Traditional research on parenthood and wellbeing often employs a positivist perspective and focuses on non-LA samples -limiting our knowledge and understanding of the influence of cultural components such as Machismo and Marianismo, have in parents' wellbeing. This study explored how Latin American (LA) parents' wellbeing is influenced by parenthood in a culture strongly influenced by such gender-based perspectives.

An interpretative perspective was employed to qualitatively explore fifteen LA parents' lived experiences and data were analysed via Thematic Analysis. The American Psychological Association's Journal Article Reporting Standards for Qualitative Research (JARS-Qual), was followed to compile this paper.

Results showed that socio-economic factors such as crime, violence, and economic inequality, negatively influence parents' wellbeing -emotions experienced and life satisfaction.

Parents find joy in sharing own personal experiences with their children and passing on gender-based models. However, parents perceive family pressure as a "burden" when expected to follow principles of Machismo/Marianismo. Similar to Asian, but unlike European parents, LA parents experience a mixture of positive and negative emotions whilst parenting -shaped by Machismo and Marianismo. This study makes a unique contribution by uncovering the unique influence of LA socio-economic challenges and cultural impositions and expectations and its influence on parental wellbeing.

The full-scale war in Ukraine has introduced unique challenges for researchers, including physical displacement, destruction of research infrastructure, and deteriorating working conditions. This qualitative study investigates the impact of the ongoing war on the mental health and academic functioning of Ukrainian researchers. Based on 30 semi-structured interviews conducted between February and April 2024, the study reveals pronounced psychological consequences, including stress, anxiety, burnout, and feelings of isolation. Academically, researchers reported significant disruptions in research productivity, loss of professional networks, and diminished institutional support. Three critical areas of impact were identified: (1) the deterioration of working conditions and researcher well-being, (2) the fragmentation of academic communities and networks, and (3) restricted access to research resources and support. Despite these challenges, many researchers demonstrated resilience by adapting to remote work, forming new international collaborations, and finding renewed purpose in contributing to Ukraine's recovery through science. The findings underscore the urgent need for comprehensive, multilevel support systems that include mental health services, financial and infrastructural assistance, and initiatives to restore academic belonging. These insights are essential for developing responsive strategies to support academic communities in crisis settings globally.

The aim of this qualitative study was to identify considerations, objections, and preferences of women with symptomatic ovarian endometrioma in the shared decision-making process.

This study was conducted as a qualitative study, including twenty patients facing or faced therapeutic treatment options for an ovarian endometrioma.

Four focus groups were held between February 2020 and June 2021 in the Netherlands. Two of them were held online due to COVID-19 pandemic.

A qualitative study was performed using semi-structured in-depth focus group methodology. All women, aged 27-44 years, suffered from pain.

The focus groups were audio recorded and fully transcribed using ATLAS-ti. Grounded theory methodology was applied for data analysis.

Outcome measure includes the most important aspects during decision-making process for patients facing or faced therapeutic treatment options for an ovarian endometrioma.

A total of twenty Dutch women with an ovarian endometrioma were included. Participants named "relief of pain", "fertility", "adverse effects or surgical complications", "recurrence of pain and lesions", and "time untill treatment effect occurs" as most important aspects during their decision-making process. In addition, women often felt "unheard", so more attention should be paid to symptoms of endometriosis.

Participants named "relief of pain", "fertility", "adverse effects or complications", "recurrence of pain and lesions", and "time untill treatment effect occurs" as most important aspects during their decision-making process.

The rapid spread of SARS-CoV-2 in 2020 exposed unprepared healthcare systems worldwide. In Germany, acute care hospitals faced significant challenges, particularly in organizing adequate personal protective equipment, managing high mortality rates, and accommodating extended hospitalization of patients with COVID-19.

This study aimed to explore the perspectives of nurse leaders on organizational interventions and strategies implemented in hospitals to address pandemic-associated challenges and derive knowledge for future crises.

A qualitative descriptive study was conducted between July 2022 and June 2023, utilizing semi-structured interviews with nurse leaders across different management levels (strategic, middle, and operative management) in hospitals in Saxony, Germany.

This study was conducted in hospitals across Saxony, Germany.

The study included 30 nurse leaders from nine different hospitals, representing a diverse sample in terms of hospital characteristics (ownership, hospital size, regional distribution, and level of care) and participant demographics.

Data were collected through semi-structured interviews, transcribed, and analyzed using qualitative content analysis in MAXQDA.

Eight strategies were identified (four core and four secondary) with various corresponding interventions that hospitals used to manage the pandemic, including infection control, adaptation of hospital capacities, human resource management, direct patient care delivery, management of the provision of non-COVID-19 care, transparent organization of the flow of information and decision-making, cooperation and teamwork, and evaluation and flexible adaptation. This study highlights the importance of flexibility, creativity, internal and external support, leadership, crisis communication, participatory decision-making, evaluation, and error management in crisis management.

This study provides a comprehensive documentation of hospital pandemic management from the perspective of nurse leaders, offering a basis for future research and practice. Effective hospital pandemic management requires a flexible, context-specific approach supported by strong leadership, internal and external support, and participatory processes. These findings emphasize the need for ongoing evaluation during crises and for a culture that encourages reflection and learning from crises to improve future responses.

Little is known about the psychosocial care of older people presenting to the emergency department (ED), or whether their psychosocial well-being during and after an ED admission can be enhanced. People over the age of 65 years experiencing psychosocial distress and mental health concerns have higher rates of ED admission than those without. As part of a larger mixed-methods study investigating the relationships between older people's psychosocial well-being and emergency care, this study aimed to explore the experiences of older people in ED and their influence on patient psychosocial well-being.

Participants aged 65 years or older receiving care in a large Australian public hospital ED were invited to participate in a telephone interview soon after discharge. Interviews were audio recorded and transcribed. Transcripts were analysed thematically.

Eleven people (five women) aged 68-87 years participated in semi-structured interviews. Analyses revealed three overarching themes: 'interpersonal interactions', 'quality of care' and 'physical environment'. The theme 'interpersonal interactions' had two subthemes: 'communication' and 'human contact'. The three subthemes of 'quality of care' were 'appropriate care', 'psychological care' and 'unmet needs'. Physical environment referred to participant impressions of the ED setting.

We found that staff sensitivity in their interactions with patients and their efforts to promote patients' physical comfort and protect their privacy influenced the psychosocial well-being of older adults in the ED. Based on the findings, we present a set of recommendations for enhancing the psychosocial care of older adults during ED admission.

Though transferability is a multidimensional concept, our representations of transferability within Health Professions Education have largely focused on whether innovations or outcomes can be applied in different contexts. However, transferability has been variously described and used as a quality criterion through the history of qualitative research. To capture the complexity of this concept we propose a tri-dimensional conceptualisation of transferability, drawing on foundational qualitative research literature and our own experiences as qualitative researchers. We consider the origins of transferability within qualitative and Health Professions Education research, including its association with the concept of generalisability. We draw attention to shifts in debate, and the need for a clear conceptualisation of transferability as a concept. The three dimensions we propose, as part of our 3D transferability model, are: applicability; theoretical engagement; and resonance. By exploring these three dimensions, we highlight the importance of a critical, multifaceted approach to understanding and operationalising transferability. To promote practical application, we make suggestions regarding the use and discussion of each dimension of transferability. In doing so, we hope this exploration will be useful for scholars seeking to achieve broader impact of their evaluative work and empirical research.

