Framework Analysis Research Articles

Lifestyle Dimensions of Public Safety Personnel Families: There's No Life Like It.

The nature and cumulative occupational demands imposed on families of public safety personnel (PSP) are substantial, in many cases non-negotiable, and distinct from the general population accentuating risk factors for family well-being. Despite this reality, the contributions of PSP families are not well understood, and a conceptual framework is needed. The aim of this paper is to summarize contextual factors (lifestyle dimensions) that shape the lives of PSP families; factors supported in the existing, albeit limited, body of research. Grounded in the interpretive/constructivist paradigm, a synthesis was central to understanding the lived experiences of PSP families. An interdisciplinary research team engaged in an iterative process of framework analysis to capture the variability and complexity of PSP family life and distilled the overarching lifestyle dimensions. Three lifestyle dimensions-logistics, risks, and identities-emerged from contextual factors and represent distinct aspects of PSP family life. PSP families play a crucial role in that their capacity to accommodate the lifestyle dimensions (i.e., logistics, risks, and identities), without which the PSP could not meet the demands of the profession. Promoting awareness of these dimensions and their consequent demands underscores the cumulative demands that put PSP families at risk. Responses from governments, public safety organizations, and communities are required to help PSP families manage non-negotiable elements of the public safety occupation that spill over into family life over which they have no control.

Implementation of a digital health intervention for young people exposed to Technology Assisted Sexual Abuse

BackgroundThe internet has become a place of increased risk of abuse, including sexual abuse, for young people (YP). One potential risk factor to online abuse and exploitation is the ability to mentalise. We developed the i-Minds app, a mentalisation-based digital health intervention (DHI) for YP who have experienced technology assisted sexual abuse (TASA), which we tested in a clinical feasibility trial. Nested within the trial was a qualitative implementation study with clinicians who referred to the trial. ObjectiveTo explore the barriers and enablers to the future integration of i-Minds into clinical practice. Participants and settingTwelve HCPs were recruited from across two trial recruitment sites (Manchester and Edinburgh). MethodsSemi-structured interviews were informed by Normalisation Process Theory (NPT). Framework analysis was used; transcripts were coded deductively to NPT constructs. ResultsPractitioners were positive about the need for, and added value of, the i-Minds app over existing interventions, including other DHIs. While they felt confident with the app, concerns remained around the safety of using the app without practitioner support. i-Minds promoted changes in practitioners' work and impacted online behaviour of YP. There was an identified need for further training and organisational support. ConclusionsPractitioners are aware of TASA but have limited knowledge, skills and tools to work with TASA in clinical practice with YP. There is a need for awareness raising and education about TASA and DHI. i-Minds offers a theory-informed DHI for working with YP exposed to TASA that is acceptable to practitioners and YP.

A rapid mixed-methods assessment of Libya’s primary care system

BackgroundLibya has experienced decades of violent conflict that have severely disrupted health service delivery. The Government of National Unity is committed to rebuilding a resilient health system built on a platform of strong primary care.AimCommissioned by the government, we set out to perform a rapid assessment of the system as it stands and identify areas for improvement.Design and settingWe used a rapid applied policy explanatory-sequential mixed-methods design, working with Libyan data and Libyan policymakers, with supporting interview data from other primary care policymakers working across the Middle East and North Africa region.MethodWe used the Primary Health Care Performance Initiative framework to structure our assessment. Review of policy documents and secondary analysis of WHO and World Bank survey data informed a series of targeted policymaker interviews. We used deductive framework analysis to synthesise our findings.ResultsWe identified 11 key documents and six key policymakers to interview. Libya has strong policy commitments to providing good quality primary care, and a high number of health staff and facilities. Access to services and trust in providers is high. However, a third of facilities are non-operational; there is a marked skew towards axillary and administrative staff; and structural challenges with financing, logistics, and standards has led to highly variable provision of care.ConclusionIn reforming the primary care system, the government should consolidate leadership, clarify governance structures and systems, and focus on setting national standards for human resources for health, facilities, stocks, and clinical care.

