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

In response to the COVID-19 pandemic, South Africa implemented a national lockdown including a ban on the sale of alcohol. This paper describes adults' perspectives on this alcohol ban, focusing on whether they support or oppose this regulation. As part of a longitudinal study that documents South African's experiences of the COVID-19 lockdown, qualitative data were collected from 49 adults and analyzed thematically. Perspectives are framed around the overarching theme of "lives versus livelihoods," presented as support and/or opposition to the ban. Participants who endorsed the ban, as preserving "lives," thought that it facilitated social distancing and therefore limited the spread of COVID-19. Those who opposed the ban suggested that it undermined the "livelihoods" of South Africans, in the context of an already-strained economy. Our findings show that decisions around whether to support or oppose the alcohol ban were informed by critical reflections on the wider socio-behavioral and health implications of such regulations. Further implications are discussed. [ABSTRACT FROM AUTHOR]

Dual Sensory Loss and learning disability is a historically neglected area of social work practice. This paper presents one element of a research study conducted with a health and social care provider in Northern Ireland. It explored staff experiences of assessing adults and children with a dual sensory loss and learning disability. Two sensory disability team managers, eight social workers and two rehabilitation officers were interviewed across sensory disability, learning disability and children with disability teams. Current levels of engagement and ways in which more inclusive services and practices could be developed were explored. Staff views indicate that there is minimal engagement between staff and service users with unique, complex needs. Staff use a range of tools, resources and skills in an attempt to promote inclusion and engagement. The paper concludes that to promote engagement staff need to develop their practice, making effective use of tools and resources. Staff skills and knowledge can be enhanced through training which is targeted, relevant and specific. There needs to be commitment to sharing good practice and cascading learning throughout teams. This will enable service users to have input into their own assessments which will form the cornerstone of all ongoing interventions. [ABSTRACT FROM AUTHOR]

Decades of collective and cumulative work by practitioners, activists and researchers have made violence prevention an important part of international development agendas. However, violence prevention and response work addressing women and children has historically been siloed. Those working at the intersection of violence against women (VaW) and violence against children (VaC) have wrestled with the age–gender divide. Addressing the historical and political influences that underpin this divide will likely enhance progress towards more integrated strategies. This paper examines the origins and development of this polarisation and potential strategies for a more coordinated and collaborative agenda. This paper draws on the insights gained from eleven (11) semi-structured interviews conducted with key violence prevention actors in VaW and VaC from across the globe, alongside relevant published literature. Informants were purposively sampled on the basis of their expertise in the field. Findings reveal key differences and tensions between the two fields, including in collection and use of research and evidence, core conceptual frameworks, and the development, funding and implementation of policy and practice. Potential opportunities for future synergies between the two fields are highlighted, particularly through a focus on the adolescent girl. [ABSTRACT FROM AUTHOR]

Several health research organisations whose work focuses on international collaboration outline guidelines that support ethical practice in health research partnerships including building consensus around good collaborative research practice. This paper explores researcher's perspectives, experiences, and reflections on the elements of successful health research partnerships between Northern and Southern countries/institutions. The study adopted a qualitative research approach using in-depth interviews to explore what an authentic partnership is as experienced and aspired by stakeholders in health research partnerships in Zambia. Interviews were conducted with stakeholders implementing various health research activities in the country. Our findings revealed that Southern partners aspired for equal status and participation, transparency, and accountability, interdependency, and reciprocity, commitment to shared goals, open dialogue and sustainability in partnerships. While to some extent these aspirations overlap with the categories covered throughout the different partnership guidelines, some key aspects go beyond what is included in existing recommendations such as status and recognition which are salient in the broader guidelines. An important aspect in dismantling power structures that causes inequality in partnerships is through generating knowledge and innovation using local resources in the South to address local needs which can be subsequently re-used to address challenges at the global level. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

Evidence suggests that physical activity (PA) programmes promoted via healthcare settings worldwide may not currently meet the needs of many patients and healthcare professionals (HCPs). This paper describes the outcomes of a qualitative enquiry into the perspectives of patients and professionals from multiple healthcare services regarding the role of PA. 19 patients and 22 HCPs were purposively recruited from physiotherapy, podiatry, chronic pain, diabetes and continence services at a community-based healthcare clinic in the United Kingdom. Participants' views were explored using semi-structured interviews and analysed using thematic analysis. Results identified five themes: differences between the social and medical rationales underpinning PA promotion; the impact of the patient-professional relationship on patient activation, self-management and PA; a risk culture surrounding PA; challenges to meet variation in patients' needs and preferences; and lack of formal role for PA as a core part of routine healthcare. The study highlights tensions between needs and aspirations, and the reality of delivering advice and support for PA. Challenges resonated with patients and HCPs across different care groups and were not condition-specific. This highlights a need for sharing good practice across healthcare services and system-level interventions to address organisational barriers to the promotion of PA. [ABSTRACT FROM AUTHOR]

Zambia has one of the highest cervical cancer rates in the world. This paper explores the acceptability of the Human Papillomavirus vaccine administered in girls (9–13 years) in Zambia. A qualitative case study was conducted in two schools in Lusaka district, which participated in the pilot for the Human Papillomavirus vaccine rollout. The study revealed that community level health systems factors such as knowledge levels about the vaccine, sexual morality concerns, conflicting views from parents on the vaccine, rumours that the vaccine contained cervical cancer and that it causes infertility in girls, previous bad experience with other vaccines, religious beliefs such as belief that God protects against illness, the nature of the school environment as well as faith in doctors shaped the uptake of the vaccine. Furthermore, formal health system factors such as availability of health workers and nature of collaboration between the Ministries of Health and Education influenced acceptability of the vaccine among the girls. Strengthening collaboration between community and formal health systems can play a vital role in supporting uptake of vaccines at community level as factors that hinder uptake of the vaccines emanate from both the community and health sector. [ABSTRACT FROM AUTHOR]

