Unmet Expectations Research Articles

Evaluating the Impact of a Paediatric Burn Club for Children and Families Using Group Concept Mapping

Access to burn camps and clubs is cited as an essential element for children following a burn injury. In the Northern Regional Burns Service, this takes the form of a club run by a multidisciplinary team, offering residential camps and family day trips. In this service evaluation, Group Concept Mapping was used to evaluate the perception of the club by staff, children and families. Opportunistic sampling was used to seek responses to the following prompts: “The challenges for children and families after a burn injury are…” and “The role of The Grafters Club is…”. The results indicate that participants perceived the club to be effective at addressing body image and confidence issues for the children but highlighted an unmet parental expectation that the club would also facilitate the sharing of experiences, normalisation of emotional reactions, and processing of guilt and other psychological distress for parents. When taken concurrently with pre-existing evidence in the literature base, it is proposed that a club model of psychosocial support for children and families could provide an accessible and informal opportunity for parental support that may be less subject to barriers perceived with traditional formal psychological support.

Predicting Mirabegron Treatment Response in Patients with Overactive Bladder: A Post Hoc Analysis of Data from Clinical Trials

BackgroundMany patients discontinue overactive bladder (OAB) treatment because of unmet treatment expectations and/or tolerability issues. ObjectiveTo develop a model for predicting the individual treatment response to mirabegron using patient baseline characteristics. Design, setting, and participantsThis was a post hoc analysis of data from eight global phase 2/3, double-blind, randomized, placebo- or active-controlled trials of mirabegron in adult patients with OAB. InterventionMirabegron 50 mg once-daily monotherapy for ≥12 wk. Outcome measurements and statistical analysisPrimary efficacy outcomes were the change in the mean number of micturitions and the number of incontinence episodes/24 h after 12 wk of treatment. Secondary efficacy outcomes were the change in the mean number of urgency episodes/24 h and the change in Symptom Bother score after 12 wk of treatment. Baseline demographic characteristics, OAB-related characteristics, and intrinsic and extrinsic factor variables were used to create multivariable linear regression models to predict the primary and secondary outcomes. Results and limitationsData for 3627 patients were included. The predicted effect of mirabegron 50 mg was an average of 2.5 fewer micturition episodes/24 h (95% confidence interval −2.85 to −2.14) and 0.81 fewer incontinence episodes/24 h (95% confidence interval −1.15 to −0.46) from baseline to week 12. A higher number of urgency episodes was predictive of a larger reduction in micturition episodes; body mass index (BMI) ≥30 kg/m2, OAB symptoms for ≥12 mo, and incontinence at baseline were predictive of a smaller reduction. Mixed stress/urgency incontinence and more than five urgency episodes per day were predictive of greater reductions in incontinence episodes. Reductions in urgency episodes and Symptom Bother score were also predicted with mirabegron. Limitations include the exclusion of placebo groups from the analysis and the use of clinical trial rather than real-world data. ConclusionsData from the predictive models provide new insights into the effects of modifiable factors (such as BMI) and nonmodifiable factors on treatment outcomes with mirabegron 50 mg. Patient summaryThis study aimed to identify factors that could predict how patients with overactive bladder respond to mirabegron treatment to help doctors effectively treat this condition. Mirabegron treatment was associated with a lower number of urinations and occurrences of urinary incontinence per day. Factors associated with worse responses to the medication included being obese.