Framework to supporting monitoring the circular economy in the context of industry 5.0: A proposal considering circularity indicators, digital transformation, and sustainability

Digital transformation can contribute to the increasing circular economy in organizations, facilitating their adherence to the economic, social, and environmental pillars of sustainability and, therefore, to the Industry 5.0 paradigm. In this context, this work proposes a framework for holistically addressing these themes with tools (circularity indicators and technological resources) to assist organizations in the manufacturing sector that aim to adopt circular processes with a focus on the pillars of sustainability. To elaborate the framework, the SODA (Strategic Options Development and Analysis) method was applied to explore, with the help of the interviewed specialist, the complexities of the problem studied, enabling the identification of 7 important issues or dimensions on the path to circularity. To shape the framework, 7 experts were interviewed (one for each dimension) to validate and classify the circularity indicators (prospected in the literature and added by them), correlating them to the spheres of sustainability and digital transformation technologies. The results of the framework analysis showed that achieving circularity demands the consideration of the following factors: the circularity of energy aiming at its efficiency, circularity of inputs for better use of resources, investments in circularity for process optimization, establishment of new circular businesses taking advantage of the good experiences obtained, circular and non-circular supply chain integration, compliance and governance for circularity meeting the expectations of stakeholders and the relevance of feasibility studies to technical, economic and environmental to implement circularity of product components.

Assessing the accountability mechanisms in the 2015 Nepal earthquakes housing reconstruction: a case study of Bungamati, Lalitpur Metropolitan city, Nepal

PurposeThis research examined the accountability measures put into practice during the housing reconstruction following the 2015 Nepal earthquakes. Additionally, it aimed to identify gaps in accountability practices and suggest approaches for improving their efficacy.Design/methodology/approachThe research methodology encompassed a qualitative approach. Around 30 research participants were selected for in-depth interviews using a purposive sampling strategy to ensure data richness and relevance. The interviews were recorded, transcribed and then iteratively analysed using thematic framework analysis. This analytical technique involved identifying recurrent themes and patterns within the transcriptions of the participants' articulation.FindingsThe study showed the pivotal role of meetings and interactive forums in promoting transparency and disseminating vital information during housing reconstruction. Additionally, it underscored the contributions of nongovernmental organizations (NGOs) and community-based organizations (CBOs) in information dissemination within affected communities. Policy challenges centre on identifying vulnerable populations, local support mechanisms and contextualizing reconstruction policies, specifically focusing on urban heritage settlements. Strengthening local service delivery and complaint mechanisms, capacity building and defining the roles and responsibilities of actors and beneficiaries are suggestive measures for a participatory and inclusive reconstruction process.Originality/valueResearch holds distinctive value due to its recent inception and its focus on both the subject matter and the specific geographical context. It contributes novel insights into the principles and practices of accountability mechanisms during the housing reconstruction process following a major disaster.

Sources of diagnostic delay for people with Crohn's disease and ulcerative colitis: Qualitative research study.

An improved understanding of the causes and experience of diagnostic delay in Inflammatory Bowel Disease (IBD). Framework analysis of semi-structured interviews with 20 adults with IBD. Participants' prior knowledge of normal bowel function/IBD was limited. Symptoms were sometimes misattributed to mild/transient conditions or normalised until intolerable. Family pressures, work, education, mistrust of doctors, fear and embarrassment could exacerbate delays. Poor availability of face-to-face appointments deterred people from seeing a GP. Patients feared that by the time they got to see their GP, their symptoms would have resolved. Patients instead self-managed symptoms, but often regretted not seeking help earlier. Limited time in consultations, language barriers, embarrassment, and delays in test results subsequently delayed specialist referrals. GPs misattributed symptoms to other conditions due to atypical or non-specific presentations, leading to reduced trust in health systems. Patients complained of poor communication, delays in accessing test results, appointments, and onward referrals-all associated with clinical deterioration. GPs were sometimes unable to 'fast-track' patients into specialist care. Consultations and endoscopies were often difficult experiences for patients, especially for non-English speakers who are also less likely to receive information on mental health support and the practicalities of living with IBD. The framework analysis demonstrates delay in the diagnosis of IBD at each stage of the patient journey. Greater awareness of IBD amongst the general population would facilitate presentation to healthcare services through symptom recognition by individuals and community advice. Greater awareness in primary care would help ensure IBD is included in differential diagnosis. In secondary care, greater attention to the wider needs of patients is needed-beyond diagnosis and treatment. All clinicians should consider atypical presentations and the fluctuating nature of IBD. Diagnostic overshadowing is a significant risk-where other diagnoses are already in play the risk of delay is considerable.

