Non-judgmental Approach Research Articles

Counseling About Cannabis Use During Pregnancy and Lactation: A Qualitative Study of Patient and Clinician Perspectives.

Legalization in many jurisdictions has increased the prevalence of cannabis use, including during pregnancy and lactation. Accordingly, clinicians providing perinatal and infant care are increasingly required to counsel about this topic, even if they do not feel comfortable or prepared for this conversation. The aim of this research was to explore how prenatal clinicians and pregnant and lactating women interact with cannabis consumption. Using qualitative description, we conducted semi-structured interviews with 75 individuals in Canada: 23 clinicians who provide pregnancy and lactation care, and 52 individuals who made cannabis consumption decisions during pregnancy and/or lactation. Data were analyzed using inductive content analysis. Three phases of the clinical encounter influenced decision-making about cannabis consumption: initiation of a discussion about cannabis, sense-making, and the outcome of the encounter. Patients and clinicians described similar ideals for a counseling encounter about cannabis consumption during pregnancy or lactation: open, patient-centered conversation grounded in an informed decision-making model to explore the benefits, risks, and alternatives to cannabis. While clinicians described these values as reflecting real clinical interactions, patients reported that in their experience, actual interactions did not live up to these ideals. Clinicians and pregnant and lactating people report desiring the same things from a counseling interaction about cannabis: sharing of information, identification of values, and facilitation of a decision. Both groups endorse an open, nonjudgemental counseling approach that explores the reasons why a patient is considering cannabis consumption and reflects these reasons against available evidence and alternatives known to be safe.

Effective components of services for recurrent care experienced parents: A literature review of what works

Recurrent care services aim to reduce the number of repeat removals amongst birth parents who have already ‘lost’ a child through care proceedings. This literature review aimed to identify published evidence about effective components of services to support parents who have experienced repeat removals of their children to care.Searches identified 19 studies that included content relating to the components of service provision within recurrent care services. Across all studies, a range of perspectives were included: birth parents (n = 425); practitioners (n ≥ 151); other professionals (n = 109).The evidence reviewed indicates the importance of relationship-based practice, building a trusted relationship between parents and practitioners, continuity and tenacity in engaging with mothers and a non-judgemental approach. Services should be flexible, holistic and client led, with a long duration of support and a flexible end date. Services should: have a trauma-informed approach; recognise unresolved loss, complex grief and trauma experienced by mothers who have ‘lost’ their children through care proceedings; and provide emotional support, therapeutic support, practical support and advocacy. Services need to have a skilled and multi-disciplinary workforce with robust supervision and ongoing training.

Community recommendations for promoting HIV testing to Black young men who have sex with men in the southern United States.

Considering the need to increase HIV testing among racial minority youth in the southern United States, we conducted an exploratory study in Alabama to elucidate recommendations on improving testing rates among Black young men who have sex with men (BYMSM). We conducted in-depth interviews and focus groups with BYMSM and prevention and outreach workers. Data collection occurred online and in person between 2020-2022. Our sample included data from n = 56 BYMSM and n = 12 prevention and outreach workers. BYMSMs' mean age = 24 years. Among prevention and outreach workers, 58% identified as male with mean age = 39 years; 83% identified as Black. Transcripts were coded thematically; five concurrent themes emerged from both BYMSM and prevention and outreach workers: promoting testing at younger ages, need for visibility and outreach, connecting through shared experiences, value of nonjudgmental approaches, and need to increase HIV knowledge in BYMSM. Findings suggest that cultivating trust is salient to promoting HIV testing in BYMSM. To end the epidemic in the southern United States, a region that is heavily rural with high rates of HIV, it may be necessary to begin prevention conversations at younger ages and equip prevention and outreach workers with communication skills that leverage de-stigmatizing approaches.

Teachers’ perspectives on diverse genders and sexualities in a South African primary school

ABSTRACT How teachers respond to, and interact with, learners of diverse genders and sexualities is critical to ensuring their safe and inclusive schooling experiences. This paper examines the perspectives and responses towards learners of diverse genders and sexualities of a selected group of teachers in a primary school in South Africa. Twelve teachers were interviewed for this qualitative study, and the findings reveal that teachers had a limited understanding of diverse genders and sexualities and mostly held heteronormative and moralistic views. They also considered children as deficient and innocent and were awkward about acknowledging and responding to diverse genders and sexualities with primary school learners. To create a safe and supportive environment for children to understand and construct their genders and sexualities, teachers need to improve their understanding of gender and sexuality, critically reflect on their conservative socialisation and moral judgements, and address their discomfort concerning diverse genders and sexualities among children. Teacher education must prepare teachers in a manner that recognises the complex ways in which gender and sexuality infuse all aspects of learners’ lives. This education should prepare all teachers to adopt a non-judgemental approach to gender and sexuality inclusion in ways that challenge heteronormativity in the primary school.

