Snowball Sampling Research Articles

Consumption of wild edible plants in the Kofale and Heban-Arsi districts, West Arsi Zone, Oromia Regional State, Ethiopia

BackgroundWild edible plants (WEPs) are neglected and have received little attention despite their significant contributions to the sustenance and livelihoods of rural communities. This study was conducted in the Kofale and Heban-Arsi districts of the Oromia Regional State, Ethiopia, to document the diversity, to assess the most preferred WEPs, their utilization, and threats they face.MethodsThe study was conducted in the Kofale and Heban-Arsi districts of the West Arsi Zone of the Oromia Regional State, Ethiopia. Data collection took place from February to September 2022 in Kofale and from November 2022 to April 2023 in Heban-Arsi district. To gather ethnobotanical information, the research employed semi-structured interviews, field observations, focus group discussions, and guided field walks. The interviews involved 290 informants who were selected via snowball sampling and systemic random sampling methods. Preference ranking values, direct matrix rankings, and use values (UVs) of documented species were computed.ResultsA total of 62 WEPs species belonging to 38 families and 56 genera were identified. The Moraceae family includes 7 species, followed by Fabaceae and Rubiaceae (each 4 species), and Lamiaceae (3 species). Shrub was the dominant growth form (32 species), followed by herbs (13 species). The largest number (24 species) of WEPs was collected from grazing lands/fields, followed by forest habitats (17 species). The most widely used edible plant part was fruit (40 species) and leaf (11 species). Most WEPs were collected for consumption from March to May (30 species), and the majority of the species (48, 77.4%) were utilized in their raw state. A large number of WEP (41 species) were consumed only during periods of food shortage, and the remaining (21 species) were used as staple food supplements. Multiple other uses of WEPs in the study area also reported. Fifty-two species mentioned for medicinal use, and the species that had the highest use value was Cordia africana Lam. (0.9). The direct matrix ranking results indicated that agricultural expansion was a principal threat to the WEPs in the study area.ConclusionThis study indicated that WEPs are widely used during food shortages in the study area, but many WEP species are under threat due to growing pressure from various anthropogenic factors. Thus, public awareness and community-based management need to be encouraged at all levels to conserve and sustainably use these resources to address food insecurity.

Exploring lack of trust and its impact on access and utilization of primary healthcare services among African immigrant women in the United States: a qualitative study of Ethiopian immigrant women

BackgroundLack of trust is a critical issue in healthcare that contributes to the growing disparities in access and utilization of health among minoritized and disadvantaged populations in the U.S. This study explored how lack of trust affects Ethiopian immigrant women’s (EIW) primary healthcare (PHC) experience and the personal and structural factors exacerbating the problem.MethodA qualitative cross-sectional design was used to collect data through in-depth interviews with EIW (N = 21) living in six states (MO, MD, VA, KS, MI and IN) and Washington DC using a pilot-tested semi-structured interview guide. A mix of purposive and snowball sampling was used to recruit participants who: (1) identify as an Ethiopian immigrant; (2) identify as a female; (3) be 18 years and older; (4) arrived in the U.S. within the last five years; and (5) speak Amharic or English languages. The interviews were recorded, transcribed verbatim, translated and cleaned for errors. An inductive thematic analysis was followed to analyze data using Nvivo12 software.ResultsThe findings showed that lack of trust is a significant concern among EIW negatively affecting their PHC experience and decisions in seeking care. The thematic analysis revealed five major factors contributing to the erosion of trust in PHC among EIW: (1) reliance on medication in U.S. healthcare system (2) preference for traditional homemade remedies over PHC recommendations and modern medicine (3) faith and its influence on trust and PHC decisions (4) lack of transparency in PHC, and (5) multilevel discrimination in PHC.ConclusionThe analysis suggested that PHC professionals provide understandable and contextualized health information, practice transparency, familiarize themselves with the healthcare system in immigrants’ countries of origin by asking their patients, and prioritize culturally competent care to gain trust. At structural and policy levels, reform is needed to dismantle systemic problems that enable and perpetuate discrimination, diversify the healthcare workforce, revise healthcare training curriculums and procedures to reflect immigrant needs, establish multi-sectoral collaboration between health, education, and immigration sectors to create conducive care environment for immigrants. Further research and conversation around alternative medicine is vital to expand evidence-based and inclusive PHC services for immigrants.

