Caught in the middle: a qualitative metasynthesis of Māori youth cultural identity

Background: Reflexive thematic analysis is widely used in qualitative research published in Palliative Medicine, and in the broader field of health research. However, this approach is often not used well. Common problems in published reflexive thematic analysis in general include assuming thematic analysis is a singular approach, rather than a family of methods, confusing themes and topics, and treating and reporting reflexive thematic analysis as if it is atheoretical. Purpose: We reviewed 20 papers published in Palliative Medicine between 2014 and 2022 that cited Braun and Clarke, identified using the search term ‘thematic analysis’ and the default ‘relevance’ setting on the journal webpage. The aim of the review was to identify common problems and instances of good practice. Problems centred around a lack of methodological coherence, and a lack of reflexive openness, clarity and detail in reporting. We considered contributors to these common problems, including the use of reporting checklists that are not coherent with the values of reflexive thematic analysis. To support qualitative researchers in producing coherent and reflexively open reports of reflexive thematic analysis we have developed the Reflexive Thematic Analysis Reporting Guidelines (the RTARG; in Supplemental Materials) informed by this review, other reviews we have done and our values and experience as qualitative researchers. The RTARG is also intended for use by peer reviewers to encourage methodologically coherent reviewing. Key learning points: Methodological incoherence and a lack of transparency are common problems in reflexive thematic analysis research published in Palliative Medicine. Coherence can be facilitated by researchers and reviewers striving to be knowing – thoughtful, deliberative, reflexive and theoretically aware – practitioners and appraisers of reflexive thematic analysis and developing an understanding of the diversity within the thematic analysis family of methods.

A transparent analytical process contributes to the methodological rigor of reflexive thematic analysis. To enhance such transparency in reflexive thematic analysis, novice researchers need to document and present the analytical processes of theme development. In this article, we showcase how qualitative comparative analysis can be integrated into reflexive thematic analysis as a strategy for novice researchers. We demonstrate how novice researchers can develop codes and categories, use qualitative comparative analysis to facilitate the exploration of the complex causal relationships between categories, and construct candidate themes based on these analyses. We then show how novice researchers can continue developing these themes by creating relationships between codes and categories on the basis of qualitative data and existing literature. Such integration of methods not only facilitates theme development, but also assists researchers in justifying the decisions made in a reflexive thematic analysis process. The analytical procedures presented in this article may thus help novice researchers engaged in reflexive thematic analysis to enhance the transparency of their analytical process.

Thematic analysis is a widely cited method for analyzing qualitative data. As a team of graduate students, we sought to explore methods of data analysis that were grounded in qualitative philosophies and aligned with our orientation as applied health researchers. We identified reflexive thematic analysis, developed by Braun and Clarke, as an interpretive method firmly situated within a qualitative paradigm that would also have broad applicability within a range of qualitative health research designs. In this approach to analysis, the subjectivity of the researcher is recognized and viewed not as problematic but instead valued as integral to the analysis process. We therefore elected to explore reflexive thematic analysis, advance and apply our analytic skills in applied qualitative health research, and provide direction and technique for researchers interested in this method of analysis. In this paper, we describe how a multidisciplinary graduate student group of applied health researchers utilized Braun and Clarke’s approach to reflexive thematic analysis. Specifically, we explore and describe our team’s process of data analysis used to analyze focus group data from a study exploring postnatal care referral behavior by traditional birth attendants in Nigeria. This paper illustrates our experience in applying the six phases of reflexive thematic analysis as described by Braun and Clarke: (1) familiarizing oneself with the data, (2) generating codes, (3) constructing themes, (4) reviewing potential themes, (5) defining and naming themes, and (6) producing the report. We highlight our experiences through each phase, outline strategies to support analytic quality, and share practical activities to guide the use of reflexive thematic analysis within an applied health research context and when working within research teams.

