Sensitive Topics Research Articles

An Exploratory Study of Fact-Checking Practices in Conflict and Authoritarian Contexts

This study explores fact-checking practices in Ethiopia and Mali in times of conflict and in a context marked by increasing restrictions to press freedom. The objective is to understand how, in this hostile environment, fact-checkers in these two countries manage to carry out their activities. Our findings reveal that fact-checkers are often victims of online bullying and harassment and fear reprisal from governments. This pushes them to self-censor, avoiding working on sensitive topics, such as military issues in Mali. In addition, fact-checking organizations in both countries highlight the difficulty of accessing reliable sources. Consequently, they focus more on debunking viral social media content, thus effectively becoming content moderators who have turned away from the mission of holding leaders accountable, one of the primary functions of fact-checking. Regarding their role conception, fact-checkers in Ethiopia and Mali see themselves more as guides helping navigate the information disorder than “guardians of truth” or “truth keepers.”

Collaborative approaches to health education: perspectives of parents and teachers on self-care and managing common health issues in UK primary schools

BackgroundHealth education in primary schools plays a critical role in equipping children with essential self-care skills, fostering health literacy, and addressing social determinants of health. This study explores the perspectives of parents and teachers on teaching self-care and managing common health issues in UK primary schools. Despite the recognized importance of health education, there is limited research on how self-care education is perceived and implemented in the primary school setting.MethodsA qualitative study was conducted using semi-structured interviews with 18 participants, including 9 generalist primary teachers and 9 parents from diverse educational and socioeconomic contexts in the West Midlands, East Midlands, Northwest, and London of England. Participants were recruited via social media and professional networks, and interviews were conducted via video conferencing platforms. Data were thematically analysed using NVivo 12 to identify recurring themes related to the delivery and impact of self-care education in primary schools.ResultsTeachers and parents highlighted key self-care topics, including hygiene, managing common illnesses like colds and cuts, and mental well-being. There was a consensus on the importance of self-care education, but views diverged on whether the responsibility should lie primarily with schools, parents, or a collaborative approach. Teachers expressed concerns about their preparedness to teach sensitive topics, citing a lack of training and resources. Socioeconomic and religious contexts further influenced perceptions, with participants emphasising further importance of school-led self-care education for children from lower socioeconomic backgrounds. Strengths were identified in current self-care education efforts, particularly in practical lessons that empower children with age-appropriate skills.ConclusionsThis study highlights the critical need for comprehensive and collaborative health education in primary schools to promote health literacy and reduce health disparities. Enhancing teacher training, integrating self-care topics into the primary curriculum, and fostering stronger partnerships between schools and families are essential to improving the quality and consistency of self-care education. Policymakers should consider implementing mandatory health education training in teacher education programs and providing ongoing professional development to support teachers. By addressing these gaps, schools can play a pivotal role in preparing children for lifelong health management, reducing the burden on healthcare services, and supporting public health objectives.

Challenges Face Exegetists in Rendering Quranic Euphemistic Expressions into English

The Arab Nomads were infamous for their brutal acts against humanity in the Pre-Islamic Era, also known as the age of ignorance. The introduction of Islam and its teachings by the Prophet Muhammad, who received the Holy Qur'an in Arabic, played a significant role in the transformation of the nomads into a more civilized society during the period of Islamic dominance in the Arabian Peninsula. Arabic is considered one of the most magnificent languages due to the elegance of its words, the sophistication of its grammar, the precision of its structures, and the versatility in expressing various concepts. Despite the fact that the ancestors of the Arabs were ancient people, the Arabs themselves were driven by a strong sense of compassion that extended to all their tribes. The ideas presented were indeed remarkable. In Arabic, euphemisms are used to soften sensitive topics, a linguistic feature shared with other languages. Euphemisms allow individuals to refer to a situation indirectly through the use of figurative language. Arabic encompasses the overarching term بلاغـــة (metonymy), with تـلطيـف (softness) being the most relevant co-hyponym. This study critically analyzes the differences and similarities in the use of euphemistic expressions between Arabic and English, shedding light on the linguistic and cultural aspects of both languages.