Stakeholder analysis of banning unhealthy product advertisement in Iran

BackgroundThe advertising of unhealthy products, including unhealthy foods, drugs with abuse potential, certain cosmetic products and services, and tobacco, has raised significant public health concerns due to its role in increasing consumption and contributing to the rise of non-communicable diseases. Policy development and enforcement in this area necessitate an in-depth analysis of the relevant stakeholders. This study aims to examine the stakeholders involved in regulating the advertisement of unhealthy products in Iran, providing critical evidence for shaping advertising regulations and reducing the societal consumption of such products.MethodsThis qualitative study, conducted in 2022, involved 18 experts experienced in the area of unhealthy product advertisement in Iran. Participants were selected through purposive and snowball sampling methods. The stakeholders' roles, power, positions, and interests were analyzed using Schmeer's guidelines.Results17 stakeholders were identified as relevant to the ban on unhealthy product advertisements, of whom 14 were classified as active and three as inactive. Key stakeholders included radio and television broadcasters, the Ministries of Health, Culture, and Industry, as well as political institutions. The Ministry of Health (MOHME) emerged as a leading advocate for the ban, while the Ministries of Culture and Industry, along with political institutions, were identified as possessing significant power with moderate support for the policy. In contrast, broadcasters and social media platforms were powerful opponents of the ban.ConclusionsThe study underscores the pivotal role of stakeholders with high power and medium interest in the success of policies aimed at banning unhealthy product advertisements. Key challenges included conflicts of interest, insufficient penalties for organizations violating advertising regulations, organizational disputes, limited human and financial resources, lack of clear implementation guidelines, weak community engagement, and inadequate oversight. Engaging key stakeholders effectively could mitigate these obstacles and facilitate more effective health policy interventions in the future.

Predictors of Traumatization Among Humanitarian Aid Workers Working With Refugees and Asylum Seekers in Türkiye.

Refugees and asylum-seekers flee their countries due to conflict, violence or persecution and seek safety in another country. Professionals working with refugees in host countries are being exposed to the narratives of their traumatic experiences, an important risk factor for vicarious posttraumatic stress. The current study examined predictors for traumatic stress in humanitarian aid workers working with refugees and asylum seekers in Türkiye. We surveyed 156 participants (67.3% women) from various disciplines (psychologists, social workers, interpreters, lawyers etc.) to examine their traumatic stress, resilience and stress coping mechanisms. We used Secondary Traumatic Stress Scale (STSS), Adult Resilience Measure (ARM) and Coping Styles Inventory (CSI) for data collection. In this cross-sectional study, data were collected online from participants who were contacted through snowball sampling method, starting with the participants working with refugees at public agencies and NGOs. The regression analyses showed that the level of traumatic stress is predicted by feelings of fatigue, number of years worked with the refugees, presence of previous psychological problems and being a social worker. The "relational resources" subdimension of resilience and "helpless coping style" are also significantly associated with traumatic stress. Considering the rapidly developing phenomenon of migration all over the world, the findings of the current study could contribute to improve protective and preventive interventions for the psychological wellbeing of humanitarian aid workers.

