Grounded theory: what makes a grounded theory study?

Factor analysis, emotional experience and behavioral feedback of contemporary Chinese youth participating in short-term monasticism: a qualitative study based on the online question-and-answer community Zhihu

Introduction

This study explores the psychological motivations, emotional experiences, and behavioral feedback of contemporary Chinese youth participating in short-term monasticism. Despite the rising popularity of these practices as a means of stress relief and spiritual exploration, limited research has addressed their socio-cultural and psychological implications in the context of modern Chinese society.

Methods

Data were collected from Zhihu, a leading online Q&A community in China, using Python web crawler technology. Relevant discussions and comments were systematically selected based on predefined criteria. The collected qualitative data were analyzed using NVivo software, with grounded theory guiding the open, axial, and selective coding processes to identify key themes and categories.

Results

The analysis revealed that short-term monasticism functions as both a stress relief mechanism and a catalyst for spiritual growth and value formation. Key themes identified include the pursuit of inner peace, spiritual exploration, self-improvement, and a deepened engagement with traditional culture. Participants reported enhanced emotional regulation, self-reflection, and an increased appreciation for their cultural heritage.

Discussion

The findings provide new insights into the role of short-term monastic practices in addressing mental health challenges and fostering personal and spiritual development among Chinese youth. These results underscore the potential of integrating traditional spiritual practices with contemporary mental health interventions, offering a holistic approach to enhancing well-being. Future research should explore the long-term effects of these practices and examine their applicability across different cultural contexts.

Factors influencing unsafe acts in the automotive industry using grounded theory and fuzzy DEMATEL

Occupational accidents are recognized as the cause of numerous severe injuries and fatalities worldwide. Unsafe Acts (UAs) and unsafe conditions are the two primary origins of accidents, dentifying and prioritizing them can help prevent accidents from occurring. So, the aim of this study was to identify and prioritize the factors influencing unsafe acts in the automotive industry using grounded theory and fuzzy DEMATEL. A conceptual model using accident reports and the grounded theory approach was created. This included steps such as data collection, open coding, axial coding, selective coding, and a model saturation test. The fuzzy DEMATEL was used to determiene intensity of the relationship between influencing factors. The 'Government policies' factor, with the highest value (D + R) of 1.49, stands out as a significant influence on workplace safety. As a criterion of the 'extra-organizational level,' it refers to factors outside the direct control of the organization but still influencing its operations. This factor's importance surpasses that of other factors in contributing to unsafe practices. Other crucial factors include the economic situation, foreign policy, social situation, and work environment, with values of (D + R) equal to 1.47, 1.35, 1.34, and 1.13, respectively. Among the cause groups, 'Organizational climate' had the maximum value (D - R), indicating its significant impact on unsafe practices. The 'Foreign policy' factor, with a value (D - R) equal to 0.77, was next in importance. This study's findings provide insights and actionable strategies for safety managers in the automotive industry. By understanding the causes of workers' unsafe actions and how human factors lead to accidents, they can formulate intervention strategies to prevent and control unsafe actions, empowering them to make a real difference in workplace safety.

Stigmas experienced by sexual and gender minority people with HIV in the Dominican Republic: a qualitative study

BACKGROUND

As part of a study to test the feasibility and acceptability of the Finding Respect and Ending Stigma around HIV (FRESH) intervention to reduce stigmas and improve HIV viral suppression, our team collected qualitative data from men who have sex with men (MSM) with HIV, transgender women with HIV, and HIV healthcare providers for their perspectives on different stigmas in Dominican Republic healthcare settings.

PURPOSE

We aimed to develop an understanding of the causes, consequences, and domains of stigma among sexual and gender minorities with HIV in Dominican Republic HIV clinics.

METHODS

Data collection occurred in Santo Domingo and Santiago (2020-2021) and included four focus groups with MSM with HIV (n = 26), in-depth interviews with transgender women with HIV (n = 14), and in-depth interviews with HIV healthcare providers (n = 16). All data collection occurred in person and was audio recorded. Standardized guides were used for focus groups and in-depth interviews. Using a deductive process, 2 research associates thematically coded data in the NVivo software.

RESULTS

On average, focus groups were 81 minutes, provider in-depth interviews were 24 minutes, and transgender women in-depth interviews were 32 minutes. We identified 4 key themes that mapped to 4 domains of stigma affecting MSM and transgender women with HIV: migrant stigma, religious stigma, sexual and gender minorities (SGM) stigma, and HIV stigma. All participant types noted the persistence of stigma and discrimination in healthcare settings in the Dominican Republic. The consequences of these stigmas were reported as being significant, including attempted suicide.

CONCLUSIONS

Interventions to reduce stigma experienced by SGM populations with HIV should address structural barriers, including inner and outer contexts of HIV care provision and cultural norms and values that propagate stigma. Findings offer insights about which stigmas could be targeted in future studies and how to potentially address stigma to improve population health in the Dominican Republic.

The burden of generational harm due to alcohol use in Tanzania: A mixed method study of pregnant women

BACKGROUND

Rates of prenatal alcohol use in Sub-Saharan Africa (SSA) are increasing despite regulatory bodies urging pregnant women to abstain from alcohol. Tanzania has minimal policies, interventions, and educational programs addressing prenatal alcohol exposure. Consequently, a considerable number of mothers and their fetuses are exposed to alcohol, leading to serious health consequences like fetal alcohol spectrum disorder (FASD). Our study aims to understand the alcohol use practices of pregnant women, the knowledge and attitudes related to prenatal alcohol exposure among different genders and generations, and how these may be influenced by community perceptions and cultural beliefs among patients at Kilimanjaro Christian Medical Center (KCMC).

