Qualitative Directed Content Analysis Research Articles

P720 Exit interviews exploring Crohn’s disease patients’ experience of changes in their bowel urgency during the mirikizumab Phase 3 clinical trial in adult patients with moderate to severe Crohn disease

Abstract Background The objective of this study was to explore the clinical trial experience of patients with Crohn’s disease (CD), including perceptions of the Urgency Numeric Rating Scale (Urgency NRS) and meaningful within-patient change (MWPC). Methods Qualitative, 90-minute exit interviews were conducted with patients who had moderate to severe CD and completed the VIVID-1 phase 3, multicentre, randomized, double-blind, placebo and active-controlled, mirikizumab clinical trial in the past 3 weeks. The semi-structured interview guide included cognitive debriefing to explore the content validity of the 11-point Urgency NRS (0=No urgency to 10=Worst possible urgency in the past 24 hours). Interview transcripts were analysed using qualitative directed content analysis and framework analysis. Results Interviewed participants (N=62) were from the US (n=29), Czech Republic (n=10), Poland (n=8), Germany (n=7), Canada (n=4), Australia (n=3) and the UK (n=1). Participants (age 22–75 years, 55% female, 53% high school education or lower) were diagnosed with CD for 1–54 years. Most participants understood the Urgency NRS as assessing the severity of feeling an immediate need to go to the bathroom and used it accurately and without difficulty. Participants interpreted the Urgency NRS as ranging from “no urgency” [0] to an “immediate, sudden need or loss of bowel control” [10]. Participants reported that a ‘good day’ or ‘remission’ would feature reduced or no or minimal bowel urgency and permit adequate time to find a bathroom, feature no accidents and allow participation in daily/leisure/social activities and work away from home. Participants considered Urgency NRS scores ≤3 as a ‘good day’ (n=45/59) and ≤2 as ‘remission’ (n=41/57). Most reported that the bowel urgency improvement they experienced was meaningful (n=51/55; Table 1) because it improved their quality of life. A 3-point Urgency NRS improvement was identified as the smallest meaningful change (n=40/54; Table 1). Most participants associated bowel urgency with CD severity when responding to a Patient Global Rating of Severity (PGRS; n=42) and a Patient Global Impression of Change (PGIC; n=32). Most participants related Urgency NRS scores of 0 to None, 2 to Very Mild, 4 to Mild, 6 to Moderate, 8 to Severe and 10 to Very Severe on the PGRS (Figure 1). Urgency NRS improvements of 3-10 points were considered Much better or Very much better on the PGIC (Figure 1). Conclusion The Urgency NRS was well understood and a ≥3-point improvement in Urgency NRS score was considered a MWPC. Participants with CD who had completed the mirikizumab clinical trial perceived a meaningful change in bowel urgency to feature reduced or minimal bowel urgency enabling improved daily functioning.

Overcoming barriers to implementation: mapping implementation strategies in four hospital in home programs within the Veterans Health Administration

ABSTRACT The Hospital at Home model, called Hospital-in-Home (HIH) in the Department of Veterans Affairs, delivers coordinated, high-value care aligned with older adult and caregiver preferences. Documenting implementation barriers and corresponding strategies to overcome them can address challenges to widespread adoption. To evaluate HIH implementation barriers and identify strategies to address them, we conducted interviews with 8 HIH staff at 4 hospitals between 2010 and 2013. We utilized qualitative directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR) and mapped identified barriers to possible strategies using the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool. We identified 11 barriers spanning 5 CFIR domains. Three implementation strategies – identifying and preparing champions, conducting educational meetings, and capturing and sharing local knowledge – achieved high expert endorsement for each barrier. A mix of strategies targeting resources, organizational readiness and fit, and leadership engagement should be considered to support the sustainability and spread of HIH.

Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study.