Investigating the effects of political correctness in social marketing messaging

Purpose Obesity imposes myriad negative consequences upon society, the economy and personal well-being. This study aims to investigate the effectiveness of using political correctness (PC) in social marketing messages to persuade consumers to change their unhealthy behavior. It also explores various underlying mechanisms that drive this effect. Specifically, this research studies that messaging approach – politically correct vs politically incorrect and gain vs loss message framing – generates higher consumer intentions to change their behavior. Design/methodology/approach Four experiments were conducted with nationally representative samples to examine the effect of PC and gain vs loss message framing on consumers’ behavior changing intentions. Findings Politically correct prosocial marketing messages displayed higher persuasiveness than politically incorrect messages. Each relationship was mediated by the perceived manipulative capacity of the message and consumers’ attitudes toward the message. Message framing performed as a boundary condition for these effects. Research limitations/implications This paper sought to contribute to the literature that investigates the effectiveness of social marketing efforts. Three specific contributions related to the effects of message frames on politically correct and incorrect social marketing messages were developed. Practical implications The strategies presented in this paper benefit firms wishing to create a more prosocial approach to their business. A firm can present a prosocial message to their target market in a frame focusing on what will be gained instead of lost. Likewise, firms should welcome this type of messaging that embraces politically correct terminology instead of shying away from it. Originality/value This paper generates actionable insights for marketers and policymakers regarding how best to communicate with targeted segments about culturally- and personally sensitive topics related to obesity and weight loss. This paper also contributes to the literature that explores the effectiveness of social marketing initiatives. The findings suggest policymakers and social marketers should be cautious and, regardless of today’s sociopolitical environment, avoid falling into the temptation of developing politically incorrect and loss-framed messages.

Feasibility and acceptability of a life skills and reproductive health empowerment interventionfor young newly married women in Rajasthan, India: A pre-post convergent mixed methods pilot study.

Background: Newly married young women face increased susceptibility to adverse health outcomes, social isolation, and disempowerment, yet interventions targeting this vulnerable group remain limited. We examined the feasibility and acceptability of TARANG, a life skills and reproductive health empowerment intervention, developed for and with young newly married women. Methods: We recruited 42 newly married women as participants in our study. We conducted a convergent mixed-methods, single-group cluster pilot study to the intervention in which 41 participants (retention rate=97.6%) completed both baseline and endline surveys in July 2023 and January 2024, respectively. We assessed three primary outcomes--feasibility using proportion of participants who completed at least 50% sessions, acceptability using proportion completely satisfied/somewhat satisfied with TARANG and usefulness using proportion who found TARANG useful/somewhat useful. We conducted in-depth interviews with a purposive sample of 12 participants to understand intervention acceptance and usefulness of the intervention and 6 program staff and moderators to understand barriers to implementing the intervention. We analyzed the quantitative data with descriptive statistics and qualitative data using thematic analysis. We triangulated data from monitoring data filled by moderators, quantitative surveys with participants, and qualitative data. Results: In the pilot study, 35/42 participants had completed at least one session. Overall, 82% participants attended at least 50% of the sessions. Among those who attended at least 1 session,97% were satisfied/somewhat satisfied with the intervention and 100% of participants found the intervention to be useful/somewhat useful. Qualitative findings reveal participants' appreciation for open discussions on sensitive topics, such as family planning, and highlight the intervention's role in filling knowledge gaps and fostering social connections, better sense of agency and improved relationships with mothers-in-law and husbands. While barriers to consistent participation were identified, feedback informed refinements to the intervention for the main trial, including session modifications, increased engagement strategies, and integration of educational videos. Conclusion: Our community-based participatory approach, developed with input from end users, demonstrated not only high acceptability and feasibility but also had many benefits for newly married women in rural/tribal Rajasthan. Our findings also led to adaptations that may enhance delivery of, and satisfaction with TARANG intervention, which will be tested with a larger sample in a rigorous cluster randomized controlled trial in Rajasthan, India. ClinicalTrials.gov : The study is registered at ClinicalTrials.gov (NCT06320964). Registered retrospectively on 13 March 2024, https://clinicaltrials.gov/study/NCT06320964.

When words fail us: An integrative review of innovative elicitation techniques for qualitative interviews.

