Coding Of Qualitative Data Research Articles

“Too few, too far away, for what is paid”: Consumer voices about the personal assistance worker crisis

BackgroundThe growing gap between demand and supply of personal assistance service (PAS) workers presents a significant burden to those who use services. The intensity and duration of hardship is growing, and consumer voices need to be heard and incorporated into the national dialogue. ObjectiveThis paper explores how PAS worker shortages manifest themselves in the daily lives of people with disabilities using or needing PAS services in the United States. MethodsWe used thematic coding of qualitative data from the 2022 National Survey on Health and Disability. Respondents (n = 330) provided open-ended responses to the prompt “Briefly explain the types of problems or issues you have had finding PAS or support workers.” ResultsThree themes emerged regarding consumer perspectives and experiences with worker shortages (1) low pay, few benefits, and undervalued work, (2) demanding working conditions and logistics, and (3) low quality workers. In combination, these themes informed a fourth theme (4) impacts for PAS consumers characterized by substandard care and additional stress and workload for those who direct their own care. ConclusionsAs a society, we have taken steps to increase opportunities for community living and created policies to uphold choice and independence for people with disabilities. In the absence of an adequate workforce to support these policies, however, we convey an empty promise. Without tangible steps to resolve these problems at the policy level, such as improved worker pay and protections, hope for resolution to these issues remains elusive.

Consensus and controversies on post-acute care decision making and referral to geriatric rehabilitation: A national survey

BackgroundTransitioning older hospital patients to the appropriate type of post-acute care has become an urgent clinical issue within the context of changing demographics and limited duration of hospital stay. ObjectiveConsensus on assessments that guide post-acute care decision making would benefit potential patients and support cooperation between settings. DesignA national web-based questionnaire focusing on professional contributions, patient involvement and the use of triage items and measures. ParticipantsHospital and geriatric rehabilitation professionals in the Netherlands participated as respondent groups, representing ‘sending’ and ‘receiving’ professionals. MethodsA comprehensive questionnaire was used with open, multiple choice and closed questions, exploring in detail how assessment of hospital patients in need of a post-acute care decision was performed. Descriptive statistics were applied together with deductive coding of qualitative data. ResultsA total of 104 hospital liaison nurses (66.7 %) and 52 GR professionals (33.3 %) participated. Respondents were reasonably satisfied with the current triage practice. Hospital liaison nurses valued their operational responsibility for triage. Geriatric rehabilitation professionals wanted active involvement in decision making and deemed hospital paramedic expertise sub-optimally applied. ‘Too little involvement’ of patients and families was felt by 50.0 % of the GR respondents versus 15.5 % of hospital respondents. The importance of half (47.8 %) of the triage items was rated differently between respondent groups. When discussing complex cases between sending and receiving professionals, views were felt as complementary. ConclusionsBoth sending and receiving professionals expressed moderate satisfaction with post-acute care decision making, whereas their views on triage assessments differed according to setting and role. The patients’ voice may be insufficiently heard in triage decisions. Shared expertise and a consensual approach can develop when triage consultation is facilitated by both hospitals and PAC facilities. This study offers ingredients to reach a multi-professional view on post-acute care decision making and referral to geriatric rehabilitation.

Qualitative Data Coding of User Experience With an Urban Air Mobility Fleet Manager Interface

The NASA Aeronautics Research Mission Directorate created the High Density Vertiplex (HDV) project to integrate and evaluate a prototype Urban Air Mobility (UAM) ecosystem. Part of the HDV testing environment included a prototype operator user interface called the Fleet Manager Interface (FMI). In 2023, HDV conducted flight testing with the FMI during which a user experience (UX) study was performed to assess the quality of UX and elicit design recommendations. As a result, a large database of open-ended, qualitative responses was generated and then coded using a new qualitative data coding technique called Directive String Coding. The key themes that arose from the coded responses showed that the UX was pleasant, system notifications should be more salient, and information across multiple screens should be integrated into a central display. As the Fleet Manger operational role is still being defined, it is vital to increase our understanding of the tools and capabilities needed for such a role. The results from HDV work will eventually feed into standards for vertiport operations that will enable safe and scalable UAM operations in the United States.

