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Computer-based testing (CBT), which refers to delivering assessments with computers, has been widely used in large English proficiency tests worldwide. Despite an increasing CBT in China, limited research is available concerning whether CBT can be used for the Test for English Majors-Band 4 (TEM 4). The current study investigated whether testing mode impacted TEM 4 score and factors (i.e., computer familiarity level and attitude towards CBT) that might correlate with performance on CBT of TEM 4. Overall 92 Chinese undergraduate students were randomly assigned to one of the groups, i.e., CBT or paper-based testing (PBT), and took the test. A mixed method was employed, including (1) quantitative and qualitative analysis of test performance in two modes, as well as CBT group participants’ computer familiarity and attitudes towards the mode; and (2) thematic analysis of semi-structured interviews. The results revealed that (1) test scores in CBT and PBT were comparable; (2) two items in the computer familiarity questionnaire, i.e., comfort level of reading articles on the computer and forgetting time when using computers, positively correlated with CBT scores; and (3) participants’ attitude towards CBT did not impact test performance.

Apart from improving the ranking of the individual and his/her institution, research publications are also known to make important contributions to the advancement of knowledge and formulation of government policies, thus enhancing institutional, sector and/or national and global development. The study explored challenges that College of Education tutors face in line with publishing research papers and other scholarly materials. Utilizing concurrent nested mixed method design, tutors of all Colleges of Education institutions in Ghana were targeted, however, 190 tutors were drawn from the five Colleges of Education zones in Ghana to participate in the study. A checklist of .72 internal consistency reliability was used to gather the quantitative data while interview schedule was used to gather qualitative data about challenges that affect academic staff publishing of research products. Data to answer research question one was analyzed using descriptive statistics, specifically, percentages and frequencies. However, data to answer research question two were analyzed using Braun and Clarke thematic analysis approach. Findings revealed that college tutors used in the study had awareness and knowledge about how research articles and abstracts are produced but not for other research products such as monograph, book chapters and so on. The study findings further showed that, weaker foundational knowledge and skills in research methodology, lack of writing experience, deficient information technology skills and lack of mentorship constituted the challenges that affected frequent publishing of research products among college tutors. Regular workshops of research methodology and production of research papers should be organized for college tutors by college management. The study further recommends that the Ministry of Education in collaboration with Ghana Education Trust Fund (GetFund) as a matter of priority should work on improving and building more infrastructure, specifically, offices for academic staff and technological infrastructure to enhance more research-based activities within the Colleges.

The COVID-19 pandemic calls for educators to deliver learning experiences that are relevant in order to empower students to adapt to these unprecedented times. Science, Technology and Society (STS) is an interdisciplinary social science course included in the undergraduate general education curriculum in the Philippines that can potentially be designed to help students make sense of the coronavirus crisis. This study aims to describe the insights on the COVID-19 pandemic among undergraduate students enrolled in STS classes through the textual analysis of their reflection papers. A total of 74 reflection papers were qualitatively textually analysed using thematic analysis. Four themes emerged from the data: (1) appreciation of the science and medical community; (2) sensitivity to the barriers of scientific progress during the COVID-19 pandemic; (3) gaining social consciousness about the impacts of the pandemic, and; (4) enrichment of critical thinking and social engagement. Educators are encouraged to incorporate STS approaches in their lessons to foster students’ critical understanding of current socio-scientific issues.

Qualitative data is important to understand certain phenomena. While quantitative data is important to understand the prevalence of attitudes and behaviour in psychosocial medical research, qualitative data can help understand and explain the reasons behind attitudes behaviour. One of the methods of collecting qualitative data is the focus group discussion. During a focus group researchers facilitate a discussion to elicit views and lay theories about the research topic. Researchers use group facilitation skills in order to make participants feel at ease and disclose their thoughts, feelings and perceptions about a particular issue with the least bias possible. This paper discusses how the text obtained after transcribing the discussions can be analysed using thematic analysis.

In qualitative research methods, a case study approach is the method that is commonly viewed in achieving the aims of exploring the management of cultural-change through management programs: It is the change in the culture of the work environment through the management and training programs in order to enhance a hotel’s performance. In addition to that, the case study approach “provides the tools to study complex phenomena within their contexts” [1]. That is the purpose of this research; it is to examine a complex phenomenon within its context. In this study, the researcher interviewed a general manager in a local hotel in Jordan. The main themes were extrapolated and analysed through thematic analysis technique. A reflective comment followed the analysis.

Designing standardized exams for EFL undergraduates is a matter of great concern in pedagogical practices that assess learners’ academic achievements. This case study was conducted at Majmaah University, Saudi Arabia, to explore the significance of educational exam standardization and its impact on the process of implementation, leading to a balanced and equitable assessment of English language skills. During the study, 250 final English skill exam questions of two semesters were analyzed. A mixed-method approach using a questionnaire and Focused Group Discussion was adopted to collect relevant data. The quantitative data were analyzed using SPSS 16, and the qualitative data was processed by thematic analysis. The quantitative data results showed that questions were balanced, valid, and reliable in language skill exam papers designed for undergraduate English students. The qualitative data revealed four major themes – standardization of questions, the efficacy of Bloom’s taxonomy, assessment/evaluation, and alignment of the question with learning outcomes. These emerging themes highlighted the effectivness of standardizing exam papers, identified problems, and suggested ways of improvement. The study indicates that exams must be scrutinized for the sake of standardization in terms of maximum course coverage; the variety in the question item; clear, concise, and precise instructions; validity and reliability of exam papers; and the alignment of questions with the course and program learning outcomes to ensure the implementation of the revised Bloom’s taxonomy. The study suggests, to generalize the results, that further investigation should be done in another Saudi university for the sake of comparison.

This paper presents an analysis of a hundred and one handwritten essays by master students in Informatics. The students reflected on their experiences of working with pen and paper for reading and writing as a mandatory assignment for the duration of a five-week intensive course. Taking an inductive approach, reflexive thematic analysis was used to identify patterns of meaning across the full dataset. The essays elicited insightful student reflections on learning, knowing, and being. One overarching theme, New connections, and four sub-theses were identified: Handwriting as note making, Being present for learning, Freedom to think, and Materiality of reading and writing. This study contributes to an improved understanding of the affordances of paper and laptops in the lecture room, based on a student-centred approach, and reflects on how student perspectives can be implemented during lectures.

Purpose The purpose of the study was to assemble knowledge, to understand the nuances of corporate governance as it is widely dispersed having multiple dimensions, to organize and categorize review papers on corporate governance under specific subjects, fields, areas of research. Thematic analysis enabled classifying review papers providing insight and spectra about corporate governance. Methodology The research study is confined to review of review papers on Corporate Governance downloaded through Google scholar and focuses only on abstracts of these reviews and determines the intensity of respective research published/ undertaken on specific category and sub-categories during the period 1988 to 2017. Document analysis was used to gather information on the (Valiente & GonzAilez, n.d.) themes, providing further break-up into individual sub-categories and identifying an array of research topics. Findings The paper provides thematic analysis of six hundred and sixty five (665) review papers, classified into nineteen (19) categories, 177 sub-categories comprising 476 review papers. On the basis of classifications significance of Corporate Governance has been observed for firm performance (5 th category 71 papers); legislative & regulatory requirement (7 th category 64 papers); executive governance (2 nd category 59 papers) these three categories have contributed maximum number of review papers. The above three categories have mostly published review papers on the Impact of Corporate Governance Variables on Firm Performance: Country comparison (19 papers), Corporate Governance Effects on/ Relationship with Firm/Corporate Performance (15 papers) and Review of Corporate Governance Reforms Country wise (16 papers). Practical Implications The research study (1) highlights existing research undertaken (2) identifies avenues for future research this will benefit research scholars & academics to explore potential research areas in context to Pakistan. It will also enhance the acumen and awareness of practitioners and policy makers regarding the vitality of corporate governance for quality decision making. Keywords: Corporate Governance, Firm & Corporate Performance, Legislative & Regulatory Requirement, Executive Governance.