The urine Determine LAM test has the potential to identify tuberculosis (TB) and reduce early mortality among people living with HIV. However, implementation of the test in practice has been slow. We aimed to understand how a Determine LAM intervention was received and worked in a Ghanaian in-hospital context. Nested in a Determine LAM intervention study, we conducted a two-phase explanatory sequential mixed methods study at three hospitals in Ghana between January 2021 and January 2022. We performed a quantitative survey with 81 healthcare workers (HCWs), four qualitative focus-group discussions with 18 HCWs, and 15 in-depth HCW interviews. Integration was performed at the methods and analysis level. Descriptive analysis, qualitative directed content analysis, and mixed methods joint display were used. The gap in access to TB testing when relying on sputum GeneXpert MTB/Rif alone was explained by difficulties in obtaining sputum samples and an in-hospital system that relies on relatives. The Determine LAM test procedure was experienced as easy, and most eligible patients received a test. HCWs expressed that immediate access to Determine LAM tests empowered them in rapid diagnosis. The HCW survey confirmed that bedside was the most common place for Determine LAM testing, but qualitative interviews with nurses revealed concerns about patient confidentiality when performing and disclosing the test results at the bedside. Less than half of Determine LAM-positive patients were initiated on TB treatment, and qualitative data identified a weak link in the communication of the Determine LAM results. Moreover, HCWs were reluctant to initiate Determine LAM-positive patients on TB treatment due to test specificity concerns. The Determine LAM intervention did not have an impact on the time to TB treatment as expected, but patients were, in general, initiated on TB treatment rapidly. We further identified a barrier to accessing TB treatment during weekends and that treatment by tradition is administrated early in the morning. The Determine LAM testing was feasible and empowered HCWs in the management of HIV-associated TB. Important gaps in routine care and Determine LAM-enhanced TB care were often explained by the context. These findings may inform in-hospital quality improvement work and scale-up of Determine LAM in similar settings.

Communication strategies for effective family-clinician conversations in the intensive care unit: A mixed methods study

ObjectivesTo explore the perspectives of intensive care patients’ family members and clinicians on conveying information during family–clinician conversations. SettingTwo medical intensive care units of a German academic tertiary care hospital. Research methodology and designThis study followed a mixed methods design using a digital survey on family-clinician conversations with open- and closed–ended questions, metric scales, and free–text options. Quantitative analysis was performed to determine similarities and differences. Qualitative directed content analysis was conducted to code all free–text responses into themes. FindingsThe responses of 100 family members, 42 nurses, and 28 physicians were analysed (response rate: 47%). All groups preferred face-to-face communication, the ask-tell-ask method, recipient design, and explaining medical terminology. The groups further commented on empathic communication by advocating the acknowledgement of the large amount of information. Qualitative themes highlighting the importance of bedside manners and written information were unique to the family members. Closed–ended questions were identified as potential trouble sources. Two communication strategies were rated as more suitable by the family members than by the physicians: being offered to choose between a summary or a detailed report at the beginning (p =.012;r = 0.288) and receiving a summary and having all questions answered at the end of a conversation (p =.023;r = 0.240). ConclusionThe shared preferences supported existing expert recommendations, the differing preferences corroborated the importance of relational aspects of communication and additional written information. More research is needed on empathic communication aspects. Implications for clinical practiceTo facilitate understanding, the clinicians may apply recipient design and the ask-tell-ask method, explain medical terminology, summarise important information, and proactively elicit questions. They may use empathic phrasing, demonstrate a respectful demeanour, and reflect on their current use of closed-ended questions and on the relational messages of their communication.

Symbolic and substantive legitimation: examining corporate commitments to sustainable development goal 12

PurposeThe purpose of this paper is to assess online corporate communication around commitments to sustainable development goal (SDG) 12, sustainable production and consumption.Design/methodology/approachGuided by legitimacy theory, a qualitative directed content analysis was conducted on 13 companies' webpages (81 webpages, 78,947 words).FindingsCompanies broadly failed to communicate about all 11 SDG 12 targets, neglected to consistently address multiple stakeholder groups, missed opportunities to provide concrete evidence of progress and relied on a mix of substantive and symbolic legitimation strategies.Originality/valueSDG 12 has been under-researched and this paper is one of the first to offer an in-depth analysis of corporate communication regarding SDG 12.

