Participant Interviews Research Articles

Health-related quality of life and symptom-specific functional impairment among patients treated with parenterally administered complement inhibitors for paroxysmal nocturnal hemoglobinuria

AbstractThis study describes the health-related quality of life (HRQoL) and symptom-specific functional impairment of patients with paroxysmal nocturnal hemoglobinuria (PNH) in a real-world setting. US-based adults with PNH treated with a parenterally administered complement inhibitor (PACI) for ≥ 6 months completed an online, cross-sectional, observational survey; a subset of patients also participated in semi-structured qualitative interviews. The survey included the PROMIS® 29 + 2 Profile v2.1 (PROMIS 29 + 2) to measure HRQoL. The FACIT-Fatigue, Neuro-QOL Item Bank v2.0 Cognitive Function Short Form, and PROMIS Item Bank v1.0 Dyspnea Functional Limitations 10a Short Form measured symptom-specific functional impairment. For each patient with PNH who completed the online survey, 3 age- and sex-matched adults from the general population (GP) also completed the survey. The HRQoL and functional impairment of the PNH sample were compared to that of the GP sample. The association between HRQoL/functional impairment and fatigue severity for the PNH sample was also investigated. Compared to the age- and sex-matched GP sample, patients treated with PACIs for PNH had significantly worse HRQoL and greater functional impairment for all measured domains (p < 0.05). Within the PNH sample, statistically significant associations (p < 0.05) were observed between fatigue severity and HRQoL/functional impairment for all outcomes except the PROMIS 29 + 2 Sleep Disturbance domain. Interview participants described fatigue-related impairments in their physical, social, and cognitive functioning. Despite receiving treatment for PNH, patients experienced deficits in HRQoL and functional impairment, suggesting that opportunities to improve patient-relevant outcomes through treatment should be identified.

Household Food Insecurity During the COVID-19 Pandemic Between Slum and Non-Slum Areas in Kinshasa, DR Congo: A Cross-Sectional Study

Introduction: Food insecurity is a vital issue, especially in places such as Kinshasa. Additionally, food insecurity has been worsened by the COVID-19 pandemic, particularly in low- and middle-income countries. Thus, this study examined food insecurity in Kinshasa after the peak of the pandemic to understand the impact of post-pandemic recovery efforts as well as the heterogeneity of this problem according to the residence of respondent (slum vs. non-slum areas). Methods: Grounded in the four key dimensions of food security (availability, access, vulnerability, and utilization), this cross-sectional study was conducted in Kinshasa with a representative sample of 2170 households selected from 62 enumeration areas. We used a questionnaire to interview participants about their food situations. Interviews were conducted with the head of each household or their designated representative by 150 master’s students using tablets powered by the SurveyCTO application. Household food security status was evaluated using the Household Food Insecurity Access Scale. A logistic regression model was developed to assess household risk factors associated with food insecurity. Results: Most people we talked to were over 40 years old, and many lived in households with fewer than six people. About a third of the households were overcrowded. The prevalence of food insecurity was 76.5% (95%CI: 74.6–78.3). Factors associated with food insecurity included being a household head aged over 50 years, insufficient living space, lower socioeconomic status, and residing in slum areas (AOR: 1.38; 95% CI: 1.06–1.79). Conclusions: Vulnerable groups, such as slum residents, older adults, and informal workers are more likely to be affected by food insecurity. Addressing these challenges requires the government to develop targeted strategies that bolster resilience and mitigate household vulnerability during crises.