Exclusive breastfeeding: an exploratory thematic analysis of the perspectives of breastfeeding mothers and significant others in the Tamale metropolis of Northern Ghana

IntroductionExclusive breastfeeding is widely recognized as the optimal way to feed infants due to its numerous health benefits for both the child and the mother. Despite its advantages, Ghana is still far from attaining World Health Organization (WHO) recommended rates. This study is aimed at exploring the knowledge attitude and practices, where the practices hinged on facilitators, barriers, and sociocultural perspectives of breastfeeding mothers and significant others on exclusive breastfeeding.MethodsThis study employed an ethnographic thematic analysis framed by the socioecological model (SEM). Thematic analysis was paired with focus group discussions (FGDs). The study participants were recruited purposively by employing a snowball sampling technique with the assistance of community health volunteers. Three (3) FGDs were formed, with 10 participants in each group, to gather perspectives from breastfeeding mothers and significant others (partners and grandmothers) in three communities with Community-based Health Planning and Services (CHPS) compounds within the Tamale metropolis. With an interview guide, all FGDs were audio-taped, transcribed verbatim, and translated from local dialects to English. The emerging themes were used in writing a narrative account, guided by the principles of thematic analysis.ResultsThis study identified three thematic areas: knowledge of exclusive breastfeeding (EBF); attitudes toward EBF and practices of EBF (facilitators, barriers, and sociocultural practices). There was some knowledge disparity among lactating mothers despite the overall high knowledge and subpar attitudes of some mothers. The practice of exclusive breastfeeding was substandard. The major hindrances identified were cultural barriers propagated by partners/husbands and grandmothers; the belief that the weather here does not support EBF; and the need for spiritual herbs in infancy. Supportive healthcare providers helped increase the practice of exclusive breastfeeding. Some support also came from partners and husbands, and some mothers showed unique positive behaviors by exclusively breastfeeding.ConclusionThis study revealed that while exclusive breastfeeding education has been ongoing for decades, sociocultural norms still influence mothers to deviate from WHO recommendations. Public education is recommended to dispel misconceptions surrounding exclusive breastfeeding, develop a food galactagogue to help with breastmilk volumes and create a supportive environment that empowers mothers and families to make informed choices that optimize the health and well-being of both infants and mothers.

Challenges in implementing educational strategies for women’s career advancement towards advancing SDGs in Malaysia

The purpose of this study is to identify the key challenges in implementing educational strategies for women’s career advancement in Malaysia’s corporate sector, and to evaluate their impacts on advancing gender equality (SDG 5) and quality education (SDG 4) in the country. The study employs a qualitative phenomenological approach, utilizing the combination of purposive and snowball sampling to conduct in-depth interviews with senior female executives in Malaysia, exploring their experiences and perceptions of obstacles on the implementation of educational strategies for women empowerment in the corporate sector. The findings uncover four major challenges in implementing effective educational strategies for women’s career advancement which are insufficient organizational support and underrepresentation of women leaders; unconscious gender bias and stereotypes; resistance to change and work-life balance challenges. The study offers practical insights for corporate sectors and human resource management to develop comprehensive policies and practices that is essential to empower women and promote gender equality within the organization. The challenges identified in the findings provide valuable direction for the development of targeted interventions and strategies that address the unique challenges women face in the corporate sector, thereby enhancing their leadership potential and contributing to the achievement of gender equality and quality education as outlined in SDG 5 and SDG 4. This qualitative approach offers a unique, in-depth understanding of the challenges and successes women face in their career advancement. The findings will provide valuable insights for corporate sectors, policymakers, and human resource management on the guidance to develop an effective framework and approach that promotes gender equality and women leadership within Malaysia’s corporate setting and contribute to both academic literature and practical interventions.

Magnitude of Psychological Distress Among Medical and Non-Medical Students During the Late Phase of the COVID-19 Pandemic in West Bengal: A Cross-Sectional Study

