Key recommendations to improve equity and access in colorectal cancer screening for rural and remote communities. A grounded theory study.

ABSTRACT A key component of constructivist grounded theory in enhancing critical inquiry is methodological self-consciousness, which demands sustained reflexivity regarding the researcher’s positionality, assumptions, and interactions. This paper illustrates how MSC informed and transformed a qualitative study on acid attack survivors in India, particularly in addressing the ethical and methodological dilemmas that emerged during data collection and analysis. While the study initially focused on women – given acid attack’s legal recognition as a gender-based violence in India – the inclusion of men survivors introduced unforeseen complexities in how narratives were shared, contested, or withheld. MSC enabled a more layered understanding of these narratives, illuminating how gendered expectations, patriarchal structures, and disability intersect to shape a spectrum of victimhood. Specifically, the paper aims to: 1. Identify and navigate the dilemmas encountered in the researcher – participant relationship during both data collection and analysis. 2. Examine the meanings of such dilemmas by critically exploring gender as an anchor in both participants’ lives and the research relationship, particularly within the context of acid attack research. Drawing from ethnographic field notes and interview excerpts, the article argues that MSC is not merely a methodological device but an ethical and epistemic imperative, foregrounding how victimhood is constructed, negotiated, and silenced within broader sociopolitical contexts.

BackgroundLong COVID‐associated cognitive impairments significantly diminish patients' quality of life. However, there is a lack of research exploring patient perspectives on treatment preferences and expectations, especially across age groups.MethodIn this qualitative study, we employed a constructivist grounded theory approach. Semi‐structured online interviews were conducted with 23 Chinese participants, comprising 10 young adults (aged 18‐39 years) and 13 older adults (aged ≥60 years).ResultA central theoretical framework of ‘Individualized and Dynamic Adaptation to Cognitive Challenges’ was developed, illustrating how factors including age, severity of cognitive symptoms, economic affordability, accessibility of medical resources, prior management experiences regarding cognitive symptoms, baseline health status, personal lifestyle, interests, and attitudes, doctor‐patient interactions, and health literacy shaped participants’ preferences and expectations. ‘Preference for non‐pharmacological interventions’ emerged as the core theme for young adults, consisting of subthemes including self‐directed strategies (formed by concepts such as psychological adaptation and practical tools like to‐do lists and alarms) and emotional and psychological support. In contrast, ‘balanced use of pharmacological interventions’ was identified as the core theme for older adults, consisting of non‐pharmacological interventions (formed by concepts such as family support and structured and predictable routines), pharmacological interventions, and holistic expectations (formed by the concept that address not only cognitive but also physical and emotional well‐being). Across both age groups, improving sleep quality and psychological well‐being was consistently highlighted as essential for effective management. Disrupted sleep was viewed not only as a symptom but also as a factor that could exacerbate cognitive symptoms. For older adults, the need for psychological support often stemmed from poorer baseline health and feelings of neglect and isolation due to limited family presence in daily life. By comparison, young adults expressed a need for emotional care primarily driven by the stigma surrounding long COVID, particularly the perceived lack of trust and understanding from older generations and broader society.ConclusionOur study is the first to qualitatively explore and compare age‐specific treatment preferences, experiences, and expectations regarding long COVID‐associated cognitive impairments. By highlighting the heterogeneity of age‐specific preferences and expectations, it provides a comprehensive theoretical framework to inform the development of dynamic, patient‐centred interventions.

Developing a conceptual framework for cultural adaptation of digital parenting interventions: A mixed-method grounded theory study from Uzbekistan

Background What does skilled coaching look like when learners discuss diverse racial or ethnic identities, or when such diversity occurs within the coach-coachee dyad? Medical education literature is sparse, and the extensive business and wellness coaching literature does not account for physician identity formation or the inherent hierarchies in graduate medical education. Objective To understand best practices for coaching racially and ethnically diverse learners through qualitative sampling of a range of expert perspectives. Methods Using constructivist grounded theory, 2 groups, expert coaches outside of medicine and leaders of academic coaching programs within medicine, underwent sequential semistructured interviews using snowball sampling. Topics included the role of coach and coachee identity in coaching, whether racial or ethnic dyad diversity influences coaching, and errors a coach may make through inquiry or lack thereof. Using iterative inductive coding, final themes were identified, and a conceptual map was created. Results In 2023, 16 subjects were interviewed (10 and 6 in each group). Five themes emerged from Group 1: (1) Contextually managing relationships; (2) Leveraging coaching competencies, in particular to create a trusted relationship; (3) Ongoing self-development; (4) Seeing the whole person; and (5) Selecting a coach with similar identity. Group 2 responses demonstrated 4 themes: (1) Intentionally building connection and rapport; (2) Navigating power differentials; (3) Acknowledging the lived experience; and (4) Exercising self-awareness. Conclusions This qualitative study of coaching experts provides themes and best practices related to how identity, particularly underrepresented racial/ethnic identity, can be addressed skillfully in the graduate medical education coaching relationship.

