“Wait with me until it’s over”: A reflexive thematic analysis of adolescents’ coping with dissociation

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.

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.

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.

Background: Competencies have emerged as being important to develop health professionals, including managers in healthcare. Professional institutions adopted specific competency frameworks to guide designing professional development opportunities for health service managers, in particularly managers working in the area of health informatics. The fast-growing nature of healthcare settings means that the required competencies continue to evolve. Objective: The aim of this protocol is to outline a reflexive thematic analysis process, including using an automated content analysis approach, and identify what is missing in existing health service management competency empirical studies in relation to health informatics competencies. Methods: A rapid literature review has been performed using a PRISMA approach for eligibility screening, with 185 publications meeting the inclusion criteria. The Leximancer natural language processing software was used to transform a large corpus of literature from natural language into semantic themes and concepts. A reflexive thematic analysis was then undertaken using the text mining automated content analysis approach to identify predominant concepts and the co-occurrence between them. Results: A search strategy was developed using three primary electronic databases: 1) Scopus; 2) ProQuest; and 3) the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and five secondary electronic databases: 1) Web of Science 2) PubMed; 3) ACM Digital Library; 4) Open Access Theses and Dissertations Database, and 5) Google Scholar. The initial search undertaken on 10 November 2020 resulted in 1,212 publications. The results of the reflexive thematic analysis will be submitted for publication by November 2021. Conclusions: New understanding and knowledge in the area of health management competencies, specifically relating to informatics will be developed. Health informatics competencies will be defined for Australian health service managers. Further, this study helps inform the discourse regarding automated content analysis for the healthcare and informatics industry, healthcare organisations and university course requirements.

Concussions from sport and recreational activities can negatively impact academic performance in adolescents. This study aims to use reflexive thematic analysis to understand the knowledge, management, and education of concussion among Irish postprimary educators. A cross‐sectional study that involved semistructured interviews with 18 secondary school teachers was conducted. Interviews were recorded and transcribed in preparation for a reflexive thematic analysis process according to research conducted by Braun and Clarke. A total of 664 data items were coded which led to the development of 5 themes (i.e., teacher's background experience, consequences of concussion, concussion in school, educating educators, and existing standards) and 22 subthemes. The implementation of concussion education initiatives for improving student safety, injury management, and recovery through mandatory teacher‐continued professional development should be explored. Teachers' knowledge of concussion is influenced by personal experiences, with safer attitudes observed in those who have witnessed or experienced concussions. The role of the Year Head in concussion management should be explored with a focus on communication pathways and dissemination of materials. Protocols for medical emergencies and academic adjustments for concussed students should be made readily available to secondary school teachers.

As Canada is implementing a new national school food program with a long-term vision of every child having access to nutritious food in school, understanding student eating perspectives and food choices in universal programs is paramount. The purpose of this study was to understand how students in two low-income and culturally diverse elementary schools in Saskatoon, Canada, perceived and participated in a 2-year, universal school lunch pilot. This study was part of a larger case study of the Good Food for Learning program. Eleven focus groups with 65 students in grades 5-8 and participatory observation in the schools were conducted. Data analysis followed a reflexive thematic analysis approach Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport, Exer Health 2019;11:589-97. doi:10.1080/2159676 × .2019.1628806, Braun V, Clarke V. Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Counselling Psychother Res 2020;21:37-47. doi:10.1002/capr.12360) using NVivo 12 Plus. Student perspectives centered around being well-fed at lunch. Students saw participation in the pilot as a matter of personal choice: student decision to participate was encouraged by the pilot's flexible and free design; availability of well-liked food; and the perceived healthiness of the food. Offering culturally diverse and inclusive food was important to students. Mitigating future barriers to student participation in universal lunch programs will require attention to student choice, agency, and diversity, and offering diverse portion sizes, adequate meal lengths, and student-centered infrastructure. School lunch programs that are universal, health promoting, tasty, and free, and offer flexibility and choice to students, may be a socially desirable way to improve student nutrition and wellbeing.

Thematic analysis methods, including the reflexive approach we have developed, are widely used in counselling and psychotherapy research, as are other approaches that seek to develop ‘patterns’ (themes, categories) across cases. Without a thorough grounding in the conceptual foundations of a wide variety of across‐case analytic approaches, and qualitative research more broadly—something rarely offered in counselling training—it can be difficult to understand how these differ, where they overlap, and which might be appropriate for a particular research project. Our aim in this paper is to support researchers in counselling and psychotherapy to select an appropriate across‐case approach for their research, and to justify their choice, by discussing conceptual and procedural differences and similarities between reflexive thematic analysis (TA) and four other across‐case approaches. Three of these are also widely used in counselling and psychotherapy research—qualitative content analysis, interpretative phenomenological analysis and grounded theory. The fourth—discourse analysis—is less widely used but importantly exemplifies the critical qualitative research tradition. We contextualise our comparative approach by highlighting the diversitywithinTA. TA is best thought of as a spectrum of methods—from types that prioritise coding accuracy and reliability to reflexive approaches like ours that emphasise the inescapable subjectivity of data interpretation. Although reflexive TA provides the point of comparison for our discussion of other across‐case approaches, our aim is not to promote reflexive TA as ‘best’. Rather, we encourage the knowing selection and use of analytic methods and methodologies in counselling and psychotherapy research.

