Reflexive Journaling Research Articles

On the move: understanding home care workers’ experiences of using various modes of transportation at work in an occupational health perspective

BackgroundThe demand for home care workers (HCWs) is increasing, but home care services face challenges in recruiting and retaining skilled workers, partly due to hazards in the work environment. Transportation to client visits is an important part of HCWs' working conditions, with various modes (e.g., walking, cycling, driving) being utilized. However, these modes are often implemented without considering HCWs' perceptions of their use. Therefore, our study aimed to understand HCWs’ perceptions and experiences of using different transportation modes at work, and how they may influence health.MethodsFourteen HCWs from a home care unit in Trondheim (Norway) participated in focus group interviews. The interviews were analyzed using a reflexive thematic analysis approach including reflexive journaling. The analytical process was guided by a biopsychosocial understanding of health.ResultsThe analysis showed that when different transportation modes were assigned, predictability of the assignment was important for the HCWs. Both walking and driving were regarded to have both positive and negative health impacts. When walking, informants thought that getting fresh air outdoors and doing physical activity was health-promoting, while bad weather conditions and too much walking could be negative for their health. When driving a car, informants talked about privacy and getting physical rest as positive for their health, while traffic and parking conditions could be stressful. Individual factors such as age, physical health, and strong preferences were highlighted as important to consider when planning HCWs’ transportation modes in an occupational health perspective.ConclusionsWalking now and then between client visits was generally believed by the HCWs to lead to positive health effects compared to only driving a car. Introducing planning of various transportation modes in advance, so that they are predictable, seems important to reduce stress among HCWs. In addition, some individual factors should be considered in the planning, and it should be realized that the planning likely represents a trade-off between promoting the psychosocial work environment when driving a car and potentially enhancing long-term physical health when using active transportation. Thus, biopsychosocial aspects of health should be considered when planning the mode of transport between client visits for HCWs.

The Adaptive Human-AI Synergy in Logistics (AHASL) Theory

This paper introduces the Adaptive Human-AI Synergy in Logistics (AHASL) theory, which focuses on integrating artificial intelligence (AI) into logistics and supply chain management. The study takes a qualitative approach, using interviews, observations, and reflexive journaling, and finds that while AI significantly improves operational efficiency and decision-making, human oversight is still required to address AI's limitations, such as bias, lack of transparency, and potential skill erosion. The AHASL model prioritizes Full-Spectrum Explainability (FSE) and a Bias Mitigation Framework (BMF) to ensure that AI-driven decisions are transparent and equitable while simultaneously arguing for retaining human expertise to retain adaptability and resilience in logistical operations. The study's findings emphasize the significance of balanced human-AI collaboration. However, they also call for more research into the long-term effects, scalability, and ethical implications of AI integration in logistics.

Reciprocal Teaching in tech with struggling university readers

Reading comprehension is a skill that is crucial in everyday life, as it allows people to read critically and understand the various texts they encounter. Reading comprehension is not a skill that is actively taught or improved upon in most Western countries, despite its relative importance to everyday life. As a result, university readers struggle with comprehension skills, which can impact their employment prospects. The present study explores the initial implementation of a potential solution to this issue. This study will focus on Phase 1 of a larger project and will implement a qualitative methodology of reflexive journaling to reflect on the initial curriculum design, pedagogical practice, and technological challenges and evaluate the construction and implementation of an online learning platform designed to assist students in improving reading comprehension.

Illuminating Meshworks of Pre-Service Teachers’ Curated Co-Living Learning Spaces

Learning spaces in higher education are fraught with colonial barriers such as teacher-centered, front facing, stark, feelingless, and unwelcoming classrooms that diminish students’ feelings of well-being. For pre-service teachers, these are also the types of classrooms that they often inherit as they foray into the profession. Three Bachelor of Education (B.Ed) assistant professors investigate how pre-service teachers’ well-being shifted when collectively (re)imagining and (re)envisioning a colonial university classroom space in a faculty building that is over 100 years old. They then share the findings of their a/r/tography, action research inquiry that captured the co-living, metabolic experiences and relational meshworks of both participants (n=11) and researchers documented through reflexive journaling, artistic artifacts, interviews (n=3), and contemplation. The researchers embody decolonizing praxes through intentional interpretation and writing scholarship as they weave their storied inquiry. They conclude with transformative urgencies for how B.Ed programs can recalibrate their physical learning spaces to better support and sustain teachers’ well-being in their future profession.

