to draw a picture of themselves and their families and teachers were asked about the children's functioning. Findings from triangulation of drawings and interviews suggested that while a firm diagnosis of emotional, behavioral, or cognitive disorder could not be reached, it was possible to differentiate between children with positive well-being and those whose well-being appeared to be compromised by developmental delay, learning difficulties, emotional problems, behavioral problems, and/or social issues. It is therefore recommended that social workers make greater use of children's drawings and educator interviews as assessment tools. However, one should not rely solely on children's drawings, but should rather combine drawings with child and educator interviews. Findings also highlight the need for South African social workers to develop indicators that are culturally and ecologically applicable to African children. [ABSTRACT FROM AUTHOR]

One of the challenges for rehabilitation professionals is to discuss sexuality with their clients. The main objective of this study was to explore occupational therapists' perceptions of the factors that influence their practice regarding the domain of sexuality, as well as the prioritization of these factors and the exploration of their needs. Descriptive qualitative study who took place in Montreal, Canada. Two focus groups were realized with seven occupational therapists working in outpatient setting in two different rehabilitation centers for physical disabilities. The focus group guide was based on the Theoretical Domains Framework (TDF). The verbatims were coded using QDA-Miner software and analyzed according to the principles of the Framework approach. The majority of participants were women (n = 6/7). Three main themes to answer the main objective emerged: (1) Occupational therapist's intrinsic factors such as professional identity and knowledge/skills; (2) Contextual and process factors of practice, including assessment/analysis and human resources; (3) Client factors such as identity factors and capabilities. Several influencing factors that have a significant impact on practice have been prioritized, for instance, the perception of the skill level of occupational therapists, interdisciplinary collaboration, culture/language and openness of the client to the subject of sexuality. The needs related to the acquisition of knowledge/know-how, human resources and continuing education were raised by clinicians. There is a need in developing training tools to support clinical practice and to overcome the many barriers encountered by occupational therapists regarding the domain of sexuality. Addressing sexuality domain with their clients remains a challenge for occupational therapists working in outpatient physical disability rehabilitation. Several factors influence the practice of occupational therapists in the domain of sexuality, including occupational therapist's intrinsic factors, their practice process, contextual factors and client-related factors. Improved interdisciplinary practice in sexuality is needed to ensure that sexuality is addressed and that there are referrals to the proper health professionals according to clients' needs. The availability of sexology resources is an important factor for occupational therapists addressing sexuality. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcome measures (PROMs) in clinical practice might enhance patient- centeredness and effectiveness of physiotherapy practice. Although patients have a crucial role in using PROMs, little is known about their perspective on its usefulness. Purpose: Explore the perspective of patients with musculoskeletal health problems on using PROMs for quality improvement in primary care physiotherapy practice, and determine what barriers and facilitators patients perceive. Methods: Semi-structured interviews were performed in 21 patients recruited from primary care physiotherapy practice and analyzed using theoretical thematic analysis. Barriers and facilitators on PROMs implementation were categorized into four predefined domains conform. Results: Across all domains, three major themes were identified: 1) Practicality; 2) Interaction with the physiotherapist for decision-making; and 3) Sharing information outside the clinical context. Generally, PROMs were perceived practically applicable instruments with added value to the interaction with the physiotherapist for shared decision-making and for stimulating quality improvement. The perceived barriers were: difficulties in administering PROMs for patients with poor computer skills, suboptimal efficiency when PROMs were administered at the expense of the consultation, the insufficient added value of PROMs for patients with recurrent health problems, and reluctance about sharing aggregated data for accountability purposes. Limitations: The dependence on the participating physiotherapists in patient recruitment might have resulted in selection bias. Conclusion: Patients perceive that using PROMs has an added value in primary care physiotherapy practice. Optimizing implementation using tailored implementation strategies related to the identified barriers in all four domains might further improve the use of PROMs in clinical practice. [ABSTRACT FROM AUTHOR]

To determine the feasibility of conducting a definitive randomised trial to evaluate the efficacy of custom-fitted footwear for increasing physical activity in children and adolescents with Down syndrome. Assessor-blinded, parallel-group randomised pilot study. Thirty-three children and adolescents with Down syndrome were randomly allocated to a custom-fitted footwear group (Clarks® footwear) or a wait-list control group. Six feasibility domains were evaluated at baseline, 6 and 12 weeks; demand (recruitment), implementation (co-interventions and adherence), acceptability, practicality (adverse events), limited efficacy testing (physical activity, disability associated with foot and ankle problems, and gait parameters), and adaptation (shoe-fit). Three participants were recruited per month. The use of co-interventions was common with six control group participants purchasing new footwear during the study. Mean adherence was 35 h/week in the custom-fitted footwear group, and there were few minor adverse events. There were trends for differences in physical activity favouring the custom-fitted footwear, but no trends for differences in disability associated with foot and ankle problems or gait parameters. The fit of the custom-fitted footwear was no better than participants' regular footwear. A definitive randomised trial is feasible. However, recruitment, use of co-interventions and footwear fit need further consideration. Conducting a definitive randomised trial to determine the efficacy of custom-fitted footwear in increasing physical activity in children and adolescents with Down syndrome is feasible. Custom-fitted footwear may improve physical activity in children and adolescents with Down syndrome. Commercially available footwear may not be suitable for children and adolescents with Down syndrome due to their unique foot shape. [ABSTRACT FROM AUTHOR]