Resilience in action: Kosovo's National Development Strategy to incorporate sustainable development goals

AbstractThrough resilience theory, this paper explores the integration and alignment of the United Nations sustainable development goals (SDGs) within Kosovo's National Development Strategy (NDS). It highlights how adaptability and strategic planning underpin sustainable development in emerging national contexts like Kosovo, offering a qualitative analysis to identify gaps and suggest improvements for SDG integration. Utilizing a qualitative analysis, this study identifies gaps and provides recommendations for better SDG integration within Kosovo's national development agenda. Data analysis involves the thematic coding of qualitative data and synthesis of case study findings by examining existing documents, strategies, and plans as manifestations of Kosovo's commitment to fostering resilience and achieving a sustainable future. Key insights include recommendations for enhancing governance, environmental protection mechanisms, and social inclusivity to achieve resilient and sustainable economic growth. The study contributes to the discourse on resilience theory in national sustainable development strategies amidst political uncertainty.

A Study on the Level of Customer Satisfaction Towards the Services of Maruti Suzuki

The study investigates customer satisfaction levels regarding Maruti Suzuki services. It employs a mixed-methods approach, combining surveys and interviews to gather comprehensive insights. The research sample includes Maruti Suzuki customers across diverse demographics, ensuring a representative perspective. The study aims to identify key factors influencing customer satisfaction, such as service quality, accessibility, and after-sales support. Statistical analysis and thematic coding of qualitative data enable a nuanced understanding of customer perceptions and preferences. The findings contribute to the existing body of knowledge on automotive service satisfaction and offer practical implications for Maruti Suzuki's service improvement strategies. Ultimately, the research aims to enhance customer experiences and foster long-term loyalty towards the brand. The study aims to explain key determinants of customer satisfaction within the context of Maruti Suzuki's services, including but not limited to service quality, accessibility, communication, and after-sales support. By identifying areas of strength and areas for improvement, the findings of this research will contribute to enhancing the overall customer experience and fostering long-term loyalty towards the Maruti Suzuki brand.

Manual Qualitative Data Coding Using MS Word for Students and Early Career Researchers in Resource-Constrained Settings

In recent years, the field of qualitative data collection, management, and analysis has undergone significant evolution, with researchers worldwide increasingly leveraging technological advancements to streamline and simplify their practices. Despite the advantages of using qualitative data coding software, several challenges persist, particularly in resource-constrained settings. Issues such as the high cost of software licenses, the time required to learn and use these tools, and the complexity of advanced features often hinder researchers, especially students and early career researchers in low-income contexts, and contribute to the generation of poor-quality research evidence. This paper aims to provide a simplified, step-by-step guide to manual qualitative data coding using Microsoft Word, a widely accessible tool in low-income contexts. It is designed to support students and early-career researchers in low-income settings, helping them to conduct effective qualitative data management and analysis without the need for expensive software. We provide a five-step detailed guide for qualitative data coding using Microsoft Word, based on a practical example from previous research on maternal and child health in rural Tanzania. We also present a hypothetical example of a student research study focusing on the drivers behind pursuing a Bachelor of Science in Nursing degree. The process begins with examining the research objectives and questions to develop preliminary themes and sub-themes, identifying relevant data sources within study interview guides, and creating guided transcription and coding templates tailored to each interview guide, followed by data coding by integrating interview data into a structured template. Practical insights are provided on transforming coded data into meaningful interpretations and analyses. This systematic approach aims to facilitate effective qualitative data management and analysis using accessible tools like Microsoft Word, thereby supporting students and early career researchers in conducting small-scale studies effectively.