“This doctor knows shit about you, but the first thing he says is, ‘you need to lose some weight’”: Anti-fat bias and the contradictory effects of fat medicalization in Czech healthcare

ABSTRACT The anti-fat bias that is built on the premised principle antagonism between a fat and a healthy body remains entrenched in healthcare. Despite evidence that being fat is conditioned by many factors beyond a person’s control, fatness is often seen as a result of irresponsible behavior and moral failure and fat patients report being exposed to mistreatment, discrimination, and shaming in healthcare. Drawing on semi-structured interviews and written testimonies, we examine the experiences of people with fat embodiment in Czech healthcare contexts and explore how they approach their health, biomedicine, and weight management. Although obesity specialists are trying to address the weight stigma and create a respectful environment, an anti-fat bias dominates in the rest of the Czech healthcare system. Moreover, even if the medicalization of fatness contributes to reducing weight stigmatization in some contexts, it also reinforces the perception of fat as a medical pathology, which, in turn, creates an obligation for fat individuals to seek biomedical treatment. We identify three strategies that fat people employ to minimize their exposure to weight-based discrimination: avoiding all healthcare contexts; seeking out younger physicians, whom they find to be generally more supportive; and going to great effort to find a doctor with a non-judgmental approach to obesity. In conclusion, we argue for a more well-being-oriented than weight-centered understanding of human health that will go beyond standardized indicators in favor of more personalized care.

Costly, confusing, polarizing, and suspect: public perceptions of plant- based eating from a thematic analysis of social media comments

IntroductionA key approach to fostering more sustainable food systems involves shifting dietary patterns towards increased plant-based eating. However, plant-based eating remains low among Canadians. The objective of this research was therefore to explore public perceptions of plant-based eating in a Canadian context.MethodsA qualitative design was used to analyze social media comments posted on Canadian news source Facebook articles between January 16th, 2019 – July 16th, 2020. Investigating perceptions of plant-based eating on social media may capture a broader sample of the population than can be captured using other qualitative methods. Template analysis, a type of codebook thematic analysis, was used to generate themes and subthemes using NVivo software.ResultsNine articles were selected for inclusion and a total of n = 4,918 comments were collected. Five themes and 19 subthemes related to plant-based eating were generated and presented with quotations. Themes included: (1) The ethics of food; (2) The affordability and accessibility of food; (3) Distrust of food system stakeholders; (4) Beliefs related to dietary behavior, health, and the environment; and (5) Sensory aspects of plant-based proteins.DiscussionFindings suggest that addressing food affordability and accessibility, increasing public food literacy, using non-judgmental approaches, and increasing food system transparency and communication may be strategies to foster plant-based eating. Results of this study provide insight for the development of more effective public health messaging about plant-based eating and help inform future research and interventions to address barriers related to plant-based eating and promote consumption.

Heavy drinkers' expectations and experiences when discussing alcohol use during a general practice visit in Australia: A qualitative study.

Our understanding of community members' expectations and experiences of discussing alcohol use in general practice settings is limited, particularly for people with heavy alcohol use. Qualitative interviews were conducted with people with heavy alcohol use to explore their experiences of discussing alcohol use with their general practitioner (GP). Interviews were audio-recorded and transcribed, and data were analysed using an inductive thematic approach. Three themes were identified: (1) patient perceptions of alcohol discussions in primary care; (2) the importance of the doctor-patient relationship; and (3) consequences of unmet health needs and expectations. Patients expect their GPs to initiate conversations about alcohol use. Positive interactions are characterised by GPs' caring, non-judgemental and collaborative approach, whereas negative interactions focus on a perceived lack of knowledge or ability to manage excessive alcohol use. Alcohol harm reduction efforts should include strategies for bolstering the therapeutic relationship between GPs and their patients.

Understanding the impact of a residential housing program for people living with HIV/AIDS: results from a realist evaluation

BackgroundIn Canada, the Public Health Agency surveillance of new HIV cases has demonstrated annual increasing rates since 2020. The rates of new HIV cases are highest in the province of...

