Putting children forward for epilepsy surgery:a qualitative study of UK parents' and health professionals' decision-making experiences

Background Against a backdrop of recommendations for increasing access to and uptake of early surgical intervention for children with medically intractable epilepsy, it is important to understand how parents and professionals decide to put children forward for epilepsy surgery and what their decisional support needs are. Aim The aim of this study was to explore how parents and health professionals make decisions regarding putting children forward for pediatric epilepsy surgery. Methods Individual interviews were conducted with nine parents of children who had undergone pediatric epilepsy surgery at a specialist children's hospital and ten healthcare professionals who made up the children's epilepsy surgery service multidisciplinary healthcare team (MDT). Three MDT meetings were also observed. Data were analyzed thematically. Findings Four themes were generated from analysis of interviews with parents: presentation of surgery as a treatment option, decision-making, looking back, and interventions. Three themes were generated from analysis of interviews/observations with health professionals: triangulating information, team working, and patient and family perspectives. Discussion Parents wanted more information and support in deciding to put their child forward for epilepsy surgery. They attempted to balance the potential benefits of surgery against any risks of harm. For health professionals, a multidisciplinary approach was seen as crucial to the decision-making process. Advocating for the family was perceived to be the responsibility of nonmedical professionals. Conclusion Decision-making can be supported by incorporating families into discussions regarding epilepsy surgery as a potential treatment option earlier in the process and by providing families with additional information and access to other parents with similar experiences.

A qualitative study of the impact of an educational intervention on older parents of adults with disabilities engaged in the phenomenon of future-care planning

This phenomenological study describes the impact of an educational intervention on the day-to-day experiences of older parent caregivers of adults with developmental disabilities who were engaged in the process of future-care planning. Qualitative strategies of individual and focus group interviewing were used with a purposive sample of older caregivers. Participants were members of an existing parent support group. Twenty-three caregivers representing 18 families were queried before and after the education program. The disabilities represented were mental retardation, cerebral palsy and autism. Parents whose children live at or away from home were included. The intervention was conducted on five Saturdays over a two month period; the duration of the study was five months. Findings used typical words of the respondents from their individual and focus group interviews to describe feelings, attitudes and experiences in making future-care plans. Data from verbatim transcriptions and researcher's field notes were coded, analyzed, sorted into themes, and subjected to interpretive analysis. Respondents showed a positive change in attitudes and actions after participating in the education program, regardless of their initial stage in care planning. Fears were replaced by hope and determination; hesitation and ineptitude by feelings of competence and confidence; and procrastination and delay by purposeful actions. Other key findings: use of a planning document greatly aided caregivers; barriers to planning were often intrinsic and amenable to education; residential plans were the most difficult aspect of planning; listening to the experiences of other parent caregivers was helpful; and making burial plans for their offspring was one aspect of planning parents wished to do themselves. ^

Middle school teachers perspectives on inclusion: A qualitative study

Historically, research has placed considerable emphasis on developing a systematic body of knowledge about education in which little voice has been given to teachers themselves. The critical role that teachers play in this generative process such as reflecting, acting and theorizing upon practices that shape life in the classroom has largely been ignored in favor of technical innovation and organizational procedure. As schools struggle to reform and restructure, an understanding of how teachers interpret their practices in context and how the culture of schools influence, constrain, or encourage these practices become critical aspects of school success or failure. ^ This study examined the perspectives on inclusion of seven middle school teachers as they attempted to include exceptional students in regular classes. The study utilized three forms of data collection: observations were made of participant interactions as they led their everyday school lives; document analysis was used as a means to gain an understanding of programs affecting exceptional students, and interviews were used to give voice to teacher's perceptions regarding inclusion, allowing description in their own words rather than those imposed by an outside inquirer. Data collection and analysis sought to identify emerging themes, categories and patterns, allowing for the creation of substantive theory grounded in empirical data. ^ The key issues that emerged in the study were considered in terms of three general categories. The first, teaching and learning, revealed stark contrasts in opinions regarding the type of human support thought necessary for successful inclusion. Regular educators clung to the traditional notion of solitary teachers directing all class activity, while exceptional educators preferred a more team-oriented approach. The second, school structure, revealed that highly collaborative structures were only partially successful in creating additional conversation between regular and exceptional educators. Collegiality was affected by lack of staff experience with the process as well as its implementation in a top-down fashion. The third, school culture and climate, revealed that regular educators believed the school was prepared for a limited amount of inclusion. Although exceptional educators acknowledged school readiness, they did not believe that inclusion was an important item on the school's reform agenda. ^

