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Articles 1 - 30 of 65
Full-Text Articles in Medicine and Health Sciences
Stressed Fracture: The Relationship Between Coping Strategies And Workload In Secondary School Athletic Trainers, Andrew Gallucci, Katherine M. Lee, Leslie W. Oglesby, Anna Porter, Leslee Funderburk, Jeff S. Forsse
Stressed Fracture: The Relationship Between Coping Strategies And Workload In Secondary School Athletic Trainers, Andrew Gallucci, Katherine M. Lee, Leslie W. Oglesby, Anna Porter, Leslee Funderburk, Jeff S. Forsse
Internet Journal of Allied Health Sciences and Practice
Purpose: The work environment for an athletic trainer (AT) working in a secondary school is typified by heavy workloads and job-related stress. Occupational stress can have negative effects on productivity, absenteeism, employee turnover, and quality of life. Research suggests that personal and situational factors can influence the coping process adopted by an individual. The approach-avoidance framework suggests that people cope with a stressor by either attempting to reduce it or removing oneself from that stressor. Previous research on other healthcare professionals suggested that use of avoidance coping was correlated with higher levels of job stress and those who perceived greater …
Hearing Loss As A Risk Factor For Cognitive Decline In The Elderly: A Rapid Review, Natalie Large, Nannette Nicholson
Hearing Loss As A Risk Factor For Cognitive Decline In The Elderly: A Rapid Review, Natalie Large, Nannette Nicholson
Internet Journal of Allied Health Sciences and Practice
Purpose: The aim of this rapid review was to identify and evaluate evidence exploring hearing loss as a risk factor for cognitive decline in the elderly population. Methods: A literature search was performed in three databases: CINAHL, Cochrane Central, and PubMed. The PRISMA template was used to record the search and selection process. Search criteria included older adults aged 65 and up with diagnosed or self-reported hearing loss and no previous diagnosis of dementia or Alzheimer’s disease. Participants were excluded if they had been diagnosed with dementia or tested for it before the study began. Hearing loss was categorized using …
The Effectiveness Of Serotonin And Tricyclic Antidepressants In Tinnitus Management: A Rapid Review, Dr. Emilie Vos, Dr. Nannette Nicholson, Melinda Johnson, Dr. Karah Gottschalk
The Effectiveness Of Serotonin And Tricyclic Antidepressants In Tinnitus Management: A Rapid Review, Dr. Emilie Vos, Dr. Nannette Nicholson, Melinda Johnson, Dr. Karah Gottschalk
Internet Journal of Allied Health Sciences and Practice
Background: Tinnitus can be defined as a health condition characterized by the perception of sound, either in the head and/or ears, in the absence of any external acoustic stimulus. Perception is often quantified by self-report, or the use of patient reported outcome measures (PROMs). The purpose of this rapid review was to evaluate the level and quality of evidence regarding the use of serotonin and norepinephrine reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI), and tricyclic antidepressants as measured by tinnitus patient-reported outcome measures (PROMs) and/or Visual Analog Scales (VAS). Methods: The Cochrane Rapid Review guidelines were followed. The PICO …
Perceptions Of Mental Health Among Pakistani Women With Micro-Finance Loans: An Interpretive Descriptive Study, Farhana Irfan Madhani, Catherine Tompkins, Susan Jack, Carolyn Byrne
Perceptions Of Mental Health Among Pakistani Women With Micro-Finance Loans: An Interpretive Descriptive Study, Farhana Irfan Madhani, Catherine Tompkins, Susan Jack, Carolyn Byrne
The Qualitative Report
Mental health has gained significant recognition and importance as a crucial aspect of overall well-being. An individual's mental health is influenced by the intersection of individual, social, cultural, and systematic sources of stress and resilience. It is important to include subjective conceptualizations of mental health and well-being to develop culturally sensitive approaches to mental health promotion. This qualitative study aimed to understand how urban-dwelling women living in Pakistan who are micro-finance loan recipients conceptualize the meaning of mental health. Using interpretive description methodology, data were collected and analyzed through in-depth, semi-structured interviews conducted in Urdu with a purposeful sample of …
Physical Therapy Students Experience Reductions In Physical Activity And Social Interaction During Coronavirus-Related Curricular Changes: A Cohort Study, Daniel W. Flowers, Amanda Bernard, Erin Mccallister, Lauren Rachal Sant
