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Thematic analysis is a widely cited method for analyzing qualitative data. As a team of graduate students, we sought to explore methods of data analysis that were grounded in qualitative philosophies and aligned with our orientation as applied health researchers. We identified reflexive thematic analysis, developed by Braun and Clarke, as an interpretive method firmly situated within a qualitative paradigm that would also have broad applicability within a range of qualitative health research designs. In this approach to analysis, the subjectivity of the researcher is recognized and viewed not as problematic but instead valued as integral to the analysis process. We therefore elected to explore reflexive thematic analysis, advance and apply our analytic skills in applied qualitative health research, and provide direction and technique for researchers interested in this method of analysis. In this paper, we describe how a multidisciplinary graduate student group of applied health researchers utilized Braun and Clarke’s approach to reflexive thematic analysis. Specifically, we explore and describe our team’s process of data analysis used to analyze focus group data from a study exploring postnatal care referral behavior by traditional birth attendants in Nigeria. This paper illustrates our experience in applying the six phases of reflexive thematic analysis as described by Braun and Clarke: (1) familiarizing oneself with the data, (2) generating codes, (3) constructing themes, (4) reviewing potential themes, (5) defining and naming themes, and (6) producing the report. We highlight our experiences through each phase, outline strategies to support analytic quality, and share practical activities to guide the use of reflexive thematic analysis within an applied health research context and when working within research teams.

The aim of the study was to develop a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) summary of findings (SoF) table format that displays the critical information from a network meta-analysis (NMA). We applied a user experience model for data analysis based on four rounds of semistructured interviews. We interviewed 32 stakeholders who conduct or use MA. Four rounds of interviews produced six candidate NMA-SoF tables. Users found a final NMA-SoF table that included the following components highly acceptable: (1) details of the clinical question (PICO), (2) a plot depicting network geometry, (3) relative and absolute effect estimates, (4) certainty of evidence, (5) ranking of treatments, and (6) interpretation of findings. Using stakeholder feedback, we developed a new GRADE NMA-SoF table that includes the relevant components that facilitate understanding NMA findings and health decision-making.

The COVID-19 pandemic has resulted in elevated mental health problems for pregnant women. Effective coping strategies likely reduce the impact of COVID-19 on mental health. This study aimed to (1) understand how COVID-19 stressors are related to different coping strategies and (2) identify whether coping strategies act as mechanisms accounting for the associations between COVID-19 stressful experiences and mental health problems in pregnancy. Participants were 304 pregnant women from Ontario, Canada. Depression, anxiety, insomnia, and perceived stress were assessed using validated measures. COVID-related stressors (i.e., financial difficulties, social isolation), subjective negative impact of COVID-19, and coping strategies used in response to COVID-19 were assessed by questionnaires. Results indicated that the subjective negative impact of COVID-19 was associated with more dysfunctional coping and less emotion-focused coping, whereas specific COVID-19 stressors, namely financial difficulties and social isolation, were associated with more dysfunctional coping and problem-focused coping. Dysfunctional coping was linked to elevated mental health problems and emotion-focused coping was linked to less mental health problems. Dysfunctional coping and emotion-focused coping partially mediated the effects of specific COVID-19 stressors on mental health outcomes. Findings indicate that coping is one pathway through which the COVID-19 pandemic impacts mental health in pregnancy. Supports and interventions for pregnant women during the pandemic should focus on bolstering coping skills, in order to minimize the mental health consequences of COVID-19.

Background Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses’ experiences of patient violence in acute care inpatient psychiatric settings. Methods An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation. Results Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered “part of the job.” Nurses often struggled with role conflict between one’s duty to care and one’s duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace. Conclusions Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.