METHODS

A total of 676 individuals seeking care at the KCMC Emergency Department (ED) or Reproductive Health Center (RHC) met our inclusion criteria, were approached for participation using a systematic random sampling method, and were enrolled. Of those, 541 women and 114 men completed the survey. The quantitative analysis focused exclusively on survey data from 533 women who reported their pregnancy status and age. Descriptive frequencies were used to compare sociodemographic factors and alcohol use practices across three female groups stratified by pregnancy status and age. Nineteen survey participants-both men and women-were purposively selected for qualitative semi-structured in-depth interviews (IDIs) exploring knowledge, attitudes, and cultural beliefs surrounding alcohol use during pregnancy. A grounded theory approach was used to analyze IDIs in NVivo.

RESULTS

A large percentage of pregnant women reported consuming alcohol at least once per week (42.2%). Older non-pregnant women exhibited the highest rate of alcohol use per week (66.0%). Many older non-pregnant women (28.7%) perceived alcohol use as acceptable during pregnancy. Younger non-pregnant women had the highest prevalence of harmful or hazardous drinking (HHD) at 16.4%. This group also reported the highest weekly alcohol expenses, with 18.1% spending over 10,000 Tanzanian shillings (TZS) per week. Median [IQR] DrInC scores were 0 [0-0] for pregnant women, 0 [0-7] for younger non-pregnant women, and 0 [0-1] for older non-pregnant women. Older non-pregnant women exhibited the highest prevalence of depression (31.4%). Median [IQR] PHQ-9 scores were 4 [3-6.25] for pregnant women, 5 [2-8] for younger non-pregnant women, and 6 [3-10] for older non-pregnant women. Qualitative analyses demonstrated that (1) cultural beliefs are intricately tied to perceived benefits of prenatal alcohol exposure, (2) a history of alcohol use preceding pregnancy largely influences prenatal alcohol use, and (3) community views of PWCA are negative.

CONCLUSIONS

Our findings demonstrate high rates of prenatal alcohol use in Moshi, Tanzania, with pre-pregnancy alcohol use as a significant predictor. Despite generally negative views of pregnant women who consume alcohol (PWCA), some sociocultural beliefs and limited knowledge about the dangers of prenatal alcohol exposure encouraged alcohol use during pregnancy. To improve health outcomes and reduce alcohol-related pregnancy complications for current and future generations, community-wide health messaging and pre-pregnancy interventions may prove beneficial for pregnant women and women of reproductive age who consume alcohol.

A worked example of contextualising and using reflexive thematic analysis in nursing research

BACKGROUND

A researcher must consider their research question within their world view before selecting a technique appropriate for analysing their data. This will affect their choices of methodology and methods for collecting and analysing data. Reflexive thematic analysis (RTA) has become a go-to technique for qualitative nurse researchers. However, the justifications for using it and its application in the context of a wider approach are under-discussed.

AIM

To rationalise the use of RTA within a wider philosophical-methodological-methods-analysis approach and provide nurse researchers with practical guidance about how to apply it to qualitative data.

DISCUSSION

This article conceptually grounds the seminal work of Braun and Clarke (2006 ) and provides a process for rigorously and systematically analysing qualitative data. Researchers undertaking qualitative research must use a rigorous philosophical-methodological-method-analysis approach. Before selecting a technique appropriate for analysing their data, they must consider their research question within their own world view. This has implications for their choice of methodology and consequently the data collection methods and analysis techniques they use. Researchers should be mindful of RTA's conceptual roots when applying it.

CONCLUSION

Transparent and rigorous data analysis leads to credible findings, supports evidence-based practice and contributes to the growing body of nursing research. Within the context of the wider philosophical-methodological-methods-analysis approach, RTA produces high-quality, credible findings when applied well.

IMPLICATIONS

for practice This article can guide nursing students and novice researchers in choosing and applying RTA to their research.

Educational Advices for New-Graduate Nurse on Social Media in China: A Grounded Theory Study

Aims: This study aimed to excavate the entry advices and suggestions for new-graduate nurses. Background: Research based on social media analysis for advices to new-graduate nurses is rare. We conducted a detailed analysis and modularization of the relevant contents based on social media. Design: A grounded theory study based on social media content. Methods: The answers to questions such like "What's your advices and suggestions for new-graduate nurses?" on a famous social media platform in China were searched, collected, coded, and analyzed until September 2023. Results: Four core category modules including professional knowledge module, professional ability module, socialization and interpersonal communication module, and personal trait module were established. The theoretical framework of 21 main categories was also established. Conclusion: Social media contents provide valuable and experienced advices and suggestions for new-graduate nurses in an efficient and convenient way. The analysis of these contents is helpful for new-graduate nurse education and management.

Social Determinants as Mediators of the Emotional State of People With Type 2 Diabetes and/or Hypertension During the COVID-19 Pandemic in Ecuador and Spain

INTRODUCTION

We aimed to explore the impact of the COVID-19 pandemic and the resulting restrictions on the emotional state of people with type 2 diabetes mellitus (T2DM) and/or hypertension in Ecuador and Spain. Given the differences in sociopolitical and socioeconomic contexts between these two countries, the research focused on how these diverse environments and their management of social policies and pandemic strategies influenced the emotional well-being of individuals with chronic illnesses.

METHODS

We conducted 36 semi-structured telephone interviews between August and December 2020 with adults diagnosed with T2DM and/or hypertension (19 in Ecuador, 17 in Spain). The interviews were recorded, anonymized and transcribed for thematic analysis. This approach allowed us to systematically identify and analyse themes related to the participants' emotional experiences during the pandemic.

RESULTS

The results revealed a significant deterioration in the emotional state of participants, attributable to the stress generated by the health crisis and concerns related to their chronic illnesses. The situation elicited a range of emotions among participants, from boredom and apathy to fear, uncertainty and depression. The study highlighted how the impact on emotional well-being was shaped by the interplay between conjunctural determinants (measures to control COVID-19 infections) and structural factors driving inequalities (social class, gender, ethnicity).