Treatment of prehypertension among adults with HIV: a randomized clinical trial

Objective: Elevated blood pressure (BP), even at prehypertensive levels, increases cardiovascular disease risk among people with HIV (PWH); yet international guidelines in low-income countries recommend treatment initiation at BP at least 140/90 mmHg. We determined the efficacy, feasibility, and acceptability of treating prehypertension in PWH in Haiti. Design: An unblinded randomized clinical trial (enrolled April 2021–March 2022) with 12-month follow-up. Setting: GHESKIO Centres, Port-au-Prince, Haiti. Participants: Two hundred fifty adults with HIV with prehypertension (SBP 120–138 or DBP 80–89) not on medication, aged 18–65 years, virally suppressed, and without pregnancy, diabetes, or kidney disease. Intervention: Participants were randomized to treatment (amlodipine 5 mg) or control (no amlodipine unless two BP ≥140/90 mmHg). Main outcome measure: Primary outcome was mean change in SBP between intervention versus control groups from enrollment to 12 months. Results: Among 250 adults, median age was 49 years, 40.8% were women. Baseline median BP was 129/78 mmHg intervention versus 128/77 mmHg control. After 12 months, the difference in mean change between study groups for SBP was -5.9 mmHg [95% confidence interval (95% CI) -8.8 to -3.0] and for DBP was -5.5 mmHg (95% CI -7.9 to -3.2). At 12 months, 5.6% intervention and 23.0% control participants developed incident hypertension (hazard ratio 0.18; 95% CI 0.07–0.47). There were no differences in viral load suppression at 12 months or drug-related serious adverse events. Intervention acceptability was high among providers and participants in qualitative interviews. Conclusion: In PWH in a resource-poor setting, prehypertension treatment was feasible, acceptable, and effective in reducing mean SBP and incident hypertension. Registration: Clinicaltrials.gov NCT04692467

Divergent imaginings: Transitioning to decarbonised mobility in ‘post-coalonial’ County Durham

ABSTRACT What happens when the various parties involved in constructing decarbonised futures’ infrastructure diverge in their imaginaries? Much of the published research on the sociotechnical imaginaries relating to electric vehicles (EVs) describes the creation of the future of decarbonised transport as a process mired in conflict, with various interested parties represented as strenuously disagreeing in their assessment of the most efficacious solution. The aim of the article is to offer an alternative account, based upon data gathered through participant observation, interviews, and grey literature. It describes the sort of personal transportation futures currently being imagined in the United Kingdom. The focus is specifically on the installation of electric vehicle charge points. The author contrasts Whitehall’s national vision for this infrastructure with the ‘post-coalonial’ vision of officers of Durham County Council in North East England have articulated an alternative, a ‘post-coalonial’ vision, and finds that the vision of both the British civil service and Government of the United Kingdom focused on private ownership and commuting, while Durham County Council envisioned publicly accessible charge points that enabled various types of different journeys. Despite the striking differences the conclusion is that contrary to the findings of previous studies the existence of these divergent infrastructural imaginaries led not to conflict but to co-existence.

Chan summer camp templestay as an educational leisure and tourism activity in China: Learning process and spiritual outcomes

Chan summer camp (CSC), a unique type of templestays in China with educational benefits, is mainly held by temples during school summer vacations. Drawing on experiential learning theory, this qualitative study explored the learning process and spiritual outcomes of CSCs in China to address the learning benefits of leisure. Participant observation and interviews were employed for data collection. Research findings showed that participants gained knowledge, skills, and positive attitudes through this Buddhist cultural immersion experience. After returning home, the templestay experience outcomes were sustained through reflection and experimentation resulted in spiritual growth. This study contributes to the leisure and tourism research on templestays, as it confirms the role of CSCs in learning and spiritual growth and reveals the learning mechanism to maintain the spiritual effects of the religion-related leisure and tourism environment.

Reaccreditation and Pathways Recognition Experiences of Small Local and Tribal Health Departments

Context: This paper describes experiences and views of leadership teams from 4 small local health departments (LHDs) seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. The Pathways program launched in 2022 provides additional supports for improvement of public health practice. Objective: Given the need to accelerate accreditation among small health departments, the purpose of this study is to share small health departments’ strategies for overcoming accreditation challenges and actionable advice for use by other health departments. Design: In this descriptive qualitative study, the study team conducted 22 individual interviews with 4 small LHDs from January to March 2024. Setting: Participating small health departments were located in the Midwestern and Western United States with staff sizes ranging from 3 to 47. Participants: Interview participants included small health department leadership teams, a local board of health member, and a contracted external accreditation consultant. Main Outcome Measures: We used a semi-structured interview guide to elicit participant experiences and views on accreditation processes, benefits, facilitators, strategies for overcoming challenges, and advice for other small health departments. Results: Participants suggested that accreditation benefits far outweighed the challenges. Perceived benefits included improved organizational procedures, equitable delivery of needed effective programs and services, and enhanced public perception. Key strategies to overcome staff capacity challenges were establishing a team approach and orienting and mentoring new staff in the “why” and “how” of accreditation. Advice included learning what is involved, taking the time to lay a foundation beforehand, and not waiting for a perfect time as accreditation is about improvement, not perfection. Conclusions: Small health departments can achieve and maintain PHAB accreditation by strategically implementing strategies to overcome staff capacity and other challenges. The Pathways Recognition program is a supportive option for small health departments wanting to improve public health practice.

