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Introduction: Engagement in hand-held phone use while driving among young drivers is a prevalent concern in society, despite countermeasures to deter the behavior. The social norm approach has been effective in reducing negative behaviors in young adults (e.g., binge drinking, drink driving). However, whether this approach can reduce hand-held phone use while driving in this population has not been thoroughly investigated., Method: The qualitative study explored young drivers' attitudes and opinions on social norm messages designed to reduce hand-held phone use while driving. In addition, young drivers' opinions on current campaigns were explored to provide further insight into the effectiveness of these messages. Thirty young drivers were interviewed and shown six social norm messages., Results: The data were analyzed using reflexive thematic analysis, resulting in five themes and one sub-theme: (1) Road safety messages with minimal impact on hand-held phone use while driving; (2) What constitutes an effective road safety message for hand-held phone use while driving; (3) Comparisons between social norm messages and road safety messages; (4) The potential benefits of combined social norms, (4a) Improving and optimizing the message; and (5) "It's kinda just numbers on a screen": Negative views on social norm messages. Results highlight the diverse opinions towards road safety campaigns and the need to increase exposure to these messages. Further, a combined social norm message was perceived as most effective in reducing engagement in hand-held phone use while driving., Conclusions: The current study provides preliminary evidence that the social norm approach may be effective in reducing hand-held phone use among young drivers. Further, this study highlights the need to maximize exposure to phone use while driving campaigns in this high-risk cohort., Practical Applications: Results support the development of a social norm messaging intervention to reduce young drivers hand-held phone use while driving., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: As more states legalize cannabis, studies are needed to understand the potential impacts of recreational cannabis legalization (RCL) on adolescents from the perspective of clinicians who care for them., Methods: This qualitative study characterized clinician perspectives on whether cannabis legalization is associated with changes in adolescents' cannabis use beliefs, behaviors, and consequences. Semi-structured qualitative interviews were conducted with 32 clinicians in a large healthcare organization from 9/6/2022-12/21/2022. Video-recorded interviews were transcribed and analyzed using thematic analysis., Results: The 32 participants (56.3 % female, mean [SD] age, 45.9 [7.6] years; 65.3 % non-Hispanic White) were from Addiction Medicine (n = 13), Psychiatry/Mental Health (n = 7), Pediatrics (n = 5), and the Emergency Department (n = 7). Clinicians described post-RCL increases in adolescent cannabis use, use of non-combustible modes and high-potency products, and younger age of first use. Clinicians reported social, physical, and policy changes, including changes in social norms, appealing advertisements, marketing, and easier access. Many noted fewer perceived harms among adolescents and greater self-medication post-RCL. They described how RCL contributed to increased parental cannabis use and permissiveness around adolescent use. Finally, many described post-RCL increases in cannabis hyperemesis syndrome, and several noted increased cannabis-related psychosis and acute intoxication, and decreased court-mandated treatment., Conclusions: Clinicians from diverse specialties described post-RCL increases in adolescent cannabis use and cannabis-related consequences, alongside changes in social norms, access, marketing and advertisements, and decreased perceptions of harms. Findings can inform strategies to support adolescents in the context of increased cannabis availability and acceptability post-legalization and support the development of hypotheses for broader-scale quantitative work., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Alcohol is recognized as a driver of intimate partner violence (IPV) perpetration and experience, but relatively little research has focused on the role of couples' drinking patterns, nor pathways between alcohol and violence. We draw on data collected among young (18-30 year old) people living in informal settlements who self-selected to enroll in an intervention trial to reduce IPV in Durban, South Africa to understand these dynamics. Between September 2015 and September 2016 quantitative data were collected from women, who reported on their own experiences of IPV and alcohol use, as well as their partner's own alcohol use. To contextualise and interpret the quantitative results, we use qualitative data from women and men (who were not in relationships with one another) to understand potential pathways through which alcohol use may shape conflict in relationships. All forms of IPV (physical and/or sexual, emotional and economic) were more common among women where either, they alone had problematic drinking levels, their partner was frequently drunk but they did not have problematic alcohol use, or they had problematic alcohol use and their partner was drunk frequently. Qualitative data suggested women and men in relationships rarely drank together. Three potential ways in which alcohol use increased conflict and IPV: disinhibition, with women and men more likely to get into arguments and speak 'badly' to one another; the impact of men's drinking on relationships, including economic provision and providing emotional support; and, the close association between alcohol consumption and infidelity, with women's public drinking being particularly stigmatized and male partner's seeing this as a challenge to their authority and control. Interventions addressing the alcohol-IPV nexus need to also address male patriarchal control and alcohol's close association with infidelity and the impact on finances, as well as reducing alcohol use., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Experiences from the COVID-19 pandemic may help to better understand resilience, competences and skills for healthcare providers and the healthcare system. Within sexual and reproductive health inequalities for migrants exist and it is an area where promoting both cultural competency and healthcare equity in the clinical encounter is expected of healthcare providers yet can create tension. The aim is to explore healthcare providers experiences of encounters with migrants in the context of the pandemic and the subsequent changes in routines and norms., Methods: A qualitative study based on semi-structured interviews with 31 healthcare providers working in sexual and reproductive healthcare in southern Sweden. Interviews were conducted during the COVID-19 pandemic influencing how healthcare providers reflected on their experiences. Analysis was done using reflexive thematic data analysis., Findings: Healthcare providers reflected on how changes in routines increased the understanding of challenges and enablers in the intercultural encounter including the impact on communication and role of relatives and male partners. They emphasized the dynamics of culture in the clinical encounter and healthcare system through highlighting the importance of structural awareness, self-reflection and the flexibility of conducts and norms, often given a cultural connotation., Conclusion: The COVID-19 pandemic resulted in changes of previously established routines directly affecting clinical encounters, which provided a unique opportunity for healthcare providers to reflect, with communication and self-reflection being discussed as central in complex encounters. It highlighted the dynamics of presumed deeply rooted cultural norms and the interplay with social factors affecting healthcare providers and patients alike., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interests., (Copyright © 2024. Published by Elsevier Ltd.)

In the United States, the burden of type 2 diabetes (T2D) health complications and outcomes is higher in Black men, and the diabetes disparities are escalating. Previous evidence-based research underscored the need to explore gender-specific experiences of chronic illness in social-cultural, historical, and clinical contexts. Our community-engaged qualitative study focused on learning from the live experiences of Black men ( n  = 15) in the Arkansas Delta area. Applying a narrative approach, we explored and learned from the participants about their perception of the consequences of T2D on manhood and the usefulness of T2D management instructions. Findings indicate that an integrated public health approach contextualizes social-cultural norms, cognitive scripts, and gender-centered expressions of manhood, a promising direction in T2D healthcare; social support is essential for emotional and physical help in continued T2D management; and connecting with Black men and their insights are vital to develop relevant and appropriate guidelines for T2D management care.