Integrated policymaking: Institutional designs for implementing the sustainable development goals (SDGs)

Increased policy coherence and integrated implementation are necessary to address pressing development problems that cut across different sectors. Meeting these demands, as called for by the 2030 Agenda for Sustainable Development, requires institutional innovation. Based on the comparative analysis of 137 countries, this paper investigates how governments have responded to this call and which contextual factors shape their institutional responses. We propose a four-dimensional typology to analyse the institutional set-ups for implementing the Sustainable Development Goals (SDG), focusing on political leadership, horizontal integration across policy sectors, vertical integration across levels of government, and integration of societal stakeholders. We apply this framework to the descriptions of national SDG-implementation bodies provided by governments in their Voluntary National Review (VNRs) and use qualitative directed content analysis and regression modelling to investigate different driving factors of institutional design choices, including socio-economic development and political regime. Besides a strong commitment from the Centre of Government in most cases, our results show that ministries of the exterior and the environment have a dominant role, indicating that sustainability is not yet perceived holistically. Further, we find that the integration of subnational governments and societal actors is often under-institutionalised: while countries with higher levels of socio-economic development appear more likely to set up mechanisms suited to achieving cross-sectoral integration, political regime type seems to have little impact on institutional design choices for SDG implementation. Conceptually, this study offers a theory-led investigation of the institutional mechanisms for integrated SDG-implementation and the factors that drive institutional innovation or inertia. Empirically, by compiling the information in an original dataset, our study paves the way for future cross-national analysis on effective integrated SDG implementation and identifies entry points for inter- and transnational support of integrated SDG implementation in the context of development cooperation.

CANCER ON TIKTOK–EVALUATING POSITIVE CULTURE AND ONLINE SELF-DISCLOSURE USING DIRECTED CONTENT ANALYSIS AND IN-DEPTH INTERVIEWS

The presented paper characterizes TikTok practices of users with cancer and uses notions of social media as positive culture (presenting oneself without undesirable traits) and online self-disclosure understood as providing intimate, private information about oneself. The research continues the work on self-disclosure of women with breast cancer using Instagram. However, this previous research revolved around posts, and thus was limited. The current study on TikTok asks the following questions: 1) are TikTok videos disclosing information in the manner the previous research on Instagram shows? 2) What are the creators’ motivations and what meanings do they give to disclosing cancer and how do the users position themselves considering the positive culture? The study uses categories from previous work and combines qualitative directed content analysis (DCA; 862 videos are analyzed) with in-depth interviews (n=8), and these go beyond DCA to a more nuanced understanding of the users’ lived experience. Similar to Instagram, TikTok is a tool for negative (e.g., fears, anxiety, pain) and positive self-disclosure (e.g., joyful life events, self-acceptance, self-affirmation) with the prevalence of positive and educational videos (e.g. prevention, debunking stereotypes and normalizing the disease). The respondents feel especially competent to educate others because of their experiences. The research undermines the traditional understanding of online self-disclosure, as for users seeking support is not that important, compared to informing and warning others. Also, the study debunks positive culture as a too-general category, as the interviewees constitute a particular niche and seem not to care how they are perceived while disclosing cancer.

