Ecological Momentary Assessment (EMA) presents a promising method to study short-term occurrences and trajectories of suicidal thoughts. This study analyzed the feasibility of using intensive EMA to assess suicidal thoughts among adolescent psychiatric inpatients in Germany. Fifty-one adolescents (12-18 years old, 74.5% female) participated in 7 days of EMA data collection during their psychiatric inpatient stay. Participants reported on momentary feelings, including suicidal thoughts, via a lent smartphone 7 times per day. In addition to a baseline meeting, adolescents attended a follow-up meeting to collect quantitative and qualitative data about their experiences of participation. Quantitative and qualitative results show a high adherence rate (i.e. percentage of answered surveys) of 78.6%, a high average satisfaction with participation, and a low average perceived burden of participation. Several participants cherished the opportunity to self-reflect and to understand current emotions by answering questions about momentary feelings frequently. However, seven adolescents (13.7%) reported an increase in negative emotions and two adolescents (3.9%) indicated an increase in suicidal thoughts after responding to the EMA surveys. These findings suggest negative emotional reactivity among some adolescents and considerable interindividual differences in emotional reactivity to EMA surveys in general. Future studies may elaborate on potential safety concerns for participants and identify which adolescents benefit from or experience distress after reporting on momentary suicidal thoughts frequently.

Equity, diversity, and inclusion (EDI) are increasingly emphasized in clinical research, yet practical guidance for applying inclusion principles across all clinical trial stages remain limited. Qualitative research can help address this gap by exploring participant experiences and identifying barriers to inclusive trial conduct. The aim of this review is to map guidelines and recommendations in relation to inclusive trials methodology and to identify areas across these resources that can be potentially informed by qualitative research. This review presents Phases 1 and 2 of the QuAlitative reSearch Supporting IncluSive Trials (Q-ASSIST) study. In Phase 1, we conducted a focused mapping review and synthesis (FMRS) of publicly available guidelines related to Phase 3 and later clinical trials involving human participants. Eligible guidelines included those offering recommendations to enhance inclusive trial design and conduct. Each guideline was mapped to a priori data extraction framework informed by the Standard Protocol Items: Recommendations for Interventional Trials and Consolidated Standards of Reporting Trials 2025 guidelines. We then performed a narrative synthesis to examine the EDI focus of the selected guidelines and structured the findings according to the PRO-EDI Framework. In Phase 2, we juxtaposed the trial stages identified through our FMRS with O'Cathain et al's framework of qualitative research in trials. We identified 15 guidelines through FMRS. Through conceptual mapping to Standard Protocol Items: Recommendations for Interventional Trials and Consolidated Standards of Reporting Trials headings, we developed a 12-stage trial lifecycle framework (the Q-ASSIST trial stages model) to organize inclusion guidance. Most guidelines emphasized early stages of trials, with later stages less frequently addressed. Mapping to the PRO-EDI framework showed strong attention to race/ethnicity, gender, socioeconomic status, and disability, but limited focus on sexual identity, education, or intersectionality. Juxtaposition with O'Cathain et al's framework highlighted similar gaps in how qualitative research has been used, especially in later trial stages. Current inclusion guidance is concentrated in the early stages of trial design, with limited attention to later trial stages. Qualitative research offers a valuable way to address these gaps by capturing participant perspectives and supporting inclusive practices across the trial lifecycle. This review provides a foundation for developing practical tools to guide more inclusive trials, with the next phase involving coproduction of guiding principles with interest holders.

"I've never had anyone listen to my story like that": Understanding the social validity of biographical mapping as an intake process in the context of personalized exercise programming.