“CLIMBING IS MY WEAPON” – A PSYCHOSOCIAL BOULDERING INTERVENTION FOR ADOLESCENTS AND ITS IMPACT ON THE PSYCHOLOGICAL WELL-BEING OF ADOLESCENTS IN LEBANON

INTRODUCTION AND AIMS Previous research highlights the positive effects of physical activity, also climbing therapy, on mental health, including benefits on depression and self-esteem. Recognising the mental health challenges faced by young people in Lebanon, particularly in the context of multiple crises and forced displacement, this interventional study explores the benefits of a psychosocial climbing programme in eastern Lebanon. METHODS In collaboration with the non-profit organisation ClimbAID, this waitlist-controlled, partially randomised, mixed-methods study examines the effects of an eight-week psychosocial bouldering group intervention on overall mental well-being, levels of psychological distress, self-efficacy and social cohesion among a group of host and refugee youth in the Bekaa Valley. Qualitative interviews with 40 participants provide insights into their experiences, lessons learned and subjective outcomes. The intervention, delivered by 2 trained facilitators and up to 2 volunteers, took place weekly for 2 hours with groups of up to 12 young people. RESULTS With 233 participants, the trial had a dropout rate of approximately 33%. The intervention group showed significant improvements in overall mental well-being and psychological distress compared with the waitlist groups. Group allocation was the only significant predictor of improved mental well-being, in addition to baseline scores. While no significant differences in self-efficacy and social cohesion were observed, qualitative analysis revealed that participants highly valued the non-judgmental approach, highlighting significant benefits in interpersonal relationships and mental well-being. CONCLUSION In the challenging humanitarian context of forced displacement, the psychosocial bouldering intervention effectively enhanced well-being and reduced psychological distress among host and refugee youth in Bekaa, Lebanon. As a group intervention, bouldering emerges as a valuable option for supporting host and refugee populations in low-income countries.

A qualitative study on the health system-related needs in women survivors of rape

BackgroundRape, as an adverse incidence, leads to irreparable complications and consequences in women. Provision of health services to women survivors of rape requires catering for their real needs and identifying current deficits as well as barriers. The present study aimed to explore health system-related needs in women survivors of rape.MethodsIn the present qualitative study, the participants consisted of 39 individuals, including 19 women survivors of rape and 20 individuals with work experience in providing services to women survivors of rape. The participants were selected using the purposive sampling method with a maximum variation in Isfahan, Iran. Data were collected through in-depth interviews as well as field notes and were concurrently analyzed via conventional qualitative content analysis method.ResultsAfter analyzing the interviews, the health system-related needs of women survivors of rape were classified into two main categories: 1- The need for efficient medical care services with three sub-categories, namely “receiving services with respect for privacy and confidentiality”, “non-judgmental behavior and approach”, and “the need to receive empathy and the feeling of not being alone”, and 2- The need for desirable conditions and structure to provide services with two sub-categories, namely “the need to receive comprehensive and integrated services”, and “establishing specialized centers for providing services to survivors”.ConclusionsOverall, explaining and highlighting the health system-related needs of women survivors of rape could provide a suitable basis for policy-making and planning according to their real needs. Receiving continuous services in separate centers with confidentiality and empathy could reduce the worries and concerns of women survivors of rape and help improve their health.

Lived experiences of mental health nurses who care for clients who are parents: An approximation of Tronto's definition of care.

Adult psychiatric services typically focus on the mental health needs of the client but they do not support his or her parenting role. Many authors highlight the importance of a non-judgmental approach when providing support and care to clients with mental illness who are parents. Assessments frequently focus on the negative aspects while the strengths of these families were often overlooked. There is a lack of scientific literature exploring nurses' experiences when caring for parents with mental illness and their families. Trust is the basis that helps clients to be open to receiving care and answering parenting-related questions. Therefore, without adequate professional-client trust, some care and interventions addressed to parents with mental illness could be poorly received by the client. Tronto's phases of care facilitated the collection of data and exploration of mental health nurses' experiences of care. Mental health nurses should be aware of the potential needs of these families, as described in the scientific literature, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique. Mental health nurses must take the person's environment into account (family, social and political aspects and different forms of stigma) since all these factors may influence how parents with mental illness receive and provide care. Introduction Many authors highlight the importance of a non-judgmental approach when providing care to parents with mental illness. However, assessments frequently focus on the negative aspects while the strengths of such families were often overlooked. Aim To explore the lived experiences of mental health nurses who care for clients who are parents. Method We conducted a qualitative phenomenological study. The main data collection technique was in-depth interviews. Data were analysed according to Colaizzi model, subsequently, the main categories that arised were compared and related to the five phases of Tronto's care. Results The main categories identified from the analysis of the interviews were: (1) individualized care, (2) continuity of care, (3) psychoeducation and counselling, (4) trust and (5) context of the client. Discussion Trust is the basis that helps parents with mental illness to be open to receiving care and answering parenting-related questions. Without trust, some interventions could be poorly received by the client. Implications for Practice Mental health nurses should be aware of the potential needs of these families, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique.