EPH116 Grounded Theory Study to Assess Barriers and Reasons for Insufficient Compliance With Valproate Risk Minimization Measures: Example of a Qualitative Method Aligned With the Recommendations of the GVP Module XVI, Addendum II

In Japan, the aging population has led to an increase in seriously ill patients requiring emergency care. Although palliative care training opportunities are limited in Japan, established programs exist in the United States (U.S.). To inform future adaptation of such programs for use in Japan, this study aims to identify barriers that emergency physicians (EPs) in Japan encounter when providing palliative care. This qualitative study explored the end-of-life care decision-making processes of EPs in Japan. Semi-structured interviews were conducted with board-certified EPs using snowball sampling. Data were analyzed using a modified grounded theory approach, which was chosen for its ability to capture culturally nuanced decision-making, emphasizing reflection, theoretical clarity, and practical applicability. Iterative coding was conducted to inductively generate concepts and develop a conceptual framework describing EPs' decision-making processes. Data collection continued until theoretical saturation was achieved. Data were collected through online interviews conducted between January and August 2024. Thirteen board-certified EPs in Japan completed interviews. Most participants were male (76.9%) and most were 11-15 years after medical school graduation (n = 7). Analysis identified 16 concepts illustrating a three-phase decision-making process: (1) deciding to accept the transfer of end-of-life patients, (2) building trust with patients and families and conducting an assessment, and (3) determining the treatment plan. Common challenges included struggles with stalled interactions amid family distress and the dilemma of making decisions in the setting of clinical uncertainty, reflecting the emotional and ethical complexity of providing end-of-life care in time-pressured emergency settings. This study highlights the challenges EPs in Japan face when making urgent decisions with limited time and information while building trust with patients and families. These findings clarify the current barriers to integrating palliative and end-of-life care in emergency settings and provide a foundation for developing culturally adapted educational programs.

While identity development is a crucial task for young individuals ages 15-25, current research inadequately centralizes identity development in the context of first-time psychosis related to schizophrenia spectrum disorders. This study addresses the knowledge gap by exploring the grand research question, “How does a young person experience their identity development after the first episode of psychosis?”. Constructivist grounded theory methods influenced by critical frameworks were used to collect and analyze data with seven young adults engaged in first episode psychosis programs. Participants were young adults, between the ages of 19-24, that at the time of the study were enrolled in or had completed two-year early intervention for psychosis outpatient mental health treatment programs in the Pacific Northwest. Data analysis resulted in a theory based on their lived experiences highlighting identity construction patterns. The theory frames identity construction as a continuous, nonlinear meaning-making and relational process. The theory revealed two potential pathways as consequences of the central meaning-making process, making sense of psychosis, called integrated identity and restricted identity. Research and practice recommendations are provided.

BACKGROUND:The epidemics had effects on psychological, social, and economic conditions and has caused changes in the health service. The experience of caring for patients with acute respiratory diseases shows that the evaluation and care of these patients is expensive and requires a lot of facilities and manpower Therefore, this study was conducted to explain the process of home care in patients with COVID-19.MATERIALS AND METHODS:The study was conducted during the years 2021–2023 by building a conceptual model using the grounded theory approach. The participants were purposefully selected among the patients with COVID-19 who had experienced home care. To collect data, semi-structured and in-depth individual interviews were used, and to analyze the interviews, five stages of analysis based on continuous comparison were used; Open coding, development of concepts according to their characteristics and dimensions, data analysis for context, entering the process into the analysis and integration of classes were used. To verify the data, the strategies of reliability, transferability, verifiability, consolidation, and reflectivity were used.RESULTS:16 participants participated in this study and a total of 18 interviews were conducted. The interview was conducted for 12 months in the year 2022 and the time of the interviews lasted an average 60 minutes. In the analysis of the interviews, 4 main themes; Contextual factors, causal factors, strategies, and consequences were extracted, using which the conceptual model was designed.CONCLUSION:Care provided by informal home requires informed and planned support. The health system should prioritize self-care and care of sick people during epidemics, and health promotion experts should continuously provide necessary training according to the conditions of communicable diseases in society.

