Conventional Qualitative Content Analysis Research Articles

Abstract 14982: Use of Electronic Health Records to Develop an Actionable Taxonomy of Patients With Persistent Hypertension

Introduction: Digital transformation of medical data present opportunities for novel approaches to manage patients with persistent hypertension (HTN). Methods: This qualitative study was a thematic analysis of clinician notes in the electronic health records of patients in the Yale New Haven Health System. Eligible patients were 18 to 85 years and had blood pressure >=160/100 mmHg at 5 or more consecutive outpatient visits between 1/1/2013 and 12/31/2018. 4,828 patients met criteria. We used conventional qualitative content analysis to develop a pragmatic framework of themes that distinguishes patients with persistent hypertension by their contributing factors. A random sample of 116 records were reviewed and analyzed when no new concepts emerge from analyses of subsequent data. Results: Of 116 patients, mean age was 64.5 (SD, 13.2) years; 55 % were female; 66 %, 21%, and 9% were White, Black, and Hispanic. The three themes emerged: (1) non-response to treatment, where patients were highly medically complex and biological resistance or secondary causes of HTN were significant components of their persistent HTN; (2) non-intensification of treatment, where issues such as provider specialty purview, competing medical priorities, patient preference, and concerns of white coat HTN contributed to treatment plans not being adjusted; (3) non-implementation of treatment plan, where varied concerns including a disconnect in patient education, difficulty obtaining medications, psychosocial barriers, or medication in tolerance caused appropriately escalated treatment plans to not be enacted. Conclusions: Our thematic analysis of patients’ medical records provides insights into actionable factors contributing to persistent HTN. These findings lay a foundation for designing digital tools for health systems to rapidly identify people with persistent HTN and connect them with targeted interventions at scale.

Following a standardised pathway: Healthcare professionals' perspectives on person-centred care within ERAS for patients with colorectal cancer.

To describe healthcare professionals' perceptions of person-centred care for patients with colorectal cancer, within the standardised care concept of Enhanced Recovery After Surgery. International guidelines for colorectal surgery describe standardised perioperative care. Combining standardised care with person-centred care could be accomplished using the person-centred nursing framework for establishing and maintaining relationships with patients. Despite strong evidence for the standardised care concepts' medical benefits, studies concerning the practice of person-centred care from a nursing point of view are sparse. A qualitative descriptive design was used. Four focus groups interviews were performed including 22 healthcare professionals with 1-29 years' experience of caring for patients with colorectal cancer. Data were analysed using qualitative conventional content analysis. The COREQ checklist for reporting qualitative research was used. Three themes emerged in the analysis; Framework in the healthcare system, Facing differences in participation and Interacting with the person beyond the illness. Conditions for person-centred care were related to the interactions between patients and healthcare professionals, the structure of care were also considered relevant. There is a discrepancy between what is considered important to do and what is done in clinical practice to create conditions for patient participation. Interacting with patients and creating an interprofessional environment are important conditions, the structure of care is also a fundamental key to promoting person-centred care. There is a need for further improvement in care of patients with colorectal cancer to achieve person-centredness within standardised care. The findings provide valuable insights into what healthcare professionals consider to be important for achieving person-centred care. This knowledge can be useful in clinical practice and education programs. At the outset of the study, three patients were interviewed aimed at improving the conditions for the healthcare professionals' focus groups.

Paradoxical perception of humanistic care in the intensive care unit: A qualitative study.

The aim of this study was to explore the perceptions of nurses, patients and attendants of humanistic care in the intensive care unit. The present study was a qualitative conventional content analysis conducted in the intensive care unit in a hospital in Iran, in 2019. Data were collected using semi-structured interviews and field notes through purposive sampling with 17 nurses who worked in an adult ICU in a teaching hospital, 4 attendants and 4 alert patients, and then analysed using the Elo-Kyngäs method in 2008. Analysis of the data led to the extraction of Four main themes as follows: (1) Insufficient understanding of nurses and patients' families of each other's roles, needs and expectations; (2) The use of personal and situational reasoning rather than ethical principles; (3) Caring stagnation; and (4) Satisfaction with care.