Many patients with persistent musculoskeletal pain have difficulty maintaining physical activity (PA) long-term following pain management programmes (PMPs). We conducted a qualitative study to explore the barriers and facilitators to maintaining PA long-term after PMPs. We also explored PA patterns that describe trajectories of activity since PMP completion. One researcher conducted semi-structured interviews with 24 people with persistent musculoskeletal pain that completed PMPs, seven partners/spouses of these patient participants, and eight healthcare professionals working on PMPs. The healthcare professionals included four physiotherapists, two occupational therapists and two psychologists. Data were analysed using reflexive thematic analysis and the findings were mapped to the Theoretical Domains Framework. Five themes were generated: (1) Internal drivers for PA maintenance, (2) Fitting PA into life, (3) Symptoms and symptom management, (4) Social networks and influences and (5) Environmental influences. The findings were mapped onto 13 of the 14 Theoretical Domains Framework domains. Four PA patterns were constructed from participants experiences of PA maintenance: (1) Consistently active, (2) Initially consistently active post-PMP but then inconsistently active, (3) Inconsistently active since PMP and (4) Same or a reduction in PA level since the PMP. The findings can inform the development of an intervention to support PA maintenance following PMPs; the intervention can address barriers and facilitators and be tailored to different PA patterns.

This study is motivated by the important role of the family in maintaining and strengthening spiritual values among adolescents of belief communities amid the currents of modernization and social marginalization. The purpose of this research is to understand the meaning of family strategies in reinforcing spiritual values among adolescents who adhere to belief systems in God Almighty. This study employs a qualitative approach with a phenomenological design to explore the lived experiences of participants in depth. Data were collected through in-depth interviews, observation, and documentation involving families from belief communities. The findings reveal that family strategies are implemented through habituation, role modeling, open communication, and value protection, which are interpreted as conscious efforts to maintain adolescents’ spiritual identity. Spiritual values are transmitted not only verbally but also through daily practices directly experienced by adolescents. The implications of this study emphasize that families play a central role as primary agents of socialization in shaping adolescents’ spiritual resilience, particularly within minority contexts, thus highlighting the need to strengthen the role of families in addressing evolving socio-cultural challenges.

Food Is Medicine (FIM) programs integrate interventions such as medically tailored meals or produce prescriptions into clinical care. However, there is limited evidence on how to design these programs to be responsive to the lived experiences of participants to optimize initiation, engagement, and long-term retention. The objective of the study was to develop interventions to promote initiation, engagement, and retention in FIM programs that are responsive to the lived experiences of participants. We used a human-centered design approach to engage current and former cardiac rehabilitation participants in the development of interventions to promote participation and engagement in a FIM program. We recruited participants through invitations sent via electronic health record messages. We interviewed participants about their experiences, preferences, and unmet needs related to healthy eating and program design. Additionally, we elicited participant feedback on draft versions of patient navigator scripts and text messages promoting healthy eating habits. A total of six participants identified themes across Theory of Planned Behavior constructs and emergent themes, including the cost of healthy food, cultural appropriateness, clear and timely communication, transportation, local food access, scheduling flexibility, the ability to provide feedback to the program, and personalized support for navigating food resources. Participants described financial strain as a key barrier to healthy eating and noted that social influence often shaped eating behaviors. Feedback on navigator scripts led to revisions clarifying program logistics, addressing barriers such as language and cultural dietary restrictions, and tailoring positive endorsements to individual health goals. Based on participant feedback, text messages were made more concise, reframed positively (eg, humor and gratitude), and encouraged to be warmer, with respectful language that is easy to understand, while avoiding stigmatizing or overly clinical phrasing. Participants also suggested that messages should reflect empathy and offer actionable information to increase trust and engagement with the program. Trust in the health care system and a sense of dignity in receiving food support emerged as critical themes influencing overall satisfaction and retention. Participants emphasized that endorsement from their health care team and cardiologist was important for building trust in the program. Communication between health care navigators and FIM navigators could help reduce the burden placed on patients to navigate food resources. Using a human-centered design approach, we gained insights about participant-identified needs for navigation scripts and text messages that are culturally sensitive and personalized to promote optimal participation in a FIM program.

This study explored experiences of Relational Accommodation (RA) for caregivers and significant others living with an adult with Body Dysmorphic Disorder (BDD) and how they respond to BDD symptoms. BDD is under-researched. In paediatric and/or obsessive-compulsive populations, RA has been found to negatively impact the lives of caregivers. To date, very little is understood about RA in caregivers for adults with BDD and how this impacts the phenomenology of BDD. Given the high suicidality rates in BDD populations, and somewhat conservative treatment outcomes, a greater understanding is needed. Eight caregivers, recruited from a BDD research conference and online support groups, were interviewed online about their experiences cohabiting with a loved one with BDD. Interviews were transcribed and subject to Interpretative Phenomenological Analysis (IPA). Four Group Experiential Themes were interpreted from participants' accounts: RA occurs in the context of Distress; RA and Self-concept are intertwined; Relational Gains and Losses; and Understanding of RA and BDD changes over time. Participant experiences of RA mirrored the OCD and/or paediatric BDD literature confirming the importance of this experience in BDD and extended existing knowledge by highlighting nuanced differences specific to being a caregiver of an adult with BDD. Improved parent- and clinician-specific guidance around RA and parent peer support groups should be considered. Future research should seek to recruit a more diverse representation of the adult caregiver experience, including that beyond the parent-child dynamic.

