Limited Access To Technology Research Articles

Factors Affecting the Internet Banking Adoption in Kathmandu Valley

In the rapid evolution of digital technology, the adoption of internet banking has become a crucial component of modern banking services. This paradigm shift towards digitization necessitates understanding the factors influencing internet banking adoption. This study aims to promote extensive adoption of internet banking in the Kathmandu Valley, encouraging financial inclusion and technological advancement in the region. This study examined factors influencing internet banking adoption among SMEs using an explanatory research design and the TAM theory, testing seven hypotheses. Data were gathered from 280 SMEs using a structured questionnaire administered through Kobo Toolbox and analyzed with Partial Least Squares Structural Equation Modeling (PLS-SEM) version 4.0. The results indicate that perceived usefulness, ease of use, and risk significantly impact the intention to use internet banking. Perceived usefulness serves as a mediator between ease of use and subjective norm, influencing their impact on the intention to use. The key challenges identified include system errors, security concerns, trust issues, lack of innovativeness, limited technology access, and awareness gaps. The study suggests the importance of user education, interface simplification, personalization, and enhanced user support to improve secure online transactions.

Development and Validation of a Mobile Application for Early Childhood Nutrition Monitoring: A Multisensor-Based Non-Contact Anthropometric System

The issue of early childhood nutrition in Indonesia, including the high prevalence of stunting, is of critical importance as it can permanently impair children's physical growth and cognitive development. Parents frequently encounter challenges in accurately and consistently monitoring their children's nutritional status, which impedes the early detection of nutritional issues. This study introduces the Multisensor-Based Non-Contact Anthropometric System (MB-NCAS), a mobile application developed to monitor nutritional status and detect stunting in early childhood. The research encompassed five phases using a modified ADDIE model: Analysis, Design, Development, Implementation, and Evaluation. In the Analysis phase, parent questionnaires identified critical nutritional needs and challenges related to stunting. The Design phase focused on setting clear objectives and developing educational content for the app. The Development phase saw the app's creation, which experts in content accuracy, media design, and instructional strategies subsequently validated. During the Implementation phase, the app was tested with parents in Malang City, who participated in pretest and posttest evaluations to assess the app's practicality and effectiveness. The results indicated significant improvements in parental knowledge and skills in monitoring child nutrition and stunting, with expert validation scores averaging 92.6% for media design, 86.25% for material content, and 87.28% for instructional design. The MB-NCAS app is a valid, reliable, and practical tool for early childhood nutrition monitoring. However, challenges such as limited technology access in certain areas may hinder its broader application. Future research should explore the app's effectiveness in diverse settings and focus on improving technology accessibility to enhance its impact on public health.

Health Informatics: A Challenge for Nurses in Public Health in Rural Mexico.

Health informatics has significantly advanced global technology, yet challenges persist in public health and rural nursing in Mexico due to social inequalities, limited technology access, and suboptimal infrastructure, compounded by the absence of nurse informaticians as viable career options. Overcoming these barriers necessitates international collaboration, empowering Mexican nurses to contribute to universal health access and advocate for health equity. Interventions must extend beyond nursing curricula to existing workforces, ensuring they can address the needs of vulnerable populations in Mexico. Long-term international support is crucial to bridge these gaps and unleash the full potential of Mexican nurses in influencing global health.

Peran Guru Pendidikan Agama Kristen (PAK) Dalam Implementasi Pembelajaran Interaktif Berbasis Teknologi Untuk Meningkatkan Motivasi Belajar Siswa

Technology-enhanced interactive learning in Christian religious education holds great potential for enhancing students' learning motivation and understanding of Christian values. This article discusses the crucial role of Christian Religious Education (CRE) teachers in designing and implementing this approach, as well as the challenges encountered in the process. Interactive learning leverages tools and platforms such as Classpoint, Slido, and other applications to create a dynamic and contemporary learning environment. Teachers are tasked with selecting and adapting Christian religious content that meets students' needs while utilizing interactive features to enhance student engagement. Challenges including limited technology access, inadequate technological skills, and resistance to change are also addressed within the context of technology integration in religious education. By combining technological innovation with appropriate pedagogical approaches, teachers can maximize the potential of interactive learning to create meaningful and effective learning experiences that deepen students' understanding and application of Christian values in everyday life.

