Codebook Approach Research Articles

The Path to Loneliness for Psychiatric Patients: A Qualitative Study of a Journey Marked by Pain, Hopelessness, Prosocial Signaling Deficits, and Coping Strategies That Are Not Effective.

Enduring loneliness has serious physical and mental health implications. Patients with mental health problems are at risk of experiencing problems related to loneliness. Therefore, it is important to increase knowledge about how loneliness is experienced and managed in this particular group. The aim of the study was to explore (1) psychiatric patients' experiences of different forms of loneliness, (2) associated problems, including difficulties with prosocial signaling, and (3) strategies used to combat loneliness, to better understand how loneliness affects psychiatric patients and how patients manage their loneliness. A total of 110 psychiatric patients were recruited at eight outpatient clinics in Region Stockholm for a larger study of loneliness. The first fifteen patients who also agreed to participate in the present substudy were invited to meet a trainee psychologist who conducted a semi-structured interview. A reflexive thematic analysis with a codebook approach was used to analyze the transcripts. The described experiences of loneliness were primarily examples of social and emotional loneliness with one prominent theme: "Hopelessly lonely". Associated problems were summarized in two themes: "The inevitable road to loneliness" and "Social signals are confusing and push others away". Regarding patients' strategies for combating loneliness, one theme emerged: "Using strategies that focus on the current moment". The results also included a total of sixteen subthemes. Loneliness was described as something painful that is inevitable and unchangeable, with a self-reinforcing loneliness loop leading to social and emotional loneliness, and as something that is intertwined with mental health problems. These results are in accordance with research. In addition, patients described a variety of prosocial signaling deficits and feelings of being disconnected from others. They also reported using strategies that primarily alleviated their immediate suffering when they were alone, rather than focusing on approaches with long-term effects on reducing loneliness, such as participating in social activities combined with effective social signaling. Future research should investigate whether increased awareness of social signaling, as well as social activities combined with improved prosocial signaling and strengthened self-belief, would constitute effective steps for patients to combat enduring loneliness. It also seems important to help patients reduce hopelessness related to loneliness.

Combining theory and usability testing to inform optimization and implementation of an online primary care depression management tool

BackgroundThe ‘Ottawa Depression Algorithm’ is an evidence-based online tool developed to support primary care professionals care for adults with depression. Uptake of such tools require provider behaviour change. Identifying issues which may impact use of an innovation in routine practice (i.e. barriers to and enablers of behaviour change) informs the selection of implementation strategies that can be deployed with the tool to support use. However, established theory-informed barriers/enablers assessment methods may be less well suited to identifying issues with tool usability. User testing methods can help to determine whether the tool itself is optimally designed. We aimed to integrate these two methodological approaches to i) identify issues impacting the usability of algorithm; and ii) identify barriers to and enablers of algorithm use in routine practice.MethodsWe conducted semi-structured interviews with primary care professionals in Ottawa, Canada. To evaluate usability, participants used a written patient scenario to work through the algorithm while verbalizing their thoughts (‘Think Aloud’). Participants were then asked about factors influencing algorithm use in routine practice (informed by the Theoretical Domains Framework). We used the codebook approach to thematic analysis to assign statements to pre-specified codes and develop themes pertaining to usability and routine use.ResultsWe interviewed 20 professionals from seven practices. Usability issues were summarised within five themes: Optimizing content and flow to align with issues faced in practice, Enhancing the most useful algorithm components, Interactivity of the algorithm and embedded tools, Clarity of presence, purpose, or function of components, and Navigational challenges and functionality of links. Barriers to and enablers of routine use were summarised within five themes: Getting to know the algorithm, Alignment with roles and pathways of influence, Integration with current ways of working, Contexts for use, and Anticipated benefits and concerns about patient communication.ConclusionsWhilst the Ottawa Depression Algorithm was viewed as a useful tool, specific usability issues and barriers to use were identified. Supplementing a theory-based barriers/enablers assessment with usability testing provided enhanced insights to inform optimization and implementation of this clinical tool. We have provided a methods guide for others who may wish to apply this approach.

Navigating payment and policy barriers to gender-affirming care for transmasculine individuals: A qualitative study and policy assessment.