Unmet expectations about material properties delay perceptual decisions

Based on our expectations about material properties, we can implicitly predict an object’s future states, e.g., a wine glass falling down will break when it hits the ground. How these expectations affect relatively low-level perceptual decisions, however, has not been systematically studied previously. To seek an answer to this question, we conducted a behavioral experiment using animations of various familiar objects (e.g., key, wine glass, etc.) freely falling and hitting the ground. During a training session, participants first built expectations about the dynamic properties of those objects. Half of the participants (N = 28) built expectations consistent with their daily lives (e.g., a key bounces rigidly), whereas the other half learned an atypical behavior (e.g., a key wobbles). This was followed by experimental sessions, in which expectations were unmet in 20% of the trials. In both training and experimental sessions, the participant’s task was to report whether the objects broke or not upon hitting the ground. Critically, a specific object always remained intact or broke - only the manner in which it did so differed. For example, a key could wobble or remain rigid but never break. We found that participants’ reaction times were longer when expectations were unmet, not only for typical material behavior but also when those expectations were atypical and learned during the training session. Furthermore, we found an interplay between long-term and newly learned expectations. Overall, our results show that expectations about material properties can impact relatively low-level perceptual decision-making processes.

Patients' experiences of completing patient‐reported outcomes in clinical trials: An interview study

AbstractThis study aimed to gain insight into how older men diagnosed with prostate cancer experience responding to ePRO about their quality of life in a clinical trial as well as what motivates and demotivates them in the process. Drop‐outs in patient‐reported outcome studies are a well‐known challenge that influence both the reliability and validity of clinical trials. Furthermore, retaining older people in electronic patient‐reported outcome (ePRO) studies has proven difficult. This study was based on qualitative semi‐structured interviews with 13 male patients. The interviews were conducted between April and May 2022 and were audio‐recorded and transcribed verbatim. We analysed the interview inductively using Braun and Clark's thematic analysis. Resulting in five core themes among participants' responses: (1) the ePRO frame is feasible, (2) it is challenging to rate one's life on a scale, (3) increased disease insight, (4) unmet expectations of emotional support, and (5) from motivation to demotivation. The informants were motivated primarily by the idea of helping with new knowledge, but also because ePRO was seen as easy to use and access from home. They were further motivated by the new knowledge they gained through ePRO about symptoms and the possibility to follow their own progress. However, relating to their own quality of life creates an expectation that nurses and doctors will do the same in their treatment, and when this does not happen, the initial motivation turns into demotivation as ePRO knowledge was not used to tailor their treatment and follow‐up. In conclusion, older men can participate in ePRO. They are motivated by helping with new knowledge, the ability to answer ePRO from home, and the insights they gain from the questionnaire. They lose motivation when their responses are not used to tailor their disease management.

A meta-synthesis of the transitioning experiences and career progression of migrant African nurses

IntroductionWith the rise in global migration, hospitals and health systems in developed countries are looking to supplement their workforces with migrant nurses who have been reported to feel devalued, underutilized with experience of deskilling and unmet expectations as they transitioned. Despite the plethora of literature reporting on the experiences of internationally trained nurses, only limited work has been done regarding understanding the experiences of Migrant African nurses. Thus, this study sought to synthesize existing qualitative studies to develop in-depth understanding of the transitioning experiences of migrant African nurses, their career progression and to highlight existing gaps to guide future studies as well as inform policies.MethodA meta-synthesis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Enhancing transparency in reporting the synthesis of qualitative research statement. A pre-planned search strategy was developed guided by the SPIDER tool for qualitative synthesis searching EMBASE via OVID, CINAHL via EBSCO, PubMed, Web of Science, and PsychINFO databases. We included published studies that 1) focused on migrant African nurses, 2) employed a qualitative design and 3) reported in English.ResultsThe search yielded 139 studies of which nine studies met the inclusion criteria and included in final synthesis. Three themes with corresponding subthemes emerged from data synthesis: 1) Navigating reality shock (a. Navigating a new culture, b. Survival strategies and support amidst the shock); 2) Discrimination and limited opportunities for promotion (a. Prejudices and preference for White over Black, b. Lack of recognition and limited opportunities for a workplace promotion); and 3) Finding one’s feet (a. Standing up for oneself and looking beyond discrimination, b. Experiencing growth).ConclusionTransitioning to a new setting can be a challenging experience for migrant African nurses warranting the availability of a tailor-made adaptation or orientation programme. Though African nurses may experience discrimination and prejudices as part of their transition, they consider their situation to be better off compared to back home. Therefore, clear transitioning policies which focus on career pathways are required by hiring institutions, and migrant nurses should be proactive in taking active roles in pushing their career ahead, instead of maintaining a culture of silence.