Evidence-based decision-making in a climate of political expediency: insights from local government

Aims: Local authorities in England are responsible for public health and health promotion. This article sought to explore how research and decision-making co-exist in a local authority in England. Methods: An Embedded Researcher was based within the local authority and used qualitative methodology to address the research aim. Interviews and focus groups were employed to ascertain a range of stakeholder views in the local authority. All transcripts were coded on NVivo 12 by the Embedded Researcher and two members of the research team cross-checked a sample for coding accuracy. Data were analysed using framework analysis. Results: The data suggest several barriers to using research to inform decision-making in health promotion and public health. The study shows that research is valued in local authorities, but not always privileged – this is due to cultural factors and practical political reasons which often means that decisions need to be made expediently. Participants outlined a juxtaposition between academic credibility; timeliness to complete the research and the financial cost associated with it; against the independence and credibility that independent academics could bring. Conclusion: Policy formulation and delivery is an integral aspect of health promotion and critical to achieving improved population health and reductions in health inequalities. However, there exists tensions between gathering research evidence and making research-informed decisions. The article concludes by advocating the use of Embedded Researchers to fully understand how research is gathered and used to support public health and health promotion policymaking.

Evolution and influencing factors of coastal resilience in the East China Sea

The coastal zone serves as a crucial hub for economic and population concentration. Amid the context of high-intensity development and global climate change, uncertain risks from diverse sources—including extreme weather events (i.e., high temperatures, typhoons, and excessive precipitation), natural disasters (i.e., floods, tsunamis, landslides, and mudslides), and societal disruptions (i.e., economic crises and viral diseases)—are escalating rapidly. Enhancing coastal resilience to minimize these risk impacts is progressively becoming a mandatory requirement for the sustainable development of coastal zones. However, existing research primarily focuses on distinct disasters, the ecological environment, or specific socio-economic aspects, thereby lacking a comprehensive theoretical framework and thorough analysis of the factors influencing coastal resilience. Here, we construct a theoretical framework centered on the unique traits and processes of coastal resilience, analyze the spatiotemporal evolution characteristics of coastal resilience from a grid and administrative division standpoint, and utilize geographic detectors to determine the factors influencing coastal resilience while considering the modifiable areal unit problem (MAUP). Our findings indicate that: (1) Coastal resilience in the East China Sea (ECS) initially declined but then increased, transitioning from a lower to a medium level. Barring the pressure index, other dimensional indices had an upward trend; (2) Continuous improvements were observed in coastal resilience across different land uses. Forests, waters, and oceans demonstrated higher resilience levels than other lands, with construction land resilience developing swiftly. The effect of changes in land use types on coastal resilience showed a rapid initial increase and subsequent decrease; (3) The change pattern of coastal resilience in the ECS is mainly unchanged and slightly increased. Areas with the most drastic changes were concentrated in Shanghai, northern Zhejiang, and central Fujian, with the main change patterns continuously rising; (4) The primary factors influencing coastal resilience in the ECS included gross domestic product and infrastructure construction level. Advanced industrial structure, technological and educational prowess, and effective government management are important determinants of coastal resilience development. The significance of human factors continues to grow. Our findings offer valuable insights for optimizing national spatial planning of coastal zones, responding to internal and external impacts, achieving resilient coastal zones, and implementing a comprehensive sustainable management approach.

Leading-edge Metaverse in education: framework, applications, challenges, and future development

