Rethinking the Place of Qualitative Methods in Behavior Analysis

Aligning Health Promotion Principles With Health Behavior Practice: Experiences With Qualitative Tuberculosis Research

Although health promotion scholars encourage researchers in the field to adopt a broad definition of health and a wide lens on the factors which shape it, critics have noted that health promotion research continues to be focused downstream on individual health behavior, downplaying the powerful role of structural determinants. We argue that increased use of qualitative approaches in health promotion could support the shift away from clinically defined disease and towards health promotion practices which advance community well-being and empowerment. We focus on three overlapping tensions, namely the inclination to predefine standards for 'healthy' behavior, the tendency to undervalue the role of structural factors, and the propensity to advocate for universal rather than targeted approaches. We support our case by exploring three examples from tuberculosis research.

Acceptability and effect on food choices of incentives promoting more sustainable diets among low-income consumers: A qualitative study

In the context of rising food costs, low-income consumers are likely to lack financial access to a sustainable diet primarily composed of healthy plant-based food. To promote a change towards more sustainable food habits, vouchers for fruit, vegetables and legumes redeemable in supermarkets have been experimented in the urban area of Dijon (France). The objective of the study was to explore the acceptability of the intervention and the effects of the vouchers on food choices through participants' perceptions. Face-to-face semi-structured interviews were conducted with twenty-seven participants, three months after the end of the intervention. The transcripts were analysed through inductive then deductive content analysis, following a process evaluation framework with two themes related to the implementation and the mechanisms of impact of the intervention. Implementation issues and feelings of discrimination were mentioned, but satisfaction was high and vouchers were considered to improve the financial situation, although the restriction on the targeted products was not always understood. Regarding the mechanisms of impact, during the intervention period, two third of the participants, especially families with young children, attached greater importance to taste and curiosity for unfamiliar food and lesser importance to price. Vouchers thus led to food purchases of higher diversity and higher enjoyment. Other participants did not change their habits, mostly because of an improper use of the vouchers or the absence of motivation for a dietary change. These findings suggest that financial incentives not only increase access to sustainable food, but also influence food choice processes and contribute to greater acceptability of plant-based food in low-income families. The results call for financial incentives to be considered as an opportunity to support changes in dietary behaviour in low-income populations.

Feasibility and acceptability of a telehealth, individually-tailored healthy lifestyle intervention for adolescent and young adult pediatric cancer survivors

OBJECTIVE

Poor nutrition and physical activity pose negative health risks for adolescent and young adult pediatric cancer survivors (AYACS). Our pilot randomized controlled trial (RCT) evaluated feasibility and acceptability of a telehealth intervention (ENHANCE) supporting AYACS' nutrition and physical activity.

METHODS

We randomized 58 AYACS and their adult care partner, when applicable, to the ENHANCE or control condition. Inclusion required an age of 15-25 years, previous chemotherapy or radiation therapy, and no eating disorder history. We utilized a 2:1 (ENHANCE [n = 35]: control [n = 23]) double-blind block randomization protocol in blocks of 6. ENHANCE comprised 12 (60-min) sessions that included education, skill-building, and values-based healthy lifestyle decision-making. The first five sessions included motivational interviewing and the final seven sessions included problem-solving training/goal setting. We evaluated feasibility based on eligibility, enrollment, attrition, and study completion percentages. We assessed fidelity using the Session Content-Fidelity Rating Tool and the Motivational Interviewing Treatment Integrity Coding form. We assessed acceptability using the Abbreviated Acceptability Rating Profile, the Revised Helping Alliance Questionnaire, and participants' exit interviews.

RESULTS

ENHANCE was feasible and highly acceptable; all but one participant who started the intervention completed all 12 sessions and all participants reported enjoying the intervention via objective assessment and during exit interviews. Interventionists delivered ENHANCE with high fidelity.

CONCLUSIONS

ENHANCE was highly acceptable among AYACS and care partners. The telehealth study design was feasible, suggesting benefits and feasibility of a future, larger, multisite RCT. Promising findings support our methodological decisions as important considerations to inform a larger RCT.