This study aimed to understand primary healthcare providers' beliefs about barriers and facilitators providing culturally competent midlife care to migrant women.

Primary healthcare is the entry level to the health system. It is usually the first point of contact in accessing the healthcare system and provides a range of services including health promotion and prevention. Migrant women are less likely to access and engage in health screening and health promotion activities and consequently may miss out on optimal health in older age.

A cross-sectional study including two free-text questions, part of an online survey, was thematically analysed. 76 primary healthcare providers answered the free-text questions.

Competing priorities as a result of migration and settlement experiences, the healthcare systems' limited resources to respond to the needs of migrant population and culturally informed beliefs and behaviour about menopause were viewed as barriers to midlife care for migrant women. Flexible models of primary healthcare and coordinated engagement with community groups were proposed to address these barriers. Primary healthcare providers perceived the current primary healthcare model to be inadequate to address the additional needs of migrant women. A review of the model of care may include 'task shifting' where nurses provide advanced care to migrant women in midlife. Perceptions of midlife and menopause are informed by culture. Hence, a culturally informed health promotion programme led by migrant women may be one strategy to address the limited participation in preventative healthcare including health screening at the time around menopause.

Reproductive health conditions present various challenges for women in all aspects of their lives, including in the workplace. This study explores the workplace experiences of employed women with reproductive healthcare needs arising predominantly from endometriosis, as well as adenomyosis and infertility.

Semi-structured interviews were conducted with 12 women with one or more of these conditions who were employed while experiencing symptoms of their condition or seeking treatment (such as in-vitro fertilization or laparoscopic surgery).

Interviewees reported significant physical and psychological hardship because of their reproductive health conditions, namely pain associated with endometriosis. The impact of reproductive health needs and treatment on women's ability to work included: difficulty managing symptoms, additional pressure to perform, exhaustion of 'sick leave', and working less and negative impact on career progression. In terms of how workplaces can improve the wellbeing of women with endometriosis and other reproductive health needs, women would benefit from: flexibility and working from home, access to paid reproductive health leave, and improved workplace education, trust and understanding.

Women's own accounts of how endometriosis and their reproductive health impacts their working lives, and what employers can do to support them, provides a platform to better understand women's needs. These findings can inform public-policy solutions and workplace policies to better meet the needs of women with endometriosis and improve their workforce participation.

With the augmentation of flexible capitalism, episodic, short-term work has been a common workforce regime in distinct fields and sectors, including education. Increasingly teachers are forced to work short-term, leading to lower-wages and insecurity. Türkiye, which had employed teachers permanently, changed its teacher workforce regime in 2005; introducing contract-based and short-term employing to the regime.

The aim of this study was to investigate the consequences of the new workforce regime on teachers' overall well-being and relationships with their peers.

The present study utilized in-depth interviews with 16 preschool teachers, who had different employing status; paid, fixed-term contracted and permanent teachers, which allowed to compare these groups. A theoretical thematic analysis for data analysis was conducted, utilizing MAXQD.

Findings revealed that the paid and fixed-term groups experienced financial insecurity, future hopelessness, bullying and discrimination in school, all of which resulted in lowered overall well-being while paid teachers reporting higher levels and permanent teachers not reporting such issues but enjoying their jobs.

The current Turkish teacher employment regime has resulted in a school environment that was detrimental to school relations and well-being of teachers. The results implied that permanent teachers were enjoying a relatively comfortable and safe zone, fixed-term teachers were confined to ambiguity and temporality, and precarious teachers postponed their life to an unknown and unimaginable future. Therefore, policy makers should consider immediate and far-reaching consequences of precariat while making workforce policies. The study suggested the termination of precarious work in schools effective immediately.

A myriad of physical, psychosocial and environmental sequelae are associated with limb loss. However, there is a paucity of empirical South African data, which focusses on these sequelae, how they interface with the amputee's quality of life as well as the challenges they experience following amputation.

This study sought to explore the biopsychosocial effects of amputation and how it affected the quality of life of transtibial amputees.

A qualitative approach guided this study. Data were collected using one-on-one interviews with 14 unilateral transtibial amputees. Data were analysed thematically.

Five broad themes emerged from the inquiry, which captured amputees' experiences of phantom limb pain, body image disturbances and their challenges related to adapting to daily activities. Participants also expressed the salience of familial support as well as the importance of psychological interventions to cope.

The findings suggested that support networks and professional psychological intervention are imperative in facilitating successful adjustment to the amputation experience. Raising awareness of limb loss, in both rural and urban settings, may help reduce the stigma attached to it.

Quality of life comprises several domains, namely physical, psychological, environmental and social. However, limited local and international data exists regarding the environmental and social effects. This study brought to the fore the positive and negative effects of amputation in each domain, as well as various strategies, which facilitate successful adjustment to amputation.

Gender-based violence is a major public health concern. Although, in many instances, violence against women and girls encompasses the entire spectrum of gender-based violence in the public eye, violence against men is a very real threat that is obscure and obliterated within cultural norms. Identification of the legal and cultural barriers men face is a very important step forward toward promoting gender equity. There is a severe paucity of research on gender-based violence against men in Sri Lanka.

A qualitative study was conducted to explore the causes, effects, and help-seeking behaviors of men subjected to gender-based violence in the Colombo district, Sri Lanka. Two focus group discussions and two in-depth interviews were carried out among seventeen purposefully selected victims of gender-based violence and ten key informant interviews were carried out among service providers recruited purposefully in the Colombo district. Transcript analysis was done by using the thematic analysis method.

The study participants of the focus group discussions described themes of preconceived notions about the male sex, gender bias, power play, and masculinity norms as causes leading to gender-based violence. Many participants described their own or a peer's life experience to explain the experiences and consequences of gender-based violence. The key informant interview revealed certain aspects of the support systems which need revision in order to make the services more accessible to men.

This study provides evidence regarding the hitherto undiscussed topic of gender-based violence against men in Sri Lanka. The findings highlight the importance of taking into consideration and inclusion of men in the development of policies for gender-based violence in Sri Lanka.

Background: This study explores barriers and facilitators to psychological safety during medical procedures among individuals diagnosed with chronic illnesses in childhood. Psychological safety in healthcare, detected via neuroception and the autonomic nervous system's responses to perceived safety or threat, is essential for the well-being and mental health of chronically ill patients, especially those with early diagnoses. Methods: Using Polyvagal Theory as a framework, semi-structured interviews were conducted with six participants (aged 20-64) who experienced chronic disease from a young age. The Neuroception of Psychological Safety Scale (NPSS) guided thematic exploration to understand participants' experiences. Thematic analysis identified key themes that reflect contributors and detractors to psychological safety during medical care. Results: Four primary themes were developed: (1) knowledge empowerment through information and facilitated inquiry, (2) holistic acknowledgment of psychological and social impacts, (3) the role of parental involvement in healthcare interactions, and (4) the need for an individualised, patient-centred approach. Participants expressed a need for psychological support integrated with their medical treatment and the importance of autonomy and clear communication. Conclusions: Psychological safety is central to medical experiences for chronically ill individuals and requires a patient-centred, psychologically informed approach. Emphasising tailored support, family involvement, and comprehensive mental health consideration can foster more effective care and enhance patients' long-term well-being.

