Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy for adolescents and young adults (AYAs, ages 14-26). PrEP uptake among AYAs remains low. Barriers to uptake include provider discomfort discussing sexuality, challenges engaging parents in sexual health conversations, and low perceived HIV risk. To address these gaps, we aimed to develop a toolkit to enhance AYA-serving primary care providers' (PCPs) comfort and confidence in discussing and prescribing PrEP. The Consolidated Framework for Implementation Research informed our approach. Four focus groups with youth-serving PCPs across three clinics in a Northeastern US city were held in April and May 2024. PCPs included residents (n = 10), attending physicians (n = 11), nurse practitioners (n = 2), and a physician assistant (n = 1). Debrief summaries were created following each focus group and analyzed. We used a rapid qualitative process, guided by an a priori codebook and reflexive thematic analysis. PCPs emphasized that the toolkit should be easy to access, interactive, and provide practical, age-appropriate prescribing information. They identified outer-setting factors such as the role of parents in AYAs' health care, sexual health education in schools, and uncertainty around laws that impact PrEP provision to minors. Within the clinical setting, providers noted that limited time often hindered sexual health discussions. Individually, PCPs reported moderate comfort with PrEP and were motivated to prescribe PrEP when AYAs expressed interest. Findings informed the development of a PrEP toolkit tailored for AYA-serving PCPs and future implementation tailored for AYA-serving PCPs. This approach may help expand access and address persistent barriers to PrEP uptake among AYAs.

ABSTRACT Despite the growing presence of mathematics coaches, little research explores how coaches themselves define effectiveness, engage in professional learning, and construct professional identities. This study investigated these dimensions through a cross-sectional survey of 42 experienced K–12 mathematics coaches working across diverse school and district contexts in Ohio. The survey included structured items analyzed using descriptive statistics and open-ended responses analyzed through reflexive thematic analysis. Coaches described evaluating their effectiveness through a combination of relational trust, student learning data, and reflective professional judgment. While student assessment data provided some validation, teacher receptivity and collaborative relationships emerged as the most meaningful indicators of impact. Participants engaged in multiple professional learning pathways, including self-directed study, collaborative networks, and formal professional development, though many encountered barriers related to time, role expectations, and institutional support. Professional identity was dynamic and context-dependent, shaped by individual commitments and systemic conditions. Most coaches identified primarily as supporters of teachers, while some articulated aspirational identities as pedagogical leaders and co-learners. Together, these findings position mathematics coaching as relational, adaptive professional work and suggest implications for supporting both experienced and novice coaches.

An increasing number of patients with congenital heart disease (CHD) are pursuing pregnancy with the potential for cardiovascular complications. This study aimed to establish patient-centered national research and care priorities to improve pregnancy-related outcomes for individuals with CHD. This mixed-methods study used a modified Stakeholder Engagement in Question Development methodology to systematically identify patient-centered priorities. Key activities included consortium engagement (phase 1), patient and provider questionnaires (phase 2), and an in-person facilitated meeting to explore survey results and follow-up virtual focus groups (phase 3). Reflexive thematic analysis was used to synthesize short- and long-term research priorities (phase 4). Three overarching goals emerged: (1) improving access to specialized CHD, cardio-obstetrics, and mental health care; (2) improving quality and consistency in clinical care; and (3) increasing patient and community engagement. These goals were then expanded into 5 central themes: (1) communication within the health care setting; (2) community engagement; (3) ancillary clinical support; (4) integration of patient-reported outcomes; and (5) implementation, education, and knowledge mobilization. Short-term (1-5-year) goals included expanded telemedicine use, best practice recommendations for multidisciplinary care coordination, and targeted educational resources. Long-term (5-10-year) goals included expansion of adult CHD and cardio-obstetrics programs, integration of mental health services, and advocacy to improve insurance coverage. The consortium provided a national, community-driven prioritization that highlights actionable pathways to improve pregnancy outcomes for people with CHD. Sustained engagement with patients and community partners is essential to achieving durable improvements across cardio-obstetric care, education, research, and mental health.