Over the past decade, access to and insurance coverage for gender-affirming medical and surgical treatment for transgender (trans) individuals in the U.S. has improved. Despite this, trans individuals continue to experience insurance-related barriers to gender-affirming care (GAC)-and in particular, transmasculine individuals may face gender-specific barriers resulting from regulations on masculinizing hormones. In this study, we interviewed transmasculine individuals from across the U.S. about their gender-affirming care experiences with a focus on insurance, payment and policy-related barriers to care. Interviews were conducted via video-conferencing software, analyzed using a codebook approach to thematic analysis, and contextualized within a broader analysis of the policy landscape dictating coverage for gender-affirming care. Participants reported insurance denials for gender-affirming care, as well as challenges with prior-authorization requirements, letter requirements, restrictive formulary lists and other challenges that complicated and/or barred access to care. Many discussed adaptive strategies to these challenges, which included utilizing community resources and knowledge, as well as receiving material support from family, friends, and partners, and developing technical and interpersonal savvy skills in response to insurance challenges. Participants expressed a range of emotional responses with regard to payment and related challenges, from annoyance and frustration to hopelessness. Our findings illuminate the persisting challenges that transmasculine individuals face when attempting to access and pay for gender-affirming care, despite improvements in insurance coverage and legal protections in recent years resulting from the Bostock ruling by the Supreme Court and the expansion of the ACA's Section 1557.

Canadian cannabis researcher perspectives on the conduct and sponsorship of scientific research by the for-profit cannabis industry

There has been considerable financial investment by the for-profit cannabis industry to conduct research on cannabis in Canada. Similar to peer industry counterparts such as the pharmaceutical, alcohol, tobacco, and food industries, there is evidence that for-profit cannabis companies are financially sponsoring research programs and researchers as well as non-financially, such as donating products. However, a large body of research has established that researchers' financial relationships with industries may influence research agendas, outcomes, lead to conflicts of interest, and bias the evidence base. Within a complex, emerging context of legalization, there is limited information on how cannabis researchers negotiate their relationships with the for-profit cannabis industry in Canada. Following a qualitative phenomenological methodology informed by moral experience for bioethics research, we conducted 38 semi-structured interviews with academic researchers, peer researchers, and clinicians with relevant perspectives about Canadian cannabis companies’ research activities. We used a codebook approach to thematic analysis which generated three central themes: Navigating Systemic Barriers to Conduct Research; Impressions and Influences; and Guiding Principles for an Ethical Research Process. Our findings suggest that Canadian cannabis researchers tend to be morally ambivalent about cannabis industry sponsorship of research: they are motivated to conduct high quality research and generate evidence for population health benefit, yet they have concerns over the potential for research agenda bias created by these relationships which could be harmful to population health. Participants spoke how they relied heavily on personal values and individual strategies (transparency, value alignment, arms-length association, independence) to determine how they manage cannabis industry relationships. Our findings highlight how the issue of industry-academic relationships is a structural problem, thus individual-level solutions without attention to the relationship itself will only deepen ethical worries about industry-sponsored research.

“I couldn’t say goodbye”: Thematic analysis of interviews with bereaved relatives who lost their loved ones during the COVID-19 pandemic

BackgroundDelivering serious news is usually challenging for healthcare professionals and the pandemic of COVID-19 and related restrictions brought additional challenges in this process.AimsTo explore the experience of bereaved relatives with receiving serious news from healthcare professionals during the pandemic COVID-19.DesignA qualitative study using thematic analysis and a codebook approach of data collected in semi-structured interviews with bereaved relatives.Setting/participantsData were collected from July to August 2022 in person/via phone with bereaved relatives who lost their relatives during the pandemic (from March 2020 to March 2022). Participants were recruited using a convenience sample and snowball method through social media and through one university hospital palliative care unit that invited bereaved relatives of deceased patients treated at the unit to participate in this study.ResultsA total of 22 participants, consisting of 4 men and 18 women, were interviewed for this study. Most of the participants were sons or daughters of individuals who had died (5 grandchildren, 14 sons/daughters, 2 spouses, 1 great-niece). Six themes were identified: Burden caused by visit ban, Fear of COVID-19, Inappropriate behaviour and communication of healthcare professionals, High need for emotional support, Need for detailed and honest communication, Tendency to make excuses for mistakes and lapses by healthcare professionals.ConclusionsDelivering serious news during a pandemic was negatively influenced by a lack of contact with patients and a lack of support and empathetic communication with staff. Overcoming these circumstances can be achieved by frequent communication using various communication tools (such as videoconferences or phone calls), and maintaining empathy and honesty in the communication process.