Marking ‘on the fly’ in interactive oral assessments in Business

Interactive orals (IOs) are described as a pedagogically rigorous and authentic form of assessment. However, there is little research to-date on the assessor experience of facilitating a conversation and marking ‘on the fly’, nor the student experience of thinking ‘on the spot’. This paper investigates assessor and student experiences of IOs in the context of a large Australian business school where IOs were implemented in five courses from several sub-disciplines. Participant interviews confirmed what is already known about IOs and their place as an assured assessment of learning in the Artificial Intelligence (AI) age. This study contributes to new knowledge on the assessor experience and suggests that academics will need a distinct skillset to ensure reliable and valid ‘conversational’ assessments.

Translation and cross-cultural adaptation of the self evaluation of breathing questionnaire (SEBQ) into Danish

ABSTRACT Background and Purpose Dysfunctional breathing (DB) with or without an underlying medical condition is associated with impaired quality of life. DB-related symptoms can be measured with the 25-item Self Evaluation of Breathing Questionnaire (SEBQ). However, the SEBQ is not available in Danish.The aim of the present study was to translate and cross-culturally adapt the SEBQ into Danish and to assess the face validity of the Danish version of the questionnaire in individuals with DB-related symptoms. Materials and Methods The SEBQ was translated and cross-culturally adapted into Danish using an internationally acknowledged six-step forward-backward translation guideline in an interactive process with an expert committee of clinicians, translators, methodologists and the SEBQ developer. Face validity was explored through semi-structured interviews with 24 adult individuals with DB-related symptoms (age 20–70 years, female n = 14). Results The SEBQ was successfully translated and cross-culturally adapted into Danish. Three major modifications were made following the translation process and participant interviews. First, an introductory paragraph, including a recall period of the previous seven days, was added. Second, the administration of the questionnaire was changed from a paper to an electronic version. Finally, adaptations regarding semantic equivalence, especially concerning being ‘breathless’ and ‘short of breath’, were performed. The participants expressed that the final version of the SEBQ embraced their DB-related symptoms, was understandable, and easy to complete. Conclusion The SEBQ is the first available Danish questionnaire to measure DB-related symptoms, following an internationally acknowledged cross-cultural adaptation and face validity evaluation approach. This promising validation should be followed by an assessment of measurement properties in individuals with DB-related symptoms to investigate the adequacy of the SEBQ in a Danish context.

Stakeholder-led proactive risk assessment of medication safety in the pharmaceutical supply chain

Abstract Introduction In 2022/23, 1.08 billion medications were dispensed to patients using NHS England, at a cost of £19.04 billion1 . However, Elliot et al (2019)2 estimate every year there are 237 million medication errors at some point of the medication process, with a high associated cost. Increasingly, media is reporting medication shortages of critical medicines3 that can contribute to errors of omission. Medication errors suggests system, tasks and processes should be explored to understand if they have been poorly designed. This paper is a pre-Brexit study that examines the pharmaceutical supply chain with stakeholders. Aim To explore risk to medication safety in the pharmaceutical supply chain using qualitative interviews of stakeholders across the supply chain and proactive risk assessment method SHERPA (Systematic Human Error Reduction and Prediction Approach). Method 1. Qualitative interviews with process models System process models were developed (by literature, field observations and interviewees) and employed to elicit stakeholder perceptions about risk to medication safety in 31 qualitative interviews. Participants included pharmacists, wholesalers, pharmaceutical industry representatives, regulators and policymakers. Ethical approval was granted by Cambridge LREC to include healthcare professionals and 6 patients. Interviews were audio-recorded, transcribed and thematically analysed using N-Vivo. 2. Focus group for SHERPA Six stakeholders participated in the SHERPA focus group4 , including pharmacists and representatives from pharmaceutical manufacturing and wholesale industries. Interview participants were invited and those that agreed, attended. The SHERPA template was completed by the group. The session was audio-recorded, transcribed and thematically analysed using N-Vivo. Results The system models led to a greater understanding of the current system ‘as-is’ and created an overview of the supply chain. SHERPA is a validated method and provided the rigour to risk assess the supply chain process and identify sources of risk. However, the error mode terminology required adjustment to healthcare. Across all supply routes, the main source of risk was failure to supply medicines that caused errors of omission and the risk of counterfeit medicines. Failure to supply resulted from shortages that take place from trading activities that result in stockpiling or exporting of medicines. A lack of robust regulation and parallel imports increased the risk of counterfeit medicines. Stakeholders highlighted deficiencies in the supply chain and poor performance of stakeholders, as medication safety concerns. In order of frequency, the deficiencies include fragmented supply chain; complacency by stakeholders; poor communication and integration across supply chain; and end-user often regarded as the pharmacist, rather than the patient. Discussion and conclusion From the findings, strategies emerged as possible solutions. These included communication of shortages in each component of supply chain; robust counterfeit strategies; use of technology (automation/digital tools); and re-design tasks and processes in dispensaries and wards. Staff training, education, and revalidation of stakeholders is vital. Key limitations in this study include biases that can occur from recruitment strategy and small sample size. The SHERPA method posed terminology problems. In conclusion, this multi-method approach reveals risk and possible solutions to improve safety and reduce cost in the NHS. It is clear this study needs to be repeated to understand the impact of Brexit and current reconfiguration of NHS.