CONCLUSION

We developed a conceptual framework illustrating how measures to control COVID-19 infections directly influenced economic, health and social determinants, which interacted with pre-existing inequalities and had a differential impact on individuals' emotional well-being. This framework can be useful for designing more effective and equitable social policies during future health crises, ensuring they address social needs and safeguard psychological and emotional well-being, particularly among vulnerable groups such as those with chronic illnesses.

PATIENT AND PUBLIC CONTRIBUTION

Thirty-six participants diagnosed with T2DM and/or hypertension (19 in Ecuador, 17 in Spain) contributed to the study by sharing their emotional experiences during the pandemic. Their detailed accounts enriched the research by providing valuable insights into how the pandemic affected their emotional well-being. There was no additional involvement or contribution from the public in the design, conduct, analysis or interpretation of the study, nor in the preparation of the manuscript.

Athlete Perspectives on Concussion Recognition and Management in Gaelic Games: A Qualitative Analysis

Background: The focus of this qualitative research was to interview current and retired Gaelic games athletes to ascertain how athletes viewed concussion recognition and management. Methods: A grounded theory methodology design was utilised to investigate concussion recognition and management experiences of a cohort of Gaelic games athletes (n = 22). Data for the study were collected using a semi-structured interview format. Results: Two major themes were identified: (1) an inconsistent identification of concussion as an injury and the absence of standardised procedures for removal from play, and (2) the impact of athlete-driven decision making on concussion management. Concussions were experienced by all the participants on multiple occasions while playing Gaelic games. However, concussion recognition and removal rarely occurred, as many athletes chose not to disclose their injuries or self-managed their concussions. Conclusions: The recognition and management of concussions in Gaelic games are currently inadequate, and they may be posing significant risks to athletes' long-term health. This research highlights the need for more stringent protocols for concussion recognition and removal at pitch side. In addition, Gaelic games require a more objective injury management plan during acute and chronic concussion recovery.

The effects of incivility on student nurses in the clinical setting: A grounded theory approach

AIM

To use a grounded theory approach to explore and understand the encounters of undergraduate nursing students with incivility in the clinical setting so that data-informed strategies for addressing this counterproductive behavior could be developed.

BACKGROUND

Nurses are being called upon to fill ever-increasing responsibilities associated with expanding roles in different specialties within healthcare. One issue that has developed in this high-pressure environment is an increase in incivility in the workplace that spills over into the clinical training environment. As a pervasive problem in the healthcare system, its effects on nursing students could compound the nursing shortage by undermining the integrity of nursing education and discouraging individuals from entering the profession. Therefore, it is vital to construct new theories regarding incivility so that this unprofessional practice can be eradicated or reduced. When this is done, there may be a renewed hope for new nursing students to practice their clinical rotations without feeling disrespected, undermined and intimidated. Students should be able to complete clinical rotations without these unnecessary barriers.

DESIGN

Qualitative grounded theory using philosophical underpinnings of symbolic interactionism and pragmatism.

METHODS

A classical grounded theory approach focusing on the Glaserian Model was used to develop an inductively derived theory from the data. Participants were interviewed about their encounters with incivility and then open coding was used to identify recurring concerns on which a model of the effect of these occurrences could be established. The study sample consisted of 32 participants of which 25 were undergraduate nursing students and seven were graduate students who participated in a focus group. Data were collected through face-to-face (in-person and virtual) structured interviews that were audiotaped. These individuals were recruited by flyers posted at varying strategic points on university campuses.

RESULTS

Open coding of student responses revealed three significant areas of concern: feelings of being disrespected, intimidated and undermined, from which the Inhibiting Actions Theory emerged.

CONCLUSION

Nursing students' perceptions of incivility and their attitudes and behaviors toward this occurrence culminated in the Inhibiting Actions Theory, which provides a framework for implementing effective policies and personnel training in clinical settings. The hope is that these research findings will be a call to action for introducing systemic changes in the clinical training environment, thereby improving the clinical experiences of nursing students and patients.

"I'm a bathroom expert": a qualitative study exploring how students with physical disabilities manage toileting during college

Introduction

Health care providers caring for youth with physical disabilities encourage them to be as independent as possible, which includes obtaining higher education when feasible. However, little is known about the experiences of higher education students in managing their toileting.

Methods

We performed 1:1 semi-structured interviews with 13 current college students with physical disabilities (4 male, 9 female), of whom six were on a formal bladder and/or bowel management program. Three researchers analyzed all transcripts using constructivist grounded theory procedures.

Results

We identified six themes, including: (1) adherence to prescribed programs, (2) importance of time management, (3) interfering with class, (4) balancing intake and toileting, (5) campus bathroom experiences, and (6) acclimating to new living situations. Students needed strong personal skills in time management, adaptability, and self-advocacy to both manage their toileting needs and engage in academic and social activities. This often took time to develop while in college. They faced barriers such as a lack of private, well-maintained bathrooms.

Conclusions

Health care providers should encourage their patients to develop these personal skills prior to starting college, while colleges need to better support these students through honoring their accommodation needs and ensuring the availability of private, accessible bathrooms.

Concussion management and concussion recovery in Gaelic games: a qualitative analysis

Background

The purpose of this qualitative research study was to interview current and retired Gaelic games athletes to understand the current landscape of concussion recovery in Gaelic sports from the athlete perspective.

Methods

A grounded theory methodology was employed to explore the experiences of a cohort of Gaelic games athletes (n = 22) regarding recovery from concussion, the levels of concussion awareness in Gaelic sports and their opinions on current concussion identification protocols. The study's data were gathered through semi-structured interviews.