Background: COVID-19 pandemic led to drastic changes worldwide affecting mental health of students. This study aimed to assess psychological distress due to COVID-19 in students during the late phase of pandemic and to establish correlation of academic course, socio-demographics, and knowledge-attitude-practices (KAP) with depression and anxiety. Methods: A cross-sectional study was conducted in Kolkata, from March to April 2022 among undergraduate medical students and undergraduate students from engineering and general science colleges, via purposive and snowball sampling. Survey questionnaire was circulated via Google forms through social media. It included Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Fear of COVID-19 scale 2020, KAP regarding COVID-19 and socio-demographics. Data were analyzed using SPSS(Version 22.0) by estimating mean, standard deviation, median, interquartile range, and displayed by charts and tables. Mann-Whitney U test/non-parametric ANOVA and Chi-square tests were used for drawing statistical inferences. P-value of <0.05 was considered significant. Results: A total of 421 responses were included: 219 medical and 202 non-medical students. Most participants were male (58.67%). Prevalence of depression was 58.42% among non-medical students and 81.73% among medical students. Prevalence of anxiety was 50.99% among non-medical students and 76.25% among medical students. Medical students had significantly better scores for knowledge and attitude (p=0.001 in both). Anxiety was influenced by residence (p=0.018), mode of travel (p=0.012), and having relatives or friends affected by COVID-19 (p=0.03). Conclusion: High prevalence of depression and anxiety among college students, especially medical students, highlights the need for student wellness activities and better mental health services in colleges across India.

Water utilization practices and wastage at household level: A case study of Lahore City

AbstractThe current research places its emphasis on addressing the issue of water shortage, which, if left unaddressed, could hinder sustainable development in the broader Punjab region, with a particular focus on the city of Lahore. In pursuit of our research objectives, we conducted a comprehensive survey that involved 600 households within Lahore. Our research methodology included the usage of both quantitative and qualitative analysis which included interviews and snowball sampling. Our findings indicate a clear and direct correlation between water shortage and patterns of water utilization and wastage. The absence of sustainable strategies to ensure adequate water supply, efficient resource management, and universal sanitation poses a substantial threat to our future. To address water shortages, it is crucial to encourage the use of water‐saving appliances and fixtures like toilets, low‐flow faucets, and showerheads. The purpose of these measures is to conserve water and align it with sustainable development goals by encouraging resource utilization that is efficient, minimizing environmental impact. By implementing these solutions, both households and border areas can benefit from significant water‐saving practices. Consequently, we recommend that the government implement targeted programs aimed at raising awareness among individuals about responsible water usage and reducing wasteful practices within households.

Navigating menstrual stigma and norms: a qualitative study on young people’s menstrual experiences and strategies for improving menstrual health

BackgroundMenstrual health is a recognised important public health issue and is essential for the realisation of gender equality and the achievement of Sustainable Development Goals. This study aimed to explore the menstrual health experiences of young people in Sweden and how the menstrual cycle affects their health and lives. The study also aimed to identify the facilitators and barriers to achieving menstrual health.MethodsWe conducted a qualitative study in Sweden. Sixteen young people aged 18–28 who have experienced the menstrual cycle participated in individual interviews. Purposeful sampling combined with snowball sampling was applied to recruit the participants. The data were analysed using reflexive thematic analysis.ResultsParticipants viewed menstruation as a sign of having a healthy and functioning body. Menstruation was linked to becoming a woman and fostered a sense of community and sisterhood, which was viewed as positive among cis women. Further, the results showed that physical and emotional symptoms related to the menstrual cycle limited the participants’ everyday lives and social relationships and had a negative effect on their sexual and mental health. While managing their emotional discomfort and other menstrual complaints, they also had to deal with the public stigma and norms about menstruation contributing to shame and worries. Barriers to menstrual health included stigma and norms related to menstruation, which led to the adoption of expected behaviours, such as avoiding participation in social activities. The normalisation of menstrual complaints also contributed to delays in seeking healthcare, despite having symptoms that had a negative effect on their health. An important factor promoting menstrual health and quality of life is access to prompt treatment to mitigate and decrease symptoms that limit everyday life.ConclusionsThe results indicate that menstrual stigma and related norms create challenging situations limiting menstruating people’s everyday lives and reluctance to seek healthcare despite needing to. To promote the menstrual health of menstruating young people in Sweden, organised and systematic screening of menstrual cycle-related symptoms should be provided within student health services at schools and universities, and primary healthcare. Policymakers should consider integrating stigma-reducing efforts into public health interventions to improve general awareness and promote gender equality.