The formation of narratives while listening to music is seen across cultures, but narrative perception in Asian Americans who have bicultural identities is not well understood. This study analyzed the potential effect of cultural identity on adolescents’ ability to form narratives with East Asian music. Two groups of adolescents (n=42), Asian American (n=28) and Non-Asian American (n=14), listened to three music excerpts with varying degrees of Asian and Western influences. The most Asian-influenced excerpt was a Gugak Korean traditional piece titled T’ungae sanjo, performed on traditional Korean folk instruments and creating a distinctly East Asian sound. The Mixed excerpt, containing both Western and Asian influences, was from Tan Dun’s Eight Memories in Watercolor. It contained a Chinese folk melody while being performed on a Western instrument. Finally, the most Western-influenced excerpt was from Toru Takemitsu’s Rain Tree Sketch. The piece contained octatonicism, a musical technique prominent in modern Western composers’ works. Participants completed a survey containing a free response question where they described their imagined narratives and a survey containing 4 questions measuring narrative engagement. Chi-square tests, t-tests, and reflexive thematic analysis were used to yield the results from the data collected. Results demonstrated that the extent of narrativization was dependent on enculturation. Asian Americans, with their bicultural identities, demonstrated consistent narrativization across all excerpts. In contrast, non-Asian Americans narrativized significantly less for the traditional Asian excerpt. Within the free responses, both cohorts identified similar themes with the Western-influenced music, as they have had overlapping exposure to Western culture leading to shared thought patterns. However, there was substantial thematic variability between cohorts with the Asian-influenced music, as the two cohorts had different levels of exposure to Asian culture. This study thus reinforces the notion that enculturation has a profound effect on narrativization in music, demonstrated through Asian American adolescents’ abilities to narrativize to music containing both Asian and Western roots.

ABSTRACTIntroductionWith Australia's ageing population increasing and the fast‐growing number of migrants from culturally diverse backgrounds, ensuring the quality of care, including hospital food services, is critical. Meals tailored to patients' needs have been shown to reduce complications and lower hospital costs, making the quality of hospital food service a key factor in overall patient satisfaction. However, data on the lived experiences of older patients from non‐English‐speaking backgrounds (NESBs) regarding hospital food services and meal quality remain limited.MethodsSemi‐structured interviews were conducted with patients aged 65 years or older from Australian Anglo and NESBs to explore their experiences with hospital food services. A reflexive thematic analysis was undertaken, with the identified similarities and differences between the two groups to inform the development of themes.ResultsThe study included 15 Australian‐Anglo background patients (mean age: 83) and 15 NESB patients (mean age: 78). The interviews revealed that care priorities, cultural identity and health needs shaped patients' experiences of hospital food, with four themes being identified: (1) No Complaint Mindset; (2) Food and Cultural Identity; (3) Experiences of Food Service and (4) Nutrition and Health. Through these themes, we found that both groups shared a ‘no complaints’ mentality, with mixed experiences of hospital meals, and preferred smaller meals. NESB participants described limited cultural inclusivity in hospital food service as being related to the lost connection between food and their cultural and linguistic backgrounds. In the same group, English language barriers hinder communication with food service staff to meet dietary needs.ConclusionThe findings from our qualitative interviews suggest that hospital food services may consider offering culturally familiar options to accommodate patients from diverse cultural and linguistic backgrounds and fostering open and effective communication regarding patients' meal preferences and dietary needs, especially for those with limited English proficiency.Patient or Public ContributionThe interview guide and process were developed based on feedback from clinicians at Flinders Medical Centre. The study findings and report were reviewed by an experienced consumer representative and a dietetic department head in an independent hospital. Both critically reviewed the manuscript, interpreted the results and contributed revisions based on their lived experiences and clinical expertise. As a result, the final manuscript is a collaborative effort between researchers and public stakeholders, including patient representatives and service providers.