Aim To synthesize suicide prevention strategies for older adults. The review question was Which suicide prevention strategies are useful for older adults? Design Integrative review. Data sources Academic Search Premier, CINAHL, Ovid PsycINFO and PubMed were searched for articles published between January 2009 and December 2019. Review methods An integrative review of quantitative, qualitative and theoretical papers with a qualitative thematic analysis. Results Key aspects of the included studies contributed to the formulation of four themes: (1) Recognizing older adults’ physical and/or mental health problems and referring them for help and treatment, (2) Designing an educational programme, (3) Communication and dialogue about warning signs and (4) Social support and awareness of causing significant others emotional pain. The findings indicate an urgent need to identify effective suicide prevention strategies for older adults.

Background and aim: Digital libraries have been attracted by many countries around the world in recent years, and many scientific outputs regarding to digital libraries have been published. The aim of this study was to analyze the scientific papers of the world in the field of digital libraries based on quantitative and qualitative indicators with focus on Iran's rank. Material and methods: This descriptive-analytical study with a scientometric approach was evaluated 5637 papers indexed in Web of Science (WoS) by the end of 2016. The HistCite software was used for data analysis and VOSviewer software was applied for drawing the maps related to thematic and co-authorship analysis. Findings: The result indicates that the scientific papers of the world have had an increasing trend in this field. H-index of articles was 93 and 18 in the world and Middle East countries, respectively. The United States of America (USA) had the highest number of articles (2221) with h-index 81. Iran had h-index 7. It was found that single-authored paper had the highest frequency among global papers. Scientific collaborative coefficient was 0.44 and 0.54 for global and Iranian researchers during 35 years, respectively. Conclusion: The research results suggest that most scientific articles of digital libraries have been published by several countries, with the USA topping the list. In the Middle East, Iran has the largest share in science production with 41 articles.

Purpose The purpose of this paper is to review and explore the primary characteristics of the best papers, which have been selected by the Toulon-Verona Conference (TVC) Excellence in Services scientific committee for the period 2008-2016. Design/methodology/approach The study includes a review of the best papers (n = 51) selected by the TVC’s scientific committee from 2008 to 2016 and obtained through the TVC’s archives. The primary highlights of each paper include number of authors, authorship profile (i.e. lead author affiliation, gender, and geographic location), co-authors’ geographic locations, classification of the papers, research topics, varieties of research methods used, number of electronic downloads (as of June 2017), number of citations, and subject keywords. Coding sheet developed to ensure standardization, consistency and to ensure the relevant data were collected for the content analysis. Mixed methods analysis (analyze quantitative data qualitative and and vice versa) was used to provide descriptive statistics. Findings In total, 51 best papers have been selected by the TVC scientific committee and reflected 145 authors. Lead authors were from a total of 50 HEIs worldwide and one consultant (private sector). Six papers were self-authored while the 45 were multi-authored. The majority of the papers written by Italian authors (58.8 percent); followed by France, Greece, and Sweden (5.9 percent each); Australia, Portugal, Spain, and UK (4 percent each); Austria, Norway, Slovenia, and Vietnam (1.9 percent each). In total, 37 papers were classified as a research paper, 10 case studies, and 4 theoretical. Practical implications The analysis for the first time define methodological trends for the TVC’s best papers and suggest possible future research topic and methodological approach for research in the management field. Originality/value The findings are unique for the TVC conference, for the TQM’s special issue, which provide practical implications for researchers and conference organizers and contribute to the literature of analyzing published papers.

Background Social support services such as day care centres are important in post-diagnostic dementia care to enable people living with dementia stay at home for longer. Little research has addressed potential inequalities in access, with no research on variations before and since COVID-19. The aim of this study was to explore inequalities in social support service usage before and since the pandemic. Methods Unpaid carers and people living with dementia were interviewed over the phone about their experiences of accessing social support services before and since the COVID-19 pandemic. Transcripts were analysed for key themes using inductive and deductive thematic analysis. Results Fifty participants (42 unpaid carers; eight people living with dementia) were interviewed, and five themes identified: (1) Service issues; (2) Access issues; (3) Relying on own initiative; (4) New inequalities due to COVID-19; and (5) Missing out on the benefits of support services. Participants reported transport, finances, and location as factors reducing their ability to access support service pre-COVID, with inequalities remaining and at times exacerbated since. Carers and people living with dementia also reported struggling with accessing basic necessities during COVID, including food and medicines. Conclusions Considering the benefits of accessing support services, resourced procedures and facilities are needed to maintain access to support services with more accessible remote support provision, enabling people from all backgrounds to access the care they need.

At the moment, the largest amount of tissue paper products are consumed in East Asia (which includes China and Japan), Europe and North America, and between 2010 and 2023, consumption of tissue paper products is expected to grow by 3% with the largest growth rate in China. Meanwhile, toilet paper, kitchen towels and facial tissues, combined make up 85.2% of all tissue paper products consumed in 2018. While different factors can be named as responsible for this growth in consumption, it is quite difficult to isolate the product-related factors that contribute to the growth of consumption of tissue paper in different countries due to the fact that tissue products have limited uniform specifications between different suppliers. This means, tissue suppliers and tissue machine manufacturers, like Valmet, are left with the challenge of understanding customers’ motivations behind demand of different tissue paper products. This is the motivation behind this study, which is to investigate what qualities of toilet paper, facial tissues and kitchen towels, are customers in the US, China and Japan satisfied or dissatisfied with. This is compared with measurements of the qualities of these products, like softness, strength, thickness, to determine the ranges of values of the products’ qualities that customers are satisfied with. Online reviews of 34 different brands of tissue paper products are collected ethically from online retailer websites (Amazon US, Amazon Japan, Walmart, JD.com), and analysed using the thematic analysis methodology to identify the list of qualities of tissue products that customers are satisfied or dissatisfied with. Then, the Pareto rule was used to identify the top 20% most important qualities to customers. These 34 brands were also purchased from these online retailers and their different qualities were measured. The results and conclusion from the study revealed different insights, among which is that softness is a must-be quality for toilet papers in all countries studied, while water absorption is a must-be quality for kitchen towels. The study also revealed ranges of the numerical values of these qualities that are acceptable to end consumers. Valmet intends to use the conclusions from the study in engagements with tissue paper suppliers in the three countries regarding product strategies and choice of technology.