Exploring the use of focused ethnography in social work research: A scoping review

Focused ethnography (FE) is an emerging method for social work researchers who examine social justice issues within specific sub-cultures and service systems. FE methods may include researchers with background knowledge, specific research questions, and the use of intensive, short-term data collection methods in time-limited settings. Although relevant to applied studies in social work, FE methods remain underspecified. This scoping review examines the extent, variety, and characteristics of FE in social work research. The protocol follows the PRISMA Extension for Scoping Reviews Checklist and Explanation (PRISMA-ScR). We searched Social Science databases between 2018 and 2022. The critical appraisal of articles is guided by published FE methodology and American Psychological Association (APA) journal reporting standards for qualitative research. Researchers justified the use of FE in relation to their ethnographic goals, research populations, and specific questions. However, they were inconsistent in their discussion of the integration of theory and reflexive processes in research methods. While most studies used thematic analysis or coding of qualitative data, some lacked the recommended elements outlined in the journal reporting standards for qualitative research. In particular, they lacked transparency when discussing the impact of background knowledge and positionality on data analytic processes and findings. In this review, we discuss the strengths and limitations of FE for social work research and offer recommendations for methodological improvement. To enhance understanding and trustworthiness of reported findings, we recommend transparency in discussions of data analytic and reflexive processes, as well as uniform reporting in accordance with APA standards for qualitative research.

Expert Opinions: Reform to the National School Meal Programs Regarding Dietary Saturated Fats

The purpose of this study is to determine whether the National School Lunch and Breakfast Programs in the US should be revised to have more relaxed regulations on saturated dietary fat consumption. Controversy over the validity of the diet-heart hypothesis—examined in a review of literature —prompted this inquiry. Qualitative data was collected through eighteen expert interviews. Trends in expert responses were identified using qualitative data coding. Participating experts were of diverse perspectives and came from across the United States. Experts answered in ways that were mostly consistent with the current Dietary Guidelines for Americans. However, most seemed to agree that it would be beneficial to relax regulations on saturated fat in order to allow for some flexibility. There was a widespread and overwhelming concern about ultra processed foods among experts.

Parenting Education in Islamic Families within the Framework of Family Resilience in Aceh, Indonesia

Parenting education plays an important role in fostering healthy family character, supporting child development, and ensuring family resilience. This research aims to apply Islamic values in parenting practices, examine the role of culture and community support, understand challenges and parenting strategies, analyze gender roles, and assess the effectiveness of parenting education programs in Aceh. The study uses qualitative methods, and analysis using parenting theory. Semi-structured interviews and literature studies were used to collect data. The analysis includes coding of qualitative data, classification, and interpretation. Ethical considerations are enforced throughout the research process, to ensure respondent consent, privacy, and confidentiality and address potential researcher bias. The results of the study concluded that parenting education requires support from Islamic values, culture, community encouragement, fair and good parenting, gender roles, and parenting education programs. Parenting education for Islamic families in Aceh based on religious values (such as monotheism and piety) and Islamic culture has been proven to create family resilience. The tsunami incident is clear evidence of the resilience of the Acehnese family based on Islamic values and religious culture. On the other hand, religious leaders and educators can encourage and enhance this parenting education model in society. The findings of this study have practical implications for developing parenting education programs and interventions that are sensitive to values and culture in promoting well-being, the Islamic family model and family resilience in Aceh, Indonesia.

Experiences of International Students at a Canadian University

Universities in Canada are increasingly attracting international students, but few studies have examined their experiences. This research identified the key supports and barriers for international students in order to make policy-relevant recommendations. This convergent mixed-methods study combined survey (n = 104) and interview (n = 14) data to investigate international student experiences through the lens of international students. Exploratory factor analyses revealed writing and mathematics skills and relationships with faculty and students as key factors for success. Frequency analyses revealed that racism was a persistent barrier. Assistance, access, diversity and equity issues were also raised. Open and axial coding of qualitative data corroborated these findings and revealed three dimensions of internationalization according to international students’ perspectives: Exchange; Understanding, Sharing, and Support; and Transformation. Recommendations to universities included offering bursaries to international students from underrepresented regions, developing intercultural awareness of faculty, and providing program-specific student support centres with peer mentors.