Abstract Objectives This review examined why personal mindfulness practice is regarded as foundational for teachers delivering mindfulness-based interventions (MBIs), particularly Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR). Although professional standards mandate sustained personal practice, empirical findings linking teacher competence or embodiment to participant outcomes remain inconsistent. The review aimed to synthesise evidence examining relationships between personal practice, embodiment, teaching competence, and participant outcomes. Method A systematic search of PsycINFO, MEDLINE, PubMed, Web of Science, and CINAHL was conducted for studies published between 2010 and 2025. Eligible studies examined teacher-related variables within MBCT or MBSR. Quantitative, qualitative, mixed-methods studies, and professional guidelines were included. Data were synthesised using a narrative synthesis approach due to the heterogeneity of designs, measures, and outcomes. Results Seventy-two publications met inclusion criteria. Quantitative studies reported mixed associations between assessed teacher competence and clinical outcomes. In contrast, qualitative studies consistently emphasised teacher embodiment, relational presence, and authenticity as central to participant experience. Mixed-methods and training studies suggested improvements in teacher interoceptive awareness and emotional regulation following extended training, although links to participant outcomes remained unclear. Conclusions While direct associations between teacher competence and symptom change remain inconsistent, converging evidence supports prioritising personal practice as foundational for cultivating embodiment and relational presence. These qualities appear central to ethical and effective teaching and warrant continued emphasis in mindfulness teacher training and future research. Preregistration This study is not preregistered.

Abstract Empirical studies show that participation in primary schools improves the well-being, development, and skills of children with and without Special Educational Needs (SEN). However, it remains unclear to what extent children’s experiences of participation vary across (diverse) SEN and non-SEN groups and school types. The present study ( n = 147) addresses this research gap using qualitative interviews conducted in German primary schools and analyzed via a Grounded Theory approach, supplemented by descriptive quantitative analyses to capture the prevalence of children’s experiences of participation. The findings show that some children experience everyday school life as externally controlled and report that teachers normally decide learning content, tasks, and organizational processes. This is reported particularly often by children with SEN (SEN, i.e. intellectual development, learning, and social-emotional development) who attend special schools (71%). Furthermore, some children view participation as unfair, seeing it as favoring certain individuals. In creative learning contexts, some children report only limited opportunities for participation, particularly children (with or without SEN) in mainstream schools (45%). These children interpret a lack of participation as unjust. By contrast, in so-called “democracy schools”, which focus on child participation, 80% of children report extensive opportunities to get involved. There, teachers are described as learning facilitators, and participation is understood as fair and self-evident. Yet such participation is also experienced as challenging, particularly by girls and by children with SEN. The findings have implications particularly with regard to children’s rights and the structural exclusion of children with SEN.

Abstract Aims Diabetic macular edema (DME) is a leading cause of vision loss among individuals with diabetes. While anti‐VEGF therapy is a widely used and effective treatment, limited research has explored participants' lived experiences throughout the treatment process. Methods This qualitative study summarizes findings from longitudinal interviews conducted at 4 and 12 months after initiating intravitreal anti‐VEGF therapy. The analysis focused on participants' emotional, physical and psychosocial responses to treatment. Results An overarching theme, ‘health, hope, and worry’, captured the ambivalent experiences of participants. Two main categories were identified: ‘hope and anxiety during injection treatment’ and ‘uncertainty and variation in visual outcomes’. Participants described a spectrum of physical discomfort and emotional reactions, influenced by expectations, bodily sensitivity and clinical context. Trust in healthcare providers, consistent care and adequate information were crucial for emotional resilience. Perceived treatment effectiveness varied, with some experiencing significant visual improvement and regained independence, while others reported little or no change, leading to frustration and anxiety about future vision. Conclusions Anti‐VEGF treatment for DME is experienced not only as a clinical intervention but as an emotionally and physically complex journey. Participants' navigate fluctuating levels of hope and worry, shaped by their bodily experiences, emotional responses and expectations of outcomes. These findings highlight the need for empathetic communication, consistent care and individualized support to promote adherence and mitigate emotional distress. The insights from this study are especially relevant for multidisciplinary diabetes care teams.

