Exploratory Thematic Analysis Research Articles

Barriers to mediation among U.S. parents of adolescents: A mixed-methods study of why parents choose not to monitor or restrict digital media use

This mixed-methods study considers why parents do not establish or maintain strategies to manage adolescents' media use. In focus groups and interviews, U.S. parents of adolescents (ages 10–17 years) described barriers including beliefs, attitudes, and values; concerns about family conflicts; and social-structural factors, such as burnout from other professional and parenting demands or how the actions of other parents constrained their own opportunities for mediation. We used this exploratory thematic analysis to develop a questionnaire tested with a national survey of U.S. parents. In factor analysis, barriers items clustered together as mediation roadblocks, issues that keep parents from initiating or continuing mediation even when they intend to; and mediation resistance, when parents question mediation practice that did not align with values like support for adolescent autonomy. Parents were much more likely to agree that values-based resistance to mediation was a barrier to monitoring or restricting adolescent media use. In addition, parents with older children and parents whose children reported that they had a controlling parenting style were more likely to agree with monitoring and restrictive mediation roadblocks. Our findings demonstrate that parental mediation research should consider how parents’ values align, or contrast with, recommended practices and how the barriers parents encounter can be addressed to enable effective mediation.

Dental students' reflective learning from a geriatric interview assignment.

As part of geriatric education at the University of British Columbia's Faculty of Dentistry, undergraduate students are required to interview an older adult over 65 years old and critically reflect in writing on the meaning of this interview to themselves and their professional lives in not more than 2000 words. They are also encouraged to use a life grid. This study explored the impact of this assignment on the students as learners and on their views about their profession. Interview assignments were collected from the entire cohort of 54 third-year students in 2021 and analyzed in 5 stages, using an exploratory thematic analysis, including an interactive coding process to identify patterns (themes) within the assignments using NVivo R1 software. Two researchers coded assignments individually and met to reach a consensus about the codes, to mitigate potential biases. Five main themes were identified, including communication, life course journey, person-centered care, social determinants of health, and access to care. A wide range of ideas emerged under each theme, including several practical suggestions to improve future practice as an oral health professional. A little over 40% of the students used the life grid in their interviews. Modifications on the interview assignment are suggested. Students' reflections highlighted their observations on a wide range of ideas within each theme, many pertaining to their future profession. They also discussed how this knowledge would inform their future practice in terms of their interactions with, and providing care to, patients with similar situations.

Structural Topic Modeling Suggests Importance of Relationships in Addiction Recovery

Despite the great deal of literature on the problem of heavy drinking and alcohol use, there is relatively little investigation into the lived experience of recovery. The current study addresses this gap through an exploratory thematic analysis of Personal Stories of recovery published in the Alcoholics Anonymous Grapevine magazine. Alcoholics Anonymous (AA) is an abstinence-oriented, social support based recovery program. Over 300 Personal Stories were transcribed and analyzed using the Structural Topic Modeling package for R. The model with optimal semantic coherence and exclusivity outlining the five most prevalent topics across all Personal Stories was selected. The five topics were conceptualized and labeled as Relationships and Spirituality, Positive Change, AA and The Fellowship, Addiction and Consequences, and Family. The results of this study suggest social connection to have a strong influence on the recovery process. The topic model also suggests that individuals who find success in sobriety through involvement with AA may truly adopt the principles of the program as their own. Considerations for future directions are discussed.

Addressing barriers to health care among Black Alaskans: contributions by social work research to an agenda of health equity

ABSTRACT Black Alaskans face serious barriers to health care. This paper reports on qualitative results of a health needs assessment to understand the health challenges facing Black Alaskans. Utilizing exploratory thematic analysis, the findings indicate that Black Alaskans experience barriers such as high cost of care, underinsurance, lack of information and education, a shortage of BIPOC health providers, stigma, negative perceptions by health-care providers, and racism both in the community and in the health-care system. The paper concludes by discussing emerging health equity initiatives to advance responsive care for Black Alaskans.

