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A PDF version of this book is available for free in open access via www.tandfebooks.com as well as the OAPEN Library platform, www.oapen.org. It has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 3.0 license and is part of the OAPEN-UK research project. This book presents a comprehensive examination of Chinese consumer behaviour and challenges the previously dichotomous interpretation of the consumption of Western and non-Western brands in China. The dominant position is that Chinese consumers are driven by a desire to imitate the lifestyles of Westerners and thereby advance their social standing locally. The alternative is that consumers reject Western brands as a symbolic gesture of loyalty to their nation-state. Drawing from survey responses and in depth interviews with Chinese consumers in both rural and urban areas, Kelly Tian and Lily Dong find that consumers situate Western brands within select historical moments. This embellishment attaches historical meanings to Western brands in ways that render them useful in asserting preferred visions of the future China. By highlighting how Western brands are used in contests for national identity, Consumer-Citizens of China challenges the notion of the \"patriot’s paradox\" and answers scholars’ questions as to whether Chinese nationalists today allow for a Sino-Western space where the Chinese can love China without hating the West. Consumer-Citizens of China will be of interest to students and scholars of business studies, Chinese and Asian Studies and Political Science. Kelly Tian is Professor of Marketing and holds the Anderson Chair of Business at New Mexico State University. Lily Dong is Associate Professor of Marketing at the University of Alaska at Fairbanks.

Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9. We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy. 16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (-0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01). PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores ≥10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 ≥10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 ≥10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 ≥14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 ≥14 (95% prediction interval: −13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: −16.4%, 15.0%). PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies. •We compared Patient Health Questionnaire-9 (PHQ-9) ≥ 10 prevalence with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence in 44 primary studies (9,242 participants and 1,389 SCID major depression cases) that administered the PHQ-9 and SCID.•We also examined whether an alternative PHQ-9 cutoff could more accurately estimate prevalence.•Pooled PHQ-9 ≥10 prevalence (25%) was double-pooled SCID major depression prevalence (12%); pooled difference from each study was 12%.•PHQ-9 ≥14 and PHQ-9 diagnostic algorithm prevalence most closely matched SCID major depression prevalence, but study-level PHQ-9 ≥14 and PHQ-9 diagnostic algorithm prevalence differed from SCID major depression prevalence with 95% prediction intervals of −14% to 15% and −16% to 15%, respectively.•Estimates of depression prevalence should be based on validated diagnostic interviews designed for determining case status; users should evaluate published reports of depression prevalence to ensure that they are based on methods intended to classify major depression.

This systematic review and individual participant data meta-analysis (IPDMA) examined the overall effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing posttraumatic stress disorder (PTSD) symptoms, achieving response and remission, and reducing treatment dropout among adults with PTSD compared to other psychological treatments. Additionally, we examined available participant-level moderators of the efficacy of EMDR. This study included randomized controlled trials. Eligible studies were identified by a systematic search in PubMed, Embase, PsyclNFO, PTSDpubs, and CENTRAL. The target population was adults with above-threshold baseline PTSD symptoms. Trials were eligible if at least 70% of study participants had been diagnosed with PTSD using a structured clinical interview. Primary outcomes included PTSD symptom severity, treatment response, and PTSD remission. Treatment dropout was a secondary outcome. The systematic search retrieved 15 eligible randomized controlled trials (RCTs); 8 of these 15 were able to be included in this IPDMA (346 patients). Comparator treatments included relaxation therapy, emotional freedom technique, trauma-focused cognitive behavioral psychotherapies, and REM-desensitization. One-stage IPDMA found no significant difference between EMDR and other psychological treatments in reducing PTSD symptom severity ( = -0.24), achieving response ( = 0.86), attaining remission ( = 1.05), or reducing treatment dropout rates ( = -0.25). Moderator analyses found unemployed participants receiving EMDR had higher PTSD symptom severity at the post-test, and males were more likely to drop out of EMDR treatment than females. The current study found no significant difference between EMDR and other psychological treatments. We found some indication of the moderating effects of gender and employment status.

