Collaborative Thematic Analysis Research Articles

Sustaining a Workforce: Reflections on Work from Home and Community Care Nurses Transitioning out of the COVID-19 Pandemic.

The COVID-19 pandemic has had an unprecedented impact on nurses' well-being and desire to practice; however, the experience of Canadian home and community care nurses remains less well understood. As the health human resources crisis in this sector persists, understanding these nurses' experiences may be vital in creating more effective retention strategies. The aim of this study was to explore how the COVID-19 pandemic shaped the working experiences, motivations, and attitudes of home and community care nurses in the Greater Toronto Area. Using an exploratory, descriptive, qualitative approach, 16 home and community care nurses participated in semistructured interviews. Data were analyzed using collaborative thematic analysis. Participants shared their reflections on work by detailing their experiences prepandemic, during crisis, transitioning out of crisis, and regarding pandemic recovery. During the COVID-19 pandemic inadequate staffing resources during and beyond the crisis period disrupted many desirable facets of work for home and community care nurses such as stable, balanced, and flexible work conditions, and exacerbated the unfavorable aspects such as isolation and inconsistent support. Many nurses were reevaluating their careers: for some, this meant stronger professional attachment and for others, it meant intentions to leave. Improved sector preparedness, wages, and workplace support were identified as strategies to sustain this workforce beyond the pandemic. Home care organizations must consider ways to address the root cause of concerns expressed by nurses who wish to practice in a supportive environment that is sufficiently staffed and sensitive to workload expectations.

Adherence to Non-Pharmacological Interventions in Parkinson's Disease: A Rapid Evidence Assessment of the Literature.

Low adherence to non-pharmacological interventions can impact treatment effectiveness. Yet, there is limited information on adherence barriers and facilitators to non-pharmacological interventions in Parkinson's disease (PD). 1) To examine the quality of adherence reporting and 2) to identify key determinants of adherence to PD non-pharmacological interventions. A rapid evidence assessment was conducted, following PRISMA guidelines, that included controlled studies of exercise, physiotherapy, occupational therapy, speech-language therapy with explicit reporting of 'adherence' OR 'compliance', published in the last 15 years. Data extracted included: adherence rates, adherence outcomes, and factors associated with adherence. A collaborative thematic analysis was conducted to identify determinants of adherence. The search yielded 2,445 articles of which 114 met criteria for full screening with 45 studies meeting all inclusion criteria. High quality adherence data that aligned with the intervention goals were reported by 22.22%(N = 10) of studies, with the majority reporting attendance/attrition rates only 51.11%(N = 23). Four major themes (34 subthemes) emerged: disease and health, personal, program design, and system and environmental. There has been limited progress in the quality of adherence reporting in PD non-pharmacological interventions over the last decade. Acknowledging this limitation, key determinants of adherence included: alignment with personal beliefs, attitudes, and expectations; the demands of the intervention and worsening disease symptoms and personal/time obligations; and accessibility and safety concerns. Program design elements found to facilitate adherence included: opportunities for social engagement and in-person offerings linked to higher levels of interventionist support, performative feedback, and social reinforcement.

“Don’t tell me how to tell my story”: Exploring young people’s perceptions around what it means to ‘feel (mis)understood’ by adults in supporting roles

