Reflexive Thematic Analysis Research Articles

“Awful Skinny Boys” – Male Musical Theatre Performers’ Experiences of Body Image: A Reflexive Thematic Analysis

“Awful Skinny Boys” – Male Musical Theatre Performers’ Experiences of Body Image: A Reflexive Thematic Analysis

Fathers’ experiences of nurses’ roles and care practices during their preterm infant’s stay in the neonatal intensive care unit

IntroductionNeonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents. AimExplore fathers’ perceptions and interactions with nurses during their preterm infants’ stay in a NICU. DesignQualitative study using ethnographic data collection techniques. MethodsTwenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis. ResultsAnalysis revealed five primary themes: (i) communication and clarity about infants’ health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers’ satisfaction with nurses’ support for mother, (iv) nurses’ personal attention to the babies, and (v) nurses’ varied personalities. ConclusionNurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant’s hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial. Relevance to Clinical PracticeNurses play a critical role in shaping the fathers’ experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities. Reporting MethodAdherence to the COREQ guidelines.

The role of emotion in urban development decision-making: A qualitative exploration of the perspectives of decision-makers

People's feelings about their neighbourhoods are important for health, but they may be undervalued in urban development decision-making. This study explores how decision-makers understand and respond to residents' emotions. Reflexive thematic analysis was conducted on a secondary dataset consisting of 123 interviews with influential professionals in urban development decision-making. We developed three themes and one subtheme: ‘(mis)understanding residents’ emotions', ‘neglecting the health impact of positive emotions’, ‘avoidance of emotion in community engagement’ and ‘sanitized emotions’. We recommend decision-makers engage directly with residents' emotions during urban development processes to ensure healthier place-making.

Diffusion of innovation, pre-registration/licence student nurses' use of social media: A reflexive thematic analysis.

To identify and report the use of social media among pre-registration (pre-licence) student nurses. A social survey was conducted in 2019 to explore student nurses' views of social media usage. Diffusion of innovation theory and social identity theory were used as the theoretical framework. A reflexive thematic analysis was undertaken of responses to an open-ended question. 351 responses were analysed. Four themes emerged: Social media as a communication tool that helps to keep in contact and communicate with friends, family, colleagues and peers; Social media and self-care including a sense of pride, boosting morale and helping to relax; Social media and learning by sharing experiences, chatting, posts and social media and professionalism, participants expressed confusion over the use of social media professionally. The diffusion of social media among UK student nurses is advancing in different aspects of UK student nurses' lives. However, the diffusion seems to slow down when it comes to the professional system. They express concerns that one social system can negatively impact another and have repercussions on a personal and/or professional level and therefore prevent UK student nurses from developing social media proficiencies. Guidance and support should be offered to UK student nurses to develop their social identity across the different systems. This diffusion can help to educate student nurses and future professionals in a globally connected world. Social media features in student nurses' personal and professional lives and presents challenges for social identity which is woven into the personal and professional personas. Nursing faculties should have social media competencies embedded into the curricula to develop and strengthen students' social and professional identities across the different systems. No Patient or Public Contribution.

Mothers’ reflections on family food habits post pandemic

The COVID-19 pandemic altered daily family routines, with the family food environment especially likely to be affected. Little is known about how families have adapted over time. The objective of the current study was to explore how family food habits evolved three years after COVID-19 was designated a pandemic. Mothers participated in an interview between March and April 2023. Reflexive thematic analysis was used to analyze the transcripts. Thirty mothers participated (97% lived in the Central Valley in California; 43% Hispanic). Themes were identified around changes in mealtime frequency, eating habits including snacking, screen time during mealtimes, and weight gain. While some unhealthy habits established during the pandemic improved, others persisted three years later. Maternal snacking, concerns about child weight gain, and overall screen time lessened after the pandemic ended, but child snacking behaviors, maternal weight gain concerns, and screen time during mealtimes continued. This research expands on the existing COVID-19 literature by examining lingering effects of the pandemic on family food habits. Findings may be helpful for health practitioners working with families to understand food related changes post-pandemic, especially those that have been particularly resistant to change.

Exploring perceptions of anti-vaping message themes: A qualitative study of Australian adolescents and adults.