Family, Friend, and Neighbour care is one of the oldest and most widespread forms of childcare used by families, yet there is far less research on this type of childcare compared to others. This study focused on Latinx immigrant FFN providers to learn about their motivations, needs, and facilitators and barriers to accessing services. Qualitative data come from a subsample of a larger study and include 5 focus groups with 41 Latinx immigrant FFN providers; these data were analysed using reflexive thematic analysis [Braun & Clarke, 2020. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 1–25]. The themes, ‘They Need Us’; ‘We’re Not Babysitters, We’re Providers’; and ‘To Face the Job at 100%’ along with their subthemes capture Latinx immigrant FFN providers’ strong commitment and sense of duty to the families that they serve. Research and practice implications are discussed.

Reflexive thematic analysis (reflexive TA) originated within psychology and the social sciences and has become an increasingly popular qualitative analytic method across a range of disciplines. In this article, we offer a brief methodological guide for researchers hoping to use the method, suitable for beginners through to those experienced in qualitative research. Reflexive TA can be used to analyze data generated via a range of methods. Reflexive TA is highly flexible, and we outline the choices that researchers need to address when conducting their research. These choices relate to the theoretical approach (realist through to relativist/experiential to critical), their orientation to analyzing the data (inductive to deductive), and the depth in which they analyze their dataset (semantic to latent). We offer an accessible but comprehensive discussion of the six phases of reflexive thematic analysis and how best to produce a rigorous analysis. Starting with familiarization of the dataset as a foundation for analysis, data are then coded, before using these codes to generate initial themes. These early themes are then reviewed and developed, before the researcher moves to defining and naming them. The final phase of analysis is the writing up of the research, at which point final changes may still be made to the results. Written from the basis of our experience of using, teaching, and training reflexive thematic analysis within psychology and the social sciences, we see it as useful for those working across a range of disciplines.

BackgroundAs the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy.ObjectiveThe aim of this study was to identify the role of information sharing and context sensitivity in various vaccination programs throughout the initial COVID-19 vaccination rollout in different countries. Moreover, we aimed to identify factors in national vaccination programs related to COVID-19 vaccine hesitancy, safety, and effectiveness. Toward this end, multidisciplinary and multinational opinions from members of the Navigating Knowledge Landscape (NKL) network were analyzed.MethodsFrom May to July 2021, 25 completed questionnaires from 27 NKL network members were collected. These contributors were from 17 different countries. The responses reflected the contributors’ subjective viewpoints on the status and details of the COVID-19 vaccination rollout in their countries. Contributors were asked to identify strengths, weaknesses, opportunities, and threats (ie, SWOT) of the respective vaccination programs. The responses were analyzed using reflexive thematic analysis, followed by frequency analysis of identified themes according to the represented countries.ResultsThe perspectives of NKL network members showed a link between organizational elements of the vaccination rollout and the accompanying societal response, both of which were related to strengths and weaknesses of the process. External sociocultural variables, improved public communication around vaccination-related issues, ethical controversies, and the spread of disinformation were the dominant themes related to opportunities and challenges. In the SWOT 2×2 matrix, Availability and Barriers emerged as internal categories, whereas Transparent communication and promotion and Societal divide emerged as key external categories.ConclusionsInventory of themes and categories inspired by elements of the SWOT framework provides an informative multidisciplinary perspective for effective implementation of public health strategies in the battle against COVID-19 or any future pandemics of a similar nature.

This paper reflects on reflexive thematic analyses with Pacific peoples from different cultural and language backgrounds. This paper will briefly describe reflexive thematic analysis according to Braun et al. (2019) and reflect upon issues concerning thematic analysis and Pacific cultures and languages. As academics, researchers, and practitioners, “we engage in a co-construction of knowledge” with our communities while adhering to cross-cultural notions of respect (Enari & Rangiwai, 2021, p. 2). We draw upon our collective cultural knowledge to offer a unique insider perspective (Enari & Rangiwai, 2021) concerning our current understandings of reflexive thematic analysis as it applies to research with Pacific peoples.