Results

Two major themes were identified, (1) Male and female athletes experience a range of acute and chronic symptoms post-SRC and (2) Gaelic sports athletes are expected to demonstrate constant allegiance and commitment to the GAA. These themes were further divided into categories and subcategories.

Conclusion

Based on the experiences of the cohort of Gaelic sports athletes, there exists a wide variation of SRC symptomology in the acute, and chronic (post-concussion syndrome) phases. In many cases, there are reports of long-term side effects associated with the perceived mismanagement or misdiagnosis of SRC in Gaelic sports. Gaelic sports athletes require a more robust SRC management system to support and manage SRC in the acute, chronic and long-term phases.

Family Members' Explanatory Models of Cancer Anorexia-Cachexia

The experience of bearing witness to the lack of appetite and involuntary weight loss that characterizes cancer anorexia-cachexia syndrome (CACS) is reported to be stressful for family members. Research identifies that family members engage in a wide range of behaviors in response to a relative who shows minimal interest in eating and is literally 'wasting away' before their eyes. Some families, though concerned about the symptoms of CACS, do not dwell excessively on the patient's nutritional intake while others continually harass the patient to eat and petition health care providers for aggressive nutritional interventions to eat in an attempt to stave off further physical deterioration. While studies have detailed how family members respond to a terminally ill relative with CACS, empirical work explicating the explanatory models of CACS that they hold is lacking. Explanatory models (EMs) reflect the beliefs and ideas that families have about why illness and symptoms occur, the extent to which they can be controlled, how they should be treated, and how interventions should be evaluated. To address this gap in the literature, a grounded theory study guided by Kleinman's Explanatory Model questions was conducted with 25 family members of advanced cancer patients. The core category of 'Wayfaring' integrates the key categories of the model and maps onto Kleinman's questions about CACS onset, etiology, natural course, physiological processes/anatomical structures involved, treatment, and the impacts of disease on patient and family. Findings suggest that a divergence between some biomedical constructions of CACS and explanatory models held by family members may fuel the family-health care provider conflict, thereby providing direction for communication with families about care of the patient with anorexia-cachexia.

'On the slope of an erupting volcano': A qualitative study on the workplace violence experiences of psychiatric nurses

WHAT IS KNOWN ON THE SUBJECT?: Workplace violence is common in healthcare. Workplace violence remains a complex and serious occupational hazard in healthcare. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Since there is no study examining detailed explanations of experiences and perspectives of workplace violence among psychiatric nurses, this study will act as a guide for psychiatric nurses. This study provides information about how psychiatric nurses evaluate the concept of workplace violence from their perspective, what it means to them and the effects of workplace violence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Considering the effects of workplace violence, a preventive, systematic and holistic approach should be used in psychiatry and community mental health centres. Supportive interventions should be used to improve the health and safety of psychiatric nurses and patients.

ABSTRACT

INTRODUCTION: Workplace violence is common in healthcare and remains a complex and serious occupational hazard.

AIM

This research was conducted to assess the workplace violence experiences and perspectives of psychiatric nurses.

METHOD

This study was a qualitative study conducted using a grounded theory approach method. The study was conducted between November 2022 and January 2023. The purposeful sampling method was used, and 11 psychiatric nurses were interviewed. Data were collected with an information form and a semi-structured interview form. The data were analysed using content analysis, and themes were created.

FINDINGS

The ages of the psychiatric nurses ranged from 38 to 57 years. Themes and sub-themes related to the workplace violence experiences and perspectives of psychiatric nurses included the way of violence (rising tension, eruption of the volcano, unintentional violence and turning to ash) and empowerment (ash cloud and ring of fire).

CONCLUSION

Psychiatric nurses stated that they were exposed to verbal and physical violence for many reasons, that this situation seriously affected their physical, mental and social health and that in addition to the devastating effects of violence, they became stronger by developing various skills to protect against violence.

IMPLICATIONS FOR PRACTICE

Supportive interventions should be used to improve the health and safety of psychiatric nurses and patients. Strategies can be developed to include psychiatric nurses in occupational health nursing courses.

Racial (In)Equity in South Los Angeles-Community Centered Experiences with COVID-19 Syndemics

Objectives

To analyze community experiences involving COVID-19 vaccination access and equity in Black and Latina/o/x communities within South Los Angeles, using a socioecological framework.

Methods

We conducted four virtual focus groups (n = 33 total participants) in 2021, with Black and Latina/o/x community members, community leaders, and community-based providers in South Los Angeles, a region highly impacted by the COVID-19 pandemic. We used a grounded theory approach to guide the analysis and generate data shaped by participant perspectives.

Results

Participants across groups consistently emphasized medical mistrust, fear/skepticism, misinformation, accessibility, and feelings of pressure and blame as factors influencing COVID-19 vaccination decisions. The need to address pandemic-related socioeconomic hardships in underresourced communities was equally highlighted.

Conclusions

Findings show that building trust, providing tailored information, and continued investment into diversity and equity initiatives can support Black and Latino/a/x communities in making informed health decisions. Community-centered support services should address the economic, social, and structural impact of the pandemic on vulnerable communities. Furthermore, public health and policy efforts must prioritize funding to equip social and health care systems with infrastructure investment in racial and ethnic minority communities.

Diagnostic uncertainty and decision-making in home-based primary care: A qualitative study of antibiotic prescribing

BACKGROUND

Evaluating infection in home-based primary care is challenging, and these challenges may impact antibiotic prescribing. A refined understanding of antibiotic decision-making in this setting can inform strategies to promote antibiotic stewardship. This study investigated antibiotic decision-making by exploring the perspectives of clinicians in home-based primary care.