Disclosing child sexual abuse (CSA) is a necessary first step to access the legal, health, and psycho-social services that survivors and their families need. However, disclosure rates are low: of young women who experienced CSA in Zimbabwe, only 9% disclosed the first incident. The purpose of this qualitative study was to explore and describe perceived barriers to disclosing CSA in Zimbabwe. We conducted focus group discussions with children aged 10–14 years (n = 40) and their parents/caregivers aged 20–62 years (n = 40), participating in an intervention trial in Chitungwiza, Zimbabwe. We found that potential retaliation against survivors and their families is a major barrier to disclosing CSA. These retaliatory acts, which we refer to as "re-victimization," arise from stigma or the victim feeling blamed or doubted and manifest through physical violence, emotional violence, and deprivation of family life and education. Our findings suggest that addressing social and cultural norms related to sex and strengthening legal protection for CSA survivors and their families could encourage CSA disclosure and could help end this violence. Our findings also highlight a need to increase children's awareness of their rights and to create safe systems for disclosure of sexual abuse. [ABSTRACT FROM AUTHOR]

A considerable portion of the US population still lacks access to technology, which causes challenges for marginalized communities to access information and services. Research on the digital divide exists in various contexts, but few have examined it in the context of human services. This study examines the impact of socioeconomic status on the methods of communication used when searching for service-related information. We analyzed both quantitative and qualitative data collected from 63 low-income and/or current human service users in Albany, New York. Education showed positive associations with smartphone ownership and personal computer use. Income was found only significant for tablet use. Non-whites were more likely to use mobile apps to web browsers compared to whites. Qualitative analysis revealed three key themes (i.e., availability, ease of use, and usefulness) as influencers of individual preference of methods. Our findings suggest that the digital divide is not merely about the income level but also educational background and culture. Human service professionals need to consider multiple channels to reach targeted populations for service delivery. Particularly, the collaboration between service providers and public libraries is worth examining to ensure the physical access and skills training for those who experience the digital divide at multiple levels. [ABSTRACT FROM AUTHOR]

Muslims in the U.S. have a long history of being active in their communities, but September 11th marked a turning point for involvement due to backlash against Islam. While we know that Muslim civic engagement increased after the tragedy, we know little about why it increased or why some Muslims avoid civic activities altogether. Using a case study on Detroit area Muslims, I find four factors that drive civic engagement as well as three factors that hinder engagement. Findings suggest that social work practitioners and educators can act to support civic engagement and address the challenges that hinder community involvement. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system. Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing. Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as "balancing on a thin line". SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers' intentions. Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking. [ABSTRACT FROM AUTHOR]

Although substantial literature exists on child sexual abuse (CSA), little is known about abuses children encounter in northern Uganda, a post-conflict area. Media reports have indicated a high incidence for CSA. The study, firstly, explored boys' and girls' experiences of sexual abuse by adults in this post-conflict region and secondly, interventions directed at improving the current situation of children at risk of child abuse and the survivors were investigated as well. The study was guided by radical feminism and nested ecological framework theories. Semi-structured interviews were conducted involving 43 sexually abused children. Narrative responses were audio recorded and transcribed. Content qualitative analysis was used to understand sexual offenses from children's perspectives. Participants mentioned the following as the most perilous situations; laxity in parental roles, cultural norms, and practices, patriarchal attitudes, child sexual desires and attitudes, family breakdown and alcoholism. The study found many reported cases of CSA in the region. The results imply the exigent need of separate units specifically for reporting and handling child sexual offenses, need for personnel training on gender issues and filing system in child protection agencies and family programs for both fathers and mothers on child protection strategies for prevention and mitigation of CSA. [ABSTRACT FROM AUTHOR]

