Sensitive Topics Research Articles

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.

“But I wanted to talk about it”: Technology-assisted child sexual abuse victims’ reasoning for delayed disclosure

BackgroundVictim disclosure is crucial in uncovering and preventing child sexual abuse, but many victims are reluctant to disclose. While research on child sexual abuse has identified a range of barriers and facilitators for disclosure, the disclosure process for technology-assisted child sexual abuse (TA-CSA) is largely unexplored. ObjectiveGain a first-person perspective on TA-CSA disclosure. Participants and settingSeven young women (aged 7–13 at onset of abuse, 17–24 at interview) were interviewed about the barriers to disclosure they had faced and potential facilitating factors that would have helped them disclose earlier. MethodsThe interviews were analyzed using data-driven reflexive thematic analysis. ResultsA wish to tell captures the desire to have had someone to share abusive experiences with. Fearing who would find out encapsulates the fear that disclosing to one person will spread beyond the initial disclosure. A need for a cue reflects the participants' lack of knowledge and the need for invitations to talk about sex and abuse. Fearing it was my fault conveys the participants' sense of guilt and their wish to understand that they were not to blame. ConclusionsDespite a wish to disclose, shame, guilt, and fear were barriers that held them back. Knowledge about TA-CSA, and invitations to the topic were seen as potential facilitators. Four suggested facilitating factors for disclosure, which society and the adult world should prioritize, were synthesized from the interviews: open dialogue on sensitive topics, providing an opportunity to tell, allowing the child to be in control of the story, and lifting the shame and self-blame.

Exploring comprehensive sexuality education experiences and barriers among students, teachers and principals in Nepal: a qualitative study

BackgroundComprehensive sexuality education (CSE) is essential in empowering adolescents with the knowledge and confidence to manage their sexual and reproductive health. Despite its recognized benefits, access to quality CSE remains limited, especially in low-income countries, where societal norms and structural barriers hinder effective delivery. The aim of this study is to investigate the experiences and perceptions among students, teachers, and principals in Nepal about comprehensive sexuality education.MethodsQualitative methods were used. 13 Semi-structured interviews and 1 focus group discussion were carried out with 15 teachers and principals working at higher secondary schools and two focus group discussions were conducted with a total of 13 adolescents. Thematic analysis was used to analyze the data.ResultsFour themes were developed: Resistance to Teaching and Learning, Preparation and Engagement Strategies, Taboos and Silencing and Structural Barriers. Students, teachers, principals and students reported discomfort and embarrassment when discussing sensitive topics, with gender dynamics playing a significant role. Strategies like warm-up sessions and continuous interaction with students and parents were used to create a supportive learning environment. However, socio-cultural barriers and family attitudes continued to hinder open discussions about sexuality. Structural barriers, including the lack of formal training for teachers and inadequate instructional materials, further impeded effective CSE delivery.ConclusionThe experiences of CSE in Nepal among students, teachers and principals highlight significant barriers including cultural taboos, gender dynamics and insufficient resources. Addressing these barriers through comprehensive teacher training, curriculum reform, and societal engagement is critical to ensure access to CSE.

Balancing barriers and strategies - Nurses' experiences of conducting lifestyle counseling.

Over 70% of the disease burden in Europe is the result of chronic diseases caused by lifestyle. Lifestyle counseling can improve lifestyle habits and thereby health. However, according to research, there are several barriers to healthcare personnel carrying out counseling. The aim of this study was to explore nurses' experiences of conducting lifestyle counseling. A qualitative descriptive study was conducted in southern Sweden between August 2021 and December 2021. Eleven nurses were recruited from both inpatient and outpatient care in northeastern Sweden through a combination of purposive and snowball sampling. Individual semistructured interviews were performed digitally using an interview guide. The interviews were analyzed via qualitative content analysis. The nurses experienced several challenges in performing lifestyle counseling. However, knowledge gaps, sensitive topics, organizational dynamics, and time constraints were balanced using strategies. The theme of their responses can be explained by the following categories: "Collaboration with patients is key," "From self-interest to teamwork," and "The organization can assist or hinder." Lifestyle counseling needs to be prioritized within healthcare. Nurses need tools and knowledge to be able to feel comfortable with the task. All healthcare organizations need to work with lifestyle counseling in a structured way according to national guidelines.

Using Paradata for Imputation of Missing Values in Sociological Survey Data: Results of Statistical Modeling (Case of Croatia and Slovakia)

Missing values are a common issue in quantitative social researches. One of the ways to handle missing data is by data imputation. This article outlines the challenges of traditional data imputation methods, which often introduce biases, and presents an advanced approach that features integration of paradata—auxiliary information collected during surveys—into the imputation process, using the European Social Survey (ESS) as its dataset. It is proposed that the usage of paradata could enhance predictive models used for imputation. It discusses the practical applications of data imputation, particularly through the lens of sensitive topics such as LGBT issues in socially conservative countries, where missingness could be heavily skewed due to social inacceptability of certain answers. To evaluate the effectiveness of the proposed approach towards imputation, the research employs the approach of using the 'ideal dataset', which is a subset of the original dataset with no missing vales, and then introduces artificial missing values that are not MCAR (Missing Completely at Random) to simulate the real case of missing data. Having artificial missingness allows for evaluation of the imputation procedure by comparing it with the original dataset. The study uses a novel approach towards creation of realistic missing data patterns through clustering based on response patterns. The research uses advanced statistical methods to handle missing data, and incorporates paradata from the survey process to improve the accuracy of predictive models. By comparing statistical metrics such as RMSE, MAE, and R-squared, the article evaluates the effectiveness of these methods in mimicking the original dataset's variability.