Psychological health in Palliative Care: Thematic analysis of a psychiatrist’s and an art therapist’s clinical reflexive journals

Background: Patients receiving palliative care often face psychological distress, which can be challenging for clinicians to manage. Therefore, reflexive and visual journaling can be used as powerful techniques for clinician selfreflection and personal development. These journals are a form of practice wisdom, providing insights into psychological health in palliative care. Aim: This study aims to describe how patients receiving palliative care experience psychological health, explore the meaning of a palliative care clinician’s work and contribute to the understanding of psychological health in palliative care through the reflexive and visual journals of clinicians. Design: Using Gibb’s reflective cycle as a framework for journaling, this study employs reflexive and visual journaling through the lenses of a psychiatrist and an art therapist. Journal data were analysed using a thematic analysis approach. Setting/participants: The two first authors journaled 107 clinical encounters and created 36 pieces of response art detailing encounters with patients and their families, and clinical conversations in two palliative care centres. Results: Patient attributes and the clinical environment were observed to influence psychological health in palliative care. The patient’s ability to navigate dying, maintain personhood, exert resilience and experience satisfying relationships contribute to psychological health. A clinical environment comprising clinicians with holistic competencies, systems promoting interdisciplinary collaborations and a values-based culture that promotes patient centricity strengthens the delivery of psychological care. Conclusions: Good psychological health in palliative care extends beyond psychopathology and is influenced by the cardinal elements of being human, value systems and systemic elements in the therapeutic environment.

Collection of Time Activity Data to Support Exposure Assessment: Protocol for a Systematic Evidence Map.

Time Activity Data (TAD) describe the timing, duration, and/or frequency of human activities. Given that activity dictates the rate of contact a person has with an environmental agent, activity data can be used to derive rigorous estimates of exposure. TAD has been used to support exposure estimation in a variety of contexts, although there has been no systematic characterization of how TAD has been collected for environmental health applications. We propose a systematic evidence map protocol in pursuit of describing the body of environmental health literature that collects TAD to estimate exposure to chemical, biological, and physical agents. Our work proposes a novel definition for TAD, identifies studies collecting TAD, compiles a list of terms used to describe TAD, and summarizes how this data has been collected to estimate various environmental exposures. This protocol details the proposed search strategy, which targets environmental exposure studies that collect information on human activities and when they occur, using Population-Exposure-Method (PEM) criteria. From each study, we will extract data that will be categorized according to a codebook that we develop. In order to refine and improve our methodology iteratively, we will use reflexive journaling to ensure that the data collected are coded and summarized appropriately. We will produce an open-source database and a systematic evidence map depicting the patterns, trends, and gaps existing in the current body of environmental health literature that collects TAD to estimate exposure to environmental agents. Researchers will be able to use this evidence map to assess prominent themes and may reference the database to identify specific studies collecting TAD, which can inform future environmental health research.

Shining a light on the unseen athletes: stories of exclusion and resistance among gay athletes in professional team sports

PurposeThis study uncovers the challenges and coping mechanisms related to stigma and discrimination experienced by gay professional team sport athletes.Design/methodology/approachUtilizing interpretive phenomenological analysis, this study recruited six gay athletes in professional team sports. Data were collected through virtual one-on-one semi-structured interviews, along with field notes and reflexive journaling, and were thematically analyzed.FindingsThe first theme highlights the discrimination and marginalization experienced by gay athletes in professional team sports, as well as the perceived differences between these athletes and their heterosexual counterparts. The second theme includes anecdotes illustrating their experiences of exclusion, along with counter-stories that resist marginalization. The last theme comprises stories that underscore the lack of acceptance and advocacy, emphasizing the awareness education aimed at making the sporting realm more inclusive.Research limitations/implicationsDespite the extensive recruiting efforts for this study, numerous sports and countries remain unexplored. Follow-up studies are required to fill this gap. As this study was initiated, additional research is needed to provide information on athletes who are still in the closet. Cross-comparisons between gay athletes and their heterosexual teammates can help bridge the gap in perspectives.Practical implicationsParticipants emphasized collective efforts in creating inclusive and welcoming environments for gay athletes, including anti-discrimination policies related to language use, showers and relocation adjustments.Social implicationsParticipants have put forth concrete recommendations for enhancing inclusivity within team sport environments and society at large, including proposals for early educational initiatives within the school systems.Originality/valueThis is the first empirical study that focuses on the experiences of gay professional team sport athletes.