Since dockless bicycle-sharing systems (DBSS) first arose in China in 2016, studies have examined their governance. However, there has been no comprehensive review of the literature on DBSS. This paper presents the first systematic review of the burgeoning literature on the governance of DBSS. It maps key research themes, identifies research trends and provides a deeper understanding of the governance literature on DBSS. We searched the Web of Science (WoS), Scopus and China National Knowledge Infrastructure (CNKI) databases to identify 95 papers written in English or Chinese between 2016 and 2019 that address the governance of DBSS. A thematic coding of these papers was supported by bibliometric analysis and knowledge mapping using the VOSviewer. More papers are written in Chinese rather than English, focusing on Chinese cities. Although the time range of our literature search was between 2016 and 2019, the first paper was published in 2017. Four key themes in the governance of DBSSs were identified within the papers, and over time the papers shifted their focus from problem-finding and problem-defining to problem-solving. Discussion of the inherent characteristics of the sharing economy and the externalities underpinning the governance of DBSS (Theme 1) and rebalancing problems for DBSS (Theme 2) first arose in early 2017, whilst discussions of the government regulation of DBSS (Themes 3) and the cross-boundary governance models underpinning DBSS (Themes 4) first arose in mid-2017. This paper concludes with a discussion of the identified themes and trends in the context of the broader literature on bicycle sharing and identifies opportunities for further research.

IntroductionSentinel lymph node biopsy (SLNB) is a diagnostic procedure developed in the 1990s. It is currently used to stage patients with primary cutaneous melanoma, provide prognostic information and guide management. The Australian Clinical Practice Guidelines state that SLNB should be considered for patients with cutaneous melanoma >1 mm in thickness (or >0.8 mm with high-risk pathology features). Until recently, sentinel lymph node (SLN) status was used to identify patients who might benefit from a completion lymph node dissection, a procedure that is no longer routinely recommended. SLN status is now also being used to identify patients who might benefit from systemic adjuvant therapies such as anti-programmed cell death 1 (PD1) checkpoint inhibitor immunotherapy or BRAF-directed molecular targeted therapy, treatments that have significantly improved relapse-free survival for patients with resected stage III melanoma and improved overall survival of patients with unresectable stage III and stage IV melanoma. Australian and international data indicate that approximately half of eligible patients receive an SLNB.Methods and analysisThis mixed-methods study seeks to understand the structural, contextual and cultural factors affecting implementation of the SLNB guidelines. Data collection will include: (1) cross-sectional questionnaires and semistructured interviews with general practitioners and dermatologists; (2) semistructured interviews with other healthcare professionals involved in the diagnosis and early definitive care of melanoma patients and key stakeholders including researchers, representatives of professional colleges, training organisations and consumer melanoma groups; and (3) documentary analysis of documents from government, health services and non-government organisations. Descriptive analyses and multivariable regression models will be used to examine factors related to SLNB practices and attitudes. Qualitative data will be analysed using thematic analysis.Ethics and disseminationEthics approval has been granted by the University of Sydney. Results will be disseminated through publications and presentations to clinicians, patients, policymakers and researchers and will inform the development of strategies for implementing SLNB guidelines in Australia.

Objective: to describe the risk factors that influence the self-injury behavior of adolescents assisted at a Psychosocial Care Center for Children and Adolescents, according to subjects’ own perceptions. Method: a descriptive, exploratory, qualitative study carried out through medical records and a focus group with 07 adolescents. The statements were submitted to thematic content analysis. Results: in the risk factors category, four subcategories emerged: Family adversity factors; Social contagion; Adverse life events; Personal characteristics. Conflicts, lack of support, drug use in the family, meeting someone who cuts themselves, social networks, religiosity, history of sexual violence and bullying were identified as risk factors that influence self-injury. Final Considerations: adolescents pointed out the need for prejudice-free dialogues in schools, in health and family devices, configuring protective factors to avoid this practice that comes from several negative events throughout life.

Aim To explore a cohort of mental health nurses’ views and experiences in developing and applying critical appraisal of research skills to identify helping and hindering factors. Background In accordance with evidence-based practice principles, there is an expectation that student (mental health) nurses will become competent in understanding research to make judgements about its trustworthiness and applicability in the clinical setting. This process is termed the ‘critical appraisal of research’ and it is deemed important to healthcare professionals because it facilitates the use of evidence from research to underpin practice. Design The study incorporated qualitative secondary research using thematic analysis and a poststructural lens. Methods Following undertaking a module including tuition on the critical appraisal of research, a cohort of student mental health nurses’ submitted essay reflections focusing on critical appraisal experiences were thematically analysed. The thematic analysis included both deductive and inductive components in adjunct to a poststructuralist analysis to explore influencing factors of language, meaning and subjectivity. Results The study identified there are both pedagogical factors and wider societal considerations influencing the critical appraisal of research experiences. Psychological and emotional factors, incorporating anxiety components were identified as a key barrier to engagement and understanding which has not previously been identified in comparable research. Enablers to the understanding and application of critical appraisal skills were identified as peer learning, accessing academic supervision, gaining a satisfaction of personal learning and self-directed learning with library skills support. Conclusions The findings indicate that there are specific pedagogic considerations which can be applied when supporting mental health student nurses in developing and gaining skills in the critical appraisal of research. It is recommended that these are applied universally for nursing students and considered for other populations of healthcare students.

Background Anti-Retroviral Therapy (ART) care is a lifelong treatment, which needs accurate and reliable data collected for long period of time. Poor quality of medical records data remains a challenge and is directly related to the quality of care of patients. To improve this, there is an increasing trend to implement electronic medical record (EMR) in hospitals. However, there is little evidence on the impact of EMR on the quality of health data in low- resource setting hospitals like Ethiopia. This comparative study aims to fill this evidence gap by assessing the completeness and reliability of paper-based and electronic medical records and explore the challenges of ensuring data quality at the Anti-Retroviral Therapy (ART) clinic at the University of Gondar Referral Hospital in Northwest Ethiopia. Methods An institution-based comparative cross-sectional study, supplemented with a qualitative approach was conducted from February 1 to March 30, 2017 at the ART clinic of the University of Gondar Hospital. A total of 250 medical records having both electronic and paper-based versions were collected and assessed. A national ART registration form which consists of 40 ART data elements was used as a checklist to assess completeness and reliability dimensions of data quality on medical records of patients on HIV care. Kappa statistics were computed to describe the level of data agreement between paper-based and electronic records across patient characteristics. In-depth interviews were conducted using semi-structured questionnaires with ten key informants to explore the challenges related with the quality of medical records. Responses of the key informant interviews were analyzed using thematic analysis. Results The overall completeness of medical records was 78% with 95% CI (70.8% - 85.1%) in paper-based and 76% with 95%CI (67.8% - 83.2%) EMR. The data reliability measured in Kappa statistics shows strong agreements on the socio-demographic data such as educational status 0.93 (0.891, 0.963), WHO staging 0.86 (0.808, 0.906); general appearance 0.83 (0.755, 0.892) and patient referral record 0.87 (0.795, 0.932). The major challenges hindering good data quality was the current side by side dual data documentation practice (the need to document both on the paper and the EMR for a single record), patient overload and low data documentation practice of health workers. Conclusion The overall completeness of ART medical records was still slightly better in paper-based records than EMR. The main reason affecting the EMR data quality was the current dual documentation practice both on the paper and electronic for each patient in the hospital and the high load of patients in the clinic. The hospital management need to decide to use either the paper or the electronic system and build the capacity of health workers to improve data quality in the hospital.