‘I'd rather learn outside because nature can teach you so many more things than being inside’: Outdoor learning experiences of young children and educators

Outdoor and nature-based activities promote better health and academic outcomes for children. The school context represents a critical opportunity to support increased outdoor time. Yet, outdoor learning (OL) is not being implemented consistently across school contexts, therefore, many students do not receive the opportunity to participate. This study was designed to support increased uptake of OL and explores young children’s perspectives of learning within an outdoor context and explores how educators support OL opportunities within an early learning context. This research places a focus on children’s voices in order to emphasize their perspective of the learning experience and to highlight experiential child-led processes within OL. We collected semi-structured interviews with students, their parents and school staff who were involved in OL. An exploratory thematic analysis was applied using QSR NVivo. Findings that emerged were organized under two main themes: Nature as the teacher and Child-led exploration of nature. Nature as a teacher contained three subthemes: 1) Seasonal change influencing inquiry, 2) Engagement with other living things in nature and 3) Dimensionality of the outdoors as an element that enhances learning – experiential immersive learning. Child-led exploration of nature contained one subtheme: Learning driven by play. These findings can be used to advocate for increased uptake of OL in education and to provide guidance to educators regarding how to include OL within their practice to enhance equitable access for children.

"Here They Look at Us as People”

Approximately 60% of all incarcerated women in the United States are mothers with minor children and most of them are single mothers. When mothers with minor children are incarcerated, the disconnection and loss of tangible support can have a traumatic impact on families. Alternatives to incarceration (ATI) can be a viable option to maintain their significant relationships while holding them accountable for their crimes and providing them with necessary rehabilitation. The purpose of this study was to examine how mothers participating in an ATI program compared this experience to conventional incarceration. Data were collected from eight focus groups involving 34 mothers who were current participants or graduates of an ATI program. Data were analyzed using exploratory thematic analysis. Analysis revealed four salient themes characterized by these in vivo themes: incarceration is not rehabilitation; incarceration is easy, the program is hard; I’m not the same person; and connection with children. Findings suggest that mothers find the ATI more rehabilitative and relational than incarceration. Future research should explore outcomes for graduates of ATI specific to their rehabilitation and connections to children. A mother’s readiness for change while incarcerated and when participating in an ATI intervention should be evaluated in relation to these outcomes. The social work profession can increase research, policy, and direct service efforts in criminal legal reform by advocating for appropriate alternatives to incarceration for mothers.

Stakeholders' Experiences Using Videoconferencing for a Group-Based Stroke Intervention During COVID-19: A Thematic Analysis.

Guidance is limited for training protocols that support stakeholders who are new to participating in telerehabilitation interventions using videoconferencing software. To explore stakeholders' experiences participating in a group-based intervention during the coronavirus disease 2019 (COVID-19) pandemic using a videoconferencing software (Zoom). Ad hoc exploratory thematic analysis. Community-based telerehabilitation. Stakeholders included group members (n = 8) who were low-income adults with chronic stroke (≥3 mo) and mild to moderate disability (National Institutes of Health Stroke Scale ≤ 16), group leaders (n = 4), and study staff (n = 4). Group-based intervention, ENGAGE, delivered using videoconferencing technology. ENGAGE blends social learning and guided discovery to facilitate community and social participation. Semistructured interviews. Stakeholders included group members (ages 26-81 yr), group leaders (ages 32-71 yr), and study staff (ages 23-55 yr). Group members characterized ENGAGE as learning, doing, and connecting with others who shared their experience. Stakeholders identified social advantages and disadvantages to the videoconferencing environment. Attitudes toward technology, past technology experiences, the amount of time allotted for training, group size, physical environments, navigation of technology disruptions, and design of the intervention workbook were facilitators for some and barriers for others. Social support facilitated technology access and intervention engagement. Stakeholders recommended training structure and content. Tailored training protocols may support stakeholders who are participating in telerehabilitation interventions using new software or devices. Future studies that identify specific tailoring variables will advance the development of telerehabilitation training protocols. What This Article Adds: These findings provide stakeholder-identified barriers and facilitators, in addition to stakeholder-informed recommendations, for technology training protocols that may support uptake of telerehabilitation in occupational therapy.