Autistic people report poorer treatment outcomes for their eating disorder (ED) in comparison to non-autistic peers. Eating disorder focused family therapy (FT-ED) is the leading outpatient intervention for adolescents with Anorexia Nervosa (AN). The aim of this study was to explore the experiences of parents of autistic young people who have received FT-ED, and any recommended adaptations to treatment. Parents of an autistic young person who had received FT-ED within the last 3years were invited to take part in interviews. Transcripts were analysed using reflexive thematic analysis. Twelve parents of autistic young people with AN completed interviews and analysis generated four core themes: (1) Questioning the principles of FT-ED, (2) Navigating the FT-ED process, (3) Parental (dis)empowerment, (4) Adapting FT-ED. This paper is the first exploration of parents of autistic young peoples' experience of FT-ED for AN, and it highlights possible treatment adaptations for this population. It is part of a larger body of work to consider adaptations to FT-ED, with the aim of making ED treatments more effective, accessible and acceptable for autistic young people and their families.

ABSTRACT Personal autonomy is a central principle in Humanistic therapy. However, for counselors of the Christian faith, the concept of grace (God’s influence) is also likely to feature in their practice. This raises the question of how to reconcile these potentially conflicting principles. This UK-based qualitative study explored how Christian-faith counselors reconcile belief in God’s influence with the principle of personal autonomy. Eight Humanistic Christian-faith counselors were interviewed, with transcripts undergoing reflexive thematic analysis. Six major themes were found: (1) Psychological Contact with a Relational God (2) Intentionality for God’s Influence (3) Internal Spiritual Locus of Evaluation (4) Surrender to the Space for Grace (5) Thin Spaces (6) Socratic Questions for Tensions. The findings indicated harmony between the two principles, operating at both philosophical and practical levels. This included a growth-through-grace conception of clients’ autonomous development. Suggestions for resolving tensions between grace and autonomy are also made. Implications of the study include the potential for Christian-faith Humanistic counselors to develop practice rationales consistent with the principle of grace, and the benefits of supervision and training in facilitating this integration.

ABSTRACT Existing studies on risk in adventure often use fixed lists of risk categories and fail to consider the layered nature of how tourists perceive these risks. Using the extreme setting of cycling on the Sichuan-Tibet Highway as a case, this study employs a mixed-methods design that integrates Reflexive Thematic Analysis with a questionnaire survey to construct a two-dimensional Risk Perception Matrix (RPM). The study first identifies four primary risk themes: environmental, physical, planning, and accidental risks. Quantitative analysis further reveals that Adverse Weather ranks highest in probability, severity, and overall risk perception scores. The RPM displays four risk quadrants, where the core risk zone reflects a strong coupling between the environment and the body, while High Difficulty of Rescue is identified as a critical, high-impact, low-probability risk. By shifting from a one-dimensional checklist to a multidimensional matrix-based analysis, this study offers a more accurate framework for managing risks at tourism destinations.

Digital media consumption among adolescents raises significant concerns, particularly regarding the circulation of violent material in peer communication spaces. This study investigates how Spanish teenagers interact within WhatsApp groups and how such interactions contribute to the dissemination and normalisation of violence during a critical stage of psychosocial development. Data were collected from 164 secondary school students (mean age 14.4 years) through open-ended questionnaires, and a reflexive thematic analysis was conducted to explore their experiences with digital content shared in messaging groups. Participants reported frequent exposure to explicit material involving physical and sexual violence, hate speech, and, in some cases, self-harm. Clear gender differences emerged: boys were more likely to circulate such content, while girls more often reported feelings of rejection, discomfort, and emotional distress. Humour frequently functioned as a discursive strategy to legitimise the material, thereby reducing its perceived seriousness and reinforcing its normalisation within everyday peer interactions. The absence of adult supervision in these digital environments further exacerbated the problem, facilitating the persistence and reach of harmful content. Findings highlight the risks inherent in unregulated digital spaces and underscore the need for targeted educational and policy interventions. Promoting empathy, strengthening digital literacy, and fostering prosocial values appear essential to counteract processes of desensitisation and to mitigate the detrimental emotional and social consequences of violent content exposure during adolescence.

Experienced nurses' perceptions of essential nursing care in the emergency department - A focus group study.

Most men with binge-spectrum eating disorders (BSEDs) never receive psychological treatment for their conditions, and research on BSEDs typically includes disproportionately low numbers of men. Qualitative information is needed to shape the development of messaging strategies to engage this population in both treatment and research. Fifteen men (53% White, 80% heterosexual, age range 26-69) who had never gone to therapy for their BSEDs provided semi-structured qualitative feedback about strategies to engage men like them in psychological treatment for and research about BSEDs. Reflexive thematic analysis identified four key themes: (1) Serious messages convey the seriousness of BSEDs (2). The ideal message would be simple and relatable and persuade men that seeking therapy makes them more manly, not less (3). Men's intersectional identities shape their reasons for not pursuing therapy (4). Men expressed spontaneous excitement about a messaging campaign to raise awareness of disordered eating in men. These findings demonstrate that no single messaging strategy will appeal to all men. Nonetheless, all men expressed enthusiasm for targeted campaigns that promote the entry of more men into psychological treatment for their BSEDs. Researchers and clinicians could use these findings to increase men's uptake of BSED treatment.