This paper examines Ghanaian young people's perceptions of the determinants of HIV- and AIDS-related stigma and discrimination, and how these perceptions may influence the de-stigmatisation process. Drawing on findings from an in-depth, multi-method qualitative study involving 104 school and street young people aged between 14 and 19 years, the paper presents young people's accounts of HIV and AIDS. The paper provokes discussion on how language and images associated with existing educational programmes on HIV and AIDS place young people in a dilemma. It also argues that fear and secrecy associated with the disease not only consolidate stigmatisation and discrimination, but also create the desire for retribution. It concludes by challenging health educators to pay particular attention to the language and images used in future educational programmes. [ABSTRACT FROM AUTHOR]

Three decades since the onset of HIV/AIDS, 33.2 million people worldwide are infected and prevalence in Kenya is on the rise. This paper contributes to discussions about HIV/AIDS education and draws on the health promotion approach and the emancipatory theory of Paulo Freire. Freire argued that through dialogue people unveil their world. The researchers used the method of dialogue to facilitate parents' and teachers' reflections on sexuality education for the children. The dialogues seemed to facilitate some reflection and showed the attitudes of the community to matters that impact on sexuality education (e.g. gender and sexuality). This paper illustrates how dialogic processes can be useful to the process of constructing realistic and contextually relevant HIV/AIDS education. The challenges for the researcher as an outsider are also discussed. [ABSTRACT FROM AUTHOR]

The HIV response is hampered by many obstacles to progression along the HIV care cascade, with men, in particular, experiencing different forms of disruption. One group of men, whose stories remain untold, are those who have succumbed to HIV-related illness. In this paper, we explore how next-of-kin account for the death of a male relative. We conducted 26 qualitative after-death interviews with family members of male PLHIV who had recently died from HIV in health and demographic surveillance sites in Malawi, Tanzania, Kenya, Uganda, Zimbabwe and South Africa. The next-of-kin expressed frustration about the defiance of their male relative to disclose his HIV status and ask for support, and attributed this to shame, fear and a lack of self-acceptance of HIV diagnosis. Next-of-kin painted a picture of their male relative as rebellious. Some claimed that their deceased relative deliberately ignored instructions received by the health worker. Others described their male relatives as unable to maintain caring relationships that would avail day-to-day treatment partners, and give purpose to their lives. Through these accounts, next-of-kin vocalised the perceived rebellious behaviour of these men, and in the process of doing so neutralised their responsibility for the premature death of their relative. [ABSTRACT FROM AUTHOR]

Medical science and other sources, such as the media, increasingly inform the general public's understanding of disease. There is often discordance between this understanding and the diagnostic interpretations of health care practitioners (HCPs). In this paper – based on a supra-analysis of qualitative interview data from two studies of joint pain, including osteoarthritis – we investigate how people imagine and make sense of the pathophysiology of their illness, and how these understandings may affect self-management behavior. We then explore how HCPs' use of medical images and models can inform patients' understanding. In conceptualizing their illness to make sense of their experience of the disease, individuals often used visualizations of their inner body; these images may arise from their own lay understanding, or may be based on images provided by HCPs. When HCPs used anatomical models or medical images judiciously, patients' orientation to their illness changed. Including patients in a more collaborative diagnostic event that uses medical images and visual models to support explanations about their condition may help them to achieve a more meaningful understanding of their illness and to manage their condition more effectively. Chronic musculoskeletal pain is a leading cause of pain and years lived with disability, and despite its being common, patients and healthcare professionals often have a different understanding of the underlying disease. An individual's understanding of his or her pathophysiology plays an important role in making sense of painful joint conditions and in decision-making about self-management and care. Including patients in a more collaborative diagnostic event using medical images and anatomical models to support explanations about their symptoms may help them to better understand their condition and manage it more effectively. Using visually informed explanations and anatomical models may also help to reassure patients about the safety and effectiveness of core treatments such as physical exercise and thereby help restore or improve patients' activity levels and return to social participation. [ABSTRACT FROM AUTHOR]

In this paper, we present findings from a qualitative study that gathered Nicaraguans’ perceptions of short-term foreign medical missions, towards deepening the understanding of what Nicaraguans value or find limited in the work of such foreign missions operating in their country. Fifty-two interviews were conducted with patients, relatives of patients, Nicaraguan physicians and nurses who partnered with or observed missions at work, ‘beneficiary’ community leaders, and individuals who were unable or unwilling to access mission-provided healthcare. Factors underlying participants’ positive and more critical accounts of foreign primary and surgical missions are described and analysed. Empirical investigation on how, whether or not, or on what bases short-term medical missions (STMs) have been perceived as beneficial, harmful, or otherwise by those on the receiving end of these efforts is limited. This study aims to contribute to the evidence base for reflecting on the ethical performance of trans-national STMs. [ABSTRACT FROM PUBLISHER]

Aboriginal and Torres Strait Islander people are the Indigenous people of Australia. The prevalence and burden of chronic disease among them is significantly higher than that of non-Indigenous Australians. This paper describes the chronic illness experiences of 19 Aboriginal and Torres Strait Islander people living in urban areas in terms of their strategic representations of self. Participants in this study used techniques of revealing and concealing chronic illness. These strategies were employed in multiple arenas - among family, among broader community, and in specific spaces including health care services. They highlight tensions that arise through the intersection between the desire to preserve family and community life, and the ways in which the physical body manifests chronic illness. In this paper we bring together notions of time (drawing on Zimbardo's time perspectives theory) and biography (drawing on Bury's disrupted biography theory). Through an analysis of shifting boundaries we conduct an exploratory investigation of the ways in which urban Aboriginal and Torres Strait Islander people in this study weave together elements of both past and future perspectives to mobilise modes of self-representation and agency in their management of chronic illness. We then consider some options for primary health care. [ABSTRACT FROM AUTHOR]