Developing Infectious Disease Outbreak Emergency Communications for Populations With Limited English Proficiency: Insights to Sustain Collaborations Between Local Health Departments and Community-Based Organizations.

State and local public health departments (LHDs) are encouraged to collaborate with community-based organizations (CBOs) to enhance communication and promote protective practices with communities made vulnerable during emergencies, but there is little evidence-based understanding of practical approaches to fostering collaboration in this context. This research focuses on how collaboration enhances LHD capacity for effective communication for people with limited English proficiency (LEP) during infectious disease outbreaks specifically and strategies to facilitate productive LHD-CBO collaboration. Qualitative, telephone interviews, conducted March-October 2021. Rural and urban jurisdictions with Chinese-speaking or Spanish-speaking populations across the United States. 36 LHD and 31 CBO staff working on outreach to Chinese and Spanish speakers during COVID-19. Interviews were audio-recorded, transcribed verbatim, and analyzed using a team-based, codebook approach to thematic analysis. During COVID-19, CBOs extended LHD capacity to develop and disseminate effective communication, meaning communication that is rapidly in-language, culturally resonant, locally relevant, and trusted. Practical strategies to enable and sustain effective collaboration were needed to address operational dimensions (eg, material and administrative) and relational dimensions (eg, promoting trust and respect). Policies and financing to support LHD-CBO collaborations are critical to improving communication with people with LEP and addressing long-standing inequities in outcomes during outbreaks.

Gay and Bisexual Men's Perceptions about a Potential HIV Vaccine within a Post-COVID-19 Era: A Qualitative Study.

To end the HIV epidemic, there is need for targeted strategies to reduce HIV incidence for those most vulnerable, including an HIV vaccine. This study seeks to understand the perceptions that non-PrEP using gay and bisexual men and other men who have sex with men (GBMSM) have about a potential HIV vaccine, while contextualizing their perspectives within the context of heightened vaccine hesitancy that has emerged since the COVID-19 pandemic. Between March and May of 2022, GBMSM (N = 20) participated in in-depth interviews, which assessed their perceptions about an HIV vaccine. Interviews were analysed using a codebook approach to thematic analysis. We oversampled for those unvaccinated against COVID-19 as a proxy for vaccine hesitation. Participants expressed a range of enthusiastic support, cautious optimism and skepticism when presented with the possibility of an HIV vaccine. Factors that drove willingness to receive an HIV vaccine included community-oriented altruism, individualized risk-benefit assessment, and/or the perception that a vaccine could provide a beneficial shift in sexual experiences. Participants also expressed hesitations about receiving an HIV vaccine, including concerns about potential side-effects and efficacy, as well as mistrust in the vaccine development process. Notably, participants often evaluated the vaccine in comparison to PrEP and condoms. Participants offered specific insights into information they would like to receive about an HIV and where/how they would like to receive it. Our findings can help inform future HIV vaccine implementation efforts by offering insights into the factors that motivate and deter GBMSM to receive an HIV vaccine.

Evaluating the Home-Based Intervention Study (HIS-UK) to Improve Condom Use Skills and Experience: A Qualitative Study

Objectives We explored participants’ experiences in a randomized controlled trial that evaluated the Home-Based Intervention Strategy (HIS-UK) to improve male condom use skills/experiences. Methods 25 men (18–25 years) who had reached the first 6 months of the intervention were interviewed. We used a codebook approach to thematic analysis to analyze the data. Results Four themes were identified: Perceived benefits of online versus in-clinic recruitment; Perceptions of the educational content; Benefits of the condom kit; Acceptability of condom testing and monthly questionnaire. Conclusion Participants valued the intervention, especially the condom kit that provided a range of different condoms and lubricants.

Listening to self-advocacy scripts produced by speakers with Broca’s aphasia and apraxia of speech: thoughts and emotions reported by unfamiliar communication partners