Interviews are central to many qualitative studies in health professions education (HPE). However, researchers often struggle to elicit rich data and engage diverse participants who may find this strategy exclusionary. Elicitation techniques are strategies tailored to address these challenges, enhancing oral conversations through other forms of interaction-for example, participant photography and neighbourhood walks. These strategies are tailored to elicit the rich data needed to address complex problems and meaningfully engage participants. Unfortunately, guidance on these techniques is scattered across literatures from diverse fields. In this synthesis, we offer an overview of the elicitation techniques available and advice about how to choose between them. We conducted an integrative review, drawing on methodological literature from across the health and social sciences. Our interdisciplinary searches yielded 3056 citations. We included 293 citations that were methodologically focused and discussed elicitation techniques used in interviews with adults. We then extracted specific elicitation techniques, summarising each technique to capture key features, as well as strengths and weaknesses. From this, we developed a framework to help researchers identify challenges in their interview-based research and to select elicitation techniques that address their challenges. To enrich data, researchers might seek to shift conversations away from participants' entrenched narratives, to externalise conversations on sensitive topics, or to elicit affect, tacit knowledge or contextual details. When empowering participants, researchers might seek to increase equity between the researcher and participant or foster interview accessibility across diverse participant populations. When chosen with study goals in mind, elicitation techniques can enrich interview data. To harness this potential, we need to re-conceptualise interviews as co-production of knowledge by researcher(s) and participant(s). To make interviews more equitable and accessible, we need to consider flexibility so that each participant can engage in ways that best suit their needs and preferences.

From ‘white man’s science’ to a ‘Brave Space’: an art of decolonising landscape from Environmental Science

In 2021, prompted by the claim of a colleague that the climate and species crises are ‘white man’s science’, two small, seed-funding research projects, explored contemporary cultural values and colonial barriers to people of colour engaging in Environmental Sciences. The project partners included organisations from diverse ethnicities, sectors, cultures and generations in specific locations across the UK. A form of deep listening (consciously focusing on people’s cultural narratives) was explored with creative storying (the making and telling of stories), as an approach to research. And from this a Brave Space emerged between the project participants; gaining the courage to face the challenges of deeply difficult and sensitive topics, such as race, power, privilege and oppression. Climate, species and cultural crises were perceived as the nexus of one crisis or emergency.

An exploratory examination of medical and nursing students’ intentions to discuss body image, weight, and eating disorders with their patients

BackgroundAlthough many people have concerns about their body image, weight, and eating behaviors these issues are not usually discussed in a productive manner with medical providers. Thus, we examined nursing and medical students’ willingness to discuss patients’ weight, body image, and eating disorders and reasons why they may do so.MethodOne hundred and eighty-three nursing and medical students (Mage = 25.06, SD = 5.43) participated in this study. Participants completed open-ended questions pertaining to their willingness to discuss body image, eating, and weight-related issues with future patients. We further queried students’ perspective on body mass index (BMI) as a measure of weight status and sought to determine if participants’ own weight, weight concerns, appearance evaluation, body appreciation, and experiences of stigma were associated with their willingness to discuss weight-related issues with prospective patients.ResultsCoding of qualitative data indicated that nursing and medical students were “sometimes” willing to discuss prospective patients’ weight, body image, and eating disorders, especially if a health concern was evident. Nursing students seemed somewhat more willing to discuss weight issues than medical students and willingness to discuss one of these issues (e.g., body image) was positively associated with willingness discuss the others. Plans for future discussions of body image and weight were marginally associated with personal experiences of weight stigma. The majority of participants indicated that BMI was not a valid measure of health.ConclusionsTaken together, findings suggest that future providers’ conversations with patients about these sensitive topics are less likely to be associated with their own experiences and more with the relevance of these topics to specific patients.

‘Because otherwise she’s not doing her job – if she doesn’t listen’: children’s and parents’ views on participation in the assessment process according to the Swedish Disability Act

ABSTRACT Social workers often experience difficulties involving children in the assessment process for disability support, but we know less about how children and their parents experience meeting with social workers in a statutory practicing context. This study examines how increased participation can be possible for children with disabilities throughout the Swedish Disability Act (SDA) assessment process. Eleven children and twelve parents were interviewed, using Talking Mats with the children. Malterud’s phenomenological method was used for analysing the data. Children feel they are listened to, but they need support expressing what they find difficult, and believe Augmentative and Alternative Communication can support their understanding. When planning a meeting, children need information beforehand to be involved in the planning. Parents believe that children should be involved in decision-making; hence, their own involvement is needed. Many children who are eligible for SDA interventions would be able to speak for themselves later in life if introduced to actively participating in assessment processes at a younger age. Accordingly, it becomes important that children with disabilities, together with parents and social workers, also gain experience in talking about sensitive topics. This may, in the long term, alleviate parents’ worries and uncertainty about how to protect their children.

