Themes, Theories, and Models

Professional development of sport psychology practitioners: From systematic review to a model of development

A clear model of professional development (PD) has the potential to enhance educational and training programs and promote effective, competent, and ethical practice. Scholars have explored facets of the PD of sport psychology practitioners (SPPs) using theoretical frameworks borrowed from counseling psychology. Yet, given the emergence of a sport-specific body of work on this topic, it appears timely to take stock of existing context-specific knowledge. In the present study, we aimed to systematically review the extant literature focused on SPP's PD to identify specific characteristics and organize this knowledge in an accessible and structured manner in the form of a process model of PD. Following the PRISMA guidelines, we identified 1147 research records in the databases SportDiscuss, PsychArticles, PsychInfo, ProQuest, and PubMed. We subsequently screened and assessed the records for eligibility (i.e., empirical studies published in English that focus on developmental characteristics of SPPs, including a clear developmental stage) reducing the sample of articles that fitted our inclusion criteria to 34 qualitative manuscripts. Finally, we critically explored these manuscripts by engaging in a reflexive thematic analysis and created four developmental phases (i.e., introduction, exploration, solidification, and fulfillment). SPPs' transition through these phases is seemingly facilitated by four processes (i.e., reflection, supervision, connections and networking with peers, and learning by doing), which also support the completion of the tasks associated with nine developmental elements (i.e., purpose, confidence and anxiety, focus, awareness, adaptability, independence, philosophy/congruence, professional identity, and the individual). We present the interaction of these developmental phases, elements, and processes in the form of a sport psychology-specific process model of PD. We discuss the implications of this model and its potential contribution to future research, supervision, and training programs. Yet, we also acknowledge how a focus on Anglophone and Western cultural contexts and a lack of methodological transparency are limitations of the extant literature.

User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study

BACKGROUND

Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams.

OBJECTIVE

This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM.

METHODS

Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project.

RESULTS

In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app.

CONCLUSIONS

Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team-facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey.

Development of an inflammatory bowel disease (IBD) Patient-Reported Experience Measure (PREM): A patient-led consensus work and 'think aloud' study for a quality improvement programme

BACKGROUND

Patient-Reported Experience Measures (PREMs) are key in improving healthcare quality, but no PREM exists for inflammatory bowel disease (IBD). This study aimed to co-produce a PREM with IBD service users for IBD service evaluation and quality improvement programme.

METHODS

A pool of 75 items was drawn from published survey instruments covering interactions with services and aspects of living with IBD. In Stage 1, during two workshops, eight expert service users reduced candidate items through a ranked-choice voting exercise and suggested further items. During Stage 2, 18 previously uninvolved people with IBD assessed the face and content validity of the candidate items in 'Think Aloud' interviews. During two final workshops (Stage 3), the expert service users removed, modified and added items based on the interview findings to produce a final version of the PREM.

RESULTS

Stage 1 generated a draft working PREM mapped to the following four domains: Patient-Centred Care; Quality; Accessibility; Communication and Involvement. The PREM included a set of nine items created by the expert group which shifted the emphasis from 'self-management' to 'living with IBD'. Stage 2 interviews showed that comprehension of the PREM was very good, although there were concerns about the wording, IBD-relevance and ambiguity of some items. During the final two workshops in Stage 3, the expert service users removed 7 items, modified 15 items and added seven new ones based on the interview findings, resulting in a 38-item PREM.

CONCLUSIONS

This study demonstrates how extensive service user involvement can inform PREM development.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved as active members of the research team and as research participants to co-produce and validate a PREM for IBD services. In Stage 1, eight expert service users ('the expert group') reduced candidate items for the PREM through a voting exercise and suggested new items. During Stage 2, 18 previously uninvolved people with IBD (the 'think aloud' participants) assessed the validity of the candidate items in 'Think Aloud' interviews as research participants. In Stage 3, the expert group removed, changed and added items based on the interview findings to produce a final version of the 38-item PREM. This study shows how service user involvement can meaningfully inform PREM development.