In recent decades, there has been an increase in motherhood at an advanced age that has raised several medical and social concerns. We conducted a qualitative interview study, guided by Interpretative Phenomenological Analysis, to focus on the motivations and experiences of Belgian women who 'renewed' their motherhood later in life, meaning they had one or several children and then (at least 10 years later) had another child at the age of 40 or older. We focused on ten women's experiences of motherhood later in life, as well as on the way they managed social norms and expectations regarding family building and the appropriate life course. We identified two main themes. The first theme describes the participants' encounters with social norms that challenged their decision to reproduce and parent later in life, and how they managed and anticipated criticism, surprise, disbelief and incomprehension about their renewed motherhood in various ways. The second theme shows how these women talked about taking responsibility as a (renewed) mother of advanced age. For them, responsible motherhood involved making thoughtful reproductive choices, attending to the range of needs of their children, and making extra efforts to safeguard the social and emotional wellbeing of their youngest children, thereby seeking to reduce potential harm resulting from these reproductive choices. This study provides insight into these women's self-conception and their interactions with prejudiced social views of motherhood and family building.

Girls' education has for many decades been central to the global development agenda, due to its positive impact on girls' health and wellbeing. In this paper, the authors revisit boys' attitudes, behaviours and norms related to girls' education, following the Samata intervention to prevent girls' school dropouts in Northern-Karnataka, South India. Data were collected from 20 boys in intervention villages before and after the intervention, and analysis was undertaken using a thematic-framework approach. Findings suggest that while boys did hold some attitudes and beliefs that supported girls' education and delayed-marriage, these remained within the framework of gender-inequitable norms concerning girls' marriageability, respectability/family-honour. Participants criticised peers who sought to jeopardise girls' respectability by teasing and community gossip about girls-boys' communication in public. Boys who rejected prevailing norms of masculinity were subjected to gossip, ridicule and violence by the community. Boys' attitudes and beliefs supported girls' education but were conditional on the maintenance of gendered hierarchies at household and interpersonal levels. Social norms concerning girls' honour, respectability and the role of boys as protectors/aggressors appeared to influence boys' response to girls' school dropouts. Future interventions aiming to address girls' education and marriage must invest time and resources to ensure that intervention components targeting boys are relevant, appropriate and effective.

Diet, physical activity, and body shape play an essential role in the development of type 2 diabetes (T2D) and are the social dimensions most targeted by health professionals in their practices or intervention aimed at preventing and controlling T2D. However, several interventions focus more on individual factors and less on social determinants likely to influence the adoption of dietary, body, and physical activity standards favorable to the prevention and control of T2D. This study aims to explore the social determinants influencing the rejection or adoption of dietary, bodily, and physical activity norms favorable to the prevention and control of T2D among migrants from sub-Saharan Africa. A qualitative exploratory design guided data collection and analysis. Semi-structured qualitative interviews and focus groups were conducted between October 2022 and March 2023 in Montreal and Quebec Cities. The cost of food, the difficulty of accessing certain foods, a reliable level of income, work schedules, the gazes of relatives or communities, migration policies, disappointment and stressful situations linked to migratory status, racial microaggressions, and the lack of food guides adapted to the realities of MASS were the main determinants identified by the participants. These determinants can influence the adoption of public health recommendations on diet for the prevention and control of T2D. People living with T2D obviously have an important role to play, but much of the work lies outside their control. Therefore, Preventive, clinical, or awareness-raising interventions should more consider the life and structural contexts in which these people navigate without ignoring their pre-migratory rules of dietary, body, and physical activity norms., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Interventions to improve HIV service uptake are increasingly addressing inequitable and restrictive gender norms. Yet comparatively little is known about which gender norms are most salient for HIV testing and treatment and how changing these specific norms translates into HIV service uptake. To explore these questions, we implemented a qualitative study during a community mobilization trial targeting social barriers to HIV service uptake in South Africa., Methods: We conducted 55 in-depth interviews in 2018, during the final months of a three-year intervention in rural Mpumalanga province. Participants included 25 intervention community members (48% women) and 30 intervention staff/community-opinion-leaders (70% women). Data were analyzed using an inductive-deductive approach., Results: We identified three avenues for gender norms change which, when coupled with other strategies, were described to support HIV service uptake: (1) Challenging norms around male toughness/avoidance of help-seeking, combined with information on the health and preventive benefits of early antiretroviral therapy (ART), eased men's fears of a positive diagnosis and facilitated HIV service uptake. (2) Challenging norms about men's expected control over women, combined with communication and conflict resolution skill-building, encouraged couple support around HIV service uptake. (3) Challenging norms around women being solely responsible for the family's health, combined with information about sero-discordance and why both members of the couple should be tested, encouraged men to test for HIV rather than relying on their partner's results. Facility-level barriers such as long wait times continued to prevent some men from accessing care., Conclusions: Despite continued facility-level barriers, we found that promoting critical reflection around several specific gender norms, coupled with information (e.g., benefits of ART) and skill-building (e.g., communication), were perceived to support men's and women's engagement in HIV services. There is a need to identify and tailor programming around specific gender norms that hinder HIV service uptake., Competing Interests: The authors have declared that no competing interests exist.

The present paper explores how aging bodies of middle-aged women can enable and constrain participation in physical activity. The study is inspired by the process sociology of Norbert Elias and builds on qualitative empirical material from passive observations (N = 57), focus groups (N = 51), and individual follow-up interviews (N = 21) with middle-aged Danish women who participated in a 3-month research project with exercise intervention. The qualitative study found that awareness of bodily aging enabled the taking up of exercise in the intervention. Additionally, taking up regular exercise in midlife can be understood as a highly rationalized leisure-time activity in relation to societal moral norms of self-responsibility for own physiological health. Furthermore, the qualitative material indicates that participation enabled a self-realization among the middle-aged women, as strong and capable bodies counter to the biomedical view of decline in the aging body. [ABSTRACT FROM AUTHOR]

Conducting research studies with vulnerable populations on sensitive topics such as adolescent pregnancy can be challenging depending on methodological approaches and ethical issues that may arise before, during, and after data collection. This methodological paper was developed based on experiences and lessons learned from a critical ethnographic study conducted to determine and understand the cultural and personal meaning of unintended adolescent pregnancy in the Rwandan context and to explore the perceived consequences and management of unintended adolescent pregnancy with and for single adolescent mothers. The purpose of this methodological paper is to discuss methodological and ethical challenges encountered while conducting this research, as well as various approaches used to overcome these challenges, and to provide guidance to researchers interested in conducting research about similar or other sensitive topics. Future researchers facing similar challenges should prioritize community engagement strategies, such as building strong relationships with gatekeepers and leaders, to facilitate access to potential participants. Additionally, researchers should engage in continuous ethical reflection and adaptation throughout the study, adjusting strategies if necessary to ensure the well-being and autonomy of participants. As a result of the practical and methodological strategies provided in this reflective paper, researchers could be able to navigate practical, methodological, and ethical challenges effectively while conducting sensitive studies on topics such as adolescent pregnancy. [ABSTRACT FROM AUTHOR]

Background and aims: Autistic children can experience challenges in making and maintaining friendships, and middle childhood (ages 6–12) may be particularly challenging as social networks become more complex. However, a large proportion of research into these experiences is based on adult reports or focuses on the experiences of adolescents, meaning that the voices of younger children are absent. Due to the exclusion of younger children from research, we have a limited understanding of their first-hand experiences of their friendships and the support they receive, which has implications for friendship support and wellbeing. This study aimed to amplify the voices of younger autistic children to explore their first-hand experiences of friendships and highlight areas of social support which may be most beneficial to primary-aged autistic children. Methods: This study used novel creative methods to support interviews with 19 autistic primary school-aged children to explore their experiences of friendship. Parent-led interviews and scrapbooks supported the children in discussing the challenges and strengths of their friendships. Results: Children discussed the challenges and strengths of their friendships including the impact of social norms on the need to have friends and their support needs in this area of life. Children also discussed gaps in their current friendships and how they would like to see these filled. It was clear that not all children required or wanted neurotypical-style friendships, with many valuing companionship and gameplay over intimacy. Analysis highlighted the heterogeneity of autistic children's friendships, especially in relation to gender and age, calling for more tailored and individualized support. Conclusion and implications: Results from the current study show that autistic children can and do have successful friendships but that these friendships may differ from those of their non-autistic peers. The study further adds to the existing literature by showing that younger autistic children can be included in research by using differentiated, accessible and creative methods, and that they are able to voice their opinions on matters surrounding support. It also calls for a tailored approach to supporting autistic children in school and speaking with children to give them autonomy over the support they want to receive. [ABSTRACT FROM AUTHOR]