IS THERE A TEMPLATE FOR HUMAN RIGHTS ACTIVISM? – A STUDY OF UGANDAN LGBT+ ORGANIZATIONS’ DIGITAL SPACES

Albeit criminalization against same-sex desires is a remnant of the British colonialization, the 2009 Anti-homosexuality Bill, catapulted Ugandan state-sponsored homophobia into the international spotlight. The ensuing battle over the Bill between on one hand, local and international human rights defenders including Northern development partners and transnational conservative and religious norm entrepreneurs in partnership with local religious and political elites, on the other; highlighted that domestic identity and sexual politics are no longer local affairs. Through a qualitative directed content analysis, the study explore to what degree six established Ugandan LGBT+ organizations engage with international norm entrepreneurs’ attempts to influence Ugandan social mores on non-heteronormative sexuality and non-conforming gender identities, in their self-controlled digital spaces - websites and Facebook- during January 2022. With few exceptions, digital spaces displayed a conspicuous uniform human rights advocacy rhetoric, where same-sex desires and gender identities are presented in essentialist terms as in LGBT+ and universal sexual rights, as opposed to sexual desires and gender identities as embedded and realized in a unique social contexts, that at least in the Ugandan context historically has include significant pluralism and multi-positionality. LGBT+ organizations’ did not discuss the impact of waves of international norm entrepreneurs’ attempts to define and influence the struggle for equal rights, and subsequent potential re-colonialization of Ugandan understandings of sexual desires outside the heteronormative model and non-conforming gender identities. The level of rhetorical uniformity could suggests the existence of a latent template for activism, which could be an unintended consequence of dependency on international funding.

‘The oxygen of shared experience’: exploring social support processes within peer support groups for carers of people with non-memory-led and inherited dementias

Objectives To explore support processes and behaviours taking place during online peer support groups for family carers of people living with rare, non-memory-led and inherited dementias (PLWRD). Methods Twenty-five family carers of PLWRD participated in a series of ongoing online peer support groups on the theme of ‘Independence and Identity’. Transcripts from 16 sessions were analysed using qualitative directed content analysis with a coding framework informed by Cutrona & Suhr’s (2004) Social Support Behaviour Code (SSBC). Results Most of the social support behaviours outlined in the SSBC were identified within the sessions, along with two novel social support categories – ‘Experiential Support’ and ‘Community Support’ – and novel support behaviours including ‘Advocacy and Collective Action’ and ‘Uses Humour’. The SSBC code ‘Relationship’ appeared to be of central importance. Conclusions This study sheds light on the unique challenges of the caring context for those affected by non-memory-led and inherited dementias and the significant contributions carers can offer to, and receive from, peers in similar situations. It highlights the importance of services which recognise the value of the informational and emotional expertise of carers of PLWRD and encourages the continued development and delivery of tailored support for these populations.

An intervention design for promoting quality of life among patients with multiple sclerosis: a protocol with a planning approach for a mixed methods study

BackgroundMultiple sclerosis is a chronic progressive disease of the central nervous system that affects the patients' quality of life. The disease's complications reduce the quality of life in patients by creating physical, psychological, social and economic problems for the patient and his/her family and reducing the patient's individual and social functioning. The aim of the present study is designing, implementing and evaluating an intervention based on the PRECEDE-PROCEED model to promote the quality of life in people with multiple sclerosis. This paper summarizes the study protocol.MethodsWe will use the PRECEDE-PROCEED model for designing the study. In the first step, the factors affecting quality of life in people with multiple sclerosis will be determined by a qualitative study. In the second step, these factors will be prioritized based on their importance and variability, then behavioral and environmental factors of the most important priority will be identified. In the third step, the predisposing, enabling and reinforcing factors related to the identified priority will be determined by a qualitative directed content analysis. In the fourth step, a questionnaire will be designed and psychometric based on the results of the previous step. The fifth step will be about planning to implement the intervention. In the sixth step, the intervention will be implemented and its effectiveness will be evaluated by process, impact and outcome evaluations.DiscussionThe results of this study will provide information about patients' needs and concerns and thus will contribute to policymakers, government, community, health professionals and families to take the necessary measures to improve quality of life in these patients.