ABSTRACT This grounded theory study explores how teachers in the United States, the United Kingdom, and Portugal express their teacher identities and best-loved selves through Instagram. In each context, our findings suggest that Instagram can amplify or mute these teachers’ best-loved selves, represented by six categories and two cross-cutting themes. The teachers’ best-loved selves are shaped by a variety of contextual, personal, and pedagogical factors that manifest in multiple ways across countries. Teachers’ positioning on Instagram allows them to contour the expression of their teacher identity to specific communities, providing interactions with other teachers who express their best-loved selves in similar fashions across contexts and subjectivities. As teachers negotiate their identities and best-loved selves outside of the classroom, and in concert with their layered and intersected contexts, they influence a community of creativity, collaboration, and confluence both locally and internationally. Future research might further examine the spaces between teacher-creators and their audiences across additional platforms and national contexts, attending to the evolving stories that continue to shape teacher identity and community.

ABSTRACT Group singing is a joyous communal activity that enhances participants’ well-being. While research highlights its positive impacts, little is known about those who facilitate these groups or the social processes of group singing facilitation. Contemporary reviews of community music literature call for more research into the facilitation role to better support community singing groups. This Australian study explored the process of group singing facilitation and developed an explanatory theory grounded in the experiences and practices of facilitators. A grounded theory design was used, underpinned by relativist ontological and interpretivist epistemological positions. Feminist research values informed the design, emphasising the need to listen to the diverse and underrepresented voices of group singing facilitators. Data were gathered through thirty semi-structured interviews and a participatory singing and data generation workshop. Established grounded theory methods were integrated with singing and song to formulate a theory grounded in the data. The resulting theory, Creating Song Magic, comprises four categories: advocating, curating, welcoming and sustaining harmonious expression, and transforming communities. The theory is conceptualised as a salutogenic process supporting community health with the potential to support the sustainability of singing groups in community settings and the growing number of health programs that incorporate group singing.

This qualitative grounded-theory study explores factors influencing blockchain adoption in health and wellness centers. Fifteen domain experts—IT managers, healthcare administrators, and academics—were interviewed, and transcripts were analyzed in MAXQDA. The analysis identifies four interrelated dimensions—organizational, technological, social, and economic—and extends the Technology–Organization–Environment framework by treating social and economic domains as distinct but interacting drivers of adoption and scalability. The resulting C-P-L-E pathway (Capability, Pilot, Legitimacy, Economics) provides a practical roadmap aligning technical readiness, organizational capacity, and socio-economic legitimacy for sustainable blockchain adoption in healthcare.

In Africa, governments have declared critical thinking skills to be a major educational priority to increase global economic competitiveness and to promote economic, political and cultural independence. However, a variety of cultural factors may affect the very definition, purpose and manifestation of critical thinking. Considering the limited knowledge of the variables and constructs that characterize critical thinking in the sub-Saharan context, this research aimed to investigate how Ugandans define and conceptualize critical thinking, and compare the local understanding of the skill with the most renowned Western definitions. To achieve this aim, the authors implemented a grounded theory study to investigate the conceptual and operational definition and outcomes of critical thinking among 54 key informants in Uganda. The study highlights the uniqueness that characterizes critical thinking in a sub-Saharan country, where the communitarian way of living still plays a relevant role in the social and cognitive formation of the person.