IntroductionMany patients now turn to the internet as a resource for healthcare information and advice. However, patients’ use of the internet to manage their health has been positioned as a potential source of strain on the doctor–patient relationship in primary care. The current evidence about what happens when internet-derived health information is introduced during consultations has relied on qualitative data derived from interview or questionnaire studies. The ‘Harnessing resources from the internet to maximise outcomes from GP consultations (HaRI)’ study combines questionnaire, interview and video-recorded consultation data to address this issue more fully.Methods and analysisThree data collection methods are employed: preconsultation patient questionnaires, video-recorded consultations between general practitioners (GP) and patients, and semistructured interviews with GPs and patients. We seek to recruit 10 GPs practising in Southeast England. We aim to collect up to 30 patient questionnaires and video-recorded consultations per GP, yielding up to 300. Up to 30 patients (approximately three per participating GP) will be selected for interviews sampled for a wide range of sociodemographic characteristics, and a variety of ways the use of, or information from, the internet was present or absent during their consultation. We will interview all 10 participating GPs about their views of online health information, reflecting on their own usage of online information during consultations and their patients’ references to online health information. Descriptive, conversation and thematic analysis will be used respectively for the patient questionnaires, video-recorded consultations and interviews.Ethics and disseminationEthical approval has been granted by the London–Camden & Kings Cross Research Ethics Committee. Alongside journal publications, dissemination activities include the creation of a toolkit to be shared with patients and doctors, to guide discussions of material from the internet in consultations.

BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 (HHKA) required schools to make changes to meals provided to children. Rural school districts have limited resources, with increased obesity rates and local food insecurity. In this study we sought to understand the perceptions of rural food service directors and the barriers to implementing the changes. METHODS Food service directors from rural school districts were invited to complete a semistructured telephone interview and online survey. A total of 51 respondents completed both, 6 completed only the online survey, and 16 completed only the telephone interview. Qualitative interview data were analyzed through open thematic coding; descriptive statistics were calculated for the quantitative data. RESULTS Food service directors mostly perceived the changes as negative, challenging, and burdensome. They believed that the changes resulted from concern about childhood obesity, which they did not view as a problem for their students. Diverse challenges were reported related to cost, preparation, and student preference. CONCLUSIONS Food service directors in isolated, rural areas need support to enhance understanding of HHKA requirements, build professional networks to learn from one another, and communicate with students, families, and other stakeholders. Future efforts should focus on changing perceptions and supporting directors in order to make implementation a success.

Rationale, aims and objectives Despite extensive evidence on the value of patient decision support interventions (DESIs), there is no consensus on optimal DESI formats. Assessing clinicians' perceptions about DESI formats can help facilitate their adoption. The aim of this study was to assess clinicians' perceptions of DESIs formats and potential use in practice. Methods Semi-structured qualitative interviews were conducted with doctors from diverse practice areas (internal medicine, OB/GYN, surgery, medical oncology, emergency medicine) and elicited perceptions toward patient DESIs formats (digital vs. paper) and timing of administration. Questions also elicited beliefs underlying attitudes, perceived social norms and self-efficacy for using DESIs and the feasibility of doing so. Data analysis was conducted using a thematic analysis approach. Results Participants identified strengths of both more comprehensive digital and shorter paper-based tools and thought they could complement each other. Participants consistently expressed the advantages of using DESIs outside the consultation to supplement clinical discussions about cancer decisions given the amount of information to discuss during these emotion-laden conversations. Participants felt that patients with older age and lower socio-economic status were more likely to use a paper-based compared with a digital DESI. Participants also noted challenges related to reliable resources such as computers and Internet in the practice setting, which would be necessary for implementing the digital DESIs on site. Conclusions Clinicians' perceptions and opinions about value of DESIs can vary widely across doctor, patient and clinic characteristics. A one-size-fits-all approach to implementation might not be feasible, suggesting that flexible approaches to providing decision support for patients are needed to drive broader adoption.

Purpose – This article aims to describe how people manage to integrate their use of paper and electronic documents in modern office work environments. Design/methodology/approach – An observational interview type study of 14 participants from 11 offices in eight organizations was conducted. Recorded data were analysed using a thematic analysis method. This involved reading and annotation of interview transcripts, categorizing, linking and connecting, corroborating, and producing an account of the study. Findings – The findings of the study can be categorized into four groups: the roles paper and electronic documents serve in today's offices, the ways in which these documents are managed, the problems associated with their management, and the types of fragmentation that exist in terms of their management and how these are dealt with. Practical implications – The study has identified the need for better integrated management of paper and electronic documents in present-day offices. The findings of the study have then been used to propose a set of guidelines for the development of integrated paper and electronic document management systems. Originality/value – Although similar studies of offices have been conducted in the past, almost all of these studies are prior to the widespread use of mobile and network-based shared technologies in office environments. Furthermore, previous studies have generally failed to identify and propose guidelines for integration of paper and electronic document management systems.

Despite scholars' reliance on Schein's (1990) three-interconnected layer framework of organizational culture (i.e., artifacts, values/norms, underlying assumptions), few, if any, measure artifacts. This gap is significant because artifacts are readily visible and provide valuable insight into understanding the perpetuation of norms through their manifestation in the work environment. Moreover, existing assessments focus on one layer only, either values/beliefs or underlying assumptions, resulting in only a partial picture of culture. In this tutorial-based paper, we demonstrate a grounded theory approach comprising content analysis, thematic analysis, and intensity scoring, to develop an unobtrusive method for coding artifacts seen in photos of office spaces. Unobtrusive methods reduce participant burden, which is critical because existing assessments of culture are time consuming and/or rely on numerous participants. We demonstrate how to use the photo coding method and wrap-up the tutorial by showing how artifact coding augments an existing qualitative culture assessment, emphasizing the added value of artifact assessment. We hope by providing an unobtrusive method to artifact coding, researchers will start assessing this important layer of culture to achieve a more comprehensive understanding of organizational culture.

A major challenge for the speech-language pathology profession in many cultures is to address the mismatch between the “linguistic homogeneity of the speech-language pathology profession and the linguistic diversity of its clientele” ( Caesar & Kohler, 2007 , p. 198). This paper outlines the development of the Multilingual Children with Speech Sound Disorders: Position Paper created to guide speech-language pathologists’ (SLPs’) facilitation of multilingual children's speech. An international expert panel was assembled comprising 57 researchers (SLPs, linguists, phoneticians, and speech scientists) with knowledge about multilingual children's speech, or children with speech sound disorders. Combined, they had worked in 33 countries and used 26 languages in professional practice. Fourteen panel members met for a one-day workshop to identify key points for inclusion in the position paper. Subsequently, 42 additional panel members participated online to contribute to drafts of the position paper. A thematic analysis was undertaken of the major areas of discussion using two data sources: (a) face-to-face workshop transcript (133 pages) and (b) online discussion artifacts (104 pages). Finally, a moderator with international expertise in working with children with speech sound disorders facilitated the incorporation of the panel's recommendations. The following themes were identified: definitions, scope, framework, evidence, challenges, practices, and consideration of a multilingual audience. The resulting position paper contains guidelines for providing services to multilingual children with speech sound disorders ( http://www.csu.edu.au/research/multilingual-speech/position-paper ). The paper is structured using the International Classification of Functioning, Disability and Health: Children and Youth Version ( World Health Organization, 2007 ) and incorporates recommendations for (a) children and families, (b) SLPs’ assessment and intervention, (c) SLPs’ professional practice, and (d) SLPs’ collaboration with other professionals. Learning outcomes: Readers will 1. recognize that multilingual children with speech sound disorders have both similar and different needs to monolingual children when working with speech-language pathologists. 2. Describe the challenges for speech-language pathologists who work with multilingual children. 3. Recall the importance of cultural competence for speech-language pathologists. 4. Identify methods for international collaboration and consultation. 5. Recognize the importance of engaging with families and people within their local communities for supporting multilingual children in context.