A qualitative study of the clinical practice of graduates of a problem-based physical therapy program

The purpose of this study was to examine the perspectives of three graduates of a problem-based leaning (PBL) physical therapy (PT) program about their clinical practice. The study used the qualitative methods of observations, interviews, and journaling to gather the data. Three sessions of audiotaped interviews and two observation sessions were conducted with three exemplars from Nova Southeastern University PBL PT program. Each participant also maintained a reflective journal. The data were analyzed using content analysis. A systematic filing system was used by employing a mechanical means of maintaining and indexing coded data and sorting data into coded classifications of subtopics or themes. All interview transcripts, field notes from observations, and journal accounts were read, and index sheets were appropriately annotated. From the findings of the study, it was noted that, from the participants' perspectives, they were practicing at typically expected levels as clinicians. The attributes that governed the perspectives of the participants about their physical therapy clinical practice included flexibility, reflection, analysis, decision-making, self-reliance, problem-solving, independent thinking, and critical thinking. Further, the findings indicated that the factors that influenced those attributes included the PBL process, parents' value system, self-reliant personality, innate personality traits, and deliberate choice. Finally, the findings indicated that the participants' perspectives, for the most part, appeared to support the espoused efficacy of the PBL educational approach. In conclusion, there is evidence that the physical therapy clinical practice of the participants were positively impacted by the PBL curriculum. Among the many attributes they noted which governed these perspectives, problem-solving, as postulated by Barrows, was one of the most frequently mentioned benefits gained from their PBL PT training. With more schools adopting the PBL approach, this research will hopefully add to the knowledge base regarding the efficacy of embracing a problem-based learning instructional approach in physical therapy programs. ^

A qualitative study of an interagency relationship: Education interventions for foster children

The Interagency Agreement between the Broward County School System and District 10 Department of Children and Families (DCF) was implemented to improve the organization's relationship and in turn improve education interventions for foster children. The purpose of this study was to examine and describe key decision-makers' perspectives of this interagency relationship after implementing mutual policy. ^ The research questions which drove this study were: (a) from the perspectives of the participants, what was the relationship between the decision-makers of the Department of Children and Families and the Broward County School System, after the implementation of a unification plan that was influenced by the court system? and, (b) how was the relationship between the school system and DCF reflected in the Interagency Agreement? ^ Data were obtained through a case study that included interviews, document analysis and field observations. Participants were key decision-makers in their respective institutional settings and were chosen using criterion sampling. The researcher analyzed and interpreted data from the District 10 DCF commissioned assessment of foster care, the State of Florida Management Plans (education section), the Interagency Agreement, and participant interviews. ^ This study focused on the following five contextual areas regarding the Interagency Agreement: interagency cooperation, interagency coordination, interagency collaboration, traditional organizational linkages, and organizational climate. The results of this study suggest that the organizations' improved relationship improved the educational system for foster children. ^ This researcher recommends that the Interagency Agreement shares the leadership structure with an active parent organization of 15 foster parents who would be divided into three subcommittees. These subcommittees would perform specific tasks such as involving other foster parents, and writing mini proposals to address the social and tutoring needs of foster children. A Wraparound process including community organizations (clubs, businessmen and concerned community groups, Big Brothers/Big Sisters, Boys and Girls Clubs) is also recommended in order to engage foster children in activities to build their social skills, friendships and self-esteem. This researcher also recommends that the Broward County School System consider a role that would provide for the development of curriculum for inservice for teachers. This would empower teachers and allow them to better address the academic and social needs of the foster children. ^

“I Am Not Stupid, I Just Don’t…”- A Qualitative Study of Expatriates’ Cross-Cultural Experiences

This qualitative study explored the unique experiences of expatriates in adjusting to cross-cultural situations and confronting challenges in global journeys. Personal narratives written by previous or current expatriates were collected as qualitative data and content analysis was conducted. The results clarified three themes contributing to the complex process of cross-cultural adaptation.