ABSTRACT Objective Mental health concerns, such as depression and anxiety, are common among individuals living with neurological disorders (NDs). Internet-delivered cognitive behavioural therapy (iCBT) offers a promising, accessible treatment option, yet participant experiences with such interventions remain underexplored. This study explored user perspectives on the Wellbeing Neuro Course, an iCBT programme designed to address both mental health and functional challenges in adults with NDs. Method Qualitative responses of 165 past iCBT participants (M = 54.0 years, SD = 12.1; 79.4% female) diagnosed with epilepsy (17.0%), multiple sclerosis (38.2%), acquired brain jury (23.6%) and/or Parkinson’s disease (21.2%) were analysed. Data were drawn from open-ended responses on the Treatment Satisfaction Questionnaire and analysed using NVivo to identify categories related to liked and disliked aspects of the Course, as well as suggestions for improvement. Results Key categories included appreciation for Normalising Wellbeing Concerns and Related Psychological Skills Practice and the Practical and Relevant Core Skills. The most common criticisms related to Course Format, with suggestions focusing on improving Course Content and Delivery. Conclusion Consultation feedback suggests future intervention refinements should prioritise enhancing the intervention delivery.

ABSTRACT Indians have formed transnational communities with not only an active economic life but also active social and civic lives in Saudi Arabia. In this interview and focus-group-based study, I attempt to answer: How do Indians perceive their belonging in Saudi Arabia? By asking questions related to associational engagement, community engagement, and recent reforms to my participants, I learn about their lived experiences and perceptions that contribute to their sense of belonging and alienation in their host nation. The findings reveal that the Indian population in Saudi Arabia constantly lives in a paradoxical flux. While their attachment to certain spaces of belonging in the host country, the presence of their family, their active civic life, and shared culture contribute to their denizenry, the geographic divide (i.e. the concentration of Hyderabadis in certain localities), their use of ‘us’ and ‘them’ language, and their placement in the recent reforms indicate their separation from the citizen population. Through these findings, segregated denizenship emerged as a concept that most adequately explained the status and lived experiences of my participants in their host country.

The relevance of this study arises from Mongolia’s emerging retail investment landscape, where public participation in the stock market remains limited. The insufficient understanding of individual investment behavior complicates efforts to enhance financial inclusion. Examining socio-demographic and behavioral characteristics helps identify the incentives and constraints shaping investment decisions and strengthens the foundation for long-term financial culture. The purpose of the study is to provide a comprehensive assessment of how socio-demographic and behavioral factors influence both the likelihood of participating in the stock market and the amount invested, as well as to clarify the mechanisms through which differences in investment behavior emerge. Objectives. The objectives include evaluating the effects of gender, age, household size, and income on the probability of purchasing stocks; assessing how investment horizon, education, prior experience, and specialized training affect investment amounts; and comparing model specifications to identify stable determinants of investment activity. Methodology. The methodology relies on a dataset of 868 respondents collected over sixteen days, of whom 519 were identified as active investors. A probit model is applied to estimate participation probabilities, while a Tobit model examines the determinants of investment amounts. Results. The findings show that gender, age, household size, and income significantly influence participation decisions, whereas income, gender, investment horizon, education, experience, and training strongly increase investment volume. Conclusions. The study highlights the need to expand financial education, strengthen practice-oriented training, and promote long-term planning as key measures to increase public engagement and support the development of a more robust investment environment in Mongolia.

