The Evolution of Psychological and Emotional Effects of Visitation on Families of People Incarcerated in the United States

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.

Mothers report feeling immense pressure to breastfeed their infants, and not doing so can be associated with stigma, shame, and judgment. Many Latina mothers struggle to meet their breastfeeding goals and substitute formula earlier than planned. During 2022, an infant formula recall caused a shortage and made acquiring formula difficult or impossible in many areas of the United States. This study explores Latina mothers' experiences with infant feeding during the time of the formula shortage. In-depth interviews (N = 7) were conducted with Latina mothers who formula-fed during the shortage. Interviews were analyzed using reflexive thematic analysis. Mean maternal age was 29.7 years, and mean infant age was 10.3 months. Three mothers were born in the United States, and 4 were immigrants. Thematic analysis generated 3 themes: (1) Fighting to breastfeed; (2) Breastfeeding is not the only way to be a "good" mother; and (3) No formula on the shelves. Participants described their determination to continue breastfeeding despite challenges before realizing that it limited their ability to care for their children. They discussed the emotional toll of the formula shortage and strategies for finding formula. The findings emphasize the need for additional structural support for infant feeding in the United States to prevent future formula shortages and for better lactation care and mental health support for mothers who want to breastfeed.

Collaborations are critical to address rural health challenges. We evaluated a new international collaboration between institutions in Georgia, the United States (US), and Scotland, United Kingdom (UK), to address rural health issues and to understand the barriers and facilitators to effective international collaboration efforts. A qualitative approach was used through in-depth interviews and focus groups with educators, researchers, and healthcare providers in the US and Scotland who were involved in the CONVERGE international rural health collaboration. Transcriptions were imported into the NVivo qualitative software program. A reflexive thematic analysis was employed to identify key themes from the collected data. Twelve interviews and two focus groups were conducted virtually with 17 participants. Two primary domains were identified from the thematic analysis: (1) motivators that increase engagement in international collaboration, and (2) mechanisms for, and barriers to, the continuity needed to create meaningful change. Six themes emerged related to commonality of issues, prospect of sharing knowledge, need of sustained funding and institutional support, and selection of human resources. Participants of CONVERGE were more likely to engage when they had a space to share ways to address challenging issues and integrate knowledge and practice. They were motivated by their desire for growth and the institutions they serve and emphasized that infrastructure support is vital for sustainable collaborations.

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.

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.

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.

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.

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.

Purpose To address the lack of research on the information needs of spinal cord injured (SCI) patients and family members in acute care, in order to inform the provision of appropriate information supports. Materials and methods Semi-structured interviews were conducted with seven traumatic SCI patients and six family members. Reflexive thematic analysis was used to analyse and interpret the data. Results Five themes were generated: (1) “You were lying in limbo and you knew nothing” describes how being situated in non-specialist acute care limited participants’ access to information; (2) “You’ll never walk again” is not enough describes the need for information about the effects of SCI and the management of secondary conditions; (3) “The delivery was awful” demonstrates the importance of information being explained clearly and empathically; (4) “It was going in one ear and out the other” highlights the need for ongoing conversations with healthcare professionals, as retaining information provided in the early stages post-injury is often difficult; and (5) “Hope” not “false hope” discusses the importance of giving patients and family members hope while simultaneously being realistic about potential recovery. Conclusions SCI patients and family members had significant unmet information needs in acute care. IMPLICATIONS FOR REHABILITATION SCI patients and family members had significant unmet information needs while in acute care. Being in non-specialist acute care significantly limited most participants’ access to information. During the acute phase of care, most patients and family members would like to know the patient’s recovery prognosis, the impact of SCI on the patient’s functional independence, how to manage secondary complications, and what to expect in rehabilitation. As patients and family members often had difficulty absorbing information in the early stages post-injury, information should be continuously repeated, reinforced and clarified. HCPs should promote realistic hope for SCI patients and family members even in the absence of neurological recovery, by focusing on what the patient is still capable of while being honest about their prognosis.