CYBERSPACE PEER SUPPORT / DEVELOPMENT PLATFORM FOR PARENTS WITH DISABLED CHILDREN: A QUALITATIVE STUDY

The aim of the present study was to explain the experiences of parents of peer support in cyberspace.This is a qualitative conventional content analysis study. This study was performed on 17 people (11 females and 6 males) of parents with disabled children. Data analysis leads to the emergence of 13 subthemes and 4 main themes, interactive network (group formation, intimate interaction), comprehensive support (peer education, emotional, service delivery), spirituality propagation (companionship in religious rites, consolation in the God's attention, peers as good listeners (inspiration), growth and progress (familiarity with peer problems, acceptance of disability, endurance promotion, problem-solving).Cyberspace created an opportunity for parents to use the experiences and support of peers with help theme accept their child's disability.

“Respecting our patients’ choices”: making the organizational decision to participate in voluntary assisted dying provision: findings from semi-structured interviews with a rural community hospice board of management

BackgroundThere is limited literature around how palliative care organizations determine the degree to which they will interface with voluntary assisted dying in jurisdictions where it is legal. The aim of this research was to describe the experience of the board of management of an Australian community-based hospice during their decision-making process around whether to support voluntary assisted dying in the facility, prior to the legislation coming into operation.MethodsThe Board considered this decision over ten meetings in 2020, during which time they received information on the legislation, relevant literature, feedback from workshops which included the community, comment from hospice founders, staff survey results and presentations by clinicians able to discuss the impact of voluntary assisted dying on palliative care services. Members were encouraged to make notes of their own experiences during this time. Following this, semi-structured interviews were conducted with seven of the nine board members. Interviews were audio-recorded and transcribed verbatim and analysed using conventional qualitative content analysis method.ResultsThe board members experienced a sense of journey in reaching an overall decision, which was to allow full participation in voluntary assisted dying provision for inpatients. Themes based on the journey motif included: starting from a personal view; moving to a hospice perspective; exploring if voluntary assisted dying can be part of end-of-life care; awareness and assessment of risks to the Hospice; arriving at a common platform to vote on; factors facilitating a safe decision-making journey; and personal impact of the journey.ConclusionsThe group highlighted several facilitators of a successful outcome including having adequate time, the availability of useful resources, sound board processes and a trusting culture. The study may provide support to other healthcare organisations as they face similar decisions triggered by legislative change.

Referral Challenges in the Mental Health Program in the Primary Health Care System: A Qualitative Study

Background. One of the main activities that plays a significant role in the prevalence of mental illnesses is the issue of referral, and according to the evidence, the lack of proper implementation of the referral system is one of the obvious weaknesses of the primary health care (PHC) system. Therefore, this study aimed to investigate the challenges of referring mental health clients in the PHC system, and the weaknesses in this process were examined from the perspective of mental health experts in health centers. Methods. The present study is a conventional qualitative content analysis. Data were collected through semi-structured interviews with primary health care psychologists. Fifteen people were selected through purposive sampling. After transcription of the interviews, the data were analyzed based on the Graneheim and Landman model. Results. Two themes and twelve categories were acquired through the present study. The theme of intra-centered referential challenges included categories such as weaknesses in health care providers screening and low referrals, clients' lack of trust in health care providers, clients' lack of cooperation, physicians' poor cooperation, and Barriers to clients' desire to visit a psychologist. Outer-centered referential challenges also included a shortage of referral centers, lack of transparency in referrals, lack of direct referrals, poor follow-up, barriers for clients to go to a higher level, and Barriers to clients’ referral to the institute. Conclusion. The findings of the present study show that poor intra-sectoral and inter-sectoral communication is one of the main challenges that has disrupted the referral process in the field of mental health in the primary health care system. It seems that many challenges such as lack of designated referral centers, poor follow-up due to lack of referral feedback, clients' financial inability to refer to a higher level, etc. can be improved by strengthening cross-sectoral communications such as two-way communication with support organizations and psychiatric and psychotherapy centers.