An Exploratory Qualitative Study of the Proximal Goal Setting of Two Introductory Modeling Physics Students

A qualitative investigation on the impact of goal-setting strategies on self-efficacy of two students taking Introductory Modeling Physics was conducted. The study found that the problem solving process can be divided into two main themes: goal-setting and self-efficacy. Self-efficacy plays a role in the goal setting process of these two students, and may be linked to the retention of students in physics.

A qualitative study of selected fourth -grade teachers' perceptions of the Sunshine State Standards

Despite a history of grappling with educational standards, never before has the federal government attempted to establish explicit national standards for what American children should learn in school. Recently, U.S. educators have developed voluntary national content standards, or explicit expectations of what students should know and be able to do. Not surprisingly, this major curriculum reform has provoked considerable debate. Today, teachers face difficult challenges working towards the implementation of standards. The objective of this study was to describe and explain the perceptions of a selected team of fourth-grade teachers regarding the language arts component of their state's Sunshine State Standards (SSS). The exploratory questions that guided this qualitative study were: (a) How are the SSS perceived by these fourth-grade teachers? (b) In what ways do the SSS affect teachers' self-perceptions? and, (c) To what extent and how do the SSS affect the participants' professional classroom behavior? ^ Direct observations, interviews, analysis of relevant documents and the researcher's critical reflective journal served as the methods of inquiry employed in this qualitative study. Bandura's Teacher Self-Efficacy Scale was used as a tool to help categorize the data specifically related to self-perception. ^ Analysis of the data suggests that participants perceived the SSS as a useful guideline as they taught. The SSS were a decisive factor in teachers' planning. They were the actual guide lines used by teachers to plan their lessons. However, participants did not believe the SSS were attainable by all students or were fair to students with special needs. They also believed there was not sufficient time allocated for the effective implementation of the SSS. This lack of time created pressure among some of the participants and others even felt disempowered regarding the curriculum and the instructional focus implemented during the test preparation time. The SSS negatively affected the participants when they felt constraints during this time, which led to their inability to carry out important activities in their classrooms. Thus, the SSS directly affected the participants' behavior in their classrooms. ^

Foreign Language Education in Colombia: A Qualitative Study of Escuela Nueva

Since 2004 the Colombian Ministry of Education has been implementing the Programa Nacional de Bilingüismo (PNB) with the goal of having bilingual high school graduates in English and Spanish by 2019. However, implementation of the PNB has been criticized by English Language Teaching (ELT) specialists in the country who say, among other things, that the PNB introduced a discourse associated exclusively with bilingualism in English and Spanish. This study analyzed interviews with 15 participants of a public school of the Colombian Escuela Nueva, a successful model of community-based education that has begun a process of internationalization, regarding the participants’ perceptions of foreign language education and the policies of the PNB. Six students, five teachers, and four administrators were each interviewed twice using semi-structured interviews. To offer a critique of the PNB, this study tried to determine to what extent the school implemented the elements of Responsible ELT, a model developed by the researcher incorporating the concepts of hegemony of English, critical language-policy research, and resistance in ELT. Findings included the following: (a) students and teachers saw English as the universal language whereas most administrators saw English imposed due to political and economic reasons; (b) some teachers misinterpreted the 1994 General Law of Education mandating the teaching of a foreign language as a law mandating English; and (c) some teachers and administrators saw the PNB’s adoption of competence standards based on the Common European Framework of Reference for languages as beneficial whereas others saw it as arbitrary. Conclusions derived from this study of this Escuela Nueva school were: (a) most participants found the goal of the PNB unrealistic; (b) most teachers and administrators saw the policies of the PNB as top-down policies without assessment or continuity; and (c) teachers and administrators mentioned a disarticulation between elementary and high school ELT policies that may be discouraging students in public schools from learning English. Thus, this study suggests that the policies of the PNB may be contributing to English becoming a gatekeeper for higher education and employment thereby becoming a tool for sustaining inequality in Colombia.