Evaluating the Coverage and Depth of Latent Dirichlet Allocation Topic Model in Comparison with Human Coding of Qualitative Data: The Case of Education Research

Fields in the social sciences, such as education research, have started to expand the use of computer-based research methods to supplement traditional research approaches. Natural language processing techniques, such as topic modeling, may support qualitative data analysis by providing early categories that researchers may interpret and refine. This study contributes to this body of research and answers the following research questions: (RQ1) What is the relative coverage of the latent Dirichlet allocation (LDA) topic model and human coding in terms of the breadth of the topics/themes extracted from the text collection? (RQ2) What is the relative depth or level of detail among identified topics using LDA topic models and human coding approaches? A dataset of student reflections was qualitatively analyzed using LDA topic modeling and human coding approaches, and the results were compared. The findings suggest that topic models can provide reliable coverage and depth of themes present in a textual collection comparable to human coding but require manual interpretation of topics. The breadth and depth of human coding output is heavily dependent on the expertise of coders and the size of the collection; these factors are better handled in the topic modeling approach.

3D Printing for Repair: An Approach for Enhancing Repair

The availability and storage of spare parts are the main barriers to product repair. One possibility would be to 3D print spare parts, which would also enable the repair of products not intended to be repaired. Besides manufacturers, 3D printing spare parts is an interesting option for self-repair by consumers. However, the digitisation of spare parts for 3D printing is a challenge. There is little guidance on how to make a 3D-printed version of the original part. This paper establishes a framework through a literature review and experimental study to describe how to use 3D printing to produce spare parts for repair. Additionally, qualitative data coding was used to find the influence of previous experience, process implementation, and part complexity on the overall success of the 3D printing for repair (3DPfR) process. Our study showed that the 3DPfR process can be described as an iterative design for an additive manufacturing process that is integrated into a repair process. Additionally, it was found that the incorrect implementation of process steps was the most important predictor of the repair result. The steps that were performed incorrectly the most were synthesising design concepts (64%) and validating print quality (also 64%).

Core values for ideal civil servants: Service‐oriented, responsive and dedicated

AbstractWhat do citizens want? How do citizens think public servants should behave? Although such questions seem straightforward, little is known about the values citizens expect public servants to uphold. This paper therefore identifies such values through extensive coding of qualitative data from representative samples of United States (n = 395), Dutch (n = 369), and South Korean (n = 379) citizens. Surprisingly, and contrasting to assumptions in the literature on citizen satisfaction, citizens hardly value effectiveness, efficiency, and accountability. In contrast, we found that the top three universal values that citizens desire from public servants are serviceability, responsiveness, and dedication. These values are generic across countries, age, gender, and education level. However, some values are more important in some countries than in others. These differences show the influence of a country's longstanding public administrative tradition and its current situation. Our findings challenge scholars and government officials to rethink what citizens want from their civil servants.

Presenting the Recognition and Evaluation Model of Factors Affecting the Acceptance of Fintechs

The purpose of this research is to provide a model of recognition and evaluation of factors affecting the acceptance of fintechs. The statistical population included experts and experts in the banking industry, who were selected as participants in the research using a targeted sampling approach. The data was collected by interview method with general guidance method and in a semi-structured way. In order to obtain the reliability and validity of the data, two methods of reviewing the participants and also the review of non-participating experts were used in the research. The reliability of the model was evaluated using the Kappa index. The value of Kappa index equal to 0.748 was calculated and it was placed at the level of valid agreement. Interviews and coding were analyzed using Maxqda software. Finally, based on the identified final criteria, the model derived from the foundation''s data analysis method is presented. Based on the results of open coding of qualitative data collected using the interview tool, it can be seen that 60 open codes have been identified among 434 parts of the interviews. All the created codes are reviewed again and compared with the texts so that nothing is missed. In the results of core coding, it can be seen that 60 primary codes are in the form of 15 categories of evaluation and monitoring, public trust and security, interaction and communication, human and social development, satisfaction, infrastructure, administrative and organizational health, transparency and accountability, and core justice. , financial factors, information technology, efficiency and effectiveness, quality of laws and regulations, quality of electronic services and participation are categorized.