A Focus Group Study of Palliative Physician and Consultation-Liaison Psychiatrist Perceptions of Dealing with Depression in the Dying.

Objective: To ascertain palliative physicians’ and consultation-liaison psychiatrists’ perceptions of depression care processes in patients with very poor prognoses, exploring key challenges and postulating solutions. Methods: A qualitative focus group study involving three 1-h online focus groups (2 palliative medicine and 1 psychiatry) were conducted between November-December 2020. Fellows and trainees were recruited from Australian and New Zealand Society of Palliative Medicine (n = 11) and Royal Australian and New Zealand College of Psychiatrists (n = 4). Data underwent conventional qualitative content analysis. Results: Participants perceived depression care to be complex and challenging. Perceived barriers included: inadequate palliative care psychiatry skills with variation in clinical approaches; lack of supportive health infrastructure (poor access to required interventions and suboptimal linkage between palliative care and psychiatry); lack of research support; and societal stigma. Suggested solutions included integrating care processes between palliative care and psychiatry to improve clinician training, establish supportive health systems and promote innovative research designs. Conclusions: Developing clinician training, supportive health systems and innovative research strategies centering on integrating palliative care and psychiatry care processes may be integral to optimising depression care when providing care to people with very poor prognoses.

Towards water literacy: an interdisciplinary analysis of standards for teaching and learning about humans and Water

Water is critical to sustain human existence. Water literacy involves understanding the interactions within and between natural and human dimensions of water systems to support informed decision-making, an important outcome for learners of all ages. It is therefore critical to foster water literacy in today’s global citizens, particularly through formal education. The purpose of this study, in tandem with a parallel study focusing on natural dimensions of water systems (Mostacedo-Marasovic et al., in press), is to examine water-related K-12 standards for teaching and learning about human dimensions of water systems to develop a comprehensive and transdisciplinary perspective on water education. Our overarching question is, “What do disciplinary standards specify as outcomes for students’ learning about water and humans?”. Our research questions are: i) “To what extent do these water-related standards address recognized domains of learning?” and ii) “What thematic outcomes for students’ learning are apparent across grades in these water-related standards?”. We use chi-square statistics and a conventional qualitative content analysis method complemented by processes from grounded theory to analyze water-related education standards (N = 341) from 12 education-oriented, governmental and non-governmental organizations based in the United States. Our results indicate that first, water-related standards emphasize the cognitive domain, including declarative and procedural knowledge. The affective domain and its social and emotional components are much less prevalent. Second, the water-related standards illustrate five categories which encompass human dimensions of water spanning K-12 grade bands, including human settlements; the nexus between water, food, and energy; public health; impacts of human activities on water quality and quantity; and water resources management. Overall, the study contributes to a more holistic and comprehensive perspective of water and human systems that can help inform teaching and learning to cultivate water literacy, including curriculum development and classroom pedagogy.

Towards water literacy: Analysis of standards for teaching and learning about water on Earth

Water is one of Earth’s fundamental natural systems. It is crucial to foster water literacy in today’s global citizens, particularly through formal education. The purpose of this research, in parallel with a study focused on human dimensions of water systems (Mostacedo-Marasovic et al., in press), is to examine water-related K-12 standards for teaching and learning about water and natural systems and develop a comprehensive and transdisciplinary perspective on water education. Our overarching question is, “What do disciplinary standards specify as outcomes for students’ learning about water and natural systems?” Our research questions are: (i) “To what extent do these water-related standards address recognized domains of learning?” and (ii) “What thematic outcomes for students’ learning are apparent across grades in these water-related standards?.” We use chi-square statistics and conventional qualitative content analysis complemented by processes from grounded theory to analyze water-related education standards (N = 196) from 11 education-oriented governmental and non-governmental organizations based in the United States and the United Nations. Our results indicate that, first, water-related standards emphasize the cognitive domain, including declarative and procedural knowledge, for water-related concepts and skills. The affective domain and its social component are far less prevalent. Second, the water-related standards illustrate four categories including abundance, distribution, and movement of water on Earth; water and the Geosphere; water and climate; and water and life. These findings provide a more comprehensive perspective from multiple disciplines of the natural sciences on outcomes for teaching and learning about water and natural systems, as well as the learning domains they address. These can inform educational efforts to cultivate water literacy across K-12 through teaching and learning.