ABSTRACT Background Self-advocacy scripts are brief, scripted narratives that people with aphasia (PWA) use to self-disclose their aphasia, explain what it is, and request supportive communicative behaviors from communication partners (CPs). In previous research, PWA have reported that self-advocacy statements, including self-advocacy scripts, facilitate their interactions with unfamiliar CPs. To understand the benefits of self-advocacy scripts, it is important to directly investigate how unfamiliar CPs respond to them. Aims The aim of this study was to characterize the thoughts and emotions reported by unfamiliar adults after listening to self-advocacy scripts produced by speakers with Broca’s aphasia and apraxia of speech. Methods & Procedures This experimental study included 238 adult research participants without aphasia. Each participant was randomly assigned to listen to one script produced by a speaker with Broca’s aphasia and apraxia of speech: either a self-advocacy script or a control script about the weather that does not mention the speaker’s aphasia. Then, they answered one open-ended question (analyzed using a codebook approach) and eight rating scale questions (analyzed using Bayesian linear regression) about the thoughts and emotions they experienced while listening to the speaker. Outcomes & Results Compared to the control script, the self-advocacy script improved listeners’ knowledge about the speakers’ condition, their perception of the speakers’ intelligence, and their patience and empathy for the speakers. Conclusions Aphasia self-advocacy scripts can have powerful, positive effects on unfamiliar listeners. The present results highlight the importance of providing support in clinical practice for collaborative development of self-advocacy scripts between people with aphasia and their clinicians.

Perceptions about doxycycline post-exposure prophylaxis (Doxy-PEP) as an STI-prevention strategy among gay and bisexual men (GBM) in the United States: Results from a qualitative study

ObjectiveTo leverage qualitative data to explore gay and bisexual men’s (GBM) perceptions about doxycycline post-exposure prophylaxis (Doxy-PEP). Doxy-PEP is a novel biomedical STI-prevention strategy that helps reduce the risk of acquiring bacterial STIs. Little is known about Doxy-PEP’s acceptability in the U.S., nor how best to engage those most vulnerable to STIs in taking up this nascent prevention strategy. MethodBetween July and September of 2023, 24 GBM from across the U.S. completed qualitative interviews about their perceptions regarding Doxy-PEP. Interviews were analyzed using a codebook approach to thematic analysis. ResultsParticipants were generally interested in using Doxy-PEP, but were concerned about the potential for antibiotic resistance, side-effects, medication interactions to occur, along with stigmatizing discourse around its use. Meanwhile, participants were motivated by the simplicity of Doxy-PEP and the protection it could confer on both an individual and community-level— as well as its potential to reduce STI-related anxiety. Finally, participants desired additional information on Doxy-PEP to address their concerns. ConclusionsThere is a need for clear guidelines and expanded public health messaging on Doxy-PEP in the U.S.

Needs and Experiences With Health Care Providers of Adult Rare Disease Patients and Caregivers of People With Rare Diseases: Protocol for a Qualitative Study.

Rare diseases in Europe are defined as diseases with a prevalence of less than 5 per 10,000 people. Despite their individual rarity, the total number of rare diseases is considerable. Rare diseases are often chronic and complex, affecting physical, mental, and neurological health. People with rare diseases face challenges such as delayed diagnosis, limited medical support, and financial burden. Caregivers, usually family members, bear significant physical and emotional burdens. Understanding the experiences of patients with rare disease and their caregivers is critical to effective care, but this is still underresearched. Better support and understanding of the challenges faced by both patients and caregivers is clearly needed. Our study will explore the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. This study aims to explore the experiences of patients with rare disease and their caregivers with Slovenian health care providers and to create a theoretical model of needs and experiences. This is a qualitative thematic analysis study, using the codebook approach. The study will conduct semi-open-ended interviews to understand the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. The interview questions will be based on an extensive literature review. Data from the interviews will be analyzed using thematic analysis to identify patterns and build a thematic map. Data will be analyzed by at least 2 coders. To ensure reliability, respondent validation will be conducted and negative cases investigated. Any discrepancies will be resolved by consulting the entire research team until a consensus is reached. This study was not specifically funded. However, author TČ is supported by grant number P3-0339 from the Slovenian Agency for Research and Innovation. This study was approved by the Medical Ethics Committee of the Republic of Slovenia (0120-47/2022/3), and recruitment is expected to begin in May 2024, with data analysis results anticipated by the end of 2025. This study will fill an important research gap in Slovenia by exploring the needs and experiences of people living with rare diseases and their caregivers. The results will contribute to the broader field of rare diseases and add knowledge that can inform future research processes and intervention strategies. It also aims to identify neglected areas that have a significant impact on the lives of people with rare diseases. This study is important not only because it addresses the immediate needs of the Slovenian rare disease community, but also because it contributes to a discussion on patient-centered care, health policy design, and the inclusion of psychosocial components in health care. PRR1-10.2196/53362.