Integrating GIS and BIM with MCDM for infrastructure planning: a comprehensive framework

PurposePresent study aimed to integrate Geographic Information Systems (GIS) and Building Information Modeling (BIM) in conjunction with multicriteria decision-making (MCDM) to enhance infrastructure investment planning.Design/methodology/approachThis analysis combines GIS databases with BIM simulations for a novel highway project. Around 150 potential alternatives were simulated, narrowed to 25 more effective routes and 3 options underwent in-depth analysis using PROMETHEE method for decision-making, based on environmental, cost and safety criteria, allowing for comprehensive cross-perspective comparisons.FindingsA comprehensive framework proposed was validated through a case study. Demonstrating its adaptability with customizable parameters. It aids decision-making, cost estimation, environmental impact analysis and outcome prediction. Considering these critical factors, this study holds the potential to advance new techniques for assessment and planning railways, power lines, gas and water.Research limitations/implicationsThe study acknowledges limitations in GIS data quality, particularly in underdeveloped areas or regions with limited technology access. It also overlooks other pertinent variables, like social, economic, political and cultural issues. Thus, conclusions from these simulations may not entirely represent reality or diverse potential scenarios.Practical implicationsThe proposed method automates decision-making, reducing subjectivity, aids in selecting effective alternatives and considers environmental criteria to mitigate negative impacts. Additionally, it minimizes costs and risks while demonstrating adaptability for assessing diverse infrastructures.Originality/valueBy integrating GIS and BIM data to support a MCDM workflow, this study proposes to fill the existing research gap in decision-making prioritization and mitigate subjective biases.

Analysis of the Implementation of Training on Digital-based Learning Media to Enhance Teachers’ Digital Literacy

This study aimed to analyze the implementation process, impact of digital-based learning media training on Tahfiz teachers' digital literacy and identified factors influencing the success or limitations of these programs. Utilizing a descriptive method, the study encompassed observations, interviews, and document analysis involving five Tahfiz teachers, a training manager, and a school administrator. The data analysis procedure followed the Miles and Huberman model, comprising three key stages: data reduction, data display, and conclusion drawing, underpinned by triangulation for validity. The findings revealed that the training enhanced teachers' access to digital resources, flexibility in learning, and provided personalized, interactive learning experiences. However, challenges like limited technology access, lack of technical skills, resistance to change, and inadequate resources tailored to Islamic values were notable. The study concludes that comprehensive training in digital literacy is crucial for Tahfiz teachers to effectively integrate technology into their teaching. The study contributes to the discourse on technology integration in religious education, offering insights for policy and practice in Tahfiz education.

Can You Hear Me Now? Patient Perceptions of Telehealth in a Rural Primary Care Population.

Background: The COVID-19 pandemic significantly increased telehealth adoption. Rural communities experience challenges relating to telehealth, including a shortage of clinicians, low health literacy, mistrust of medicine, and limited technology access, yet rural perceptions have not been a subject of robust study. The setting of this study was a rural Midwestern family medicine clinic within an academic health system. Methods: Surveys were given to all patients of age 18 or older visiting the clinic over a one-week period. Those who expressed interest were contacted for a semistructured interview. Descriptive statistics and chi-square testing were used to analyze survey results for significant relationships, while interview transcripts were analyzed for themes. Results: Of respondents, 27% indicated prior telehealth use and were more likely to prefer telehealth visits (p = 0.03). Perceptions of telehealth were sorted into themes, including scope of care, convenience, and technology. Telehealth was preferred for discussing test results or mental health. Barriers such as travel time and transportation access favored telehealth. Although more convenient, telehealth was found to be less effective for relationship building. The absence of physical examination during phone visits was a concern. Phone visits were more prevalent due to failure of video-based technology. Conclusions: Despite the potential to address these unique challenges in rural communities, telehealth acceptance is poor. Barriers such as accessibility of technology can be improved through governmental and health systemwide measures. Future work can help develop interventions that counter negative perceptions of telehealth while increasing interest and uptake in rural communities.

Recruitment strategies in marginalized industries for occupational health research: an example in a pilot study of cleaning staff during COVID-19.