Challanges of Meeting the Palliative Care Needs of Colorectal Cancer patients in Iran: A Qualitative Research.

Background:Despite the high prevalence of Colorectal Cancer (CRC) in Iran and the need to pay more attention to the Palliative Care (PC) needs of patients with this disease, a few studies have previously examined the PC needs of them by gaining the patients', family members', and treatment team's views. This study aimed to investigate the challenges in the way of meeting the PC needs of CRC patients.Materials and Methods:This study was a qualitative content analysis study conducted on 43 participants (including 15 patients, 20 health care providers, and eight family members) through purposive sampling and semi-structured individual interviews in Omid Educational and Medical Center and Iranian Cancer “Control Center (MACSA) in Isfahan from May 2020 to December 2021. Data analysis was performed simultaneously with data collection using conventional qualitative content analysis with the Graneheim and Lundman approach. In order to assess the trustworthiness of the obtained data, credibility, dependability, confirmability, and transferability criteria were used.Results:Data analysis led to the production of 615 primary codes, 16 sub-categories, and five main categories. These five main categories included “Lack of facilities and equipment”, “Lack of quality of services provided by the treatment team”, “Insufficient financial support to the patient and family”, “Insufficient psychological and emotional support from the patient and family”, and “Inefficiency of the patient and community awareness process”.Conclusions:To improve the quality of care and increase patients’ satisfaction with the provided services, it is recommended that policymakers should meet the challenges of the PC.

Swedish managers’ experience of yearly staff development dialogues, aiming for employee development, performance, and well-being

BackgroundSocietal development and a competitive corporate climate have resulted in increased emphasis on performance management (PM) but also sustainability and health challenges in working life. Opportunities for employee well-being, development and performance are thus highly relevant for organisations and society. PM includes a manager-employee dialogue process and is identified as a complex challenge when combined with employee development and well-being. Managers have a key role in PM, and research in collaboration with practitioners in specific contexts is needed. An exploratory study, focusing on managers’ experience of dialogues between managers and employees in practice, was therefore conducted in collaboration with an inter-municipal corporation company in southern Sweden.MethodsA qualitative study with an inductive design, supported by semi-structured focus group interviews, was chosen based on the exploratory character of the study. Thirty-five managers were approached in the company and 15, of varying age and managerial experience, agreed to participate. Staff Development Dialogues (SDD) were used in the company PM model to facilitate employee development, performance, and well-being. Data was analysed using conventional qualitative content analysis to obtain new insights without using pre-set classifications.ResultsThe analysis resulted in three categories of SDD experiences: SDD in a business context; Managers in relation to SDD; and Employees in relation to SDD. The findings revealed varying SDD experiences as well as approaches, and analytical themes were considered in relation to the organisational context and the specific SDD content and process. The study showed the importance of SDD adaptation and a well-being perspective in the dialogues was related to relational aspects and the manager-employee approach to SDDs.DiscussionThe findings confirm the complexity and challenges of PM including development and well-being. Adaptation to specific departments as well as employees is important, and using the same PM strategy throughout an organisation can be questioned. The identified link between a relational approach and a well-being perspective indicates a missed opportunity for systematic workplace health promotion. Strengthening the well-being perspective can, thus, improve the quality of an SDD model, which in turn can facilitate the creation of sustainable workplaces and better fulfilment of employers’ health-related obligations for systematic work environment management.