Minimising electronic cigarette (e-cigarette) uptake and encouraging vaping cessation have become important components of public health agendas. Given the success of well-designed anti-smoking campaigns, attention has turned to developing health communications that target vaping. Although prior work has identified a range of potentially effective campaign messages, several gaps in the literature remain. We aimed to (i) identify message themes perceived to be effective at minimising e-cigarette use and (ii) elicit opinion on how these message themes could be optimised in terms of message execution and delivery. Focus groups (n = 16) were conducted with adolescents (14-15 and 16-17 year olds), young adults (18-24 year olds), and adults (25-39 year olds). The groups reported on message themes they believed would assist with minimising e-cigarette use. They then provided feedback on 14 message themes developed by the research team. Data were analysed using reflexive thematic analysis. Groups discussed a range of message themes they believed would be effective. These included themes focused on the health harms associated with vaping, the chemical ingredients in e-cigarettes, use dependence, and social attitudes to use. Groups discussed the importance of using evidence-based personal testimonies, and reported that messages would be most effectively communicated via social media, in public places, and at point of sale. Results build on existing research by identifying message themes perceived to be most effective, and how these would best be executed. Results have the potential to inform the development of co-designed health communication campaigns addressing youth vaping. Using a stratified focus group methodology, we collected rich and detailed qualitative data on Australians' perceptions of anti-vaping message themes. Themes considered most effective were those that addressed the health harms of vaping, the chemical ingredients in e-cigarettes, social consequences of use and the impacts of dependence. We recommend further work to develop and trial a range of specific anti-vaping messages based on the themes identified as having the most potential. This process should include iterative co-design with the target audience to optimise future health communication campaigns.

“Because people don’t know what it is, they don’t really know it exists”: a qualitative study of postgraduate medical educators’ perceptions of dyscalculia

BackgroundDyscalculia is defined as a specific learning difference or neurodiversity. Despite a move within postgraduate medical education (PGME) towards promoting inclusivity and addressing differential attainment, dyscalculia remains an unexplored area.MethodsUsing an interpretivist, constructivist, qualitative methodology, this scoping study explores PGME educators’ attitudes, understanding and perceived challenges of supporting doctors in training (DiT) with dyscalculia. Through purposive sampling, semi-structured interviews and reflexive thematic analysis, the stories of ten Wales-based PGME educators were explored.ResultsMultiple themes emerged relating to lack of educator knowledge, experience and identification of learners with dyscalculia. Participants’ roles as educators and clinicians were inextricably linked, with PGME seen as deeply embedded in social interactions. Overall, a positive attitude towards doctors with dyscalculia underpinned the strongly DiT-centred approach to supporting learning, tempered by uncertainty over potential patient safety-related risks. Perceiving themselves as learners, educators saw the educator-learner relationship as a major learning route given the lack of dyscalculia training available, with experience leading to confidence.ConclusionsOverall, educators perceived a need for greater dyscalculia awareness, understanding and knowledge, pre-emptive training and evidence-based, feasible guidance introduction. Although methodological limitations are inherent, this study constructs novel, detailed understanding from educators relating to dyscalculia in PGME, providing a basis for future research.

Influencers of participation in social roles and activities among women veterans with lower extremity amputations: an exploratory qualitative study.

Women military Veterans with lower extremity amputations are a growing subpopulation of Veterans. There is a paucity of exploration into factors influencing participation in meaningful social roles and activities within this population. Thus, the purpose of this qualitative study was to evaluate influencers of participation among women Veterans with lower limb amputations. Women Veterans participated in semi-structured internet-based video focus groups led by a clinician researcher. Participants were encouraged to describe their experiences around participating in meaningful social roles and activities, with specific consideration of known influencers of participation. Data were analyzed using reflexive thematic analysis. Eleven women Veterans with lower extremity amputations participated across three focus groups conducted between August 1 and September 30, 2021. Participants described many factors influencing their participation, including heat and sweat, body image, and footwear. To the authors' knowledge, this study is the first to qualitatively evaluate the experiences of women Veterans with limb loss in regard to their perceptions around participation. The results of this study echo the findings of other quantitative and qualitative studies including women Veterans, with a new lens on the construct of participation.

‘Find your groove’: exploring how dancing can support physical literacy for individuals with Parkinson’s

ABSTRACT The purpose of this study was to examine teaching strategies utilized by instructors within a dance class for individuals with Parkinson’s, and to describe ways in which dancers respond to the teaching strategies utilized; both through the lens of physical literacy. Dance instructors offer important insight into the content design and facilitation of these classes for individuals with Parkinson’s so they can experience the physical, psychological, and social benefits of dancing. Observations of nine dance classes (occurring online and via hybrid format) were conducted. Data was analyzed using reflexive thematic analysis and five themes were created: (1) Tuning in and connecting dancers with their bodies; (2) Creating a fun, low-pressure, and responsive environment; (3) Designing opportunities for dancers to be creative during class; (4) Overcoming challenges and feeling successful; (5) Connecting and dancing together. Dance classes led by adaptable, encouraging, and responsive instructors offer joyful and motivating dancing experiences for individuals with Parkinson’s. These findings paint a picture of specific pedagogical strategies and behaviours utilized by dance instructors to support expressions of physical literacy within classes for individuals with Parkinson’s.