Navigating Collaboration: Factors Influencing Special Education Teachers' Relationships with BCBAs in Diverse School Contexts

This Multiperspectival Interpretative Phenomenological Analysis (MIPA) delves into the nuanced experiences of 20 special education teachers across severe, mild to moderate, and early childhood backgrounds collaborating with Board Certified Behavior Analysts (BCBAs) in school settings. While identifying facilitators and barriers to this collaboration, the study sheds light on factors that contribute to a breakdown in rapport between teachers and BCBAs. Notable challenges include perceived condescension, feelings of blame for intervention shortcomings, and receiving recommendations deemed non-feasible or impractical. Despite these hurdles, special education teachers acknowledge the expertise of BCBAs and value their contributions. The study underscores the imperative for enhanced collaboration, communication, and mutual understanding between BCBAs and special education teachers to effectively support students exhibiting challenging behaviors in diverse school settings. Recommendations include BCBAs incorporating teacher-focused measures of social validity to foster a more collaborative and supportive partnership and tailoring BCBA training to address specific challenges encountered within educational settings.

Evaluating Social Validity to Inform Intervention Development: Qualitative Analysis of Caregiver Interviews

Evaluating social validity of interventions is paramount to the applied dimension of applied behavior analysis, but in research contexts, social validity is frequently assessed only after an intervention has concluded. The present study sought to evaluate the social validity of a proposed intervention prior to intervention development through qualitative analysis of interviews with stakeholders. We interviewed ten caregivers of children with autism about their experiences and challenges engaging in play with their children. We also solicited their opinions on the proposed components of the intervention, including (1) video models; (2) smart speaker prompts; and (3) feedback and coaching via video chat. Qualitative analysis of the interview transcripts revealed several domains related to caregivers' experiences, including challenges with social communication, openness to learning skills, and desires to build connections with one's child. Opinions about the proposed intervention components were largely positive, citing the convenience of using technology to access the mostly asynchronous intervention. Some participants expressed hesitation or discomfort surrounding feedback and coaching via video chat. Participants made several helpful suggestions regarding the content and features of the intervention. We discuss our findings in the context of an interactive social validation process.

How Can Qualitative Methods Be Applied to Behavior Analytic Research: A Discussion and Suggestions for Implementation

Behavior analysts in research and clinical practice are interested in an ever-expanding array of topics. They are compelled to explore the social validity of the interventions they propose and the findings they generate. As the field moves in these important directions, qualitative methods are becoming increasingly relevant. Representing a departure from small-n design favored by behavior analysts, qualitative approaches provide analysts a unique set of tools to answer questions that prioritize voice, experience, and understandings in context. Despite recognition of the value of qualitative approaches in other disciplines, application of qualitative methods in behavior analysis remains limited. One likely explanation is that behavior analysts are not yet fluent in applying qualitative approaches within their clinical and research investigations. To address this issue, exploration of qualitative research approaches in behavior analytic literature is needed, alongside practical advice for analysts who are interested in using qualitative methods. This article briefly outlines qualitative literature which pertains to behavior analysts wanting to incorporate qualitative methods into their inquiries. Attention is primarily drawn to the need for coherence in designing and implementing a robust qualitative study that aligns with the behavior analyst's aims and perspective on knowing. A set of guiding questions are provided to orient behavior analysts to considerations in qualitative research and outline how analysts can conceptualize a strong qualitative study. This article aims to support increased application of qualitative methods by behavior analysts, where these methods best address the function of the behavior analytic investigation.

Promoting Reciprocal Relations across Subfields of Behavior Analysis via Collaborations

Several barriers may inhibit the growth of behavior analysis as a more integrated and collaborative field. Two such barriers are siloed environments that reinforce a basic-applied distinction, and a lack of translational research pathways. We describe the perils of silos, and elaborate on potential solutions to increase reciprocal relations among subfields in behavior analysis. We promote a five-tiered system to classify research in behavior analysis, and discuss literature on cultivating effective intra and cross-disciplinary collaborations, including using the framework of metacontingencies to understand collaborations. We also propose quantitative and qualitative measures to examine whether the potential solutions increase intra and interdisciplinary interactions. These measures include bibliometric (e.g., citations across fields), sociometric (e.g., social network analysis), and narrative analysis. We apply some of these measures to publications from 2011-2022 from the Journal of the Experimental Analysis of Behavior and Journal of Applied Behavior Analysis, and argue that behavior analysis overall may benefit from a more collaborative approach.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40614-023-00386-x.