Community youth mental health awareness in Pakistan through the train-the-trainer model: Qualitative study of stakeholder perspectives

BackgroundYouth in low-resource settings such as Pakistan have high levels of unmet mental health needs. Mental health stigma and sparse resources are key barriers to accessing help. AimTo capture end-users’ and trainers’ perspectives of youth mental health awareness in Pakistan informed by the Train-the-Trainer framework. MethodA qualitative research design was adopted, utilizing focus group discussions to hear the voices of those engaged in the study. Following the facilitation of four youth mental health awareness events in disadvantaged communities, five focus groups were conducted with 29 participants, i.e., mothers (n = 7 and n = 3), youth (n = 3 female and n = 7 male), and trainers (n = 9). Data were integrated and analysed through framework thematic analysis, which is a codebook approach to thematic analysis. ResultsThree themes related to perceived individual, community and implementation enablers and challenges. Trainers, mothers and youth reported undergoing parallel processes of personal growth. Communities were viewed as sources of both stigma and solutions, through engagement and addressing contextual issues such as gender. ConclusionParticipants in community youth mental health awareness welcomed the opportunity to acquire and transfer new knowledge, but also identified required supports to engage and actively involve communities in Majority World Countries.

A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial.

Community health workers (CHWs) play an important role in health systems in low- and middle-income countries, including South Africa. Bukhali is a CHW-delivered intervention as part of a randomised controlled trial, to improve the health trajectories of young women in Soweto, South Africa. This study aimed to qualitatively explore factors influencing implementation of the preconception and pregnancy phases of Bukhali, from the perspective of the CHWs (Health Helpers, HHs) delivering the intervention. As part of the Bukhali trial process evaluation, three focus group discussions were conducted with the 13 HHs employed by the trial. A thematic approach was used to analyse the data, drawing on elements of a reflexive thematic and codebook approach. The following six themes were developed, representing factors impacting implementation of the HH roles: interaction with the existing public healthcare sector; participant perceptions of health; health literacy and language barriers; participants' socioeconomic constraints; family, partner, and community views of trial components; and the HH-participant relationship. HHs reported uses of several trial-based tools to overcome implementation challenges, increasing their ability to implement their roles as planned. The relationship of trust between the HH and participants seemed to function as one important mechanism for impact. The findings supported a number of adaptations to the implementation of Bukhali, such as intensified trial-based follow-up of referrals that do not receive management at clinics, continued HH training and community engagement parallel to trial implementation, with an increased emphasis on health-related stigma and education. HH perspectives on intervention implementation highlighted adaptations across three broad strategic areas: navigating and bridging healthcare systems, adaptability to individual participant needs, and navigating stigma around disease. These findings provide recommendations for the next phases of Bukhali, for other CHW-delivered preconception and pregnancy trials, and for the strengthening of CHW roles in clinical settings with similar implementation challenges. Trial registration: Pan African Clinical Trials Registry; PACTR201903750173871, Registered March 27, 2019.

Pathways to opioid use and implications for prevention: voices of young adults in recovery

BackgroundOpioid use remains a major public health issue, especially among young adults. Despite investment in harm reduction and supply-side strategies such as reducing overprescribing and safe medication disposal, little is known about demand-side issues, such as reasons for use and pathways to opioid use. Adolescents and young adults who struggle with opioid use disorder (OUD) are multifaceted individuals with varied individual histories, experiences, challenges, skills, relationships, and lives.MethodsTo inform the development of prevention strategies that hold promise for addressing opioid use, this study employs brief structured surveys and semi-structured in-depth interviews with 30 young adults (ages 18–29; 19 female, 23 White, 16 from Suburban areas) in recovery from OUD. For survey data, we used descriptive statistics to summarize the means and variance of retrospectively reported risk and protective factors associated with opioid use. For in-depth interview data, we used a combination of thematic analysis and codebook approaches to generate common themes and experiences shared by participants.ResultsSurveys revealed that the most endorsed risk factors pertained to emotions (emotional neglect and emotional abuse) followed by sexual abuse, physical abuse, and physical neglect. Themes generated from qualitative analyses reveal challenging experiences during adolescence, such as unaddressed mental health, social, and emotional needs, which were often reported as reasons for opioid initiation and use. Through surveys and interviews, we also identified positive assets, such as skills and social relationships that were present for many participants during adolescence.ConclusionImplications include the need for universal prevention strategies that include emotion-focused interventions and supports alongside current harm reduction and environmental strategies to regulate prescriptions; the potential utility of more emotion-focused items being included on screening tools; and more voices of young people in recovery.