The incorporation of cutting-edge metaverse technologies into the field of education has emerged as a transformative paradigm, reshaping conventional learning environments and paving the way for novel immersive and interactive educational experiences. This paper undertakes a comprehensive examination of the framework, applications, challenges, and future development prospects of metaverse technologies within the educational domain, focusing on a diverse array of techniques that contribute to the continuous evolution of this innovative educational landscape. The framework analysis delves into the design and implementation strategies that form the foundation of metaverse-based educational platforms. Utilizing augmented reality (AR), virtual reality (VR), and mixed reality (MR), these frameworks strive to create dynamic and captivating learning environments that transcend geographical limitations. The paper explores how these technologies enable realistic simulations, collaborative problem-solving, and experiential learning, thereby fostering a more interactive and participatory educational experience. Case studies and examples illustrate their utilization across disciplines, spanning from science and mathematics to humanities and vocational training. The paper underscores the significance of artificial intelligence (AI) and machine learning (ML) algorithms in tailoring educational content to individual learning styles, thereby enhancing personalization and adaptability within metaverse-based educational systems. Nevertheless, the research also addresses the challenges associated with implementing metaverse technologies in education. Issues such as accessibility, digital equity, and data privacy are discussed, accompanied by considerations for overcoming these challenges to ensure a more inclusive and secure educational landscape. Looking ahead, the paper outlines potential developments in metaverse education, exploring emerging technologies and trends such as blockchain-based credentialing, haptic feedback integration, and the incorporation of the Internet of Things (IoT). The paper acknowledges the diverse techniques contributing to its ongoing evolution, emphasizing the dynamic nature of this transformative educational landscape.

Management of refractory disease and persistent symptoms in inflammatory arthritis: qualitative framework analysis of interviews with patients and healthcare professionals.

This study aims to explore patients' and clinicians' experiences in managing and living with refractory disease (RD) and persistent physical and emotional symptoms (PPES) in patients with RA or polyarticular JIA from their perspectives through interviews and/or focus groups. A qualitative exploration with 25 patients and 32 multidisciplinary rheumatology healthcare professionals (HCPs) was conducted to obtain participants respective understanding and experiences of managing RD/PPES and its impact on the patient-professional relationship. A pragmatic epistemology approach with framework analysis was employed. Four key themes were identified from both patients and professionals in the management of RD/PPES: risk/perpetuating factors/triggers; need for a patient-centred holistic approach to care, diagnosis and treatment; discordance and impact on the patient-practitioner relationship and current problems in managing RD/PPES. These themes covered 22 subthemes, with none being patient specific and seven being HCP specific. Suggestions for potential management strategies were highlighted throughout, such as involving other specialties or a multidisciplinary team, assessing/treating patient-reported outcome measures and psychosocial factors, patient (re)education, need for adjustments/aids or adaptations, checking the diagnosis and further investigations/imaging and optimizing medications. Management strategies need to be developed that enable appropriate treatment plans for those with RD/PPES that account for wider biopsychosocial factors beyond inflammation and reduce discordance in the patient-practitioner relationship.

The importance of group factors in the delivery of group-based parenting programmes: a process evaluation of Mellow Babies

IntroductionThe role of the group has been largely overlooked within evaluations of group-based parenting programmes. Group contextual factors, including size and level of homogeneity, may impact on essential group processes, such as group identification and cohesion, that are necessary to activate interpersonal change mechanisms and attain programme outcomes. This process evaluation of Mellow Babies, a 14-week attachment-based group parenting programme for mothers of infants aged under 18 months, explores how group context affected mother and practitioner experiences of the programme.MethodsIn-depth interviews were conducted with fourteen mothers and three practitioners from three different Mellow Babies groups. Framework Analysis was employed to analyse data, using groups as cases within the framework matrix while preserving individual participants within each case. This allowed comparisons to be made within and between groups.ResultsFour group contextual factors impacted on the quality of programme delivery: (1) group size; (2) level of group homogeneity; (3) pre-existing relationships; and (4) personalities within the group. These contextual factors affected the hypothesised intervention mechanisms: (1) fluid progression through the stages of group development; (2) a safe, non-judgemental, contained space; (3) social identification with group; (4) group cohesion; and (5) a culture of openness, support and empowerment.DiscussionFindings have implications for future delivery and implementation of group-based parenting programmes, for example, the importance of considering group composition during programme recruitment. Practitioners may also benefit from a stronger focus on group processes and enabling group dynamics within training, supervision, and the programme manual.