‘It’s a struggle’ – the role of the school Health and Well-being Lead in supporting families in poverty

This article explores one primary school’s response to addressing poverty experienced by children and families, within a post-Covid context. It draws on a small-scale qualitative case study exploring the role of the Health and Well-being Lead (HWBL) in a primary school in a relatively affluent market town in the south-east of England. A psychoanalytical approach was taken to understand the data drawing on the researchers different situated experiences and knowledges. Participants included children, parents and staff at the school. All parent participants shared their financial challenges, which they referred to as ‘struggles’, with many relating to the impact of the cost of living and adverse unexpected events. Staff raised concerns about how cuts to support services and funding for schools had contributed to and exacerbated challenges due to long waiting lists and a lack of early intervention. The role of the HWBL was recognised by both parents and staff as an important resource within the school. Integral to this role was a non-judgemental and empathic approach, which created an open and trusting relationship with parents. Despite the apparent success of the role, it was evident that the workload and the increase in ‘struggles’ experienced by families was having an impact on both the HWBL and other staff. While we acknowledge that such a role could benefit other schools, we argue that this will only be successful and sustainable if the government also addresses the need for early intervention, funding and the workload crisis in children’s services and schools.

Substance use and sexual identity: health disparities in NYC sexual health clinics

ABSTRACT Background The prevalence of alcohol and other drug (AOD) use among lesbian, gay, and bisexual (LGB) adults is well documented; less is known about rates of unhealthy AOD use that could escalate into substance use disorders. Methods In a retrospective sample of 11,278 patients seen in New York City Sexual Health clinics, rates of unhealthy AOD use were compared by sexual identity (i.e., gay/lesbian, bisexual, and heterosexual). Results Patients who identified as LGB reported higher rates of unhealthy AOD use than patients who identified as heterosexual. Patients who identified as bisexual reported the highest rates of AOD use. Conclusion Findings are consistent with existing research on LGB health disparities. Healthcare providers can use non-judgmental approaches to elicit information from clients about sexual orientation, sexual health, and substance use. Implementing SBIRT in school and community settings addresses these behaviors without contributing to stigma.

'It is important to feel invited': what patients require when using the Utrecht Symptom Diary - 4 Dimensional, a qualitative exploration.

In palliative care, the Utrecht Symptom Diary - 4 Dimensional (USD-4D), a Dutch-adapted and validated patient-reported outcome measure, supports multidimensional symptom management through identification and monitoring of, as well as dialogue on symptoms and needs. For the USD-4D to optimally support patients' autonomy, it is essential to know what patients need to use it. This study aims to identify what patients need when using the USD-4D in clinical palliative care. A generic qualitative design with primary and secondary analyses of semistructured interviews. Patients ⩾18 years with a life-limiting illness were purposefully recruited within hospice and home care settings if they were in their last year of life as identified by the surprise question. Patients had to be aware of their life-threatening condition. Patients were selected in two tranches. In the first tranche, patients had to have completed the USD-4D at least once. The second tranche consisted of patients who were not familiar with the USD-4D in clinical practice and were interviewed in a previous study on the content validity of the USD-4D. The interviews were transcribed verbatim and were subjected to thematic analysis. Twenty-five patients were included (14 men, ages 44-87). Patients' needs when using the USD-4D were summarized in three themes: (1) feeling invited, (2) being aware of the purpose and function of the USD-4D, and (3) experiencing a personal and nonjudgmental approach. For patients to optimally benefit from the USD-4D as a supportive measure of their autonomy in clinical palliative care, it is essential that they feel invited to use it. Healthcare providers are tasked with setting the right preconditions for patients to want and to be able to use the USD-4D. For patients, this means healthcare providers should always be attuned to their personal preferences when communicating the purpose and function of the USD-4D and when they enter into dialogue with them.