An Exploratory Thematic Analysis of Factors That Influence Sleep in Music Therapy Undergraduate Students

Abstract Sleep has an essential role in the health, wellbeing, and ability to learn of undergraduate college and university students (UCUS). Due to high credit loads, the music curriculum, and music therapy competencies, music therapy students may experience difficulties obtaining adequate sleep. Therefore, the purpose of this study was to understand factors that enable or inhibit sleep in undergraduate music therapy students. We conducted semi-structured interviews with 14 junior and senior level music therapy UCUS at public institutions in the United States. We used an inductive approach to thematic analysis to analyze data and incorporated member checking and trustworthiness to clarify and verify the results. We identified three themes (supported by seven subthemes) as factors that impacted the sleep of undergraduate music therapy students: (a) academic schedule and expected time commitment; (b) intrinsic motivation to become better student music therapists; and (c) wellness-based education and personal factors. The results of this study provide insight into the various factors that might adversely affect sleep in undergraduate music therapy students and have consequences on their health, wellbeing, and learning. Implications for students and educators, limitations of the study, and suggestions for future research are provided.

"That Was the Happiest Time of My Life": Understanding Childhood Eco-Connections in Appalachian Communities.

The goal of this study was to explore facets of childhood eco-connections, using retrospective qualitative data from adults. One hundred and forty-five adults from predominantly rural and small-town communities in southern Appalachia (71.7% female), average age 36.23 years (SD = 12.08) participated in semi-structured qualitative interviews on key life experiences and the places they grew up. Mentions about place-related childhood memories or interactions were grouped into four themes based on exploratory thematic content analysis: nature nostalgia (positive reminiscences about nature experiences); nature immersion (extensive contact with the natural world during childhood); formative experiences with nature (nature interactions that taught a skill or life lesson); and rhythms of nature (appreciation of seasonal or cyclical patterns). Childhood eco-connections are multifaceted and often emerge from early impactful or intense experiences. Pro-environmentalism messages to youth may benefit from more references to childhood eco-connections.

Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America.

Sustainability, or continued use of evidence-based interventions for long-term patient benefit, is the least studied aspect of implementation science. In this study, we evaluate sustainability of a Pediatric Early Warning System (PEWS), an evidence-based intervention to improve early identification of clinical deterioration in hospitalized children, in low-resource settings using the Clinical Capacity for Sustainability Framework (CCS). We conducted a secondary analysis of a qualitative study to identify barriers and enablers to PEWS implementation. Semi-structured interviews with PEWS implementation leaders and hospital directors at 5 Latin American pediatric oncology centers sustaining PEWS were conducted virtually in Spanish from June to August 2020. Interviews were recorded, professionally transcribed, and translated into English. Exploratory thematic content analysis yielded staff perceptions on PEWS sustainability. Coded segments were analyzed to identify participant perception about the current state and importance of sustaining PEWS, as well as sustainability successes and challenges. Identified sustainability determinants were mapped to the CCS to evaluate its applicability. We interviewed 71 staff including physicians (45%), nurses (45%), and administrators (10%). Participants emphasized the importance of sustaining PEWS for continued patient benefits. Identified sustainability determinants included supportive leadership encouraging ongoing interest in PEWS, beneficial patient outcomes enhancing perceived value of PEWS, integrating PEWS into the routine of patient care, ongoing staff turnover creating training challenges, adequate material resources to promote PEWS use, and the COVID-19 pandemic. While most identified factors mapped to the CCS, COVID-19 emerged as an additional external sustainability challenge. Together, these challenges resulted in multiple impacts on PEWS sustainment, ranging from a small reduction in PEWS quality to complete disruption of PEWS use and subsequent loss of benefits to patients. Participants described several innovative strategies to address identified challenges and promote PEWS sustainability. This study describes clinician perspectives on sustainable implementation of evidence-based interventions in low-resource settings, including sustainability determinants and potential sustainability strategies. Identified factors mapped well to the CCS, however, external factors, such as the COVID pandemic, may additionally impact sustainability. This work highlights an urgent need for theoretically-driven, empirically-informed strategies to support sustainable implementation of evidence-based interventions in settings of all resource-levels.