The role of toilets in public spaces: An interview study with individuals experiencing gastrointestinal issues

This study, conducted in Norway, addresses the issue of inadequate access to toilets in public spaces and transportation systems, particularly concerning individuals with disabilities who have heightened needs of toilets. The study employed in-depth interviews with individuals experiencing various gastrointestinal issues, including bladder-related problems. Utilizing a qualitative approach, interviews were conducted via telephone to accommodate potential travel difficulties. This approach also leveraged previous successes with sensitive topics. A sample size of 10 interviews was chosen based on prior research indicating that key themes typically emerge within this range. Key findings indicate significant barriers to participation in societal activities due to insufficient toilet facilities. For transport in particular, boats and trains emerge as preferred modes over buses, trams and subways due to the presence of onboard toilets. Notably, urban areas and recreational spots like parks and beaches suffer from a lack of restroom facilities. In order to improve these facilities, informants highlighted measures such as provision of open, hygienic toilets with barrier-free access. These measures should be coupled with clear signage and awareness campaigns regarding toilet facilities tailored to individuals with diverse health needs. The study underscores the critical role of toilets in maintaining public health and acknowledges the right to access toilets as recognized by the United Nations. Testimonials from individuals with disabilities underscore the profound impact of toilet accessibility on their daily lives, revealing instances of social isolation and restricted activities due to inadequate facilities. Proposed interventions encompass improved hygiene standards, increased toilet availability, and enhanced staff training to cater to the diverse needs of users. The study advocates for legislative reforms and policy guidelines to address the pressing issue of toilet accessibility, aiming to foster inclusivity and equal participation in public life for individuals with disabilities.

Enhancing the Process of Collecting Patient Medical and Surgical History: Navigating Sensitive Topics and Evolving Practices

Enhancing the Process of Collecting Patient Medical and Surgical History: Navigating Sensitive Topics and Evolving Practices

Exploring Young Adults' Mental Health Help‐Seeking Journey: Preliminary Findings on Resource Navigation Behavior

ABSTRACTYoung adults are among the most vulnerable populations susceptible to mental health concerns, yet they encounter various barriers in accessing resources and obtaining necessary support and treatment. While prior research has predominantly focused on technology utilization in mental health help‐seeking, a more comprehensive understanding of how individuals navigate the broader landscape of available resources is crucial. To address this gap, we conducted in‐depth interviews with 18 young adults to explore their lived experiences and resource navigation during the mental health help‐seeking process. Guided by the Social‐Ecological Framework, our study categorized the resources utilized by young adults into four categories: technological, interpersonal, community‐based, and societal. Through thematic analysis, we report preliminary findings that identify specific characteristics of resources that young adults value and prioritize throughout their help‐seeking journey. These findings provide implications for designing multi‐level mental health resources and interventions to facilitate young adults' help‐seeking. We also discuss methodological considerations to encourage in‐depth conversations with marginalized groups on sensitive topics like mental health, emphasizing the importance of creating a safe, non‐judgmental space for participants to share their experiences openly.

Secret Information Needs & Practices of LGBTQ+ Young Adults

ABSTRACTYoung adults have been shown to prefer online sources when searching for information about sensitive topics, such as sexual health (Baker et al., 2020; Buhi et al., 2009). This is especially true for LGBTQ+ young adults, who may want to keep potentially sensitive information needs about their sexuality or gender identity a secret as they explore their identity, or because they may need to for safety reasons (Delmonaco & Haimson, 2022; Kitzie, 2019). This pilot survey study aimed to explore what types of information needs LGBTQ+ young adults may keep secret from the people in their lives, at what age they had their first secret information need, what skills helped them to fulfill their secret information needs, and which skills/resources they would have liked to have when trying to address their secret information needs. Preliminary results suggest that topics relating to health and participants' LGBTQ+ identities were more likely to be kept secret than other everyday life information needs.