Equity in Global Health Research.

Equity in Global Health Research.

The factors that affect violence against nurses in emergency departments

BackgroundViolence against nurses within healthcare setting is a serious issue of concern within the global healthcare sector. A considerably large percentage of nurses, 30%, in particular, have experienced or witnessed cases of violence in the workplace. ObjectiveTo conduct a scoping review on the factors influencing violence against nurses in emergency departments. DesignLiterature review. Setting(s)The SLR was performed in various academic databases namely SpringerLink, Google Scholar, Science Direct, ERIC, and Academic Search Elite. ParticipantsA total of N = 10 articles were included in the study. MethodsA scoping/mapping review (SR) was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. ResultsThe literature review consisted of 10 articles published in the English language within the last 10 yrs (between 2013 and 2022). The studies reviewed utilized various designs. Cross-sectional were 7, Case study was 1, while Qualitative retrospective descriptive studies were 2. The total sample size of all the studies recruited was N = 38, 031 participants. The reviewed literature revealed various factors that contribute to violence against nurses namely the level of a nurse’s experience, low quality of service, unmet expectations, patient or colleague disruptive behaviors, delay in care or waiting time, mistakes in care/errors, degree of pain of the patient, death of a patient, class in roles among colleagues, and high workload and overcrowding. ConclusionsViolence against nurses is a major problem in the healthcare sector due to its adverse consequences; however, it remains persistent. This study reveals that the main factors of violence against nurses are fewer years of experience as a nurse, level of pain of patients, quality of healthcare service, waiting time, unmet patient expectation, and disagreements among nurses in the workplace.

Corresponding about Death: Analyzing Letters Exchanged between Patients with Cancer and Medical Students.

Medical students lack opportunities to have authentic conversations with patients with cancer in busy hospitals. An improved understanding of what such communication might look like may provide a framework for end-of-life curricula. The authors performed thematic analysis using written correspondence between patient and student participants in the University of California, San Francisco's Firefly Program whose letters discussed death or dying. Four themes emerged: (1) turmoil, (2) grief, (3) making peace, and (4) past, present, and future. Medical students expressed a fifth theme: unmet student expectations. The study provides educators with a unique perspective to help inform curriculum development and patient care.

FAILURE TO MEET EXPECTATIONS OF SPORT OR RECREATION FOLLOWING TOTAL HIP ARTHROPLASTY IS ASSOCIATED WITH YOUNGER AGE, HIGH BMI, AND POOR GENERAL HEALTH

Total hip arthroplasty (THA) has high rates of patient satisfaction; however patient expectations for recreational and sporting activities are not always met. Our study aimed to identify preoperative factors that predict whether patient expectations for sporting or recreational activity are met 12 months following THA.Patient reported outcome measures (PROMs) were collected prospectively from 2015-2018 at one private hospital in Sydney. Age, gender, postcode, weight, and height were recorded preoperatively. Included participants underwent primary THA by one of the investigating surgeons. Univariable and multivariable analyses were performed with an expectation fulfilment score used as the primary outcome variable. Preoperative predictor variables included: age, gender, BMI, Socio-economic Indexes for Areas (SEIFA), Oxford Hip Score, Hip Osteoarthritis Outcome Score, EQ-5D-5L and EQ Visual Analogue Scale (EQ VAS).1019 participants were eligible and included. 13% reported that preoperative expectations of sport or recreation were not met at 12 months. Younger age, lower preoperative EQ VAS, and higher BMI were associated with failed expectations on multivariable analysis. Odds of failed expectations increased by 2% for every one year younger in age (OR= 0.98, 95% CI = 0.96 to 1.00, p=.048), by 2% for every one point lower on EQ VAS (OR=0.98, 95% CI = 0.98 to 0.99, p=.002), and by 4% for every one-point increase in BMI (OR = 1.04, 95% CI = 1.00 to 1.09, p=.042).Failure to have expectations met for sporting or recreational activity was associated with younger age, poorer general health, and high BMI. With a rise in younger patients who likely have higher physical demands, a tailored preoperative education is preferable to generic models to better manage patient expectations.Younger age, higher BMI, and poorer health may predict unmet expectations for sport and recreation after THA. Tailored education in these groups should be considered.