Decision-making is the process of making informed choices about medical treatments and care. This study aimed to synthesize qualitative evidence on adolescents' lived experiences of decision-making in cancer care, with particular attention to the barriers, facilitators, and emotional dimensions influencing their participation. This study was conducted using the qualitative meta-synthesis methodology outlined by Sandelowski and Barroso (2007). We searched in four databases (PubMed, CINAHL, Embase, and Web of Science) for studies on decision-making in adolescents with cancer. The search period was set from 1989 to April 2023. Eligible studies were peer-reviewed qualitative research on decision-making in cancer care among adolescents; studies focusing only on parents, providers, or clinical trials were excluded. A meta-synthesis was conducted at the quotation-level through iterative discussion and consensus-building. We reviewed 18 articles published between 2004 and 2022, involving a total of 343 adolescent participants. Over half were conducted in the United States. Medicine was the most prevalent field, with eight articles, followed by nursing (n = 6). Among the 18 studies, seven articles provided detailed research methods, including three qualitative descriptive studies, three ethnographic studies, and one grounded theory study. The comprehensive meta-synthesis revealed three main categories and seven subcategories: (1) the "I" in decision-making, (2) healthcare environments make decision-making challenging, and (3) attitude toward illness. The findings suggest the need to develop adolescent-centered decision-making models and provide ethics-based training for healthcare professionals. Creating supportive care environments that respect adolescents' autonomy and encourage active participation is also essential.

BackgroundDigital health technologies are increasingly used as complementary and alternative means of seeking sexual and reproductive health services. These platforms now play a critical role in facilitating services such as contraception counseling, abortion care, sexually transmitted infection testing and treatment, and fertility-related support, particularly for individuals who face barriers to in-person care. Despite their increasing prevalence, there is an emerging concern that such platforms could inadvertently trigger or perpetuate trauma among end-user patients. This risk is particularly salient for individuals from equity-deserving populations who already navigate stigma, discrimination, or prior traumatic experiences in health care settings.ObjectiveThis study aimed to develop a theoretical account of how digital health technologies can cause or perpetuate emotional trauma among people who seek technology-based sexual and reproductive health services.MethodsWe used the Charmaz constructivist grounded theory approach by conducting interviews with 25 participants who have used government and other regulated digital health platforms (ie, web-based platforms and mHealth apps) to access sexual and reproductive health information or services including sexually transmitted infection testing, contraception, and abortion. Data analysis occurred alongside data collection, and data were analyzed inductively using open, axial, and theoretical coding.ResultsWe developed an explanatory model that shows that technology-related harm can occur in two main ways: (1) digital platform design features (ie, navigation challenges, data and security breaches, and inappropriate display of content) and (2) digital platform–related interpersonal interactions (targeted campaigns and depersonalized digital health interactions). While these activities can cause harm to users in general, they are more likely to result in emotional trauma for individuals with prior traumatic experiences and in emotional discomfort for those without such histories.ConclusionsWeb-based platforms provide opportunities for advancing access to sexual and reproductive health and services. At the same time, these technologies can also serve as conduits through which trauma can be triggered, perpetuated, and exacerbated. While technology-related trauma could occur unintentionally via design choices, some activities, including technology-related interactions, could trigger or perpetuate trauma among end users. To mitigate the risks, both technology developers (particularly designers) and health providers should consider design choices and implementation strategies that not only prevent trauma but also promote users’ emotional well-being.

ABSTRACT This study explores how primary school teachers experience teaching pupils who are working ‘at greater depth’ standards in a mixed ability class setting. The open enquiry uses a constructivist grounded theory (CGT) methodological approach. The overall aim is to provide a basis for theory to be constructed, to support future teaching, learning, and school development. The research outcomes are grounded in the first-hand experiences of teachers. A resulting strategic model has been developed to enable enhancement in teaching practices, based on the theoretical findings of ‘strong leadership’, ‘confidence’ and ‘creativity’. The intention of establishing awareness and guidance through this work is to help the most able children flourish and to support effective classroom management for all.

Although the theory of work and personal role reconciliation has been recently published, the personal roles dimension has not yet been explored in depth. This article aims to describe its theorization. Constructivist grounded theory was employed to conceptualize the phenomenon of interest from the perspectives of nurses, their families, and administrative staff. Data were derived from 202 h of non-participant observation in two high-complexity hospitals in Chile (one public and one private), 57 institutional documents, and 51 in-depth interviews. Data analysis followed the constant comparative method and multilevel coding. To ensure methodological rigor, the study adhered to the 13 criteria for constructivist grounded theory research proposed by Charmaz and Thornberg and was approved by a Scientific Ethics Committee. Personal roles are defined as the set of behaviors associated with the personal context of intensive care unit nurses, which are shaped by eight sources of interaction: (1) Family dimension; (2) Extended family; (3) Community groups; (4) Recreation spaces; (5) Religious institutions; (6) Health care institutions; (7) Educational institutions; and (8) Other public services. The study presents the theorization process of the personal dimension involved in the reconciliation of work and personal roles among nurses in Intensive Care Units. Personal roles are essential to understanding this reconciliation process. The findings provide evidence of the existence of eight sources of interaction, which are influenced by the cultural context.

