Utilizing a Matrix Approach to Analyze Qualitative Longitudinal Research: A Case Example During the COVID-19 Pandemic

Exploring the varied manifestations of structural violence in the lives of children on the autism spectrum and their families: a qualitative longitudinal study in Kurdistan, Iran

BACKGROUND

There are many dimensions regarding autism that are closely connected to social structures, policies, and power dynamics, silently impacting the well-being of individuals within the autism spectrum. This research aims to explore these overlooked aspects using a theoretical framework called "structural violence."

METHODS

The study was conducted in Kurdistan, Iran, and a qualitative longitudinal approach was chosen. A purposive sampling method was employed to select the participants, with 11 parents taking part. The study data comprised 29 interviews using a topic guide conducted over a span of 2 years. Thematic analysis and a matrix-based approach were utilized for data analysis. To enhance the scientific rigor of this research, four criteria, including Guba and Lincoln's principles, were implemented to ensure methodological accuracy.

RESULTS

The research findings highlight four primary forms through which structural violence impacts children on the autism spectrum and their families: access to healthcare, geographic disparities, awareness and stigma, and poverty and financial burden. Additionally, the study identified 11 subthemes related to structural violence in the context of autism and families.

CONCLUSIONS

We illustrated how structural forces create barriers to accessing adequate healthcare services, exacerbate discrimination based on ethnicity and geography, perpetuate stigma, and contribute to poverty and the inability to meet basic needs. These factors not only worsen health issues but also deepen existing disparities in healthcare access and outcomes for children on the autism spectrum and families. We emphasize the urgent need for systemic changes to address these issues. It is essential to promote public awareness, provide better access to health and support services, and address economic and political factors that contribute to these inequalities.

Attitudes and perceptions towards public health safety measures during a global health crisis: Social and personal consequences

The COVID-19 pandemic that spread throughout the globe has significantly altered our social and personal relationships. During the early phase of the pandemic, pharmaceutical interventions such as vaccine research and production were still in development, with international health agencies and governments promoting public health safety measures such as limiting mobility, school and work closures, lockdowns, economic incentives, mask-wearing, social distancing, quarantine, and hygiene to reduce the spread and flatten the curve regarding transmission and hospitalization. During the early wave (May 2020 through July 2020), we utilized a qualitative longitudinal research design coupled with weekly Zoom diary entries to investigate participant (n = 14) experiences. In doing so, we captured participant attitudes towards public health safety measures, as well as perceptions of social and interpersonal relationships during the pandemic. The main themes that emerged in our findings include feelings of safety and preparedness, personal accountability and collective responsibility, and changes to social life and relationships. While individuals have learned how to live with the pandemic, and have a new sense of normalcy, lessons learned from the impact of public health measures and social relationships have applicability moving forward post-pandemic. In particular, how to best protect against the deleterious effects of isolation during a future public health crisis.

A mixed methods partner-focused cost and budget impact analysis to deploy implementation strategies for school-based prevention

BACKGROUND

Obtaining information on implementation strategy costs and local budget impacts from multiple perspectives is essential to data-driven decision-making about resource allocation for successful evidence-based intervention delivery. This mixed methods study determines the costs and priorities of deploying Enhanced Replicating Effective Programs (REP) to implement the Michigan Model for Health™, a universal school-based prevention intervention, from key shareholder perspectives.

METHODS

Our study included teachers in 8 high schools across 3 Michigan counties as part of a pilot cluster randomized trial. We used activity-based costing, mapping key Enhanced REP activities across implementation phases. We included multiple perspectives, including state agencies, regional education service agencies, lead organization, and implementers. We also conducted a budget impact analysis (BIA, assessing the potential financial impact of adopting Enhanced REP) and a scenario analysis to estimate replication and account for cost variability. We used an experimental embedded mixed methods approach, conducting semi-structured interviews and collecting field notes during the trial to expand and explain the cost data and the implications of costs across relevant perspectives.

RESULTS

Based on trial results, we estimate costs for deploying Enhanced REP are $11,903/school, with an estimated range between $8263/school and $15,201/school. We estimate that adding four additional schools, consistent with the pilot, would cost $8659/school. Qualitative results indicated misalignment in school and teacher priorities in some cases. Implementation activities, including training and implementation facilitation with the health coordinator, were sometimes in addition to regular teaching responsibilities. The extent to which this occurred was partly due to leadership priorities (e.g., sticking to the district PD schedule) and organizational priorities (e.g., budget).

CONCLUSIONS

Previous research findings indicate that, from a societal perspective, universal prevention is an excellent return on investment. However, notable misalignment in cost burden and priorities exists across shareholder groups. Our results indicate significant personal time costs by teachers when engaging in implementation strategy activities that impose an opportunity cost. Additional strategies are needed to improve the alignment of costs and benefits to enhance the success and sustainability of implementation. We focus on those perspectives informed by the analysis and discuss opportunities to expand a multi-level focus and create greater alignment across perspectives.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04752189. Registered on 12 February 2021.

Community well-being dimensions in Gunung Mulu National Park, Sarawak, Malaysian Borneo

The local communities living around national parks or areas like World Heritage Site (WHS) are crucial stakeholders to such settings. Their well-being needs to be unraveled so that the holistic management of the national park is in good condition to stabilize its status as WHS through the support and empowerment of the community. Numerous studies have been conducted on the biodiversity and geology of Gunung Mulu National Park (GMNP), but the community psychology aspect that is the foundation of conservation efforts has not been addressed. Therefore, this study aims to examine the community well-being dimensions in terms of environment, economics, social aspects as well as authority intervention based on the perspective of the local community and professionals with an emphasis on the current issues in GMNP. Quantitative and qualitative approaches were used in this study through a questionnaire to 99 local communities, and individual interviews that were conducted in GMNP and four nearby villages. Data were analyzed descriptively with four themes: environment; economics; social; and authority intervention. The findings showed that locals were satisfied in residing area in terms of environmental conditions. However, it does not reflect the actual situation, i.e., river water cloudiness, wildlife threat, degradation of wetlands, and solid waste issues are still happening. The constraints of the COVID-19 pandemic portrayed that they were very dissatisfied with their monthly income, which is very low compared to before. In terms of social, the services and facilities, especially treated water and electricity need improvement. It also noted that authority intervention especially related to road proposal, financial and skills assistance, and community conflicts could influence locals' support for the planning and policies implemented in the national parks or WHS areas. This study suggests that relevant stakeholders should emphasize bottom-up approaches by considering aspects of community well-being that stem from multiple dimensions in order to achieve holistic national park management.