Patient and clinician perspectives on the timing of serious illness conversations in oncology.

223 Background: Serious illness conversations (SICs) about patients’ values and care preferences are tied to improved outcomes and quality of life. However, SICs can be hard to implement early in the cancer care journey, and questions remain about how and when to start. Following a pragmatic trial testing behavioral nudges to promote SICs in oncology (NCT04867850), we used an explanatory-sequential mixed methods design to gauge patient and clinician perspectives on the best communication strategy for SICs. Methods: Thirty patients with cancer at high mortality risk and 16 oncology clinicians were recruited from our academic cancer center. Guided by the Consolidated Framework for Implementation Research, our interviews systematically assessed multi-level factors shaping SIC implementation. In addition to interviews, patients completed a structured survey with validated measures on patient-focused communication and care planning. Survey data were studied descriptively, interviews were analyzed thematically, and both were integrated to triangulate qualitative and quantitative results. Results: Participants described two SIC types, which we classified as event-triggered and phased . Clinicians identified event-triggered SICs as prompted by acute incidents (e.g., disease stage transition) and more likely to lead to EHR documentation. However, they were seen as prohibitively time-consuming, and as such, did not become a top priority until a crisis arose. Patients were also uncomfortable with extensive early SICs, wanting to keep hope and avoid information overload soon after a diagnosis. They preferred not to discuss “turns for the worse” until they faced an acute challenge, at which point they valued thorough SICs. In surveys, almost all patients reported asking about benefits (96%), risks (93%), and quality of life (81%) tied to treatment, but few raised sensitive topics like planning for if things got worse (44%). By contrast, phased SICs were described as ongoing, progressive conversations not prompted by specific events and that arose early but deepened over time as a patient and care team nurtured their relationship. Patients and clinicians described phased SICs as better at promoting person-centered care and an essential foundation for SICs prompted by potential transitions. However, since these discussions occur gradually, clinicians reported challenges documenting them, reducing their value at informing future decisions and the ability to know whether conversations occurred at all. Conclusions: Interventions to increase SICs often focus on acute moments in the care trajectory. However, our study suggests that ongoing, staged approaches to SICs are vital for goal-concordant care as well and may be more easily integrated into busy clinical workflows. Further work should investigate ways to support clinicians in both SIC types, such as flexible documentation tools aligned with each approach.

Rethinking the “Conspiracy Crisis”: Use and Misuse of “Conspiracy Theory” Labels After Covid‐19

Against the backdrop of the Covid-19 pandemic, this article undertakes a critical evaluation of a series of shortcomings of the view of conspiracy theories that is predominant among scholars and the general public. Reviewing numerous studies on the topic, we critically assess: (a) how justified the claim is that we are in a conspiracy-thinking emergency, (b) how the label of conspiracy theorist can be weaponized to delegitimize heterodox views, and (c) the practical consequences, for academic research and the well-functioning of democracies, of unpopular ideas being labeled as conspiratorial. The empirical sources reviewed here suggest that beliefs in conspiracy theories have not increased over time and are less consequential than commonly believed, even in times of a global pandemic. Instead, the concept of conspiracy theory has become more prevalent and its derogatory connotation evokes a stigma that tilts the democratic playing field against dissenting viewpoints. The stigmatization and political leveraging of this notion, we argue, lead to biases not only in the public discussion on various sensitive topics but also in the academic literature on conspiracy theories themselves. We analyze these academic blind spots in light of the diminishing political diversity in academia and recent perspectives on scientific censorship. We propose to complement the research on conspiracy theorists with an analysis of individuals at the opposite end of the spectrum, who are inclined to systematically trust institutional authorities and are highly prejudiced against heterodox opinions. Proposed solutions include promoting balanced news coverage, fostering critical thinking through debates, and piercing information bubbles to provide access to diverse perspectives.

Analysis of the Researcher’s Attitudes in the Process of Studying Sensitive Topics: the Experience of Interviewing Participants of Military Conflicts

Analysis of the Researcher’s Attitudes in the Process of Studying Sensitive Topics: the Experience of Interviewing Participants of Military Conflicts

Interviewing people on sensitive topics: challenges and strategies.