In Victoria, recent reforms to the child and family welfare system, through the introduction of the Children Youth and Families Act (2005), have significantly strengthened the principle of the 'best interests' of the child. Giving substance to the principle, this legislation defines a set of standards and a practice framework to guide its application. How this is to be applied is of particular interest to the Aboriginal child and family welfare sector, given that the principle of best interests has historically underpinned the removal of thousands of Aboriginal and Torres Strait Islander children from their families on the basis of their race (Bamblett, 2006). This paper presents the findings of a qualitative research study that aimed to identify an Aboriginal perspective on the best interests principle as it applies to Victorian Aboriginal children. In-depth interviews were conducted with six experienced Aboriginal child and family welfare practitioners. The outcomes of this study highlight the distinct cultural perspectives that inform Aboriginal child and family welfare practice and raise a number of concerns in regard to an ongoing ethnocentric application of the principle by mainstream service providers. Key findings of the study are discussed, including the importance of increasing understanding of Aboriginal child-rearing practices, recognising that there is a distinct Aboriginal understanding of what constitutes a best interests framework, and the implications of this for both Aboriginal and mainstream child and family welfare practice. The paper discusses these findings within the context of recent Victorian legislative reform, which promotes Aboriginal self-determination, and argues that more work is needed to ensure Aboriginal perspectives are incorporated into service provision to Aboriginal children and families if we are truly to meet the best interests of Aboriginal children. [ABSTRACT FROM AUTHOR]

This paper draws on focus group and interview data from 45 young men from the north of England to explore the barriers to effective sex and relationships education (SRE). Recent policy debates in relation to establishing statutory SRE in schools provide an opportunity to revisit how it is currently delivered to, and received by, young men. The paper considers the central role played by masculinities and how this role is mediated by social exclusion and poor engagement; it is suggested that addressing masculinities directly should be a priority for future SRE. In conclusion, some tentative approaches to addressing the issues are suggested. [ABSTRACT FROM AUTHOR]

This paper examines the possible responses for resistance to health information among women. The data are drawn from a broader qualitative study of how 60 women in Finnmark, a region of Norway, which examined how the participants responded to health information related to coffee, exercise, smoking and diet. This paper focuses on responses to health information about smoking. The study suggests that health information challenges the women's conception of their selves. This may make them take a distance to health information which then makes health information less effective. [ABSTRACT FROM AUTHOR]

There is widespread concern among people living in some parts of Altai territory in Siberia about potential health effects from fallout from rockets launched from the Baikonur cosmodrome in Kazakhstan. Extensive research has so far failed to provide evidence to support these concerns. As a consequence, the problem has been labelled by Russian scientists as 'collective psychosocial distress' or 'raketophobia'. The aim of this paper is to provide an understanding of the factors underlying popular concerns about rockets. The paper is based on data collected in 2006 using multiple methods (individual semi-structured interviews, natural group discussions, round tables and participant observation). Concerns related to the impact of the rocket launches among the local population were explored. The analytical framework is informed by discourse analysis and discursive psychology. The findings are that the processes of collective social construction amplify risks perceived to be associated with rocket launches. In the Altai context, this social amplification builds on a societal vulnerability triggered by the collapse of the Soviet ideology. The environmental concern provides opportunities for repressed debates to be expressed that emerge from culturally embedded frustrations and fears that would otherwise be ignored by the political agenda. Moreover, the signals that shape the perception of risk are intrinsic components of local information flows, so that the communication process between experts and policy-makers and the local population itself contributes to the amplification of perceived risks. Concern about the health effects of rockets can be traced to the conditions that existed when the USSR ceased to exist. An effective response must address these deep-seated issues. [ABSTRACT FROM AUTHOR]

Background Throughout history women with intellectual disability have been commonly subjected to involuntary sterilisation. Involuntary sterilisation involves debate about fundamental human rights, such as the right to maintain fertility and to have children. In this paper, the experiences of a small group of Icelandic women with intellectual disability with regard to the issue of sterilisation are discussed. Method The research was based on 6 life stories of women with intellectual disability born between 1946 and 1965. Additional participants included 3 siblings of these women. Results The findings of the research indicate that the sterilisation procedures resulted in a deep emotional impact on all of the women who participated in this research. The women expressed a range of emotions, such as sadness, anger, and grief, especially those who had been sterilised without their knowledge. Conclusion Despite the negative consequences experienced by the women as a result of sterilisation, the women did not portray themselves as victims but rather as survivors. The findings reiterate the importance of respecting the women's sexuality and right to self-determination. [ABSTRACT FROM AUTHOR]

Previous literature confirms that older black minority ethnic populations are less likely than white populations to contact dementia services in the UK. However, it is unknown whether this is due to a higher or lower prevalence of dementia or due to different needs or coping strategies within these communities. The aim of this study was to explore the understanding and perceptions of dementia amongst Sikhs living in the UK. Six focus groups were involved with 28 Sikh participants who were recruited from Gurdware (Sikh places of worship). Data were analysed using constant comparative methodology. The themes reported in this paper include “awareness and interpretation of the characteristics of dementia”, “multiple perspectives of the same symptoms” and “causes of dementia”. The findings have been discussed in the context of existing research and provide an introductory insight into informing culturally appropriate interventions. [ABSTRACT FROM AUTHOR]

Background: Adolescents and Young Adults (AYAs) with cancer are being disadvantaged within the present health care system. Some of the factors identified as leading to this disadvantage include medical issues specific to AYAs with cancer, delay in diagnosis, fragmented services, lack of access to clinical trials and psychosocial life stage issues. Objective: A major study investigated the experience that accompanies the stages of diagnosis, treatment, dying and death of an AYA from the perspective of family members. This paper discusses the major theme of the reality of hospitalisation. Methods: Narrative inquiry was the methodology for this study. The participants were a self-selected purposeful sample of 26 family members. Open-ended interviews were conducted to obtain a story of the experience of having an AYA family member live with and die of cancer. A meta-narrative of the family member's experience was developed by NVivo8. Results: In amongst the mass of data this study produced, a major theme to emerge was the experience 'of the reality of hospitalisation'. Within this theme issues regarding: The place of treatment; the hospital experience; not fitting in; and, confronting illness and death were revealed. Conclusion: While on the whole the cancer was treated with state of the art medicine, the experiences of the hospitalisation repeated consistently throughout this narrative reveals a failure to meet the higher order needs specific to adolescents and young adults and their families As a result this cohort were exposed to a landscape which did not facilitate a therapeutic experience, as well as would be expected for children and older adults. [ABSTRACT FROM AUTHOR]