Assessment of the Election Participation of Overseas Filipinos in Taiwan: Towards Strengthened Citizens’ Engagement for the Upcoming Elections

The researcher sought to assess the election participation of overseas Filipinos in Taiwan in terms of registration and election, as well as the challenges faced by Commission on Elections (COMELEC) and Manila Economic and Cultural Offices (MECOs), and the proposed recommendations to strengthen citizens’ engagement. The researcher used a mixed method approach, specifically utilizing the Triangulation Design under the Convergence Model. This design combines elements of quantitative and qualitative research to answer the research questions. Applying purposive and snowball sampling techniques, a survey questionnaire was distributed to overseas Filipinos in Taiwan to assess their election participation. On the other hand, judgmental technique was used to gather qualitative data through series of interviews from key participants of the COMELEC and MECOs. The researcher analyzed the results using different statistical treatments, such as simple percentage, ordinal simple percentage, weighted mean, qualitative data analysis and narrative analysis. The study revealed that the factors affecting the election participation of the overseas Filipinos in Taiwan were time constraints, limited access to voting centers, lack of information, and lack of interest which contributes to the statistical gaps in the voter turnout from 2004 to 2022 National Election Overseas, with an average of seventy percent (70%) of overseas voters who did not vote. This result weakened the citizen engagement of the overseas Filipinos in Taiwan with respect to registration and election processes. The study also showed that there were additional challenges faced and encountered by the COMELEC, especially the Office for Overseas Voting (OFOV), and MECOs, such as manpower and logistics constraints, low turnout rate due to lack of awareness and information by the overseas Filipinos in Taiwan, limited locations of registration and voting centers, lack of interest to vote, unavailability of the overseas Filipinos in programs and forums, modes of voting adopted, and existing laws on in-person registration and voting requirement. This study recommended various activities, reforms and programs to strengthen the citizen engagement of the overseas Filipinos in Taiwan.

Early career occupational therapists’ perceptions of occupational justice in practice in Singapore

Introduction: Occupational justice addresses social, political and economic factors influencing occupational participation as a human right. Implementing occupational justice is challenging due to institutional, personal, environmental and cultural barriers, and may be further complicated in non-Western contexts. Early career occupational therapists often struggle to apply these principles while transitioning from education to practice, despite their desire to advocate for justice-focused practices. Methods: This qualitative descriptive study, grounded in social constructivism, explored the experiences of early career occupational therapists applying occupational justice in Singapore. Using snowball sampling of 2020 and 2021 graduates, participants engaged in one-time semi-structured interviews, which were transcribed verbatim and thematically analysed. Findings: Of 140 potential participants, 10 responded and completed the study. Four themes were developed: (1) Feeling uncertain about occupational justice, (2) Perceived relevance in the Singaporean context, (3) Early career challenges and (4) Aspiration to be agents of change. Conclusion: Early career occupational therapists expressed uncertainty in applying occupational justice concepts, often confusing them with occupation-centred practice. Despite recognising individual influences, they felt ill-prepared to tackle systemic barriers and advocate for broader social change. However, participants were aware and willing to support occupational justice ideals, suggesting a need for more guidance to integrate individual therapeutic goals with societal advocacy.

A Study on Cultural Adaptability with Respect to Diversity and Inclusion at Workplace''