Purpose This study aims to investigate how employees enact a corporate e-learning platform in everyday work. It further examines how these enactments influence workplace learning and professional development, highlighting the ambivalent dynamics that arise when digital learning technologies become part of organisational routines. By moving beyond behaviourist approaches, this study provides a nuanced account of how digital learning is both enabled and constrained in the work context. Design/methodology/approach Adopting a constructivist, sociomaterial perspective, the case study draws on 17 semi-structured interviews with employees from various departments, including human resource (HR) and the works council, in an international conglomerate. Virtual interviews enabled screen-sharing to support data interpretation. The empirical material was examined through reflexive thematic analysis. Findings The platform configures learning as both ambivalent and increasingly individualised. Through its design and metrics, learning is subtly shaped by datafication, influencing how employees perceive their performance and organisational expectations. Combined with temporal pressures, platform flexibility and work demands, these dynamics shift responsibility for learning onto employees. Limited guidance from HR programs and managers leaves them to navigate and manage learning largely on their own. Originality/value While corporate e-learning is often evaluated quantitatively, this study provides an in-depth, qualitative account of how such platforms are experienced and enacted. It offers new insights into the ambivalent role of digital learning technologies in shaping – not merely delivering – workplace learning.

"The players are the focus, it's never spoken about as coaches": Perceived factors influencing the mental health of Australian elite-level coaches.

Despite the high prevalence of tobacco use among people with substance use disorder (SUD), tobacco cessation is not a routine part of SUD treatment in South Africa. No studies have explored how people receiving SUD treatment view the effects of tobacco use on SUD treatment or their barriers to tobacco cessation. Clinicians need this information to develop locally relevant, person-centred tobacco cessation interventions. To address this gap, this study aimed to explore perceptions of tobacco use and its impact on SUD recovery among people receiving SUD treatment in South Africa. In-depth interviews were conducted with 20 participants (14 males, 6 females) recruited from five outpatient SUD treatment programmes in Cape Town, South Africa. On average, participants were 34.6 years old (SD = 10.1) and began smoking tobacco when 13.4 years old (SD = 2.6). At the time of the study, 40.0% (n = 8) had quit tobacco. Interviews explored experiences of tobacco use and its impact on SUD recovery. Data were analysed using reflexive thematic analysis. The analysis generated four themes: (1) tobacco interconnects with other substance use; (2) psychosocial functions of tobacco: identity, connection and coping; (3) detrimental impact on SUD recovery; and (4) ambivalence about tobacco cessation, despite acknowledged benefits. Participants reported that their tobacco use intertwined with and reinforced their substance use, heightening cravings and impacting efforts to remain abstinent. Participants identified barriers to cessation that included using tobacco as a coping mechanism and as a tool for social connection, difficulties managing physiological withdrawal symptoms, and limited cessation support within SUD treatment and their social environments. Findings highlight the need for tobacco cessation interventions within South Africa's SUD services. To overcome psychosocial and physiological barriers, SUD services should consider providing pharmacological interventions, psychosocial and behavioural counselling, and social support for tobacco cessation. Integrating these interventions into SUD treatment services could improve tobacco cessation rates and recovery outcomes for South Africans with SUDs.

ABSTRACT Inclusive education is a central policy goal across education systems, yet children with multiple disabilities remain marginalised within many centralised assessment frameworks. This study examines how assessment and placement processes within a centralised assessment framework shape educational pathways, drawing on qualitative data from ten assessment centres in Türkiye. Perspectives from assessment professionals, teachers, and mothers (N = 30) were analysed using reflexive thematic analysis. Four interconnected themes were identified: medicalised assessment practices, segregation as a default placement, limited expectations for learning, and tensions between policy intentions and classroom practice. Building on these findings, the study develops a conceptual model that reconceptualises centralised assessment as an institutional filtering mechanism rather than a neutral administrative process. The model shows how procedural logics organise placement decisions and structure access to inclusive education before classroom engagement begins. By situating an empirically grounded case within international debates, the study demonstrates how institutional processes shape the enactment of inclusion. The findings offer insights transferable to other centralised assessment frameworks and provide a process-oriented explanation of how systemic barriers are produced and sustained.