Physical Therapy Students Experience Reductions In Physical Activity And Social Interaction During Coronavirus-Related Curricular Changes: A Cohort Study, Daniel W. Flowers, Amanda Bernard, Erin Mccallister, Lauren Rachal Sant
Internet Journal of Allied Health Sciences and Practice
Purpose: The Coronavirus disease 2019 (COVID-19) pandemic challenged physical therapy students and faculty. The faculty at this institution implemented a modular curriculum progressing from in-person to remote learning to parallel a predicted autumn COVID-19 surge. This study compares the effect of varying educational models on physical therapy students’ physical activity and social isolation outcomes during their program’s response to the COVID-19 pandemic. We hypothesized that changes in students’ physical activity and social interaction would be observed throughout the semester as the curriculum became more distance based. Methods: This prospective cohort investigation of 42 students from a single physical therapy program …
A New Christmas Eve: Match Day Eve, Gehan A. Pendlebury
A New Christmas Eve: Match Day Eve, Gehan A. Pendlebury
be Still
The transition of medical student to resident physician represents the student becoming the teacher -- a teacher that will continue to evolve over time. Residents teach medical students, yet residents are taught by their attending physicians. In many ways, Match Day is a milestone marking the beginning of that incremental learning process. The word "doctor" derives from the Latin word “docere” meaning "to teach" as doctors should be teaching their patients good health in their practice of medicine. Likewise, it is an inherent responsibility of all physicians to pass on their knowledge and skills for the betterment of the next …
“Chains Weigh Heavy”: Body Mapping Embodied Experiences Of Anxiety, Priya Vaughan Dr, Anna Tewson, Patricia Morgan Dr, Katherine M. Boydell Professor
“Chains Weigh Heavy”: Body Mapping Embodied Experiences Of Anxiety, Priya Vaughan Dr, Anna Tewson, Patricia Morgan Dr, Katherine M. Boydell Professor
The Qualitative Report
Anxiety has both cognitive and somatic dimensions as is ubiquitous at a population level. We report on an arts-based research workshop gathering data on embodied experiences of anxiety and non-anxiety. We developed an innovative short body mapping workshop to collect data and undertook thematic analysis to analyse textual and visual data. 35 body maps were produced. “Tightness,” “pain,” and “heaviness” were the most frequently expressed embodied sensations of anxiety. By contrast, when not feeling anxious, participants’ bodies primarily felt “energetic,” “ordered,” and “open.” Anxiety was most frequently felt in the stomach, head and heart. 35 Participants mostly used an abstracted, …
“We Live On An Island:” Perspectives On Rural Family Caregiving For Adults With Alzheimer’S Disease And Related Dementias In The United States, Heather J. Williamson, Andria B. Begay, Dorothy J. Dunn, Rachel Bacon, Mark Remiker, Yolanda E. Garcia, Michael J. Mccarthy, Julie A. Baldwin
“We Live On An Island:” Perspectives On Rural Family Caregiving For Adults With Alzheimer’S Disease And Related Dementias In The United States, Heather J. Williamson, Andria B. Begay, Dorothy J. Dunn, Rachel Bacon, Mark Remiker, Yolanda E. Garcia, Michael J. Mccarthy, Julie A. Baldwin
The Qualitative Report
As the United States’ aging population grows, there will be increased prevalence of individuals living with Alzheimer’s Disease and related dementias (ADRD), who largely rely on the support of their family caregivers. Family caregivers residing in rural areas face additional challenges with managing caregiving responsibilities and navigating support services. The purpose of this multilevel phenomenological qualitative study was to explore the assets, unique needs, and resources of rural-residing ADRD caregivers from the caregiver, provider, and policy influencers’ perspectives. The study took place between 2019 through 2021 in northern Arizona, a largely rural and geographically vast area home to caregivers from …
Medicine And Motherhood: The Silent Loads, Gehan A. Pendlebury
Medicine And Motherhood: The Silent Loads, Gehan A. Pendlebury
be Still
This poem articulates the challenging and often misunderstood experience of being a mother in medical school It describes a silent load that often takes a toll on mothers in medicine It describes the feeling of simultaneously being pulled in opposing directions, the pain of missing on special family moments and events The poem offers hope and solidarity for mothers who are enduring this unique experience.