The Context of the Emergency Department as a Location for a Smoking Cessation Intervention-Process Evaluation Findings From the Cessation of Smoking Trial in the Emergency Department Trial.

Hospital emergency departments (ED) offer an opportunity to engage with large numbers of people who smoke to prompt cessation, although the acceptability of opportunistic intervention in this context has been questioned. This process evaluation study was embedded into the Cessation of Smoking Trial in the Emergency Department (COSTED) randomized controlled trial and sought to explore the context of intervention delivery within the ED. Qualitative interviews were conducted with participants and staff across six EDs participating in the COSTED randomized controlled trial. Interview data were thematically analyzed specifically exploring contextual influences. Data were triangulated with ethnographic observations. In participant interviews (N = 34), it was acceptable overall to receive a brief opportunistic smoking cessation intervention in the ED. Contextual factors are impacted at a range of levels. At the micro level participant views and experiences combined with staff tailoring were important. Being given an e-cigarette starter kit by a "credible source" helped to legitimize vaping for smoking cessation and gave confidence in personal ability to switch away from tobacco. At the meso level, adaptations to intervention delivery were made in response to the context of the ED. Stop smoking advisors (N = 11) had to adapt and deliver the intervention flexibly depending on space and clinical need. At the macro level, hospital policies supportive of vaping legitimized the approach. Smoking cessation outcomes reported in the main trial across sites were very similar because of the high credibility, acceptability, and flexible approach to delivering the COSTED intervention in the ED. Attending a hospital ED is the right time and place to receive smoking cessation intervention, even for those not motivated to quit. People are willing to receive intervention, and clinical staff are willing to support intervention delivery. Despite challenges, overall the context is helpful in supporting people to switch away from tobacco. The intervention, with flexible and tailored implementation, is adaptable to different ED contexts. This suggests that wider implementation across NHS Trusts of the effective COSTED intervention is feasible and will ultimately support smoking cessation for people attending EDs, who may not otherwise have sought support.

Lived experience and lessons learned from the support of two secondary eye care units to improve cataract surgery and refractive services in two regions of Ethiopia: health system-strengthening support.

Blindness and poor eyesight are significant public health issues globally and specifically in Ethiopia. In Ethiopia, there is limited access to cataract surgery and refractive error treatment centers. Therefore, this study aimed to evaluate the role of health system support in improving access to eye care services, particularly cataract surgery and refractive error treatment services in two secondary eye care units (SECUs). A parallel mixed-lived experience study was conducted in two SECUs. A desk review of relevant project documents and health facility activity reports was performed for quantitative data. The study was conducted from 12 December 2022 to 30 January 2023. A total of 21 in-depth interview participants were included. Overall, 14 106 cataract surgeries were performed during the pilot project implementation period. Assela Teaching and Referral Hospital Eye Care Unit performed cataract surgery 20-30 times per week. Similarly, Debre Tabor Comprehensive Hospital performed cataract surgery 18-24 times per week. The refractive service of the two SECUs was planned to range from 15-30 to 60 per week, and the refractive services were increased from 50-60 per week in both eye care units. This project has significantly helped the existing health system achieve the 2030 global target and has improved access to eye care services in selected SECUs. The use of cataract surgery and refractive error performance markedly increased from 0 to 100%.