Exploring Parent Experiences With Early Palliative Care Practices in the NICU.

The anxiety and uncertain outcome of an admission of a seriously ill infant to the neonatal intensive care unit (NICU) can cause great stress for parents and contribute to poor mental health outcomes. Early implementation of family-centered palliative care (PC) may provide support for NICU parents. Key concepts of early PC in the NICU include shared decision-making, care planning, and support for coping with distress. The purpose of this study was to explore parent experiences during their child's NICU admission with the early PC practices of shared decision-making, care planning, and coping with distress. Qualitative descriptive methodology was used. Strategies of reflexive journaling, peer debriefing, and data audits were used to enhance trustworthiness. Parents (N = 16) were interviewed, and data were analyzed by conventional content analysis. Targeted recruitment of fathers occurred to ensure they comprised 25% of sample. Parents' descriptions of decision-making were contextualized in gathering information to make a decision, the emotional impact of the decision, and influences on their decision-making. In experiences with care planning, parents described learning to advocate, having a spectator versus participant role, and experiencing care planning as communication. Key themes expressed regarding parental coping were exposure to trauma, survival mode, and a changing support network. These findings highlight key areas for practice improvement: providing more support and collaboration in decision-making, true engagement of parents in care planning, and encouraging peer support and interaction in the NICU and in online communities.

The Embodied Self-Representations of Older Women: A Qualitative Study Protocol for Developing and Evaluating a Therapeutic Model with Narrative and Phototherapy Techniques

Gendered ageism, the intersection of ageism and gender bias, conceptualizes how social constructions shape attitudes toward older women and restrict their access to societal resources. As oppressive gendered ageist stereotypes can affect how older women perceive their embodied selves, interventions tailored to women’s needs are essential to maintaining a positive identity. This research protocol aims to develop an arts-based intervention specifically adapted to the psychosocial needs of community-dwelling older Italian women. It centers on the embodied self-representations of older women from a life-course perspective that integrates narrative and phototherapy techniques. In the first phase of this research project, a pragmatic approach will be taken to explore professionals’ use of phototherapy techniques with aging women; the data will be analyzed through reflexive thematic analysis. Building on the findings and the literature, an intervention will then be developed for older women. In the second phase, a narrative approach will be taken to probe the embodied self-representations of older Italian women as expressed in their narratives and photographic art products; the data will be analyzed through polytextual analysis of personal narratives. In the third phase, interviews based on the arts-based approach and the Client Change Interview will be conducted with older women to examine the psychosocial contribution of the intervention and their experiences with the artistic process and products; the data will be analyzed through reflexive thematic analysis. To uphold qualitative research rigor, data triangulation, reflexive journaling, auditing, and member checking will be employed. The data collection will be conducted between 2024 and 2025. The findings of this study will shed light on the embodied self-representations of older women in Italy as they emerge in their narratives and phototherapy artworks and will provide an empirically based intervention that integrates narrative and phototherapy techniques tailored to their psychosocial needs.

(Self-) Reflection / Reflexivity in Sensitive, Qualitative Research: A Scoping Review

This scoping review offers insight into researcher well-being when working with sensitive and traumatic topics in a qualitative research context. The study identified existing empirical research concerning researcher well-being and mental health. The databases included SSCI, ASSIA < IBISS, Scopus, Social Policy and Practice, PsycInfo, Social Science Database/Social Science Premium Collection (Proquest), and Open Grey. An international search was conducted, with no time constraints on publication dates to gather as wide a selection as possible. 55 papers met the criteria. We found that the terminology used within the papers was not consistent which necessitated grouping the (self-) reflection/reflexive practices researchers used and categorizing them under the umbrella term SRR practices. The research questions were: 1. Which disciplines or fields are conducting SRR practices on sensitive topics? 2. What SRR practices do researchers employ in the context of sensitive research? 3. What were the self-reported outcomes from using SRR practices as a tool of researchers working on sensitive research? A key finding of the scoping review is that many researchers who work on sensitive topics feel unprepared and receive little or no training or support for SRR practices. This poses particular challenges for early career researchers. We also identified that qualitative researchers have developed a range of SRR practices to manage the emotional impact of their sensitive research work. Many authors of the scoped papers stress the importance of peer-support as well as formal and informal debriefing meetings. Another key SRR practice discussed by many researchers is reflexive journaling. Our scoping review suggests that if it is combined with other activities, self-reflexive journaling can be an excellent way to acknowledge and assess the emotional impact of sensitive research.