Imposter Phenomenon And Dunning-Kruger Effect: Leveraging Internal Conflicts For Professional Growth And Wellness, Arkene Levy, Algevis Wrench, Maria Padilla, Vijay Rajput Md
Imposter Phenomenon And Dunning-Kruger Effect: Leveraging Internal Conflicts For Professional Growth And Wellness, Arkene Levy, Algevis Wrench, Maria Padilla, Vijay Rajput Md
be Still
Working together as a team, we all came to realize that addressing uncomfortable topics such as imposter phenomenon is important to build resilience among faculty and students.
An Examination Of Emotional Resilience Among Athletic Trainers Working In The Secondary School Setting, Shaine Henert, William Pitney, Bethany Wood, Nicholas E. Grahovec, Tyler A. Wood
An Examination Of Emotional Resilience Among Athletic Trainers Working In The Secondary School Setting, Shaine Henert, William Pitney, Bethany Wood, Nicholas E. Grahovec, Tyler A. Wood
Internet Journal of Allied Health Sciences and Practice
Purpose: Athletic training is a demanding profession that is a stressor for many practitioners. Emotional resilience allows Athletic Trainers (ATs) to persist in their roles and benefit from long and successful careers. The purpose of this study was to explore the level of emotional resilience of ATs working in secondary school settings and identify factors perceived to contribute to or mitigate one's emotional resilience. Method: A sequential explanatory mixed-method design using a cross-sectional online survey followed by in-depth interviews was used to gather information from 160 (16% response rate) secondary school NATA members - 97 (60.6%) female; 63 (39.4%) male …
Assessment And Diagnostic Practices Relating To Autism Spectrum Disorder In The United States And Mexico, Maria Valdez, Jessica R. Stewart, Wan-Lin Chang, Ruth Crutchfield, Ralph Carlson
Assessment And Diagnostic Practices Relating To Autism Spectrum Disorder In The United States And Mexico, Maria Valdez, Jessica R. Stewart, Wan-Lin Chang, Ruth Crutchfield, Ralph Carlson
Internet Journal of Allied Health Sciences and Practice
Purpose: The present study examined and compared professional assessment and diagnostic practices relating to autism spectrum disorder (ASD) in Mexico and the United States (U.S.). This information is of great importance because there is an extremely limited amount of information pertaining the assessment and diagnostic practices for ASD in Mexico and little is known about how these practices compare to those in the U.S. Methods: Archival data from a survey investigating ASD in the U.S. and Mexico was used for this study. Participants included 29 professionals from the U.S. and 7 professionals from Mexico. Professionals were from a variety of …
Correlates Of Caffeinated Energy Drinks, Substance Use, And Behavior Among Adolescents, Lauren N. Maziarz, Lauren A. Dial, Bradley Fevrier, William Ivoska
Correlates Of Caffeinated Energy Drinks, Substance Use, And Behavior Among Adolescents, Lauren N. Maziarz, Lauren A. Dial, Bradley Fevrier, William Ivoska
Internet Journal of Allied Health Sciences and Practice
Background: Caffeinated energy drinks (CCEDs) are frequently consumed by adolescents aged 10-19, yet the effects of consumption on adolescent behavior are not well understood. Previous research has identified positive associations between CCED use and other substances such as alcohol and marijuana but studies among adolescents are lacking. Methods: We conducted a secondary analysis using data collected from the 2019 Alcohol, Drug Addition, and Mental Health Services (ADAMHS) Board/Wood County Educational Service Center’s youth survey. Ten public schools in Wood County, Ohio participated (n=6,152). Results: CCED use was common among our sample (43.4% overall). Reported consumption increased with age and was …
A Conceptualisation Of Resilience Among Cancer Surviving Employed Women In Malaysia, Melati Sumari, Nordinah Mohd Kassim, Nor Safatul Aznin A.Razak
A Conceptualisation Of Resilience Among Cancer Surviving Employed Women In Malaysia, Melati Sumari, Nordinah Mohd Kassim, Nor Safatul Aznin A.Razak
The Qualitative Report