This commentary describes challenges in recruiting workers from marginalized industries with examples from a pilot study of janitors, custodians, and maids and their experiences of cleaning and disinfection protocols during COVID-19 and potentially associated respiratory symptoms. Recruitment strategies included contacting a local hospital, national workers' unions, and a large Arizona employer; using online Facebook groups; and contacting Arizona maid service companies and a school district. English and Spanish online and hard copy surveys about cleaning protocols and respiratory symptoms were used. Participants could also participate in online/phone interviews. Worker's compensation, liability, and confidentiality were concerns across organizations. Online surveys yielded unreliable data. Hard copy surveys were used due to workers' limited technology access. We reflect upon these challenges and discuss other strategies for recruiting from marginalized populations for occupational health research. Building trust with organizations and workers and considering technology access may ultimately increase recruitment feasibility.

Teachers’ Perceived Value of Integrating ICT in Transposing English Language Teaching in Nepal

In the evolving landscape of English Language Teaching (ELT), the integration of Information and Communication Technology (ICT) has emerged as a fundamental pedagogical approach. This research delves into the perceptions and value attributed by teachers in Nepal towards the incorporation of ICT tools and methodologies in their teaching practices. I have used content analysis method to gather the related field of studies and analysed the data. Findings indicate that significant challenges such as limited technology access, lack of trainings, administrative support, over-load of unnecessary paper-work cause major obstacles in transposing ICT in classroom. However, ICT also offers great opportunities to transfer the traditional teaching practices, develop ICT skills, access to vast source of information and more importantly, the potential era for a paradigm shifts in the recent practices. The study emphasizes the need for a strategic approach, including investment in technology infrastructure, teacher training and supportive policy environment, to enhance ICT integration in ELT classrooms. In addition, the study provides valuable insights for policy makers, educators, researchers, and other stakeholders in their efforts to integrate ICT in teaching and learning in Nepal. Most importantly, this research contributes to the escalating discourse on ICT integration in ELT by providing nuanced insights grounded in the Nepalese context. The findings advocate for a holistic approach encompassing infrastructural development, targeted professional development initiatives, and transformative pedagogical strategies to optimize the potential benefits of ICT in transposing English language teaching practices in Nepal.

“Do you think I ever learn English?”: experiences of limited technology access among Middle Eastern refugee mothers in regional Australia

PurposeThe purpose of this study was to gain a deeper understanding of the experiences and challenges of Middle Eastern refugee mothers in using technology for language learning in regional Australian context.Design/methodology/approachThis study used a qualitative research design and used a narrative enquiry technique to understand participants’ experiences of language acquisition with limited access to technology in new resettlement setting.FindingsThe findings presented in this paper were derived from a qualitative investigation conducted on a sample of 21 refugee mothers from Middle Eastern countries. The research aimed to explore the role of a language education programme on their integration within the regional Australian context. Participants discussed a variety of aspects of their everyday lives within their new resettlement context while offering insights on the language education programme and its impacts on their educational progress. The theme “lack of access/use of technology in English language learning” emerged from the narratives. This paper draws on selected interview data from the participants.Originality/valueThis study fills the gap in the literature on Middle Eastern refugees in regional Australia by exploring how lack/limited technology access can impact language acquisition of women from under-represented contexts.

Key Factors Influencing Adoption of Online Dispute Resolution in Banking Sector: An Empirical Analysis

Background: Online dispute resolution system helps banks to reduce expenses and time associated with dispute resolution while enhancing client satisfaction and loyalty However, it faces several challenges necessitating the establishment of standards to ensure consistency and security. Objectives: Many online dispute resolution (ODR) services like email, chat, and video conferencing offer global grievance solutions, yet individuals face challenges due to diverse regulations, leading to security, privacy, and connectivity issues. Thus, this study aims to understand how customers perceive online dispute resolution for resolving banking issues. Methods: The research adopts an explanatory research design and employs a convenient sampling method for data collection. It's grounded in the Unified Theory of Acceptance and Use of Technology theory. A total of 403 data points were gathered using structured questionnaires and were analyzed using both descriptive and inferential analysis. Results: This study reveals that the trust placed in ODR technology, trust in the bank's services, and the perceived ease of use (effort expectancy) are crucial determinants shaping individuals' intentions to engage with ODR. The challenges of limited technology access, lack of awareness and trust, and inadequate infrastructure pose constraints on online dispute resolution's effectiveness. Addressing these limitations involves enhancing access to technology, and infrastructure and organizing awareness programs as managerial solutions. Conclusion: Trust in ODR technology, trust in the bank's services, and perceived ease of use are key factors influencing individuals' intentions to utilize ODR. Challenges, including limited technology access, lack of awareness and trust, and inadequate infrastructure, pose significant constraints on the effectiveness of online dispute resolution. Managerial solutions should prioritize enhancing technology access, improving infrastructure, and implementing awareness programs to overcome these barriers and optimize the potential of ODR.