METHODS

Clinicians from the Department of Veterans Affairs Home-Based Primary Care Program were recruited. Semi-structured interviews were conducted from June 2022 through September 2022 using a discussion guide. Transcripts were analyzed using grounded theory. The constant comparative method was used to develop a coding structure and to identify themes.

RESULTS

Theoretical saturation was reached after 22 clinicians (physicians, n = 7; physician assistants, n = 2, advanced practice registered nurses, n = 13) from 19 programs were interviewed. Mean age was 48.5 ± 9.3 years, 91% were female, and 59% had ≥6 years of experience in home-based primary care. Participants reported uncertainty about the diagnosis of infection due to the characteristics of homebound patients (atypical presentations of disease, presence of multiple chronic conditions, presence of cognitive impairment) and the challenges of delivering medical care in the home (limited access to diagnostic testing, suboptimal quality of microbiological specimens, barriers to establishing remote access to the electronic health record). When faced with diagnostic uncertainty about infection, participants described many factors that influenced the decision to prescribe antibiotics, including those that promoted prescribing (desire to avoid hospitalization, pressure from caregivers, unreliable plans for follow-up) and those that inhibited prescribing (perceptions of antibiotic-associated harms, willingness to trial non-pharmacological interventions first, presence of caregivers who were trusted by clinicians to monitor symptoms).

CONCLUSIONS

Clinicians face the difficult task of balancing diagnostic uncertainty with many competing considerations during the treatment of infection in home-based primary care. Recognizing these issues provides insight into strategies to promote antibiotic stewardship in home care settings.

Research on an innovative design and evaluation method of Chinese tea sets based on GT-AHP-FCE

AIMS

In order to explore new consumer demands for Chinese tea set products, propose an innovative tea set product design and evaluation method to improve the user experience and satisfaction of the produced tea sets, thereby promoting the development of the tea set market and the promotion of tea culture.

METHODS

Firstly, grounded theory (GT) was used to analyze interview data to extract consumer demand indicators and construct a design evaluation hierarchical model. Secondly, the Analytical Hierarchy Process (AHP) was used to calculate the weights of the indicators, determine their priority of importance, and obtain several indicators that have a greater impact on the tea set design to guide innovative design practice. Lastly, the tea set design schemes were evaluated using the fuzzy comprehensive evaluation method to select the optimal design scheme and also to act as a guideline for further design optimization.

CONCLUSION

This study explores the innovative design and evaluation method for tea set products based on GT-AHP-FCE and validates the feasibility of this approach through a practical example of tea set design inspired by "The Classic of Mountains and Seas.". It provides innovative theoretical and practical guidance for designers of subsequent tea set products and also provides a new path for the inheritance and innovation of traditional culture.

"When a man drinks alcohol it's cool but when a woman drinks she is a hoe": A qualitative exploration of alcohol, gender, stigma, and sexual assault in Moshi, Tanzania

Alcohol's ever-increasing global use poses a distinct threat to human well-being, with intake and associated burdens rising especially quickly in low- and middle-income countries like Tanzania. Prior research has shown alcohol use and related consequences differ by gender in Moshi, Tanzania, with important implications for both clinical care and future alcohol-reduction interventions. This study builds upon this knowledge by providing a deeper understanding of how gender differences affect alcohol-related stigma and sexual assault among Emergency Department (ED) and Reproductive Health Center (RHC) patients at Kilimanjaro Christian Medical Center (KCMC) in Moshi. In-depth interviews were conducted among ED and RHC KCMC patients (n = 19) selected for participation via purposive sampling. A mix of inductive and deductive coding schemes was used to identify themes and subthemes. All data were analyzed through a grounded theory approach. Gender roles that linked men with financial responsibilities and women with child caretaking led to different expectations on alcohol intake, with alcohol use encouraged for men but vilified for women. Women who drank, for example, were deemed poor mothers and undesirable spouses. Patients likewise emphasized that both alcohol-related stigma and sexual violence disproportionately impacted women, the latter fueled through alcohol use, with serious and lasting acts of discrimination and isolation from community members seen among women alcohol users but not for men. Women alcohol users in Moshi are subject to severe social consequences, facing disproportionate stigma and sexual violence as compared to men. Alcohol-related treatment for women should be mindful of the disproportionate burdens present in this context while treatment for men should be cognizant of the social pressures to drink. Strategies to address and/or mitigate these factors should be incorporated in subsequent care and interventions.

A study of the mechanism for intergenerational transmission of gender roles in single-parent families

The divorce rate in China is rising yearly, and the concept of marriage is changing, triggering many social topics related to single parents. Among them, gender-awareness education for children in single-parent families is particularly worthy of attention, as there has been insufficient exploration of how parents transfer their gender role concepts to their children. This study conducted in-depth interviews with 58 single parents and children from 29 families in Suzhou and constructed the mechanism for intergenerational transmission of gender roles in single-parent families based on grounded theory. It found that single parents' gender stereotypes, the starting point of the intergenerational transmission mechanism, have been diluted. It affords them a more enlightened attitude towards child-rearing style, and they expect more equality in the gender role of their offspring. However, in some parents' actual parenting process, when the children's sexualization behaviours exceed their acceptance range, they will communicate with children in an authoritative and didactic way to "correct" the children's behaviour. In addition to direct verbal instruction, parents' expectations of their children's gender roles will be implicitly conveyed through various parent-child interactions in daily life to affect the formation of their children's gender roles. In the intergenerational transmission of gender roles, external people (such as grandparents, teachers and peer groups) have horizontal socialisation effects on children to modify or strengthen the results of gender education from their parents. Under the comprehensive influence of the above factors, the children's gender roles are finally determined. These studies expand previous theories and studies and have significant theoretical and practical implications.