The subjective and emotional experience of feeling (mis)understood by another person is distinct from being literally (mis)understood. While there is literature exploring young people’s experiences of feeling (mis)understood in therapeutic or clinical settings by adults and the impacts thereof, there is limited exploration of young people’s conceptualisations and perspectives of feeling (mis)understood within a range of young person-supporting adult relationships. This paper reports on the first stage of a project that was co-designed and co-produced by young people, exploring how young people experience and conceptualise ‘feeling (mis)understood’ in the context of receiving support from adults in their lives. This initial stage of the project captures young people’s views on what feeling (mis)understood feels like, its impact on their mental health, and how adults can help young people to feel understood. Conceptualisation, design, fieldwork, analysis and writing were all co-produced with peer-researchers. Data for this project was generated through four workshops each held in England, Scotland, Wales and Northern Ireland. A total of 26 participants aged between 16 and 24 years of age took part in these workshops, and each workshop was facilitated by two peer-researchers and a member of university staff. Data was analysed through collaborative thematic analysis. The study found that feeling understood by supporting adults has a very positive impact on young people’s wellbeing, mental health and help-seeking behaviour. Feeling misunderstood was found to have the converse effect, and in addition was found to make young people less likely to seek further support. Young people also identified a number of key actions adults can take to help the young people they support feel better understood. The findings of this research suggest that practitioners in the health and social care sector working with young people should consider the ways in which they can help young people feel better understood.

Using collaborative autoethnography to explore the teaching of qualitative research methods in medicine

This article explores experiences of teaching qualitative research (QR) broadly, and qualitative methods (QM) more specifically in medicine, highlighting the challenges faced, and offering recommendations for overcoming them. Using collective online interviews, collaborative autoethnography (CAE) was employed to generate data comprising educator’s reflective accounts of teaching QM in medical schools across two continents. Three main themes were identified through collaborative thematic analysis: making meaningful contributions from a marginalized position; finding our pedagogical feet; and recognizing the translational applicability and value of QR. We reflected on the marginalized positioning of QM in medical curricula and the underestimation of the value of QR to understanding pressing health issues. Analysis of these reflections pointed to a lack of formal training for educators and curriculum space for qualitative approaches. Our teaching pedagogies, developed through our own research experiences, self-reflection and student feedback, were primarily student-centered employing a range of novel approaches designed to foster skills and interest in the craft of QR, and introduce a greater appreciation of the significance of QR approaches to medicine. CAE further allowed us to identify some key recommendations that could help medical educators plan for teaching QM and other research methods more effectively in medicine. Future curriculum development should consider the benefits of exposing learners to a range of methods and approaches from across the qualitative-quantitative spectrum.

The invisible work of co-creating disability access in work integrated learning.

Promoting health equity necessitates the diversification of healthcare workforces. Disability is one aspect of diversity that is increasing in healthcare. While the number of Disabled students in health professions increases, barriers in their work integrated learning (WIL), such as placements in hospitals or clinics, persist. While literature has addressed some of these barriers, there is less known about the social processes that enable access in work integrated learning when it does occur. Therefore, an interdisciplinary team from design, geography, occupational science, nursing, occupational therapy, critical disability studies, and knowledge mobilization explored questions regarding social processes involved in WIL accessibility in clinical settings. The team conducted twenty-five in-depth interviews with 4 placement coordinators, 8 placement supervisors, 6 access professionals, 4 education leaders (e.g. Deans) and 3 healthcare leaders (e.g. site education leaders) from two hospitals and two universities in eastern Canada. The team's collaborative thematic analysis of participant narratives constructed four themes regarding the invisible work clinical and academic educators engage in to create access: putting in extra time, doing emotional labour, engaging in relational work, and navigating complexities. This labour is unrecognized and optional, and therefore its result-access to education-is inequitably distributed. Educators, policy makers, and institutions need to know how access is created in WIL to promote diversity within health professions and systems.

The Brother–Sister Sibling Dyad as a Pathway to Gender-Based Violence Prevention: Engaging Male Siblings in Family-Strengthening Programs in Humanitarian Settings