Development and preliminary evaluation of a food literacy measure for use with young people in Canada

This paper presents the culmination of a multi-year research project aimed at creating a comprehensive food literacy framework and corresponding measure. Specifically, this paper documents the development and validation of a food literacy measure for young people facing social inequities. This study aimed to: 1) identify items to measure 12 attributes of food literacy 2) test the measure with the identified target groups, considering attribute, face, and content validity, inter-rater reliability and test-retest reliability; and 3) refine the measure. The study's design consisted of a five-phase approach, which included drafting the food literacy measure, expert review, cognitive interviews, pilot testing, and validity and reliability testing. Seven international experts provided feedback on the measure and 25 individuals aged 16-25 years old participated in cognitive interviews. Two-hundred and fifty-five (255) young people completed the test survey and 147 completed a retest survey two weeks later. These surveys identified food literacy factors. To further evaluate the validity of these factors. 193 participants completed a confirmatory test, which was used for confirmatory factor analysis (CFA) to assess the final model's fit. Interview participants were recruited from local programs and services from across Ontario, Canada, while survey participants were recruited from across Canada via social media. The research study was conducted between January 2018 and December 2019. The main outcome measures were validity and reliability scores for a food literacy measurement tool, which consisted of 50 questions across 10 attributes of food literacy. Interview analyses were guided by the four stages of cognitive processing. Exploratory factor analysis (EFA) was used to identify the factors that improved the Cronbach alpha of the food literacy measure. Test-retest reliability was assessed using percent agreement, Cohen Kappa, and weighted Kappa. Confirmatory factor analysis (CFA) was used to produce an acceptable final model with an RMSEA estimate. The final food literacy measure consisted of 50 questions addressing 10 food literacy attributes. EFA showed an improvement in Cronbach alpha when compared to the initial attribute construction. Test-retest reliability showed percent agreement ranging from 64% to 97%, with most items having fair (0.21-0.40) to moderate (0.41-0.60) Kappa values. CFA produced an acceptable final model with an RMSEA estimate of 0.0437. The food literacy measure is a comprehensive tool for assessing food literacy among young people. Additional research is needed to explore the measure's modularity, its use as an evaluation tool, and its suitability for use with diverse samples, including individuals from varied gender, geographic locations, ethnicities and cultural backgrounds.

Practice research in free improvisation

This article focuses on interaction processes during the performance of free improvisation in the jazz idiom, and their correlation to the construction of individual musical identities. In this article, I regard musical identity as an artistic, dynamic and personal process characterized by continual communication, construction and negotiation with the surrounding social and cultural environment. Interaction, just like improvisation, is a fundamental defining element in jazz and free improvisation, playing a crucial role in shaping the musical identity of each musician during their performance. This is presented here as analogous to the moulding of individual identity in our everyday social interactions. This research is based on the author’s active participation in improvisation sessions and interviews with professional jazz musicians based in Lisbon, Portugal. Additionally, it explores how the context of free improvisation, when musical restrictions are minimized, intensifies the focus on the interactive improvisational process. This attribute makes free improvisation an ideal terrain for research on interaction and its relation with musical identity.

Effects of Qualitative Interview Participation on Muslim American Identity Integration: A Mixed-Method Investigation

ABSTRACT Participation in research studies about one’s identity has been found to act as a form of counseling intervention. This mixed-method convergent parallel design study sought to examine whether participating in a 45-minute one-on-one semi-structured interview on Muslim American identity integration affected participants’ views of their identity one year later. Participants included 29 ethnically diverse second-generation Muslim Americans residing in the U.S. Midwest who were retained at one-year follow-up from a semi-structured identity interview of 53 participants. Participants completed a survey with measures of identity, identity integration, and open-ended questions inquiring how the study influenced them. Descriptive quantitative analyses and thematic analysis of qualitative data were used to examine the participants’ perceptions of the interview. Qualitative responses displayed five themes (Self-Understanding and Reflection, Affirmation, Connecting With In-Group, “Normal” Conversation Topic, and No Change) aligning with the three primary domains incorporated in ethnic identity development. The blendedness of the participants’ Muslim and American identities, American centrality, and participants’ self-reported positive private regard toward their American identity were lower at Time 2 compared to Time 1. More research is needed regarding the influence of participating in identity-based mixed-methods studies on Muslim American identity formation.