TRANSFORMING BREAST CANCER CARE: THE IMPACT OF TELEPHARMACY AND TECHNOLOGY

This article explores the transformative potential of telepharmacy in breast cancer care. Overcoming geographical barriers, telepharmacy increases access to specialized care, fostering patient satisfaction. Despite challenges like limited technology access and privacy concerns, its personalized approach aligns with patient-centric care. The future of breast cancer care may be significantly impacted, with telepharmacy enabling continuous monitoring, tailored interventions, and comprehensive support. A call to action urges healthcare providers to adopt telepharmacy, collaborating with policymakers to address implementation challenges. Researchers are encouraged to delve into the evolving field, evaluating effectiveness and patient outcomes. Through collective efforts, theres potential to revolutionize breast cancer care, offering enhanced accessibility and personalization via telepharmacys transformative capabilities. KEYWORDS: Telepharmacy, Breast Cancer Care, Patient Satisfaction, Patient-Centric Care, Continuous Monitoring

RURAL-URBAN DIFFERENCES IN DIGITAL HEALTH USE OF MEDICARE BENEFICIARIES

Abstract Growing reliance on digital healthcare appears to marginalize rural older adults with limited technology access and experience. Existing research explores telehealth uptake of Medicare beneficiaries but does not consider the role of locality in digital health use (DHU). Using the 2021 National Health and Aging Trends Study data, this study compares rural-urban Medicare beneficiaries’ DHU (weighted N=18,729,829). Informed by the Senior Technology Acceptance Model, multiple linear regressions were performed on rural and urban models separately, including DHU, social determinant, and technology readiness variables. Participants in this study were predominantly White, female, and in their 70s. In the final model, men were more likely to use DHU than women in both rural-urban samples (β=.13, β=.08, p<.05, respectively). Tablet access was the only significant device for DHU among rural residents (β=.18, p<.05), while computer access (β=.12, p<.05) was the most significant among urban residents. Online grocery shopping was the most predictive prior technology experience of DHU for rural dwellers (β=.24, p<.05), while online banking led for urban dwellers (β=.21, p<.05). These unique differences between rural-urban samples can inform research on how to specifically design and implement digital interventions to increase rural older adult uptake. Healthcare workers can emphasize similarities between DHU and older adults’ prior technology experience to build perceived ease of use. Expanding opportunities for rural older adults to interact with technology in daily life builds experience which best predicts DHU. Policymakers should consider the impact of locality and involve aging community stakeholders to advance equitable DHU in the digital age.

Critical Factors Influencing Data Use and Utilization in Health Systems: A Focus on Data and Interoperability Standards for Health Information Exchange (HIE) in Uganda’s Healthcare System

Abstract Limited use and utilization of health data in Uganda's healthcare system is influenced by various factors including; absence of standardized data formats, lack of data governance policies, unskilled data management human resources, limited data use culture, poor data quality, complacency, limited political will, and lack of interoperability. Worse still, the existing data interoperability standards majorly designed for developed world health systems, may not be suitable for Uganda, due to differences in health information maturity levels. This paper examines the critical factors affecting data use and utilization in Uganda, specifically focusing on interoperability and data standards. A cross-sectional design was employed in this study in selected health facilities with electronic systems in Uganda. Purposive sampling was used to select sites and participants based on predetermined criteria. The study included 28 health center IVs, referral hospitals, government entities, and eHealth stakeholders. The findings highlight key factors including limited data collection and management systems, poor data quality, inadequate data analysis capacity, absence of data exchange standards, limited technology access, inadequate funding, and deficiencies in data sharing and dissemination. These factors if addressed through data and interoperability standards, can play a pivotal role in promoting efficient and effective healthcare delivery and outcomes in Uganda.

What impacts the acceptability of wearable devices that detect opioid overdose in people who use opioids? A qualitative study.