A first look at consistency of documentation across care settings during emergency transitions of long-term care residents

BackgroundDocumentation during resident transitions from long-term care (LTC) to the emergency department (ED) can be inconsistent, leading to inappropriate care. Inconsistent documentation can lead to undertreatment, inefficiencies and adverse patient outcomes. Many individuals residing in LTC have some form of cognitive impairment and may not be able to advocate for themselves, making accurate and consistent documentation vital to ensuring they receive safe care. We examined documentation consistency related to reason for transfer across care settings during these transitions.MethodsWe included residents of LTC aged 65 or over who experienced an emergency transition from LTC to the ED via emergency medical services. We used a standardized and pilot-tested tracking tool to collect resident chart/patient record data. We collected data from 38 participating LTC facilities to two participating EDs in Western Canadian provinces. Using qualitative directed content analysis, we categorized documentation from LTC to the ED by sufficiency and clinical consistency.ResultsWe included 591 eligible transitions in this analysis. Documentation was coded as consistent, inconsistent, or ambiguous. We identified the most common reasons for transition for consistent cases (falls), ambiguous cases (sudden change in condition) and inconsistent cases (falls). Among inconsistent cases, three subcategories were identified: insufficient reporting, potential progression of a condition during transition and unclear reasons for inconsistency.ConclusionsShared continuing education on documentation across care settings should result in documentation supports geriatric emergency care; on-the-job training needs to support reporting of specific signs and symptoms that warrant an emergent response, and discourage the use of vague descriptors.

Using social marketing theory as a framework for understanding barriers and facilitators of human papillomavirus screening in women: A qualitative study.

Human papillomavirus (HPV) is known as the common sexually transmitted disease and the cause of cervical cancer. The HPV test is being proposed as the primary screening tool for cervical cancer. This study aimed to identify barriers and facilitators of screening based on the social marketing model in designing interventions and planning to increase HPV screening. This qualitative directed content analysis was conducted between December 2020 to September 2021 to identify the key concepts of social marketing theory (i.e., the four P's: product, price, place, and promotion) in Mashhad, Iran. Semistructured interviews were fulfilled with 24 individuals (10 women with HPV and 14 key informants) after obtaining participants' consent, who were initially purposively sampled and snowball sampling was then used to facilitate further recruitment. Data analysis was carried out simultaneously with data collection. Following the code extraction, four main categories (themes) and 10 subcategories extracted. Subcategories included knowledge on screening, screening benefits, and motivational factors for screening (product), individual inhibitors, environmental inhibitors, and facility problems related to price, place of service delivery, and service delivery channels (place) and health promotion and education. Lack of knowledge about HPV and screening, negative attitudes toward sexually transmitted diseases, taboo about sexual issues in society, fear of the reaction of spouse and family members, lack of proper policies and information and communication challenges, high costs of screening, access barriers to facilities such as difficult transportation have been challenges of health systems. It is suggested that HPV screening as a standard method for detection of cervical cancer be considered and the barriers to access are removed.

Factors Affecting Psychological Distress in Family Caregivers of Critically Ill Patients: A Qualitative Study.

Family caregivers often experience psychological distress during a critical care hospitalization, potentially compromising their ability to function effectively in a supportive role. A better understanding of the sources of family caregiver distress is needed to inform strategies to mitigate its development and impact. To explore sources of family caregiver psychological distress during a critical care hospitalization and how caregivers' experiences may differ by their anxiety level. Forty adult family members of patients receiving mechanical ventilation for more than 72 hours in 2 intensive care units at an academic medical center were interviewed. A qualitative directed content analysis was done. Experiences were compared by anxiety level group, defined using the Hospital Anxiety and Depression Scale: anxiety (n = 15), borderline anxiety (n = 11), and low anxiety (n=14). Most family members (32%) were adult children; no major demographic differences were noted across anxiety groups. Among caregivers in the anxiety group, salient factors included early unknowns around critical illness, health care team processes, care decisions made, financial and housing concerns, family dysfunction, and new responsibilities. In general, low-anxiety family caregivers did not express their concerns using language of distress but rather expressed emotion and disappointment and often took action to process their concerns. Factors influencing family caregiver distress during the critical care stay were wide-ranging and varied by level of anxiety. The findings highlight several key areas and potential interventions to reduce psychological distress, especially among caregivers with anxiety.

Threats to professional dignity of Iranian clinical nurses: Aqualitative study.