Sociohistorical development of sim racing in European and Asia-Pacific esports: A cross-cultural qualitative study

With the accelerated growth of the sim racing industry over the last few years, research on the phenomenon has started to emerge. Nonetheless, the history of sim racing remains unmapped. This study aims to fill the gap by investigating the development in sim racing in Europe and in Asia-Pacific between 1997 and 2021. Twenty four semi-structured interviews were carried out with experts representing sim racing associations, event organizers, and teams from Europe and Asia-Pacific. Data were analyzed using an inductive-deductive codebook approach. The results show the evolution of sim racing throughout five sociohistorical stages, which demonstrate how sim racing emerged as a hybrid of esports and motorsports and has kept evolving since ‘in-between’ their respective actors until today. The findings suggest that the slow evolution of sim racing has been particularly dependent on networked sociocultural actors, while positively affected by uncontrollable events like the COVID-19 pandemic. As a key implication, we find that the history of sim racing differs from that of esports by its multifaceted dependence on the motorsports ecosystem.

A Life Course Approach on Older Portuguese Gay and Bisexual People: The Multifactorial Development of Sexual Identity

Research shows that successful development of sexual identity is essential for healthy and well-adjusted ageing. Gay and bisexual (GB) older people have experienced cumulative events throughout their lives that may have affected the development of their identity. In addition, the few previous studies show an alarming lack of community connectedness among older GB people in Portugal. This study assessed the factors that have contributed to the development of sexual identity in Portuguese GB older adults throughout their lives, using an inductive qualitative cross-sectional approach based on Life Course Theory. Twenty-two semi-structured interviews were carried out with older (60+ years) GB people living in the community and using the lifeline technique. The interviews were analyzed using thematic analysis with a codebook approach. Results suggest a multifactorial contribution of factors throughout the life cycle that have affected the development of GB older people’s sexual identity. These include historical–cultural factors (e.g., sexual repression and traditionalism of the dictatorship), psychosocial factors (e.g., cumulative sexual stigma), relational factors (e.g., relational clandestinity) and intrapersonal factors (e.g., concealment of sexual orientation). The existence of the Internalized Sexual Minority Disconnectedness phenomenon and its contribution to the formation of the sexual identity of older GB adults were also verified. These results reveal important clues about the development of older GB people in Portugal and the factors that may be affecting the current invisibility of these people in the social and health-related context. Relevant implications for the clinical context are also discussed.

Process of co‐production of mental health service plans for refugee children in Turkey

AbstractRefugee children and young people have high levels of unmet mental health needs. A trauma‐informed service transformation framework was applied with 14 professionals in Turkey. Through participatory focus groups, professionals co‐produced service plans and considered enabling and challenging factors for implementation. Data were analysed through a thematic codebook approach. Established themes suggested that implementation should concurrently address societal barriers, agency fragmentation, lack of contextual interventions and sustainability. These led to the development of a Theory of Change. A trauma‐informed and scaled service model of collaborative care can holistically meet refugee children and young people's complex needs, while maximising sparse resources.

Suicide prevention programming across ecological levels: Recommendations from Latinx immigrant origin youth and their parents.

Latinx immigrant-origin youth (IOY) have unique risks for suicidal thoughts and behaviors. It has been suggested that these risks should be addressed from an ecological perspective, addressing cultural and family context as well as structural and systemic barriers to prevention. This study sought to explore perspectives of immigrant-origin Latinx adolescents and their caregivers on suicide and its prevention, including the potential impact of stressors specific to immigrant status. Focus groups were conducted in 2018-2019 with Latinx immigrant-origin caregivers (N = 41, 97.5% female) and adolescents (ages = 14-19, N = 56, 50% female). Participants were recruited from community-based organizations in two different cities. A codebook approach to thematic analysis was used to identify themes, which were subsequently mapped onto levels of the Center for Disease Control's Social-Ecological Framework for Violence Prevention. Participants identified both contributors to suicidal behavior and potential components of prevention programming across ecological levels. Specific recommendations for suicide prevention included engaging in recreation, parenting education and support, enhancing academic supports for adolescents, and enhancing school-family communication. Structural barriers (e.g., caregiver work schedules) to implementing recommendations were described. Our results highlight the potential role of access to school and community-based supports as public health-oriented suicide prevention strategies and suggest a need to address barriers faced by immigrant families in accessing these supports alongside addressing barriers to mental health treatment. Policies impacting immigrant families' financial stability and increasing the availability of recreational and academic opportunities may promote mental health and prevent suicidal thoughts and behavior among IOY. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Barriers and needs in mental healthcare of adults with autism spectrum disorder in Germany: a qualitative study in autistic adults, relatives, and healthcare providers