Challenges and Needs in Implementing Sexual Education for Deaf Students: A Case Study from Indonesia

The primary aim of sex education is to provide accurate information on handling risky sexual behavior. For deaf students, who may struggle with complex concepts, effective sex education is crucial to safeguard them against sexual assault and risky sexual behavior. This study examined the implementation of sex education in special schools for the deaf in Yogyakarta, Indonesia, focusing on the challenges faced by educators in delivering this sensitive content. Utilizing a case study and qualitative methodologies, this research gathered insights from school principals and teachers who took part in group discussions. Findings reveal that deaf students face significant challenges with sexual conduct, both individually and in their interactions with others. Despite incorporating sex education into science, religion, and self-development classes, teachers encounter difficulties in addressing sensitive topics and preventing age-inappropriate behaviors. Educators require specialized educational materials to address key topics such as body awareness, physical changes, reproductive health, relationships, pregnancy, and sensitive content. Such materials must be designed with clear visual aids and simple language to effectively meet the learning needs of deaf students. There is a pressing need for resources that facilitate understanding while preventing the imitation of inappropriate behaviors. To enhance sex education for deaf students, it is essential to develop and implement tailored educational resources that use visual aids and straightforward language. By addressing the unique needs of these students, educators can more effectively convey critical information, thereby reducing the risk of inappropriate behavior.

PROJECT-RESEARCH ACTIVITIES IN SEXUAL EDUCATION OF ADOLESCENTS

Background. Sexual education in schools plays a huge role in preventing deviant behavior among adolescents. Firstly, sexual education helps adolescents understand their bodies, emotions and feelings; this contributes to the formation of a healthy self-image and relationships with others. Second, knowledge about sex and sexual relationships helps prevent undesirable consequences such as early pregnancy, infections and violence. Thus, sexual education in schools is an important tool in preventing deviant behavior among adolescents, helping them develop healthy relationships, make informed decisions and avoid dangerous situations. Purpose. Is to study the role of project-research work with adolescents within the framework of sexual education as prevention of deviant behavior among adolescents. Materials and methods. To solve the identified issue, the following research methods were used: analysis of foreign and domestic sources on organizing sexual education; questionnaires, observations, analysis of the organization of project-research work and consideration of possible inclusion of deviant behavior in adolescents in the scope of preventive measures. Result. Research shows that adolescents who have completed a sex education program based on project-research activities postpone the onset of their sexual activity more often and are more responsible in their use of contraception. Project-research activities are an effective tool for achieving the goals of sex education since they allow students to actively participate, develop critical thinking and discuss sensitive topics, help adolescents understand their needs and desires, and learn to build healthy relationships.

When a gatekeeper denies a researcher access: circumstances of gate closure in social work research

Social work research often requires the exploration of sensitive topics that concern hard-to-reach populations. In order to gain access to these groups, researchers are often forced to rely on gatekeepers during the research process. Gatekeepers become intermediaries who help the researchers to establish this access. In this article, we focus on institutional gatekeepers and the circumstances under which they deny access to research participants. And how the researchers themselves react to this situation in the context of Czech social work research. We used qualitative research, in particular semi-structured interviews with researchers. Based on the research, we identified three main practices of researchers when gatekeepers refuse access. These are conducting research despite denial, making changes to methodology and conducting covert research. The identified procedures bring with them a number of ethical questions that need to be addressed.

Reforming Physician Licensure in the United States to Improve Access to Telehealth: State, Regional, and Federal Initiatives.

Policy Points The reinstitution of pre-COVID-19 pandemic licensure regulations has impeded interstate telehealth. This has disproportionately impacted patients who live near a state border; geographically mobile patients, such as college students; and patients with rare diseases who may need care from a specialist outside their state. Several promising and feasible reforms are available, at both state and federal levels, to facilitate interstate telehealth. For example, states can offer exemptions to licensure requirements for certain types of telehealth such as follow-up care or create licensure registries that impose little reduced paperwork and fees on physicians. On the federal level, congressional interventions that mimic the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018 can waive provider licensing and geographic restrictions to telehealth within certain federal programs such as Medicare. Any discussion of medical licensure reform, however, must also consider the current political climate, one in which states are taking divergent stances on sensitive topics such as reproductive care, gender-affirming care, and substance use treatments.