Challenges of Help-Seeking in Iranian Family Caregivers of Patients with Cancer: A Qualitative Study

Background: The nature of cancer is such that it causes several problems for patients and caregivers. As a vital source of support for patients with cancer, family caregivers must seek assistance and make use of available resources to overcome these issues and offer better care for the patient. Objectives: This study aimed at exploring the challenges of seeking help in Iranian family caregivers of patients with cancer from supportive sources. Methods: This qualitative study was conducted from 2019 to 2021 on 15 family caregivers with a wide variety of caring experiences and 13 health professionals (i.e. nurse, physician, social worker, clergyman, and family counselor who were engaged with services for the patient and caregiver) via purposive sampling and semi-structured in-depth interviews in a central cancer care hospital in Isfahan. Graneheim and Lundman's conventional qualitative content analysis approach was used to analyze the data. To assess data trustworthiness, Lincoln and Guba's criteria were used. Data management was performed using MAXQDA (v. 10) software. Results: Four main categories were identified consisted of (1) being strained by social desirability; (2) stigmatizing attitudes toward help-seeking; (3) reactive self-forgetfulness; and (4) resistance to change. Conclusions: The need to develop and implement interventions geared to enhance family caregivers' preferred attitudes and personal skills in order to overcome socio-cultural obstacles to help-seeking behaviors was underlined in this research. Both health care professionals and the community should be prepared to make support services more accessible and usable for family caregivers.

Exploring Barriers to One Health Antimicrobial Stewardship in Sri Lanka: A Qualitative Study among Healthcare Professionals.

Antimicrobial resistance (AMR) is a global health threat, but little is known about the perceptions regarding antimicrobials and AMR among healthcare professionals in Sri Lanka. This research aimed to take a One Health approach to explore the knowledge, attitudes and perceptions of antibiotic stewardship and AMR among healthcare professionals in Sri Lanka. A qualitative study, using telephone interviews, allowing for an in-depth exploration of attitudes, beliefs and perspectives was conducted. Healthcare professionals from both the medical and veterinary sectors were included (n = 29). Interviews were conducted by an independent interviewer and were audio-recorded and transcribed. Conventional qualitative content analysis was undertaken. Four main categories were identified: (1) understanding of AMR and observing AMR, (2) barriers to antimicrobial stewardship, (3) personal factors in, and as a result of, inappropriate antibiotic usage and (4) how to tackle AMR. Healthcare professionals showed poor awareness regarding the spread of AMR and identified inappropriate prescribing behaviours by their inter- and intra-professional colleagues. Patient demands and the influence of pharmaceutical companies were factors contributing to poor prescribing behaviour. Suggestions for the future are stricter regulation of AMR control policy, effective government involvement, and awareness campaigns for healthcare professionals and the public.

Trapped in My Roles as a Woman With No Help: Experiences of Intimate Partner Violence Against Chinese Women.

An understanding of intimate partner violence (IPV) experiences is a crucial first step toward shaping effective responses. However, relevant knowledge among Chinese women is scant. This study described Chinese women's IPV experiences by analyzing 46 posts shared by 42 women on a public online forum. Five overarching themes were identified using conventional qualitative content analysis: being trapped in my roles, no power in the relationship, the struggles are real but I need to tolerate, I want to leave but have no help, and hope for the future. This study has important implications for future research, practice, and education.

Social workers’ perceptions of assessing the parental capacity of parents with intellectual disabilities in child protection investigations

Parental capacity is one of the main aspects assessed by social workers as part of child protection investigations. The aim of this study is to explore the social workers' perceptions of assessing the parental capacity of parents with intellectual disabilities in child protection investigations. Four focus group interviews were conducted with twelve social workers in May-October 2021. Data were analysed using an inductive, conventional qualitative content analysis. One overarching theme, "Parental capacity in relation to the child's needs was assessed, not disability of parents" was created. Three main categories and ten sub-categories were identified exploring the social workers' perceptions of assessing parental capacity. The study shows that social workers perceive the assessment of parental capacity in parents with intellectual disabilities as demanding and complex, in which the assessment of what is good enough is perceived as the most difficult task.

