Exploring women’s views toward no-lo alcohol products during pregnancy: a photo elicitation guided qualitative study

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.

BackgroundAnabolic androgenic steroids (AAS) are synthetic forms of testosterone frequently used as performance enhancing drugs among gay, bisexual, and queer (GBQ) men. Despite widespread use, associated harms, and the likely existence of an AAS use disorder, there is no medical consensus on standards of care for people who use AAS, with most medical providers focusing exclusively on abstinence. Individuals using AAS have developed community-based harm reduction strategies to mitigate these harms.MethodsThis paper is a sub-analysis of qualitative data obtained through semi-structured interviews with GBQ men using AAS for 8 or more weeks recruited through convenience and snowball sampling from clinical sites and LGBTQ + venues in New York City as well as through social media. Interviews were coded with themes developed using reflexive thematic analysis. Data related to harm reduction techniques were then re-analyzed through a prevention strategies framework lens of primary, secondary, and tertiary harm prevention.ResultsThematic saturation was reached at twelve interviews in the primary analysis, with men reporting frequent use of multiple harm reduction techniques. For primary prevention, men avoided oral steroids and simultaneous substance use, tried to obtain AAS from reputable sources, used “cycling” to dose steroids, and practiced sterile injection techniques. Secondary prevention methods included patient-directed lab testing for hematocrit, liver and kidney function, cholesterol, prostate specific antigen, testosterone, and self-performed blood pressure checks. Tertiary prevention included donating blood and the use of medications without a prescription, including aromatase inhibitors, selective estrogen receptor blockers, aspirin, statins, angiotensin receptor blockers, clomiphene, and human chorionic gonadotropin.ConclusionsDespite many GBQ men experiencing harms from anabolic androgenic steroids, community members have often sought harm reduction techniques in lieu of abstinence. Though many of these techniques embrace clinical reasoning and may be more broadly applicable, additional research is needed to understand the impact of each intervention on the overall health of individuals using AAS.

Introduction: Clinicians often determine an ‘expected body weight’ (EBW) for patients who have lost weight due to an eating disorder (ED). However, there is inconsistent guidance and limited empirical research on whether and when these weights should be shared with patients. This study explores clinician and patient perspectives on discussions of EBWs.Methods: Semi-structured interviews were conducted with 24 multidisciplinary clinicians treating EDs and 16 individuals with recent outpatient ED treatment experience (i.e., in the past 6 months). Clinicians shared their experiences with and rationales for sharing EBWs with patients and patients’ family members. Patients shared their experiences being informed of their EBWs in ED treatment, factors influencing their comfort level discussing EBWs with clinicians, and perceived impact of these discussions on their recovery. Interviews were analyzed using reflexive thematic analysis with a critical realist lens. Results: Clinician and patient perspectives aligned regarding when, how, and why to hold these discussions. Both groups emphasized that these discussions should occur after patients are medically stable and underscored the importance of framing the EBW as one aspect of a holistic recovery. Additionally, clinicians and patients highlighted the potential therapeutic benefits of these discussions, while also acknowledging challenges relating to parental involvement and weight bias. Discussion: Findings suggest that when discussions of EBWs are approached intentionally—accounting for timing, framing, and individual patient needs—clinicians and patients see potential therapeutic benefit. Future research can focus on developing evidence-based guidelines for sharing EBWs, addressing patient willingness to be informed of their EBW, weight bias, and parental involvement.

Barriers and Facilitators to Harm Reduction for Opioid Use Disorder: A Qualitative Study of People With Lived Experience

While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic-androgenic steroid (AAS) consumers. This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist's regarding AAS harm reduction. Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis. While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively. Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers.

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.

Understanding motivators for cervical cancer screening among young women is critical for improving participation rates and reducing the incidence of cervical cancer. Young women have low participation rates in the CervicalScreen Norway. In 2022, the first cohort of school-based human papilloma virus vaccinated women entered the screening programme at the age of 25 years. This paper investigates reflections regarding cervical cancer screening and factors that influence attendance among first or second-time invitees in the CervicalScreen Norway. The study comprises 18 qualitative semi-structured individual interviews with Norwegian women aged 25-29 years of which 14 had attended screening. We used reflexive thematic analysis with a critical approach and identified three main themes related to trust, social expectations, and perceived vulnerability. The three main themes were 'trusting health authorities but wishing for a clearer message'; 'normalisation of screening participation driven by social expectations'; and 'efforts to avoid vulnerability during the test procedure'. Trusting the authorities to provide beneficial health initiatives, the women would follow advice about screening. Social expectations led to consider screening participation as the right thing to do. These young women felt vulnerable and inexperienced with gynaecological examinations and opted for screeners that reduced their feeling of vulnerability. Providing clear information on the screening procedure and expectations during gynaecological examinations is essential to reduce vulnerability and enhance participation among young women. Communication should highlight that screening is readily accessible in primary healthcare and be shared through media platforms popular with younger women.