Catcalling victims’ long-term psychological impacts: A qualitative study

Catcalling incidents are a form of street harassment that occurs in public spaces, conducted by strangers through verbal expressions and behavioral intentions with sexual nuances. This research investigates the psychological dynamics of catcalling events as women perceive them. A qualitative method involves a phenomenological approach and recruiting four participants using purposive sampling. Data were collected from semi-structured interviews, with thematic data analysis using the qualitative data management software NVivo 12. The trustworthiness strategy of the research includes reflexive journaling during the thematic analysis process and a participant-checking procedure. The findings show that catcalling incidents contribute to negative feelings and destructive self-perceptions. In the short term, the psychological impacts of catcalling include fear and worry, discomfort, anxiety, and increased alertness when facing unsafe situations, while the long-term impacts include feelings of guilt, criticism of one’s body shape and appearance, and feeling ashamed of one’s identity as a woman. The research argues that negative body images resulting from catcalling incidents contribute to the risk of low self-esteem.

How Person-Centred Is Cardiac Rehabilitation in England? Using Bourdieu to Explore Socio-Cultural Influences and Personalisation.

The National Health Service (NHS) cardiac rehabilitation patient care pathway has remained largely unchanged for many years despite, on average, half of all eligible patients declining to engage. To investigate reasons for non-engagement, we explored the experiences of ten cardiac patients who participated in cardiac rehabilitation, dropped out, or declined, as well as experiences of seven people deemed significant others by participants. Our ethnographic study involved participant observations, repeat in-depth semi-structured interviews, and reflexive journaling. Reflexive thematic analysis was conducted, focusing on participants' lived experiences. Utilising Bourdieusian concepts of habitus, capital, and field, this article highlights how personal biography, material conditions, and dispositional inclinations combine to make cardiac health care decision-making individual and complex. Despite this, health professionals were not always attuned to specific circumstances arising from differences in patients' experiences and lifeworlds. By considering service improvement recommendations that acknowledge socio-cultural influences, cardiac rehabilitation can work towards providing patients and their significant others with more appropriate, personalised, and person-centred support.

The Case of Contradictions: How Prolonged Engagement, Reflexive Journaling, and Observations can Contradict Qualitative Methods

Interviews and focus groups are common methods for conducting qualitative research. They provide in-depth descriptions of a phenomenon by listening to and analyzing participants' words. Yet, when a researcher immerses themself in an environment for a prolonged period participants are able to act and think naturalistically rather than in a formal interview setting. Prolonged engagement allows the researcher to blend into the participants' environment, therefore increasing the likelihood that the activities that occur in the presence of the researcher do not differ from the activities that occur without the researcher present. This prolonged interaction can provide more in-depth data including observations and address questions of credibility, rather than only conducting an interview or focus group. However, the observations can also bring forward contradictions participants display that differ from the interview or focus group conversation. By spending 3 months in Ghana with the International Agricultural Education Fellowship Program conducting monitoring and evaluation efforts, using a mixed-methods approach, contradictions arose from observations and reflexive journaling that would not have been found without the prolonged engagement. The purpose of this study is to provide methodological insight by examining how contradictions from interviews and focus groups arise when the researcher is immersed in the participants' environment and highlight the importance of prolonged engagement, observations, and reflexive journaling to qualitative credibility.