Purpose: To explore and describe clients' needs during a surgical intervention process for Dupuytren's disease. Materials and methods: Design: Interview study with 21 men undergoing surgical intervention for Dupuytren's disease. Qualitative content analysis was performed with the model of Patient Evaluation Process as a theoretical framework. Results: The primary reason for seeking medical care was to receive an intervention to improve hand function. The need for knowledge was evident during the care process, and was connected to involvement in decision-making. During surgery and rehabilitation, participants needed support with pain relief, a sense of security, support for self-care, or sick leave. There was also a need for participation in the evaluation and improvement of care. Clients' life situations contributed to the occurrence of needs or were a resource for handling them. Depending on patient character, clients handled their perceived needs differently. Conclusions: Clients' needs during a surgical intervention process include needs for improvement of hand function, knowledge, and support during treatment, and participation in evaluation. Clients' needs change during the care process and can be influenced by their life situation or their character. The identified needs ought to be included in quality assessments from the carers' perspective, to ensure that important needs of the clients are met by the surgical intervention process. Communication and interaction between client and health care provider is a key aspect of fulfilling clients' needs. Implications for rehabilitation: Patients have need for knowledge throughout the care process: about the disease, risk factors, treatment options, practical and medical information related to the treatment and recovery, and about the care process as a whole. Need for knowledge is closely connected to patients' experience of being involved in decision making. Patients need support with both general human and specific medical issues during surgery and rehabilitation. Patients' needs change during the care process and can be influenced by the patient's life situation or character. From the carers' perspective, the identified needs ought to be included in quality assessments to ensure that important needs of the clients are met by the surgical intervention process. [ABSTRACT FROM AUTHOR]

High rates of children involved with the child welfare system are prescribed psychotropics. In response, federal legislation has mandated state child welfare agencies to develop policies to improve the coordination and oversight around the use of psychotropics. This project aimed to support such policies by developing and pilot-testing a field guide for team discussions and decision-making related to the use of psychotropics among youth in child welfare. We used a community-based participatory research (CBPR) framework to engage a team of local stakeholders, including former youth in foster care and parents, in the research. We developed a field guide to facilitate team discussions and decisions around the individual needs and preferences of youth and families, and we pilot-tested the field guide with child welfare staff, parents, and care team members in seven teammeetings. Parents and care team members, in particular, highly valued the guide and found it useful to increase knowledge and improve practices such as side effect monitoring and information sharing. Childwelfare responses were more mixed, and some reported feeling burdened by the additional tasks. More work is needed to integrate the guide into routine child welfare practice and reduce burden on staff. [ABSTRACT FROM AUTHOR]

Aims: To explore how older Norwegian women living at home experience ageing, and how their everyday life has been influenced by their encounters with the challenges of life. Methods: A qualitative design, interviewing ten women age 90 or older, was employed. Results: The overall theme of the findings is how everyday life in old age is influenced by past, present and future. The subcategories focus on (a) changes in daily life, (b) giving an account of life as it is, (c) various perceptions of experienced loss, and finally, (d) thoughts about the future. Conclusions: Older women need the opportunity to reflect upon their past, present and future existence to have a good everyday life in old age. Our findings might be important in shaping health promotion interventions for older people. [ABSTRACT FROM AUTHOR]

This study extends a typology of parent–offspring drug talk styles to early adolescents and investigates associations with adolescent substance use. Data come from a self-report survey associated with a school-based, 7th grade drug prevention curriculum. Mixed methods were used to collect data across four measurement occasions spanning 30 months. Findings highlight the frequencies of various drug-talk styles over time (i.e., situated direct, ongoing direct, situated indirect, ongoing indirect, never talked), messages adolescents hear from parents, and comparisons of alcohol, cigarette, and marijuana use by drug-talk style. This study advances an understanding of parent–adolescent communication about substances and holds practical implications for drug prevention efforts. [ABSTRACT FROM PUBLISHER]

As a result of new global priorities, there is a growing need for high-quality evaluations of gender-integrated health programmes. This systematic review examined 99 peer-reviewed articles on evaluations of gender-integrated (accommodating and transformative) health programmes with regard to their theory of change (ToC), study design, gender integration in data collection, analysis, and gender measures used. Half of the evaluations explicitly described a ToC or conceptual framework (n = 50) that guided strategies for their interventions. Over half (61%) of the evaluations used quantitative methods exclusively; 11% used qualitative methods exclusively; and 28% used mixed methods. Qualitative methods were not commonly detailed. Evaluations of transformative interventions were less likely than those of accommodating interventions to employ randomised control trials. Two-thirds of the reviewed evaluations reported including at least one specific gender-related outcome (n = 18 accommodating,n = 44 transformative). To strengthen evaluations of gender-integrated programmes, we recommend use of ToCs, explicitly including gender in the ToC, use of gender-sensitive measures, mixed-method designs, in-depth descriptions of qualitative methods, and attention to gender-related factors in data collection logistics. We also recommend further research to develop valid and reliable gender measures that are globally relevant. [ABSTRACT FROM PUBLISHER]