This study examines the experiences faced by employed female cancer survivors when developing resilience. We used a phenomenological approach to understand these experiences and challenges. A total of ten participants with different types of cancer participated in this research, which was carried out using semi-structured interviews. Social media was used for triangulating the data collected. The meanings of resilience were monitored through the particpants’ social media accounts (namely, Facebook and Instagram) from the time of diagnosis until they returned to work. Data were analysed using thematic analysis. Five themes emerged from the data collected: (a) resilience through painful experience, (b) …
Coping Strategies For Inner Conflicts Between Gay Bear Identity And Health Concerns, Chichun Lin, Darren D. Moore
Coping Strategies For Inner Conflicts Between Gay Bear Identity And Health Concerns, Chichun Lin, Darren D. Moore
The Qualitative Report
Gay bear refers to a burly gay man with a hirsute body and face. Chinese gay bear men are highly homogeneous and strictly emphasize a uniform bear appearance; however, obesity is an obvious health issue in this population. This study aims to explore the Chinese gay bear men's inner conflicts between bear identity and health concerns. Eleven Chinese gay bear men including four Taiwanese, two mainland Chinese, two Hong Kong, two Malaysian, and one Singaporean were interviewed. The study used a thematic analysis approach and found three coping strategies including (a) Eat healthy but maintain a minimal bear standard; (b) …
The Lived Experience Of Postpartum Anxiety During Covid-19: A Hermeneutic Phenomenological Study, Walker Ladd Phd, Jenny De Decker
The Lived Experience Of Postpartum Anxiety During Covid-19: A Hermeneutic Phenomenological Study, Walker Ladd Phd, Jenny De Decker
The Qualitative Report
The experience of pregnancy and postpartum anxiety disorders results in adverse birth outcomes and the disrupted development of infants and children. Since the COVID-19 Pandemic, the Centers for Disease Control and Prevention (CDC) has designated pregnant and postpartum women as more vulnerable to COVID-19 (CDC, 2021), and perinatal mood and anxiety disorders rates have increased. However, research regarding the lived experience of women with postpartum anxiety (PPA) during a global pandemic remains lacking. Using van Manen’s hermeneutic phenomenological research method, we interviewed eight women self-identifying as having had PPA during the COVID-19 pandemic. Analysis revealed five themes describing the lived …
Influences On The Attachment Style Of Deaf Adults With Hearing Parents, Ellen Schaefer-Salins
Influences On The Attachment Style Of Deaf Adults With Hearing Parents, Ellen Schaefer-Salins
JADARA
The current study explored variables that could contribute to the development of a secure or insecure attachment style of 15 deaf adults between the ages of 30 and 50 with hearing parents. There is a paucity of information on the relationship of deaf adults to their hearing parent and how that relationship may influence attachment. For the current study, quantitative methods were used to explore both childhood and adulthood variables, such as type of communication used with parents, type and level of schooling, and current attachment style. Variables also studied include age, gender, race, birth order, marital status, the hearing …
Self-Portraits For Social Change: Audience Response To A Photovoice Exhibition By Women With Disability, Diane Macdonald, Angela Dew, Karen Fisher Assoc Prof, Katherine Boydell
Self-Portraits For Social Change: Audience Response To A Photovoice Exhibition By Women With Disability, Diane Macdonald, Angela Dew, Karen Fisher Assoc Prof, Katherine Boydell
The Qualitative Report
Negative attitudes about and behaviours towards women with disability are harmful and exclusionary, contributing to poorer health, income, educational, and employment outcomes. Our study focused on what audiences learnt, felt, and did (what changed) after viewing self-portraits and stories by women with disability. We questioned whether a public exhibition of their artworks, created through photovoice methodology, could be an effective platform to provoke social change and increase inclusion for people with disability. We collected audience response to our exhibition to address a research gap and to provide an example for other photovoice researchers. We employed interpretive thematic analysis through a …