The Life Stories of Older Gay Men in Italy and Their Response to a Tele-Drama-Based Intervention: A Qualitative Study Protocol

The global rise in the older adults’ population underscores the urgency of addressing mental health issues among older LGBT adults. Older gay men, navigating the intersection of ageism and homophobia, often confront complex stigma affecting their well-being. In Italy, where research on older LGBT adults is very limited, investigation of this issue is crucial. The overarching purpose of this qualitative research project is to explore the life stories of older gay men in Italy and examine their response to a group tele-drama intervention tailored to their unique psychosocial needs. Narrative interviews will be conducted with older gay men in Italy, and the resulting data will be subjected to narrative analysis principles. Volunteers or social workers who work with older gay men will also be interviewed and the data will be analyzed according to thematic analysis, followed by a triangulation of the two datasets. Building on these findings and relevant literature, a group tele-drama intervention will be adapted for older gay men. Video-recorded intervention sessions will be analyzed using the 6-Key model of drama therapy assessment. Post-intervention, participants will undergo Client Change Interviews, with the data thematically analyzed. Ensuring the qualitative rigor of the study will involve triangulation, reflexive journaling, and member checking. The three-year data collection period will span from 2023 to 2025. The findings of this study will shed light on the life stories of older gay men in Italy and the design and contribution of a tele-drama-based therapy program that can help them cope with challenges associated with the intersectionality of ageism and homophobia.

Transitional Care from Hospital to Cardiac Rehabilitation During COVID-19: The Perspectives of Older Adults and Their Healthcare Providers.

Transitional care to cardiac rehabilitation during the pandemic was a complex process for older adults, with additional challenges for decision-making and participation. This study aimed to explore the perspectives of older adults and health providers on transitional care from the hospital to cardiac rehabilitation, focusing on patient participation in decision-making. A qualitative exploratory design was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Document analysis and reflexive journaling were used to support triangulation of findings. Six themes emerged from the data, related to insufficient follow-up from providers, the importance of patients' emotional and psychological health and the support provided by family members, the need for information tailored to patients' needs and spaces for participation in decision-making, as well as challenges during COVID-19, including delayed medical procedures, rushed discharge and isolating hospital stays. The findings of this study indicated a number of potential gaps in the provision of transitional care services as reported by older adults who had a cardiovascular event, often during the first few weeks post hospital discharge.

From isolation to collaboration

The purpose of this study was to explore the development of a group of Brazilian Physical Education (PE) teachers, who struggled with remote teaching, into a community of practice (CoP) during the COVID-19 pandemic. The study focused on factors that supported the CoP cultivation process in an online format. Employing action research methodology, the study involved 15 PE teachers, with one of them acting as a teacher-facilitator, and one critical friend. Data were generated through CoP’s meetings, interviews, critical friend conversations, and reflexive journaling. Thematic analysis resulted in four overarching themes: a) the pandemic as a catalyst for collaboration; b) teachers’ self-organization to enact the community; c) development of collaborative research; and d) dialogue towards a new cycle of collaboration. Noteworthy was that teachers’ self-organization was critical for guiding the CoP throughout stages of development. Further aspects that contributed to CoP’s development in a pandemic scenario are discussed.

Outcomes management practices in tiered school-based speech-language therapy: A Canadian example.

Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service-delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. The first aim was to explore how school-based speech-language therapists approached outcomes management as their clinical programmes transitioned to tiered service-delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. A secondary deductive-inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. Participants reported measuring and qualitatively assessing seven key outcomes for school-based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy-in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. School-based speech-language therapists measure, assess and manage multiple outcomes relevant to school-based practice in tiered service-delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service-delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical-research collaboration and knowledge exchange is recommended. What is already known on the subject Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech-language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school-based practice. What are the potential or actual clinical implications of this work? Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school-based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools.

"My Autism Is My Own": Autistic Identity and Intersectionality in the School Context.