Smallholder Views on Chinese Agricultural Investments in Mozambique and Tanzania in the Context of VGGTs

Based on a case study in each country, this study documents the views of Mozambican and Tanzanian smallholders regarding Chinese agricultural investments and the extent to which investors abide by their legitimate land tenure rights as defined by the Voluntary Guidelines for the Responsible Governance of Tenure of Land, Forests and Fisheries in the Context of National Food Security (VGGTs). The VGGTs offer guidelines to government on how to protect the land tenure of rural communities when land is being acquired for large-scale land investments. The study also assessed the impact of the COVID-19 pandemic on smallholders. Due to COVID-19, instead of fieldwork, we conducted telephone interviews with 20 smallholders in Mozambique and 35 in Tanzania. The Mozambican case showed that even when land set aside for investors was not in dispute, smallholders still had unmet expectations, especially regarding investors’ corporate social responsibility activities. In the Tanzanian case, even though the land leased by the Chinese investor had been designated as general land, it had laid fallow for a long period, and smallholders had moved back onto the land, only to be displaced in 2017. Although smallholders’ views on the investment were mixed, the case underscored the need for government to assess current land use before allocating it to investors—regardless of how the land is classified and especially in areas where land shortages are creating conflict. The cases show that even if communities are consulted about proposed land investments, guidelines need to include clauses that allow for ongoing communications between investors, communities and government officials such that if communities are unsatisfied with the results of the investment, renegotiation is possible. Further, in the event of crises, such as COVID-19, investors should partner with communities and government to limit the extent of harm in communities as a result of the crisis.

Nursing students` experience of writing a bachelor thesis – a qualitative study

The bachelor thesis (BT) in nursing education is a significant piece of academic work for students. It serves as an instrument for demonstrating and assessing the knowledge they have gained throughout their education. The BT also introduces the students to the field of research. Students often write it on their own, and it has been characterized as the ultimate self-regulating learning task for undergraduate students. This study aims to explore undergraduate nursing students’ experiences of being in the process of writing their BT. It is valuable to gain information on students’ experiences in the middle of the writing process to improve the pedagogical and practical organization of the BT course in nursing education. Individual interviews were conducted with 14 students who were in the process of writing their BT. Qualitative content analysis was used to analyse the interviews. The theory of self-regulated learning was used to explore and contextualize the findings. The main findings are that the nursing students operated in both an individual and a social context while writing on their BT. Further, the study describes how students utilized and developed previous knowledge and organized the writing process. It also discusses how their personal abilities and motivation affected their learning process. The findings also show that students viewed discussions and feedback on their BT as being positive, and they provide information on how students experienced obstacles and unmet expectations. This study found that the most important self-regulated learning strategies used by the students while writing the BT were help-seeking, goal setting, time planning, and study techniques.

Novel Industry Engagement approaches for academic projects leading to internships, placements, and entrepreneurships

A popular pedagogical approach in engineering education that has been proven to be successful in building problem-solving, design, and collaborative abilities is project-based learning. Giving students freedom to choose the type and scope of the projects they want to work on has apparent advantages but doing so without professional advice or a defined plan of action can lead to confusion, frustration, and unmet expectations. Additionally, engineering schools must give their students the chance to interact with industry during their studies, which can be challenging owing to logistical and time constraints. This paper describes a case study in which undergraduate computer science and computer engineering students met with business professionals to get feedback during the last stage of project implementation. Students presented their concepts to faculty members and industry guests on campus in the form of a project poster. The success of the strategy in raising students' self-efficacy and performance is attested to by internships, employability, and evaluation results, as well as by the satisfaction of the participants. The proposed research continues with suggestions for engineering educators who want to put similar initiatives into practice as well as a brief description of the authors' future goals.