The following research about cultural adaptability among employees studies the perception of employees regarding diversity and inclusion at workplace and how they adapt the culture of the same. The boost in globalization and advancement in the technology has brought the people around the world much closer than anticipated. With this thought organizations are focusing more and more on recruiting diverse workforce to attain the competitive edge in the market. Managing diversified workforce sometimes can be proven as a difficult task for the organizations as there can be presence of prejudice in the minds of employees which can create hinderance in working as a team with people of diverse background. It is important to understand how employees are adapting the culture of diversity and inclusion and what potential benefits and threats they are experiencing due to it. In order to achieve the objectives of the research, primary data collection was done through an online survey which was circulated amongst the employees of Banking and Finance sector. A questionnaire was formed for this purpose and the data collection was done through snowball sampling technique. The questionnaire was divided into three sections. The first section consisted of the demographic questions like gender age and employment type were asked. The second section of the questionnaire comprised a total of 17 questions based on different accepts of diversity. The third section of questionnaire consisted of questions regarding the adaptability within employees with respect to diversity and inclusion at workplace. A total of 112 responses were taken and analyzed using Chi-square test. In this study we observe that despite of diverse culture in the organization it is not necessary that employees are able to adapt the culture of diversity and inclusion. And there can be many factors contributing to that such as very less or no effort by organization to make the environment of organization culturally adaptable for all the employees, lack of policies for the fair and equal treatment of employees. Absence of programs to help employees overcome their prejudices and respect and accept their colleague’s despite of their background.

Qualitative modeling of factors affecting auditor’s judgment and decision-making

Purpose The purpose of this paper is to provide a qualitative model in the field of factors affecting auditors’ judgment and decision-making. The current research follows a descriptive survey method. Design/methodology/approach A survey method was used to conduct this research, with a questionnaire as the primary tool. The statistical population consists of auditors with extensive knowledge and opinions on the research problem and its theoretical foundations. A sample of eight auditors was selected using the snowball sampling method. Findings The research results indicated that factors influencing auditors’ judgment and decision-making include reviewing audit reports from past periods, the knowledge and expertise of audit partners, input from the audit team, understanding social, cultural, political and economic environmental issues, auditor independence, technical and specialized skills of auditors, increasing experience, knowledge of business owners’ activities, rising audit fees and inhibiting forces in auditors’ judgment and decision-making. These inhibiting forces include lack of client knowledge, emotions, mental states, ethical considerations, business unit ownership structure, complexity of reviewed unit activities, state-owned business unit ownership, lack of understanding of employer activities and lack of expertise in the employer’s industry. Practical implications The model presented in this research aids in enhancing and refining the judgment and decision-making of independent auditors, resulting in more favorable financial reports for report users. Additionally, the theory developed through this research method can lead to the formulation of hypotheses that future researchers can test. Originality/value Auditor judgment is a vital aspect of independent audits, emphasized in auditing standards and professional codes of conduct.

Unraveling The Threads of Tradition: The Transformation of Kepayang (Pangium edule Reinw.) Ethnobotanical Knowledge in Sarolangun, Central Sumatra

For centuries, the Sarolangun community in Central Sumatra has depended on kepayang for its essential roles in nutrition, medicine, environmental conservation, and cultural practices. However, modernization now threatens the preservation of indigenous knowledge and traditions related to kepayang. This study investigates the shifts in ethnobotanical knowledge concerning kepayang in six villages across three sub-districts of Sarolangun Regency, Jambi Province, encompassing urban, peri-urban, and rural landscapes representative of the region’s main kepayang production areas. Using a descriptive-analytical approach, data were collected from 68 participants through in-depth interviews and participatory observations utilizing snowball sampling. Findings reveal the plant’s diverse uses and evolving application patterns, with a broader range of uses in rural areas compared to urban ones. Despite these shifts, kepayang retains its culinary significance throughout the community, symbolizing cultural continuity. Additionally, its role in oral traditions continues to impart moral values to younger generations, supporting collective wisdom essential for conservation. This research advocates for a balanced conservation strategy that integrates ecological preservation with cultural heritage and sustainable development, adapting to local knowledge’s evolution while exploring kepayang's potential for economic benefits within the community.

Transition experiences of UK junior doctors who leave clinical practice to pursue careers in medical education: a qualitative study

ObjectivesThe increasing complexity and scale of medical education in the UK demands increasing numbers of medical educators. A small proportion of educators are qualified doctors, but did not reach completion...

Behind closed doors: Freelance nurses and the reality of unmet care needs in Italian home care setting. Insight from a phenomenological descriptive study.