School is an important context for identity development across childhood and adolescence. These formative experiences impact adulthood. Minimal research has examined first-person autistic perspectives of how school experiences shape autistic identity as well as other intersecting identities. In this study, we examined the school messages that autistic individuals received and how individuals engaged with these external messages to formulate their identities. Ten U.S.-based autistic adolescents and adults ages 15-35 participated in qualitative interviews about their elementary through secondary school experiences, interactions with teachers and peers, and how these shaped their identities. Two interviewees also engaged in three follow-up interviews each for member checking and further data gathering. Using a critical constructivist approach informed by grounded theory, we coded interviews inductively. We ensured the trustworthiness of data through peer debriefing, reflexive journaling, memoing, and member checking. In the school context, autistic students received stigmatizing messages from teachers and peers regarding their autism. These messages varied in relation to students' other identities, including race and gender. Participants felt that, following autism disclosure, teachers viewed them narrowly through an autism lens. Participants actively resisted these negative messages from teachers and peers by reclaiming their autistic identity. They reframed and redefined their autistic identity, embraced their autism-related strengths, and actively made choices about how, when, and to whom to disclose their autism. Decisions around autism disclosure intersected with decisions to emphasize other identities such as race or mental health, especially when these identities were more visible or more acceptable to others. The school context conveyed powerful, stigmatizing messages around autism. In response, autistic students actively reclaimed and shaped their identities to prioritize a positive, empowered sense of self. Findings show a need for educators to model positive perceptions of autism, build an inclusive school community, and advocate for autistic representation in schools to facilitate autism-affirming messages.

Professional stakeholders’ perceptions of child marriage in Lebanon among Syrian refugees

Though eradicating child marriage is part of Goal Five of the United Nations Sustainable Development Goals, and some progress has been made, Lebanon struggles with ending child marriage within its borders, primarily due to the many Syrian refugees who fled to Lebanon during and after the Syrian crisis that started in 2011. This study aimed to explore Lebanese professional stakeholders’ perceptions of child marriage in Lebanon and identify potential gaps in services and interventions currently used to combat child marriage. An interpretive description (ID) approach guided data collection and analysis, combining semi-structured interviews with purposively selected professional stakeholders, document analysis, and reflexive journaling. Field notes were also used to orient data collection and analysis. Twenty-eight in-depth interviews were conducted using a purposive sample of professional stakeholders in Lebanon with a professional interest in child marriage. The interviews were transcribed and analyzed using a thematic analysis approach. Four significant themes related to the perceptions of causal pathways to child marriage in Lebanon were identified: 1) the financial burden of girls; 2) concerns around girls’ safety, security, and protecting their honor (including protecting them from potential rape); 3) Syrian religious traditions, customs, and practices; and 4) the lack of awareness of the dangers and consequences of child marriage. Findings indicate that the interventions currently being used or proposed are not aligned with the professional stakeholders’ perceptions of the causal pathways to child marriage. We argue that professional stakeholders’ excessive focus on public information campaigns to raise awareness of the dangers of child marriage as the primary intervention demonstrates a disregard for some of the more significant issues. We argue for the need for professional stakeholders to 1) advocate for a minimum age of marriage law in Lebanon; 2) advocate for the criminalization of child marriage in Lebanon; 3) implement poverty alleviation efforts within the Syrian community in Lebanon, and 4) provide more safety for girls within rural and refugee-populated areas within Lebanon, especially en-route to schools and within schools. By altering their approaches to interventions, Lebanon's professional stakeholders working to eradicate child marriage will ostensibly have greater success in eliminating child marriage practices.

Let down by Low Expectations: A Qualitative Interview/participatory Photography Study of Feeding Problems in Autistic Children

ABSTRACT Feeding problems are common in autistic children. They include eating a limited repertoire of foods and often impact on health and quality of life. To examine the experiences of parents of autistic children who have feeding problems, and their service needs. A pragmatic, qualitative research approach was adopted. Six participants were recruited using purposive and snowball sampling. Data was collected via semi-structured interviews. Participants also submitted photographs with captions. These illustrated their child’s feeding problems and the effect on them and their family. Interviews were transcribed. They were analyzed alongside the photos and captions using inductive thematic analysis. Rigor was ensured via member checking, peer review of themes, and reflexive journaling. Five themes emerged. Parents and children found ‘mealtimes difficult.’ Parents were ‘unsure when or whether to pursue help.’ They felt ‘let down by a lack of support.’ ‘Lowered expectations of parents and professionals’ prevailed about their child’s feeding problems. Parents desired ‘services that are easily accessible and supportive.’ This is the first qualitative study of parents’ experiences of feeding problems in autistic children in the UK. It has been the first study to incorporate participatory photography. These problems have a negative impact on the child’s learning and the child’s, and family’s wellbeing. Support needs are largely unmet. This study has provided rich insight into autistic children’s feeding problems. The findings will inform the design of better support for autistic children and their families.