Although previous research has documented the mental and physical health impacts that COVID-19 had on frontline health workers in the United States, little is known about how the pandemic affected their families. This study sought to explore the impact COVID-19 had on the individual functioning of frontline health care workers in the USA and the perceived impact it had on their family members during the initial nine months of the pandemic. More specifically, this study sought to explore if and how family roles, routines, rules, and social-emotional well-being changed as a result of COVID-19. Twenty-eight frontline health care workers across the United States who were parents to at least one child residing in the home under 24 were interviewed. Data were analyzed using reflexive thematic analysis. From the analysis, four major themes emerged with regard to the changes and perceived impact to family functioning, family experiences of new hygiene practices, and stigma related to being a health care practitioner or having a family member working in health care, and psychological distress. The results of this study can be used by mental health clinicians to inform policy, develop practice guidelines, and help identify and target interventions for health care workers and their family members.

Introduction Migration is at the core of today’s professional sport. In football, since 2020, the rate of migrant players has increased by 20% (Poli et al., 2024). Transnational mobility has become a highly valuable commodity making transnational football career an inescapable pathway to either professional level or world-class level. Therefore, understanding cross-borders sports mobility processes is crucial for both players and stakeholders to effectively prepare and negotiate cultural transitions. Transnational career and pathway research in sport psychology is recent, limited, and suggests that maintaining a career as a migratory athlete remains challenging (Book et al., 2021; Ryba & et al., 2016; Storm et al., 2022). By identifying challenges faced, and psychological process involved, those researches highlight at what extent culture frames athletes’ sport and non-sport life experiences. However, no studies focused on neither the first cultural transition nor African athletes. From analysis of some previous studies, it seems that the experience of the first cultural transition shapes the willingness to initiate and the experience of the following migrations (Book et al., 2021; Ryba et al., 2016). On the other hand, African countries are deeply distinct from the most other countries worldwide regarding relevant features shaping people’s life experience: social security, gross domestic product, facilities, governance, and race. Furthermore, African countries are among those displaying the highest growth of expatriate footballers (Poli et al., 2024). Additionally, most of athletic migrations from Africa correspond to forced migration (United Nations Humans Rights Council, 2022), with the difference that it is triggered by a contract. Thus, what characterize the experience of the first cultural transition of African footballers? This study aimed to explore the athletic transnational career of Cameroonian footballers to characterize their experience of the first cultural transition. Methods This study is grounded within Critical Realism philosophy. It is useful to engage causal analysis and explanation of social problems and suggest practical recommendations for social change (Fletcher, 2017). Fourteen Cameroonian former footballers were purposively sampled following three criteria: having spent at least the formative years in Cameroon, did the first cultural transition for athletic career development, and having played professionally for a football club abroad at least one season. The participants’ position in the pitch included all the main positions acknowledged in football (goalkeeper, defender, midfielder, and striker), and the country of their first cultural transition included the four continents (Kingdom of Saudi Arabia, Germany, France, Indonesia, Greece, Côte d’Ivoire, Paraguay, Italy, Switzerland, and Turkey). The semi-structured interviews based on life story and timeline interviews approaches were conducted, focusing on the participants’ experience of athletic transnational mobilities. This included a series of two interview sessions which lasted between 25 and 121 minutes. A total of 26 interviews were audio recorded, transcribed, and reflexively thematically analyzed (Braun & Clarke, 2021). The study applied the four rigorous criteria to ensure qualitative study trustworthiness: credibility, dependability, confirmability, and transferability (Lincoln & Guba, 1985). Results Nine themes (with their sub-themes) and their relationship were identified: Mental Health Issues (MHI), Context of athletic migration and seven