Perceptions of Supervisors of Peer Support Workers (PSW) in Behavioral Health: Results from a National Survey

This content analysis of open-ended survey responses compares and contrasts perceptions on supervision from supervisors with experience providing direct peer support services (PS) and supervisors without experience providing direct peer support services (NPS).A 16-item online survey was distributed via the National Association of Peer Supporters (N.A.P.S.) listserv and through peer networks and peer run organizations. Responses from 837 respondents, across 46 US states, were analyzed. Four open ended questions assessed supervisors' perceptions on differences supervising peer support workers (PSW) as compared to other staff, important qualities of PSW supervisors, roles when supervising a PSW, and concerns about PSWs in the organization. Among NPS and PS, three major differences in themes emerged: the knowledge required of supervisors, understanding of the role of the PSW, and supervisors' beliefs regarding PSW competencies. PS have a more nuanced understanding of the peer support worker role and the impact of lived experience in the role.

Exploring experiences of ableism in academia: a constructivist inquiry

To understand the experiences of the disabled in academia, a fully accessible and inclusive workshop conference was held in March 2018. Grounded in critical disability studies within a constructivist inquiry analytical approach, this article provides a contextualisation of ableism in academia garnered through creative data generation. The nuanced experiences of disabled academics in higher education as well as their collective understandings of these experiences as constructed through normalisation and able-bodiedness are presented. We show that disabled academics are marginalised and othered in academic institutions; that the neoliberalisation of higher education has created productivity expectations, which contribute to the silencing of the disabled academics' perspectives and experiences due to constructions of normality and stigmatisation; and that it is important to enact policies, procedures, and practices that value disabled academics and bring about cultural and institutional changes in favour of equality and inclusion.

Expert by Experience engagement in gambling reform: qualitative study of gamblers in the United Kingdom

To explore how Experts by Experience (EbyE) conceptualize key priorities for preventing and reducing gambling-related harm in the United Kingdom (UK). To identify barriers and facilitators to EbyE engagement in decisions for gambling research, education, treatment (RET) and policy development. Qualitative study utilizing semi-structured interviews with 20 participants from the UK between March and July 2020. Gamblers aged 29-60 years who self-reported that they had experienced gambling-related harm, and who actively used their experiences to inform strategies to prevent and reduce gambling-related harm in the UK. Participants were motivated to: advocate for gambling reform, and raise awareness of their experiences of gambling addiction or disorder. Gambling regulation was described as not adequately keeping pace with gambling industry practices, with initiatives needed to prevent the harms associated with product design, how individuals engaged with products and marketing practices. The reliance on voluntary contributions by the gambling industry for RET was perceived as a potential barrier to reform. Participants recommended new independent structures which engaged EbyE in meaningful ways in contributing to decision-making. An independent body run by and for EbyE was one mechanism that participants perceived could represent the voices of those impacted by gambling-related harm. Individuals with a lived experience of gambling-related harm, including affected social network members, bring a range of unique experiences and perspectives, and should be seen as valuable stakeholders in co-producing strategies to prevent and reduce gambling-related harm.

Yuck! Plural Valuation of Constructed Wetland Maintenance for Decentralized Wastewater Treatment in Rural India

In 2012, an estimated 50% of rural households in India had a system of drainage for moving wastewater away from their homes, but 0.0% have access to safe, reuseable, treated wastewater. Constructed wetlands can provide decentralized wastewater treatment for rural villages and lead to multiple benefits, such as reusable water, reduced disease, and decreased environmental pollution. However, the maintenance of decentralized wastewater technologies is poorly understood. We used a case study design across four communities and six constructed wetlands to understand the social and cultural variables impacting the maintenance of constructed wetlands for decentralized wastewater treatment to provide agricultural irrigation water. Semi-structured interviews (n = 39) and focus groups (n = 4) were conducted with people from Telangana and Karnataka, India. Interviewees were classed into four groups: (1) Scientists, (2) Farmers, (3) Privileged Community Members, and (4) Socially Disadvantaged Community members. Inductive, constant comparison qualitative data analysis was used to develop a model for explaining the existing practice of wetland maintenance. Three themes emerged from the data: mental models of constructed wetland maintenance show plural valuation of ecosystem services, yuck as a leverage point for decreasing social cohesion in the community, and recommendations for improving maintenance through human-centered design. Based on the results, we propose a model for understanding how to incorporate the plural valuation of ecosystem services provided by constructed wetlands and human-centered design to support long-term adoption and maintenance of decentralized wastewater treatment technologies.