Knowledge of Maternal Mortality Risk Among Women with Substance Use Disorders during Pregnancy and Postpartum.

The purpose of this study was to investigate knowledge of maternal mortality risk of women with substance use disorder in the perinatal period. This study was conducted using a qualitative descriptive design. Participants were recruited from a residential substance use treatment center in a rural Midwestern city. We used semi-structured interviews during which participants described their understanding of maternal mortality risk and their related experiences. We analyzed the transcribed interviews using content analysis to yield themes and subthemes. Sixteen women participated. Three main themes were identified: Women with substance use disorder lack understanding of maternal mortality; Women with substance use disorder experience barriers to perinatal care; and Women with substance use disorder have additional risk factors for maternal mortality. Nurses can use validated screening tools, offer brief interventions, and refer women to appropriate substance use disorder treatment and mental health resources. Nurses must educate women with substance use disorder about their risk for maternal mortality as well as the signs and symptoms of perinatal mood and anxiety disorders. Nurses should provide education about the access and use of naloxone. A non-judgmental and trauma-informed approach should be used during interactions with this population.

Stigmatizing and inaccessible: The perspectives of female sex workers on barriers to reproductive healthcare utilization - A scoping review.

To systematically map the extent, range and nature of qualitative studies that explored female sex workers' own perspectives on barriers to accessing reproductive healthcare services. A scoping review of the literature utilizing Arksey and O'Malley's method. A search of the electronic databases MEDLINE/ PubMed, PsycNET, Sociological Abstracts, ProQuest, ScienceDirect, HeinOnline, Scopus, Web of Science and Google Scholar was conducted for items published in English between 2001 and 2021. Twenty-one studies were included in the review, the majority of which were conducted in lower-middle-income countries. RHC themes studied were diverse, with a few more studies focusing on STI/HIV, contraceptive use and pregnancy than those focusing on childbirth and postnatal care. The findings indicate barriers in four main domains: socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. Stigma was a major multifaceted barrier. Female sex workers experience exclusion in utilizing reproductive healthcare services globally. As such, healthcare services are advised to adopt a nonjudgemental approach, to enhance physical accessibility and to train nurses and other healthcare professionals on reproductive health needs of female sex workers. Finally, knowledge production processes on the RHC of FSW should adopt a holistic view of FSW, by exploring their needs and barriers related to childbirth and maternity care and by including the perspectives of FSW in high-income countries. The review offered an in-depth understanding of female sex workers' own perspectives regarding needs and barriers in utilizing reproductive healthcare services. Findings indicated socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. The review could inform the training of nurses and other healthcare professionals in reproductive healthcare services globally. Researchers should adopt a holistic view of female sex workers, by exploring their family planning needs, including barriers related to childbirth, maternity and postpartum care. We adhered to the EQUATOR guidelines PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.

Bodies, beauty, brands: Professional, personal and everyday life online

This article focuses on two successful Italian web personalities who work in the beauty industry and embody the overlapping between business and public identity. Clio MakeUp (Clio Zammatteo, @cliomakeup) and Estetista Cinica (Cristina Fogazzi, @estetistacinica) are two professionals whose success and personal histories are similar and different at the same time. Coming from low-to-middle-class backgrounds, they are both ‘self-made-women’ who managed to build two beauty enterprises (a make-up brand of the same name, the former; a skincare and beauty brand, VeraLab, the latter) tightly intertwined to their public personas. In both cases their business’ success is strictly connected to two loyal online communities: Clio Zammatteo built her whole career around her online presence, starting in 2008 as the first successful Italian make-up YouTuber, reaching a large community way before she entered the beauty business with her make-up brand; Cristina Fogazzi worked her way from beautician to businesswoman, and successfully used Instagram to communicate her brand and personal philosophy, conquering a large and engaged community of followers and customers. This article will address Zammatteo’s and Fogazzi’s interconnected personal and professional identities from different perspectives. First, I will explore how they put themselves and their own non-conforming bodies at the centre of a communication strategy that defies conventional beauty standards and constantly connects their social media presence to their brands’ body-positive and non-judgemental approach. Second, I will focus on the habit of sharing their everyday life to reinforce their public personas and their brands. Third, I will analyse how their fashion choices intersect their media presence and the conversation about normative appearance, and how they resonate with their respective communities. Finally, building on the recurring presence of their domestic space on social media, I will investigate how both Zammatteo and Fogazzi negotiated their presence, bodies and personal spaces online during the pandemic.