challenges related to: Club and Contract, Team, Pitch, Way of life, Geography, Home country, and High Level Athlete status. MHI emerged as output of the context and challenges. MHI were characterized by players’ psychological distress and inability to understand that condition, and inability of the club leading team to understand what they were going through. The context of athletic migration was characterized by unplanned transition, adolescence, club’s facilities, and perception of moving abroad as having succeed their football career and life (satisfaction of achieving the dream). Challenges characterized tough situations players went through like contract disruption (club and team), broken In-group (team), injury (pitch), new mentality (way of life), winter (geography), long-distance relationship (home country), and experience of professionalism (High Level Athlete status). Discussion/Conclusion This research is the first to study the first cultural transition of athletes and to use a sample of athletes from Africa. The results depict main features characterizing the experience of the first athletic migration of young talented Cameroonian footballers. Applying critical realism philosophy, MHI was identified as the effect of the migration context and challenges faced. Those findings are consistent with the holistic developmental and ecological perspectives to talent development (Wylleman & Rosier, 2016), Intersectionality (Book et al., 2021), cultural sport psychology (Schinke & Hanrahan, 2009), and challenges underscored in previous transnational athletic career studies (Book et al., 2021; Ryba et al., 2016; Storm et al., 2022). Most importantly, this study highlights new result patterns enriching literature and providing critical information for African athletes and sport stakeholders: MHI (explicitly underscored), context of athletic migration, challenges related to winter, new mentality, broken In-group, etc. As successful talented footballers, they anticipated migration with professional contract as the guarantee of happiness. Actually, those young talented footballers navigated through the satisfaction of achieving professional level and distress. They struggled with psychological distress by shouldering the acculturation load and some professional football’s drifts in an environment which was not supportive enough, because it does not understand them. They could not seek for help because the lack means to understand their condition. Thus, this study is directly related to two Sustainable Development Goals (the third and eighth) by addressing mental health and decent work (United Nations Humans Rights Council, 2022). The results suggest several practical implications: informed football stakeholders’ action, strengthen coaches’ training, adjust sport psychologists’ intervention, and build solid preparatory foundation for next transnational African footballers. References Book, R. T., Jr., Henriksen, K., & Stambulova, N. (2021). Oatmeal is better than no meal: The career pathways of African American male professional athletes from underserved communities in the United States. International Journal of Sport and Exercise Psychology, 19(4), 504–523. https://doi.org/10.1080/1612197X.2020.1735258 Braun, V., & Clarke, V. (2021). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(3), 328–352. https://doi.org/10.1080/14780887.2020.1769238 Fletcher, A. J. (2017). Applying critical realism in qualitative research: Methodology meets method. International Journal of Social Research Methodology: Theory & Practice, 20(2), 181–194. https://doi.org/10.1080/13645579.2016.1144401 Lincoln, Y., & Guba, E. G. (1985). Naturalistic inquiry. Sage. Poli, R., Ravenel, L., & Besson, R. (2024, May). Origins and destinations of football expatriates (2020–2024). CIES Football Observatory [Monthly Report n°95]. https://football-observatory.com/MonthlyReport95 Ryba, T. V., Stambulova, N. B., & Ronkainen, N. J. (2016). The work of cultural transition: An emerging model. Frontiers in Psychology, 7, Article 427. https://doi.org/10.3389/fpsyg.2016.00427 Schinke, R. J., & Hanrahan, S. J. (Eds.). (2009). Cultural sport psychology. Human Kinetics. https://doi.org/10.5040/9781492595366 Storm, L. K., Book, R. T., Jr., Hoyer, S. S., Henriksen, K., Küttel, A., & Larsen, C. H. (2022). Every boy’s dream: A mixed method study of young professional Danish football players’ transnational migration. Psychology of Sport and Exercise, 59, 1–11. https://doi.org/10.1016/j.psychsport.2021.102125 United Nations Human Rights Council. (2022). Mid-year trends 2022. https://www.unhcr.org/mid-year-trends Wylleman, P., & Rosier, N. (2016). Holistic perspective on the development of elite athletes. In M. Raab, P. Wylleman, R. Seiler, A.-M. Elbe, & A. Hatzigeorgiadis (Eds.), Sport and exercise psychology research: From theory to practice (pp. 270–282). Elsevier Inc.