Driving Outside the Wire: Examining Factors Impacting Veterans' Postdeployment Driving

Combat Veterans (CVs) deployed to Iraq or Afghanistan experience driving difficulty, based on medical conditions and/or deployment exposures, elevating their risk of motor vehicle crash-related injury or death. To address grounded theory rigor and incorporate constructs such as the Person Environment Occupation Performance model, we revised the Hannold et al. (2013) conceptual framework. We conducted two focus groups with seven CVs. Conceptual framework revisions were based on an iterative process and thematic analysis. We elicited CVs' perspectives on deployment training, driving pre- and postdeployment, strategies, and intervention preferences. Personal, environmental, and task factors underpinned CVs' driving. Participants described triggers (e.g., stressful stimuli), use of environmental (e.g., car controls) or personal (e.g., avoiding traffic) strategies, and outcomes of appropriate or risky driving. Findings illustrated CVs' driving difficulty and informed development of a Veteran-centric driving intervention. Improving driving fitness has implications for Veterans' participation and community integration.

Public Expressions of Trust and Distrust in Governmental Dietary Advice in Sweden

We examine public trust and distrust in governmental food and nutrition authorities, through analyzing 727 letters sent electronically to the Swedish National Food Agency by lay people. Using thematic analysis, four themes were developed, defining public expressions of trust and distrust in official dietary advice. Trust was expressed as (a) seeking to confirm and clarify dietary advice or (b) seeking official arbitration between competing dietary advice. Distrust was expressed as (c) questioning and scrutinizing dietary advice or (d) protesting and resisting dietary advice. Notably, expressions of distrust employed discursive practices that both mirrored authoritative discourses and subverted official advice, by appealing to scientific language and "alternative" evidence. All letters positioned the agency as the ultimate authority on healthy eating; notwithstanding whether the agency's advice was to be followed or resisted. Thus, the letters revealed how the same authoritative discourses can simultaneously be a site of public trust and distrust.

Overweight and Obesity Among School Bus Drivers in Rural Arkansas

Introduction

Obesity is a major public health concern. Compared with other occupational groups, transportation workers, such as school bus drivers, have higher rates of obesity. However, little is known about the body weight and related health behaviors of these drivers, and opportunities for intervention are undetermined.

Methods

We collected multilevel data from school bus drivers working from 4 school bus garages in Little Rock, Arkansas, and their work environment from January through July of 2017. Data on weight, height, sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables were collected from 45 drivers. Analyses explored associations between body mass index (BMI; weight in kg/ height in m²) and sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables. Two focus groups with a total of 20 drivers explored drivers’ perspectives about healthy weight. Observational data at the bus and garage levels were collected through 2 “ride-alongs” and an environmental scan.

Results

Drivers in our sample were predominately overweight or obese (91.1%), and most did not meet dietary or physical activity guidelines. Drivers who were currently dieting had higher BMIs (36.4; standard deviation [SD], 8.2) than drivers who were not dieting (28.5; SD, 7.7); drivers who reported eating less to lose weight had higher BMIs (38.1; SD, 8.5) than those who did not report eating less (29.5; SD, 6.0). Drivers who did not meet physical activity recommendations had higher BMIs (36.5; SD, 9.8) than those who met recommendations (30.9; SD, 4.8). Structural barriers and work stress were significant barriers to achieving a healthy weight. Resources for healthful eating and physical activity were limited in the garage.

Conclusion

Our study provides preliminary data on the prevalence, risk factors, and perceptions of overweight and obesity among school bus drivers. Study data on drivers’ body weight, health-related behaviors, and psychosocial characteristics could serve as a basis for worksite interventions to improve drivers’ health.

Opening the Door to Physical Activity for Children With Cerebral Palsy: Experiences of Participants in the BeFAST or BeSTRONG Program

This study explored children's experiences of participating in one-to-one physical training programs to identify how programs can best promote physical activity participation for children with cerebral palsy. A qualitative descriptive design with self-determination theory was used. Semistructured interviews were conducted with 6 children with cerebral palsy, age 8-14 years, who participated in a fundamental-movement-skills or lower-limb strength-training program. A hybrid approach of deductive and inductive analysis was used. Four themes developed: World around me (i.e., social/physical environments), Made for me (i.e., individualizing programs), Teach me how (i.e., teaching strategies facilitated skill learning), and I know me (i.e., sense of self). Results include recommendations for delivery of physical training programs. Using an individualized approach in a structured one-to-one program that employs skill-teaching strategies and self-reflection opportunities may provide a foundation to increase physical activity participation, related self-confidence, and desire to participate.