Interviewing participants on sensitive topics is challenging and requires carefully planned and executed strategies throughout the research process. Sensitive topics have the potential to cause distress to participants or researchers. In this methods paper, strategies for conducting interviews on sensitive topics are described, including choosing the appropriate interview approach, creating a safe and comfortable environment, building rapport, utilizing sensitive and open questioning, reflexivity of the researcher, and awareness of the potential therapeutic effect of the interviews on participants. The strategies are illustrated with experiences from research on sensitive topics.

Representations of ‘risky’ drinking during pregnancy on Mumsnet: A discourse analysis

AbstractIntroductionOnline forums provide an environment for peer discussions to anonymously share experiences about sensitive topics. In this article we explore discussions about alcohol use during pregnancy, including representations of ‘appropriate’ behaviour and risks, in relation to alcohol use.MethodsWe sampled Mumsnet posts from 2016 to 2021 and analysed these using a two‐staged approach: describing the content of original posts and employing discourse analysis on the entire thread which focused on unpacking the significance, activity and identity within the discourse.ResultsSeventy‐three threads with 1554 replies analysed. Users engaged with different sources of evidence and mentioned guidelines and scientific sources, though most commonly provided, requested and appreciated anecdotal information. Risk was discussed in several ways but all users engaged with ‘othering’ drinking they perceived as risky. Only a few prescribed risks to any and all levels of drinking. There was a lack of knowledge around drinking while trying to conceive and early pregnancy. Expectations and norms of behaviour during pregnancy engaged in a ‘good motherhood’ discourse. Users positioned their drinking according to perceived norms through language choices; when not pregnant (or unknowingly pregnant) being ‘plastered’ was justified but when pregnant drinking only ‘sips’ or ‘tiny’ quantities of alcohol was considered appropriate.Discussion and ConclusionsForum users demonstrated a desire to adhere to ‘responsible motherhood’, which did not equate to abstinence if consumption was perceived as acceptable and justified. Future research should explore information needs and effective approaches to health communication for pregnant women or those planning pregnancy.

The perspective and preferences of adolescents in addressing sensitive health topics with their family doctor – The influence of childhood adversities

ObjectiveTo investigate whether adverse childhood experiences (ACEs) influence adolescents’ perspectives and preferences in addressing sensitive health topics and their general perception of family doctor's care, and also to study the impact of addressing sensitive topics regarding adolescents’ health-related quality of life (HRQoL). MethodsTwo hundred and forty-five tenth to twelfth grade students completed a questionnaire, comprising the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and scales to assess experiences, preferences, perspectives, the general perception of family doctor visits, and HRQoL. ResultsThe total CTQ-SF score negatively predicted the preferences in addressing sensitive topics and the general perception of family doctor's care. Being asked about sensitive topics positively predicted the perception of family doctor's care and was positively associated with three dimensions of HRQoL. ConclusionThe greater the frequency of ACEs reported by the adolescents, the less willing they were to be asked about sensitive topics and the worse was the general perception of family doctor’s care. However, when asked about sensitive topics, the adolescents had a more positive general perception and a better HRQoL. Practice ImplicationsThis study helps family doctors understand the need to adapt communication skills and to build a trustful relationship with adolescents who reported ACEs.

Perspectives of Nursing Home Staff in Advance Care Planning Conversations: Experiences from the APPROACHES Project

ObjectivesAdvance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences – a Role offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP. DesignQualitative interviews regarding ACP specialists’ experiences and perceived intervention impact. Setting and ParticipantsStaff of intervention-assigned nursing home facilities who completed a minimum of 10 ACP conversations with residents during APPROACHES program implementation. MethodsFourteen staff were interviewed. Interviews were transcribed and coded by the research team. ResultsThere were 21 codes identified that were then distilled into the following 5 themes: (1) experiences with the ACP specialist program, (2) engaging in ACP conversations, (3) considerations related to dementia, (4) benefits and challenges of ACP, and (5) involvement of multiple people in the ACP process. Participant responses suggested variability in experiences with the ACP specialist program and highlighted many aspects relevant to engaging in conversations with families and residents, particularly those living with dementia. Benefits of ACP, including relationship building and increased preparedness for changes in health status, were balanced with challenges related to sensitive conversation topics and logistical difficulties in scheduling ACP discussions. ACP specialists discussed the multiple roles that others played in the ACP process. Conclusions and ImplicationsFindings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.