Household violence poses a significant threat to the physical and mental health of adolescent girls. In conflict-affected communities, increased stresses to safety, security, health, and livelihoods may heighten this risk. While it is widely evidenced that the caregiver-child relationship can increase or protect against girls’ risk of violence, less is known about the role of male siblings. Sibling Support for Adolescent Girls in Emergencies (SSAGE) used whole-family support programming to synchronously engage adolescent girls, their male siblings, and their caregivers in conflict-affected communities in Jordan and Niger, using gender-transformative approaches to explore the impacts of gender norms, power, and violence and encourage support and emotional connection. We conducted qualitative research activities, including focus group discussions, participatory group activities, and in-depth, paired, and key informant interviews with 469 SSAGE participants and program facilitators to explore SSAGE’s impact on the male-female sibling dyad in both settings. The multi-stakeholder team used a collaborative thematic analysis approach to identify emergent themes. Findings suggest that the inclusion of male siblings in family strengthening programs may have a positive impact on factors related to girls’ protection, with research participants discussing decreased perpetration of physical and verbal violence by male siblings, increased equity in household labor between siblings, and improved trust and mutual support among siblings. These changes were facilitated by improved communication and interrogation of positive gender identities. In humanitarian settings, interventions that support more gender-transformative, egalitarian, and emotionally effective relationships between male-female siblings can work towards improving girls’ protective assets. More research on the impact of this relationship on girls’ experience of immediate and long-term experience of violence is needed. In settings where gender power dynamics among male-female siblings are less salient, other relationship dyads should be explored.

Coproduction in evaluating a dual diagnosis tool with youth in a residential mental health service

PurposeThe purpose of this study was to utilise a lived experience (LE) informed/co-designed approach to explore the service-user experience of using the reasons for use package (RFUP) within a youth residential rehabilitation mental health setting.Design/methodology/approachLE researchers (those who have lived through mental illness or distress), Master of social work students, a community of mental health service manager, community of mental health researchers, dual diagnosis service researchers and university-based researchers collaborated on the project. The study used an exploratory, qualitative approach of semi-structured interviews to invite young people's experiences of the resource. The research team conducted a collaborative thematic analysis drawing on the range of perspectives.FindingsThrough five interviews with young people, key themes identified included: client factors and extra-therapeutic events, relationship factors, technique/model factors/delivery and outcomes/things noticed.Practical implicationsThe RFUP was a useful clinical tool with the young people in this pilot as it improved awareness of reasons for drug use and impact on mental health, service user to staff relationship, quality of the resource, mode of delivery and participant self-knowledge.Originality/valueYoung people valued the supportive role that the RFUP played in facilitating positive relationships with their workers.

Critical Incidences in U.S. Health Care Systems Experienced by Undocumented Young Adults.

Purpose: Undocumented (“illegal immigrant”) young adults and families face many barriers when seeking health care, including discrimination, which contributes to health disparities. Using critical race theory, an investigation of experiences of health care among undocumented young adults was conducted to highlight their limitations to health care access.Methods: Using a community-based participatory paradigm, a qualitative research approach was used to explore the experiences of 13 participants via a semistructured interview. Upon transcription and broad theme analysis conducted by the primary team members, a gathering of community experts was arranged. This gathering consisted of the primary team members as well as community young adults who identified as undocumented or of mixed-status families, in which all engaged in a collaborative analysis of themes and confirmation of corresponding illustrative data. Furthermore, community experts provided feedback on their insights for the necessary next steps.Results: Through collaborative thematic analysis and confirmation of illustrative data, four themes emerged: (1) emotional and financial stress, (2) fear of exposure, (3) dependence on community health clinics, and (4) hospitals as a last resource.Conclusion: Undocumented young adults and their families make great attempts to access health care, however, because of systemic barriers, they engage in strategies to preserve their safety in such attempts. Due to lack of insurance and financial strain, undocumented families depend on resources they most trust, typically health clinics. However, as many families depend on this resource, they may hinder efficiency in getting the specific help they need, especially if they do not have the capacity to adequately address medical issues that require immediate attention.