A survey of the knowledge, perceptions of and attitudes to digital health of healthcare professionals in 14 Bulgarian hospitals: First large-scale study on digital health in Bulgarian inpatient facilities.

To explore the knowledge, perceptions of and attitudes to digital health of Bulgarian hospital professionals in the first study of digital health in this professional group. A paper-based questionnaire was administered to doctors, trainee doctors, nurses, midwives, and laboratory assistants working in multiprofile or specialized hospitals. Topics included the following: state, objectives, benefits, and future of digital health; data storage, access, security, and sharing; main software used; patient-held Personal Information System (PIS); and telemedicine. A total of 1187 participants from 14 hospitals completed the survey in two phases: September 2013-April 2014 and May 2015-April 2017. Data were analyzed through descriptive statistics and multilevel logistic regression. Three-quarters of participants evaluated the state of development of digital health in Bulgaria as subpar (36.0% negative; 38.9% passable; 24.5% positive). 27.2% (323) endorsed patients having unconditional access to their data. In contrast, 89.5% (1062) of participants considered it appropriate to have full access to patient data recorded by colleagues. Doctors were more likely to endorse patients having access to their data than healthcare specialists (OR = 1.79 at facility, OR = 1.77 at location). The largely negative or lukewarm attitudes toward the state of development of digital health in Bulgaria are likely to result from the high number of failed projects, unmet expectations, misunderstood benefits, and unforeseen challenges. This study provides a much-needed stimulus and baseline for researching the ways in which the digital health landscape in Bulgaria has matured-or not.

Clinicopathological and survival features of neuroendocrine tumors: A retrospective analysis of 153 cases, our current remarks on a heterogeneous tumor group, and still unmet future expectations.

Neuroendocrine neoplasms (NENs) originate from the diffuse neuroendocrine cell system and constitute a heterogeneous group of tumors exhibiting diverse clinical and biological characteristics. NENs include well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). In the present study, we performed a retrospective analysis of patients diagnosed with NET to evaluate clinicopathological characteristics, treatment and outcomes. Data from 153 patients diagnosed with NET who were treated and followed up at three tertiary care centers from November 2002 to June 2021 were retrospectively evaluated. Clinicopathological and prognostic factors, treatment modalities and survival data were analyzed. Kaplan-Meier analysis was used to assess survival data and comparisons were performed using the logrank test. Median age (IQR) was 53 (18-80) years. 85.6% of the patients had gastro-entero-pancreatic (GEP)-NET. The primary tumor was resected in 95 patients (62.1%) and metastasectomy were performed in 22 patients (14.4%). Seventy-eight patients received systemic therapy for metastatic disease. Patients were followed up for a median of 22 (IQR = 33.8) months. The estimated one-year and three-year survival rate was 89.8% and 74.4%, respectively. Median progression-free survival (PFS) were 10.1, 8.5, and 4.2 months after first-, second- and third-line therapy, respectively. The number of systemic treatment options and diagnostic tools for NETs has significantly improved in the last few years. NET classification, which treatment will be more appropriate for which group of patients, the molecular basis of this disease and the development of treatment strategies are open-ended questions that still need to be investigated.

Exploring key informants' perceptions of Covid-19 vaccine hesitancy in a disadvantaged urban community in Ireland: Emergence of a '4Cs' model.