Access, Engagement, And Experiences With Critical Incident Response Resources In Athletic Training, Karen L. Holmes, Elizabeth R. Neil, Kelcey C. Granger, Lindsey E. Eberman
Access, Engagement, And Experiences With Critical Incident Response Resources In Athletic Training, Karen L. Holmes, Elizabeth R. Neil, Kelcey C. Granger, Lindsey E. Eberman
Internet Journal of Allied Health Sciences and Practice
Purpose: Experiencing an event that involves actual or threatened death or serious injury is a critical incident and produces serious emotional responses. Athletic trainers (ATs) experience critical incidents in their day-to-day work. The purpose of this study was to explore how ATs experience a critical incident during the course of clinical practice. Methods: We used one-on-one, web-based, semi-structured interviewing with a criterion sample of ATs who experienced a critical incident and used any critical incident response resources in the last year (n=17; age=32±8; years of experience=9±7; years in current position=4±5). We used a 3-person team with a multi-phase process to …
African-American Lay Pastoral Care Facilitators’ Perspectives On Dementia Caregiver Education And Training, Nik M. Lampe, Nidhi Desai, Tomeka Norton-Brown, Alexandra C. H. Nowakowski, Robert L. Glueckauf
African-American Lay Pastoral Care Facilitators’ Perspectives On Dementia Caregiver Education And Training, Nik M. Lampe, Nidhi Desai, Tomeka Norton-Brown, Alexandra C. H. Nowakowski, Robert L. Glueckauf
The Qualitative Report
The African-American Alzheimer’s Caregiver Training and Support Project 2 (ACTS 2) is a faith-integrated, skills-training and support program for distressed African American family caregivers of persons living with dementia across Florida. Caregivers participate in a 12-week, telephone-based, skills-building and support program led by faith community workers (i.e., lay pastoral care facilitators) who provide volunteer services to their denominations. In this case study, we examined facilitators’ perspectives and recommendations for supplementary audiovisual and written training materials to optimize group process and goal-setting skills. Utilizing a qualitative approach, we explored facilitators’ needs, experiences in using current training materials, and recommendations for supplementary …
The Role Of Social Work In Residential Aged Care Facilities: Evaluation Of A Pilot Program In Australia, Jodie L. Lee Ms, Michael Splawa-Neyman Mr, Fiona Mcdermott Associate Professor
The Role Of Social Work In Residential Aged Care Facilities: Evaluation Of A Pilot Program In Australia, Jodie L. Lee Ms, Michael Splawa-Neyman Mr, Fiona Mcdermott Associate Professor
The Qualitative Report
In some international settings, social workers are employed within aged care settings. However, in Australia, social workers rarely work in residential aged care facilities. In an innovative program, an Australian health network employed a social worker in an aged residential care facility from 2010 to 2011. In this research we examine and evaluate this program. Qualitative semi-structured interviews with nine key stakeholders and data extraction from medical records were conducted. Data from medical records and interview transcripts were coded and themes extracted using thematic analysis. Thematic analysis identified five key themes reflecting the roles performed by the social worker. These …
Work The Heart, Train The Brain, Monica Sciturro, Jenna Knafo
Work The Heart, Train The Brain, Monica Sciturro, Jenna Knafo
be Still
No abstract provided.
The Path To Balance, Snigdha Ila, Pallavi Velagapudi, Vishal Ila
The Path To Balance, Snigdha Ila, Pallavi Velagapudi, Vishal Ila
be Still
No abstract provided.
Balance, In All Things, Justin S. Straughan
Balance, In All Things, Justin S. Straughan
be Still
This poem is a vent for the inherent frustration felt from trying to find a career in and bridge the transition between politics and medicine. It reflects a stubborn determination to not give in to critics' "never-enough-ism" while also trying to be open to improvement and not give in to pride nor cynicism.