Analysing influential factors in e-learning technology acceptance for digital learning effectiveness enhancement

This study aims to discover the factors that influence the acceptance of electronic learning media and its effect on the effectiveness of digital instruction. The study involved a learning management system and online tutorials using management system (MS) teams from various faculties at the Universitas Terbuka. These include the Faculty of Economics and Business, the Faculty of Teacher Training and Education, the Faculty of Science and Technology, and the Faculty of Law, Social Sciences, and Political Sciences. also conducted in three regional offices in Ambon, Gorontalo and Makassar, which were selected through purposive sampling. Primary data sources include participant questionnaires and interviews. Analytical methods include correlation and multiple regression analysis, with descriptive statistics used to summarize the dataset. Variable selection involves reliability and validity tests and classical assumption tests like multicollinearity. The F-test demonstrates a statistically significant and beneficial influence of utilizing e-learning media and individual ability, training, and intention to use it for digital learning success. The results of ttests and regression models provide empirical evidence supporting the significant effect of e-learning media and intention to use on the effectiveness of digital learning. However, variables related to training and ability do not show any significant influence.

Integrating community health workers into HIV care clinics: a qualitative study with health system leaders and clinicians in the Southern United States

BackgroundCommunity health workers (CHWs) can support patient engagement in care for a variety of health conditions, including HIV. This paper reports on the experiences of HIV clinics and health departments that integrated CHWs into their health systems as part of a capacity-building initiative to address HIV-related disparities in the United States.MethodsSemi-structured interviews were conducted with key informants (n = 14) in two Ryan White HIV/AIDS program jurisdictions: Mississippi (jurisdiction covers the entire state) and the city of New Orleans, Louisiana. This work was part of a larger evaluation of an initiative that used a Learning Collaborative model to facilitate the implementation of evidence-informed interventions to address HIV care continuum gaps in four jurisdictions. The two jurisdictions that focused on integrating CHWs into HIV care clinics and support service agencies were selected for this sub-analysis. Interview participants included HIV clinic leaders and staff, health department leaders, and other Learning Collaborative leaders. Interview transcripts were coded and analyzed for themes related to the acceptability, feasibility, and perceived impact of CHW integration.ResultsOverall, participants expressed interest in having support from CHWs at HIV clinics and service agencies to assist with patient retention and engagement efforts. However, there were challenges integrating CHWs into existing systems (e.g., gaining access to electronic health records, changing policies to conduct home visits, and clarifying roles and scope of work). Negotiating contracts and accessing funding for CHW positions presented major challenges that often contributed to turnover and conflicts around scope of practice. When health departments leveraged existing funding streams to support CHW positions, the clinics and agencies where the CHWs worked had limited flexibility over the hiring process.ConclusionsOur findings reinforce the value and acceptability of CHWs as part of the workforce in HIV clinical and support service settings; however, integrating CHWs into clinics and service agencies required effort. Training the CHWs was not sufficient; other staff and clinicians had to understand the role of CHWs to facilitate their integration into health systems. Resources are needed to support organizations in incorporating CHWs effectively, and long-term, flexible sources of funding are necessary for these positions.

Produce Safety Behaviors, Motivators, Barriers, and Beliefs in Pediatric Cancer Patient Caretakers

Cancer patients, who face increased foodborne illness susceptibility and severity, are often placed on neutropenic diets (NDs), which eliminate the consumption of fresh produce, among other foods perceived as high-risk. Such diets are clinically disputed because they have never been proven effective in reducing foodborne illness, leading to unstandardized dietary guideline content, format, and delivery methods. To inform a strategic communication approach, this study explored the produce safety handling behavior, barriers, motivators, and beliefs of pediatric cancer patient caretakers using a mixed methods convergent parallel design. A quantitative survey revealed high frequencies (> 60%) for generally recommended produce safety behaviors, such as rinsing produce and washing cutting boards, and more mixed responses for restrictive produce safety behaviors, such as peeling produce and avoiding pre-cut, self-serve, and school cafeteria produce. Total produce safety frequency scores were not significantly affected by demographic factors or Child Vulnerability Scale (CVS) scores. Qualitative interviews established a wide domain of caretaker produce safety experiences and beliefs, finding that eight of seventeen interview participants from different hospitals received produce restrictions typical of the ND. Ultimately, five caretaker archetypes were identified, with common motivators and barriers linked to materials received, child’s health and perceived susceptibility, and self-efficacy beliefs. Finally, response-driven communication strategy improvements were recommended. Although sample sizes in this work were small, and further validation is advised, this work highlights the inconsistent use of the restrictive ND, advances understanding of the drivers of produce safety behaviors in cancer patient caretakers, and supports future endeavors to streamline communication strategy interventions.