Social Studies Working Students' Experiences of Online Learning

Working students felt the impact of the uncertainties brought by the pandemic and faced issues influenced by various factors such as time constraints, home-schooling, and limited workspaces at home. This descriptive phenomenological qualitative study focused on describing the experiences of social studies working students during the COVID-19 pandemic. This study was conducted among six (6) social studies working students determined through purposive sampling. The data were gathered using a duly-validated researcher-made questionnaire administered through online platforms such as messenger and e-mail. The accumulated data was then analyzed using conventional qualitative content analysis. Social studies working on students’ experiences of online learning during the COVID-19 pandemic emerged to have three (3) major themes which are motivational experiences, roadblock experiences, and coping experiences, and six (6) major categories. The motivational experiences considered by social studies working students to pursue working while studying encompasses intrapersonal motivation and interpersonal motivation. Furthermore, during the course of their working-while-studying experience, they faced roadblock experiences such as challenges encountered and thoughts of discontinuing. In light of this, social studies working students had coping experiences namely coping with responsibilities and coping with feeling overwhelmed which helped them cope up with the demands of their duties. Delving into the experiences of social studies working students during the COVID-19 pandemic is critical in order to understand what they were going through. It is vital that these individuals' lived experiences be considered, knowing that they constitute an essential part of society.

Explaining the challenges and adaptation strategies of nurses in caring for patients with COVID-19: a qualitative study in Iran

BackgroundNurses, as the primary human resource in the fight against COVID-19, encounter several obstacles and concerns. As a result, the current study used a qualitative method to describe the problems and adaptation techniques of nurses caring for COVID-19 patients.MethodsThe current study used a qualitative conventional content analysis technique with 30 nurses working in COVID-19 wards in Tehran hospitals. Purposive sampling, snowball sampling, and semi-structured interviews were used to get access to participants and gather data. The data was examined using conventional qualitative content analysis and the MAXQDA-18 program. To assess the quality of study findings, Guba and Lincoln’s trustworthiness criteria were fulfilled.ResultsThe data analysis revealed two main categories and sixteen subcategories: (1) experiences and challenges (lack of protective equipment, high work pressure, marginalized physical health, problems related to the use of protective equipment, being excluded, a lack of a supportive work environment, problems related to patients, psychological problems, fear, marginalized personal and family life, and the challenge of communicating with patients’ families); and (2) adaptation strategies for work conditions (performing religious-spiritual activities, creating an empathetic atmosphere in the workplace, spiritualizing their work, trying to convince the family and gaining their support, and strengthening their sense of self-worth and responsibility).ConclusionNurses’ working conditions can be improved by providing adequate protective equipment, a suitable work environment, and more social and financial support; paying more attention to nurses’ physical and mental health; and considering appropriate communication mechanisms for nurses to communicate with their families and patients’ families.

Factors affecting the formation of nurses’ moral sensitivity in cardiopulmonary resuscitation settings: A qualitative study