The Importance Of Explicit And Timely Knowledge Exchange Practices Stemming From Research With Indigenous Families, Elizabeth J. Cooper, S Michelle Driedger
The Importance Of Explicit And Timely Knowledge Exchange Practices Stemming From Research With Indigenous Families, Elizabeth J. Cooper, S Michelle Driedger
The Qualitative Report
Ethical research practice within community-based research involves many dimensions, including a commitment to return results to participants in a timely and accessible fashion. Often, current Indigenous community-based research is driven by a partnership model; however, dissemination of findings may not always follow this approach. As a result, products may not be as useful to participants who were motivated to be involved in the research process. We conducted a seven-week workshop on three occasions with different First Nations and Metis women and girls (age 8-12) in Winnipeg, Manitoba. The workshop explored participants’ perspectives around health, safety, and family wellbeing using a …
Throwing Pebbles While Waiting: An Autoethnographic Exploration Of Mental Health And Colonialism, Kelly Limes Taylor, Rita Sørly, Bengt Karlsson
Throwing Pebbles While Waiting: An Autoethnographic Exploration Of Mental Health And Colonialism, Kelly Limes Taylor, Rita Sørly, Bengt Karlsson
The Qualitative Report
In this article, three scholars jointly investigate questions of Western colonization and mental health. While their areas of interest and experience vary, the authors discuss oppression as a common thread connecting their ideas about mental health and its medicalization. In line with Toyosaki et al. (2009), the researchers did a community autoethnography, performing written dialogue as a dynamic research method. Using a sequential model, Kelly Limes Taylor wrote about her experience, passed it on to Rita Sørly and Bengt Karlsson. Karlsson added his story to the previous writing, and he passed it on to Sørly for further addition of stories. …
Escaping The Escapism: A Grounded Theory Of The Addiction And Recovery Process In Online Video Gaming, Jayson Carmona, Jason Whiting Phd
Escaping The Escapism: A Grounded Theory Of The Addiction And Recovery Process In Online Video Gaming, Jayson Carmona, Jason Whiting Phd
The Qualitative Report
The purpose of this grounded theory study was to describe the experience of people who struggled with self-described addiction to World of Warcraft™ (WoW). WoW is a massive multiplayer online role-playing game (MMORPG), and many players have shared their stories of compulsive use and recovery efforts on two different websites: www.wowdetox.com, and a Reddit forum called /r/noWoW. We analyzed 140 unique posts on these sites to develop a process model describing how posters experienced addiction and recovery from WoW. We used grounded theory methods to create a model with categories including, time sink, impairment in work and relationships, and …
Understanding The Stigma And Feasibility Of Opening A Safe Injection Facility In Baltimore City: A Qualitative Case Study, Timothy Dupree, Caroline I. Wood, Andrea M. Brace
Understanding The Stigma And Feasibility Of Opening A Safe Injection Facility In Baltimore City: A Qualitative Case Study, Timothy Dupree, Caroline I. Wood, Andrea M. Brace
The Qualitative Report
Supervised injection facilities (SIFs) are medically supervised facilities designed to provide a hygienic environment in which drug users can consume illicit drugs intravenously. SIFs can be cost saving, help to reduce transmission of disease, and decrease drug overdoses. There are no SIFs in the United States. In this study we used a multiple case study design to understand the stigma surrounding the use of a SIF and the feasibility of implementing the drug prevention strategy in Baltimore City by comparing experiences with opening a SIF in Sydney, Australia. We interviewed one healthcare worker at the Sydney SIF and ten community …
Coping With Medical School: An Interpretive Phenomenological Study, Sebastian C K Shaw, John L. Anderson
Coping With Medical School: An Interpretive Phenomenological Study, Sebastian C K Shaw, John L. Anderson
The Qualitative Report
Anecdotal evidence suggested that hopelessness and helplessness (HH) were often reported by undergraduate medical students. It is known that medical students are more susceptible to high levels of stress and depression than other student groups. There is currently concern about suicide rates in students and high drop-out rates in junior doctors. But what can be said of HH within this population? This study was aimed at eliciting medical students’ experiences of HH. An interpretive phenomenological approach was adopted. Participants were recruited from a single medical school. Loosely structured, audio-recorded interviews were carried out. Recordings were then transcribed verbatim, then underwent …
An Analysis Of Reflections On Researcher Positionality, Oluwatoyin Olukotun, Elizabeth Mkandawire, Jeri Antilla, Faten Alfaifa, Jennifer Weitzel, Victoria Scheer, Mary Olukotun, Dr. Lucy Mkandawire-Valhmu
An Analysis Of Reflections On Researcher Positionality, Oluwatoyin Olukotun, Elizabeth Mkandawire, Jeri Antilla, Faten Alfaifa, Jennifer Weitzel, Victoria Scheer, Mary Olukotun, Dr. Lucy Mkandawire-Valhmu
The Qualitative Report
Reflexivity is a central tenet of qualitative research. Engaging in self-reflexive praxis allows researchers to identify areas of tension in the research process that need to be further deconstructed. In this paper, we draw on our collective self-reflective experiences as qualitative health researchers whose scholarship is informed by critical and postcolonial feminist epistemologies to offer some guidance on how to approach the concept of insider versus outsider in the research process. Specifically, we analyze recurring methodological tensions related to positionality and outline how they were addressed. The lessons learned from our studies can be instructive to other qualitative researchers.