All My Relations

Objective: Provincial and territorial legislation across Canada mandates child welfare agencies to release youth from their care at the age of majority. Consequently, youth exiting care tend to have limited support networks, mostly comprised of formal and short-term connections. There is a gap in research examining long-term supportive relationships from the perspectives of youth who have 'aged out' of care. Methods: This PAR photovoice project involved 8 former youth in care ages 19 to 29 in Vancouver, B.C. over the course of 12 weeks, and entailed collaborative thematic analysis of the photographs. The lead researcher executed additional analysis following the data collection phase. Results: Relationships to culture, spirituality and the land were identified as important by racialized and Indigenous youth. Animal companions also emerged as an important non-human connection. Key barriers included a lack of culturally matched foster placements and social workers, gentrification, housing restrictions and a narrow definition of family relationships. Key strengthening factors included supportive community organizations and culturally responsive workers. Conclusion and Implications: Findings highlight the importance of including the relationships that matter to youth in care within child welfare decision-making and planning processes, and a need for systemic investment in long-term nurturing of those relationships. Connections that are outside of the traditional social capital framework for young people in care, such as non-human relationships, also need to be valued. By doing so, youth exiting care have a better chance at accumulating social capital and building a support network they can rely on during their transition to adulthood.

Using the meaningful physical education features as a lens to view student experiences of democratic pedagogy in higher education

ABSTRACT Background: Higher education (HE) physical education (PE) can provide opportunities for students to develop meaning(s) and value(s) towards movement experiences. However, it is an under researched area in the educational sphere and little is known about what or how students find, meaningful movement. While there has been increasing interest in the features of meaningful PE, few studies have explored how they relate to students’ experiences of movement in the context of HE or, the meaning held for certain features such as ‘fun’. In seeking to address this gap, the purpose of this article was to explore what university students found meaningful in PE. Method: Using data from a larger digital ethnographic study, this research featured six students studying a university PE class taught by an educator with a sociocultural perspective towards education and movement. Digital video narratives and reflective essays served as qualitative data and were analysed using collaborative thematic analysis. Findings: Four themes are described in relation to students’ meaningful experiences. These are, (a) meaningful PE is fun and contains elements of delight, (b) meaningful PE is a combination of fun and challenge, (c) meaningful PE develops motor competency in personally relevant areas and (d) meaningful PE is a social and personally relevant experience. Our findings demonstrate the interlinking nature of meaningful PE features and, specifically, how they are embodied by HE students. Conclusion: We argue that students can have meaningful PE experiences, even when educators do not plan for them. Furthermore, the features of meaningful PE, particularly in relation to ‘fun’, can extend to university settings. Moreover, sociocultural educators with a clear vision for classes can contribute to students developing foundational beliefs towards movement. This is exhibited through employing democratic pedagogies such as high levels of reflection and goal setting.

Technology to encourage meaningful activities following brain injury

Background: Cognitive and behavioural difficulties after acquired brain injury (ABI) may lead to reduced engagement in leisure and social activities. Increasing participation is a goal of neuropsychological rehabilitation and assistive and behaviour change technology can play an important role in this. Focus groups and interviews were conductive with brain injury rehabilitation stakeholders (n = 24): people with ABI (n = 9), family members (n = 3) and care providers (n = 12) in order to understand the barriers to engaging in meaningful activities and what helps to overcome these barriers. A collaborative thematic analysis was performed by a multi-disciplinary research team using an approach based on Grounded Theory. Results: Four central, interlinked, barriers were found: Access, Cognitive Difficulties, Anticipation (of Physical or Cognitive Difficulties) and Motivation. To overcome these barriers, participants cited themes such as External Motivation from both Other People and Technology, Maintaining Momentum and different aspects of Being Planful. Conclusions: The results point to future directions for the purposeful development of effective assistive technology for this user group. Technology that is social, persuasive, adapts to individual needs and supports people to plan activities are likely to be particularly useful within neuropsychological rehabilitation. Implications For Rehabilitation Adults with ABI and their carers describe problems accessing activities, cognitive difficulties, anticipationof physical or cognitive difficulties and low motivation as the key barriers to undertaking meaningfulactivities. Current solutions are external prompting, maintaining momentum and being planful. This detailed qualitative analysis of a diverse group of carers and service users allows insight into theassistive technologies that could aid rehabilitation.