The term 'Missed Nursing Care' (MNC) refers to any aspect of nursing care that is not delivered, partially delivered, or delayed. MNC has significant negative consequences, including adverse patient outcomes, safety risks, and decreased job satisfaction. While extensively studied in hospitals, MNC in community healthcare settings, remains under-researched, especially in Italy. This study aims to explore the phenomenon of MNC in Italian home care settings by documenting and analyzing the lived experiences of freelance nurses, focusing on the characteristics, influencing factors, and consequences of MNC as perceived by these healthcare professionals. This is a descriptive phenomenological study. Using snowball sampling, 12 Italian freelance nurses were recruited and interviewed from November 2022 to February 2023. Data collection was based on in-depth interviews, that have been transcribed and analyzed using Giorgi's phenomenological framework. The study report adhered to the COREQ-32 checklist for qualitative research. Thematic analysis revealed four main themes: dimensions of MNC, organizational challenges, consequences of MNC, and family-nurse collaboration. Freelance nurses frequently addressed unmet fundamental and complex nursing needs, highlighting significant clinical, psychological, and economic impacts on patients and families. Organizational issues, such as rigid public service schedules and inadequate staffing, were identified as primary contributors to MNC. Families played a crucial role in managing care and collaborating with freelance nurses to ensure continuity. This study provides novel insights into MNC in Italian home care settings, emphasizing the critical role of freelance nurses in filling care gaps. The findings suggest the need for systemic changes to improve flexibility, staffing, and integration of public and private nursing services. Further research, particularly quantitative studies, is essential to validate these findings and explore broader implications for patient care and health outcomes.

Pediatric Emergency Medicine Physicians' Perspectives of Concussion in Young Children.

Traumatic brain injury (TBI) during early childhood (before 6 years) is prevalent, accounting for rising rates of emergency department visits. These injuries may lead to postconcussive symptoms, which may be subtle and difficult to diagnose in young children. Inadequate discharge counseling may lead to prolonged duration of symptoms and possible developmental delays. We aimed to explore pediatric emergency medicine (PEM) physicians' perspectives on "concussion" terminology, diagnosis, and management, specifically in a young child with mild TBI. We conducted semistructured interviews using open-ended questions involving a hypothetical scenario. We recruited currently practicing PEM physicians by a snowball sampling method. A research team recorded, transcribed, and analyzed the interviews. Using social constructionism as the philosophical framework, we developed and refined codes and derived themes until reaching thematic saturation. Peer debriefing with an expert collaborator aided with revisions of themes. A single PEM researcher interviewed 13 participants. Three primary themes emerged. Our first theme identified the role of guidelines and tools in the diagnostic workup. Most participants utilized a clinical prediction tool for neuroimaging but no clinical symptom scales. Our second theme described the difficulties and inconsistencies in the approach to diagnosis of concussion, largely due to young age, lack of verbal skills and unreliable examinations. Our last theme focused on the difficulty in providing clear discharge instructions to parents. Many participants described difficulty providing activity restrictions, instead allowing self-modulation, and lack of counseling for educational tasks. Variability exists among PEM physicians in diagnosis and management of concussions in young children. Discomfort with lack of reliability of symptoms and underappreciation of typical early childhood characteristics may account for findings. Educational initiatives, age-appropriate clinical tools and treatment-guided outcomes research are needed to guide PEM physicians in the care of young children with head injuries.