This study explored the occupational devotion of lifestyle entrepreneurs and their well-being. Although the number of enterprises in the sports industry increased over the past years, limited literature exists on this topic. Therefore, this paper focused on lifestyle entrepreneurs who turned their sports into their occupations. We conducted semi-structured interviews and a follow-up survey with lifestyle entrepreneurs (N = 13) from various sports (e.g., yoga, kiting, football). The thematic analysis revealed a strong connection between the individuals’ choice of career and well-being. Other themes (and sub-themes), such as mental and physical health and value (co-)creation, were identified, corroborating the authors’ assumption that these lifestyle entrepreneurs started a career in their sports to reach a higher quality of life. The results uncovered that well-being and occupational devotion are closely linked. Co-creation is connected to well-being, and this can accrue social capital in the community. Thus, the results recommended support for lifestyle entrepreneurs as they provide community benefits.

A three-stage process is being undertaken to investigate the fundamentals of care. Stage One (reported here) involves the use of a met a-narrative review methodology to undertake a thematic analysis, categorization and synthesis of selected contents extracted from seminal texts relating to nursing practice. Stage Two will involve a search for evidence to inform the fundamentals of care and a refinement of the review method. Stage Three will extend the reviews of the elements defined as fundamentals of care. This introductory paper covers the following aspects: the conceptual basis upon which nursing care is delivered; how the fundamentals of care have been defined in the literature and in practice; an argument that physiological aspects of care, self-care elements and aspects of the environment of care are central to the conceptual refinement of the term fundamentals of care; and that efforts to systematize such information will enhance overall care delivery through improvements in patient safety and quality initiatives in health systems.

Introduction and Aims The Northern Territory Government has recently planned and implemented an extensive suite of alcohol harm minimisation policies, including the reintroduction of the Banned Drinker Register (BDR). It is an explicit alcohol supply reduction measure that places persons who consume alcohol at harmful levels onto a register, prohibiting the purchase of alcohol from take‐away liquor outlets. This paper explores industry stakeholders' perspectives regarding the extent to which the BDR is meeting its objectives to improve community health and safety by reducing alcohol‐related harms. Design and Methods Interviews and one focus group were conducted with 66 alcohol industry stakeholders from urban and remote locations. Focusing on outcomes both central (crime and safety) and peripheral (health and therapeutic support) to the stakeholders' interest, the authors used inductive thematic analysis to examine participants' perceptions about the effectiveness of the BDR. Results Analysis revealed mixed views about the effectiveness of the BDR. There is a tension between the objective to address public amenity and decrease crime, as expressed by the participants, compared to the health‐focused approach to therapeutic services and referrals identified in other sources. Discussion and Conclusions Drawing on these findings, alongside other relevant sources, the authors argue there is a need for a more effective communication strategy to the public and professional community to enhance the capacity of the BDR to meet its goals. The authors recognise the limitations of alcohol industry stakeholder views and identify the need for a comprehensive evaluation approach that includes multiple stakeholder perspectives.

INTRODUCTION: Childbirth is a life-changing event where fathers desire being involved. As fathers take a more active role, fear of childbirth can arise. The aim of this study was to explore fathers' experiences of childbirth fear during pregnancy and after the birth of their baby. METHODS: This was a qualitative longitudinal prospective study that included 14 interviews with seven fathers, one during the prenatal period, and one follow-up interview after childbirth. Data were analyzed using thematic analysis according to Braun and Clark. RESULTS: The main theme 'Being vulnerable during the transition to fatherhood' was based on the perception of childbirth as risky with threats toward the woman's and baby's health, not being able to give and receive enough support, unable to handle the unknown process of birth, and not being a good father. Helpful strategies for coping with fear were to talk about fear, to learn more about childbirth and techniques on how to handle fear, and to avoid dealing with fear. Fathers' fear of childbirth changed after the birth of their baby. Their thoughts of another childbirth did not evoke the same strong feelings of fear. Issues important for the reduction of childbirth fear were: receiving professional support, actively taking part in the childbirth process, and the partner having an uncomplicated birth. CONCLUSIONS: Fathers with childbirth fear regarded childbirth as risky, but they expressed helpful coping strategies. After the birth of their baby, they became less fearful. Quality of fear-reducing support to expectant fathers may influence how they cope with their transition into fatherhood.

Cisgender female sex workers (CFSW) continue to face structural barriers to HIV prevention. We analyzed the acceptability of the oral HIV self-test (HIV-ST) among CFSW as part of a pragmatic trial on HIV prevention in Brazil. Data from in-depth interviews conducted with 12 women from diverse sex worker contexts and participant observation were analyzed using thematic analysis. CFSW valued autonomy in their workplaces and saw the HIV-ST as a possibility for self-care. Some feared clients’ reactions, manager reprimands, and a positive result. HIV and sex work stigma largely drove self-care practices and perceived acceptability of the self-test. We argue that the autonomy offered by the self-test presents a paradox: increasing autonomy on the one hand while risking sidestepping structural dimensions of HIV vulnerability on the other. These nuances must be considered in interventions promoting the HIV-ST by considering the specificities of sex worker contexts, addressing stigma, and effectively involving CFSW and their organizations in intervention development.

Hospitals, with many features that can evoke severe behavior in patients with autism spectrum disorder (ASD), often use restraint as a behavior management strategy. Prior research on restraint in patients with ASD has primarily focused on children or specific departments. Twenty-five physicians and medical trainees from an urban teaching hospital participated in discussions about experiences managing severe behavior in patients with ASD across the lifespan. Twenty themes emerged from thematic analysis of participant transcripts. The five most salient themes included: lack of procedural knowledge with restraint implemented by other hospital professionals; alternative strategies to manage severe behavior; negative perceptions of restraint; helpful role of caregivers; and limited experience treating patients with ASD, and critical need for training in function-based management.

Feeding difficulties are often reported in children with cerebral palsy (CP) and are associated with caregiver stress. This study explored the feeding experiences and support of caregivers with children who have CP. A qualitative approach was used where semi-structured telephone interviews were conducted and audio recorded. Thematic analysis was used to code and analyse the transcribed interview data from the eleven mothers that participated. Four major themes were identified from the data: Child-centred world, Making decisions, Knowing their child, and Seeking and receiving support. Caregivers knew their child’s unique needs and made daily decisions around feeding based upon the child’s feedback and changing condition. Family support was viewed as important, although the caregivers still reported feeling stressed. Health professional support varied from “amazing” to “frustrating”, which contributed to the caregivers’ stress. However, no single support strategy was appropriate as their needs or preferences varied. It is recommended that health professionals take an individualised partnership approach with caregivers and their child, with particular attention to those caregivers who lack a friend or family support and those who are physically isolated., Highlights Provides insight into caregivers’ experiences in managing feeding difficulties of their child with cerebral palsy.Major themes were: child-centred world, making decisions, knowing their child, and seeking and receiving support.Caregivers experienced stress in many aspects of their child’s feeding difficulties.Health professional support should be individualised, reasonable, and timely.A variety of support strategies should be used to meet the different needs and preferences of caregivers.