Pilot Test of Mopati, a Multi-Level Adherence Intervention for People Living with HIV and Their Treatment Partners in Botswana

BackgroundLow-cost, scalable strategies are necessary to reach the UNAIDS 2030 target of ending HIV as a public health threat. Use of treatment partners, informal caregivers selected by people living with HIV to support antiretroviral therapy adherence, is one such strategy that is included in many countries’ HIV guidelines, including Botswana, a country with high HIV prevalence.MethodFrom June 2021 to June 2022, we pilot tested a clinic-based treatment partner intervention (“Mopati”), including standardized language for providers to guide patients on treatment partner selection and workshops to train treatment partners on providing non-directive support to patients using a non-confrontational, non-judgmental approach. Sixty unsuppressed patients (30 per clinic) and 45 treatment partners (17 intervention, 28 control) were recruited from an intervention–control clinic matched-pair in Gaborone, Botswana.ResultsMopati had medium-to-large effects on increasing patients’ adherence, adherence self-efficacy, intrinsic adherence motivation, and perceived non-directive support from treatment partners, and decreasing treatment partner caregiver burden. Aggregate viral suppression rates significantly increased in the intervention (vs. control) clinic. Qualitative data from 14 clinic staff, 21 patients, and 16 treatment partners indicated that Mopati was viewed as effective. Providers said the guidance empowered them to be proactive in communicating about adherence; most reported using the guidance.ConclusionThis study shows preliminary support for the use of treatment partners in HIV care, and further evidence for interventions that leverage patients’ existing support. This research can inform ways to improve adherence to HIV treatment as well as the treatment of HIV-related comorbid conditions in lower-resource settings.Trial RegistrationClinicalTrials.gov Identifier: NCT04796610.

“I think most people feel like healthcare professionals tell them to take their treatments and judge them for not taking them”: reflexive thematic analysis of the views of adults with cystic fibrosis on how treatment adherence is discussed in healthcare

Objective Previous research exploring patient-practitioner communication in relation to adherence in cystic fibrosis (CF) is limited. This UK study explored the views of adults with CF on how treatment adherence (related to all CF treatments) is discussed in routine CF care. Methods 12 White British adults (ten females; aged 20–37 years; mean 30.1 years) with CF participated in semi-structured interviews. Results Three overarching themes were developed through reflexive thematic analysis: (1) ‘The power of language’; (2) ‘Healthcare professionals do not recognise the importance of context’; and (3) ‘“Admitting” non-adherence is difficult’. The way in which adherence is discussed in adult CF care is viewed as paternalistic and infantilising. Participants reported that healthcare professionals do not always consider the desire to balance treatment-taking with living a normal life. Unwelcome responses from healthcare professionals, and the inability to accurately self-report the amount of treatment taken made it difficult to ‘admit’ non-adherence. Conclusions A culture change is needed in CF care such that people who struggle to take their treatments are not labelled as disobedient, wilfully disobeying orders from healthcare professionals in positions of authority. Instead, an open, honest, non-judgemental approach, as recommended by healthcare agencies for over a decade, should be adopted.

How do medical students without formal training in empathy development understand empathy in the context of patient care?

Background
 Empathy is a crucial component of clinical practice and professionalism. Quantitative studies have reported empathy erosion in medical students. However, studies investigating medical students' perspectives on their understanding and behavioral expressions of empathy with patients are limited.
 Objective
 This study aimed to explore medical students' perspectives on the nature, significance, and expressions of empathy during their undergraduate training.
 Methods
 The study used a qualitative phenomenological approach. Twenty-five medical students (out of a total of 45) were invited to participate. Semi-structured online interviews were conducted to elicit experiential details from participants. The recorded interviews were transcribed verbatim, and data were analyzed using Braun and Clarke's thematic analysis method.
 Results
 Students described their beliefs and understanding about empathy and reflected on the process of empathizing with patients. Most students defined empathy as having four interrelated and overlapping dimensions: cognitive, affective, behavioral, and moral. In addition, they believed that empathizing with patients was a bidirectional relational process, necessitating empathic inclination, adequate time, a non-judgmental approach, and effective communication and listening skills.
 Conclusion
 Empathy is more than a personal attribute; it is a multi-faceted, dynamic, and bidirectional relational process. Adequate time, support, stress management strategies, formal training, and encouragement from experienced teachers are crucial elements to fostering genuine or deep empathy in medical students. In addition, students should be trained in developing emotional regulation and maintaining an appropriate balance between professional detachment and empathic connections.