“I Will Still Fight for It till the End”: Factors That Sustain and Detract from Indian Youths’ Climate Activism

This qualitative study utilized semi-structured interviews with 22 Indian youth climate activists (mean age = 19) from 13 cities across India to explore factors that sustain or detract from climate activism. Data were analyzed using reflexive Thematic Analysis. In addition to two gatekeeping factors (lack of family support and financial and job pressures) that may prevent youth from joining or cause youth to quit their climate activism entirely, this study identified factors that affected youth’s sustained climate activism: two detracting factors (negative interactions with government, and online and in-person bullying and harassment); four supporting factors (sense of community, internal motivations, seeing tangible achievements, and personal growth); and one factor (climate anxiety) with mixed effects on sustaining youth activism. Further, we describe ways in which youth holding minoritized identities, including lower-income, Muslim, and rural youth, had distinct experiences.

From Avoidance to Competence? How the Identity Project Inspires Teachers to Engage with Ethnicity and Culture with Their Students

ABSTRACT Multicultural education highlights the need to promote students’ diverse identities, recognizing their ethnic-cultural backgrounds as resources in their teaching. However, most teachers perceive they lack competence and learning material to this end. Research suggests the Identity Project may be an appropriate tool to resolve some of these challenges. We explore both teachers’ and students’ narratives about teaching issues of ethnicity and culture in multicultural classrooms centering on potential changes from before to after teachers delivered the IP. We conducted one focus group interview with seven teachers before they were trained and implemented the IP in their classrooms, and individual interviews with them after they had completed the intervention. Data from three focus groups with 16 students from the same schools, and individual interviews with 16 other students that received the intervention are included to add perspective to the teachers’ narratives. A reflexive thematic analysis resulted in four themes: From avoidance to embracing the diversity topics, from not addressing to affirming student identities, teachers pushing for inclusion (or exclusion), using cultural background as a learning/teaching tool. Our findings imply that the IP can be a tool for multicultural education that enhances teachers’ competence in supporting students’ identity development.

How do family carers assist people with dementia? A qualitative observation study of daily tasks

Introduction: As people with dementia progressively experience difficulties when performing daily tasks, family carers often become the main providers of support. Little is known about the role of carer support during task performance. Therefore, Occupational Therapy interventions are often underinformed in this area. Knowledge of how carers assist people with dementia could support Occupational Therapists in promoting participation in daily tasks. The objective was to explore how carers support people with dementia during the performance of daily tasks. Methods: A secondary analysis was conducted on observations video-recorded for the TASKed project, where people with dementia completed a task with carer support. Data were analysed using an inductive reflexive thematic analysis approach. Findings: Video recordings of 21 dyads were included in this study. Five themes were generated depicting how carers supported people with dementia during task performance: (1) person-enabled assistance, (2) goal-directed assistance, (3) carer-led assistance, (4) partnership-oriented assistance and (5) bystander. Conclusion: Our findings suggest carers employ different approaches when assisting people with dementia with daily tasks. Knowledge of these different modes of assistance could help Occupational Therapists and researchers understand what works well and what could be changed to facilitate the participation of people with dementia in daily activities.

One More Tool in the Tool Belt: A Qualitative Interview Study Investigating Patient and Clinician Opinions on the Integration of Psychometrics Into Routine Testing for Disorders of Gut-Brain Interaction.

Introduction Disorders of gut-brain interaction (DGBIs) encompass a common group of disorders characterised by chronic gastrointestinal symptoms. Psychological comorbidities are common in patients with DGBIs and are linked with poorer patient outcomes. Consequently, assessing and managing mental wellbeing may lead to improvements in symptoms and quality of life. Methods This study aimed to explore patients' and clinicians' opinions on integrating psychometrics into routine DGBI testing. Semi-structured interviews were conducted with 16 patients with gastroduodenal DGBI and 19 clinicians who see and treat these patients. Interviews were analysed using inductive, reflexive thematic analysis. Results Three key clinician themes were developed: (1) psychology as part of holistic care, emphasising the importance of a multidisciplinary approach; (2) the value of psychometrics in clinical practice, highlighting their potential for screening and expanding management; and (3) navigating barriers to utilising psychometrics, addressing the need for standardisation to maintain the therapeutic relationship. Four key patient themes were developed: (1) the utility of psychometrics in clinical care, reflecting the perceived benefits; (2) openness to psychological management, indicating patients' willingness to explore psychological treatments; (3) concerns with psychological integration, addressing potential stigma and fear of labelling; and (4) the significance of clinician factors, emphasising the importance of clinician bedside manner, knowledgeand collaboration. Conclusions These themes demonstrate that patients and clinicians see value in integrating psychometrics into routine DGBI testing. Despite potential barriers, psychometrics advance patient and clinician understanding and facilitate multidisciplinary management. Recommendations for navigating challenges were provided, and considering these, patients and clinicians supported the use of psychometrics as screening tools for patients with DGBIs.