Although researchers have segmented the customer markets of many products and services, they seem to neglect to categorize that of older people's homes. In addition, they overlook a comparison of the intentions and affecting factors of the volitional customers and the nonvolitional customers' decision-makers. This study filled these gaps by qualitatively segmenting the older people's home customers market in Vietnam. The database was user-generated content, and the analysis method was inductive. The study identified six segments of potential and nonpotential customers: those who wanted or did not want to go to or send their parents to older people's homes and those who were flexible or fluctuating. The volitional customers and the decision-makers of the nonvolitional customers shared similar characteristics, such as financial and emotional independence or dependence and social norm resistance or conformation. Other factors, such as information intelligence and health conditions, were faint compared to these characteristics. Based on these observations, this study discussed some implications for expanding the existence and contribution of older people's homes more effectively. [ABSTRACT FROM AUTHOR]

Objective: To explore their perceptions and attitudes toward condom use and the underlying reasons for the low usage frequency among Chinese older adults. Methods: A qualitative study design utilizing interpretive phenomenological analysis was employed. Data were collected through field observation and face‐to‐face in‐depth interviews among older adults aged 50 years or above and having engaged in sexual activities within the previous year. Results: Three main themes emerged: perceiving unnecessary due to misconceptions and low awareness, interactive stereotypes rooted in sociocultural beliefs, and stigmatized social norms including gender inequity and economic unbalance. Conclusions: Tailored interventions focusing on addressing misconceptions, increasing awareness, and reducing culturally ingrained stereotypes and stigma surrounding condom use are essential to promote condom use among older adults in order to prevent HIV transmission in China. [ABSTRACT FROM AUTHOR]

Caregivers can provide insight into the welfare aspects of institutional child maltreatment not apparent to children in care. This qualitative study investigated how socio-ecological and contextual aspects of the welfare system were linked to (quality of) care provision and the well-being of minors in care. Semi-structured interviews were conducted with 12 Swiss former caregivers. Welfare aspects included a shortage of resources, poor working conditions, and lack of oversight by the authorities. Social norms also contributed to stigmatization, discrimination, and the normalization of adverse care practices. Potential protective factors included external support and resource provision, caregiver resistance, and (later) social acknowledgment. [ABSTRACT FROM AUTHOR]

Prior studies on Japanese parents raising children with developmental disorders have predominantly emphasized negative psychological aspects like parenting conflicts and challenges. Purpose of this study was to construct a conceptual model to aid mothers in parenting children with developmental disorders by identifying effective parenting strategies. In this qualitative study, participants were mothers who engaged in a home program through individual outpatient occupational therapy. Therapy sessions occurred biweekly, totaling 12 sessions, each lasting 40 min. Data collection involved semi-structured interviews, and the data were analyzed through the Modified Grounded Theory Approach. Analysis of mothers' narratives revealed heightened physical burden, psychological distress, severe stress, and social isolation. Our findings highlight those mothers who engaged in the home program navigated the intricate parenting landscape through problem-solving, including managing negative emotions, their demanding schedules, and societal norms. This study offers insights into the perceptions, experiences, and behaviors of families in supporting the development of parenting strategies within the family. Occupational therapy should prioritize evaluating a mother's parenting context and her interactions with her environment. Furthermore, it is crucial to provide support for her to independently formulate suitable parenting strategies that resonate with the specific circumstances of her family. [ABSTRACT FROM AUTHOR]

The perception of the value of children (VOC) can elucidate why individuals consider it beneficial to have children by uncovering their subjective intentions and experiences regarding their fertility decisions. Using VOC perceptions to understand fertility change in the modernization process, this qualitative study explores how parents' VOC change meshes with China's socioeconomic and cultural contexts. This article examines intergenerational VOC evolution under the support and constraints of socioeconomic environments and cultural norms. Grandparents, embedded in the rural economy and traditional culture, exhibit economic/utilitarian and social/normative VOC. Young parents, living, and having grown up in urban economic and modernized cultural contexts, recognize emotional/psychological VOC for fertility intention. Migrant parents living in urban economies but bound by traditional culture believe that social/normative VOC is important for fertility intention. The results advance understanding of the integration of individuals' psychological intentions with the socioeconomic-cultural contexts that influence their fertility and VOC. [ABSTRACT FROM AUTHOR]

In the evolving landscape of older person care, the imperative to explore holistic approaches persists, especially in regions with distinct societal norms around informal caregiving. The deeply ingrained tradition of familial caregiving, often led by female family members, has historically compensated for healthcare system gaps in less integrated systems. Hence, societal expectations may affect registered nurses' experiences and impact the quality of care for older persons. This study aims to describe the meaning of caring for older persons in care settings in Greece. Ten in-depth interviews with registered nurses in older person care settings underwent qualitative thematic analysis. Four themes emerged from the analysis: (i) Living and bonding with older people as a basis for caring, (ii) Caring as a double-faced fulfillment, (iii) A sense of insufficiency in the caring relationship, and (iv) The encounter of existential issues creating loneliness. This research provides insights into the meaning of caring for older persons, highlighting the experiences of the closest professional caregivers of older individuals. A specific capture of the entanglement of cultural norms, societal expectations, and their impact on professional caregivers' experiences may contribute to quality care provision in systems rooted in familial caregiving traditions. [ABSTRACT FROM AUTHOR]

Background: Cultural beliefs significantly shape societal attitudes toward mental illness, and these social attitudes profoundly impact help-seeking behaviors. Therefore, it is important to focus on understanding and addressing these social behaviors. Aim: This study aimed to evaluate the effect of chronic mental illness interpretations based on culture and religious beliefs on non-medical help-seeking behaviors among patients in Türkiye. Methods: The study was conducted from September to October 2023 using an inductive qualitative approach. In-depth face-to-face interviews were carried out with individuals diagnosed with chronic mental illness and their relatives, registered in a state-owned Community Mental Health Center (CMHC) in Türkiye. Using purposive sampling, 13 individuals who met the criteria were interviewed. Thematic analysis was used to identify themes. Results: Three main themes and eight sub-themes were identified, including the reasons for seeking non-medical help (psychological challenges, subjective norms, physical requirements), factors contributing to seeking non-medical help (predisposing factors, enabling factors, and myths), and reflections on the benefits of non-medical practices (perceived physical benefits, perceived psychological benefits). Conclusions: It was concluded that individuals with chronic mental illness and their relatives living in the Eastern Anatolia Region of Türkiye engaged in non-medical help-seeking behaviors and mostly turned to traditional religious practices. Culture and religious beliefs emerged as primary factors leading patients to seek non-medical treatment approaches. Consequently, there is a perceived need to explore non-medical alternative methods across various mental health settings and with diverse samples in future research endeavors. [ABSTRACT FROM AUTHOR]