IntroductionDiscrete choice experiments (DCEs) are increasingly used to elicit value sets for paediatric health-related quality of life instruments, including the EQ-5D-Y. In a multinational pilot study that compared EQ-5D-Y-5L health state preferences among children, adolescents and adults, more inconsistencies in DCE responses were observed among children and adolescents than adults. Possible explanations for inconsistencies could be youths’ limited understanding of health state preferences or lack of engagement with the online survey. This protocol describes the methods of a study that explores the feasibility of eliciting health state preferences for the EQ-5D-Y-5L from Canadian children and adolescents using DCE.Methods and analysisA convergent parallel mixed methods study will be conducted with a purposive, stratified sample of 36 Canadian children and adolescents (13–18 years). In the quantitative study component, participants will complete an online questionnaire with EQ-5D-Y-5L and DCE exercises. The quantitative data on participants’ sociodemographic characteristics, EQ-5D-Y-5L, and feasibility indicators of DCE (ie, incompletion, speeding, flatlining, violation of dominant choice task) will be analysed using descriptive statistics. The second component will be a qualitative focus group discussion to understand their experiences of completing the DCE tasks. Six focus groups (with six participants per group) will be conducted. The qualitative data will be analysed using content analysis. The findings from both components will then be integrated using narrative synthesis.Ethics and disseminationEthics approval was obtained from the Hamilton Integrated Research Ethics Board (#17034). We will publish findings in peer-reviewed journals and present at key conferences. We will also disseminate results within the EuroQol community as the study findings are part of a methodological research programme aimed at informing the design of an EQ-5D-Y-5L valuation study in Canada.

IntroductionImproving healthcare quality in low-/middle-income countries (LMICs) is a critical step in the pathway to Universal Health Coverage and health-related sustainable development goals. This study aimed to map the available evidence on the impacts of health system governance interventions on the quality of healthcare services in LMICs.MethodsWe conducted a scoping review of the literature. The search strategy used a combination of keywords and phrases relevant to health system governance, quality of healthcare and LMICs. Studies published in English until August 2023, with no start date limitation, were searched on PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, Google Scholar and ProQuest. Additional publications were identified by snowballing. The effects reported by the studies on processes of care and quality impacts were reviewed.ResultsThe findings from 201 primary studies were grouped under (1) leadership, (2) system design, (3) accountability and transparency, (4) financing, (5) private sector partnerships, (6) information and monitoring; (7) participation and engagement and (8) regulation.ConclusionsWe identified a stronger evidence base linking improved quality of care with health financing, private sector partnerships and community participation and engagement strategies. The evidence related to leadership, system design, information and monitoring, and accountability and transparency is limited.

Background Understanding organizational mechanisms that protect the mental health of the healthcare workforce during pandemics and epidemics is critical to support decision-making related to worker health and safety. This systematic review aimed to identify organizational-level factors, strategies or interventions that support the mental health of healthcare workers during pandemics or epidemics. Methods A comprehensive search was used, including online databases, a grey literature review, and handsearching of reference lists. Studies were eligible for inclusion if they described implementing or testing organizational-level factors, strategies or interventions to support healthcare workers’ mental health during pandemics or epidemics. There were no limitations by language, publication status, or publication date. Two reviewers independently conducted screening, data extraction, data analysis and quality appraisal, with conflicts resolved through discussion or third-party arbitration. Data analysis was guided by the Job Demands-Resources Model. A narrative synthesis is presented, given the high degree of heterogeneity across studies. Results A total of 10,805 articles from database searches and 190 records from other sources were screened. The final review included 86 articles. Studies were of low ( n  = 11), moderate ( n  = 39), and high quality ( n  = 36). Regarding job demands, 40 studies explored high work pressure or heavy workload factors, with the majority investigating working hours ( n  = 32). Increased working hours may be associated with an increased risk of diverse mental health outcomes. Regarding job resources, leadership factors, strategies (support, appreciation, responsiveness; n  = 19) and leadership interventions ( n  = 3) may be associated with decreased burnout, anxiety, stress, and increased well-being. The availability and adequacy of personal protective equipment ( n  = 20) may be associated with decreased burnout, anxiety, depression, and stress. Mixed findings were reported on associations between diverse mental health outcomes and training and education ( n  = 28) or peer support ( n  = 3). Results should be interpreted cautiously given the high heterogeneity among factors, strategies, and interventions assessed and outcomes measured. Conclusions Organizational-level mechanisms can critically influence the mental health of healthcare workers’ during pandemics and epidemics. More focused attention is needed to explore and act on the integral role of leadership and the availability of protective equipment to support healthcare workers’ mental health.