The grandparent-as-parent role is a growing social issue both within Australia and internationally. This paper explores the experience of grief as reported by grandparents who are raising their grandchildren. The data presented are part of a larger qualitative study that investigated the lived experience of 34 grandparents who have taken on the full-time care of grandchildren when their own children have been unable to parent them. In-depth interviews conducted with the grandparent participants and analysed through a three-layer narrative analysis reveal the paradoxical dimension of grandparents' experience as they navigate the complex issues that characterise their predominantly unanticipated role. While all of the grandparents referred to the benefits, satisfaction, and joy of taking on the parenting of grandchildren, their narratives were deeply imbued with experiences of loss and grief. The discussion analyses this experience in relation to grief theory and posits that the complex and disenfranchised nature of grandparents' grief means it often goes unacknowledged, including in the policies, programs, and services developed to support grandparents-as-parents. [ABSTRACT FROM AUTHOR]

Non-disabled responses to visible impairment embody either social invisibility or over-attentiveness. The subjective and inter-subjective experiences of impaired bodies and intersubjective encounters within society are important aspects of disablement and the construction of a disabled identity. Impairment is read by and influences the social structure of ableism. This paper attempts to understand how ableist discourses about impaired bodies have impacted on and been resisted by disabled people and how embodiment is related to identity. In pursuit of these aims, a qualitative study was conducted with seven people who have visible physical impairments. The results indicate that disabled embodiment is produced and experienced within an ableist context that mobilizes the charitable gaze and the medical model to signify impaired bodies at the expense of the recognition of disabled identity. In order to deconstruct ableism and to recognize and respect the value of the disabled identity, a politics of recognition is required. [ABSTRACT FROM AUTHOR]

Scientific-bureaucratic medicine (SBM) has been the dominant discourse on evidence-based medicine in the English National Health System (NHS). It has being claimed that SBM has led to new forms of medical professionalism with an emphasis on organisational values and the control of autonomy. This paper explores the medical professions' response to SBM, where SBM is manifested in the form of National Institute of Health and Clinical Excellence (NICE) guidelines. Seventy-four face-to-face informal interviews were carried out with clinicians and managers between 2007 and 2009. Three major themes emerged from the analysis each of which was linked to doctors' receptiveness to NICE guidelines implementation. The first emphasised organisational values, which accounted for conditional acceptance of NICE guidelines. The second was proactive professionalism or entrepreneurial professionalism, which was linked to the rejection of NICE guidelines and the emergence of alternative forms of introducing new ideas for the expansion of their clinical practice. The third was related to the prominence of clinical autonomy linked with doctors' resistance to the use of NICE guidelines. It is argued that this evidence does not reflect a significant emergence of new forms of professionalism but the development of multiple occupational identities. [ABSTRACT FROM AUTHOR]

Disability research in Portugal is scarce and often lacks the perspective of disabled people. This paper tries to bring insights from leaders of disability associations about the community of disabled people in Portugal, the barriers to their politicization and links with disabled identity. It seems that most disabled people get trapped in a tragic paradigmatic vicious cycle due to a system-induced disempowerment which is sustained by a dominant individual and remediation model that extends to families, society, policies and politicians. The disabled associative movement has been unable to reach the majority of disabled people. Suggestions are thus made in order to transform this social reality by disseminating politically aware alternative disability paradigms and the possibility of a positive disabled identity, as well as by generating societal involvement in disability as a public matter. [ABSTRACT FROM AUTHOR]

This paper reports on a focus group study aimed at exploring the difficulties that palliative care healthcare professionals encounter while assessing the spiritual distress of their patients. Three focus groups were conducted in a hospice (n = 15). Participants were all healthcare professionals working in the hospice in-patient unit. Interviews were taped and later transcribed. The data was analysed through content analysis. Emergent themes included: lack of vocabulary around spiritual issues, personal issues surrounding death and dying, training issues, fear of being unable to resolve spiritual problems, time constraints and difficulty separating spiritual and religious needs. Participants provided a number of recommendations for improving care. This pilot study has generated useful data in relation to how spiritual care of patients might be improved. Despite the abundance of academic publications and policies on spirituality, this area is not integrated well into palliative care. [ABSTRACT FROM AUTHOR]

The concept and definition of pastoral care in aged care remains ambiguous. This paper reports on the defining characteristics and meaning of pastoral care from the perspective of older recipients, their family members and pastoral care workers. Using a qualitative descriptive approach semistructured in-depth interviews were conducted with 18 pastoral care workers and 11 older people. Transcribed data were analysed using NVivo software and coded for emerging themes. The defining characteristics of pastoral care that emerged from analysis of transcribed interviews were: a trusting relationship, spiritual support, emotional support and practical support. Findings also portray the role of the pastoral care worker as spiritual guide, confidante, and emotional and practical supporter acting within a trusting relationship. Future studies should confirm these results by exploring the perceptions of experts in the field of pastoral care. [ABSTRACT FROM AUTHOR]

According to data analyzed from the Gallup Daily Tracking Politics and Economy survey between 2015 and 2017, nearly half (46.7%) of LGBT adults in the U.S. are religious, and just over half (53.3%) of LGBT adults are not religious. The majority who identified as religious attend Protestant churches. The Pentecostal church is a member of the Protestant Christian tradition. In a Constructivist Grounded Theory study of six U.S. gay male, Pentecostal Christians, our study excavates and chronicles their journey toward wholeness. Three major themes emerged from our study: embracing the journey, belonging to a community, and living unapologetically. From these themes, we learned that wholeness becomes possible when gay male Christians can form identities that are uniquely and holistically their own. We used these themes as a clarion call for clinicians who engage with clients encountering a conflict between their religious/spiritual tradition and their sexual orientation to actively assist their clients with reducing the dissonance they experience. [ABSTRACT FROM AUTHOR]