Lung cancer is the leading cause of cancer-related death globally and provides a major disease burden likely to substantially impact quality of life (QoL). Patient-reported outcome measures (PROMs) have been identified as effective methods of evaluating patient QoL. Existing lung cancer-specific PROMs however have uncertain utility and minimal patient involvement in their design and development. This qualitative study aimed to evaluate the patient perspective of existing PROMs and to explore their appropriateness for population-based descriptions of lung cancer-related QoL.

A descriptive qualitative study was conducted consisting of semi-structured interviews with 14 patients recruited from the Victorian Lung Cancer Registry and Alfred Hospital using purposive sampling. Interviews first explored the factors most important to lung cancer patients QoL, and second, patient's perspectives on the appropriateness of existing PROMs. Thematic analysis was used to develop themes, and content analysis was conducted to determine PROM acceptability.

Five novel themes were identified by patients as being important impacts on QoL: Personal attitude toward the disease is important for coping; independence is valued; relationships with family and friends are important; relationships with treating team are meaningful; personal and public awareness of lung cancer is limited. These patient-identified impacts are poorly covered in existing lung cancer-specific PROMs. Patients welcomed and appreciated the opportunity to complete PROMs; however, they identified problems with existing PROMs relevance, tone, and formatting.

Existing lung cancer PROMs poorly reflect the five themes identified in this study as most important to lung cancer patients QoL. This study reaffirms the need to review existing PROMs to ensure utility and construct validity. Future PROM development must engage key patient-generated themes and evolve to reflect the changing management and therapeutic landscape.

The aim was to explore the patient experience of those attending screening appointments for rare endocrine syndromes. Obtaining insights into the factors that potentially enhanced or detracted from attendance and engagement with the clinics could assist in developing strategies to promote patient engagement. A qualitative approach using semi-structured interviews was employed to understand individuals' perceptions and experience of the screening clinics. Twelve interviews were conducted with patients (age 10-66 years, purposive sampling). Four main themes were identified: (1) Perception at a distance, (2) Seeing my future self (3) The body and person in clinic and (4) The patient or doctor, who knows best? These highlighted several areas which could be used to inform approaches to promote enhanced patient engagement: the importance of careful management of projections of self, balancing information overload and honesty, interpersonal relationships and humanisation of care and assisting with the early navigation for the non-expert individual.

Background: Assertiveness in nursing is crucial to improving communication, reducing interpersonal tensions, and improving healthcare outcomes. Objective: The objective of this systematic review was to identify and synthesize the literature on assertiveness in nursing, focusing on nurses' perspectives regarding its role, influencing factors, challenges, and impact within complex healthcare settings. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An integrated mixed methods approach was used to capture the multifaceted nature of assertiveness in nursing. The evaluation covered both qualitative and quantitative investigations, concentrating on quantitative publications between 2018 and 2024 and qualitative publications without a time limit. Diverse methodologies were incorporated using the SPIDER framework. A comprehensive electronic search was conducted across six databases: PubMed, Medline, CINAHL, PsychInfo, Wiley Online Library, and Web of Science. Ultimately, 15 research papers were included in the review out of 9490 publications that were initially identified. Included studies were critically appraised using the Critical Appraisal Skills Program (CASP) and the Joanna Briggs Institute Critical Appraisal checklists. Results: A total of 9490 studies were identified, of which 15 (eight quantitative and seven qualitative) were included in this review. The review and subsequent analysis revealed five major themes: (1) facilitators of assertiveness; (2) barriers to assertiveness; (3) assertiveness training; (4) interaction with other staff; and (5) patient relationships. Conclusions: Assertiveness is essential for proficient nursing practice, especially in complex healthcare environments. It facilitates improved communication, alleviates stress, and augments patient care. Future research should explore the long-term benefits of assertiveness training and its influence across various cultural settings.

To investigate the challenges and needs of new nurse managers transitioning from staff nurses to manager roles.

Nursing managers are often selected based on clinical expertise, not proven leadership skills. Their complex roles and evolving healthcare policies result in heightened expectations from society, institutions, patients, and staff. The often-overlooked transition phase from staff nurse to manager presents distinct challenges and needs. Clarifying these aspects is crucial for developing effective nursing policies and improvement initiatives.

A phenomenological qualitative study was conducted at a tertiary hospital in Beijing, following the COREQ guidelines from April to June 2023. Fourteen new nurse managers were interviewed using a semi-structured interview guide based on the role theory. Data were analyzed using Nvivo 12.0 and Colaizzi's thematic analysis.

Four themes emerged, including role ambiguity (adjustment difficulties, unclear expectations, poor handling), role conflict (inconsistencies between work and family, management, competencies), role learning (self-improvement, external support, resilience), and role behaviors (summarizing experiences, time management, promoting coworkers, research capability).

Identifying the difficulties and needs of new nurse managers during their role transition can help healthcare organizations develop tailored training, external support, positive psychology, and academic advancement strategies.

New nurse managers face significant transition obstacles, necessitating comprehensive support. This prompts healthcare organizations to adopt best practices for facilitating role adaptation and talent development.

To ensure the successful adaptation of new nurse managers, comprehensive and tailored strategies should be developed based on identified transition challenges and needs. This support will enhance their competencies and stress management. Nursing policymakers should encourage new nurse managers to participate in the formulation of policies and training programs.

Overweight among adolescents is worldwide still considered a serious public health problem. Although both parents influence children's energy balance-related behavior, most studies have predominantly focused on mothers and white populations. Therefore, in this study, we contribute to the research by exploring the perceptions and needs of Dutch fathers with a migration background on parenting, specifically regarding promoting healthy energy balance-related behaviors among their children, and what motivates fathers to participate in parenting programs focused on these behaviors.

We used a qualitative research design. Informal conversations (n = 2), semi-structured interviews (n = 11) and one focus group (n = 13) were conducted with professionals specialized in intercultural pedagogy and fathers participating in a parenting program organized by these professionals. Interviews and focus group were audio-recorded and transcribed. Atlas.ti 8 was used for theme detection, categorization, and classification using inductive and deductive approaches. The data was analyzed using grounded theory analysis.

Fathers joined parenting programs to improve their parenting skills and knowledge and address health and socio-cultural challenges. Furthermore, intergenerational differences were evident: second-generation fathers were more proactive in tackling parenting challenges related to healthy lifestyles. Fathers highlighted challenges related to parenting in two cultures. Although participating in the parenting program facilitated fathers in adopting a healthier lifestyle for both themselves and their families, improving communication with family members, and experiencing changes regarding gender dynamics within their household, influencing their teenage children, to adopt healthier habits remained a challenge, especially in comparison to younger children.