Latinx/a/o students make up almost half of the California Community College system’s population. However, Latinx/a/o students account for about 15% of three-year completion rates (certificate, degree, or transfer). In support of student success strategies, the literature describes the role of counselors, as importantly, it explains how counselors help students navigate the complexities of higher education. This mixed-methods study investigated how community college counseling practices and services are perceived by Latinx/a/o students; and identified which of those practices and services best supported the success of this student population. Key findings included the importance of counseling services, as well as preferred counseling appointment logistics and topics for discussion. Additionally, both positive and negative participant experiences with counseling were presented. Findings seem to suggest that proactive/intrusive counseling, appreciative advising, and culturally responsive counseling theories are particularly helpful for the study’s population. Recommendations informed by key findings were noted for community college counselors, counseling department deans, and vice-presidents.

Individuals with advanced cancer face profound daily disruptions, yet research specifically focusing on their personal participation experiences remains limited. This study aimed to explore the daily life experiences and participation perceptions of advanced-stage cancer patients receiving palliative care. Semi-structured interviews were conducted with eight patients, and data were analyzed using reflexive thematic analysis. Four themes were identified: (1) dependence in activities of daily living and loss of function, (2) altered occupational identity and social participation restrictions, (3) occupational disruption and longing for the past (4) the role of support systems and care services. Participants emphasized that social isolation, unmet rehabilitation needs, and the loss of meaningful roles affected them as much as physical symptoms. The findings suggest that maintaining occupational identity is a vital need, distinct from mere functional ability. Consequently, there is an urgent need for patient-centered rehabilitation services within palliative care settings to address these fundamental humanistic needs.

Background: Mental health disorders are a growing global crisis, disproportionately affecting vulnerable populations with limited access to care. In Zambia, services remain predominantly biomedical, under-resourced, and lacking formalized psychosocial interventions. Support groups, grounded in group psychotherapy and peer support theory, have shown promise in reducing symptom severity and improving quality of life. Aim: This study examined the effectiveness of mental health support groups on clinical and functional outcomes within this context. Methods and Materials: A prospective cohort study design was used to examine the effectiveness of mental health support groups. A total of 263 participants from 21 groups were assessed at baseline and nine months using the alcohol use disorder identification test (AUDIT), Patient health questionnaire 9 items (PHQ-9), and world health organization quality of life brief (WHOQOL-BREF). Non-parametric analyses and regression models were applied to evaluate changes in symptom severity and predictors of wellness outcomes. Results: Symptom severity significantly decreased from baseline (M = 3.992, SD = 0.829) to follow-up (M = 2.209, SD = 1.691), with a large effect size (rrb = .888). Attendance correlated weakly but significantly with symptom reduction, while facilitator type showed minor associations with quality of life (p = 0.05). Regression analysis identified symptom severity at follow-up as the strongest predictor of wellness outcomes. Structured support groups demonstrated therapeutic value in reducing distress and enhancing coping. Conclusion: Findings highlight the need for tailored interventions for individuals with persistent high severity and suggest that integrating support groups into primary care could strengthen Zambia’s mental health system, reduce stigma, and expand access to psychosocial support.

Introduction Physical literacy (PL) is defined as “the motivation, confidence, physical competence, knowledge, and understanding required to value and take responsibility for engagement in physical activities for life.” Previous research suggests that higher parental PL is associated with positive attitudes and involvement in children’s physical activity. As approximately 90% of children in Japan attend early childhood education and care settings, the role of childcare workers in supporting children’s physical activity has become increasingly important. Therefore, we aimed to examine the characteristics of childcare workers’ PL and its association with their support for promoting children’s physical activity. Methods Secondary data from 201 childcare workers provided by a company managing early childhood education and care facilities were used. PL was assessed using the Physical Literacy for Life self-assessment tool (PL4L). Support for promoting children’s physical activity was assessed using five items from a previous study and an additional item developed for this study. The construct validity of the support items was examined using confirmatory factor analysis, and internal consistency was assessed using Cronbach’s alpha. The Mann–Whitney U and Kruskal–Wallis tests were used to compare childcare workers’ PL scores by gender, sports club participation at each school age, and stage of change for participation in physical activity. Structural equation modeling was used to examine whether childcare workers’ PL was related to support for promoting children’s physical activity. Results Childcare workers who had participated in sports clubs during junior high school, high school, or university tended to report higher PL scores than those who had not. PL scores differed by stage of change for participation in physical activity, with childcare workers in the Maintenance stage showing significantly higher total PL scores than those in the Pre-contemplation stage. Structural equation modeling showed an acceptable model fit and reasonable factor loadings, and the path coefficients from childcare workers’ PL to support were statistically significant. Discussion Childcare workers’ PL appears to be associated with their experience of sports club participation and stage of change for participation in physical activity. Enhancing childcare workers’ PL may aid their support for promoting children’s physical activity.