Global epidemiological evidence indicates high rates of mental illness but low rates of diagnosis among older people. In China, service providers identify older adults with mental disorders in varied ways. Taking Shanghai as an example, this study revealed how the identification methods of geriatric mental health disorders in nonspecialized institutions diverge, providing a reference for the integration of services. A purposive sampling method was adopted to conduct semi-structured interviews with 24 service providers from various nonspecialized geriatric mental health care institutions. Interview audio was recorded with consent and converted into verbatim transcripts. The interview data were analysed thematically. Although service providers from the health care system tended to apply a biomedical-oriented assessment, those from the social care system typically identified mental disorders among older people based on selective attention and interpersonal relationships. Although there are stark differences, the various identification mechanisms implicitly converge—the relationship with clients has become an important consideration. Geriatric mental health issues urgently require the integration of formal and informal care resources. Referring to the idea of task transfer, social identification mechanisms are expected to be a useful supplement to traditional biomedical-oriented identification. [ABSTRACT FROM AUTHOR]

Social support, racial/ethnic identity, and foster care exposure are concepts largely understudied in child welfare research. With the rise of racialized violence against persons of color and the COVID-19 pandemic, these intersecting identities are of great importance. Semi-structured interviews were conducted with 14 youth of color with current or past foster care exposure. Three themes were identified: 1) feeling uncomfortably me, 2) not equal in opportunity, and 3) skin as a threat. Increased mental health support by caseworkers and understanding collective racial trauma is needed to help foster youth of color as they strive to achieve self-sufficiency in emerging adulthood. [ABSTRACT FROM AUTHOR]

Mental ill-health is one of the greatest public health challenges in Sweden, and it is estimated that every third person seeking primary care in the country suffers from mental ill-health. Without proper treatment at an early stage, mental ill-health may lead to long-term illness and have a significant impact on functional ability. As district nurses are specialists in public health nursing, they have been pointed out as having a key role in the prevention and management of mental ill-health. The aim was to explore district nurses' practice in caring for people with mental ill-health within primary health care. Individual semi-structured interviews were conducted with district nurses (n = 18) and the transcribed text was subjected to qualitative content analysis. The result was formulated as several subthemes, eventually developed into three themes: Practicing within an organisation where traditional attitudes are impediments, Perceiving mental healthcare as not being an obvious part of district nursing, Working as fellow human beings rather than "professionals". The findings indicate that district nurses feel uncertainty in their practice in this area. Working independently with mental ill-health was not always considered socially acceptable among district nurses. Despite these challenges they tried to remain involved without becoming emotionally overwhelmed. They also strived to meet the needs of these patients with 'small things', that could be effective and a part of recovery-oriented practice, even if they might be defined as unprofessional, and their efficacy negated. [ABSTRACT FROM AUTHOR]

Notions of who counts as a sexual partner – that is, what specific actions, feelings, or relationships become defined as part of one's sexual history – often carry assumptions about sexual scripts, power, and social identities. In this exploratory study, we analysed semi-structured interviews with eighteen women from a diverse 2019 community sample (mean age = 36.39, SD = 12.24) collected in a large Southwestern U.S. city in order to examine how women made decisions about who was classified as a sexual partner throughout their lifetime when reviewing their sexual histories and previous sexual encounters. We identified six behavioural, relational, and emotional themes in how women defined and demarcated sexual versus nonsexual partners: 1) Having penile-vaginal intercourse; 2) Engaging in non-penile-vaginal intercourse (PVI) forms of sex; 3) Having an orgasm with someone; 4) Any physical sexual contact involving genitals; 5) Having a romantic relationship with someone; and 6) Feeling attraction and desire for a person. Tensions about heterosexist biases in sexual inventories were discussed, as were methodological implications for measuring, studying, and identifying non-PVI sexual encounters. [ABSTRACT FROM AUTHOR]

This study aimed to investigate rehabilitation staff perceptions of factors influencing stroke survivor activity outside of dedicated therapy time for the purpose of supporting successful translation of activity promoting interventions in a rehabilitation unit. Purposive sampling of multi-disciplinary teams from four rehabilitation units was performed, and semi-structured interviews were conducted by telephone, digitally audio-recorded and then transcribed verbatim. A stepped iterative process of thematic analysis was employed until data saturation was reached. All but one of the 22 participants were female, the majority were either physiotherapists or occupational therapists, with a median of 4 years (interquartile range, 2–10) working at their respective rehabilitation units. Analysis of the data revealed three themes: (i) stroke survivor characteristics influence their activity outside therapy, (ii) the rehabilitation environment influences physical, cognitive, and social activity, and (iii) institutional priorities, staff culture, and attitude can be barriers to activity. Rehabilitation units were perceived to be unstimulating, and visitors considered enablers of activity when resources were perceived to be scarce. Our results suggest careful consideration of the involvement of visitors, an individual's needs and preferences, and the institution's priorities and staff attitude may result in greater stroke survivor activity during rehabilitation. Staff should consider stroke survivor impairments and a rehabilitation unit's institutional priorities and staff attitudes when aiming to enhance stroke survivor engagement in activity. The physical and social environment of a rehabilitation unit can be optimised by rehabilitation staff to promote activity. Utilisation of visitors of stroke survivors on a rehabilitation unit may be one way to enhance engagement in activity. Discussion within the rehabilitation team concerning "ownership" of the role of supporting stroke survivor activity outside of structured therapy time may support better engagement in same. [ABSTRACT FROM AUTHOR]