The aim of this study was to explore key informants' views on and experiences with Covid-19 vaccine hesitancy in a Dublin community with a high concentration of economic and social disadvantage and to identify feasible, community-centred solutions for improving vaccination acceptance and uptake. Qualitative, semi-structured interviews were carried out at a local community-centre and a central hair salon. Twelve key informants from the target community were selected based on their professional experience with vulnerable population groups: the unemployed, adults in recovery from addiction, the elderly, and Irish Travellers. Inductive thematic framework analysis was conducted to identify emergent themes and sub-themes. Drivers of vaccine hesitancy identified by key informants largely fell under the WHO '3Cs' model of hesitancy: lack of confidence in the vaccine and its providers, complacency towards the health risks of Covid-19, and inconvenient access conditions. Covid-19 Communications emerged as a fourth 'C' whereby unclear and negative messages, confusing public health measures, and unmet expectations of the vaccine's effectiveness exacerbated anti-authority sentiments and vaccine scepticism during the pandemic. Community-specific solutions involve the provision of accurate and accessible information, collaborating with community-based organizations to build trust in the vaccine through relationship building and ongoing dialogue, and ensuring acceptable access conditions. The proposed Confidence, Complacency, Convenience, Covid-19 Communications ('4Cs') model provides a tool for considering vaccine hesitancy in disadvantaged urban communities reacting to the rapid development and distribution of a novel vaccine. The model and in-depth key informants' perspectives can be used to compliment equitable vaccination efforts currently underway by public health agencies and non-governmental organizations.

Patient and Family Perpetrated Cyber-Incivility and Cyber-Aggression Within Healthcare: A Cross-Sectional Descriptive Study.

Verbal violence may manifest in written form as cyber incivility within patient portal communications. As a form of digital technology, patient portal messages create a physical and emotional distance leading the sender to be disinhibited and disassociated from the recipient nurse. Written patient portal messages may contain uncivil language deemed verbally violent when the content escalates beyond professional standards. When these messages are encountered as part of patient care, they may lead to nurses' psychological distress. Although cyber-incivility has been studied within social media and business, little is known about cyber-incivility within healthcare. The purpose of the study was to define cyber-incivility as it manifests within healthcare compared to business, determine sender demographics, and quantify the impact on nurses. A cross-sectional descriptive study was conducted to analyze portal communications. Nurses forwarded aggressive messages to leadership and quantified their level of distress after receiving the message. Sender demographics were tracked, and content was analyzed using Braun and Clarke's Thematic Analysis. Of the 31 included messages, senders were of varying ages, genders, and marital statuses. Messages rarely related to medications and rarely contained expletives. The most distressing messages were ad hominem, demanding, accusatory, or contained threats. These messages illustrated how healthcare cyber-incivility manifested and deviated from appropriate professional standards to become a form of verbal workplace violence. Message content also identified antecedents; related to unmet expectations, patient accountability, or difficulty navigating healthcare. Written incivil/uncivil/aggressive patient portal messages contained personal attacks and professionally degrading content, which were distressing to nurses. A healthcare-specific framework was created and provided context to understand the difficult and aggressive messages nurses received while providing digital patient care. Awareness of cyber-incivility within healthcare allows for better support of nurses who are exposed to this form of workplace violence and is foundational to future intervention development.

“I’ve Lost My Callouses:” A Phenomenological Investigation of Music Therapists Who Left the Profession

Although changing industries is common for many professionals, there is a lack of research regarding why music therapists have left the profession. The purpose of this phenomenological investigation was to explore why music therapists in the United States left the profession and understand how music therapy academic and clinical training might be applied across a range of occupational opportunities. We interviewed eight music therapists who had worked in and left the profession for employment in other industries. We used interpretative phenomenological analysis to analyze transcripts and incorporated member checking and trustworthiness to verify our findings. The first theme described how there were multiple factors that contributed to the decision to leave the music therapy profession. The second theme described how participants grappled with the decision to leave the music therapy profession. Regarding why music therapists left the profession and how their education and training were related to their new industry, we used a modified social ecological model to depict four superordinate themes (supported by 11 themes) that described (1) individual and interpersonal factors contributing to the need for occupational change; (2) music therapy skills that facilitated occupational change; (3) unmet professional expectations that contributed to occupational change; and (4) desired changes to the music therapy curriculum for greater career flexibility. Constituting an idiosyncratic process for each participant, leaving the music therapy profession was a complex and multifaceted phenomenon. Implications for education and greater career flexibility, limitations of the study, and suggestions for future research are provided.