A deeper understanding of the needs, perceptions, and experiences of migrant populations concerning parenting regarding the promotion of healthy energy balance-related behaviors among their children can lead to better-tailored health promotion programs that prioritize cultural and linguistic inclusivity.

Evidence suggests that earlier bowel resection may offer more stable remission in localized luminal terminal ileal (TI) Crohn's disease compared with ongoing medical therapy. Surgery is still considered late in the treatment pathway. The aim of this study was to understand the clinician's perspective on 'early' surgery by qualitatively exploring how clinicians make treatment-related decisions.

Semistructured interviews with clinicians across the UK with an interest in inflammatory bowel disease (IBD) were undertaken using videoconferencing (February-November 2022). Inductive thematic analysis of interview transcripts was performed; 10% of the data were double-coded. Data saturation was confirmed before stopping recruitment.

Participants included nine consultant surgeons, seven consultant gastroenterologists and seven specialist nurses (n = 23) from secondary care and tertiary referral centres. Five key themes were identified: timing of surgery in practice, barriers to timely surgery, factors influencing decision-making, offering choice and the patient's perspective. A practice of exhausting medical options before considering surgery was commonly described. A lack of IBD specialists (especially surgeons), inadequate opportunities for multidisciplinary teamwork and long waiting lists for surgical clinics and theatre were cited as barriers to timely surgery. According to interviewees, patients prefer medical therapy over surgery; the most dreaded risk is thought to be that of a stoma.

This study provides new insights into the barriers to earlier surgery for TI disease. Organizational barriers should be considered when designing local services. Collaborative multidisciplinary teamwork may allow clinicians to consider surgery sooner. A study investigating the patient perspective is warranted.

Breast cancer is the most common cancer in the UK, accounting for 15% of all new cases in women. Evidence still points to disparities in outcomes linked to ethnicity and screening uptake is overall lower in South Asians than the White population. We investigated the experiences and perceptions of Gujarati Hindu community members on their 'cancer journeys'.

This study took a participatory approach, involving participants in generating and refining recommendations to improve treatment based on their cohort's experiences and perceptions. Data were collected through two focus groups in 2022, followed by a feedback workshop session, where participants helped refine the research team's initial analysis and agree recommendation. Data were analysed thematically.

14 women participated in this study from the same support group. They had experienced breast cancer or were undergoing breast cancer treatment at the time of data collection and lived in Greater London. Barriers to engaging in the three key stages of their 'cancer journey' (screening, diagnosis, and treatment) were identified. These centred around language difficulties, not knowing what to expect, and not knowing who to ask for information. Suggestions for improvements included recruiting community champions, having diverse representation on educational materials, and referrals to support groups.

This study adds to the growing literature on the need for culturally tailored and sensitive approaches to cancer treatment. It reinforces the need for health professionals' training around effectively communicating with diverse groups and normalising referral to support groups.

Heatwaves pose significant threats to vulnerable populations, making resilience efforts crucial. This study aims to explore stakeholders' perspectives on heatwave resilience from a public health perspective, with a specific focus on operationalising the commitment to 'Leave No One Behind' (LNOB) as outlined in the United Nations 2030 Agenda for Sustainable Development. In-depth qualitative interviews were conducted with key stakeholders from national and local government, industry and business, academia, and civil society organizations. Interviews examined stakeholders' understanding of the progress and challenges associated with fulfilling the commitment of LNOB in the context of heat resilience from a public health perspective, in England, UK. Content analysis of interview transcripts was undertaken. Stakeholders emphasize the importance of equity, inclusivity, and public health priorities in heatwave resilience efforts while specifically addressing the commitment to LNOB. Disparities in vulnerability due to socioeconomic factors, challenges in identifying and supporting vulnerable populations, progress made in addressing heatwave resilience, and the role of government and society in improving resilience efforts were emphasized. Stakeholders highlighted the need for targeted interventions, strengthened community support networks, and policy changes to address systemic inequalities and promote inclusivity in resilience strategies. Stakeholders' perspectives underscore the importance of aligning heatwave resilience efforts with global goals, particularly in promoting public health equity and inclusivity. By addressing the challenges identified and implementing the recommendations for improvement, policymakers and practitioners should work towards more equitable and inclusive resilience strategies to safeguard public health during heatwaves.

Committing a family member with schizophrenia to a psychiatric ward is a coping mechanism often employed under challenging circumstances. This decision entails significant emotional repercussions and ethical dilemmas, potentially undermining the psychological well-being of the family and eroding public trust in mental health services and professionals. This study investigates the experiences of regret among family members after deciding to commit a relative to a locked ward, adhering to the COREQ guidelines. Employing a descriptive qualitative methodology, we conducted in-depth interviews with 14 family members in Heilongjiang Province, China, who faced this difficult choice. Data were analysed using reflexive thematic analysis, which identified seven themes within three stages: Decision antecedent (limited comprehension of schizophrenia and treatment, deficiencies in supportive environment), decision process (suboptimal communication, hospitalisation and weighing of alternative options) and decision outcome (emotional burden of a loved one's hospital life, the indelible mark of schizophrenia, impact on family dynamics). The study highlights the need for targeted interventions, including addressing biased social media portrayals, enhancing the accuracy of medical information, ensuring transparency in psychiatric practices and improving support for families during hospitalisation.

It is estimated that 61% of deaths caused by Cardiovascular Diseases (CVDs) globally are attributed to lifestyle-related risk factors including tobacco use, alcohol abuse, poor diet, and inadequate physical activity. Meanwhile, inadequate knowledge and misperceptions about CVDs are disproportionately increasing the prevalence of CVDs in Africa. Moreover, pre-diagnosis awareness/knowledge about CVDs among patients is essential in shaping the extent and scope of education to be provided by healthcare workers.

Explore the experiences of patients living with CVDs (PLwCVDs) and accessing care at the Cardiothoracic Centre, Ho Teaching Hospital, regarding their knowledge of CVD-risk factors and coping strategies that work for them.

We leveraged descriptive phenomenological design to explore the experiences of patients accessing care at the Cardiothoracic Centre at the Ho Teaching Hospital, Ghana. Using the purposive sampling technique, 17 PLwCVDs for 3yrs and above were recruited and included in the study. Thematic analysis was conducted using the qualitative computerised data software, NVivo version 14. Recruitment of participants and general conduct of the study commenced on November 1, 2023 and ended on April 30, 2024.

We found that PLwCVDs and accessing care at the Cardiothoracic Centre at Ho Teaching Hospital have adequate pre-diagnosis awareness about CVD-risk factors and their knowledge of same was optimal. Moreover, past unhealthy lifestyles (such as poor dieting, abuse of alcohol, smoking, and inadequate physical activity) may have contributed to participants developing the CVDs. Furthermore, prayers and participation in church activities were the main coping strategies employed by the participants in dealing with CVDs.

The PLwCVDs and receiving treatment at the Cardiothoracic Centre at the Ho Teaching Hospital are knowledgeable in the CVD-risk factors and adopting positive coping strategies. The Cardiothoracic Centre and government must explore social media facilities to intensify public education and also correct misconceptions about CVDs.