A growing number of adolescents are seeking medical care to alleviate gender dysphoria (GD). This qualitative study explored the subjective experiences of GD among help-seeking transgender and gender nonconforming (TGNC) youth in order to develop a more nuanced conceptualization of the phenomenon. Fifteen life-mode interviews were conducted with newly referred youth between the ages of 13 and 19. All participants were assigned female at birth. The data were analyzed using thematic analysis. The participants targeted five major themes that characterize GD: (1) Bodily sensations were constant reminders of GD throughout the day, (2) emotional memories from the past of being different and outside triggered GD, (3) the process of coming out was a transformative experience that changed how the participants understood themselves, (4) GD both increased and decreased in relation to others, (5) everyday life required careful negotiation to feel whole without developing new forms of GD. Based on the results, we suggest a more conceptually nuanced model of GD, one which accounts for how bodily sensations and emotional memories from the past were sources that elicited GD. The sources were mediated through the process of coming out and relating to others, and this resulted in the negotiation of GD today. The conceptual model suggested in the present study could ideally shed light on preexisting knowledge on TGNC youth struggling with GD. In addition, an improved understanding of GD could ideally help clinicians when addressing individual treatment needs.

Although vaccination is one of the most cost-effective ways of preventing disease, vaccine hesitancy has been included among the ten threats of global health. Addressing low adult vaccination rates requires an adequate understanding of people's views. We explored perceived barriers to immunization among under-vaccinated adults to identify potential differences among vaccine supporters, refuters, and those who are undecided. We conducted a multi-center, mixed-methods study at 23 primary care practices in Greece. Each day, we asked three new randomly-selected adult healthcare users who attended the practice over the course of 30 consecutive working days. We used thematic content analysis to analyze their written answers to open-ended questions that addressed reasons for not getting vaccinated. Out of 1571 participants, two-thirds reported they were under-vaccinated as adults, thus accounting for three out of five of the supporters and the vast majority of the undecided and refuters. "Concerns/fears," a "perception of low susceptibility to disease due to good health status," the "absence of healthcare professional's recommendation," and "previous negative experiences" were four themes common to all three groups. Additional barriers reported by supporters and the undecided included "knowledge gaps about the necessity of adult vaccination," "negligence," and lack of "accessibility." Among refuters, additional themes identified were "mistrust in pharmaceutical companies" and "disbelief in vaccine effectiveness." In conclusion, under-vaccination is common, not only among refuters or the undecided, but also among supporters of adult vaccination. We found similarities and differences in under-vaccinated adults' perceived barriers, depending on their individual perspectives. Physicians and public health services should take into consideration the impact of the wide range of attitudes and beliefs in their effort to address the underlying barriers to vaccination compliance as they attempt to increase vaccination coverage in adults.

Background Multiple sclerosis (MS) is an inflammatory demyelinating disease with no known cure. Numerous diets are promoted to reduce symptoms or even cure MS, despite insufficient evidence for any therapeutic diet. There are few qualitative studies exploring the experiences of people with MS in relation to diet, and no use of theory to explain the findings. Purpose To explore the experiences of adults with MS when navigating dietary advice, their attitudes when making dietary decisions, and their needs regarding dietary resources and education. Methods In this qualitative study, we conducted six focus groups with people with MS (n = 33 plus one spouse without MS). Groups were audio-recorded and transcribed verbatim. Primary analysis used a general inductive approach with thematic analysis. Secondary analysis aligned themes with the constructs of the self-determination theory. Results Six themes emerged: (a) confusion about where to seek dietary advice; (b) scepticism towards national dietary guidelines; (c) personalized approaches to dietary change; (d) barriers to dietary changes; (e) judging if dietary changes work; and (f) wanting dietary guidelines for MS. Conclusion People with MS are highly motivated to make dietary changes and improve their health. The self-determination theory explained why people with MS make dietary modifications, and the varying levels of motivation. MS-specific dietary resources and nutrition education need to incorporate ways to increase autonomous forms of motivation. Future dietary intervention studies could use the self-determination theory as a framework to improve long-term adherence to healthier diets.

Rationale, aims and objectives Little is known about hesitancy to receive the COVID‐19 vaccines. The objectives of this study were (1) to assess the perceptions of healthcare workers (HCWs) and the general population regarding the COVID‐19 vaccines, (2) to evaluate factors influencing the acceptance of vaccination using the health belief model (HBM), and (3) to qualitatively explore the suggested intervention strategies to promote the vaccination. Methods This was a cross‐sectional study based on electronic survey data that was collected in Iraq during December first‐19th, 2020. The electronic survey was designed using Qualtrics. HBM was followed to develop the survey items. A regression analysis was used to identify factors influencing people accepting vaccination. Thematic analysis for participant comments to an open‐ended question. Results A total of 1680 completed surveys were received. The mean age of 31.2 ± 9.9 years, 53.0% were female and 47.0% were male. The largest group was HCWs (45.7%), followed by general population (37.5%) and health college students (16.8%). Our findings expressed some hesitancy to receive the COVID‐19 vaccine with the acceptance rate of 61.7%. The HCWs perceived significantly higher susceptibility and severity of the COVID‐19 infection compared to the general population. The HCWs were significantly more likely than the general population to receive COVID‐19 vaccine. Concerns with proper storage was the biggest barrier to vaccine receipt. The regression analysis indicated eight factors that were significantly associated with the willingness to receive COVID‐19 vaccine: Preventive measures, perceived benefit, perceived barriers, cue to action, subjective norm, supportive of vaccination in general and having received a flu vaccine before. Conclusions Awareness campaign can focus on enhancing the vaccine perceived benefit, debunking misconceptions, and increasing the disease perceived severity. Additionally, the public health leaders need to minimize the perceived barriers by providing the vaccines and appeasing people concerns about their storage, effectiveness, and adverse events.

This paper aims to describe how healthcare providers perceived spirituality and spiritual care while caring for dying patients and their families in a hospice setting in Karachi, Pakistan. Using a qualitative interpretive description design, individual in-depth interviews were conducted among healthcare providers. Thematic analysis approach was used for data analysis. Spirituality and spiritual care were perceived as shared human connections, relating to each other, acts of compassion, showing mutual respect while maintaining dignity in care and empowering patients and families. Developing spiritual competency, self-awareness, training and education, and self-care strategies for healthcare providers are essential components promoting spiritual care in a hospice setting.

Background Increased self-management is a suggested solution to the burden on health-care services of long-term conditions (LTCs). This requires effective sharing of knowledge between health-care professionals and patients, and is an underexplored area. Objective To understand how patients and health-care professionals (HCPs) share and utilize knowledge in the social context of health-care interactions within long-term condition management. Methods Thematic analysis of 93 hours of observations of health-care interactions and 33 semi-structured interviews involving patients, carers and HCPs. Results 3 themes were identified: normative social roles, differing professional roles and the value of knowledge. Knowledge sharing was a complex process heavily influenced by social and cultural norms within the health-care context. Not all knowledge was easily shared within routine health-care interactions. Discussion The social context in which health-care is practised influences what knowledge is shared and how this is achieved. It favours sharing of clinical knowledge from HCPs to patients and disadvantages patients in their ability to share their unique knowledge based on lived experience of illness. The opportunities for patients to be supported in their knowledge, skills and confidence within routine health-care interactions are limited. Conclusion Both patients and HCPs need support to recognize the characteristics of the social context of health care and their understandings of their roles within this in order for them to move beyond accepted behaviours to develop more effective partnership working. Patient or public contribution Patients were involved in initial design of the study, particularly ethics of ethnographic observation.