This study aimed to describe the beliefs associated with the intention to become licensed to prescribe among psychologists in Pennsylvania using the theory of planned behavior. We conducted a survey (March–May 2023) of attitudes, subjective norms, and perceived control among members of the Pennsylvania Psychological Association, generating a response rate of 24.2% (n = 284). The primary outcome was how likely the respondent was to become licensed to prescribe if authorizing legislation passes in Pennsylvania, followed by an open-ended question about their rationale. The association between the likelihood of becoming a prescriber and the attitudes, subjective norms, and perceived control about prescribing was estimated using logistic regression, adjusting for demographic and professional information. Results were calculated as average marginal effects (AME) and corresponding 95% confidence interval. Open-ended responses were assessed using inductive thematic coding. Approximately 35% of psychologists reported being likely to become a prescriber. Direct social norms were associated with a 15.4 percentage-point increase ([0.12, 0.19]) in the probability of becoming a prescriber, and indirect attitudes were associated with a 9.7 percentage-point increase ([0.06, 0.14]). These results were supported by the qualitative themes that emerged: Personal Reasons, Professional Reasons, and Improving Patient Care. These themes included concerns about age, changing professional psychology, medication, increasing access to care, and licensure requirements. Psychologists' attitudes and social norms about prescribing psychology are key indicators of their intention to become licensed to prescribe. These findings could inform interventions to improve licensure rates and policymakers considering the adoption of psychologist prescriptive authority. Public Significance Statement: This study suggests that the intention of psychologists in Pennsylvania to become licensed prescribers is motivated by their attitudes about prescribing and if they believe most people think prescribing would be good. Psychologists were primarily concerned about a mix of personal, professional, and patient issues related to prescribing. These findings could (1) inform the development of an educational intervention to improve prescribing licensure rates and (2) provide additional considerations for policymakers exploring the adoption of prescriptive authority for psychologists in their state. [ABSTRACT FROM AUTHOR]

This article brings together the experiences of parents whose children are placed in out‐of‐home care (OHC) with the theoretical concept of moral injury. The findings are based on empirical data from a research and development project conducted in seven Swedish municipalities with the aim of developing support for such parents. This article draws on a data set of qualitative interviews with 40 parents, 30 mothers and 10 fathers, with children in OHC. The interview transcripts were analysed thematically, with an abductive approach to theories and the empirical data. The findings illustrate how parents of children in OHC experience moral injury in relation to seven aspects: professionals' morally problematic and distressing behaviour, problematic services, an adversarial system, systemic bias, parent's actions, children's withdrawal and feeling excluded. The injuries are related to events in several periods—prior to the child's removal, during the execution of removal and during OHC—and tend to last for many years. These findings stress that the social services must be aware of the injuries parents experience and must minimize the possible harm and moral injury. We also suggest that parents of children in OHC should have an appointed social worker as a means of support. [ABSTRACT FROM AUTHOR]

Objectives: Providing personal demographic information is routine practice in the United States, and yet, little is known about the impacts of this process. This study aims to examine the experiences and perspectives of Multiracial/ethnic adults in the United States when disclosing racial/ethnic identity. Methods: Seventeen semistructured interviews were conducted with adults identifying as Multiracial/ethnic. The Multiracial/ethnic identities of participants included Black or African American and White; Black or African American, American Indian or Alaska Native (AI/AN) and Hispanic or Latino; Black or African American and Hispanic or Latino; Black or African American and AI/AN; AI/AN and White and Asian, Native Hawaiian or Pacific Islander and White. Multiple participants reported identifying with multiple ethnic groups for any single broad category. Three identified as sexual minorities. Nine were Millennials; six were Gen X; one was Gen Z; one was Baby Boomer. Qualitative data were analyzed using staged hybrid inductive–deductive thematic analysis. Results: Disclosure of racial and ethnic identities presents a unique stressor for Multiracial/ethnic populations due to methods used to obtain data, perceived mismatch of identity and phenotype and exposure to prejudice. Social norms, constructs and movements impact the categories that a Multiracial/ethnic person indicates to external parties. Conclusions: The stress and negative feelings that Multiracial/ethnic adults face when identifying their race/ethnicity underscore the broader implications of standard demographic questions on feelings of inclusivity and visibility within a population. Patient or Public Contribution: Gathering data on individuals' racial and ethnic backgrounds is a standard practice, and yet, it can pose challenges for those who identify with multiple groups or do not see their identities reflected in the options provided. Such individuals may feel excluded or experience unfair treatment when disclosing their identity, leading to significant stress. As the frequency of this data collection increases, it is essential that the questions are posed empathetically and equitably, with a strong commitment to enhancing inclusivity throughout the process. [ABSTRACT FROM AUTHOR]

To explore barriers and facilitators to community reintegration experienced by people following traumatic upper limb amputation (ULA). An exploratory qualitative study was conducted with ten adults with major ULA due to trauma. Data from individual, semi-structured interviews was analysed using Braun and Clarke's reflexive thematic analysis. Underlying and influencing community reintegration for participants, was a process of adjustment to the impacts of amputation on everyday function and re-establishing their identity. Participants felt social networks and peer support facilitated the return to social and community activities, as did drawing on personal attributes such as positivity, resilience and self-belief. Prosthetic devices were facilitative for community reintegration by minimising visible differences and unwanted attention through restored cosmesis and in the performance of functional tasks to fulfil social norms and meaningful roles despite issues with comfort and function. Despite the adaptation and evolution of abilities, perspectives and identities, the functional impact of ULA on everyday community activities was an ongoing challenge for all participants. ULA has a significant and lifelong impact on an individual's ability to complete tasks and fulfil meaningful roles in the community. Recommendations based on the study's findings will inform clinicians to support community reintegration for people following traumatic ULA. Rehabilitative environments and interventions that promote self-efficacy, positivity, problem-solving skills and resilience may support adjustment and community reintegration following upper limb amputation. Facilitating appropriate peer support and the strengthening of existing social supports may assist social and community reintegration. The facilitative effects of prosthetics on community participation and reintegration may be enhanced through client-centred, goal-directed and timely prosthetic provision and training. Ongoing barriers and challenges with community participation may indicate the need for ongoing therapeutic intervention and support. [ABSTRACT FROM AUTHOR]

We apply a Bourdieusian lens to understand the reproduction of a patriarchal illusio that works to maintain violence-supportive attitudes and concurrent low levels of support for gender equality among young people. We analyze interview and focus group data collected with young women and men and conclude that we must disrupt the reproduction of patriarchal norms by: recognizing the intentional operation of backlash by men's rights activist groups that undermine attempts to transform society; ensuring girls' and women's safety on new technologies to reduce their exposure to sexism and violence; and introducing prevention early to disrupt misogynist social norms being internalized. [ABSTRACT FROM AUTHOR]