Older adults with bipolar disorder experience distinct challenges compared to younger age groups with bipolar disorder. They potentially require adaptations to the care they receive. This study aimed to explore experiences of care and changing care needs in older adults with bipolar disorder. People with bipolar disorder (aged ≥60) were recruited through three NHS Trusts in the North West of England, charity organisations, a confidential university participant database, and social media. Participants completed single time-point biographical narrative interviews, which were analysed using narrative analysis. Sixteen participants' accounts led to the creation of four themes: (1) 'Navigating the disruption caused by diagnosis'; (2) 'The removal of services that provided hope'; (3) 'Later life: We are on our own now'; and (4) 'Changing care needs in later life: We still need support'. The care needs of older adults with bipolar disorder appear to change over time, and services often fail to offer adequate, tailored care for this group at present. Current support requires adaptation to be effective and appropriate and to enable this group to age well in later life.

Patient flow problems, including discharge delay and after-hours discharge, have been a consistently major issue, especially for intensive care units (ICUs). Evidence suggests that discharge delay and after-hours discharge are associated with increased ICU and hospital length of stay, leading to worsened patient outcomes and increased healthcare costs. They can also increase ICU readmission and post-ICU mortality. The factors influencing discharge processes are not well elucidated.

This study aimed to explore the barriers and facilitators to the ICU patient discharge processes in adult ICUs.

This qualitative exploratory multisite observational study was conducted in three regional adult ICUs in Queensland, Australia. We used staff interviews, fieldnotes, and document analysis as data collection techniques. Data analysis commenced with a deductive content analysis using the Structure, Process, and Outcomes framework. Following this, an inductive process was taken using the Theoretical Domains Framework.

We conducted 59 staff interviews and analysed the discharge documents across three sites. Four domains, including context and resources, beliefs about consequences, social/professional role and identity, and behaviour regulation, were strongly related to the factors that influenced the discharge processes. The findings revealed barriers to discharge, including finding the right bed, disconnected and ineffective information systems, ineffective communication and coordination within and across teams and departments, and uncertainty and inconsistency in discharge decision making. Facilitators included clarity on professional roles in ICU discharge, effective communication within the ICU team, and context specific strategies to support the discharge processes.

The findings provide an in-depth understanding of the barriers and facilitators to the ICU discharge processes. Multifaceted strategies should be considered to facilitate and manage ICU discharge safely and efficiently, including the use of clearer discharge criteria and guidelines, digital systems that aid communication and coordination, and early planning of ICU patient discharge.

Limited awareness about the importance of preconception health is a recognised barrier to preparing for pregnancy.

Opportunities exist to improve the health of future parents through preconception care. One of the recognised barriers to pregnancy preparation is a lack of knowledge and a lack of presentation for information and care.

To explore the understanding of "preconception health" amongst people of reproductive age in Australia to inform the delivery of preconception care.

A qualitative descriptive study using online interviews with people of reproductive age in Australia. Recruitment was via social media (Facebook). Interview transcripts were analysed thematically.

Of the 20 women and five men we interviewed, all acknowledged the importance of preparing for pregnancy. Despite broadly understanding the concept, most participants had limited understanding of the details of preconception health. To increase their knowledge, participants' preferred sources of information included education in schools, reputable online sources, primary and maternity healthcare providers, and community members with lived experience.

People in Australia are keen to learn about preparing for pregnancy and appreciate this as important. Suggested avenues to improve awareness and understanding about optimal preconception health included through school education, primary and reproductive healthcare providers, and online resources. This can improve understanding and behaviours before first and subsequent pregnancies.

Preconception care requires a life-course approach, beginning with universal education through schools, enhanced by readily accessible reputable online resources, and access to trusted primary and maternity care providers. Maternity care providers can be key drivers in this process.

As the healthcare field is undergoing a paradigm shift, the role of interprofessional education (IPE) is being widely accepted and recognized. Despite this, IPE interventions are not employed globally and the use of such interventions is variable. Additionally, there is an ongoing debate over how and when to employ IPE interventions. This qualitative study was conducted at Royal College of Surgeons in Ireland - Bahrain (RCSI Bahrain) to understand medical and nursing students' attitudes, expectations, perspectives and experiences in relation to IPE.

Medical and nursing students from all cycles and levels of the medical and nursing programs at RCSI Bahrain participated in Focus Group Discussions (FGDs) and interviews where they discussed issues and opinions related to IPE. These discussions were then transcribed for analysis. Thematic analysis of the data using a grounded theory approach was carried out using a four-staged process of reading transcripts, identifying possible themes and structures and building theory.

16 elected class representatives participated in the study. The comprehensive process of thematic analysis led to the emergence of five themes and associated subthemes: integrated curriculum (realistic interventions, idealistic interventions, varied perspectives), role recognition (communication, task division), understanding of team dynamics (harmonious collaboration, amplification of strengths, team management), cultural practices (organizational culture, interpersonal culture), and social conditioning (identity navigation, stereotype persistence, varied mindsets). The sequential relationship between these themes provides an approach for integrated IPE in healthcare curricula.

This qualitative study investigated medical and nursing students' perspectives on IPE at RCSI Bahrain. The identified themes provide a valuable framework for policymakers and medical educators to design and implement effective IPE interventions, thereby enhancing interprofessional collaboration and improving patient outcomes in healthcare settings.

Patient and public involvement is regarded as vital in fostering high-quality care. While involvement has clear societal advantages, it is still widely viewed as tokenistic and surrounded by issues of representation. This study aims to understand how patients and informal caregivers can be trained to effectively contribute to improved quality of healthcare services.

Using an action research approach, a 15-week training programme for patients and informal caregivers called the Patient As a Person Academy was developed, tested and evaluated in three development cycles. Evaluation methods varied per development cycle and included open-ended questionnaires (N=27) and semistructured interviews (N=35) as well as agile evaluation sessions of all 15 training sessions.

We purposively sampled patients and informal caregivers who had prior experience in patient and public involvement. Patients and informal caregivers who participated as patient and partner educators in health professions education in the Netherlands could participate.

Participants followed the Patient As a Person Academy, a 15-week training programme that aims to prepare patients and informal caregivers to become patient partners.

Participants reported that the Patient As a Person Academy's focus on self-management skills, understanding healthcare professionals' perspectives and communication skills helped them to engage in meaningful dialogue with healthcare professionals as patient partners and made them more confident in their roles. However, tailoring towards individual participants' levels of acceptance of illness and reflexivity was needed. Participants reported that, next to the training programme, peer-to-peer coaching and guidance towards roles in quality improvement initiatives would be necessary to optimise their contributions.

Initiatives like the Patient As a Person Academy may alleviate the problems of tokenism in patient and public involvement. However, extensively preparing patients and informal caregivers raises issues around representation.

ChatGPT has initiated a new era of inquiry into sources of information within the scientific community. Studies leveraging ChatGPT in the medical field have demonstrated notable performance in academic processes and healthcare applications. This research presents how medical students have benefited from ChatGPT during their educational journey and the challenges they encountered, as reported through their personal experiences. The methodological framework of this study adheres to the stages of qualitative research. An explanatory case study, a qualitative research method, was adopted to determine user experiences with ChatGPT. Content analysis based on student experiences with ChatGPT indicates that it may offer advantages in health education as a resource for scientific research activities. However, adverse reports were also identified, including ethical issues, lack of personal data protection, and potential misuse in scientific research. This study emphasizes the need for comprehensive steps in effectively integrating AI tools like ChatGPT into medical education as a new technology.