Translanguaging pedagogies in a Mandarin-English dual language bilingual education classroom: contextualised learning from teacher-researcher collaboration

ABSTRACT Teacher-researcher collaborative inquiry helps illuminate contextual demands and affordances of teaching and learning and how they shape and inform theory and practice. Elaborating on a university-school study in a Mandarin-English dual language bilingual education (DLBE) programme in the U.S., we examine how the researcher worked alongside a Grade 3 Mandarin teacher in implementing translanguaging approaches across different content areas. We focus particularly on critical moments of dissonance in their research partnership that capture their changing understandings and constant negotiations of translanguaging stance, design, and shifts. Through open and focused coding of qualitative data, we identified both parties’ evolving perspectives and teaching/research practices. Ambivalence, doubts, and contradictions characterised their collaboration process as both researcher and teacher wrestled with what translanguaging means to Chinese education within a DLBE context where English hegemony reigns both inside and outside school. Important critical moments are highlighted to illuminate how the pair gradually developed a shared understanding about the need for a more comprehensive, critical, and contextualised lens to translanguaging pedagogies and to learn how to orchestrate translanguaging spaces in DLBE programmes while privileging students’ use of Mandarin.

Diagnostic radiography students’ perceptions towards communication with service users who are deaf or hearing impaired

IntroductionCommunication issues can arise when deaf or hearing impaired individuals access National Health Service (NHS) radiology services if reasonable adjustments and inclusive services are not facilitated. This study aims to assess student diagnostic radiographers' attitudes and communication experience with service users who are deaf or hearing impaired. MethodsAn anonymous online survey was conducted on UK undergraduate diagnostic radiography students from a single university. The sample size of students invited to participate in the study was n = 156. The measurement scales and questions included quantitative attitudinal 5-point Likert and qualitative free-response questions. Statistical analysis included the Kruskal–Wallis H test, Mann–Whitney U test, pairwise comparisons of variables and thematic coding of qualitative data. Resultsn=48 students responded. The student's perceptions of communication experiences with deaf or hearing-impaired patients were positive (72.9%) but depended on the amount of experience whilst on clinical placement (first-year students had less clinical placement experience than years two and three). Overall confidence in communicating was 47.9% with no difference by gender (p = 0.87) but variance by age category (p = 0.03), with the 18–29 group less confident and first-year students having less experience to draw upon for responses (p = 0.04). Confidence in gaining consent (56.3%) demonstrated no variation by gender (p = 0.75) or cohort (p = 0.54), but variance by age category (p = 0.03) due to difference in unmatched sample sizes. Participants elaborated on positive service adaptations that can be facilitated for service users who are deaf or hearing impaired and issues that caused negative communication experiences. ConclusionThe study has produced data on the experience of student radiographers interacting with an understudied service user group who are deaf or hearing impaired. Qualitative responses discussed a range of resources to assist clinical practice communication and recommendations for further improvements and training opportunities. Implications for practiceThe findings of this study can help to inform future research, policy, practice, and educational training.

The COVID-19 pandemic’s intersectional impact on work life, home life and wellbeing: an exploratory mixed-methods analysis of Georgia women’s experiences during the pandemic