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Religion and spirituality are central to everyday life in Nigeria. Social work educators recognize that learning cannot be separated from the influence of context, including religion and spirituality. This study presents the first empirical inquiry into religion and spirituality in social work education in Nigeria. The qualitative study explored the inclusion of religion and spirituality on Nigerian social work programs from the viewpoints of social work educators, adopting a phenomenological approach. Data from key informants' semi-structured interviews with 12 purposively sampled social work educators based at three Nigerian universities (University of Nigeria, Nsukka; University of Benin, and Nnamdi Azikiwe University) were analyzed thematically. The findings highlight the importance of religion and spirituality in social work education; yet point to coverage being limited and located within elective modules, and for social work educators to recognize the relevance of religious and spiritual aspects of their students' and service users' existence in developing educational curricula. The study calls for prioritizing the integration of religion and spirituality in social work degree programs. Strengthening the links between religion, spirituality, and social work will better prepare future practitioners to be cultural component and work with the profession's values of social justice. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe people's day-to-day experiences with weight-based discrimination and to distill themes that shed new light on this phenomenon. A qualitative study was conducted in 2019 using a purposive sampling strategy. A racially and ethnically diverse sample of 32 U.S. adult men and women with a body mass index ≥30 kg/m2 completed a semi-structured interview. Primary types of interpersonal weight-based discrimination included offensive comments, negative assumptions, social rejection, and unwanted attention or bullying. Participants also encountered environmental sources of weight bias such as inadequate seating in public venues. Three higher order themes that cut across people's experiences with weight-based discrimination were identified: 1) the often-ambiguous nature of weight-based discrimination; 2) intersections between body weight and other social identities; and 3) the role of social comparison processes. Findings provide a detailed portrait of people's everyday experiences with weight-based discrimination. These experiences often reflected widely held negative stereotypes about people with higher body weight and conveyed the socially devalued status of higher-weight individuals in society. Findings have important implications for future research and interventions aimed at reducing the harmful effects of weight-based discrimination on health and emotional wellbeing. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine cultural beliefs, attitudes, and practices of Black sub-Saharan Africans (BsSAs) in the UK regarding their type 2 diabetes (T2D) self-management using the concepts of the PEN-3 cultural model. A qualitative study involved 36 semi-structured interviews with BsSAs living with T2D in the UK to examine relevant cultural practices and beliefs that have contributed to the uneven burden of self-management behaviours. A narrative thematic analysis of the data was then conducted for the study using NVivo software and guided by the PEN-3 cultural model, which moves beyond individualistic health behaviour models of diabetes but centralises culture in understanding health behaviours. Cultural perceptions and self-management behaviours of T2D varied among the BsSAs. Systems of self-management and treatment practices that were congruent with their cultural beliefs and personal priorities were seen as essential in the positive response to self-managing T2D. Knowledge and perceptions of non-conventional and alternative remedies linked to cultural beliefs reflected the existential health-seeking behaviours, and the significance attached to BsSAs negotiated cultural identities and collective practices within the communities. Social network supports were seen as enablers while advice and regimens from healthcare professionals (HCPs) were presented as medicalised and devoid of cultural sensitivities to respondents. The study findings highlight the need to be not only aware of the negative impact of diabetes perceptions and health behaviours among the BsSA communities, but also be aware of the enabling factors and collective practices within the communities that are equally critical in influencing the self-management and health-seeking decisions of BsSAs living with T2D. PEN-3 model was significant with exploring not only how cultural context shapes health beliefs and practices, but also how social networks and systems play a critical role in enabling or nurturing positive health behaviours and health outcomes. [ABSTRACT FROM AUTHOR]

With online-learning becoming the new mode of learning, providers need to understand the barriers that learners face. The objective of this study is to utilise a multi-method approach to examine the barriers that affect learner's intention to use e-Learning services. The multi-method approach consists of qualitative semi-structured interviews of 8 participants, topic-modelling on 3227 reviews from Coursera dataset and 463 responses from an online survey for quantitative analysis. The interviews revealed themes like 'rigid-course-structure', 'complexity', 'quality-of-facilitator', and 'value-addition'. The topic-modelling approach extracted themes like, 'technique-of-teaching', 'language-of-speaker', 'course-content', 'privacy', 'payment-issues', etc. The empirical study revealed that value [course-content ('course-content', 'value-addition') and facilitator-issues ('quality-of-facilitator', 'handling-of-queries')], tradition [trust ('privacy concerns', 'authenticity', 'reliability')] and risk [payment issues ('payment-failures', 'refund issues')] barriers have a notable negative impact on usage-intention. The originality of this works lies in the fact that it explores payment-failure, facilitator-quality, and course-value affecting the acceptance of e-Learning services from the innovation-resistance-theory stance utilising data from various sources (qualitative data from interviews and online reviews and quantitative survey-based data). This work has also discussed different limitations in this study and scope for future research. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore rehabilitation clinicians' understanding of how sex and gender facilitate or hinder care provided to patients with traumatic brain injury (TBI). Sixteen clinicians from various specialities, attending to patients with TBI from a large rehabilitation hospital in Ontario, Canada, were recruited using purposive sampling. Data was collected through semi-structured interviews and thematic analysis was used to identify reoccurring themes. Three themes that facilitate or hinder care of TBI patients were identified: (1) knowledge and evidence; (2) gender and other aspects of recovery; and (3) family caregiving. Lack of education about the topic and inconsistent scientific evidence limited clinicians' attention to sex and gender topics. Social, financial, and cultural characteristics of patients were considered to be more relevant than their sex and gender. The gendered nature of caregiving and its burden on caregivers' health were acknowledged. Currently, attention to topics of sex and gender as they may influence patients' recovery is limited. However, clinicians are willing to be educated on these topics to enhance rehabilitation care. Further research on the gendered nature of interactions between patient, clinician, and family caregiver during recovery is warranted. Sex and gender matter for patients undergoing recovery for their traumatic brain injury; however, clinical attention to this topic is limited. Based on the clinicians' perceptions, resources that address patients' psychosocial vulnerabilities should be prioritized (e.g., unequal access to care, financial status, cultural diversity etc.). Clinicians highlighted that psychosocial vulnerability and patients' life roles, before and after injury, are sex and gender specific. Guidelines about sex and gender influences in traumatic brain injury rehabilitation have the potential to enhance clinical practice. [ABSTRACT FROM AUTHOR]