Laparoscopy has often been considered a core part of the workup for pelvic pain. However, many of these laparoscopies find no pathology.

To evaluate the experiences of patients following laparoscopy for pelvic pain when there is no diagnosis found.

This descriptive qualitative study reviewed patients who underwent a diagnostic laparoscopy for persistent pelvic pain with no pathology found. Participants completed a written questionnaire and an in-depth semi-structured interview. Interview data were thematically analysed.

Fifteen patients were interviewed with a median age of 30 years. Six themes were identified: desire for a diagnosis, hope as a coping strategy, inadequate communication, having 'next steps' of management offered, mental health impacts, and system issues. Participants wanted a diagnosis to help understand their condition, to enable connection with others, and believed that clinicians viewed pain with a diagnosis more seriously. Participants who were confident preoperatively that laparoscopy would lead to a diagnosis reported this contributing to poorer postoperative mental health. Participants discussed diagnoses not listed in the medical records, which provided hope for future management options. Participants reported worse mental health following the laparoscopy.

This study provides insight into the experiences of patients following a laparoscopy without an identifiable diagnosis. It highlights the importance of pre- and postoperative counselling, including discussing the potential for no findings at laparoscopy; the language used around other potential diagnoses; and the value in considering a patient's pre-existing mental health. The findings of this study are relevant for all clinicians counselling people with persistent pelvic pain where endometriosis is suspected.

Research on female genital cosmetic surgery usually comes from Anglophone countries. We investigated female genital cosmetic surgery in the predominantly Muslim South-East Asian country of Indonesia, aiming to identify the procedures offered by medical clinics on Instagram, how they are justified, and what they claim to achieve; and to understand what this means for women and their bodies. The 184 eligible posts from 19 clinics between 1 January to 31 March 2021 offered vaginoplasty, labiaplasty, hymenoplasty, and other procedures. Reflexive thematic analysis yielded three themes: Why you should have female genital cosmetic surgery, Indications for female genital cosmetic surgery, and What you will gain from female genital cosmetic surgery. Posts were similar to those identified in other countries, revealing implicit vulvar aesthetics, expectations that women choose to 'improve' their genitals, the need to please men, and that female genital cosmetic surgery is straightforward. Two differences from Anglophone advertising were the use of euphemisms to describe the vulva and an emphasis on physical 'virginity'. Across countries, female genital cosmetic surgery advertising appears to arise from patriarchal constructs of women's bodies and determination to control them. We contend that Indonesia shares with other countries the need for education-of medical practitioners and the general public-about sexuality and the vulva, and that the advertising of female genital cosmetic surgery should be regulated and rigorously monitored.

Experiencing side effects when wearing N95/P2 masks has negative impacts on health workers and increases exposure to pathogens. While side effects of wearing P2/N95 masks have been reported previously, these masks have never been used as widely as during the COVID-19 pandemic. This study examines Australian hospital nurses' experiences and perceptions of P2/N95 mask usage and its impacts on patient care at a time when P2/N95 masks were widely used. A qualitative exploratory-descriptive design involving semistructured interviews and focus groups was conducted with 12 nurses employed at a public health service in Melbourne, Australia. The data were thematically analyzed. Participants shared experiences resulted in four themes derived from the data: "adverse health impacts," "occupational challenges caused by scarcity of P2/N95 masks," "impact of wearing P2/N95 masks on patient care and work practices," and "adaptive strategies to improve patient care." Nurses experienced notable adverse effects from P2/N95 masks, affecting patient care quality. This study's findings underscore the importance of enhancing training, education, and policies regarding mask usage to uphold high standards of patient care and reduce exposure to pathogens.

The shortage of general practitioners (GPs) is a worsening problem in many countries and poses a threat to the services provided by primary care and by extension for the entire healthcare system. Issues with GP workforce recruitment and retention can be reasons for this shortage.

To describe GP trainees and newly qualified GPs experiences and perceptions on how their training and early experiences of work influence their career intentions in primary care in Estonia.

A qualitative study with GP trainees (n = 12) and newly qualified GPs (n = 13) using semi-structured group interviews (n = 6) was conducted. Interviews were conducted from October until November 2020. Data were analysed using thematic analysis with NVivo Software.

Although early-career GPs in Estonia envision their future roles as GP practice owners with patient list, this is often postponed due to various reasons. Early-career GPs expressed a sense of unpreparedness to fill all the roles of GPs' and found the process of establishing a GP practice and taking on a patient lists very complicated. They value work-life balance and prefer workplaces, which offer flexible working conditions.

Potential strategies were identified to enhance the willingness of early-career GPs to continue their career as GP practice owners with patient list: improving the GP training program by placing more emphasis on managing skills and making the process of establishing GP practice and taking on a patient list less bureaucratic and more accessible.

Little is known about the situation of Ukrainian parents with children up to the age of three who have fled to Germany since Russia's attack on Ukraine. The aim of the National Center for Early Intervention research project is to explore the perspective of this group on their lives in Germany. This analysis focuses on the burdens and resources of the parents and their knowledge and use of support services.

In 17 interviews (duration approx. one hour each), parents (16 mothers, one father) who had fled from Ukraine to Germany with children up to the age of three were interviewed between October and December 2022, and their answers were qualitatively analyzed using structured content analysis.

The interviewees primarily described the psychological stress caused by war and flight, negative emotions such as feelings of loneliness, sadness and lack of motivation, and obstacles to integration as burdens. Resources were primarily networks of Ukrainian- and Russian-speaking people in Germany as well as personal resources such as self-care skills. Supporting services were generally communicated via electronic media. Services for childcare, language courses, and support with health issues were considered particularly useful. A lack of childcare was the most important reason for not taking up other services.

The psychological stress of the interviewees indicates a need for therapy capacities in their native language. Childcare may enable Ukrainians to attend language courses that promote integration. The self-organized networks of the Ukrainian- and Russian-speaking community should be involved in the development of interventions for this target group in a participatory manner from the outset.

Using a blended diet as an alternative to commercial formula is becoming more popular amongst parents and carers of children and young people (CYP) requiring long-term enteral tube feeding (ETF). Emerging evidence has demonstrated physiological and social benefits; however, families report feeling unsupported to use a blended diet in settings outside the home. This study aimed to explore the attitudes of health and social care staff towards the use of blended diets for CYP. Health and social care professionals with experience of blended diets were invited to partake in an online semi-structured qualitative interview. Thematic analysis was used to identify themes. Five participants from health, education and social care settings were interviewed. Online interviews worked effectively for data collection to allow flexibility to accommodate participants' care roles and avoid face-to-face contact necessary with Coronavirus disease 2019 restrictions. Three themes were identified in the data:• Change from medicalised enteral tube feeding practice.• Individual, person-centred approach.• Open support networks and responsibility.Findings showed that blended diets can be accommodated; however, barriers to implementation remain. Medicalisation of ETF continues to impair acceptance of blended diets whilst effective multi-disciplinary team communication and support facilitates its use in settings outside the home.