사립유치원 경력교사가 경험하는 직무에 대한 고민과 요구

The purpose of this study is to find out the concerns and demands of the job experienced by experienced teachers in private kindergartens. To this end, seven experienced teachers who obtained the qualification as first-class full-time kindergarten teachers in Seoul were selected as participants for in-depth interviews. As a result of the study, from the concerns about the job experienced by experienced teachers in private kindergartens to the concerns arising from the kindergarten working environment, it was found that 'concerns of experienced teachers about unstable teaching jobs', 'concerns of experienced teachers for new job expansion', and 'challenges for adaptation to the new environment of experienced teachers'. The concerns arising from the perception of experienced members were 'excessive burden of work given to experienced teachers' and 'difficulty in recognizing and performing roles as intermediaries'. The demands for jobs experienced by experienced kindergarten teachers in private kindergartens were 'improving the reasonable treatment and treatment of experienced teachers' and 'development of teacher education programs for differentiated experienced teachers' due to the improvement of the institutional level. The improvements at the individual level were 'activation of mentoring using experienced teachers' and 'operation of a kindergarten professional learning community for experienced teachers'. It is expected that the job environment of experienced kindergarten teachers will be improved through this study.

Impact of Trauma on the Lives of Black Men With Multiple Arrests

A mixed-methods study was carried out to better characterize the life course experiences, with a focus on trauma, of men who had perpetrated gun violence and other violent crime, and who had multiple arrests and incarcerations. A small sample of 13 men with a history of a minimum of 12 arrests each as well as histories of gun violence, other violent crime, and incarceration was drawn from a social program providing cognitive therapy and job skills training in a major urban center. Participants completed the Adverse Childhood Experiences Questionnaire and Post Traumatic Stress Disorder Checklist for DSM-5 and completed an in-depth interview. Results demonstrated that the participants had extraordinarily significant levels of trauma exposure but that they had minimal avowed trauma symptoms. The exception is that every participant demonstrated a clinically relevant score on the Arousal subscale (Criterion E). Participants in interviews discussed a number of characteristics of their developmental years. They described near constant exposure to traumatic events, in some cases starting from very young ages. Most participants described a personal experience of numbing or desensitization to their experiences. They described the impact of gangs on both protecting them from trauma and exposing them to trauma, and they described their subsequent experiences of incarceration. They offered recommendations for strategies to minimize violent crime in communities.

Barriers influencing the sustainable development of community-based tourism (CBT): evidence from Ciaotou heritage village in Taiwan

PurposeIn recent years, community-based tourism (CBT) in the global market has been combined with specific themes in order to establish various tourism activities. Relatively few studies have comprehensively investigated how this type of CBT should be developed. Therefore, this study takes CBT with festival themes combined with community characteristics as a case study, which explores what obstacles exist in CBT with a combination of community characteristics – the industrial history of sugar factories and external themes, such as, formal flower displays.Design/methodology/approachThe thematic analysis is employed for data analysis of interviews. All interview participants were stakeholders.FindingsThis study identifies five types of obstacles: policy-related, environmental-related, innovation-related, industry-related and communication-related. Based on these findings, it is vital to consider both community and other characteristics of CBT. At the same time, after evaluating the rational perceptions of different stakeholders within the same type of obstacle, this study proposes a more specific and comprehensive development strategies for CBT.Originality/valueTo the best of the authors' knowledge, this is the first study of community agricultural tourism which collected the viewpoints of different stakeholders – tourists, residents, community associations, local businesses and the government. This study employs in-depth analysis of external policies and environmental and agricultural factors to discover and develop relevant coping strategies and implications.