BackgroundAutism refers to a neurodevelopmental condition with characteristic impairments in social interaction and communication, restrictive and repetitive behaviors, as well as difficulties in sensory information processing and daily living skills. Even though symptoms persist from early childhood throughout the lifespan and often require long-term support, there is a lack of mental health services that sufficiently meet the needs of autistic adults. Previous evidence suggested individual, professional and structural barriers to healthcare for autistic adults. Here, using a peer research approach, we sought to systematically investigate barriers and needs in mental healthcare of autistic adults in Germany at the three relevant levels (individual, professional, structural) and from three relevant perspectives (autistic adults, relatives and healthcare providers), in order to obtain specific recommendations for optimized healthcare.MethodsMaximum variation sampling was used to account for the complexity of the research field. Semi-structured, open-ended interviews were conducted with autistic adults (n = 15) and focus groups with relatives/partners (n = 12), and healthcare providers of several professions (n = 15). Data analysis was performed using the codebook approach of thematic analysis.ResultsPoor mental healthcare of autistic adults in Germany was characterized by six central and overarching themes: (i) lack of knowledge about autism, (ii) a need for increased participation/involvement, (iii) consideration of autism-specific needs in treatment, (iv) lack of services, (v) limited access to services, and (vi) improvement of stakeholder collaboration. Themes were similarly reported across participants, emphasizing dissatisfaction in all stakeholders.ConclusionsWe identified major barriers to mental healthcare for autistic adults in Germany that affect autistic adults, but are also of concern to relatives and healthcare providers. Our results point to specific and generic areas for improvement, independent of stakeholder perspectives, which could guide future development of needs- and evidence-based services, recommendations and guidelines of mental healthcare for people with autism across the lifespan.Trial registrationThis study protocol was preregistered at the Open Science Framework (https://osf.io/5x8pg).

Initial insights into the impact and implementation of Creating Active Schools in Bradford, UK

BackgroundFew whole-school physical activity programmes integrate implementation science frameworks within the design, delivery, and evaluation. As a result, knowledge of the key factors that support implementation at scale is lacking. The Creating Active Schools (CAS) programme was co-designed and is underpinned by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Consolidated Framework for Implementation Research (CFIR). The study aims to understand the initial impact and implementation of CAS in Bradford over 9 months using McKay’s et al.’s (2019) implementation evaluation roadmap.MethodsFocus groups and interviews were conducted with school staff (n = 30, schools = 25), CAS Champions (n = 9), and the CAS strategic lead (n = 1). Qualitative data were analysed both inductively and deductively. The deductive analysis involved coding data into a priori themes based on McKay et al’s implementation evaluation roadmap, using a codebook approach to thematic analysis. The inductive analysis included producing initial codes and reviewing themes before finalising.ResultsIdentified themes aligned into three categories: (i) key ingredients for successful adoption and implementation of CAS, (ii) CAS implementation: challenges and solutions, and (iv) the perceived effectiveness of CAS at the school level. This included the willingness of schools to adopt and implement whole-school approaches when they are perceived as high quality and aligned with current school values. The programme implementation processes were seen as supportive; schools identified and valued the step-change approach to implementing CAS long-term. Formal and informal communities of practice provided “safe spaces” for cross-school support. Conversely, challenges persisted with gaining broader reach within schools, school staff’s self-competence and shifting school culture around physical activity. This resulted in varied uptake between and within schools.ConclusionsThis study provides novel insights into the implementation of CAS, with outcomes aligning to the adoption, reach, and sustainability. Successful implementation of CAS was underpinned by determinants including acceptability, intervention complexity, school culture and school stakeholders’ perceived self-efficacy. The combination of McKay’s evaluation roadmap and CFIR establishes a rigorous approach for evaluating activity promotion programmes underpinned by behavioural and implementation science. Resultantly this study offers originality and progression in understanding the implementation and effectiveness of whole-school approaches to physical activity.