Meeting recruitment targets in an expeditious manner is essential to the successful completion of any research project. However, despite the high prevalence and debilitating nature of Long COVID (LC), recruitment of participants into some LC studies has been challenging. We aimed to a) identify factors influencing participation in LC research among individuals who were infected by SARS-CoV-2 but had declined participation in a LC study and b) to compare these factors to those previously recognized. Using a semi-structured guide, we interviewed thirteen people about their thoughts, experiences, and attitudes concerning participation in LC research. We imported interview transcripts into Nvivo 14 and analyzed them using thematic analysis. For coding, we used Charmaz's coding scheme of open and focused coding within an application of the constant comparative method. Basic descriptive statistics were also deployed to supplement our qualitative analysis. Fifteen factors describe the facilitators and barriers mentioned by participants. The top three facilitators were Personal and social motivation, Incentives, and Familiarity and credibility of institutions involved with COVID-19; the top three barriers were Invasiveness, Social and political context, and Lack of time. Skepticism and infringement on participants' daily lives served as major obstacles to participation while trust, personal factors, and administrative factors encouraged participation. The facilitators and barriers identified are similar to those recognized previously except that in the politically charged atmosphere surrounding the COVID-19 pandemic, trust was especially vital. Many factors affect people's decisions to participate in LC research but only some are modifiable by researchers. Building trust, offering incentives participants value, and removing logistical barriers may improve recruitment rates.

Background The growth in online qualitative research and data collection provides several advantages for health service researchers and participants, including convenience and extended geographic reach. However, these online processes can also present unexpected challenges, including instances of participant fraud or scam behaviour. This study describes an incident of participant fraud identified during online focus group discussions and interviews for a PhD health services research project on paediatric neurodevelopmental care. Methods We aimed to recruit carers of Australian children with neurodevelopmental disorders. Potential participants were recruited via a publicly available social media advert on Facebook offering $50 AUD compensation. Those who expressed interest via email ( n  = 254) were sent a pre-interview Qualtrics survey to complete. We identified imposters at an early stage via inconsistencies in their self-reported geographical location and that captured by the survey as well as recognition of suspicious actions before, during and after focus group discussions and interviews. Results Interest in participation was unexpectedly high. We determined that all potential participants were likely imposters, posing as multiple individuals and using different IP addresses across Nigeria, Australia, and the United States. In doing so, we were able to characterise several “red flags” for identifying imposter participants, particularly those posing as multiple individuals. These comprise a combination of factors including large volumes and strange timings of email responses, unlikely demographic characteristics, short or vague interviews, a preference for nonvisual participation, fixation on monetary compensation, and inconsistencies in reported geographical location. Additionally, we propose several strategies to combat this issue such as providing proof of location or eligibility during recruitment and data collection, examining email and consent form patterns, and comparing demographic data with regional statistics. Conclusions The emergent risk of imposter participants is an important consideration for those seeking to conduct health services research using qualitative approaches in online environments. Methodological design choices intended to improve equity and access for the target population may have an unintended consequence of improving access for fraudulent actors unless appropriate risk mitigation strategies are also employed. Lessons learned from this experience are likely to be valuable for novice health service researchers involved in online focus group discussions and interviews.

Stigma is one of the many factors hindering tuberculosis (TB) control by negatively affecting hospital delay and treatment compliance. In Zambia, the morbidity and mortality due to TB remains high, despite extended public health attempts to control the epidemic and to diminish stigma. To enhance understanding of TB-related stigmatizing perceptions and to describe TB patients' experiences of stigma in order to point out recommendations to improve TB policy. We conducted a mixed method study at Kanyama clinic and surrounding areas, in Lusaka, Zambia; structured interviews with 300 TB patients, multiple in-depth interviews with 30 TB patients and 10 biomedical health workers, 3 focus group discussions with TB patients and treatment supporters, complemented by participant observation and policy analysis of the TB control program. Predictors of stigma were identified by use of multivariate regression analyses; qualitative analysis of the in-depth interviews, focus group discussions and participant observation was used for triangulation of the study findings. We focused on the 138/300 patients that described TB-related perceptions and attitudes, of whom 113 (82%) reported stigma. Stigma provoking TB conceptions were associated with human immunodeficiency virus (HIV)-infection, alleged immoral behaviour, (perceived) incurability, and (traditional) myths about TB aetiology. Consequences of stigma prevailed both among children and adults and included low self-esteem, insults, ridicule, discrimination, social exclusion, and isolation leading to a decreased quality of life and social status, non-disclosure, and/or difficulties with treatment compliance and adherence. Women had significantly more stigma-related problems than men. The findings illustrate that many TB patients faced stigma-related issues, often hindering effective TB control and suggesting that current efforts to reduce stigma are not yet optimal. The content and implementation of sensitization programs should be improved and more emphasis needs to be placed on women and children.