Coping strategies are specific methods used in managing the internal and external demands faced by individuals, which are found to be going beyond their resources. This qualitative study aimed to describe the coping strategies adopted by Correctional and Rehabilitation Officers working in Sri Lankan prisons to reduce their stress and subsequent burnout. The study was carried out in 2017 in the Welikada Closed Prison and Badulla Remand Prison. Twenty prison correctional and rehabilitation officers participated in in-depth interviews. Officers with experience of more than two years in the prison setting were included. Both officers with and without burnout were selected based on the findings of a previous component of the study, with one rehabilitation officer and nine correctional officers from each category. A semi-structured in-depth interview guide was used. Thematic analysis was carried out. Both male and female officers between 23 and 55 years participated in the interviews. Some of the common problems leading to stressful situations were increased workload with additional and irrelevant duties expected from them, poor relationships with superiors, colleagues and inmates and poor support and pressure from the superiors. Six themes were extracted from the content discussed during the interviews. These were discussing with others as a means of seeking support, positive thinking, avoidance of the situation, distraction by involving in other activities, deviating the stress to others and trying to remove or reduce the stressor. Some of the participants thought they needed to learn better ways of coping with the occupational stress and burnout. Many of them believed that workshops on stress management need to be included in their continuous training. The high rank prison officials responsible for the welfare of prison officers were informed of the findings following the study, in order for them to make necessary improvements at the institution and policy level.

Personal protective equipment (PPE) is worn in a range of industrial environments by women and men alike. However, the majority of PPE is designed around male anthropometrics and the impacts of this on women are largely undocumented. Reflexive thematic analysis was used to develop themes from in-depth interviews with 30 women working in diverse roles in industrial environments, around their experiences of wearing PPE. Four themes developed: ‘There's nothing here for me’; ‘Collateral damage’; ‘Organisational culture and the burden of responsibility’; and ‘Personally protective women’. The findings significantly expand upon previous literature concerning: the reduced range of PPE available for women when compared with men; considerable fit and comfort issues; and physical, day-to-day and health-related consequences. This work evidences the increased PPE-related burden on women, and demonstrates fundamental links between women wearing ill-fitting or inappropriate PPE and their reduced sense of belonging, confidence and morale.

BackgroundThis study investigated the perceived barriers and potential facilitators for culturally sensitive care among general practitioners in Flanders. Understanding these dynamics is crucial for improving healthcare quality and equity.MethodologyTwenty-one in-depth interviews were conducted with Flemish GPs. Braun and Clarke’s reflexive thematic analysis was employed to develop and interpret themes that elucidate shared underlying meanings and capture the nuanced challenges and strategies related to cultural sensitivity in healthcare.ResultsTwo core themes were generated: GPs’ uncertainty and opposition. These themes manifest in emotional responses such as frustration, miscomprehension, and feelings of helplessness, influencing relational outcomes marked by patient disconnect and reduced motivation for cultural sensitivity. The barriers identified are exacerbated by resource scarcity and limited intercultural contact. Conversely, facilitators include structural elements like interpreters and individual strategies such as engagement, aimed at enhancing GPs’ confidence in culturally diverse encounters. A meta-theme of perceived lack of control underscores the challenges, particularly regarding language barriers and resource constraints, highlighting the critical role of GPs’ empowerment through enhanced intercultural communication skills.ConclusionAddressing GPs’ uncertainties and oppositions can mitigate related issues, thereby promoting comprehensive culturally sensitive care. Essential strategies include continuous education and policy reforms to dismantle structural barriers. Moreover, incentivizing culturally sensitive care through quality care financial incentives could bolster GP motivation. These insights are pivotal for stakeholders—practitioners, policymakers, and educators—committed to advancing culturally sensitive healthcare practices and, ultimately, for fostering more equitable care provision.

People with severe mental health difficulties (SMHDs) often have poorer access to kidney healthcare. To better understand the barriers and facilitators to kidney healthcare for this population, we conducted interviews with nine individuals with SMHDs and four family members. Through reflexive thematic analysis, we generated three themes: (1) 'One size doesn't fit all' describes the need for individualised kidney healthcare, adapted to meet the specific needs of each person with a SMHD. (2) 'You just can't say, "I'm only dealing with your kidney here"' describes how fragmentation of physical and mental healthcare services can lead to poorer outcomes for people with SMHDs, underscoring the need for coordinated care. (3) 'Just treat me with respect' describes the impact of healthcare provider attitudes. Overall, participants praised the dedication and kindness of renal clinicians. However, some participants also described experiences of stigma and discrimination, and called for additional education for healthcare providers regarding SMHDs.