Inequities with access to naloxone and fentanyl test strips (FTS) due to cost and stigma have reinforced the necessity of community-based distribution of lifesaving harm reduction supplies. In Wichita and Sedgwick County, the epicenter of the opioid epidemic in Kansas, Safe Streets Wichita, a grassroots prevention and harm reduction coalition, started Project Wichita Overdose Recovery Kit Expedited Delivery (WORKED), a free volunteer-led intramuscular naloxone and FTS program. To assess the lessons learned from those involved with Project WORKED, interviews with 12 key stakeholders were conducted. These interviews focused on reflection, constructive criticism, and feedback. Individuals interviewed for this study included volunteers, former/current employees, and naloxone and FTS kit recipients, with special considerations for those with lived experiences of substance-related harms. Based on a reflexive thematic analysis, findings highlight the importance of meaningfully engaging community members most affected by substance-related harms, emphasizing a strengths-based perspective of harm reduction, and being cognizant of the barriers that undermine harm reduction supply distribution efforts and harm reduction in general. These findings help serve as the foundation by which interviewees envision a more holistic and comprehensive approach to harm reduction. Findings will be used to inform the fidelity, efficiency, accessibility, and longevity of community-based naloxone and FTS distribution and the implementation of harm reduction strategies in general across the state of Kansas

Substantial increases in drug overdose deaths, the prevailing lack of access to care for substance use disorder, and the adverse effects of stigma and criminalization underlie the need for comprehensive evidence-based strategies that improve the health, safety, and well-being of people who use drugs. Harm reduction has emerged as a promising approach in the mitigation of substance-related harms. However, many harm reduction strategies remain illegal especially in Kansas. Eleven stakeholders, including law enforcement/criminal justice officials, state legislators, and health care professionals were interviewed to explore their perspectives on harm reduction and gather their recommendations Using reflexive thematic analysis, we developed three themes for the first research question (stigma, alternatives to criminalization, and authentic conversations and relationships) and six themes for the second research question (roadmap to a more comprehensive harm reduction, barriers to harm reduction, facilitators to harm reduction, connection of harm reduction to behavioral health reform, social determinants of health, and protection of public safety).

This study investigated (i) the social and political factors driving risk averse decision making for children's physically active play in schools, and (ii) the policies shaping these decisions in Victoria, Australia. A theory-informed multi-method case study design combined policy document mapping, semi-structured interviews, and photo elicitation with 30 education policy actors. Data were analysed using reflexive thematic analysis. Findings showed the policy landscape was heavily skewed towards managing risk and safety (84%; n = 42), with fewer, mostly optional, policies for promoting physical activity, and a lack of policy to promote or protect play. Thematic findings indicated an intersecting range of factors in this setting (including occupational health and safety, knowledge and skill gaps, parent factors, children's physical capabilities, an undervaluing of play) can deter schools from providing an environment that enables children's freely chosen, physically active play. Multi-faceted, systems-based approaches that go beyond interventions aimed at individual behaviour change are needed.

Background Children and youth with neurodisabilities may experience different challenges during their transition to adulthood, such as pursuing postsecondary education, finding employment, and navigating a new adult health care system. Families, including siblings, have an important role in the process for when youth with neurodisabilities are transitioning to adulthood. Siblings are in a unique position, where they can have different roles such as a friend, mentor, or caregiver. Siblings can offer various supports to their brother or sister with a neurodisability, but they require knowledge and skills for these different supporting roles. Currently, there are limited programs available for siblings to learn how to support their brother or sister with a neurodisability during transition. A first step to develop these sibling support programs is to understand the experiences of siblings of youth with a neurodisability. The purpose of this report is to describe a protocol of a qualitative case study aimed at examining the experiences of siblings including their roles and responsibilities to their brother or sister with a neurodisability during health care transition. Methods An exploratory single case study design will be used. An integrated knowledge translation approach to conducting this study will be used by partnering with the Sibling Youth Advisory Council comprised of siblings who have a brother or sister with a disability throughout all study phases. Participants will include siblings (ages 14–40 years old) with a brother or sister (ages 14–21 years old) with a neurodisability in Ontario, Canada. Semi-structured interviews will be conducted, that will be augmented by photo elicitation and drawings of family tree diagrams. Data will be analyzed using reflexive thematic analysis. Discussion Findings from this study will be shared with siblings, families, researchers, and the broader community. It is important to understand the roles and responsibilities that siblings are choosing to have to support their brother or sister with a neurodisability, and how these roles may change over time as their sibling is growing up and transitions to adulthood. Siblings may require knowledge and skills in these roles, and an understanding about siblings’ experiences in certain roles can help to inform the development of a resource to support siblings during health care transition.