A novel framework for Indigenous eye health care in New Zealand: Ngā Mata o te Ariki

ABSTRACT Clinical relevance Development of an Indigenous eye health framework could offer the opportunity for eye health professionals to enhance engagement with Indigenous populations. Background Indigenous populations globally experience disproportionately poorer eye health outcomes than non-Indigenous peoples. Incorporating Māori perspectives of eye care and pre-existing Indigenous models of health offers potential to enhance Māori experience and engagement with eye health services. This study seeks to develop and refine a practical framework for eye health care that incorporates nine established Indigenous health principles. Methods Qualitative methodology, guided by Indigenous Māori research principles, was used to evaluate interviews with five leading senior Māori academics surrounding the ongoing development and refinement of a Kaupapa Māori (Māori worldview centric) framework for eye care in Aotearoa New Zealand, created following Māori health consumer consultation. Interviews were semi-structured and analysed using reflexive thematic analysis. Results Seven key themes arose in relation to the development of a Kaupapa Māori framework for eye care in Aotearoa New Zealand: 1) vision is critical to Māori well-being, 2) cultural safety is important, 3) Māori health beliefs must be upheld, 4) achieving pae ora (healthy futures) is important, 5) key concepts and focus of the framework must be clear, 6) pūrākau (traditional Indigenous stories) are valuable resources in developing health frameworks and 7) embedding Matariki (fundamental Māori) principles is valuable. Conclusions Using Kaupapa Māori principles allowed development and refinement of a framework that encourages clinicians to consider Indigenous health principles when engaging with Māori patients who seek eye care. Application of this framework may contribute to enhancing cultural safety and responsiveness of eye care for Māori.

Wider health needs in attention deficit hyperactivity disorder from lived and professional experience: a qualitative framework analysis

ObjectivesThis study aimed to explore the perspectives of people with attention deficit hyperactivity disorder (ADHD), their supporters and primary care professionals (PCPs), on the wider physical and mental health needs...

Barriers and system improvements for physical activity promotion after gestational diabetes: A qualitative exploration of the views of healthcare professionals.

Physical activity is an important behaviour for managing the ten times increased risk of type 2 diabetes after gestational diabetes. Previous studies exploring physical activity promotion in healthcare focus on general practitioners but have not explored the gestational diabetes pathway. Therefore, this paper explores the barriers to and suggestions for, activity promotion along the gestational diabetes healthcare pathway. The paper was written in accordance with the Standards for Reporting Qualitative Research. Patient and Public Involvement with women who had lived experiences of gestational diabetes informed purposeful sampling by identifying which healthcare professional roles should be targeted in participant recruitment. Participants were recruited through word-of-mouth, that is, email and connections with local healthcare service leads. Twelve participants took part in semi-structured one-to-one interviews, analysed using reflexive thematic analysis. Participants included a Public Health Midwife (n = 1), Diabetes Midwifes (n = 3), Diabetes Dietitian (n = 1), Diabetes Consultants (n = 2), Diabetes Specialist Nurse (n = 1), general practitioners (n = 2), Practice nurse (n = 1) and a Dietitian from the UK National Diabetes Prevention Program (n = 1). Six themes were generated: 'management of gestational diabetes takes precedent', 'poor continuity of care', 'lack of capacity to promote PA', 'beliefs about the acceptability of PA promotion', 'resources to support conversations about PA' and 'adapting healthcare services for women post-gestational diabetes'. During pregnancy messaging around physical activity is consistent, yet this is specific for managing gestational diabetes and is not followed through postnatally. Improvements in continuity of care are necessary, in addition to ensuring the availability and links with wider exercise and activity schemes.