Reminiscing is a therapeutic nursing intervention for older adults. Nursing students and elders who participated in reminiscing interviews were excited by this activity. Researchers across disciplines collaborated in this qualitative research project to clarify the meaning and experience of reminiscing for the student and the diverse elder. Following the student-elder interview, researchers conducted unstructured interviews with a purposive sample of students and elder participants. Four patterns emerged: discovery of the value of intergenerational interaction and relationships; rejection of stereotypes; a willingness to overcome painful aspects of reminiscence; and gerotranscendence wisdom and peace. These findings have implications for nursing education, nursing practice, and further research. [ABSTRACT FROM PUBLISHER]

To understand the challenges in delivering comprehensive care for patients recovering from stroke in Guangdong Province, China. A cross-sectional qualitative study was conducted in two tertiary hospitals with different socio-economic characteristics in Guangdong Province, Southern China. Interviews were conducted with 16 stroke care providers including doctors, nurses, rehabilitation therapists and care workers. The interviews were audiotaped, transcribed and translated from Mandarin to English. Thematic analysis was used to draw out descriptive and analytical themes relating to care providers' experiences of existing routine stroke care services and the perceptions of challenges in delivering comprehensive stroke care. The interviews with stroke care providers highlighted three key factors that hinder the capacity of the two hospitals to deliver comprehensive stroke care. First, expertise and knowledge regarding stroke and stroke care are lacking among both providers and patients; second, stroke care systems are not fully integrated, with inadequate coordination of the stroke team and inconsistency in care following discharge of stroke patients; third, stroke patients have insufficient social support. While comprehensive stroke care has become a priority in China, our study highlights some important gaps in the current provision of stroke care. Comprehensive integrated stroke care is essential to maximize the effectiveness of stroke services and in China it needs to be further improved. Multidisciplinary stroke care systems should strengthen collaborations across all relevant disciplines and should include a clear role for registered nurses. Follow-up care after discharge needs more engagement with family caregivers. [ABSTRACT FROM AUTHOR]

To assess fibromyalgia patients' experiences and appraisals about a multidisciplinary intervention programme, in Catalonia's primary care, regarding its format and contents, benefits, and health impact in the short and long term. Qualitative interpretative research design through hermeneutic phenomenology perspective. Two focus groups discussions were conducted in February and July 2020. The purposive heterogeneous sample included 19 fibromyalgia patients who attended a multicomponent programme. In addition, thematic analysis on the verbatims was performed. Findings were organized into five main domains with an explanatory theme each. Overall, the informants valued the programme as a positive experience due to its holistic approach, health benefits, suffering relief, group effect, and fibromyalgia legitimacy promotion. Detected improvable aspects focused on extending the timeframe, including family members as beneficiaries, deepening the thematic contents, and getting regular access to this healthcare service. Furthermore, the intervention was considered feasible to be incorporated into usual clinical care. the programme fulfilled users' expectations about results and procedure and showed promise as a treatment strategy to reinforce the usual practice. Our findings suggest a broad perspective on fibromyalgia patients' suffering, which urges us to adjust the intervention programme to their real health needs. [ABSTRACT FROM AUTHOR]

Bronchiectasis is a chronic respiratory disease that impacts significantly on quality of life for those who have it. There is a paucity of literature exploring the perspectives of children and young people. The aim of this study was to examine the day-to-day life experience of a group of young people with bronchiectasis. A qualitative study using semi-structured interviews explored fifteen young people's perspectives of life with bronchiectasis. Key themes were identified using an inductive iterative approach through constant comparative analysis guided by Thorne's interpretive description. Life with bronchiectasis was conceptualized by participants as "Pretty Normal". This consisted of two co-existing life views which represented how young people balanced the ups and downs of adolescence while learning to accommodate the demands of living with bronchiectasis. Three key thematic elements "sore and tired", 'life interrupted and "looking after self", influenced and challenged these two views of life. Young people with bronchiectasis portray life as being the same as their peers. Despite this, they recognized that the symptoms, interruptions, and self-management responsibilities led them to find ways of coping and integrating their experience into a new and modified view of normal. [ABSTRACT FROM AUTHOR]

With adverse events and injuries recurring in residential aged care facilities (RACFs), older adults' safety in residential age care settings has attracted extensive attention from governments, researchers, and healthcare providers. Risk management is of utmost importance in reducing risks and improving the quality of care for older adults in long-term care. Although previous studies have made great efforts to explore risk management methods and technologies in RACFs, little is known about how managers identify and respond to risks in practice. This qualitative study aimed to elucidate the perceptions and experiences of managers involved in risk management in RACFs in China. This study used a phenomenological research design. We conducted semi-structured interviews with 13 managers across 11 RACFs in Changsha City, Hunan Province, China. Data were analysed using Colaizzi's seven steps and NVivo 12 plus software. "Facilitation of an error-free culture" emerged as a central theme of managers' perceptions of risk management. Four sub-themes were revealed, namely "creating an age-friendly physical environment," "paying close attention to frail older adults," "improving the competence of nursing staff," and "building effective management programs." Facilitation of an error-free culture was of prime importance in risk management. Managers' experiences can help RACFs to better manage risks, as well as provide new perspectives and approaches for RACFs to improve the quality and outcomes of care. This study developed initiatives for improving resident safety in RACFs and may foster interest in the developing these initiatives. [ABSTRACT FROM AUTHOR]