The concept of big data visualization has become a revolutionary artistic form of expression that has fulfilled the void between computational analytics and artistic expression in the modern scientific studies. This paper examines the ways in which massive datasets (defined in terms of volume, velocity, variety, veracity and value) are transforming the art creative process as it allows the conversion of dense information into attractive visual stories. Combining new technologies (e.g., real-time data streaming, machine learning, interactive visualization platforms, etc.) enables artists and researchers to establish dynamic, immersive, and participatory experiences. Processing, D3.js, and Tableau are the tools that can help to transform raw data into aesthetic representations and encourage data scientists, designers, and artists to work together interdisciplinarily. Moreover, the big data visualization is applied in the context of such fields as climate science, genomics, urban analytics, and so forth, where data-driven visual artworks convey important information and social issues. Interactive installations and digital exhibitions improve the level of participation of the audience and provide an opportunity to interact in real-time with changing datasets. The findings suggest that big data visualization does not only increase the interpretability of visual data, but it amplifies the limits of artistic creativity and allows new means of narration and perception. This study identifies the increased importance of data as a material and as a medium in the modern art that will contribute to the development of new creative and analytical paradigms.

Haiti is experiencing a severe humanitarian crisis characterised by political instability and economic and security hardship. These adversities contribute to significant mental health challenges, which are also exacerbated by poor access to psychological support due to a shortage of specialised professionals. Problem Management Plus (PM+), a scalable and low-intensity intervention developed by the World Health Organization, is based on a task-sharing approach to address the treatment gap by training non-specialist helpers to provide psychosocial support. This study aimed to explore the implementation process of PM+ in Haiti, focusing on the barriers and facilitators that influenced its delivery. Specifically, the study focused on understanding the contextual factors affecting intervention accessibility, participant experiences and potential adaptations to enhance its effect. A qualitative study was conducted across three Haitian cities, where trained helpers delivered PM+. Data were collected through the PSYCHLOPS tool with end-users and via cognitive interviews with stakeholders. Thematic analysis was conducted incorporating Lund's social determinants of mental health model and Bronfenbrenner's ecological systems theory to interpret findings. Sixteen end-users and five stakeholders participated in the study. Key barriers to implementation and its success mainly included economic constraints and safety concerns. Facilitating factors included strong community engagement, adaptive implementation strategies (such as flexible scheduling, remote supervision and culturally responsive adjustments), alongside strong organisational support. End-users described substantial difficulties in managing everyday problems and emotional distress, as reported during pre-intervention qualitative assessments. PM+ appeared feasible in the Haitian context from an implementation perspective; however, its implementability depends on cultural adaptations, economic considerations and sustained support for facilitators. Addressing systemic barriers and integrating task-sharing interventions within existing health structures could enhance the long-term impact.

Infant respiration is a physiological marker of health and wellbeing that can provide insight into sleep and wake patterns. Technological innovation presents opportunities to enhance measurements of physiological signals, which improves ecological validity and participant experiences. This is particularly true in the context of studying infant sleep, as it can be disrupted by changes in the environment and the physical sensation of unfamiliar or uncomfortable sensors. The goal of this study was to examine if a commercially available video baby monitor (Nanit system) can accurately estimate respiration during a nap relative to a commonly used cardiorespiratory sensor (Isansys Lifetouch sensor). Thirty-three infants (M = 9.7 months; range = 1-22 months) took a nap while wearing the Lifetouch sensor and Nanit Breathing Band. Infants slept in view of the Nanit camera. A computer vision algorithm applied to the video detected movement of the patterns on the fabric band worn around the infant's torso to determine respiratory rates. The results showed strong consistency between the devices. More than 95% of the minute-by-minute respiration data fell within the limits of agreement, with little bias. Agreement was not influenced by age or nap duration, suggesting the Nanit Breathing Band provides a valid measure of respiration across infancy.