Research on cultural and creative design method of 2022 World Cup lamps based on AHP-FCE

AIMS

Through an in-depth study of Qatari culture, to explore the application of the essence of the unique national culture to World Cup creative design, and to provide new ideas and reference design framework and ideas for the integration of culture and World Cup creative design.

METHOD

Carry out design practice with Qatari culture, and discuss in detail the specific strategy of integrating national culture into the cultural and creative design of the World Cup. First, conduct user interviews based on grounded theory to collect and evaluate demand indicators and establish a hierarchical model, and then use the Analytic Hierarchy Process (AHP) to analyze user needs, construct design elements for the World Cup cultural and creative design, and calculate the weight of each design element to determine the design Ordering among elements. Finally, the optimal scheme is selected by scoring the scheme through fuzzy comprehensive evaluation method (FCE), so as to determine the final design scheme of the product.

CONCLUSION

The article explores the specific practice method of integrating culture and design, and provides a solution reference for how to integrate excellent national culture into the World Cup cultural and creative design, which not only improves the cultural and spiritual connotation of the product, but also effectively realises the heritage and innovation of culture.

"They had the lunch lady coming up to assist": The experiences of menarche and menstrual management for adolescents with physical disabilities

BACKGROUND

Menarche is a pivotal time in an adolescent's life but can be experienced differently by those with physical disabilities. Parents typically serve as the primary educators and support for their daughters during this time. Little is known about the parent's perspective of their daughter's experience preparing for menarche and learning to manage menses.

OBJECTIVE

We sought to understand the parent's perspective of the experience of their daughter with a physical disability around menarche and their preferences for health care provider support.

METHODS

Individual semi-structured interviews were conducted with 21 parents of a daughter with a physical disability ages 7-26. Interviews were coded by 2 reviewers using Grounded Theory, with disagreements resolved by consensus.

RESULTS

Six themes emerged regarding the parent's perception of the experiences, including 1) variation in emotional responses to menarche, 2) parent's perception of their daughter's experience with menses and menstrual symptoms, 3) cross-section of disability and menstrual management, 4) menstrual management at school, 5) parental knowledge correlating to daughter's preparation for menarche, and 6) desires for health care provider support.

CONCLUSIONS

All parents reported that their daughters faced challenges during menarche, ranging from emotional distress to dealing with the inaccessibility of hygiene products. Managing periods at schools was particularly burdensome. Parents who were better educated about what to expect were better able to prepare their daughters, but had difficulties finding informed, supportive providers. Health care providers should provide both anticipatory guidance and holistic, respectful, and equitable options for the management of menstrual symptoms.

Religiosity and type 2 diabetes self-management among Muslims residing in California

Type 2 diabetes (T2D) is a public health issue that needs to be addressed. In the U.S., 11.3% of the population have diabetes. It is estimated that 90-95% of all diabetes cases are T2D cases. One of the best methods to address T2D is self-management. Prior research found a relationship between religiosity and T2D self-management. The purpose of this study was to examine religiosity and T2D self-management. This was a cross-sectional and qualitative study, which included Muslim adults, who have T2D and live in California. We utilized snowballing to recruit participants and the saturation concept to determine the number of participants. Additionally, we used semi-structured design for the interviews and focus groups. We had 30 participants for the interviews (however, only 25 provided demographic data) and 28 for the combined focus groups. Zoom was used to conduct the interviews and two focus groups. The grounded theory was used to deduce themes from the interviews and focus groups. The main themes for religiosity and self-management are Allah sustains life, everything will be ok/hope, faith gives strength, and the role of self within the fate concept. The themes for self-efficacy are diabetes requires new life approach, stress, and Islamic religious practices promote self-management. The main theme for perceived seriousness is taking action and making changes. Our findings provide significant insight about the relationship between religiosity, perceived seriousness, fatalism, and self-efficacy and self-management of T2D. A recommendation based on this study is that providers and health educators should be aware of the different experiences Muslims with T2D face, and tailor recommendations and programs based on that.

Patients' perspectives on, experience with and concerns about crohn's disease: insights from Chinese social media

AIM

The aim of this study was to explore the experience and perceptions of patients with Crohn's disease in China.

METHODS

Data mining was used to investigate posts in Crohn's disease online medical communities. The data were collected through the crawler code, and latent Dirichlet allocation (LDA) and grounded theory were used to mine the theme features after data cleaning.

RESULTS

In analyzing the topic characteristics of online posts, LDA divided 6757 posts into 15 topics on four aspects: seeking disease information, making decisions on medication use, psychological burden, and communicating about diet and nutrition.

CONCLUSION

Overall, social media is patient-centric and helps us better understand the experiences and perceptions of patients. This study can help medical staff predict the thoughts and concerns of Crohn's disease patients during the treatment process, facilitate doctor-patient communication, and assist in the formulation of medical policies.

Developing a competency framework for extracorporeal membrane oxygenation nurses: A qualitative study

AIM

To develop a competency framework applicable to Chinese extracorporeal membrane oxygenation (ECMO) nurses.

DESIGN

A qualitative study was performed following the consolidated criteria for reporting qualitative research.

METHODS

Semi-structured interviews based on the critical incident technique were conducted among 21 ECMO care providers recruited from five well-known ECMO centres in Guangzhou, China. Interview transcripts were coded and analysed using the constant comparative method. The data collection period lasted from November 2021 to April 2022.

RESULTS

A competency framework for ECMO nurses was identified. It included four domains: knowledge, skills, behaviours and attitudes, containing 33 subcompetencies and 66 items.

RELEVANCE TO CLINICAL PRACTICE

This framework can be a reference for the assessment and training of ECMO nurses.