Opportunities arising from the COVID-19: an international orthopaedic surgeons’ perspective

PurposeThe unprecedented COVID-19 experience has posed severe challenges to the health care system and several of these are documented in orthopaedic surgery; however, although the pandemic has also brought positive changes, these have not been precisely documented. The purpose of this survey is to identify positive perceptions by orthopaedic surgeons at an international level.MethodsA cross-sectional, web-based survey inviting 120 orthopaedic surgeons was conducted in April 2020 querying about the positive lessons COVID-19 would teach us. From all responses, thematic codes were obtained and an exploratory thematic analysis was carried out to determine the prevalent themes.ResultsA total of 100 responses (83% response rate) from a total of seven countries were received. The variety of responses received were grouped into 13 different thematic codes. The thematic analysis generated two major themes: “Virtual reorganization” and “Wellness and sustainability”. Fifty-four per cent of the participants reported positive changes in service reorganization and virtual consultation, whereas 30% replied with an increased feeling of well-being which overlapped with environmental benefits, including reduced paperwork, reduced travelling and increased quality time for family and reflection.ConclusionsDespite the negative aspects of the pandemic, responders reported several positive changes particularly relating to service reorganization and personal well-being. This study prompts further larger scale research to unravel further detail in those positive aspects and strongly enhance our future orthopaedic practice.

Identifying physician-perceived barriers to a pragmatic treatment trial in rheumatoid arthritis.

The aim of this qualitative research was to identify physician-perceived patient and clinic barriers to patient recruitment in a rheumatoid arthritis (RA) pragmatic trial of anti-tumor necrosis factor (TNF) biologic versus non-TNF biologic/Janus-Kinase inhibitor initiation after an inadequate response to methotrexate. Semistructured telephone interviews were conducted with 26 rheumatologists in March 2019. An exploratory thematic analysis approach was used to analyze the interview data. Physician perceived patient barriers to the implementation of an RA pragmatic trial. This theme covers three subthemes: (1) patients' personal barriers, (2) patients' treatment-related factors, and (3) trial-related factors (eg, patient recruitment, side effects, mode of use, etc). Physicians perceived clinic barriers interfered with the pragmatic trial enrollment from the clinic or the healthcare system perspective. This theme covered four subthemes: (1) clinic-related factors, (2) patient-related factors, (3) research personnel, and (4) facilitators (positive factors of the clinic). Our results from the inductive thematic analysis will help researchers understand the key patient and clinic/system factors/barriers that may influence pragmatic RA trial implementation. The themes suggest there are factors that can be modified (eg, coordinator effort needed, effective patient recruitment during clinic visits, provider engagement) and challenges to overcome (patient insurance status, busy clinic flow, and space issues including limited number of patient rooms). In summary, these themes provide a basis for our and other research teams to develop clinic-centered and patientcentered strategies to implement a pragmatic RA trial.

Patient perspectives on elective orthopaedic surgery during the COVID-19 pandemic: a comparison between patients from different ethnic backgrounds.