An Experiential Learning of a Philosophy of Music Education Inspired by the Work of Canadian Composer R. Murray Schafer

Experiential learning is an educational approach that has been associated with different fields including music education, but rarely with philosophy. Our project consisted of a philosophical experience in action using the work of the Canadian composer R. Murray Schafer. In his Soundscape concept, all sounds in an environment become part of the music that surrounds us. Pre-service student teachers were introduced to his philosophy of music education through experiential learning rather than through a traditional lecture. Additionally, we followed three of them as they taught grades 3, 9 and 11. Our goal was to see to what extent experiential learning of philosophy could be an appropriate pedagogical tool in higher education. Our research question was: How can student-teachers construct their own understanding of a philosophy of music education after having experienced it from the perspective of a student and of a teacher? The following data were examined through collaborative thematic analysis of 1) an open question, 2) their own music composition following Shafer’s guidelines, and 3) their experience of teaching the children. Participants were able to explain in their own words the main components of Shafer’s view on music education, they described how they could use this vision in their own teaching and they identified specific outcomes (creativity, freedom, motivation and critical thinking) from using this approach. The conclusion was drawn that the experiential learning framework can be an appropriate tool for instructing topics that have traditionally been seen as purely theoretical.

Responding effectively to adult mental health patient feedback in an online environment: A coproduced framework.

BackgroundResponding to online patient feedback is considered integral to patient safety and quality improvement. However, guidance on how to respond effectively is limited, with limited attention paid to patient perceptions and reactions.ObjectivesTo identify factors considered potentially helpful in enhancing response quality; coproduce a best‐practice response framework; and quality‐appraise existing responses.DesignA four‐stage mixed methodology: (i) systematic search of stories published on Care Opinion about adult mental health services in the South West of England; (ii) collaborative thematic analysis of responses to identify factors potentially helpful in enhancing response quality; (iii) validation of identified factors by a patient‐carer group (n = 12) leading to the coproduction of a best‐practice response framework; and (iv) quality appraisal of existing responses.ResultsA total of 245 stories were identified, with 183 (74.7%) receiving a response. Twenty‐four (9.8%) had been heard but not yet responded to. 1.6% (n = 4/245) may lead to a change. Nineteen factors were considered influential in response quality. These centred around seven subject areas: (i) introductions; (ii) explanations; (iii) speed of response; (iv) thanks and apologies; (v) response content; (vi) signposting; and (vii) response sign‐off that were developed into a conceptual framework (the Plymouth, Listen, Learn and Respond framework). Quality appraisal of existing responses highlighted areas for further improvement demonstrating the framework's utility.ConclusionThis study advances existing understanding by providing previously unavailable guidance. It has clear practical and theoretical implications for those looking to improve health‐care services, patient safety and quality of care. Further validation of the conceptual framework is encouraged.

Innovative co-evaluation and co-creation of an online learning programme with de Bono’s Six Thinking Hats

In order to enhance diversity, internationalisation and widening participation, Queen Margaret University’s PgCert in Professional and Higher Education was re-designed for online delivery in 2015-16. This programme has run successfully in a blended-learning format for over a decade and this change was anticipated to be a major transition for both staff and students. So as to maximise student engagement in the online environment, we involved students in the re-design of the programme and evaluation, during and after the first year of delivery. This included a video record of the application of de Bono’s (1989) ‘Six Thinking Hats’ in facilitating staff reflections, an online survey designed and run by two student representatives and a final collaborative thematic analysis of data with staff and students. In this paper, we focus on student and staff experiences of and perspectives on transitioning to the online environment and reflect on the student-engaged design and innovative evaluation method used.

The 4C framework for making reasonable adjustments for people with learning disabilities.