To explore factors that foster positive mental health among adults with type 1 and type 2 diabetes and identify opportunities for more accessible, person-centred mental health support within diabetes care. Participants were purposively sampled from the Mental health IN Diabetes Monitoring And Pathways (MIND-MAP) cohort study. Semi-structured online interviews were conducted with 32 adults in Victoria, Australia. Interviews explored factors associated with emotional well-being and experiences and preferences for mental health support. Data were analysed using reflexive thematic analysis, informed by phenomenology and constructivist grounded theory. The study was co-designed with guidance from a multidisciplinary Steering Committee and lived experience input through a Community Advisory Group comprising 12 adults with type 1 or type 2 diabetes. Participants described internal strengths (e.g. acceptance, perspective-taking) and external supports (e.g. peer connections, empathetic health professionals, timely access to mental health care) that supported their mental health. Several barriers to accessing mental health support were reported, including limited-service access, geographic and financial constraints, discomfort discussing emotions, and a lack of diabetes-specific mental health expertise. Emotional support was often absent at diagnosis and other key transition points. Participants called for support that is empathetic, non-judgemental, tailored and embedded within diabetes services. Adults with type 1 and type 2 diabetes show resilience in managing mental health, yet systemic, practical and attitudinal barriers remain. Care models should build on personal strengths, normalise emotional support and integrate psychological care from diagnosis, as well as harness the value of peer support.

"We are exhausted, but we just love it": A qualitative study exploring burnout and work engagement among advanced practice cancer nurses in Australia.

Emerging research suggests tabletop role-playing games may support the basic psychological needs of players, contributing to well-being and flourishing. Yet, exactly how tabletop role-playing games promote needs satisfaction remains unclear and requires further research. This research focus is critical due to the rising interest in the therapeutic use of tabletop role-playing games. This study used an online qualitative survey (N = 1120) and reflexive thematic analysis to investigate this area in Dungeons & Dragons (D&D) 5th Edition. Five key themes were developed: Compelling versus Uncompelling Game Worlds, Character Engagement versus Disengagement, Supporting versus Restricting Player Agency, Fair versus Unfair Adjudication, and Social Cohesion versus Conflict. Themes are discussed in relation to the satisfaction (or frustration) of players’ basic psychological needs. This study found that the Dungeon Master, and to a lesser degree, other players, can satisfy all three basic psychological needs (autonomy, competence, and relatedness) by creating an autonomy-supportive environment in their D&D games. These findings have important implications for training, game design, and implementation of D&D in both casual and therapeutic settings.

Cancer Survivors' and Health Care Professionals' Views on Managing Cardiovascular Disease Risk in Cancer: A Qualitative Study to Inform a Model of Care.

Palliative Care in Children with Severe Neurological Impairment: The PediQUEST Refine Case Series.

Undergraduate nursing students' perceptions of using holopatient in learning and clinical training: An exploratory-descriptive qualitative study.

ABSTRACTBackgroundClinicians routinely make micro‐level allocation decisions at the bedside—how much time to spend, which tests to order, or how intensively to treat. While fairness and efficiency have been studied, little is known about how patients' social backgrounds shape these decisions under universal coverage. In Japan, where financial access and free provider choice minimize monetary barriers, bedside allocation may often occur implicitly and through local negotiation rather than explicit protocols.MethodsWe conducted semi‐structured interviews with 12 physicians across internal medicine, emergency, and community care settings. Transcripts were analyzed using reflexive thematic analysis to examine how social factors—such as family support, logistics/transport, and patient capability/engagement—enter allocation reasoning.ResultsThree recurring reasoning tendencies emerged: Strict Egalitarians, who minimize social factors and seek uniform plans; Contextual Pragmatists, who adjust when family or logistical support is weak; and Responsibility‐Sensitive Allocators, who weigh engagement and self‐management after addressing practical barriers. These were not fixed categories—clinicians shifted among them case‐by‐case, influenced by team norms and local capacity. Across tendencies, stewardship and balance were emphasized, yet reasoning remained largely implicit and negotiated.ConclusionJapan's “implicit and negotiated” bedside allocation enables flexibility and trust but can obscure the ethical rationale for daily decisions. Future empirical and normative work should clarify when egalitarian, pragmatic, or responsibility‐sensitive reasoning is ethically warranted and how to make reasons transparent without impeding workflow. This study suggests the practical value of maintaining flexibility while ensuring that allocation decisions remain explainable and revisable—a stance we term “answerable flexibility.”