Geographical Literacy, Attitudes, and Experiences of Freshman Students: A Qualitative Study at Florida International University

The purpose of the study was to explore the geography literacy, attitudes and experiences of Florida International University (FIU) freshman students scoring at the low and high ends of a geography literacy survey. The Geography Literacy and ABC Models formed the conceptual framework. Participants were freshman students enrolled in the Finite Math course at FIU. Since it is assumed that students who perform poorly on geography assessments do not have an interest in the subject, testing and interviewing students allowed the researcher to explore the assumption. In Phase I, participants completed the Geography Literacy Survey (GLS) with items taken from the 2010 NAEP Geography Subject Area Assessment. The low 35% and high 20% performers were invited for Phase II, which consisted of semi-structured interviews. A total of 187 students participated in Phase I and 12 in Phase II. The primary research question asked was what are the geography attitudes and experiences of freshman students scoring at the low and high ends of a geographical literacy survey? The students had positive attitudes regardless of how they performed on the GLS. The study included a quantitative sub-question regarding the performance of the students on the GLS. The students’ performance on the GLS was equivalent to the performance of 12th grade students from the NAEP Assessment. There were three qualitative sub-questions from which the following themes were identified: the students’ definition of geography is limited, students recall more out of school experiences with geography, and students find geography valuable. In addition, there were five emergent themes: there is a concern regarding a lack of geographical knowledge, rote memorization of geographical content is overemphasized, geographical concepts are related to other subjects, taking the high school level AP Human Geography course is powerful, and there is a need for real-world applications of geographical knowledge. The researcher offered as suggestions for practice to reposition geography in our schools to avoid misunderstandings, highlight its interconnectedness to other fields, connect the material to real world events/daily decision-making, make research projects meaningful, partner with local geographers, and offer a mandatory geography courses at all educational levels.

Fall prevention among older adults: a quantitative and qualitative study

The purpose of this study was to investigate the effect of a fall prevention program on older adults as well as to explore the perceptions of older adults have on fall risk and the fall prevention program. This research was completed in Newfoundland and Labrador, Canada with participants above the age of 65. The 10-week fall prevention program focused on balance, strength, and flexibility and was followed by focus groups with the control and intervention groups. Pre and post-test measures (postural sway, TUG test, foam and dome test, ABC Scale, ESE Scale, FES Scale, SAFFE) were completed to determine if the fall prevention program decreased fall risk. The results of the quantitative portion of the study did not produce significant results however the qualitative portion was very informative. Five themes emerged from the focus group data: risk factor awareness, confidence, connectedness, quality of life, and program promotion. This research highlights the importance of fall prevention programs for older adults, not only to keep them healthy, but also for the personal and social benefits they facilitate.

Exploring individuals' experiences of time-sensitive practice in rural Newfoundland and Labrador: a qualitative study

Rural residents of NL face some of the most complex and challenging mental health issues including depression, schizophrenia, and risk of suicide with inadequate and hard to access treatment services. Due to the increasing demands for mental health services, government officials have been emphasizing the need for more responsive and person-centered services to meet client needs. Time-sensitive counselling, an alternative approach to long-term counselling, provides more timely and focused interventions. Mental Health services in Bonavista, a rural community in NL, recently began offering time-sensitive counselling services to its residents, entitled the “Change Clinic.” This phenomenological qualitative research study explored individuals’ experiences of time-sensitive counselling services as offered by mental health services in Bonavista. The results of this research study are detailed and suggest that time-sensitive counselling services can assist in meeting the service needs of rural residents of NL.

The feasibility and acceptability of trial procedures for a pragmatic randomised controlled trial of a structured physical activity intervention for people diagnosed with colorectal cancer : findings from a pilot trial of cardiac rehabilitation versus usual care (no rehabilitation) with an embedded qualitative study

Funding This work is supported by the National Institute for Health Research—Health Service and Development Research, Project reference number: NIHR—HS&DR Project:12/5001/09.

Managing chronic widespread pain in primary care : a qualitative study of patient perspectives and implications for treatment delivery

Funding The MUSICIAN trial was supported by an award from Arthritis Research UK, Chesterfield, UK. Grant number: 17292. The funding body approved the design of the study. They played no role in the collection, analysis, and interpretation of data or the writing of the manuscript.

Migration and Perception of Health Status: a Qualitative Study in Kazakh Chinese

This qualitative study explored the rural to urban migration’s effect and its related factors on later life health status and health perception among Kazakh Chinese. The participants were same sex sibling pairs, of which one moved from rural to urban areas in early life and the other stayed in rural areas. Rural participants tend to have more selected chronic diseases conditions and other self-reported conditions than urban participants but less physical limitations in older age. There is no clear difference on the health perceptions between rural and urban participants. Health care access and environmental factors are the major differences that may affect health in later life for rural participants.