The Missing Link: Academic Motivation as a Mediator in the Relationship between Mindfulness and Critical Thinking Skills in Indonesian First-Year Undergraduates

Background Critical thinking is essential for university students to deal with academic demands. Preliminary research indicates that first-year undergraduate students in Indonesia have low critical thinking skills, highlighting the importance of developing these skills early to better adapt to university life. Objective This research examined the role of academic motivation as a mediator between mindfulness and critical thinking skills among first-year undergraduate students in Indonesia. Methods Data were collected through e-flyers and questionnaires distributed via social media, using convenience and snowball sampling techniques. The sample included 186 first-year students (aged 18–23, M = 18.9) from the class of 2022. Critical thinking was assessed with the Analog Test, mindfulness was measured using the 15-item Five Facet Mindfulness Questionnaire (FFMQ-15), and academic motivation was evaluated with the Indonesian Short Version of the Academic Motivation Scale. Pearson correlation and regression analyses were performed. Results The study found a statistically significant indirect effect of mindfulness on critical thinking, mediated by intrinsic academic motivation (β = 0.010, p = 0.027, 95% CI = 0.00065–0.023). While this mediation effect was significant, the effect size was small, suggesting that while mindfulness influenced critical thinking through intrinsic motivation, its practical significance was limited. Conclusion This study highlights that mindfulness predicts critical thinking primarily through intrinsic academic motivation, with no significant direct effect. The small effect size suggests that other factors may also influence this relationship. Further research is needed to identify additional mediators or contextual variables.

Traumatic Stress and Coping Experiences of Health Professionals Working in Earthquake Zones: A Phenomenological Study

Objective: This study aimed to examine the traumatic stress and coping strategies of healthcare professionals who provided services during the earthquakes in Kahramanmaraş on February 6, employing a phenomenological approach. Method: The study, which utilized the phenomenological method, involved conducting semi-structured in-depth interviews face-to-face with 20 healthcare professionals who provided services during the February 6 Kahramanmaraş earthquakes. Researchers used the snowball sampling technique to recruit participants and continued interviews until no new information emerged. Researchers recorded and transcribed all interviews for analysis. They applied thematic analysis to the data, ensuring the study aligned with the COREQ checklist for reporting. Results: The data analysis revealed three main themes (thoughts and feelings about healthcare provision, the effects of the earthquake, and traumatic stress and coping experiences) along with eight sub-themes: thoughts, feelings, mental, physical, social, traumatic stress, effects, and coping. Conclusion: Healthcare professionals who provided services during the February 6 Kahramanmaraş earthquakes experienced significant psychosocial effects from the traumatic stress they faced. They encountered substantial difficulties in managing these stressors. The study advocates for implementing necessary measures and support systems to help healthcare professionals effectively cope with stress in disaster situations.

Turkish Adaptation of Counter-Empathy Scale and its Psychometric Properties

Objective: This study aims to adapt the Counter-Empathy Scale, which assesses counter-empathy, a new concept in the literature, to Turkish and to examine its psychometric properties. Method: The study was conducted with a community sample of 347 people, 209 (60.2%) of whom were women, aged 18-66 (34.04±12.66), reached through convenience and snowball sampling methods. Counter-Empathy Scale (CES), Toronto Empathy Scale (TES), Adult Prosocialness Scale (APS), Horney-Coolidge Tridimensional Inventory (HCTI), and Existential Anger Scale (EAS) were applied to the participants. Results: As a result of the confirmatory factor analysis conducted for the validity of the scale, it was determined that the goodness of fit index values (X2/df=3.21, AGFI=0.89, GFI=0.91, CFI=0.92) were at an acceptable level, and the 2-factor model proposed in the original study was confirmed. In addition, it was observed that the factor loadings of all items in the scale varied between .55 and .81. Statistically significant results were obtained in the correlation analyses conducted for convergent validity. It was also determined that the scale could distinguish groups with a history of psychiatric or psychological help from groups without at a significant level. It was determined that the Cronbach Alpha reliability coefficients of the scale were .87 for the entire scale, .84 for the dimension of taking pleasure in others’ pain, and .86 for the sub-dimension of feeling annoyed with others’ happiness. The item-total correlations of all items were above .50. It was observed that the test-retest correlation coefficients were between .71 and .86. Conclusion: The results obtained from all analyses showed that the Counter-Empathy Scale is a valid and reliable scale with strong psychometric properties and is a measurement tool that can be used in research conducted in Turkish culture and clinical settings.