Based on a multi-phase study conducted on the World Health Organization’s (WHO) age-friendly cities program, healthy-cities program, and global sustainable-cities initiatives, this paper assesses how older adults – particularly those living with chronic health conditions and disabilities – discuss mobility challenges in qualitative research. Initial results indicate that demobilizing levels of travel cost and travel risk are implied, with older adults refraining from direct discussion. Reflective analysis is performed on marginalized older adults’ conceptual associations, ideologies, and response to social norms, to identify sources of pressure which may lead to downplaying or self-censorship on transport disadvantage. Results highlight that inequalities may arise from both the built environment and how research trainees communicate in research. Despite literature which suggests severe impacts of transport disadvantage, older adults may face difficulties in voicing their needs when research trainees adhere to the following social norms. First, physical access and feasibility may be minimized as mere matters of convenience to the able-bodied individual; second, overcoming transportation barriers may be seen as based on one’s effort – as opposed to the disabling effects of the built environment; third, health and fitness in general may be also associated with one’s effort, and increasingly also to one’s commitment to environmental-sustainability; fourth, older adults may feel pressure to align perspectives with more privileged stakeholders, or with the general public; fifth, money and income may be delegitimized as apt research topics, regardless of how inability to overcome travel costs may impact daily-wellbeing. Implications for educating future gerontology-research trainees conclude the study. [ABSTRACT FROM AUTHOR]

Postwar migrants from the Caribbean and Indian subcontinent (Bangladesh, India, and Pakistan) to the UK are now experiencing the onset of age‐related diseases such as dementia. Our evidence base, both quantitative and qualitative, documenting the experiences of family caregivers of people with dementia is largely drawn from studies undertaken with white European, North American, and Australasian populations. Consequently, there is a need for research in the field of dementia caregiving to reflect the increasing diversity in ethnic identities of the older adult population of the UK. Using semistructured interviews, we investigated the experiences of 18 caregivers of people with dementia in Black Caribbean, Black African, and South Asian (Indian, Pakistani, and Bangladeshi) communities in England. Participants were recruited from the Join Dementia Research platform and were predominantly female intergenerational carers. We identified the following three themes: motivation to care (spending time with the care recipient and reciprocity), positive and negative consequences of caregiving (rewards and consequences), and the cultural context of caregiving (cultural norms and values supporting caregiving and negative attitudes towards dementia). Our findings develop existing literature by identifying (a) the importance of spending time with the person they care for, (b) the absence of faith as a caregiving driver, and (c) the challenge of watching the declining health of a parent. We highlight how the different motivations to care are intertwined and dynamic. This is illustrated by the linking of obligation and reciprocity in our dataset and positive and negative experiences of caregiving. [ABSTRACT FROM AUTHOR]

Gender differences have been found in the outcomes of vocational rehabilitation (VR) and in Supported Employment (SE), therefore, the purpose of this study was to explore employment specialists' (ES) social representations of gender in relation to work and VR and how these social representations influence the ES's work in the VR process according to SE. The qualitative method of focus group discussions was employed. Ten focus groups were held with 39 ESs from four categories of SE organizations in Sweden. Topic analysis was applied to the transcribed material from the focus groups. Five themes with different social representations about gender and disability in relation to VR and working life formed in the analysis: (1) differences in personal and health factors among VR-participants, (2) gender norms in society influencing VR, (3) energy-intensive environmental issues influencing VR, (4) gender-specific interactions in VR, and (5) gendered paths in the welfare system. Social representations of higher strains on women with disabilities compared to men with disabilities both in private and working life, which reflect the lived experiences of the ESs, is a possible explanation for gender differences in VR and working life for persons with disabilities. Gender differences in the outcomes of vocational rehabilitation (VR) interventions have been noticed worldwide. In this study, pervasive social representations about gender and disability in relation to VR were found, but also unconsciousness about gender among VR professionals. Therefore, awareness of gender is necessary in VR. Individualized and person-centered approaches to VR like Supported Employment, although considered best practice, might hide structures like gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR. Therefore, knowledge of discrimination is important in VR. Gender-sensitivity in vocational rehabilitation models with a person-centered and individualized approach is needed and there might also be a need to systematically tailor vocational rehabilitation models to reach gender equality in the outcomes of the interventions. Therefore, gender equality indicators are needed for VR models, to evaluate model effectiveness from a gender perspective. [ABSTRACT FROM AUTHOR]

This study examines healthcare access for pregnant women in a rural developing country context. Drawing upon institutional theory and Levesque et al's model of access, the study finds pregnant women face challenges both of a formal and informal nature in accessing healthcare. The findings suggest the need for integrated and collaborative workings across formal and informal institutional networks. Theoretically, the study makes two contributions. First, it adds value to institutional theory by incorporating a dimension of access. Second, it builds upon Levesque et al.'s healthcare access framework by highlighting the role and significance of a third dimension—that is informal institutions, in addition to the current two—formal institutions and individual factors. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a debilitating and common health issue. General Practitioners (GPs) often prescribe opioids to treat chronic pain, despite limited evidence of benefit and increasing evidence of harms, including prescription Opioid Use Disorder (pOUD). Australian GPs are worried about the harms of long-term opioids, but few are involved in the treatment of pOUD. There is little research on GPs' experiences diagnosing and managing pOUD in their chronic pain patients. Methods: This qualitative research used semi-structured interviews and a case study to investigate GPs' experiences through the lens of the Theory of Planned Behaviour (TPB). TPB describes three factors, an individual's perceived beliefs/attitudes, perceived social norms and perceived behavioural controls. Participants were interviewed via an online video conferencing platform. Interviews were transcribed verbatim and thematically analysed. Results: Twenty-four GPs took part. Participants were aware of the complex presentations for chronic pain patients and concerned about long-term opioid use. Their approach was holistic, but they had limited understanding of pOUD diagnosis and suggested that pOUD had only one treatment: Opioid Agonist Treatment (OAT). Participants felt uncomfortable prescribing opioids and were fearful of difficult, conflictual conversations with patients about the possibility of pOUD. This led to avoidance and negative attitudes towards diagnosing pOUD. There were few positive social norms, few colleagues diagnosed or managed pOUD. Participants reported that their colleagues only offered positive support as this would allow them to avoid managing pOUD themselves, while patients and other staff were often unsupportive. Negative behavioural controls were common with low levels of knowledge, skill, professional supports, inadequate time and remuneration described by many participants. They felt OAT was not core general practice and required specialist management. This dichotomous approach was reflected in their views that the health system only supported treatment for chronic pain or pOUD, not both conditions. Conclusions: Negative beliefs, negative social norms and negative behavioural controls decreased individual behavioural intention for this group of GPs. Diagnosing and managing pOUD in chronic pain patients prescribed opioids was perceived as difficult and unsupported. Interventions to change behaviour must address negative perceptions in order to lead to more positive intentions to engage in the management of pOUD. [ABSTRACT FROM AUTHOR]

Trans young adults of color experience systemic harm that contributes to negative health outcomes and hinders their ability to live freely. The present study used a grounded theory qualitative methodology rooted in a critical–ideological paradigm to understand the intersections of racial and gender oppression. Trans young adults of color from across the United States (N = 15; ages 20–29; majority racial identities: Asian, Black, and multiracial; majority gender identities: nonbinary and transmasculine) participated in a semistructured interview. Analyses identified a six-category empirical framework explaining major dimensions and processes of intersectional experiences of trans people of color. The core category, Reclaiming Creativity, reflected how trans communities of color use creativity to build their identities and communities beyond intersectional oppressive societal norms and imagine a better, more liberated world. The remaining five categories were Creating and Recreating Identity, Experiencing Discrimination and Its Impacts on Wellness, Surviving Oppression and Compromising Authentic Self, Embracing Identity Strengths, and Finding Liberation. They provided insights into the role of creativity within the intersectional experiences of trans young adults of color. In doing so, they provided directions to address structural injustice, pursue liberation, and allow creativity to flourish. Public Significance Statement: Interviews with a diverse sample of young adults found that trans people of color have complex experiences navigating the overlap of social stigma and harm from transphobia and racism. Participants used creativity to construct their identities, survive oppression, and create strength and joy. Particularly in the context of antitrans legislative attacks across the United States, these experiences should be recognized and honored by efforts to address structural injustice and inequity, promote rights and dignity, and create environments where the creativity of trans people of color can thrive. [ABSTRACT FROM AUTHOR]