BackgroundTrauma experiences in early childhood can significantly impact children’s development. Child-Parent Psychotherapy (CPP) is an evidence-based treatment that addresses traumatic stress and child-parent attachment in children ages 0–6 years. Successful implementation of evidence-based interventions is challenging and presupposes a thorough understanding of the context in which it is being implemented. The objectives of this study were to explore the beliefs and experiences of therapists involved in the training and implementation of CPP in child and adolescent mental health- and child welfare services in Norway. The aim was to understand how health professionals experience implementation of CPP and identify determinants that could enhance or support the implementation process.MethodsTherapists were recruited from two subsequent CPP-training courses at the Regional Centre for Child and Adolescent Mental Health. We conducted ten semi-structured focus group interviews with forty therapists. They were interviewed after approximately six months of an 18-month CPP training initiative and again at the end of the training. We used reflexive thematic analysis to identify themes and determinants from descriptions of beliefs, attitudes and experiences with the training and implementation of CPP.ResultsFour major themes were identified: (1) Intrinsic motivation due to alignment between personal needs and client needs, (2) Psychological readiness influences how therapists engage with CPP, (3) CPP offers welcomed flexibility and professional autonomy, but ambivalence emerges in practice, and (4) Leadership support is not the same as implementation leadership. These themes and determinants were often interconnected and multileveled, reflecting the complexity of implementation processes.ConclusionsImplementation of CCP was influenced by determinants such as therapists’ intrinsic motivation, psychological readiness, and a balance between flexibility and intervention structure. Proactive leadership or strong self-leadership appears to be necessary to create opportunities for implementation engagement. The successful implementation of CPP appears to require tailoring to individual, organizational, and cultural needs.

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.

A researcher must consider their research question within their world view before selecting a technique appropriate for analysing their data. This will affect their choices of methodology and methods for collecting and analysing data. Reflexive thematic analysis (RTA) has become a go-to technique for qualitative nurse researchers. However, the justifications for using it and its application in the context of a wider approach are under-discussed. To rationalise the use of RTA within a wider philosophical-methodological-methods-analysis approach and provide nurse researchers with practical guidance about how to apply it to qualitative data. This article conceptually grounds the seminal work of Braun and Clarke (2006 ) and provides a process for rigorously and systematically analysing qualitative data. Researchers undertaking qualitative research must use a rigorous philosophical-methodological-method-analysis approach. Before selecting a technique appropriate for analysing their data, they must consider their research question within their own world view. This has implications for their choice of methodology and consequently the data collection methods and analysis techniques they use. Researchers should be mindful of RTA's conceptual roots when applying it. Transparent and rigorous data analysis leads to credible findings, supports evidence-based practice and contributes to the growing body of nursing research. Within the context of the wider philosophical-methodological-methods-analysis approach, RTA produces high-quality, credible findings when applied well. for practice This article can guide nursing students and novice researchers in choosing and applying RTA to their research.

Chat-based cancer counseling in Switzerland: A reflexive thematic analysis of chat protocols focused on cancer survivors' needs Abstract: Background: The number of people diagnosed with cancer and continue to live as cancer survivors is growing. Together with their relatives, they have information and counseling needs during the illness trajectory. With Cancerline, the Swiss Cancer League offers a chat-based counseling service for cancer survivors. Research question/objective: For the first time, the qualitative study investigated which needs cancer survivors express in Cancerline to gain insights for the further development and quality assurance of chat-based cancer counseling. Methods: Based on the principles of Interpretive Description, 669 chat counseling transcripts were analyzed using Braun et al. (2018) reflexive thematic analysis in an iterative process in six analysis steps. Results: Cancer survivorship needs in Cancerline are multifaceted, and we have identified nine themes: need anonymous chat to communicate, get informed, weigh ethical dilemmas and make decisions, seek meaning and hope, find ways to manage burdensome emotions, resolve social conflict and not burden others, feel understood and give space to own needs, clarify role as significant other acting correctly and seeking security. Conclusions: Chat-based counseling may contribute to supporting cancer survivors with information needs about cancer in a flexible way that is close to everyday life. Professionals can sensitize survivors to chat-based counseling, which makes low-threshold counseling accessible.

Background: Despite dietitians being important members of the multidisciplinary team delivering family therapy for anorexia nervosa (FT-AN), their specific responsibilities and roles are unclear and their involvement in the treatment can be a contentious issue. Methodology: Clinicians (n = 20) experienced in the delivery of FT-AN who were working at a specialist child and adolescent eating disorder service responded to an online survey about their experience of including a dietitian in FT-AN and how they understand the role. Both categorical and open-ended questions were used. Reflexive thematic analysis was used to analyse the qualitative free-text responses of clinician perspectives on the role of the dietitian in FT-AN. Results: All clinicians agreed that dietetics had a role within FT-AN and most frequently sought dietetic involvement in the early phases of FT-AN. Reflexive thematic analysis of responses identified three main themes. These were (1) collaboration is key, (2) confidence as a core consideration and (3) case-by-case approach. These themes evidenced the role of the dietitian within FT-AN and highlighted both the benefits and concerns of this involvement. Conclusions: This study demonstrated that dietitians can take a core role as collaborators within therapy-led teams that facilitate joint working and sharing of expertise. However, dietetic input should be considered on a case-by-case basis, given its potential for creating an over-focus on nutrition and potentially diminishing parental confidence in feeding. When indicated for selected cases, nutritional counselling should be offered in joint sessions with the therapist rather than separately. The findings of the study were limited by the small sample size of participants recruited from a single centre and heterogeneity in the professional background of respondents. Although the integration of dietetics within the multidisciplinary team and the ability of dietitians to individualise patient care can enhance FT-AN treatment, potential benefits and disbenefits should be considered for each case.