The intervention of Islamic Religious Education Teachers in Puberty Assistance: NVIVO Analysis

This research explores the role of Islamic Religious Education (PAI) teachers in accompanying students during puberty, a critical transition phase in the lives of Muslim adolescents that involves significant physical, emotional, and spiritual changes. Appropriate assistance during this period is crucial to help teenagers understand the changes occurring and carry out their religious responsibilities well. Using a qualitative approach with phenomenological methods, this research involved in-depth interviews with 10 PAI teachers from elementary and junior high schools. The analysis using NVivo 12 shows that the PAI teacher's role includes religious education, emotional guidance, spiritual formation, and social facilitation. Despite facing unique challenges, PAI teachers overcame them with various adaptive and responsive strategies. Through intensive personal guidance, key strategies that have proven effective include creating a supportive and open environment where students feel comfortable discussing sensitive topics. This research highlights the importance of a holistic and integrative approach in assisting puberty and provides practical recommendations such as [specific recommendations] to increase the effectiveness of this assistance. This research contributes to the Islamic religious education literature by providing new insights into the multifaceted role of PAI teachers and the challenges they face, as well as suggesting strategies for improving student support during puberty.

Integration of patient and public involvement in a doctoral research study using the research cycle

BackgroundPatient and public involvement (PPI) in research is widely acknowledged as essential to achieving successful and impactful research. Despite this acknowledgement, there are limited reports on how to approach and apply meaningful PPI throughout the research cycle and how to address challenges for researchers such as doctoral students, particularly when undertaking research on sensitive topics. This paper provides insights and examples for researchers new to PPI, on the impact of active PPI and recommendations for building and developing a PPI group in a paediatric focused doctoral research study with bereaved parents and carers.MethodsPPI was informed by the research cycle. The GRIPP2 short-form checklist was used to report PPI. The research was funded by the National Institute for Health and Care Research.ResultsPPI enhanced the research through input into the study design, recruitment, co-design of the study website and branding; and ethics amendments to increase participation in response to the COVID-19 pandemic. The literature review was extended to incorporate a PPI consultation phase and members contributed to data analysis. A flexible approach enabled involvement to develop iteratively throughout the research study, resulting in changes being made to enhance the study design and outcomes.ConclusionThis paper contributes to the limited knowledge base on embedding PPI into a doctoral research study and within the paediatric setting specifically working in partnership with bereaved parents and carers. Employing an adaptive approach to meet individual PPI needs, building a trusting and respectful partnership, creating shared ownership and investment in the research, are essential components to successful PPI.

Stakeholders' Experiences and Preferences Regarding Comprehensive Sexuality Education in Zambia: Implications for Determining Programme Priorities and Strategies.

Understanding and exploring stakeholders' perceptions and preferences regarding comprehensive sexuality education (CSE) is critical in enhancing programme acceptability. We conducted this qualitative study to explore stakeholders' experiences and preferences of CSE in Kitwe district, Zambia. We employed a qualitative descriptive design within the interpretive paradigm at nine purposefully selected secondary schools. Data were collected through classroom observation, in-depth interviews, and focus group discussions. In depth interviews were undertaken among 21 pupils, 17 teachers, 4 policymakers, 4 parents, and 4 religious leaders. Two focus group discussions were conducted among 14 pupils with each group having seven pupils. Data were analysed using inductive thematic analysis. Interviews continued until data saturation. Our analysis yielded themes on stakeholder experiences of CSE which included: a lack of pupil-centred pedagogy; a lack of stakeholder engagement; a lack of CSE competency and skills; holding back culturally sensitive topics; a lack of guidance from the comprehensive sexuality curriculum; and a lack of CSE prioritisation in schools. Themes on preferences included: the formation of community advisory boards; the need to enhance teachers' professional competencies, linking CSE with community SRH services, pupils SRH needs assessment. A community participatory approach to the design and implementation of a CSE programme is critical in enhancing programme acceptability in schools. While understanding the experiences and preferences of pupils regarding CSE can help determine programme content and priority, improving teachers' competency and skills through appropriate CSE training can help to reconcile teachers' personal beliefs and the content of CSE.

School District Leader Perspectives on Surveying Middle School Youth About Sexual Violence.

Schools are important contexts for preventing sexual violence (SV) among adolescents. Evaluating whether programming is effective requires surveying youth about SV experiences. However, school communities often have concerns about asking students, particularly those in middle school, about these experiences. This study sought to understand the types of concerns that school district leaders have related to surveying middle school students about SV and to identify ways to mitigate these concerns. We conducted semi-structured interviews with superintendents and school board members (n = 19) across Washington State and used inductive thematic analysis. Concerns regarding surveying students about SV centered around 3 main themes: community norms and misconceptions, parental/caregiver discomfort, and survey language and administration. Concerns were particularly salient for sixth-grade students. Suggestions for mitigating concerns included: providing clear motivation and reframing messaging to community members, involving parents and students in the survey process, and modifying survey language and administration. Researchers administering surveys to middle school students on sensitive topics including SV may face pushback and must consider flexible approaches to allow research and evaluation to be conducted.