Policy reforms implemented in Saudi Arabia in recent years aim to modernize the culture and infrastructure of healthcare delivery and are expected to integrate person‐ and patient‐centered care principles throughout the national healthcare system. However, in a complex multicultural environment where most nurses are international migrant workers, unique challenges emerge that frame the delivery of care. Better understanding is needed about what nurses perceive to be high‐quality, person‐centered care in Saudi Arabia and how they manage to enact it in practice. Semi‐structured interviews were conducted with 21 nurses working in two tertiary hospitals in Riyadh, the capital city. Participants included Saudi citizens (n = 9) and expatriates (n = 12) who were asked to describe their perceptions of quality nursing care and explain the obstacles that they encounter in providing such care. Nurses reported extensive efforts to achieve individualized, empathetic, developmentally appropriate care. Their descriptions of care aligned with principles of patient‐centeredness in care but were not separable from challenges at the patient, organizational, and regional levels, including staffing and supplies shortages, gaps in regional care coordination, inadequate language translation services, variability in cultural beliefs about healthcare communication, and overt discrimination against expatriate workers. Nurses reported creative strategies to achieve professional nursing values while navigating a dynamic landscape of constraints. The findings add to literature suggesting that person‐centeredness in care cannot be understood outside the social and organizational conditions that shape it. [ABSTRACT FROM AUTHOR]

This study explores the experiences of nurses that provide 'complex', generalist healthcare in hospital settings. Complex care is described as care for patients experiencing acute issues additional to multimorbidity, ageing or psychosocial complexity. Nurses are the largest professional group of frontline healthcare workers and patients experiencing chronic conditions are overrepresented in acute care settings. Research exploring nurses' experiences of hospital‐based complex care is limited, however. This study aims to add to what is known currently. Four 'complex care' nurses undertook in‐depth semistructured interviews and their narratives were analysed using the conceptual framework of complex adaptive phenomenology. Two overarching themes constituting the 'essence' of complex care nursing were identified: Contextual factors and attribute/value‐based elements. Creating meaningful patient outcomes and feeling part of a team were experienced as fulfilling, whereas time constraints, institutional settings and systemic barriers to comprehensive caregiving diminished the experience of providing complex care. Overall, work meaning presented as a dynamic phenomenon, shaped by personal and professional values, local settings and systemic factors. It is recommended that more expansive research be undertaken to explore the experience of complex care for nurses. Such knowledge can contribute to initiatives that draw a skilled, effective and engaged hospital‐based complex care nursing workforce. [ABSTRACT FROM AUTHOR]

One's health security (i.e., the ability to minimize risks and respond to public health threats) is a conferred right of citizenship but individuals construct identities during the process of securing their health. However, how this occurs, in relationship to the state, remains largely implicit or taken‐for‐granted. The Coronavirus Disease 2019 (COVID‐19)' provided a unique opportunity to explore the relationship between oneself and governing social norms of health citizenship. We drew on secondary analysis of data from a previous (published) qualitative descriptive study that was conducted during May to September 2020 of COVID‐19, to explore 72 immigrants' experience (from 21 countries) of health security in the Greater Toronto Area, Canada. Data were collected through semi‐structured interviews and analysed using critical realism. The majority of participants were women. We demonstrate how individuals implicitly engaged in 'extra' work—gendered and driven by mechanisms of good citizenship—connected to the will to health, against ethopolitical work to regulate risks, of and for themselves, in public discourse. Public discourse tended to follow racialized hegemonic norms, which also reproduced systemic cultural racism. We argue that empathetic understanding of this process is conducive to enhancing one's resistance to stereotypes, and to bolstering immigrants' resilience to seeking health security during public health emergencies. [ABSTRACT FROM AUTHOR]

With the surge in Asian-White intermarriages, understanding these couples' experiences is crucial for providing effective clinical guidance in the current racial climate. Interviews with 20 White individuals married to Asian Americans were analyzed. Five major themes emerged from multiple case analyses: cultural differences affecting the couples; cultural differences with extended family and others; racism and the impact of the pandemic; concerns about children; and the benefits and strengths of intermarrying. Clinicians assisting interracial couples may employ these results to tailor their interventions based on the social context. [ABSTRACT FROM AUTHOR]

The field research focused on teenage pregnancy had the general objective of sensitizing and educating the school community about the challenges associated with early pregnancy, promoting prevention, quality of life formation, and appropriate support. To achieve these objectives, the research utilized an exploratory and descriptive methodology, employing both qualitative and quantitative approaches to gain a comprehensive understanding of the topic. During the research, questionnaires and interviews were conducted to collect data on students’ knowledge about contraceptive methods, the consequences of teenage pregnancy, and the importance of family planning. Additionally, discussion groups were held to promote open dialogue about sexuality, prevention, and support for pregnant teenagers. The findings indicated significant gaps in understanding of contraceptive methods, family planning, and the implications of teenage pregnancy among the participants. Consequently, most participants expressed a need for more information and educational resources on the subject. The educational and awareness activities were well-received, and participants reported an improved understanding of the issues addressed. The research also highlighted the importance of adequate support for pregnant teenagers, emphasizing the need for emotional and social support in schools. Thus, the field research not only contributed to raising awareness about teenage pregnancy but also provided practical directions for future interventions, focusing on preventive education and support for pregnant teenagers within the school environment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is twofold. First, it identifies whether sustainability reporting has become an institutionalized cultural norm in the daily routines and organizational practices of Spanish public hospitals. Second, it finds out why sustainability reporting has become (or not) an institutionalized norm in the Spanish public hospital field. Design/methodology/approach: To accomplish the research aims, the authors have adopted a qualitative method approach by combining two main data sources: (1) a documentary analysis of reports published by 60 Spanish public hospitals that consistently maintained their commitment to this activity over the past 10 years; and (2) a semi-structured interview with seven hospital managers and with seven participants from professional organizations. Findings: The authors have found that sustainability reporting has not become an institutionalized practice in the Spanish public hospital setting. Based on the notion of normativity, the findings indicate that the institutional conditions that support the emergence of a norm are not met (Bebbington et al., 2012). In particular, the lack of a coherent normative framework, the absence of congruence with previous similar practices and the lack of clarity in the norm explain why a reporting norm has not emerged. Currently, the societal context has not developed an appropriate discourse around the development of sustainability reporting in the Spanish public sector. Originality/value: The contribution of this research is double: (1) From a practical level, this paper contributes to the accounting literature by analyzing the development of sustainability reporting practices in the public sector; (2) According to the notion of normativity, the novelty of this paper is to explore whether a sustainability reporting norm emerges in Spanish public hospitals. [ABSTRACT FROM AUTHOR]