Identifying threats to the nurses' professional dignity has an important role in maintaining and promoting their dignity. This study aimed to evaluate the perception of Iranian nurses' experiences of threats to their professional dignity in clinical settings. A qualitative directed content analysis approach was used. The present qualitative study was conducted in Iran.Clinical nurses were selected using the purposive sampling method. Data were collected through in-depth semi-structured interviews with 15 clinical nurses from October 2020 to March 2021. The qualitative content analysis method was used to analyze the data. Two main categories and 16 subcategories were extracted as follows: (1) professional factors (containing seven subcategories) and (2) organizational factors (containing nine subcategories). To promote the professional dignity of nurses, it is recommended to identify the factors threatening their professional dignity and create healthy work environments for them.

What implementation strategies are relational? Using Relational Theory to explore the ERIC implementation strategies.

The identification and use of implementation strategies in implementation research and practice have strengthened our understanding of the implementation process as well as the causal pathways between mechanisms, strategies, and implementation outcomes. Although these contributions have advanced the application of strategies, there is still a need to learn more about how strategies might integrate relational exchanges and interactions. The inclusion of critical perspectives has been limited in implementation science, and theories such as Relational Theory can expand our understanding of the relational nature of implementation and enhance rigor through alternative theoretical applications. This study applied Relational Theory through a qualitative directed content analysis of the 73 Expert Recommendations for Implementation Change (ERIC) implementation strategies and examine relational components in strategy descriptions. Three reviewers used the structured approach to review and categorize the implementation strategies based on the Relational and Transactional Strategy Continuum measure, which operationalizes types of interactions, exchanges and alliances. Relational alliance strategies are those in which there is mutual growth and accountability, frequent interaction, shared power, and potential vulnerability. Operational alliances include forms of working exchanges between parties with balanced transactional and relational features. Operational alliances can be somewhat interactive in nature, with minor exchanges and limited accountability. Transactional alliance strategies are mostly uni-directional, influenced by power differentials, and do not require mutual growth, commitment, or exchange; thus, the power of growth is inherently one-sided. Results from the review suggest more implementation strategies with relational alliance features (highly relational, n = 17, semi-relational, n = 19) compared to transactional (highly transactional, n = 9, semi-transactional, n = 10) and 18 strategies coded as operational alliances. The qualitative review revealed opportunities to further expand how relational exchanges are considered within the implementation strategies descriptions, as well as the role of actors and power dynamics within strategy exchanges. The Relational and Transactional Strategy Continuum measure can help practitioners and researchers consider the sequencing, pairing, and impact on outcomes of different types and combinations of strategies in implementation practice and research. Additionally, the measure can support reflection on strategies that promote positive alliances, frequent connections, bi-directional communication, and power sharing.

Situation awareness in intensive care unit nurses: A qualitative directed content analysis.

BackgroundSituation awareness (SA) is an essential cognitive construct to create positive patient safety outcomes. SA of the nurses in the intensive care unit (ICU), where conditions may change rapidly, is particularly important. The present study aimed to explain the perception and experience of SA in ICU nurses based on Endsley's SA model.Materials and methodsThis qualitative directed content analysis was conducted on nurses in six hospitals in Tehran, Iran, from December 2020 to July 2021. Twenty-seven ICU nurses were selected using purposive sampling. Data were collected by semi-structured interviews and field observations. The data were analyzed based on the Elo and Kyngas method modified by Assarroudi et al. COREQ checklist was used to report the research.ResultsThe concept of SA in ICU nurses, based on Endsley's model, includes perception of patients' clinical cues, perception of the human environment, perception of the physical environment, and perception of the organizational environment as generic categories of the perception of the elements in the environment. SA in ICU nurses also includes the main categories of comprehension the current situation through a sense of salience and interpretation of cues and projection the future situation through the prediction of patient status into the near future and environmental foresight.ConclusionFindings have further developed the concept of SA in ICU nurses based on Endsley's SA model. The insights and knowledge gained from this study can be useful for future practice, education, and research on SA among ICU nurses.

Tailored interviewing to uncover the perspectives of children with multiple disabilities on daily activities: A qualitative analyses of interview methods and interviewer skills.