ObjectiveTo examine the views of adolescents with excess weight and parents of adolescents with excess weight towards weight and weight management.DesignA qualitative study design using semi-structured phone interviews. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis to interpret the data.SettingsParents and adolescents based in the UK and recruited through schools, social media and youth centres.ParticipantsTen parents and 16 adolescents, including four linked parent-child dyads.ResultsBoth parents and adolescents reported that adolescents felt societal pressure to achieve an ‘ideal body’ and that this pressure was the primary motivator for weight loss. All interviewed parents perceived themselves as overweight; however, those who had minimal weight-based shame were more likely to normalise weight discussions, reducing weight shame in their children. Adolescents preferred parents to display healthy behaviours rather than initiate weight-based discussions; however, they wanted to feel supported if the conversations were self-initiated.ConclusionWeight is a sensitive issue in intergenerational relationships, primarily driven by feelings of shame. Adolescents feel supported by a ‘show not tell’ approach from parents, which is more likely in families with less shame. While guidelines encourage clinicians to initiate weight-related conversations, this may not be welcomed by adolescents, although they do want confidence that they could access weight management support if they choose to seek help.

Background Medical educators operate in high-pressure environments where resilience is critical to their well-being and professional effectiveness. Studies exploring how medical educators conceptualise resilience is limited, particularly outside Western contexts. As such, research investigating culturally-sensitive conceptualisations of resilience in an Asian context is overdue. This study addresses this gap by exploring how medical educators in Hong Kong (HK) conceptualise resilience, attending to the cultural and professional nuances that shape these understandings. Method Twenty medical educators teaching medical students, trainees and/or physicians at HK’s two medical schools were recruited via email using maximum variation sampling. Semi-structured online interviews were conducted in English, audio- and video-recorded and transcribed verbatim. Researchers adopted a constructivist epistemology and employed a socio-ecological model to guide Reflexive Thematic Analysis of the transcripts. Results Medical educators predominantly conceptualised resilience as a dynamic process, though some also described it as an outcome of navigating adversity, and to a lesser extent, as an inherent trait. Notably, conceptualisations of resilience as a process and as an outcome often overlapped. Adversity was consistently identified as a fundamental component across definitions. Participants aligned their understandings of resilience closely with their professional roles and pervading sociocultural influences, emphasising relational and cultural dimensions. This holistic approach distinguished their perspectives from more individualised Western notions of resilience. Conclusions Traditional Western frameworks of resilience may not adequately capture its complexities in other cultural contexts. Echoing the socio-ecological model, participants’ conceptualisations were deeply intertwined with HK’s cultural values and socio-contextual dynamics. These findings underscore the need to broaden global understandings of resilience beyond Western paradigms. Importantly, our findings can inform the design of culturally-sensitive faculty development programmes aiming to support medical educator resilience in the future.

Industry stakeholders, academic experts, and regulatory bodies emphasize the importance of prioritizing a patient-centered experience in clinical trials to enhance retention, adherence, and trial participation. Concurrently, there has been a notable rise in the adoption of technology-mediated decentralized methodologies for conducting clinical trials. Nonetheless, is a truly patient-centric approach being achieved? The shift to decentralized approaches risks prioritizing operational efficiency and remote data collection over the nuanced and diverse needs of participants. This raises critical questions about whether the current implementation of decentralized clinical trials (DCTs) fully aligns with the principles of patient centeredness. Using a qualitative approach, our study aims to understand the perceptions of clinical research staff (CRS) of this transition and its impact on delivering a patient-centered experience. A total of 15 CRS with experience of facilitating DCTs were interviewed, and transcripts were analyzed. Our findings reveal 1 superordinate theme-the quality and frequency of interactions with patients and CRS are limited-and six main themes: (1) increasing demands of the CRS role, (2) creating difficulties for patients, (3) knowing the patient and understanding their experience, (4) impacts on forming and maintaining CRS-patient relationship, (5) difficulty in delivering desired level of support and care, and (6) perceived affects to conduct of a trial. While DCTs offer advantages in improving accessibility, they introduce new complexities that can negatively impact patient engagement, retention, and the CRS-patient relationship. This study offers insights into the perspectives of CRS on delivering a patient-centered experience in DCTs. It highlights the benefits of DCTs alongside the challenges they present, emphasizing the need for additional support, training, streamlined technology, and resources to help CRS adapt to evolving trial dynamics. To fully realize the patient-centered potential of DCTs, technology and trial designers must recognize the complex interplay of factors shaping the patient experience. This requires collaboration with CRS and patients to address the diverse needs of all stakeholders, prioritizing the broader aspects of the patient experience beyond at-home convenience and data collection.