Objective: High quality obstetric anaesthetic care is integral to reducing preventable maternal deaths in Low-and-Middle-Income-Countries (LMICs). We applied behavioural science to evaluate SAFE Obstetrics, a 3-day Continuing Professional Development (CPD) course, on physician and non-physician anaesthetists' practice behaviours across 3 LMICs.Methods: Seven anaesthetist Fellows from Bangladesh, Nepal and Tanzania were trained in qualitative methods and behavioural science. Structured interviews were undertaken by Fellows and two UK behavioural scientists with course participants. Interviews were based on the Theoretical Domains Framework: a comprehensive framework of influences on behaviour change. Interviews were recorded, transcribed and analysed using content and thematic analysis.Results: 78 physician and non-physician anaesthetists participated (n = 26 Bangladesh, n = 24 Nepal and n = 28 Tanzania). Participants reported positive improvements in patient-centered working, safety, teamwork and confidence. Across countries, we found similar barriers and facilitators: environmental resources, a strong professional identity and positive social influences were key facilitators of change.Conclusion: This multi-country theory-based evaluation highlighted the impact of SAFE Obstetrics on participants' clinical practice. A supportive work environment was crucial for implementing learning following training; CPD courses in LMICs must furnish participants with skills and equipment to address training implementation challenges. Building local behavioural science capacity can strengthen LMIC health intervention evaluations. [ABSTRACT FROM AUTHOR]

In this article, we explore associations between women's health and participation in working life, work ability and sickness absence. Through interviews with nurses and hospital managers, we identified three main occupational barriers connected to biological and physiological sex differences: considerations on women's health, work organization and work environment as conditions for health, and equality and expectations in society. We find that individual experiences, job systems, and societal attitudes affect each other negatively, and that systemic problems tend to be individualized. The lack of recognition of women's health affects work participation, work ability and sickness absence in women, representing a challenge to female occupational health, as well as to gender equality and public health in general. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore alcohol drinking behavior using the theory of planned behavior as a framework. Methods: A semi-structured interview methodology was employed with early adolescents (10–14 years of age; N = 61, boy = 27, and girls = 34) in Chonburi Province, Thailand. A descriptive qualitative approach was applied between December 2019 and March 2020. The purposive study sample was used, and a thematic qualitative analysis was performed. Results: The main finding is that the attitude and the subjective norms appear to be the components with the most influence on underage drinking. Early adolescents pressured by peers and offered alcohol from their parents would have more intent to drink than others. Therefore, perceiving self-control to resist alcohol use is attributed to being terrified to be punished and unwanted to disappoint the parents. Conclusions: The findings suggest that for intervention development, enhancing adolescents' life skills, self-esteem, alcohol drinking refusal skill, and family-based intervention are needed to change young people's intention on alcohol drinking. [ABSTRACT FROM AUTHOR]

Phenomenon: In 2011, the American Medical Association added a section on professionalism and social media (i.e., e-professionalism) to the Code of Medical Ethics. Given the constantly evolving nature of social media use, research is needed to explore the attitudes and behaviors of current medical students, for most of whom social media has been a central facet of interpersonal communication and society since they were born. The goal of the current study is to examine students' social media use and attitudes related to online professionalism. Approach: Two-hundred-twenty-two medical students completed a mixed-methods cross-sectional online survey assessing perceptions of professionalism on social media. The survey was informed using the theory of planned behavior and included validated measures of attitudes, norms, and perceived behavioral control related to social media use and online professionalism. We analyzed data using thematic analysis and descriptive statistics and t-tests were conducted using SPSS 26. Qualitative and quantitative data were integrated during the data interpretation phase. Findings: Quantitative results revealed that students had a positive attitude toward having a social media presence as medical students and future physicians. Students reported: positive attitudes toward sharing positive thoughts, posting photos with family members, and posting photos in white coats or scrubs; neutral attitudes toward posting personal and political opinions; negative attitudes toward posting photos with alcohol, commenting about colleagues or the workplace, using profanity, connecting with patients, and commenting about patients. T-tests revealed significant differences between what students consider to be professional online behaviors for themselves as medical students versus what they believe society will expect of them as a physician. Students reported strong perceived behavioral control regarding professional social media behavior. While students reported they would face some difficulty "cleaning up" some previous content, students strongly disagreed that people's opinions of their online professional image were beyond their control. The qualitative analysis revealed students' perceptions of (a) what it means to demonstrate "online professionalism," (b) the challenges they face related to social media, and (c) training and standards related to social media use. Insights: Overall, our study confirms that students would benefit from e-professionalism training that is not merely disciplinary, but offers them evidence-based recommendations for maintaining medical professionalism while also embracing their personal identity and the benefits of social media as a (future) physician. Policies, guidelines, and training programs should constantly evolve as social norms regarding online communication and online identities evolve. [ABSTRACT FROM AUTHOR]

Reversing the growth pattern in passenger aviation emissions is necessary for climate change mitigation. However, climate-related concerns and norms do not correlate strongly with practices. This study provides an example of a rapid process of social institutionalisation of long-distance travel, which has become a default tool for meeting social expectations and performing social rituals. It draws on 21 in-depth interviews conducted in the Reykjavik region of Iceland. We show that the prevalence of flying has become so high that people who do not fly are subject to normative pressure. On the other hand, as awareness of its climate impact increases, the norms for the justified use of flights are evolving. As a result, the purpose of flying has become more important. To reduce cognitive dissonance, study participants distinguish their individualised, carefully planned, and meaningful trips from standardised mass and status-oriented travel – a moral disengagement tactic that depends on differences in cultural capital. Distinguishing between necessary and excessive forms of consumption is an important aspect of demand reduction, but this form of selective sanctioning seems problematic from the perspectives of climate impact and social justice. We suggest policy implications and propose methodological improvements to measuring travel-related social norms. [ABSTRACT FROM AUTHOR]

An increasing number of studies have investigated the distinct challenges faced by male victims of sexual assault. However, there is a lack of research focusing on how they perceive their sexual victimization experience and their help-seeking behavior. This qualitative study aimed to explore the experiences of cisgender men who had been sexually assaulted in adulthood and their subsequent help-seeking processes within a Danish context. Our findings underscore the crucial importance of acknowledging the sexual assault, which entails a multifaceted process that intertwines with the helpseeking behavior. This process is influenced by various factors, including gender norms, disclosing the assault, and the impact of assault-related symptoms. The role of male rape myths and masculinity is discussed. Our research offers valuable insights into male victims’ experiences and emphasizes the need to raise awareness and to promote a gender-inclusive view on sexual assault. [ABSTRACT FROM AUTHOR]

One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients. [ABSTRACT FROM AUTHOR]

Objectives: Normative beliefs around gender and sexuality place individuals in the Two Spirit, lesbian, gay, bisexual, trans, and queer (2SLGBTQ) community at risk for poorer health outcomes within the health care system compared with their heterosexual and cisgender counterparts, particularly within gendered areas of care including family planning and fertility intentions. The purpose of this research was to explore the effect that the normative beliefs of heteronormativity and cisnormativity had on the experiences of 2SLGBTQ people engaged in family planning, and to begin to understand how health care providers can provide appropriate, safe, and holistic care. Methods: We conducted a qualitative study using case study methodology and completing semi-structured interviews with 11 participants with diverse genders and sexualities. Findings: For members of the 2SLGBTQ community, family planning is greatly affected by ideals of normal, intersections of identities, health care systems, and community. They may face additional emotional labor and intentional decision-making when related to family planning. Heteronormativity and cisnormativity greatly impact the health care that is received. Conclusions: The findings contribute information in the limited field of research related to the 2SLGBTQ community and may support health care providers in providing holistic care. [ABSTRACT FROM AUTHOR]