People from minoritised ethnic groups are diagnosed with dementia later in the disease. We explored pathways that may determine the timing of diagnoses in a UK ethnically diverse, urban area. We conducted 61 semi-structured interviews: 10 community-dwelling older people from minoritised ethnic backgrounds with diagnosed and undiagnosed dementia (mean age = 72years; males = 5/10), 30 family members (51; 10/30), 16 health or social care professionals (42; 3/15), 3 paid carers and 2 interpreters for people with dementia. We used reflexive thematic analysis and the Model of Pathways to Treatment to consider diagnostic delay. We identified three themes: (1) Cultural identity and practices shape responses: gendered expectations that families relieve elders of household roles reduce awareness or concern when functioning declines; expectations that religious practices are maintained mean problems doing so triggers help-seeking. Second-generation family members often held insider and outsider identities, balancing traditional and Western perspectives. (2) Becoming like a tourist: daily experiences became unfamiliar for people developing dementia in an adopted country, sometimes engendering a need to reconnect with a home country. For professionals and interpreters, translating meanings faithfully, and balancing relatives' and clients' voices, were challenging. (3) Naming and conceptualising dementia: the term dementia was stigmatised, with cultural nuances in how it was understood; initial presentations often included physical symptoms with cognitive concerns. Greater understanding of dilemmas faced by minoritised ethnic communities, closer collaboration with interpreters and workforce diversity could reduce time from symptom appraisal to diagnosis, and support culturally competent diagnostic assessments.

Obesity is a major global health issue, increasing morbidity and mortality through its association with noncommunicable diseases. Black African women experience disproportionately high obesity rates, reaching 37% in the UK, reflecting complex genetic, sociocultural, and environmental factors, with migration influencing dietary changes. This study explored factors shaping the dietary choices of Black African immigrant women with overweight and obesity in the UK, focusing on individual, sociocultural, and environmental influences. A qualitative design was employed, using semi-structured online interviews with 15 participants, analyzed thematically through reflexive thematic analysis. Participants were African immigrant women from sub-Saharan Africa, ages ≥18 years, first- or second-generation immigrants, with a BMI >25 kg/m2. Recruitment and interviews occurred between March and May 2024. Findings revealed tensions between sociocultural food preferences and children’s Westernized tastes. Cultural identity, food-related shame, and ambivalence about traditional diets in public or work settings shaped practices. Work demands and limited time constrained preparation of traditional meals, while economic pressures and high costs of culturally appropriate foods restricted choices. Psychological stress and reliance on convenience foods emerged as coping strategies, often undermining health intentions. These findings highlight the need for culturally tailored, community-based interventions addressing barriers of cost, access, and time as well as potential strategies to support dietary autonomy and cultural retention. Future research should adopt longitudinal approaches to examine how these dynamics evolve, informing sustainable interventions.

Since the Stonewall uprisings, there has been greater social acceptance of homosexuality within Western contexts. Nevertheless, those who are at the intersection of more than one minority identity continue to face prejudice and discrimination, including homophobia and racism. Though there has been increasing work regarding the experiences of sexual minority people of colour (POC), a lacuna remains regarding the experiences of sexual minority British Muslim South Asian men and the integration of sexual minority and religious identities, particularly within a context of increased societal acceptance towards sexual minorities and societal Islamophobia. In this study, 38 sexual minority British Muslim South Asian men were recruited via snowball sampling and interviewed. Data were examined via reflexive thematic analysis. Five themes were identified: degrees of “outness”, hegemonic Whiteness and the LGBTQ+ community, internalisation of White hegemony, distancing from the sexual minority religio‐cultural ingroup, and attempting to reconcile potential identity conflict between sexual orientation identity and religious and cultural identities. Respondents' experiences highlighted substantial social exclusion due to intersectional disadvantage as well as a lack of intra‐community social support, suggesting substantial isolation, psychological implications and a general eschewing of identity affiliation based on sexual attraction. This has implications on services predicated on identity affiliation which may potentially exclude the needs of hidden and intersectionally disadvantaged populations.