BackgroundWomen have been especially impacted by the COVID-19 pandemic. This exploratory study aimed to characterize women’s adverse experiences related to their work, home lives, and wellbeing during the height of the COVID-19 pandemic and to describe demographic differences of those lived experiences.MethodsUsing the validated Epidemic-Pandemic Impacts Inventory, we collected data from reproductive-aged women in the state of Georgia about their exposure to adverse events during the pandemic. A latent class analysis (LCA) was performed to identify subgroups of women reporting similar adverse experiences and describe their sociodemographic characteristics. An optional open-ended question yielded qualitative data that were analyzed thematically and merged with subgroup findings. Data were collected from September 2020 to January 2021.Results423 individuals aged 18–49 completed the survey with 314 (74.2%) providing qualitative responses. The LCA yielded 4 subgroups: (1) a “low exposure” subgroup (n = 123, 29.1%) with relatively low probability of adverse experiences across domains (e.g. financial insecurity, health challenges, barriers to access to healthcare, intimate partner violence (IPV)); (2) a “high exposure” subgroup (n = 46, 10.9%) with high probability of experiencing multiple adversities across domains including the loss of loved ones to COVID-19; (3) a “caregiving stress” subgroup (n = 104, 24.6%) with high probability of experiencing challenges with home and work life including increased partner conflict; and (4) a “mental health changes” subgroup (n = 150, 35.5%) characterized by relatively low probability of adverse experiences but high probability of negative changes in mental health and lifestyle. Individuals in subgroups 1 and 4, which had low probabilities of adverse experiences, were significantly more likely to be non-Hispanic white. Individuals in subgroup 2 were more likely to identify with a sexual or racial/ethnic minority population. Inductive coding of qualitative data yielded themes such as stress, mental health, financial impact, and adaptation/resilience, providing context for pandemic-related adversity.ConclusionThough many individuals in our sample experienced hardship, minority populations were unequally impacted by pandemic-related adversity in work life, home life, and wellbeing. Recovery and future emergency preparedness efforts in Georgia must incorporate support mechanisms for mental health and IPV, focusing especially on the intersectional needs of racial, ethnic, and sexual minorities.

Using artificial intelligence to support rapid, mixed-methods analysis: Developing an automated qualitative assistant (AQUA).

Context: Qualitative research - crucial for understanding human behavior - remains underutilized, in part due to the time and cost of annotating qualitative data (coding). Artificial intelligence (AI) has been suggested as a means to reduce those burdens. Older AI techniques (Latent Semantic Indexing / Latent Dirichlet Allocation (LSI/LDA)) have fallen short, in part because qualitative data is rife with idiom, non-standard expressions, and jargon. Objective: To develop an AI platform using updated techniques to augment qualitative data coding. Study Design and Analysis: We previously completed traditional qualitative analysis of a large dataset, with 11 qualitative categories and 72 subcategories (categories), and a final Cohen's kappa ≥ 0.65 as a measure of human inter-coder reliability (ICR) after coding. We built our Automated Qualitative Assistant (AQUA) using a semi-classical approach, replacing LSI/LDA with a graph-theoretic topic extraction and clustering method. AQUA was given the previously-identified qualitative categories and tasked with coding free-text data into those categories. Item coding was scored using cosine-similarity. Population Studied: Pennsylvanian adults. Instrument: Free-text responses to five open ended questions related to the COVID-19 pandemic (e.g. "What worries you most about the COVID-19 pandemic?"). Outcome Measures: AQUA's coding was compared to human coding using Cohen's kappa. This was done on all categories in aggregate, and also on category clusters to identify category groups amenable to AQUA support. AQUA's time to complete coding was compared to the time taken by the human coding team. Dataset: Five unlimited free-text survey answers from 538 responders. Results: AQUA's kappa for all categories was low (kappa~0.45), reflecting the challenge of automated analysis of diverse language. However, for several 3-category combinations (with less linguistic diversity), AQUA performed comparably to human coders, with an ICR kappa range of 0.62 to 0.72 based on test-train split. AQUA's analysis (including human interpretation) took approximately 5 hours, compared to approximately 30 person hours for traditional coding. Conclusions: AQUA enables qualitative researchers to identify categories amenable to automated coding, and to rapidly conduct that coding on the entirety of very large datasets. This saves time and money, and avoids limitations inherent in limiting qualitative analysis to limited samples of a given dataset.

PPE portraits: patient and clinician experiences at a COVID-19 testing site.