‘The Emperor's new clothes?’ Healthcare professionals’ perceptions of the nursing associate role in two UK National Health Service hospitals: A qualitative interview study

BackgroundThe introduction of nursing associates in England in 2017 as a professional ‘bridging’ role aimed to mitigate chronic staffing shortages, enable career progression of healthcare assistants and release registered nurses to provide more complex care. Limited evidence exists about the alignment between the identity and purpose of nursing associate roles described by the UK independent regulator, the Nursing & Midwifery Council, and the expectations, obligations, and team dynamics encountered in practice. PurposeInvestigate the perceptions of nursing associate roles through the views and experiences of role holders, registered nurses, and healthcare assistants. SettingTwo British National Health Service (NHS) Hospital Trusts in London, England (UK). MethodsFor this registered service evaluation, data were collected via in-person, semi-structured interviews. Verbatim transcripts were coded inductively. An adapted framework analysis method, suitable for use with Excel, was applied to support the identification of cross cutting themes. We used the Standards for Reporting Qualitative Research checklist for reporting this study. ResultsEleven registered nurses, five nursing associates, and five healthcare assistants participated. Their experiences seldom reflected the policy vision of the nursing associate role in practice. Several participants likened the nursing associate role to the fable of the ‘Emperor's New Clothes’ in which expectations and reality diverge. With this over-arching theme, four sub-themes were identified: (1) preparedness of organisational infrastructure to support this role; (2) credibility of the role in practice; (3) perceived organisational “blindness” to the ambiguities of the role and (4) increasing task orientation and segmentation in care delivery. ConclusionThere is a discrepancy between the identity of the nursing associate role as imagined in the policy agenda and its reality in practice. There is a need for more protected and well-defined training, clear role boundaries, and accessible career progression pathways for nursing associates. Moreover, honest dialogue at an organisational and policy level must continue, so that the challenges and opportunities of the nursing associate role are properly realised. Tweetable abstractEmperor's new clothes! Experiences and views of new nursing associate roles in NHS (UK) acute hospitals @CarolynSpring3.

Developing attributes and attribute-levels for subacromial pain syndrome: A systematic review and qualitative study.

Subacromial pain syndrome (SAPS), the most common cause of shoulder pain, can be treated through different treatments with similar effects. Therefore, in terms of deciding on the right treatment fit, patient preferences need to be understood. We aimed to identify treatment characteristics that delineate interventions (attributes) and corresponding sets of specific categorical range (attribute-levels) for SAPS. This multiple method study systematically reviewed both qualitative and quantitative studies on patient preferences for treatment of SAPS, which informed semi-structured interviews with 9 clinicians and 14 patients. The qualitative data from the interviews was analyzed using the framework analysis formulated by Ritchie and Spencer. Attributes and attribute levels of the systematic review and interviews were summarized and categorized. The search resulted in 2607 studies, 16 of which met the eligibility criteria. The review identified 120 potential attributes, which were synthesized into 25 potential attributes. Fourteen new potential attributes were identified through the interviews, equaling a total of 39 attributes across 11 categories. Levels for 37 attributes were identified through systematic review and interviews, we were unable to identify levels for 2 attributes. This study identified attributes and attribute levels for the treatment of SAPS. There was a discrepancy in the frequency of the represented attributes between the literature and interviews. This study may improve the understanding of patient preferences for the treatment of SAPS and help individualize care. Our study informs a future discrete choice experiment and supports shared decision-making in clinical practice.

The use of evidence to guide decision-making during the COVID-19 pandemic: divergent perspectives from a qualitative case study in British Columbia, Canada

BackgroundThe challenges of evidence-informed decision-making in a public health emergency have never been so notable as during the COVID-19 pandemic. Questions about the decision-making process, including what forms of evidence were used, and how evidence informed—or did not inform—policy have been debated.MethodsWe examined decision-makers' observations on evidence-use in early COVID-19 policy-making in British Columbia (BC), Canada through a qualitative case study. From July 2021- January 2022, we conducted 18 semi-structured key informant interviews with BC elected officials, provincial and regional-level health officials, and civil society actors involved in the public health response. The questions focused on: (1) the use of evidence in policy-making; (2) the interface between researchers and policy-makers; and (3) key challenges perceived by respondents as barriers to applying evidence to COVID-19 policy decisions. Data were analyzed thematically, using a constant comparative method. Framework analysis was also employed to generate analytic insights across stakeholder perspectives.ResultsOverall, while many actors’ impressions were that BC's early COVID-19 policy response was evidence-informed, an overarching theme was a lack of clarity and uncertainty as to what evidence was used and how it flowed into decision-making processes. Perspectives diverged on the relationship between 'government' and public health expertise, and whether or not public health actors had an independent voice in articulating evidence to inform pandemic governance. Respondents perceived a lack of coordination and continuity across data sources, and a lack of explicit guidelines on evidence-use in the decision-making process, which resulted in a sense of fragmentation. The tension between the processes involved in research and the need for rapid decision-making was perceived as a barrier to using evidence to inform policy.ConclusionsAreas to be considered in planning for future emergencies include: information flow between policy-makers and researchers, coordination of data collection and use, and transparency as to how decisions are made—all of which reflect a need to improve communication. Based on our findings, clear mechanisms and processes for channeling varied forms of evidence into decision-making need to be identified, and doing so will strengthen preparedness for future public health crises.