As countries implement Article 11 of the World Health Organization (WHO) Framework Convention on Tobacco Control, graphic warning labels that use images of people and their body parts to illustrate the consequences of smoking are being added to cigarette packs. According to exemplification theory, these case examples--exemplars--can shape perceptions about risk and may resonate differently among demographic subpopulations. Drawing on data from eight focus groups (N = 63) with smokers and nonsmokers from vulnerable populations, this qualitative study explores whether people considered exemplars in their reactions to and evaluations of U.S. graphic health warning labels initially proposed by the Food and Drug Administration. Participants made reference to prior and concurrent mass media messages and exemplars during the focus groups and used demographic cues in making sense of the images on the warning labels. Participants were particularly sensitive to age of the exemplars and how it might affect label effectiveness and beliefs about smoking. Race and socioeconomic status also were salient for some participants. We recommend that exemplars and exemplification be considered when selecting and evaluating graphic health warnings for tobacco labels and associated media campaigns. [ABSTRACT FROM AUTHOR]

Background: Because substance use disorder (SUD) treatment is expanding, and detoxification (detox) is often the entry point to SUD treatment, it is critical to provide ready access to detox services. Objectives: The purpose of the current study was to examine patient, program, and system barriers or facilitators to detox access within an integrated health care system with variable rates of detox utilization across facilities. Methods: Inpatient and outpatient providers from 31 different U.S. Veterans Health Administration detox programs were interviewed. Results: Qualitative analyses identified six facilitators and 11 barriers to detox access. Facilitators included program staff and program characteristics such as encouragement and immediate access, as well as systemic cooperation and patient circumstances. Barriers to detox included programmatic and systemic problems, including lack of available detox services, program rules or admission requirements, funding shortages, stigma related to a SUD diagnosis or receiving detox services, and a deficiency of education and training. Other major barriers pertained to patients' lack of motivation and competing responsibilities. Conclusions/Importance: To improve detox access, health care settings should consider enhancing supportive relationships by emphasizing outreach, engagement, and rapport-building with patients, improving systemic communication and teamwork, educating patients on available detox services and the detox process, and addressing patient centered barriers such as resistance to detox or competing responsibilities. In addition, programs should consider open-door and immediate-admission policies. These approaches may improve detox access, which is important for increasing the likelihood of transitioning patients to SUD treatment, thus improving outcomes and reducing utilization of high-cost services. [ABSTRACT FROM AUTHOR]

Appropriate and woman-led health care for displaced women is essential to respecting basic human rights. In this article, we describe the results of an analysis of the association between mental health and reproductive health service use from a sample of Congolese refugee women residing in short- and long-term camps in Rwanda, with a post-hoc qualitative potion added to expand upon the data-based results. Our findings suggest that structural factors including health policy initiatives affect or even inhibit individual care choices. [ABSTRACT FROM AUTHOR]

Despite increasing utilization of hospice care, older adults with cancer enroll in hospice for shorter periods of time than those with other life-limiting illnesses. How older adults with cancer and their family members consider hospice is unknown. The purpose of this study was to compare decision making in late-stage cancer in people who enrolled in hospice with those who declined. Concepts from the Carroll and Johnson (1990) decision-making framework guided the development of a hospice decision-making model. The study design was exploratory-descriptive, cross-sectional, and used a two-group comparison. Qualitative and quantitative data were collected in the same interview. Open-ended questions were used to explore the illness trajectory and decision-making process. The interrelationships between functional ability, quality of life, and social support with hospice decision making were assessed using the Katz, QLQ-30, and Lubben Social Network Scales. Study participants included 42 older adults with cancer who had been offered hospice enrollment (24 non-hospice and 18 hospice) and 38 caregivers (15 non-hospice and 23 hospice); N = 80. The decisional model illustrates that the recognition of advanced cancer and information and communication needs were experienced similarly by both groups. There was interaction between the decisional stages: formulation of awareness and generation of alternatives that informed the evaluation of hospice but these stages were different in the hospice and non-hospice groups. The hospice enrollment decision represents a critical developmental juncture, which is accompanied by a transformed identity and substantive cognitive shift. Increased attention to the psychosocial and emotional issues that accompany this transition are important for quality end-of-life care. [ABSTRACT FROM PUBLISHER]

Life-story methodology and innovative methods were used to explore the process of becoming a developmental adaptive sailing coach. Jarvis's (2009) lifelong learning theory framed the thematic analysis. The findings revealed that the coach, Jenny, was exposed from a young age to collaborative environments. Social interactions with others such as mentors, colleagues, and athletes made major contributions to her coaching knowledge. As Jenny was exposed to a mixture of challenges and learning situations, she advanced from recreational para-swimming instructor to developmental adaptive sailing coach. The conclusions inform future research in disability sport coaching, coach education, and applied sport psychology. [ABSTRACT FROM AUTHOR]