The occupational anxiety of teachers caused by China's 'double reduction' policy-a study based on the grounded theory

Teachers' occupational anxiety is a kind of negative emotional state of teachers, which is prevalent in Chinese teachers. Unfortunately, in the existing research, teachers' occupational anxiety caused by China's 'double reduction' policy has not been paid attention to. Based on the grounded theory, this study conducted in-depth interviews with 45 in-service primary and junior high school teachers, and used NVivo 12 to process recording materials. Through a series of steps such as open coding, axial coding and selective coding, we found that the core feature of teachers' occupational anxiety caused by the 'double reduction' policy was that the implementation of the 'double reduction' policy was incomplete matching the actual educational ecology. Then we constructed a theoretical model of the formation mechanism of teachers' occupational anxiety caused by the 'double reduction' policy. The study showed that due to the influence of teachers' own personality characteristics and incomplete match between external factors, although teachers insisted on self-adjustment, it was difficult to fundamentally solve the teachers' occupational anxiety caused by the 'double reduction' policy.

Analysis of Factors Affecting Psychological Resilience of Emergency Room Nurses Under Public Health Emergencies

Resilience is essential for frontline health workers to cope with the unfavorable situations, especially under public health emergencies. Emergency room (ER) nurses are a special cohort of health professionals that may present moderate level of resilience. This study aimed to identify factors that are correlated with resilience in this special cohort to provide directions for intervention and management. ER nurses that have encountered a public health emergency within 3 months were recruited using purposive sampling and snowball technique for the study. Questionnaires, including Connor-Davidson Resilience Scale (CD-RISC), Zung Self-Rating Depression Scale (SDS), and Maslach Burnout Inventory-Human Services Survey (MBI-HSS) were established, followed by an in-depth interview to identify different clusters of themes. Thirteen ER nurses were recruited, and the average CD-RISC score was 66 ± 21. Resilience was negatively correlated with SDS index, and positively correlated with personal accomplishment. Five clusters of themes were identified from in-depth interviews, including physical tolerability, psychological tolerability, tenacity of internal drive, institutional implementation, and external adjustment. This study identified factors associated with resilience in ER nurses under public health emergencies, providing useful information for future directions for intervention.

Using Grounded Theory to Identify Online Public Opinion in China to Improve Risk Management-The Case of COVID-19

BACKGROUND

During the outbreak of COVID-19, online public opinion related to the epidemic was rapidly generated and developed rapidly. If some online public opinions cannot be effectively responded to and guided, it will bring risks to social order. The government should understand how to use information on social media to grasp public demands, provide useful information in a timely manner and take countermeasures. Studying the formation mechanism of online public opinion during the outbreak can help the government make scientific decisions and improve risk management capabilities.

METHODS

The research selects the public opinion information of online platforms represented by WeChat, online communities, Sina Weibo and search engines, involving 75 relevant texts (1 January to 31 March 2022). According to the grounded theory method, using the QSR NVivo12 qualitative research software, the collected network texts were successively researched using open coding, axial coding and theoretical coding.

RESULTS

The structure of online public opinion during the COVID-19 epidemic was obtained. The operation mechanism of the online public opinion system about COVID-19 was mainly affected by the interaction of online public opinion objects, online public opinion subjects, online public opinion intermediaries and government forces. It was based on social facts and citizens' appeals as the starting point, subject behaviors and prevention and control measures as the focus, government's governance as macro-control and citizens' evaluation as the guide.

CONCLUSIONS

Scientific analysis of online public opinion is an important tool to identify and manage risks and improve the quality of government activities. Online public opinion has the function of assisting government decision-making, and the government can identify the important information reflected in it, especially the mainstream public opinion, as a reference for decision-making. By taking effective measures and properly responding to citizens' reasonable demands, the government can prevent social risks and avoid new negative public opinions. Contributions: According to the characteristics of the basic model of online public opinion, this study provides risk mitigation suggestions for Chinese public sectors to use online public opinion, optimize epidemic prevention policies and formulate strategic measures.

Development and validation of employee safety voice scale in the Chinese organizational context

Safety voice helps organizations to identify safety issues timely and is critical to the long-term growth of the organization. Safety voice has become a hot research topic in organizational safety, and different scales have been developed. However, the unique cultural context in China has led to the need to redevelop safety voice measurement tools. In this paper, we developed an initial scale of safety voice for employees in Chinese organizational contexts fusing in-depth interviews and mature scales. The initial scale based on two samples (n1 = 205, n2 = 420) was revised and validated using item analysis, exploratory factor analysis, confirmatory factor analysis, and reliability analysis to finalize the final scale. We finally found that the safety voice scale in Chinese organizational contexts contains two dimensions: promotive safety voice and prohibitive safety voice. The scale developed in this paper is a reliable tool to measure safety voice behavior of Chinese employees.

Antecedents and Consequences of Online Healthcare Community Usage: A Grounded Theory Approach

The online healthcare community has grown rapidly in recent years. However, the antecedents and consequences of the use of online healthcare community platforms have not been systematized. Using grounded theory, this study collects first-hand data on the use of online healthcare communities through in-depth interviews and analyzes the interview data using a three-level coding approach including open coding, axial coding, and selective coding. The results showed the following. (1) Doctors, hospitals, and the online platforms themselves, along with the impact of healthcare environmental factors, affect patients using the online healthcare community. (2) The use of an online healthcare platform affects patient-related factors, such as emotional dependence and patient satisfaction, as well as factors related to doctor–patient interactions, such as the perception of healthcare quality and the doctor–patient relationship, through mediating factors, including doctor–patient communication, treatment processes, and healthcare costs. (3) Improving patients’ healthcare experience and the doctor–patient relationship may feed back into operation quality and the operating environment of the online healthcare community, thus promoting the promotion and use of an online healthcare community platform.