Suspending elective surgery during the first wave of coronavirus (COVID-19) led to record-breaking numbers of patients on waiting lists. Patients in Black, Asian and minority ethnic (BAME) groups are disproportionately affected by COVID-19. This study compares the perspectives of patients from different ethnic backgrounds on the return to elective surgery. Some 151 patients were sampled from cancelled operating lists at two hospitals. Semi-structured interviews focused on the impact of COVID-19, and views about resuming elective surgery. The Generalized Anxiety Disorder 7-iten Scale (GAD-7) measured anxiety. A visual analogue scale (VAS) measured pain. Data were analysed using exploratory thematic analysis. Fewer BAME patients were pleased about restarting surgery, compared with white patients (47.3% vs 82.6%, p<0.001), and a greater proportion wanted to postpone their operation until after the pandemic (21.8% vs 9.3%, p=0.048). White/white British patients had higher GAD-7 scores (2 (0-21) vs 0 (0-16), p=0.009). Black/Black British patients had significantly higher VAS scores compared with white/white British and Asian/Asian British patients (85 vs 75 vs 70 respectively, p<0.05). The delay in surgery due to the pandemic has had a devastating impact on patients awaiting operations. The variation in pain and anxiety levels between ethnic groups must be addressed when redesigning services to avoid discrepancies in postoperative clinical outcomes. Patients in BAME groups are more likely to postpone their operation, which may lead to further health deterioration, psychosocial and socio-economic consequences, and poorer clinical outcomes following surgery. The thoughts, feelings and concerns of all must be considered when redesigning services to prevent health inequalities between patients from different backgrounds.

A qualitative exploration of videoconferencing technology in clinical neuropsychology: Clinicians’ perspectives

Objective: The implementation of videoconferencing technology (VCT) in healthcare has been expedited by the Covid-19 pandemic. This study aimed to explore clinicians’ experiences of using VCT and their views on its suitability for delivering neuropsychological care.Method: An exploratory thematic analysis was conducted using data from two focus groups of professionals working in clinical neuropsychology (N=9). Results were reported in accordance with COREQ criteria for qualitative research.Results: Six key themes were developed. Clinician experiences of using ‘technology’, the perceived ‘suitability’ of VCT for patients, and the potential ‘impact on wellbeing’ that VCT could have on both clinicians and patients, were highlighted. ‘Changing the therapeutic milieu’ and ‘neuropsychological considerations’ – such as assessment validity and opportunities for cognitive rehabilitation – were also conceptualised. VCT was also viewed as a means of ‘facilitating access’, particularly throughout Covid-19 restrictions.Conclusions: Whilst benefits of VCT were identified, a number of concerns were raised about how routine use of VCT may impact clinicians and their patients. Clinicians tended to view VCT as an adjunct to traditional services in the context of Covid-19, rather than a potential replacement. Further research is required to better understand the perspectives of professionals working in neuropsychology and their patients.

Quantitative and qualitative assessment of anterior segment optical coherence tomography capture of disease state in childhood anterior uveitis

Background/aimsAnterior segment optical coherence tomography (AS-OCT) assessment of anterior chamber inflammation is an emerging tool. We describe the performance of AS-OCT in a paediatric population.MethodsA mixed-methods prospective study, using routine...

Ethnic brand identity work: Responding to authenticity tensions through celebrity endorsement in brand digital self-presentation

Based on an exploratory thematic analysis of the interviews with representatives of brands with intense ethnic digital self-presentation and on confirmatory analysis of the content of the brands’ digital media, this qualitative study introduces a notion of brand identity work. Four contributions are made: theorising brand identity work as a process of identity construction that involves brand building and brand presentation; unpacking a typology of tensions between brand building and brand presentation specific to ethnic marketing; suggesting a dynamic view of authenticity and uncovering a typology of presentation strategies that address these conflicts. We find that behind the tensions between brand-building and brand presentation stands brands’ concern about authenticity. Depending on the type of authenticity tensions, brands develop self-presentation strategies, notably, celebrity endorsement. Social media content analysis shows that brands use self-presentation strategies separately or in combination.

An Exploratory Snapshot of Podcast Discourse Regarding Business Start-Ups: Where Does Psychological Capital, Sustainability, and Spirituality Fit?

This exploratory-sequential thematic analysis was undertaken to discover or connect how experts in business or entrepreneurship view, use, or adopt notions of spirituality and or psychological sustainability in start-ups. A “Start-up” is a business that is new or directly out of concept. Within this study, a thematic analysis sought to expose any themes from three separate podcast transcripts from the United States. The podcasts specialize in business start-ups and entrepreneurship. After intensive analyses of the transcripts of podcast conversations, a variety of themes were documented, categorized, then presented within a table that unfortunately reveals that these keyword subjects are neglected in this form of media, and the subjects did not arise in any level of discussion regarding the business life-cycle. In terms of study design, preliminary qualitative designs are often considerations at the outset of secondary source analyses. Thematic analysis is an accepted form of qualitative research. This exploratory thematic analysis may provoke future studies in these areas which have implications in the fields of psychology, business, and religious studies.