What can PrEP do for female sex workers? Unpacking the “effectosphere” of biomedical HIV prevention in Dar es Salaam

Pre-exposure prophylaxis (PrEP) is a drug with the power to prevent HIV transmission. This study delved into the broader implications of PrEP use among female sex workers in Dar es Salaam, Tanzania, a group disproportionately affected by HIV and socio-structural challenges. Through 46 in-depth interviews with 40 women who were either former or current PrEP users or intended to start PrEP between January 2021 and February 2022, we sought to explore the nuanced effects of PrEP. Inspired by Whyte et al. and “Social Life of Medicines”, we asked what PrEP could do in the lives of female sex workers and analyzed the data using reflexive thematic analysis and an interpretative phenomenological approach. We found that PrEP had multiple and diverse effects in many domains of women's lives and refer to these collectively as the “effectosphere” of PrEP. The study identifies four key themes that jointly describe this effectosphere: (1) PrEP could promote human flourishing and empowerment by facilitating a feeling of freedom and confidence which could promote health, social relations, and economic and work opportunities, (2) PrEP could inflict harm (and fears of such harms), partially reflecting medical mistrust rooted in an understanding that sex workers were undesired in society, (3) PrEP could expose sensitive information about its users that could lead to stigma, arguments and needs for elaborate explanations, and (4) PrEP could medicalize daily life, evidenced through daily pill taking, clinical appointments, side-effects, becoming reliant on the medication, and the challenges of integrating PrEP use with other life priorities. We argue that investigating the full effectosphere of any medicine in particular geographic and sociocultural contexts can lead to a better understanding of its use and non-use, highlighting that engaging with medication extends beyond just “taking a pill.”

UK female veterans’ physical health: perceived impact of military service and experiences of accessing healthcare. Findings of a qualitative study

IntroductionWomen make up almost 14% of the UK’s veteran population; however, little is known about female veterans’ physical health and experiences of accessing healthcare after military service. As part of...

An Exploration of LGBTQA+ Young People’s Coping Strategies When Navigating Suicidal Thoughts and Behaviors

ABSTRACT LGBTQA+ young people experience suicidal thoughts and behaviors at a much greater rate than their heterosexual and cisgender peers. This study explored firsthand accounts of the coping strategies employed by LGBTQA+ young people when experiencing suicidal thoughts and behaviors. LGBTQA+ young people (N = 27; ages 14–25) in Australia with a history of suicidal thoughts and/or attempts participated in semi-structured interviews. Using reflexive thematic analysis, four major themes were developed: (1) It’s about the journey, not the destination, (2) Connecting with others, (3) When I knew better, I coped better, and (4) Doing the best I can with what I have. LGBTQA+ young people reported utilizing a range of coping strategies, however these were limited by a lack of knowledge around mental health, gender and sexuality diversity, and available resources. Experiences of discrimination within support settings and limited access to clinicians with knowledge of sexuality and gender diversity were cited as significant barriers. Interventions to increase mental health literacy in LGBTQA+ young people and improvements to clinician knowledge of sexuality and gender diversity are needed to enhance LGBTQA+ young people’s access to effective coping strategies when experiencing suicidal thoughts and behaviors.

Deficits and opportunities, pivots and shifts for scaling-up voluntary medical male circumcision in Uganda: a qualitative reflexive thematic analysis study

Despite voluntary medical male circumcision (VMMC) being a cost-effective intervention for preventing HIV transmission, its scale-up has faced challenges. Several interventions to address these challenges in priority countries, including Uganda, have not yielded the desired results. This cross-sectional qualitative study aimed to explore the factors that affect the demand for VMMC and identify possible solutions. Semi-structured phone interviews were conducted with 29 males aged at least 18 and not more than 65 drawn randomly from a database representative of the general population maintained by an independent research organisation. Reflexive thematic analysis was conducted, and data analysis was done using NVivo version 12. The results were presented in narrative format with supporting quotes. The study received ethical and regulatory clearance to be conducted in Uganda. The average age of the respondents was 28 years. Almost all respondents had some education, and most lived in rural areas. Two themes were generated, namely, 1) deficits and opportunities for VMMC, which are issues that currently hinder the uptake of VMMC but, if addressed, would lead to better demand, and 2) pivots and shifts for VMMC, which are changes that need to be made to improve the uptake of VMMC. We found that several challenges, including myths, misconceptions, health system gaps, and uncertainties about the postoperative period, hindered the uptake of VMMC. Pivots and shifts for improving the uptake of VMMC include intensifying VMMC campaigns, addressing inequities, and addressing access barriers. We concluded that several challenges, including myths and misconceptions, health system-related gaps, and uncertainties in the post-circumcision period, persist and negatively impact the scale-up of VMMC in Uganda. VMMC beneficiaries have plausible proposals for addressing challenges. The Uganda Ministry of Health should address the myths, misconceptions, health system-related gaps, and uncertainties about the postoperative period and should involve VMMC beneficiaries in reviewing interventions to address gaps.