Background: Certain factors may facilitate or inhibit the formation of moral sensitivity in nurses performing cardiopulmonary resuscitation (CPR). The identification of these factors in the context can help develop strategies to promote nurses' moral sensitivity and offer new insights into the consequences of their moral decisions.Objective: Taking into account the possibly multi-factorial nature of moral sensitivity, this study aimed to identify the factors affecting the formation of nurses' moral sensitivity in CPR settings.Research design and methods: This study performed a conventional qualitative content analysis. Twenty-one participants were selected via purposive and theoretical sampling. The data were collected through in-depth semi-structured interviews and simultaneously analyzed via content analysis.Participants and research context: In total, twenty-one participants (fourteen clinical care nurses, three head nurses, two educational supervisors, and two faculty members) from different cities of Iran were interviewed.Ethical considerations: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran (IR.UMSU.REC.1399.337).Findings: Four categories (underlying factors, professional factors, organizational inhibitors of ethics, and professional limitations) and 13 sub-categories were extracted.Discussion: The formation of moral sensitivity requires a range of ethical standards and their maintenance, not only at the individual level but also at the profession, organization, and community levels. So eliminating inhibitors of ethics in these contexts can improve nurse's ethical performance in CPR settings.Conclusion: Any measures taken or decisions made by nurses in CPR are driven by numerous ethical issues to which nurses must be morally sensitive. Some factors facilitate and some inhibit the formation of moral sensitivity in nurses.

Parents’ perceptions of functional electrical stimulation as an upper limb intervention for young children with hemiparesis: qualitative interviews with mothers

Background/objectiveTo explore parents’ perceptions of an upper extremity (UE) intervention using functional electrical stimulation (FES) for young children with hemiparesis.MethodsParents of children aged 3–6 years with a history of perinatal stroke, impaired UE function, and participation in a 12-week FES intervention delivered at a hospital were included in this exploratory qualitative study. Nine mothers participated in a semi-structured interview < 1 week after their child completed the FES intervention (MyndMove®, MyndTec Inc.) targeting the hemiparetic UE. Open-ended questions queried parents’ goals, perceived benefits, and challenges of the FES intervention. Interviews were audio recorded and transcribed verbatim. Qualitative conventional content analysis was used to analyze the transcripts.ResultsFive themes were identified. 1) Parents’ expectations for the FES intervention. Mothers described setting functional, exploratory, and realistic goals, yet feeling initial apprehension towards FES. 2) Perceived improvement. Physical, functional, and psychological improvements were observed with FES; however, there was still room for improvement. 3) Factors influencing the FES intervention. Program structure, therapist factors, and child factors influenced perceived success. 4) Lack of access to intensive therapy. Mothers noted that FES is not provided in mainstream therapy; however, they wanted access to FES outside of the study. They also highlighted socioeconomic challenges to accessing FES. 5) Strategies to facilitate participation. The mothers provided suggestions for program structure and delivery, and session delivery.ConclusionsMothers perceived the FES intervention to have physical, functional and psychological benefits for their children. Interest in continuing with FES highlights a need to improve access to this therapy for young children.

Why male adolescent bicyclists perform risky stunts? A qualitative study

Stunts are one of the main reasons for traffic accidents, particularly among male adolescent bicyclists (ABs). Nonetheless, there are limited data about the theoretical framework of its contributing factors. Moreover, the theoretical frameworks explaining the factors contributing to other risky behaviors have not been used in the area of risky bicycle stunts. The aim of this qualitative study was to explore the factors contributing to risky stunts among male ABs in Iran. This qualitative study was conducted from September 2019 to December 2020 using conventional content analysis. Participants were 29 male ABs purposively selected from Isfahan, Iran. Data were collected through eighteen interviews with sixteen ABs and three focus group discussions with thirteen ABs. Data analysis was conducted concurrently with data collection through conventional qualitative content analysis. The mean of participants’ age was 16.4 ± 1.1 years. Factors contributing to their engagement in risky stunts were grouped into three main themes, namely predisposing personal factors (such as risk underestimation, perceived superiority, sensation seeking, emotional condition, and previous stunt-related experiences), reinforcing social factors (such as supportive social norms and weaknesses of traffic regulations), and environmental conditions (such as time conditions and structural factors). This study provides a new classification of the facilitators to risky stunts among male ABs and reveals new facilitators to these stunts, namely perceived superiority and police non-deterrent reactions to stunts. Therefore, programs on the improvement of safe bicycling should focus not only on perceptual and emotional factors and correction of false perceived superiority through education, but also on social norms and beliefs, regulations, and environmental factors.