BackgroundMethylenedioxymethamphetamine (MDMA) is a popular drug worldwide and use is prevalent in Aotearoa New Zealand. Although associated with some significant harms, including fatalities, MDMA is ultimately less harmful than other commonly consumed drugs. We aimed to expand the understanding of MDMA harm and harm reduction strategies from a consumer perspective so that national harm reduction efforts can be better informed.MethodsWe conducted 14 semi-structured focus group discussions including 60 people (aged 18–67, median = 21) who use MDMA in the Southern region of Aotearoa New Zealand to explore their thoughts and experiences regarding MDMA associated harm and harm reduction. Reflexive thematic analysis was conducted from a critical realist perspective.ResultsFive themes were generated; (1) Mindset and setting matters; (2) Looking after your body and mind, not overdoing it; (3) Other substances increase risk and harm; (4) Trusted friends and peers are protective; and (5) Valid information is key for healthy self-determination; and one subtheme 5.1) Drug checking is essential harm reduction.ConclusionsWe discuss the implications for MDMA consumers and aim to inform national drug policy and the harm reduction practices of consumers and organisations, for the ultimate purpose of reducing MDMA-related harm in Aotearoa New Zealand.

Despite its importance, recruiting a sufficient sample size for randomised controlled trials (RCTs) can pose a significant challenge, which has real-world impact on reliability of evidence, trial completion and ultimately, patient care. Technology has potential to enhance the recruitment process, but there is a lack of evidence regarding its current use and effectiveness. Consistent with findings from the PRioRiTy I study, the current research aims to explore the advantages and disadvantages to using technology during the recruitment process for RCTs. Semi-structured interviews (n=7) were conducted with researchers involved in RCT recruitment in Ireland. Subsequently, a Public & Patient Involvement (PPI) panel focus group (n=3) was conducted to add further depth to these findings. The data were qualitatively analysed through 'Reflexive Thematic Analysis' to extract prominent themes. A superordinate theme arose: 'Tech is just a medium so that you can reach more people', along with two themes, which were corroborated by the PPI focus group: 'Technology is used if and when the benefits outweigh the costs' and 'Success of recruitment through technology depends on the nature of the study.' This study provided a deeper understanding of the factors which influence researchers to employ technology in recruitment for RCTs. Implications suggest that future researchers should aim to adapt their recruitment approaches to meet digital tool preferences of their target cohort; and engage with patient groups in the community to allow networking opportunities for future studies. This research may contribute towards maximising efficiency in RCT recruitment.

The influence of commercial actors, practices and processes on the health and wellbeing of women is still not well understood. The alcohol industry has developed a range of products to appeal to new ‘health conscious’ markets, such as ‘low-calorie’ and ‘low-sugar’ products. While these products may have specific appeal for women, there has been little in-depth research that has sought to understand how women conceptualize these products and the range of symbolic meanings that women associate with these products. An online qualitatively led survey was conducted with n = 497 Australian women who had consumed alcohol in the last year. Questions related to the reasons for and influences on alcohol use, the purchasing of ‘low-calorie’ or ‘low-sugar’ products and the influence that these products might have on women’s alcohol use. Data were interpreted using reflexive thematic analysis. Women consumed alcohol to relax, cope with everyday stressors and because of the alignment with social practices and social connection. Women perceived that these products provided a healthier alternative to traditional alcohol products and that they aligned with women’s values relating to weight and the thin ideal. Some women were concerned that these products could increase alcohol consumption by reducing the perceptions of risk associated with alcohol. Policy consideration is needed to address how product claims and attributes may influence population groups’ interpretations of the risks and benefits of these alcohol products, including the illusion that these products have protective potential and are better for overall health and wellbeing.

ABSTRACTObjectiveClinicians often determine an “expected body weight” (EBW) for patients who have lost weight due to an eating disorder (ED). However, there is inconsistent guidance and limited empirical research on when, how, and why to discuss EBWs with patients. This study explores clinician and patient perspectives on discussions of EBWs.MethodSemi‐structured interviews were conducted with 24 multidisciplinary ED clinicians and 16 individuals with outpatient ED treatment experience in the past 6 months. Clinicians shared their experiences with and rationales for sharing EBWs with patients and patients' family members. Patients shared their experiences of being informed about their EBWs, factors influencing their comfort level discussing EBWs with clinicians, and perceived impact of these discussions on their recovery. Interviews were analyzed using reflexive thematic analysis with a critical realist lens.ResultsClinician and patient perspectives aligned regarding when, how, and why to hold these discussions. Both groups emphasized that these discussions should occur after patients have demonstrated engagement with recovery and underscored the importance of framing the EBW as one aspect of a holistic recovery. Additionally, clinicians and patients highlighted the potential therapeutic benefits of these discussions, while also acknowledging challenges relating to parental involvement and weight bias.DiscussionFindings suggest that when discussions of EBWs are approached intentionally—accounting for timing, framing, and individual patient needs—clinicians and patients see potential therapeutic benefit. Future research can focus on developing evidence‐based guidelines for sharing EBWs, addressing patient willingness to be informed of their EBW, weight bias, and parental involvement.