Drug-related deaths involving an opioid are at all-time highs across the United Kingdom. Current overdose antidotes (naloxone) require events to be witnessed and recognised for reversal. Wearable technologies have potential for remote overdose detection or response but their acceptability among people who use opioids (PWUO) is not well understood. This study explored facilitators and barriers to wearable technology acceptability to PWUO. Twenty-four participants (79% male, average age 46 years) with current (n = 15) and past (n = 9) illicit heroin use and 54% (n = 13) who were engaged in opioid substitution therapy participated in semi-structured interviews (n = 7) and three focus groups (n = 17) in London and Nottingham from March to June 2022. Participants evaluated real devices, discussing characteristics, engagement factors, target populations, implementation strategies and preferences. Conversations were recorded, transcribed and thematically analysed. Three themes emerged: device-, person- and environment-specific factors impacting acceptability. Facilitators included inconspicuousness under the device theme and targeting subpopulations of PWUO at the individual theme. Barriers included affordability of devices and limited technology access within the environment theme. Trust in device accuracy for high and overdose differentiation was a crucial facilitator, while trust between technology and PWUO was a significant environmental barrier. Determinants of acceptability can be categorised into device, person and environmental factors. PWUO, on the whole, require devices that are inconspicuous, comfortable, accessible, easy to use, controlled by trustworthy organisations and highly accurate. Device developers must consider how the type of end-user and their environment moderate acceptability of the device.

Flipping the Script in the New Normal: Investigating the Efficacy of Flip Learning for English Language Learning in University Settings

This research aims to illustrate the capacity of flipped learning to revitalize the classroom atmosphere and promote increased levels of student engagement and enthusiasm within the contemporary post-pandemic educational setting. Employing a mixed-methods approach, it includes surveys and interviews with 100 students from Indonesian universities. The study aims to uncover the benefits and challenges of implementing flip learning in non-English department English classrooms and explore how students perceive this approach. The intervention involved delivering pre-recorded lectures and activities for students to complete before class, followed by in-person activities and discussions to reinforce learning. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data underwent thematic analysis. The results indicate that implementing flip learning for non-English department students at the university level offers several benefits, including enhanced student engagement and motivation, improved short-term learning outcomes, increased student-teacher interaction, more opportunities for problem-solving practice, collaborative learning experiences, and flexible learning pace. However, challenges like increased workload, group activities, limited technology access, and teacher adaptation to new teaching methods may arise. Despite these challenges, the benefits of flip learning outweigh the drawbacks, making it a viable approach for non-English department university students studying English. These findings lay the groundwork for future research to address workload management, effective collaboration, technology accessibility, teacher support, long-term learning assessment, and implementing flipped learning in diverse educational contexts.

Team-based versus technology-based supportive cancer care (SCC): Assessment of implementation across 24 different clinical settings.

1528 Background: Advanced care planning and symptom management, otherwise known as Supportive Cancer Care (SCC), are fundamental services that patients should receive after a cancer diagnosis. We launched a 24-clinic site cluster randomized clinical trial in July 2022 comparing two SCC delivery approaches: a team-based intervention in which patients engage in advanced care planning and symptom assessments with a lay health worker versus a technology-based intervention in which patients receive internet-based SCC education. The preliminary aim of this study is to evaluate clinic characteristics that may impact implementation and effectiveness of these SCC delivery approaches. Methods: We invited study staff at all 24 sites, including community oncology clinics, Kaiser Permanente clinics, Veterans Affairs facilities, safety-net hospitals, and academic centers, to participate in a survey and semi-structured interview. We used Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, and Implementation (RE-AIM) frameworks to assess organizational culture, readiness, facilitators, and barriers to SCC delivery. Surveys were analyzed using descriptive statistics; interviews were analyzed using thematic analysis. Results: Among 30 interview participants across 24 clinics, of which 23 completed surveys, 9 (30%) were clinic principal investigators, 11 (36.7%) were research staff, and 10 (33.3%) were implementation staff. Survey respondents implementing team-based SCC were more confident that their approach: 1) accounted for patient care preferences (93.3%) and 2) had strong evidence (86.7%) than respondents implementing technology-based SCC (62.5% and 25.0% respectively). More respondents implementing team-based SCC expressed confidence in organization leadership (100%) and adequate resources for SCC (86.7%) than respondents implementing technology-based SCC (75.0%). Among interview participants, team-based approaches for SCC delivery were considered more effective, as they could: 1) reduce time burden for clinicians 2) tailor delivery to patient preferences; and 3) increase patient support. Participants believed that team-based approaches would also be more difficult and costly to implement. Barriers to both SCC delivery approaches include: a) limited technology access for patients, b) competing organization priorities which limit staffing and funding for SCC, and c) information overload for patients and caregivers. Conclusions: Implementation of SCC delivery approaches is needed but requires organizational leadership and implementation resources. Team-based approaches are considered more effective, but barriers such as staffing and funding may inhibit the scalability. Implementation evaluations are crucial to understand real-world applicability and scalability of SCC delivery.