Purpose: Sexual and gender minority youth (SGMY) experience unique challenges related to identity and disclosure, and cope in vibrant ways. Qualitative research has not yet fulsomely explored the risk, resilience, and identity intersections that impact vulnerable SGMY wellbeing. Methods: This digital photo-elicitation study (QueerView) recruited thirty SGMY (aged 14–29) from priority populations that had one or more of the following experiences: trans and gender diverse, homelessness, child welfare, and immigration. From submission of fifteen photos representing resilience and a semi-structured interview via web conferencing, constructivist grounded theory was utilized for multimodal analysis of photos, interview video, and interview transcript. Triangulation, an audit trail, and member checking were employed to support trustworthiness. Results: A visual model emerged showing how participants work towards an integrative self, with themes of reflecting and knowing, discrimination and intersectional challenges, connecting, performing, curating, coping, (re)defining and (re)creating, growing and being. Sub-themes of the impact of family dynamic and values, mental health and trauma, and the cathartic benefit from advocacy and leadership offered insight. Participant images were captured in a digital gallery. Conclusions: QueerView animates the complex lives of multiply marginalized SGMY and their intersectional strengths and challenges while demonstrating the utility of a digital multimodal approach. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to understand the knowledge, attitudes and beliefs of early childhood health and education professionals on bilingualism and heritage language maintenance for children with language delay, and how their interactions with caregivers may influence the decision-making process to maintain or not maintain speaking heritage languages with children. Method: A qualitative methodology was used to explore the research aims. Seven early childhood health and education professionals with experience working with bilingual families participated in in-depth interviews. Data were analysed using a grounded theory approach and a symbolic interactionism theoretical framework. Result: Understandings of bilingualism and language development were strongly influenced by socially and culturally contextualised factors, such as the linguistic context in Australia. Barriers and facilitators to supporting bilingualism and helping caregivers make informed choices included: unique child and family characteristics, the level of trust in professional advice, and the level of professional agency to support knowledge and practice. Conclusion: Findings highlighted the need to focus on the processes involved in supporting caregivers to make informed decisions about bilingualism and heritage language maintenance for children with language delay. The need for professional development on bilingualism and language development for early childhood health and education professionals was also highlighted. [ABSTRACT FROM AUTHOR]

To ascertain stakeholders' agreement and disagreement about inter-professional collaboration (IPC) when supporting the child with a developmental language disorder (DLD) in school. Two rounds of an online Delphi survey were undertaken with a purposive sample of 26 participants (researchers, practitioners and parents). Topics were informed by the views of children engaged in an earlier phase of the research. Agreement was set at an inter-quartile range of 1, with level of agreement measured using a five-point semantic differential scale. Qualitative data were examined using content analysis. There was strong agreement across the stakeholder groups about the child-led goals of IPC. Stakeholders also agreed that DLD is best viewed as a learning difference rather than a disorder. We identified ambivalence across the groups about the right of the child with DLD to have influence in decision-making about supports in school. We propose that IPC should be viewed as a means of ensuring the inclusion of the child in school. A shift in focus from remediating perceived deficits of the child, to affecting change in classroom practice, is also indicated. The need to reinforce the unconditional right of the child to have influence in decisions about supports is highlighted. Implications for IPC when meeting the needs of children with a developmental disability in school are outlined. The goal of inter-professional collaboration should be to ensure the inclusion of the child with a developmental disability in school. Interventions delivered in school should focus on changing practice in the classroom, rather than on the child's perceived deficits. The child with a developmental disability should be given influence in collaborative decision-making to ensure supports are relevant and responsive to their needs. [ABSTRACT FROM AUTHOR]

The landscape of health in South Africa has changed dramatically with the unprecedented rise in the burden of disease. Public health care facilities struggle to provide quality, patient-centered care to patients with complex health needs. Interprofessional teamwork is strongly advocated to improve the quality and patient-centeredness of care. This study explored the barriers and facilitators of interprofessional teamwork amongst health professionals working at a tertiary level public hospital in South Africa. The study employed a qualitative, descriptive, exploratory design. Data were collected during three focus group discussions with 14 purposively selected participants from several health professions. Barriers such as high patient turnover, lack of human resources, time, hierarchy, referral process, lack of knowledge of the roles and scopes of practice, negative attitudes, communication inefficiencies, language barriers, and professional jealousy were found to impede interprofessional teamwork. Facilitators of interprofessional teamwork included increased human resources, communication technology, respect, and relationship building. Although health professionals understand the barriers and facilitators of interprofessional teams in the provision of patient care, this study concludes that interprofessional capacity building is needed for successful interprofessional teamwork at a tertiary level public hospital setting. [ABSTRACT FROM AUTHOR]

Latinx immigrants in new destinations – small communities with fast-growing immigrant populations – present challenges for human service agencies lacking the bilingual professionals and experience required to serve them. This study examined public health administrators' efforts to serve Latinx immigrants by relying upon dedicated, but overwhelmed, para- and non-professional bilingual staff. Administrators, led by their professional values, spurred agency responses in spite of local leaders' limited support for immigrants. These findings suggest that administrators in new destinations lead the way in serving new Latinx residents. Yet, administrators' reliance on para-and non-professional bilingual staff to meet the needs of this vulnerable population generates questions about the quality of care immigrants received from a largely non-professional workforce. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe experiences of childhood brain tumor survivors (CBTS) and key figures in their environment after returning to school, using the International Classification of Functioning, Disability and Health – Children and Youth framework. We conducted semi-structured interviews with five children, nine parents, 28 teachers, and 14 health professionals at three predetermined times over a two-year period. A qualitative content analysis was performed by linking meaningful units from transcribed interviews to ICF codes. Children experienced diverse body dysfunctions that could impede school participation, mostly related to knowledge acquisition and application, executive functioning and social life. Support at school and professional aftercare were essential to alleviate the child's difficulties. The teacher's attitude, parental involvement, and practices of collaboration belonging to the child's supportive network further influenced the reintegration process. Also, child-specific factors including emotional reactions to illness, age, and balance between school life and leisure time were considered to affect school readjustment. The International Classification of Functioning, Disability and Health framework is a useful instrument to systematically describe experiences of CBTS and key figures regarding school life, providing a common language to communicate for stakeholders in education and healthcare following the child's return. The International Classification of Functioning, Disability and Health – Children and Youth framework is a useful instrument to describe experiences regarding school life of childhood brain tumor survivors (CBTS) and key figures in their environment. The ICF-CY model can be combined with a standardized assessment of neurocognition or performance to achieve a comprehensive view of the child's participation at school, by exploring both personal and environmental factors. Childhood brain tumor survivors mostly show impairments in acquiring and applying knowledge, executive functioning and social life, which may require increased support at school and professional aftercare. A positive attitude of school staff, high parental involvement in school life and adequate collaboration between parents, education and healthcare are important to prioritize in the context of reintegration into school of CBTS. [ABSTRACT FROM AUTHOR]