With shifts in international aid, international donors have increasingly regarded non-governmental organisations (NGOs) as capable of providing alternative public service arrangements. As funding flows to NGOs, particularly in contexts where both actors work towards strengthening health system resilience, NGO-donor relationships evolve. However, despite calls to investigate the contribution of relationships between actors within health systems, including NGOs and their donors, to health system resilience, empirical research is limited. Understanding these relationships is crucial for comprehending their role in fostering resilient health systems. This research fills this gap, by examining how NGO-donor coordination contributes to health system resilience in Lebanon.

This research focuses on Lebanon's primary health system, primarily managed by NGOs through contracts and heavily funded by donors. It examines NGOs operating under the national primary healthcare network (PHCN). The participants, including staff from these NGOs and donor agencies funding them, were purposively selected. 31 semi-structured interviews were conducted. The analysis framework relied on a thematic analysis.

The findings revealed that the flexibility in NGO-donor coordination in Lebanon depends on donors' trust, regular coordination and donors' willingness to listen to NGOs' needs. In this light, they uncovered that flexible NGO-donor coordination enhances NGOs' resilience capacities in shocks, allowing them to operate flexibly. By strengthening NGOs' resilience, which contributes to the resilience of the broader health system, this relationship contributes to health system resilience.

The findings contradict the mainstream development literature on NGO-donor relationships. The latter focuses on donor funding requirements that often result in rigid NGO-donor coordination, making it difficult for NGOs to be resilient. Rather, they emphasise the donors' role in implementing flexible development approaches, through flexible NGO-donor coordination, strengthening health system resilience. Overall, this paper contributes to the health system resilience literature by exploring how specific configurations of NGO-donor coordination strengthen health system resilience.

Older adults with cancer value the perspectives of significant others and their carers regarding decision-making about treatment. Understanding the support provided by carers, and their perspectives on involvement in treatment decision-making, can help us improve our communication with patients and their supports. We aimed to describe the roles, burden, and decision-making preferences of carers of older adults with cancer.

We performed a cross-sectional survey of carers of older adults (≥65y) with cancer at three centres in Sydney, Australia. Type, frequency, and perspectives on providing care were evaluated using Likert scales. Preferred and perceived role in treatment decision-making by modified Control Preferences Scale, and carer burden by Zarit Burden Index (ZBI-12), were evaluated. Preferred role in decision-making and carer burden were compared between groups (culturally and linguistically diverse backgrounds [CALD], sex, and carer age ≥ 65) by chi-squared or t-tests.

One-hundred and fourteen returned surveys were included (23 partially completed). Carer characteristics: median age 55y (range 24-90), female (74 %), child (49 %) and spouse (35 %) of the care-recipient. Care-recipient characteristics: median age 75y (range 65-96), receiving anti-cancer treatment (85 %), and CALD background (44 %). Carers were frequently involved in communication and information gathering (45 % -80 %) and supported instrumental activities of daily living (IADLs) (43 % - 81 %) more frequently than basic activities of daily living (ADLs) (2-13 %). Most (91 %) preferred to be present when treatment options were discussed. Their preferred role in treatment decision-making was passive in 66 %, collaborative in 30 %, and active in 4 %, with most (72 %) playing their preferred role. The preferred role was associated with carer age (p = 0.01) and CALD background (p = 0.04), with younger (<65y) carers and those caring for CALD older adults preferring a more passive role. Carer burden was 'low' in 29 %, 'moderate' in 31 %, and 'high' in 39 %, and providing psychological support was rated most challenging.

Carers of older adults with cancer play varied support roles, particularly in communication and information gathering. Carers prefer to be present for discussions about treatment options, though favour a passive role in treatment decision-making, upholding patient autonomy. Understanding the communication preferences of carers is an important consideration when supporting the patient in deciding treatment options and direction of care.

Helicopter Emergency Medical Services (HEMS) in the United Kingdom (UK) deliver enhanced care to high-acuity, critically ill and injured patients. To enable patients to meet the HEMS team who treated them, many services within the UK have developed or are in the process of developing a Patient and Family Aftercare Service (PFAS). This study aims to evaluate whether the introduction of PFAS mitigates anxiety associated with patient aftercare visits.

A service evaluation of anxiety in HEMS team members before and after patient aftercare visits were conducted. The study was carried out between 1 September 2023, and 31 October 2023, and patient visits were undertaken between March 2022 and July 2023. An electronic survey was distributed to the respondents who provided informed consent for participation. The survey comprised the validated generalised anxiety disorder anxiety scale (GAD-7) and five additional contextualised statements developed through the wider PFAS. Anonymised data were collected using REDCap, a secure electronic database and was analysed in R programming. Free-text comments were reported by content analysis, placed into themes, and discussed with a narrative to complement the quantitative analysis.

Of the 33 recipients, 25 completed the questionnaire. Between the pre- and post-aftercare visits, a statistically significant difference was found between scores for GAD-7 (0.004, p < 0.05) and contextualised statements (0.001, p < 0.05). In addition, six broad themes were identified through content analysis. These include the emotional impact of patient interaction, coping strategies and structural changes in the aftercare system, challenges in patient and family expectations, anxieties relating to operational commitments, memory and recall of the incident, and a positive impact on personal growth.

Anxiety related to patient aftercare visits was reduced when measured before and after the patient visits. Following this service evaluation, we can hypothesise that within pre-hospital care, PFAS plays an important structural role. Future research should focus on affirming the correct tool to measure anxiety in multi-disciplinary teams and prospectively evaluating these methods collaboratively across multiple pre-hospital services.

Freshwater harmful algal blooms (HABs) are a global environmental, economic, social, and public health hazard. While there is an increasing understanding of the ecological considerations of HABs, there is limited understanding of human dimensions and management needs. We conducted semi-structured key informant interviews with 28 water managers and researchers to better understand how they perceive current management and to identify future management priorities in regard to HABs. For this study, we interviewed 31 key informants from three regions of the United States (New England, Ohio, and the Mountain West). We solicited insights across aspects of HABs management, including prevention, forecasting, monitoring, response, and communication. Nutrient management was the main consideration for the prevention of HAB events. Key informants noted that forecasting has the potential to be a valuable tool in the future but is not yet accurate enough at a local scale for widespread use. Monitoring was found to be implemented in varying ways across and even within the states and regions, with a need for more funding and standardization. HAB event responses vary greatly from chemical and physical treatments that suppress toxins to no-swim advisories, all with a mix of strengths and weaknesses. Finally, an increase in and improvement of communication efforts was identified as critical for reducing public health risks. These findings provide perceptions of current management practices and future plans while including opportunities to improve current freshwater HAB management efforts.

While the appropriateness of restorative justice for sexual and family violence continues to experience worldwide feminist debate, these programs already exist. We thematically analyzed the transcripts of former members of a second-wave feminist antirape organization in Australia to ascertain their perspectives on a victim-centered conferencing model. They provided informed and valuable insights drawn from their decades of advocacy. Participants supported restorative justice in principle, stressing respect for victims' agency and independence in all policies and program designs. Their reservations, consistent with concerns in the literature, related to meeting victims' needs within a constrained system rather than principled opposition to the concept.