Altered smell and taste: Anosmia, parosmia and the impact of long Covid-19.

BackgroundQualitative olfactory (smell) dysfunctions are a common side effect of post-viral illness and known to impact quality of life and health status. Evidence is emerging that taste and smell loss are common symptoms of Covid-19 that may emerge and persist long after initial infection. The aim of the present study was to document the impact of post Covid-19 alterations to taste and smell.MethodsWe conducted exploratory thematic analysis of user-generated text from 9000 users of the AbScent Covid-19 Smell and Taste Loss moderated Facebook support group from March 24 to 30th September 2020.ResultsParticipants reported difficulty explaining and managing an altered sense of taste and smell; a lack of interpersonal and professional explanation or support; altered eating; appetite loss, weight change; loss of pleasure in food, eating and social engagement; altered intimacy and an altered relationship to self and others.ConclusionsOur findings suggest altered taste and smell with Covid-19 may lead to severe disruption to daily living that impacts on psychological well-being, physical health, relationships and sense of self. More specifically, participants reported impacts that related to reduced desire and ability to eat and prepare food; weight gain, weight loss and nutritional insufficiency; emotional wellbeing; professional practice; intimacy and social bonding; and the disruption of people’s sense of reality and themselves. Our findings should inform further research and suggest areas for the training, assessment and treatment practices of health care professionals working with long Covid.

The experiences of peer-facilitators delivering a physical activity intervention for emergency service workers and their families

IntroductionEmergency service workers (e.g. police, fire, ambulance officers) are regularly exposed to occupational stressors and potentially traumatic events, resulting in an increased risk of poor mental and physical health. For example, emergency service workers are twice as likely to experience suicidal thoughts compared to the general population and one in ten will develop posttraumatic stress disorder. Despite this, emergency service workers face barriers to accessing traditional mental healthcare. Physical activity is non-stigmatising and may help improve the mental and physical health of this population; however, novel ways to help people engage are needed. Peers with lived experience may be well-placed to co-deliver physical activity programs alongside health professionals. The aim of this study was to understand the experiences of peer-facilitators co-delivering an online physical activity intervention for emergency service workers and their families. MethodsQualitative interviews were conducted with 6 peer-facilitators. Interviews were audio recorded, transcribed, and analysed using exploratory thematic analysis. ResultsTwo main themes were explored. The first theme related to the value of lived experience that reflected two subthemes, i) credibility and relatedness by virtue of experience; and ii) knowledge and confidence by virtue of experience. The second theme related to the impact of the peer-facilitator role on the peers themselves, whereby peer-facilitators reported an increased sense of purpose and social connection. DiscussionThis qualitative study provides insights into how peer-facilitators can complement health professionals in the delivery of physical activity interventions for emergency service workers. Further research is needed to elucidate training requirements and safety protocols.

Body Image and Disordered Eating Among LGBTQ+ University Students and Recent Graduates in Rural Appalachia: A Thematic Analysis

LGBTQ+ university students and recent graduates of a large rural Appalachian institution were interviewed for an exploratory thematic analysis on body image and disordered eating behaviors. While participants noted an overall sense of comfortability in the university setting, there were varying obstacles associated with navigating intersecting identities and physical presentation that were noted in the data. Excerpts from participant interviews were coded into five unique themes: (1) feeling “othered”/different from peers as well as fellow LGBTQ+ community members, (2) seeking comfortability with body/self, (3) facing stereotypes and image expectations based on presumed gender identity and/or sexual/affectional orientation, (4) general experiences as an LGBTQ+ community member in a rural university town, and (5) seeking increased support from the university. This study concludes that significant challenges related to body image are exacerbated by common experiences as a person in the LGBTQ+ community.