Electronic Technologies to Ensure Individual Learning of Education Seekers with Special Needs

This article aims to analyze the utilization of electronic technologies for facilitating individualized education for education seekers with special needs. The study involved 110 teachers from diverse educational institutions in Kazakhstan, each possessing experience in working with students with special needs. Inclusion criteria ensured a variety of grade levels, subject areas, and teaching experiences. Participants, eligible with a minimum of one year's teaching experience and prior work with students with special needs, were surveyed using a specially designed questionnaire. This research provides a comprehensive examination of the challenges faced by students with special education needs, encompassing cognitive, physical, and sensory disabilities. The study explores the role of specialized software, such as text-reading computer programs and speech recognition systems, in enhancing behaviour and positive interactions. The emphasis on adaptive technologies, interactive whiteboards, tablets, advanced training programs, and video platforms reflects the evolving landscape of educational technology for inclusive practices. The findings underscore the significance of electronic technologies, with 87 out of 110 teachers emphasizing the role of special software. Interactive whiteboards, tablets, and advanced training programs were also recognized by a considerable number of participants. Adaptive technologies, altering content based on student needs, were utilized by 81 teachers. While 59 teachers incorporated special video platforms, 48 used communication applications. Conclusions: the study highlights challenges in the provision of individualized education for students with disabilities, including limited technology access, language barriers, cultural insensitivity of electronic tools, and financial constraints. The identified difficulties underscore the need for comprehensive strategies to address these barriers and ensure equitable access to electronic technologies for effective inclusive education. This research contributes valuable insights into the current landscape of electronic technology integration in inclusive education and provides a foundation for future efforts to enhance individualized learning experiences for students with special needs.

Correlations between Social Determinants of Health and Technology Access among Rural African American Alabamians.

Certain populations have been excluded from the benefits of telehealth and the recent advances and widespread use of technology in health promotion due to limited technology access. Although research has identified these specific groups, none has explored these issues using the social determinants of health (SDH) framework. This exploratory study aimed 1) to investigate technology access and 2) to identify associated SDHs. A cross-sectional research design was implemented, and participants were recruited from rural Alabama (N=185). Binary logistic regressions were conducted. Only 60% of participants had technology access. People with food insecurity and health illiteracy were less likely to have internet and PC/tablet access. In addition, older age was associated with a lower likelihood of access to a smartphone. This study provided insights into SDH correlates of the digital divide, particularly among rural African Americans, and indicated that addressing affordability could be a partial solution.

Exploring how cultural and structural elements relate to communal coping for separated Latina/o/x immigrant families

Abstract Family immigration-related separation is incredibly stressful; however, Latina/o/x separated families might engage in communal coping to help mitigate those stressors. Utilizing the extended theoretical model of communal coping, we conducted semi-structured interviews with 20 family triads (i.e., separated parent, separated child, primary caregiver) who were experiencing or had recently experienced immigration-related family separation. We explored cultural and structural elements associated with communally or individually coping, and we considered why family members, all of whom experienced separation stress, might cope differently. Among the different types of family members, gender norms were related to communally coping, relying on extended family for support, and protective buffering. Physical distance, as well as limited technology access and literacy also hindered communal coping. When exploring within-family-triad experiences, three themes were apparent: (a) one-sided communal coping, (b) protective buffering at the cost of one’s own needs, and (c) communal coping impeded by relational strain. Our findings emphasize the importance of considering the multidimensional nature of a stressor (i.e., family separation) when determining whether people are communally coping; how cultural and structural elements relate to coping; and including multiple family members’ perspectives.