This study investigates how multilingual students use role play as a powerful medium to reclaim their linguistic and cultural identities within the monolingual Cypriot educational space. The concept of monolingual multilingualism, i.e. the purposeful and strategic use of a single heritage or home language in role play, is used to explore how role enactment, topic of play, and language used serve as acts of identity visibility, cultural reclamation, and social belonging. Sixteen students aged 12-15 from various linguistic backgrounds created and performed role plays in their selected language. Data were collected through role plays, classroom observations, and student interviews, and analyzed using reflexive thematic analysis, responsive interviewing, and discourse analysis. Findings illustrate that students' selection of role and language were powerful symbols of asserting belonging, demonstrating linguistic pride and competence, and valuing languages entirely excluded from a monolingual learning system. The study addresses the importance of inclusive pedagogies in monolingual learning contexts where students' multiple linguistic repertoires and multilingual identities are welcomed as creative and contextually fluid resources for self-expression, meaning-making, and cultural affirmation. It is in these pedagogical spaces where students' home and heritage languages are viewed as fundamental components of students' cognitive, emotional, social, and academic development.

The purposeful design of environments built for meaningful physical activity experiences is underexplored. Development policies and regulations often overlook community involvement in active landscape design for enhanced physical activity engagement. This article addresses this gap by presenting findings from "MoveScape"-an academic-industry collaboration using participatory methods to explore the quality and meaningfulness of physical activity experiences to inform active landscape design that support physical literacy and community well-being. Based at a new housing development in the East of England, 4 focus group workshops (N = 26, 33-68y, 73% male) employed elements of appreciative inquiry, and invited local residents to explore meaningful physical activity, physical literacy, and neighborhood perceptions. Participants shared and envisioned physical activity experiences around their community. Reflexive thematic analysis was used to code and categorize data. Eight themes were developed; (1) "safety and security"; (2) "sense of belonging"; (3) "attractive, eco-friendly, and aesthetically pleasing spaces"; (4) "inclusive, diverse and accessible spaces"; (5) "sustainable and durable spaces"; (6) "health considerations"; (7) "social interactions"; and (8) "valued spending." Key recommendations for active landscape design, include prioritizing safety and security through better lighting and well-maintained environments, fostering a sense of belonging by designing inclusive, multigenerational spaces that encourage social interaction, and ensuring accessibility for diverse needs. Sustainable and aesthetically pleasing landscapes support long-term engagement. Key recommendations relate to embedding community voice and participatory methods in the active landscape design process to enhance meaningful physical activity through community investment, cultural identity, and long-term usability.

Indigenous Sámi women in Norway are entitled to equitable and culturally safe maternity care. However, research on the Sámi perspectives in maternity care is limited. To explore midwives' experiences with Sámi women in birthing units in Northern Norway, we conducted 11 interviews, which were analysed using reflexive thematic analysis. The main theme, “We are all Norwegians: We are all the same,” reflects a recurring perception that equality in care means treating all women equally, regardless of their cultural background. This approach, while well-intentioned, risked obscuring the specific cultural needs of Sámi women. The analysis showed tensions between sameness and difference: some midwives emphasised individualised, woman-centred care without reference to cultural identity, while others recognised that Sámi women's backgrounds could shape communication, expectations, and needs in childbirth. Midwives with Sámi heritage described their background as influencing their understanding, even when they did not self-identify as Sámi. While midwives strive to provide individualised and equal care, this may unintentionally reproduce assimilative norms and contribute to culturally unsafe care by under-communicating difference. The findings underscore the importance of enhancing cultural safety in Norwegian midwifery through education, reflection on historical injustices, and acknowledgement of Sámi women's cultural identities.