Introduction: Involvement in sexual activities increases during adolescence in many countries, including Cambodia. The objective of this study is to explore the perspectives and interpretations of sex held by Cambodian adolescents within the context of their social norms and culture. Methods: A qualitative research design was used to conduct in-depth interviews with a purposive sample of 91 Cambodian adolescents aged between 15 and 19 years. Participants were recruited from rural areas, and data was collected through face-to-face interviews using semi-structured interview guides. Thematic analysis was used to analyze the data. Results: Four themes as perspectives of sex were identified: (1) Desire: Releasing sexual desire and stress; (2) relationship: an emotional connection and demonstration of love; (3) roles: responsibilities within a woman's marital duties; and (4) values: the value of virginity and future engagement. Cambodian adolescents' perspectives and interpretations of sex were deeply influenced by their social norms and cultural values. Men typically perceived sex through the lens of instinct and pleasure, while women often emphasized a deep sense of familial duty and held premarital sex to be morally unacceptable. Discussion: The findings suggest that interventions aimed at improving the sexual health of Cambodian adolescents should be designed with an understanding of the social norms and cultural values that shape their perspectives and interpretations of sex. Such interventions should focus on promoting safe sex practices and providing accurate and comprehensive sexual education. [ABSTRACT FROM AUTHOR]

Intoduction: Transactional sex (TS) is common in areas of sub-Saharan Africa, motivated by reasons beyond financial support. Through this qualitative study we sought to understand the motivation driving TS among adolescent schoolgirls in rural western Kenya where rates are reportedly high. Identifying and understanding drivers within the local context is necessary for implementation of successful public health policy and programming to reduce the associated harms impacting health and wellbeing. Methods: To understand the drivers of sexual behaviors, individual views, and sociocultural norms, we spoke with schoolgirls, male peers, parents and teachers. The three latter groups may influence, encourage, and shape girls' views and behaviors and thus contribute to the perpetuation of cultural and societal norms. Results: One hundred and ninety-nine participants took part across 20 FGDs; 8 comprised of schoolgirl groups, and 4 each of schoolboy, parent or teacher groups. Through thematic analysis, poverty emerged as the key driver of TS and a normative behaviour amongst secondary school girls. Subthemes including parental influence, need for menstrual pads, pressure from boda boda drivers, peer pressure, and blame were part of a complex relationship linking poverty with TS. Discussion: We conclude that whilst TS is perceived as inevitable, normal and acceptable it is not really a choice for many girls. Exploring ways to encourage communication between families, including around menstruation, may help enable girls to ask for help in acquiring essential items. In addition, education at a community level may shift social norms over time and decrease the prevalence of age-disparate TS among schoolgirls and older, wealthier men in the community. [ABSTRACT FROM AUTHOR]

Older women without children, like all older adults, evaluate their lives and face a conflict between despair and ego integrity as proposed by Erikson's theory of development. Their uniqueness lies in their deviation from the societal norm of parenthood prevalent in pro-natalist societies such as Israel. This study aims to explore how older childless women evaluate their lives. Using a qualitative approach, 20 semi-structured, in-depth interviews were conducted with women over 60 years of age who do not have children. Three main themes emerged from the participants' responses: their experiences as women without children in a pro-natalist society, the significance of freedom in their lives, and their life experiences from conflicting perspectives—an internal and external locus of control. The study's findings demonstrate that older childless women adeptly utilize different perspectives across various aspects of their lives, contributing to ego integrity, contrary to the prevailing societal notion that in the absence of children, women are damaged and lack identity. It is conceivable that other segments of the older adult population, diverging from mainstream societal norms, may similarly leverage these different perspectives to uphold their ego. [ABSTRACT FROM AUTHOR]

Sexual revictimization can have a negative impact on many facets of women's wellbeing, yet limited evidence exists regarding specific interventions that support healing and the reduction of further revictimization. This paper will explore regional and rural women's experience of a group-based empowerment program, the Shark Cage program, in Victoria, Australia. The "Shark Cage" program aims to address revictimization by empowering women and girls to build personal boundaries and assertiveness within the context of gender equality and human rights. Data were collected via participant observations across the 8-week program, in combination with semi-structured interviews with participants (N = 11) pre and post intervention. All participants had access to therapeutic support outside of the program. Findings indicate that the program fostered connections among women with shared experiences of sexual revictimization, reducing feelings of isolation. Participants detailed the benefit of developing and practicing skills in reducing revictimization, such as assertiveness and boundary setting. Program learning and recovery was embedded within a network of embodied emotions, social connections, cultural norms and place-based relations that influenced how participants recovery could be understood, processed and addressed. [ABSTRACT FROM AUTHOR]

Deaf Bedouin young women must contend not only with the typical developmental tasks of young adulthood but also the traditional demands of Bedouin society. They aim to fulfill themselves and develop, but discrimination and institutional neglect, coupled with their society's traditions, pose a complex challenge. This qualitative study of 14 deaf Bedouin young women in Israel found that they display self-esteem, apparently to cope with the challenges of being sidelined because they are young and deaf Bedouin women as well as members of the country's Arab minority. Also, it is apparent that the hearing population has not invested sufficiently in the women's development, making it more difficult for them to function as adults on various levels. Given this background and the cultural characteristics of Bedouin society, in which young women are tightly controlled, their options appear to be suffering in silence or engaging in life-threatening behavior. Deaf Bedouin young women are at great risk but receive no therapeutic support. Deaf Bedouin young women display high self-esteem and accept their deafness. Being part of a minority—in addition to belonging to the minority of deaf people—is doubly challenging for them. Despite the poor education they have received, they aspire to higher education and a profession and are confident they can succeed if given a chance. [ABSTRACT FROM AUTHOR]

Background and Objectives Racism and religion are recognized as prevailing Social Determinants of Health (SDoH). To explore ways in which racism and religion looms in the daily lives of African Americans, we analyzed the experiences of African Americans born during the Jim Crow years and living in the Southern Appalachian Region of the United States. Research Design and Methods Twenty-seven African Americans participated in this qualitative descriptive study that utilized criterion sampling, open-ended semistructured interviews, and content analysis to identify a typology of categories related to experienced racism and ways in which religion was used in response to those experiences. Results Participants were an average age of 82.22 years (SD  = 5.07); primarily women (n  = 19, 70.4%); married (n  = 11, 40.7%); junior high school (n  = 6, 22.2%), high school or general educational diploma (n  = 7, 25.9%), completed college or professional school (n  = 6, 22.2%); were retired (n  = 27, 100.0%); and affiliated with Baptist churches (n  = 18, 66.7%). Experiences with racism included inequities in healthcare and education, and racially motivated physical violence. Religious practices/beliefs included forgiveness, humility, and humanity. Discussion and Implications Racism experienced by African American participants was likely countered by religious practices/beliefs inspired through intergenerational teachings with affiliations to the Black Church. These experiences of the oldest old) African Americans living in communities of the Southern Appalachia, United States, illustrate the pervasive nature of racism. The religious beliefs that are frequently transmitted intergenerationally through the Black Church are relevant to understand present-day encounters with racism among African Americans and possibly other communities of color. [ABSTRACT FROM AUTHOR]