Qualitative data provides deep insights into an individual's behaviors and beliefs, and the contextual factors that may shape these. Big qualitative data analysis is an emerging field that aims to identify trends and patterns in large qualitative datasets. The purpose of this review was to identify the methods used to analyse large bodies of qualitative data, their cited strengths and limitations and comparisons between manual and digital analysis approaches.

A multifaceted approach has been taken to develop the review relying on academic, gray and media-based literature, using approaches such as iterative analysis, frequency analysis, text network analysis and team discussion.

The review identified 520 articles that detailed analysis approaches of big qualitative data. From these publications a diverse range of methods and software used for analysis were identified, with thematic analysis and basic software being most common. Studies were most commonly conducted in high-income countries, and the most common data sources were open-ended survey responses, interview transcripts, and first-person narratives.

We identified an emerging trend to expand the sources of qualitative data (e.g., using social media data, images, or videos), and develop new methods and software for analysis. As the qualitative analysis field may continue to change, it will be necessary to conduct further research to compare the utility of different big qualitative analysis methods and to develop standardized guidelines to raise awareness and support researchers in the use of more novel approaches for big qualitative analysis.

https://osf.io/hbvsy/?view_only=.

Chronic diseases such as type 2 diabetes mellitus and coronary heart disease cause medical, social, and economic burdens worldwide. Disease management programs in Germany mostly lack components to improve patients' self-management and health-promoting lifestyles despite clear guideline recommendations. Therefore, a Personalized Self-Management Support Program (P-SUP) was developed, which includes: (1) peer support groups; (2) telephone coaching; (3) feedback reports and, (4) a web portal. This study aims to explore patients' and implementing stakeholders' experiences in the implementation of P-SUP to identify barriers and facilitators to the implementation of the intervention.

A qualitative study was conducted using face-to-face focus group interviews with participating patients and telephone-based one-to-one expert interviews with implementing stakeholders, involved in the delivery of the intervention. The transcribed interview reports were analyzed using qualitative content analysis, and the contents were categorized according to Donabedian's Structure-Process-Outcome framework.

A total of six themes among patients (N = 35) and five themes among implementing stakeholders (N = 32) represent the experiences. The patient themes were: (1) technical conditions, (2) indoor facilities, (3) group composition, (4) acceptance of digital components, (5) supervision and feedback and (6) impact on lifestyle behavior. The themes among the implementing stakeholders were: (1) multiprofessional approach, (2) human resources, (3) patient acceptance, (4) supervision and feedback and (5) impact on lifestyle behavior.

Multiprofessional interventions such as P-SUP appear to be valuable for patients and implementing stakeholders. Although infrastructural barriers made the implementation of peer support and digital patient education difficult, patients rated the exchange with peers and experts on health-related topics positively. The lack of supervision and feedback during the course of the intervention might be compensated by regular telephone coaching. The findings from this study can be used in future studies to guide researchers and implementing stakeholders and to improve the feasibility and effectiveness of complex interventions in different contexts.

The P-SUP study was registered in the German Clinical Trials Register (DRKS) on 16/07/2020 under the registration number DRKS00020592.

Alternative education provision such as Pupil Referral Units support young people who have been excluded from mainstream school settings and often from disadvantaged backgrounds. However, there is limited research to date exploring educators' perceptions of the complex needs of young people in PRUs, and the extent to which PRUs as currently configured can meet such needs.

Between March 2019 and October 2020 twenty-two participants holding various educational roles from five different Pupil Referral Units across London and Southeast England were interviewed. The interviews aimed to explore the participants' experiences of working with students in PRU's and examine some of the challenges that they might encounter. Semi-structured interviews were analysed using Reflexive thematic analysis.

The three identified themes and their sub-themes highlighted the complex needs of these young people and identified significant barriers to effective service provision. The first theme 'Complexities of PRU population' highlighted the challenges that young people in PRUs face and perceived systemic short falls in addressing such complexity. The second theme 'Challenges of the PRU environment' highlights the frustrations that educators experience when it comes to providing adequate support to young people in PRU's, the absence of agency support, and the uncertainty that these educational settings can bring. The third theme 'Peer Group Influences' highlights the impact of peer groups from beyond the classroom on engagement within the classroom.

Despite the clear complex needs of young people in PRUs, staff reported feeling ill-equipped to support these individuals and lacked access to effective inter-agency support. Participants reported that pupils' mental health difficulties were exacerbated by exclusion and reintegration practices, an over-zealous focus on educational outcomes and the impact of gang influences on their school lives. Implications include more specific mental health training for staff working in PRU's, improved inter-agency working and the incorporation of trauma-informed approaches in educational practice.

Burnout among psychotherapists is a pervasive challenge affecting both professional well-being and client care. This study aims to explore the experience of burnout among integrative psychotherapists and examine the strategies they employ to cope with this phenomenon. Interviews were conducted with 17 integrative psychotherapists, and the data were analyzed using Braun and Clarke's six-step thematic analysis. Through this analysis, two themes were identified: (1) work-related pressures and burnout manifestations and (2) strategies for maintaining optimal functioning. Fatigue, headaches, challenges in decision-making or session planning, numbness in the form of paralysis, and disconnection from clients emerged as primary symptoms, impacting therapeutic efficacy. Participants' intense sense of responsibility toward clients and their self-worth validation through client progress intensified burnout risks, particularly among novices. Personal therapy and clinical supervision emerged as pivotal in mitigating burnout, offering support, and enhancing therapist resilience. Additionally, peer support and organizational interventions were deemed crucial during crises, emphasizing the need for structured support systems within professional bodies. These findings contribute to a deeper understanding of burnout in psychotherapy and highlight the need for targeted interventions to enhance professionals' resilience and sustain effective client outcomes.

Post-apartheid, the education system shifted its focus from a segregated education system to an inclusive education system, which resulted in greater consideration of the role and function of special needs schools. In 2014 the National Department of Basic Education developed and implemented an inclusive approach and policies to provide guidelines on the running of special needs schools (SNS). The study was conducted in six SNS in Ekurhuleni South District, South Africa.

The study explored the experiences of teachers and healthcare workers when implementing policies in SNS in the study area.

This exploratory qualitative study used purposive sampling to select 13 teachers and healthcare workers for in-depth interviews. Collected data were analysed using inductive thematic analysis and ATLAS-ti version 23.

Teachers and healthcare workers had different working experiences and understandings about inclusive education and policies, as well as their role in implementing these policies. Experienced challenges included lack of training, limited resources, lack of parental support, issues with differentiated curriculum, an unacceptable teaching environment; and poor referral systems. These challenges evoked strategies such as improvising, collaborating, and referring. Participants indicated that they required further training, resources, and support to successfully implement inclusive policies.

Both teachers and healthcare workers agreed that resources were lacking at all SNS represented. Staff training was urgently needed as the current curricula at SNS were differentiated for learners with physical and intellectual disabilities.

Findings may inform policy implementation and change in SNS.