Uncovering the perspective of children with multiple disabilities is important in health care to enable person-centred health care. For occupational therapists, uncovering the child perspective on meaningful activities is necessary to set appropriate goals for treatment. It is not always evident that children with multiple disabilities can express themselves in an interview. The interviewer should adapt his communication to the child. In literature, alternative communication is widely studied, but a clear algorithm for deciding what to use to successfully gain insight into the child perspective is missing. This study aims to identify helpful interview techniques and interviewer skills and how they can be used to effectively uncover the perspective of children. Videos of nine interviews with children with a mitochondrial disorder, conducted by an occupational therapist, were analysed by five researchers. The interviews were analysed to see how well the interviewee had obtained the child's perspectives followed by observation of communicative abilities of the child and the types of questions the interviewer asked. A qualitative directed content analysis of the semi-structured interviews followed. An interview pattern was observed in the children's communication leading to six successful interviews. Children communicated verbally on four different levels and also used non-verbal communication. The interviewer used five types of questions, which varied between and within the children. The content analysis resulted in two themes: parental influences and interviewer skills. Results show the importance of matching the type of questions to the verbal communication level of the child and revealed several interviewer skills and techniques. An overview to guide tailor-made interviewing is presented. The interviewer has a major role in successful interviewing and thus in enabling the inclusion of the child perspective in research and care.

Making the Schoolhouse Rock: A Content Analysis of Two Popular Music Pedagogies

Abstract In popular music education, there has been an increase in the amount of literature, pedagogical resources, and organizations that are available, and two pedagogical approaches for teaching popular music are informal music learning (IML) and modern band (MB). However, there is little existing scholarly critical analysis comparing these approaches. The purpose of this qualitative directed content analysis was to explore the similarities and differences between IML and MB in kindergarten through 12th-grade settings and examine how major characteristics of each approach are represented in scholarly and curricular resources. While similarities exist in the literature on these approaches, there are also distinct differences between them, such as orientation toward process or performance, use of composition and improvisation, and teacher role and approach. Moreover, the representation of the principles of both IML and MB were not always consistent in the resources we examined, with some aspects highly represented and others rarely mentioned. Learning more about both approaches could be beneficial to scholars and teachers interested in popular music pedagogy and how they are implemented in classrooms.

Experiences of Occupational Value When Doing Creative Activities in a Mental Health Context

Everything a person does generates a unique experience of occupational value, and occupational values can in turn generate meaning in life. Doing creative activities positively influences subjective health and well-being. This article provides information about how and to what extent people diagnosed with mental illness experienced occupational value when participating in an intervention with creative activities. Thirty-three participants provided data within a mixed-methods design. Data were analyzed by quantitative non-parametric statistical methods and qualitative directed content analysis. Interventions with creative activities enable a high degree of experienced occupation value and are associated with all dimensions in the occupational value triad.

Ambiguous Loss and Coping Strategies in Couples Raising a Child With Down Syndrome: A Qualitative Directed Content Analysis Study

Despite years of research about developmental diversity, relatively little is known about the experience of couples raising a child with Down syndrome. Previous research has identified that Ambiguous Loss Theory can be helpful to understand the parents’ process of navigating the uncertainty, challenges, stressors, and demands of raising a child diagnosed with a neurodevelopmental disorder. Building on previous research and the framework of ambiguous loss, this study sought to provide insight into the lived experience of couples raising a child diagnosed with Down syndrome. Using a qualitative directed content analysis of the paired responses to open-ended questions from 16 couples, the current study provides insight into the couple’s experience of ambiguous loss and greater understanding about their coping strategies. Results indicated a process of dealing with ambiguous loss by most couples. Coping strategies reported by the couples included medical and educational advocacy, deepening and building connections, and gaining new perspectives on raising a child with Down syndrome. Implications for policy and practice are also included, based on the coping strategies, skills, and resources available to parents of children with Down syndrome or other neurodevelopmental disorders.