Context: The COVID-19 pandemic mandated personal protective equipment (PPE) in healthcare settings, obscuring clinician faces and expressions, and depersonalizing patient care experiences. PPE Portraits (affixing a clinician's photo to the front of PPE) was first introduced in 2015 during the West Africa Ebola epidemic, and has been shown to help maintain patient-provider connection at times when patients may be fearful, isolated, and unable to identify clinicians caring for them. Objective: To evaluate patient and clinician experiences with PPE Portraits. Study Design: Implementation pilot with mixed methods evaluation. Setting: A drive-thru COVID-19 testing site affiliated with a large academic medical center. Population studied: Patients (n=18) and clinicians (n=6) interviewed in March-April 2020. Clinicians were recruited through convenience sampling. Clinicians answered questions via recorded interviews or email. Patients were interviewed by phone through random sampling stratified by date of service. Patients were sent a post-visit survey. Intervention: Health workers affixed a PPE Portrait in order to connect better with individuals in their care. Outcome Measures: Patient and clinician experiences with PPE Portraits (assessed through inductive coding of qualitative data) and patient experiences with fear (assessed through survey). Results: Patient surveys indicated varying levels of fear, including mild (16%), moderate (66%), and severe (18%). Patients reported that seeing the PPE Portrait was comforting; four patients stated that it did not impact their care because they already trusted the facility. Clinicians corroborated patient sentiments, reporting that the intervention humanized both the testing experience for patients and also the interactions among patients and clinicians. They noted that patients seemed more at ease and that portraits fostered connection and trust, thereby reducing anxiety and fear and signaling to patients that they were being given holistic, optimal care. A majority of clinicians felt this intervention should be replicated, and they recommended having surplus portrait supplies on site to facilitate ad hoc portrait creation. Conclusion: PPE Portraits humanized the COVID-19 testing experiences for patients and clinicians during a time of fear. Clinicians recommended PPE Portraits for other healthcare settings that require PPE. Future research could assess how PPE Portraits promote patient-provider connection and trust.

Emergency Medicine Around the World: Analysis of the 2019 American College of Emergency Physicians International Ambassador Country Reports.

ObjectiveThe specialty of emergency medicine and recognition of the need for emergency care continue to grow globally. The specialty and emergency care systems vary according to context. This study characterizes the specialty of emergency medicine around the world, trends according to region and income level, and challenges for the specialty.MethodsWe distributed a 56‐question electronic survey to all members of the American College of Emergency Physicians International Ambassador Program between March 2019 and January 2020. The Ambassador Program leadership designed the survey covering specialty recognition, workforce, system components, and emergency medicine training. We analyzed results by country and in aggregate using SAS software (SAS Institute Inc). We tested the associations between World Bank income group and number of emergency medicine residency‐trained physicians (RTPs) and emergency medicine specialty recognition using non‐parametric Fisher's exact testing. We performed inductive coding of qualitative data for themes.ResultsSixty‐three out of 78 countries’ teams (80%) responded to the survey. Response countries represented roughly 67% of the world's population and included countries in all World Bank income groups. Fifty‐four countries (86%) recognized emergency medicine as a specialty. Ten (16%) had no emergency medicine residency programs, and 19 (30%) had only one. Eight (11%) reported having no emergency medicine RTPs and 30 (48%) had <100. Fifty‐seven (90%) had an emergency medical services (EMS) system, and 52 (83%) had an emergency access number. Higher country income was associated with a higher number of emergency medicine RTPs per capita (P = 0.02). Only 6 countries (8%) had >5 emergency medicine RTPs per 100,000 population, all high income. All 5 low‐income countries in the sample had <2 emergency medicine RTPs per 100,000 population. Challenges in emergency medicine development included lack of resources (38%), burnout and poor working conditions (31%), and low salaries (23%).ConclusionsMost surveyed countries recognized emergency medicine as a specialty. However, numbers of emergency medicine RTPs were small, particularly in lower income countries. Most surveyed countries reported an EMS system and emergency access number. Lack of resources, burnout, and poor pay were major threats to emergency medicine growth.