Background People with learning disabilities experience significant inequalities in accessing healthcare. Legal frameworks, such as the Equality Act 2010, are intended to reduce such disparities in care, and require organisations to make 'reasonable adjustments' for people with disabilities, including learning disabilities. However, reasonable adjustments are often not clearly defined or adequately implemented in clinical practice. Aim To examine and synthesise the challenges in caring for people with learning disabilities to develop a framework for making reasonable adjustments for people with learning disabilities in hospital. This framework would assist ward staff in identifying and managing the challenges of delivering person-centred, safe and effective healthcare to people with learning disabilities in this setting. Method Fourth-generation evaluation, collaborative thematic analysis, reflection and a secondary analysis were used to develop a framework for making reasonable adjustments in the hospital setting. The authors attended ward manager and matron group meetings to collect their claims, concerns and issues, then conducted a collaborative thematic analysis with the group members to identify the main themes. Findings Four main themes were identified from the ward manager and matron group meetings: communication, choice-making, collaboration and coordination. These were used to develop the 4C framework for making reasonable adjustments for people with learning disabilities in hospital. Discussion The 4C framework has provided a basis for delivering person-centred care for people with learning disabilities. It has been used to inform training needs analyses, develop audit tools to review delivery of care that is adjusted appropriately to the individual patient; and to develop competencies for learning disability champions. The most significant benefit of the 4C framework has been in helping to evaluate and resolve practice-based scenarios. Conclusion Use of the 4C framework may enhance the care of people with learning disabilities in hospital, by enabling reasonable adjustments to be made in these settings.

Inuit women's stories of strength: informing Inuit community-based HIV and STI prevention and sexual health promotion programming

BackgroundThere is a dearth of literature to guide the development of community-based HIV and sexually transmitted infection (STI) prevention and sexual health promotion programs within Inuit communities.ObjectiveThe aim of this study was to create a dialogue with Inuit women to address the lack of information available to inform programming to improve the sexual health of Inuit women, their families, and their communities in the Canadian Arctic.DesignThis study used Indigenous methodologies and methods by drawing from Inuit Qaujimajatuqangit and postcolonial research theory in a framework of Two-Eyed Seeing, and using storytelling sessions to gather data. Community-based participatory research principles informed the design of the study, ensuring participants were involved in all stages of the project. Nine storytelling sessions took place with 21 Inuit women aged 18–61 years. Storytelling sessions were audio recorded and transcribed verbatim, and Atlas.ti aided in the organization of the data for collaborative thematic analysis within three participatory analysis sessions with 13 of the participating women.ResultsFrom the storytelling and analysis sessions, five major themes emerged: (a) the way it used to be, (b) change, (c) family, (d) intimate relationships and (e) holistic strategies. Participating women emphasized that HIV and STI prevention and sexual health promotion programming needs to take a holistic, community-wide, family-focused and youth-centred approach within their communities.ConclusionParticipants identified several important determinants of sexual health and shared ideas for innovative approaches they believe will work as prevention efforts within their communities. This article specifically focuses on key characteristics of programming aimed at STI and HIV prevention and sexual health promotion that were identified throughout participants’ stories. This study has provided a narrative to complement the epidemiological data that highlight the urgent need for prevention programming.

Public Expectation, Pressure, and Avoiding the Choke: A Case Study from Elite Sport

This case study focused on pressure, stereotype threat, choking, and the coping experiences of the New Zealand All Blacks rugby team during the period from 2004-2011 leading into their success at the 2011 Rugby World Cup (RWC). Employing a narrative approach this case study examined public expectation, pressure, and coach-led coping strategies designed to “avoid the choke” by the All Blacks team. An in-depth interview was completed with one of the All Blacks’ coaches and analyzed via collaborative thematic analysis (Riessman, 2008). In addition multiple secondary data sources (e.g., coach & player autobiographies; media interviews) were analyzed via holistic-content analysis (Lieblich et al., 1998). Collectively these analyses revealed five key themes: public expectation and pressure, learning from 2007 RWC, coping with RWC pressure, decision-making under pressure, and avoiding the choke. Practical recommendations are offered for team sport coaches with respect to coping with pressure and avoiding choking.