In recent years, cultural safety has been proposed as a transformative approach to health care allowing improved consideration of Indigenous patient needs, expectations, rights and identities. This community‐based participatory study aimed to identify potential barriers and enablers to cultural safety in health care provided to Atikamekw living with diabetes in Québec, Canada. Based on a qualitative descriptive design, the study uses talking circles as a data collection strategy. Three talking circles were conducted with Atikamekw living with diabetes and caregivers, as well as with health professionals of the family medicine teaching clinic providing services to the community. Two team members performed deductive thematic analysis based on key dimensions of cultural safety. Results highlight four categories of barriers and enablers to cultural safety for Atikamekw living with diabetes, related to social determinants of health (including colonialism), health services organization, language and communication, as well as Atikamekw traditional practices and cultural perspectives of health. This study is one of the few that provides concrete suggestions to address key aspects of diabetes care in a culturally respectful way. Our findings indicate that potential enablers of cultural safety reside at different (from individual to structural) levels of change. Solutions in this matter will require strong political will and policy support to ensure intervention sustainability. Patient or public contribution Partners and patients have been involved in identifying the need for this study, framing the research question, developing the data collection tools, recruiting participants and interpreting results.

Background Community awareness of the harms of overdiagnosis remains low. Objective To evaluate community responses to a public health campaign designed for health service waiting rooms that focuses on the harms of unnecessary diagnostic imaging for low back pain. Methods We conducted two focus groups of 19 community members with or without low back pain in Sydney, Australia. This study formed the fourth and final stage of the development process of a public health campaign: (a) initial design, (b) expert review and revision, (c) online experiment and (d) community views & revision. We evaluated reactions to components of the campaign that included digital posters and an information leaflet using strong imagery and messaging about the risk of overdiagnosis. We conducted a qualitative thematic analysis to identify main themes. Results Community members reacted with surprise, initial mistrust, and occasionally anger towards imagery and messaging that suggested diagnostic imaging tests could be unnecessary and harmful. With further reflection and discussion, and after reading longer format information about overdiagnosis, the participants found some of the messages informative and useful. Participants appeared to gain a better understanding of the concept of overdiagnosis and the importance of not rushing to imaging. Conclusions Public health campaigns including posters and leaflets displayed in waiting rooms could raise awareness about overuse of diagnostic imaging and the harms of overdiagnosis more broadly. However, negative reactions are possible and must be managed carefully. Patient or public contribution We involved a community participation manager who provided advice on the focus group discussion guide, participant recruitment and manuscript presentation.

Context: The pool of papers published in ESEM. Objective: To utilize citation analysis and automated topic analysis to characterize the SE research literature over the years focusing on those papers published in ESEM. Method: We collected data from Scopus database consisting of 513 ESEM papers. For thematic analysis, we used topic modeling to automatically generate the most probable topic distributions given the data. Results: Nearly 42% of the papers have not been cited at all but the effect seems to wear off as time passes. Using text mining of article titles and abstracts, we found that currently the most popular research topics in the ESEM community are: systematic reviews, testing, defects, cost estimation, and team work. Conclusions: While this study analyzes the paper pool of the ESEM symposium, the approach can easily be applied to any other sub-set of SE papers to conduct large scale studies. Due to large volumes of research in SE, we suggest using the automated analysis of bibliometrics as we have done in this paper.

Material hardship and stress, associated with poor infant outcomes, increased during the Coronavirus Disease 2019 pandemic. Chinese American families were vulnerable to racism-driven disparities. Little is known about maternal perceptions of pandemic impacts on their infants, family, and community. Purposive sampling of low-income Chinese American mothers (n = 25) with infants (1-15 months). Semi-structured qualitative interviews conducted in Mandarin, Cantonese, or English were audio-recorded, transcribed, and translated. Transcripts coded using applied thematic analysis in an iterative process of textual analysis until thematic saturation. Three themes emerged: (1) Heightened family hardship included financial strain, disruption of transnational childcare, experiences of racism; (2) Altered infant routines/developmental consequences included using protective equipment on infants, concerns about infant socio-emotional development; (3) Coping strategies included stockpiling essentials, adapting family diets. Strategies to mitigate disparities include expanding social needs screening, correcting misinformation, strengthening support networks, and including low-income Chinese Americans in these efforts.

Unlearning has evinced immense traction and opportunity in debates pertaining to organizational learning, innovation, management of change, knowledge management, and new product development, to name but a few. Provided the diversity and expansiveness of the phenomenon, past studies have undertaken both narrative and systematic reviews to synthesize the field of organizational unlearning (OU). Although highly commendable and enlightening, these scholarly efforts would be augmented by contemplating the share of leading management journals towards furthering the research on unlearning. Moreover, a systematic comprehension of the research themes of OU can be instrumental in representing the intellectual structure of the field. For this purpose, we undertake a combination of bibliometric and thematic analysis to identify critical trends that have helped shape unlearning research. The results discern the main scientific actors (articles, authors, journals, universities), research design, and dimensions of OU. In addition, eight clusters of unlearning along with underlying theoretical perspectives are analyzed, which may help scholars integrate the development of one domain to another, formulate pertinent research questions related to OU, and encourage interdisciplinary research.

Objectives This study aimed to explore the impact of the coronavirus disease 2019 (COVID‐19) pandemic on self‐care of individuals living with rheumatoid arthritis (RA). Methods Guided by a constructivist, qualitative design, we conducted one‐to‐one in‐depth telephone interviews between March and October 2020 with participants with RA purposively sampled for maximum variation in age, sex and education, who were participating in one of two ongoing randomized‐controlled trials. An inductive, reflexive thematic analysis approach was used. Results Twenty‐six participants (aged 27–73 years; 23 females) in British Columbia, Canada were interviewed. We identified three themes: (1) Adapting to maintain self‐care describes how participants took measures to continue self‐care activities while preventing virus transmissions. While spending more time at home, some participants reported improved self‐care. (2) Managing emotions describes resilience‐building strategies such as keeping perspective, positive reframing and avoiding negative thoughts. Participants described both letting go and maintaining a sense of control to accommodate difficulties and emotional responses. (3) Changing communication with health professionals outlined positive experiences of remote consultations with health professionals, particularly if good relationships had been established prepandemic. Conclusion The insights gained may inform clinicians and researchers on ways to support the self‐care strategies of individuals with RA and other chronic illnesses during and after the COVID‐19 pandemic. The findings reveal opportunities to further examine remote consultations to optimize patient engagement and care. Patient or Public Contribution This project is jointly designed and conducted with patient partners in British Columbia, Canada. Patient partners across the United Kingdom also played in a key role in providing interpretations of themes during data analysis.