Along with the rise in the number of social media users in Ethiopia, ethnic-based online hate speech is on the rise, leading to profound social division and strife. The present grounded theory study examines the mechanisms involved in the occurrence and propagation of ethnic-based hate speech in Ethiopia. To this end, it heavily relies on social media contents collected from ten Facebook, four YouTube, and four Twitter accounts that are selected as hot spots. The number of social media followers they have, posting hate speech content, and using both Amharic and English in their communications are the reasons for identifying the 18 accounts as hot spots. In addition to social media content, six key informants, who are working in combating hate speech and disinformation in Ethiopia, were interviewed. By employing inductive coding approach, and analytic tools such as open coding, constant comparative analysis, theoretical coding, and memoing, codes and categories that would address the research question are generated. The finding showed three main categories that show the mechanisms involved in ethnic-based hate speech occurrence: earned reputation, trolling and poaching, and users’ fallibility. The paper presents each of the categories and subcategories, a proposed conceptual model, and recommendations deemed necessary to counteract hate speech.

BackgroundThe complexity, difficulty and uncertainty inherent in the medical field pose significant challenges to physicians’ ability to adapt. For interns, career resilience plays a crucial role in the transition from academia to clinical practice. This study aimed to explore the mechanism of career resilience formation during the role-transition process of medical interns.MethodsWe conducted in-depth semi-structured interviews with 16 medical interns from a regional medical university in Northwest China, recruited via purposive and snowball sampling through professional networks. Data were collected between August and September 2024; interviews lasted 35–50 min (online/offline), were audio-recorded, transcribed verbatim, and analyzed using Straussian grounded theory (open–axial–selective coding with constant comparison), guided by the Critical Incident Technique and the STAR framework. The research team performed the coding, and the process was validated through regular peer-debriefing sessions with two independent researchers. Analysis was facilitated using NVivo software (version 12) until theoretical saturation was reached.ResultsA Challenge-Resource-Adaptation (CRA) model was constructed to explain how medical interns develop career resilience in the face of practical challenges and role transitions during the internship. Three pillars of career resilience were identified: (1) career development challenges (knowledge updating, identity establishment, career planning); (2) facilitative resources (guidance and feedback, resources and opportunities, emotional support); and (3) proactive career adaptation (compliance/pressure management and innovative breakthrough). The CRA model depicts a recursive loop whereby each innovative breakthrough elevates demands for further knowledge updating. Illustratively, weekly mentor-guided guideline reviews and skills-lab rehearsal closed knowledge-practice gaps, enabling independent ward rounds; exposure to advanced procedures helped clarify specialty choices.ConclusionCareer development challenges are the trigger factor, facilitative resources are the favorable conditions, and career adaptation behavior is the external manifestation of resilience. Overall, career resilience during internship emerges as a self-reinforcing process in which targeted resources convert concrete challenges into adaptive behaviors. The CRA model identifies mentor feedback, advanced clinical opportunities, and emotional support as key leverage points for strengthening medical curricula and workplace design.

Introduction: Accessible movies, which primarily employ descriptive video as their presentation method, serve as a form of cultural exchange without barriers. They have built a bridge for individuals with visual impairments (ie, those who are blind or have low vision) to engage with film and television culture and to communicate with society. This study developed a theoretical model for audio description creation by coding 10 accessible movies, addressing issues of inconsistency and lack of standardization, to enhance the viewing experience for individuals with visual impairment. Methods: The audio description of 10 representative accessible movies was selected and transcribed into text. Using grounded theory analysis and the qualitative coding tool Nvivo12 Plus, the texts underwent three-level coding, resulting in a theoretical model for the audio description creation process. Results: The analysis identified two major themes: text deconstruction and meaning reconstruction, leading to the concept of “from de-alienation to re-alienation.” The model explained the process of conveying films to individuals with visual impairments by first deconstructing the work to facilitate basic plot comprehension, and then reconstructing the work's meaning to enhance character images, supplement and interpret plots, and summarize significance. Discussion: The model addresses how creators should restore basic storylines and reconstruct deeper meanings, improving the quality of audio descriptions. Implications for Practitioners: This model provides new insights into the audio description creation process in China, promoting greater standardization and helping creators produce meaningful and reflective content for viewers with visual impairments.