Emotional Intimacy and the Black Matrifocal Family in Northeast Brazil

AbstractIn this article, I explore the affective landscape of matrifocal kinship in Brogodó to examine how the emotional intimacy that Black women shared with their women kin buffered the effects of unmet marital expectations, marital conflict, and divorce. I describe how women viewed their relationships with their families as a source of love and emotional intimacy that was more reliable and fulfilling than what they could expect from husbands who did not meet the romantic love ideal. Research that relies too heavily on functional assumptions about the relationship between matrifocality and marriage dissolution misses how the desire for emotional intimacy influences women's perspectives on and decision‐making around marriage dissolution. I argue that women's reliance on consanguineal kin as an affective alternative to romantic love and companionate marriage was a critical factor in their decisions to end their marriages. I also assert that rather than weakening extended family ties, in Brogodó the spread of notions of romantic love and companionate marriage strengthened the matrifocal family model by reinforcing women's views that consanguineal rather than affinal kin were at the center of their worlds.

Unmet expectations and job involvement among doctors: does individual conscientiousness play a mitigating role?

Background/Aims Doctors are responsible for leading the care of patients. This study analysed the moderating role of individual conscientiousness on the relationship between psychological contract breach and levels of job involvement among medical doctors working in Ghana. A psychological contract breach occurs when an organisation does not deliver on their expected obligations to an employee, whether these expectations are written or unwritten. Methods All 251 doctors working in the upper east and upper west regions of Ghana were invited to participate, of which 214 doctors responded. Participants completed self-administered questionnaires, with 15 statements relating to psychological contract breach, 10 statements relating to job involvement and four statements relating to individual conscientiousness. Respondents rated their agreement to the statements on a 7-point Likert scale (1=least agreement; 7=strongest agreement). Participant demographics were also collected. Relationships between the data for each section were analysed using the Statistical Package for the Social Sciences (version 24) and the Smart PLS 2.0M.3. Results Psychological contract breach was found to have a significant negative relationship with job involvement (P<0.05). Conscientiousness had a moderating effect on this relationship, meaning that doctors who were more conscientious were less likely to reduce their job involvement when a psychological contract breach occurred. Conclusions When a psychological contract breach occurs, doctors who have a conscientious personality trait are likely to continue showing high levels of job involvement. This implies that doctors who are naturally hardworking, organised, disciplined and highly motivated are more likely to persevere with psychological and emotional commitment to their role, but this may make them more vulnerable to mistreatment (whether intentional or not) by their employer.

Challenges of distance English teaching: Narrative analysis of Iranian mainstream EFL teachers’ lived experiences

Abstract This study aimed to examine what challenges Iranian EFL teachers in the mainstream educational system experienced in distance classes during the COVID-19 pandemic. Telephone unstructured narrative interview was employed to collect data from 20 teacher participants, and two theoretical frameworks, CoI and TPACK, were used to interpret the results. The thematic narrative analysis yielded ten themes: non-customized platforms, material-related issues, connection/internet issues, pedagogical problems, evaluation problems, insufficiency of teachers’ knowledge of technology, unmet expectations, physical absence of teacher/student, student-related issues, and dealing with negative emotions. The authors discuss that while some challenges are the antecedent contextual challenges that existed and will probably continue to exist in the context of distance classes, some other challenges can be avoided if teachers are equipped with TPACK to fulfill their new roles in the community of distance classes.