The COVID-19 pandemic has presented many unique challenges to patient care especially in emergency medicine. These challenges result in an altered patient experience. Patient experience refers to the cumulative impression made on patients during their medical visit and is measured by a standardized survey tool. Patient experience is considered a key measure of quality of care. The volume of survey data received makes it difficult to spot trends and concerns in patient comments. Topic modeling and sentiment analysis are well documented analytic techniques that can be used to gain insight into patient experience and make sense of vast quantities of data. This study examined three periods of time, pre, during and post-COVID-19 first wave in order to identify key trends in sentiment and topics related to patient experience. Previously collected, anonymized Press Ganey (PG) survey data was used from three northeastern emergency department that make up an academic emergency department. Data was collected for three contiguous time periods: Pre-COVID-19 (12/10/2019- 3/10/2020), During COVID-19: (3/11/2020–6/10/2020), and Post-first wave COVID-19 (6/11/2020- 9/10/2020). Preprocessing of the data was carried out then a sentiment label (i.e., positive, negative, neutral, mixed) was assigned by the tool. These labels were used to assess the validity of Press Ganey labels. Next, a topic modeling approach from machine learning was used to analyze the contents of the patient comments and uncover concerns and perceptions of patient experiences. Themes that emerged from the analysis of patient comments included concerns over personal safety and exposure to the virus, exclusion of family from decision making and care and high levels of scrutiny over systems issues, care, and treatment protocols. Topic modeling showed shifting priorities and concerns throughout the three periods examined. Prior to the pandemic, patient comments were largely positive and focused on technical expertise and perceptions of competence. New topics and concerns that patients reported relevant to the pandemic were identified during-COVID-19. Comments on systems issues regarding processes to limit viral spread and concerns over family/visitor restrictions were dominant. Although there was evidence of praise and appreciation of the efforts of staff there was also a high level of scrutiny of the processes encountered during the emergency visit. Sentiment analysis and topic modeling offer a unique method for organizing and analyzing the shifting concerns of patients and families. Suggestions of interventions are made to address these evolving concerns. The automation of analysis using artificial intelligence would allow for rapid and accurate analysis of patient feedback.

Integrity is considered an important corporate value. Yet recent global events have highlighted the challenges firms face at living up to their stated values, especially when extended supply chain partners are involved. The concept of Supply Chain Integrity (SCI) can help firms shift focus beyond internal corporate integrity, toward supply chain integrity. Researchers and managers will benefit from an understanding of the SCI concept toward implementing SCI to better align supply chain partners with stated corporate values. This research fully develops and empirically grounds the firm-level, inter-firm-oriented SCI concept. The thematic analysis of six firms' archival and website content elaborated empirical descriptions of SCI themes and enabled the development of a process model for SCI, presenting a novel view of the underlying process by which firms can assess, develop, and maintain SCI across their supply chains. We propose the SCI model as an evolutionary process to improve a firm's supply chain sustainability, rather than a dichotomous end state where firms either "have" integrity or they don't. The SCI model could be used as a tool to help leaders create necessary change to better align values and supporting statements with culture, while influencing and affecting stakeholders across the supply chain. This is particularly important in today's world, where business leaders must consider all stakeholders and address important stakeholder-driven issues such as supply chain sustainability, resilience, and security, which are now at the forefront in the ever-changing environment.

As a result of the devastating health effects of the COVID-19 outbreak, the lockdown has been considered a safety measure in many countries. In Pakistan, the first case of COVID-19 was reported in February 2020. The purpose of this qualitative study was to investigate people’s risk perception and protective behavior during the lockdown. Twenty-two (22) participants from eight big cities across Pakistan were interviewed. A six-step reflective thematic analysis was used for data analysis. The study focused on risk perception and protective behaviors. Our main analytical goal was to understand how risk perception shapes human behavior in the context of lockdown, pandemic-related information flow, and corresponding meaning-making. The study revealed that people influenced by information and advice campaigns form a perception of risk that has shaped their protective behavior. They used familiar means of coping with distress, including the search for strength through religious belief practices and following the precautions recommended by health professionals through the media.

Introduction Midwives experiencing traumatic births are emotionally affected by this process, lose their self-confidence, and may intend to leave the profession. This study aims to carry out a meta-synthesis of current qualitative research exploring the experiences of midwives witnessing traumatic births. Methods The meta-synthesis consisted of 18 full-text studies in English, obtained from PubMed, Scopus, Web of Sciences, Cumulative Index of Nursing and Allied Health Literature (CINAHL), EMBASE, and PsycINFO databases. The results of the studies were analyzed using the thematic analysis technique. The study includes qualitative, mixedmethod, and full-text studies published between 2000 and 2020 that explored the experiences of midwives and obstetric nurses witnessing birth trauma. Results The thematic analysis identified seven themes: post-traumatic feelings, posttraumatic stress symptoms, the impact of trauma on professional values, social support, learning from experience, legal process, and reflection of emotions of women experiencing traumatic birth on the midwife. Conclusions Midwives who witnessed traumatic birth were mostly emotionally affected. They lost their self-confidence and intended to leave their profession. They emphasized the importance of peer support through which they could share their experiences after trauma. Psychological education should be provided to midwives who witness the trauma by specialists, and midwives should be strengthened against the effects of trauma in terms of both the institutional policies where the birth takes place and midwifery-specific legal policies.

Introduction Tobacco smoking is one of the leading causes of death and disability in the Association of Southeast Asian Nations (ASEAN). Despite implementation of some tobacco control measures, youth continue to initiate smoking. This narrative review outlines how tobacco advertising, promotion, and sponsorship (TAPS) may influence smoking attitudes and uptake among youth in the region. Methods Nine electronic databases were searched on EBSCOhost to identify studies published up until December 2019. All studies published in English that investigated youth smoking and TAPS in ASEAN countries were included. Thematic analysis was used to investigate the influence of TAPS on youth smoking. Results Thirty-seven studies were identified. This research showed that youth were exposed and receptive to tobacco advertising, which may contribute to positive attitudes towards tobacco brands and smoking. Studies also demonstrated that youth were exposed to point-of-sale (POS) advertisements or promotions and individual sales promotions. However, little research has explored how these strategies influence attitudes and consumption behaviors among youth, or, how online advertising and cigarette packet branding may influence youth smoking. Conclusions Youth in ASEAN countries continue to be exposed to TAPS, particularly through POS advertisements or promotions and individual sales promotions. There is also cause for concern about 'below-the-line' advertising and the increasing role of cigarette packaging as a promotional tool. These findings support calls for all ASEAN countries to ratify the Framework Convention on Tobacco Control (FCTC), introduce comprehensive bans on all forms of tobacco advertising, including POS advertising and cigarette pack displays, and implement plain packaging legislation for tobacco products.

Background and Objective This article explores the need for conceptual advances and practical guidance in the application of the GRADE approach within public health contexts. Methods We convened an expert workshop and conducted a scoping review to identify challenges experienced by GRADE users in public health contexts. We developed this concept article through thematic analysis and an iterative process of consultation and discussion conducted with members electronically and at three GRADE Working Group meetings. Results Five priority issues can pose challenges for public health guideline developers and systematic reviewers when applying GRADE: (1) incorporating the perspectives of diverse stakeholders; (2) selecting and prioritizing health and “nonhealth” outcomes; (3) interpreting outcomes and identifying a threshold for decision-making; (4) assessing certainty of evidence from diverse sources, including nonrandomized studies; and (5) addressing implications for decision makers, including concerns about conditional recommendations. We illustrate these challenges with examples from public health guidelines and systematic reviews, identifying gaps where conceptual advances may facilitate the consistent application or further development of the methodology and provide solutions. Conclusion The GRADE Public Health Group will respond to these challenges with solutions that are coherent with existing guidance and can be consistently implemented across public health decision-making contexts. post-print 456 KB