Implementation of the London Measure of Unplanned Pregnancy in routine antenatal care: A mixed-methods evaluation in three London NHS Trusts.

Unplanned pregnancies are associated with increased risks. Despite this, they are currently not routinely detected during antenatal care. This study evaluates the implementation of the London Measure of Unplanned Pregnancy (LMUP) - a validated measure of pregnancy planning - into antenatal care at University College London Hospital, Homerton Hospital, and St Thomas' Hospital, England, 2019-2023. We conducted a mixed methods evaluation of the pilot. Uptake and acceptability were measured using anonymized data with non-completion of the LMUP as a proxy measure of acceptability overall. We conducted focus groups with midwives, and one-to-one interviews with women, to explore their thoughts of asking, or being asked the LMUP, which we analyzed with a Framework Analysis. Asking the LMUP at antenatal appointments is feasible and acceptable to women and midwives, and the LMUP performed as expected. Advantages of asking the LMUP, highlighted by participants, include providing additional support and personalizing care. Midwives' concerns about judgment were unsubstantiated; women with unplanned pregnancies valued such discussions. These findings support the implementation of the LMUP in routine antenatal care and show how it can provide valuable insights into the circumstances of women's pregnancies. This can be used to help midwives personalize care, and potentially reduce adverse outcomes and subsequent unplanned pregnancy. Integration of the LMUP into the Maternity Services Data Set will establish national data collection of a validated measure of unplanned pregnancy and enable analysis of the prevalence, factors, and implications of unplanned pregnancies across subpopulations and over time to inform implementation.

How to achieve high-quality development of SRDI enterprises-A study of the TOE framework-based configuration.

The high-quality development of SRDI enterprises is crucial for China to overcome critical technological bottlenecks and thereby achieve technological independence and strength. However, the factors driving the high-quality development of SRDI enterprises are not isolated elements, but rather a complex system of interconnected antecedents. This study employs the TOE framework and fuzzy set Qualitative Comparative Analysis (fsQCA) with 141 Chinese SRDI "little giant" listed companies as samples to explore how various factors contribute to their high-quality development. The findings indicate: (1) No single factor is necessary for SRDI enterprises' high-quality development. (2) It is the synergy of multiple factors, in various combinations, that drives their high-quality development. (3) Technological innovation plays a key role in these pathways; SRDI enterprises should leverage their resources and capabilities for a synergistic technology-organization-environment match, selecting the most suitable development path. The results of this study not only enrich our understanding of the factors influencing SRDI enterprises' high-quality development but also offer insights for both the enterprises and government policy-making.

Barriers and facilitators to learning health systems in primary care: a framework analysis

BackgroundThe learning health system (LHS) concept is a potential solution to the challenges currently faced by primary care. There are few descriptions of the barriers and facilitators to achieving an...