The Illness Experience of Long COVID Patients: A Qualitative Study Based on the Online Q&A Community Zhihu

Long COVID is a public health problem that cannot be ignored, and it is critical to understand the long COVID patients' living situations and support this group through their illness narratives. This study is based on grounded theory, and coded the self-produced texts of long COVID patients on the largest online Q&A community in China, Zhihu APP, in an attempt to explore the illness experiences of long COVID patients in China and to understand how they adapt to their illness and reconstruct their lives. The results show that patients face not only the threat of pain from the illness itself, but also social stigma and discrimination. Patients turn their illness experiences into motivation to move forward and reconstruct self and life by 'pushing forward the biographical flows again', 'impression management' and 'self-compassion'. These findings can help policy-makers and medical institutions to provide timely and appropriate policy support and psychological assistance to patients with long COVID, to create a supportive and inclusive social environment, and to reduce discrimination and stigma against them.

The Innovation and Development Path of Cultural and Creative Industries in Anhui Province, China: Nvivo12-Based Policy Text Analysis

The policy planning of cultural and creative industries is the leading factor affecting the development of cultural and creative industries and is also an important factor in driving China's economic transformation. How to combine the policy with the actual industrial development and how to scientifically assess the construction effect of cultural and creative industries and build the corresponding planning system are the key points of the current development of cultural and creative industries in Anhui Province, China. The study first analyzes the regional cultural characteristics and development status of Anhui Province, then uses Nvivo12 qualitative software to conduct grounded research and qualitative text analysis on 20 Chinese cultural and creative industry development policy texts, and summarizes three core elements that promote the development of China's cultural and creative industry: “development task,” “development goal,” and “development guarantee.” Then, according to the three core elements of the text, we propose policy recommendations for the innovation and development of Anhui's cultural and creative industries: focus on “cultural heritage and sustainable development” policy formulation, explore Anhui's regional characteristics and culture; strengthen the development of urban-rural cultural integration and mechanism innovation; optimize and adjust the structure and supply of cultural industries; top-level design to clarify the strategic direction of culture, and coordinate the research tasks to empower industrial innovation. Relying on new media means, it integrates three major development strategies to build a new mechanism for internationalized communication of cultural and creative industries in Anhui Province, develop regional advantageous industries, form advantageous cultural industry clusters, effectively spread local culture, and promote sustainable development of local economy.

Risk Factors Identification of Unsafe Acts in Deep Coal Mine Workers Based on Grounded Theory and HFACS

The risk factors affecting workers' unsafe acts were comprehensively identified by Human Factors Analysis and Classification System (HFACS) and grounded theory based on interview data and accident reports from deep coal mines. Firstly, we collected accident case and field interview data from deep coal mines issued by authoritative institutions. Then, the data were coded according to grounded theory to obtain relevant concepts and types. The HFACS model was used to classify the concepts and categories. Finally, the relationship between core and secondary categories was sorted out by applying a story plot. The results show that risk factors of unsafe acts of deep coal mine workers include environmental factors, organizational influence, unsafe supervision and unsafe state of miners, and the main manifestations of unsafe acts are errors and violations. Among them, the unsafe state of miners is the intermediate variable, and other factors indirectly affect risky actions of coal miners through unsafe sates. Resource management, organizational processes and failure to correct problems are the top three risk factors that occur more frequently in unsafe acts. The three most common types of unsafe act are unreasonable labor organization, failure to enforce rules, and inadequate technical specifications. By combining grounded theory and the HFACS framework to analyze data, risk factors for deep coal miners can be quickly identified, and more precise and comprehensive conceptual models of risk factors in unsafe acts of deep coal miners can be obtained.

Spiritual Counseling During the COVID-19 Pandemic in Italy: a Qualitative Study

The COVID-19 pandemic has created profound upheavals in today's society, accompanied by psychological effects. The discomfort experienced during the pandemic accompanied by the increased availability of time has offered many people the chance to reconnect with their spiritual dimension, which is considered a vital resource in managing the stress produced by the perception of risk to their health. This study addresses the motivations that led research participants to choose to receive spiritual support via a 10-week training. The work also explores the changes perceived by the participants as they overcame the difficulties resulting from the pandemic. The research involved nine people between the ages of 19 and 59 who took part in an online experience focused on the spiritual dimension. Almost all the participants came from an area in Northern Italy most affected by the pandemic. A qualitative research design was used, with semistructured interviews designed to understand participants' views on the topic under investigation. The areas that emerged from the interviews concerned the motivations that led the participants to choose a spiritual support process, the role of spirituality in daily life, and the changes participants experienced after the conclusion of the experience related to managing the stress caused by the pandemic. In agreement with the existing literature, the results show that spiritual support can be useful in counteracting the negative effects of the pandemic, producing improvements in the quality of life.

Moral Distress in Community and Hospital Settings for the Care of Elderly People. A Grounded Theory Qualitative Study

Background: Moral distress has frequently been investigated in single healthcare settings and concerning a single type of professional. This study aimed to describe the experience of moral distress in all the types of professionals providing daily care to elderly patients and residents. Methods: The Grounded Theory approach, developed by Corbin and Strauss, was used. This study included participants from hospital and nursing homes of northern Italy. Purposive and theoretical sampling was used. Between December 2020 and April 2021, semi-structured interviews were conducted. Results: Thirteen participants were included in the study. Four categories were derived from the data: talking and listening, care provider wellbeing, decision making, protective factors, and potential solutions. The core category identified was “sharing daily”. Interviewees confirm how hard it may be to communicate to the elderly, but at the same time, how adequate communication with the leader is a protective factor of moral distress. They also confirm how communication is key to managing or downsizing misunderstandings at all levels. Findings highlight the scarcity of operators as a fundamental trigger of moral distress. Conclusions: Many determinants of this phenomenon lie behind the direct control of professionals, but education can help them learn how to prevent, manage, or downsize the consequences.