What are we planning, exactly? The perspectives of people with intellectual disabilities, their carers and professionals on end-of-life care planning: A focus group study

Background: Deaths of people with intellectual disabilities are often unplanned for and poorly managed. Little is known about how to involve people with intellectual disabilities in end-of-life care planning. Aim: To explore the perspectives of people with intellectual disabilities, families, health and social care professionals and policy makers on end-of-life care planning within intellectual disability services. Design: A total of 11 focus groups and 1 semi-structured interview were analysed using qualitative framework and matrix analysis. The analysis was conducted inclusively with co-researchers with intellectual disabilities. Setting/participants: A total of 60 participants (14 people with intellectual disabilities, 9 family carers, 21 intellectual disability professionals, 8 healthcare professionals and 8 policy makers) from the UK. Results: There were differences in how end-of-life care planning was understood by stakeholder groups, covering four areas: funeral planning, illness planning, planning for living and talking about dying. This impacted when end-of-life care planning should happen and with whom. Participants agreed that end-of-life care planning was important, and most wanted to be involved, but in practice discussions were postponed. Barriers included issues with understanding, how or when to initiate the topic and a reluctance to talk about dying. Conclusions: To develop effective interventions and resources aiding end-of-life care planning with people with intellectual disabilities, clarity is needed around what is being planned for, with whom and when. Research and development are needed into supporting intellectual disability staff in end-of-life care planning conversations. Collaboration between intellectual disability staff and palliative care services may facilitate timely end-of-life care planning and thus optimal palliative end-of-life care.

BARRIERS TO THE ADOPTION OF SUSTAINABILITY PRACTICES IN SMALL HOTEL BUSINESSES: A QUALITATIVE STUDY IN GHANA

Purpose- By integrating sustainability into their business operations, small tourism and hospitality accommodation enterprises will not only contribute to achieving sustainable development goals 7, 9,12,13 and 14, but also promote a culture of environmental and social consciousness that aligns with the broader objectives of the United Nations’ Agenda 2030. Therefore, this study explores barriers to the adoption of sustainability practices among small hotel businesses in Ghana. Methodology- Using a qualitative research framework and descriptive analysis method, face-to-face interviews were conducted with 16 small hotel managers in the Cape Coast Metropolis of Ghana. The interview technique was adopted because it allowed for the acquisition of detailed information from participants on barriers to the adoption of sustainability practices. Findings- The findings revealed a spectrum of internal barriers: lack of awareness and understanding of sustainability principles, attitudes, negligence among hotel staff, and financial constraints. External barriers, such as owner interference in managerial decision-making, exploitative supplier actions, burdensome taxes and levies, and seasonal fluctuations with low hotel patronage, were also identified as the main barriers to the adoption of sustainability practices in small hotel businesses in Ghana. Conclusion- The study concludes by recommending targeted sustainability education and training programs to enhance sustainability awareness and cost-effective practices, while changes in organizational structures such as empowering managers and fostering collaboration between owners and managers are imperative for effective sustainability adoption and integration. Additionally, small hotel businesses should diversify revenue streams beyond peak seasons and, with collaborative efforts, advocate for supportive policies and regulations at all levels to create a conducive environment for the adoption of sustainable practices.

Motivation and Behaviors Related to Sport Specialization in Collegiate Baseball Players.

Early sport specialization is a growing concern among youth sport athletes, particularly in baseball. Motivation to participate in sports is an important factor in determining which sports youth athletes participate in and why. To qualitatively investigate the youth sport participation behaviors and motivations of collegiate baseball players. Qualitative study. Online teleconference. We conducted 25 semistructured interviews with collegiate baseball athletes who were classified as high-level (n = 8), moderate-level (n = 9), or low-level (n = 8) specialists before college. Participants completed individual semistructured interviews to allow us to develop an understanding of their youth and high school sports experiences and associated motivations to engage in those experiences. A framework analysis approach was used to analyze the transcript data and identify themes among the 3 specialization groups. From our interview analysis, 6 overall themes emerged: (1) motivation, (2) stress, (3) quitting, (4) barriers, (5) facilitators of success, and (6) future directions. Moderate- and high-level specialists described greater levels of passion, participating in deliberate practice, greater levels of performance-related stress, and more desire to quit sports than low-level specialists. None of the groups cited parents as an overbearing external motivator to participate in sport at an early age. Participants who were classified as low-, moderate-, or high-level specialists noted different experiences related to their motivation, stress level, desire to quit, barriers to participating in baseball, facilitators of success, and their overall future career goals after completing baseball. This information may be useful for parents, coaches, and health care professionals to better communicate the benefits and risks associated with sport specialization to youth athletes. Future research is needed to determine if differences in motivation levels exist in younger populations.