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Full-Text Articles in Psychiatric and Mental Health

Generalized Anxiety Disorder Symptoms Stratified By Age In Primary Care, Robin E. Mccoy Jan 2023

Generalized Anxiety Disorder Symptoms Stratified By Age In Primary Care, Robin E. Mccoy

Walden Dissertations and Doctoral Studies

Little is known as to the age-related presentation of somatic complaints of those diagnosed with generalized anxiety disorder in primary care settings. A retrospective medical records review sought to identify the affective symptoms of generalized anxiety disorder (GAD) by age as recorded by primary care providers and to test the association of these symptoms by age. Guided by Engle’s (1977) biopsychosocial (BPS) model, a large administrative claim database system was used to derive a sample of 1,336, including 500 patients diagnosed with generalized anxiety disorder between 2018 to 2021. Binary logistics regression, one-way ANOVA, chi-square, correlation, and logistical regression with …


The Essence Of Therapeutic Relationships In Equine-Assisted Psychotherapy, Joy Clark Akin Jan 2023

The Essence Of Therapeutic Relationships In Equine-Assisted Psychotherapy, Joy Clark Akin

Walden Dissertations and Doctoral Studies

AbstractTraditional psychotherapeutic approaches are not always effective in alleviating psychological symptoms and improving functioning in young adults. Equine-assisted psychotherapy (EAP) has been shown as a beneficial alternative therapeutic method developed for clients not helped by traditional methods. However, the essence of the therapeutic relationship that develops between the client, horse, therapist, and equine specialist has not been explored. The purpose of this phenomenological study was to explore the lived experience of the therapeutic relationship in young adults who participated in EAP. The frameworks of person-centered theory and self psychology guided the development of interview questions, data analysis, and interpretation. Four …


The Relationship Between Loneliness And Experiential Avoidance After Implementation Of A Self-Compassion Intervention, Alyssa Mielock Jan 2023

The Relationship Between Loneliness And Experiential Avoidance After Implementation Of A Self-Compassion Intervention, Alyssa Mielock

Graduate Research Theses & Dissertations

An individual’s perception of a social relationship is distinct from an individual’s difficulty forming and maintaining social relationships. Loneliness is defined as an individual’s distress resulting from the discrepancy between perceived and desired social relationship quality. In the short term, loneliness may act as a motivator for an individual to seek social support to minimize distress. However, long-term loneliness is associated with physical and psychological impairments. There have been several risk factors identified that contribute to chronic loneliness, such as social isolation, psychopathology, and ineffective coping strategies. Ineffective coping may be one mechanism by which loneliness is associated with psychopathology …


Identification And Removal Of Barriers To Va Mental Health Treatment For Black Female Veterans, Thea Jenune Williams Jan 2023

Identification And Removal Of Barriers To Va Mental Health Treatment For Black Female Veterans, Thea Jenune Williams

DSW Capstone Projects

The Department of Veteran Affairs (VA) operates the largest integrated health care system in the country. The VA dates back to 1865, when President Lincoln signed legislature establishing a network for caring for the nation’s wounded after the Civil War. Many see this system as a safety net for the nation’s military veterans. Research shows veterans have reported several factors that interfere with them receiving needed mental health treatment from the VA. The majority of veterans are males however the number of females is quickly growing. Currently, females make up 11% of the veteran population and are projected to reach …


Sustaining Breaths For Restorative Rest: A Preliminary Evaluation Of Sleep, Mental Health, And Cognitive Function Following Hypoglossal Nerve Stimulation For Obstructive Sleep Apnea, Elliottnell Perez Jan 2023

Sustaining Breaths For Restorative Rest: A Preliminary Evaluation Of Sleep, Mental Health, And Cognitive Function Following Hypoglossal Nerve Stimulation For Obstructive Sleep Apnea, Elliottnell Perez

Theses and Dissertations

Introduction: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that produces repetitive obstruction or collapse of the upper airway. Positive airway pressure (PAP) therapy is the gold standard treatment for OSA. Hypoglossal nerve stimulation (HNS) is considered an alternative treatment for patients who are unable to tolerate PAP therapy. The purpose of the study was to examine sleep, mental health, and cognitive health outcomes before and after HNS to determine its viability as an alternative treatment.

Methods: The study utilized a single-group, pretest-posttest design. Objective and subjective sleep was measured using actigraphy, sleep diary, and questionnaires. Objective and subjective …


Secondary Traumatic Stress Is An Occupational Hazard For Pet Hospice Support Staff: Psychoeducational Support Groups Provide The Cure, Kari Hayden Jan 2023

Secondary Traumatic Stress Is An Occupational Hazard For Pet Hospice Support Staff: Psychoeducational Support Groups Provide The Cure, Kari Hayden

DSW Capstone Projects

There are three separate yet interrelated products presented in this final capstone product. The completed product is focused on pet hospice veterinary support staff and the need for an evidence-based social work intervention to combat secondary traumatic stress. This capstone uses the andragogical approach to adult learning theory as the foundation to construct a psychoeducational peer support group specific to this population. Implications for clinical social work in veterinary medicine are presented within this project.

The first scholarly product presented is the Systematic Literature Review (SLR). The SLR utilizes a scoping review process in an attempt to locate prior research …


Examining Measurement Invariance Of The Pios And Pios-R Across Christian, Jewish, And Muslim Groups, Johanna Anita Younce Jan 2023

Examining Measurement Invariance Of The Pios And Pios-R Across Christian, Jewish, And Muslim Groups, Johanna Anita Younce

Graduate Research Theses & Dissertations

The Penn Inventory of Scrupulosity (PIOS) was developed in a sample of primarily Christian participants. Since scrupulosity is intertwined with religion, it is important to establish that the PIOS and its revised version (PIOS-R) are invariant across the religions with which the measure is primarily utilized: Christianity, Islam, and Judaism. Additionally, there was inconsistency in the literature as to the factor structure of the PIOS/PIOS-R, so three of the models in the literature each were examined and compared for the PIOS and the PIOS-R. 718 participants were recruited through MTurk and reported affiliation with either Christianity (n = 274), Islam …


Mental Health Experiences Of Black Males Beyond Juvenile Delinquency, Jasmine D. Spratling Jan 2023

Mental Health Experiences Of Black Males Beyond Juvenile Delinquency, Jasmine D. Spratling

Walden Dissertations and Doctoral Studies

Incarceration rates around the United States continue to increase for Black male adolescents. These numbers are even more significant in Atlanta, where youth spend time in juvenile detention centers and return soon once released. Summary findings from existing research showed the lack of mental health services provided once a youth has been released from incarceration, but a lack of specifics around the services needed remains. The purpose of the current study was to explore the experiences of Black male adolescents who received little to no trauma informed care post-incarceration. A qualitative, phenomenological approach was used to conduct semistructured interviews with …


Mental Health In Black Women With Endometriosis-Related Symptoms During Covid-19, Anjanette Jaye Blunt Jan 2023

Mental Health In Black Women With Endometriosis-Related Symptoms During Covid-19, Anjanette Jaye Blunt

Walden Dissertations and Doctoral Studies

Endometriosis is an incurable chronic illness impacting 190 million women worldwide. Despite the prevalence of this painful disease, research addressing how it affects Black women in the United States was limited. Research addressing this phenomenon during the COVID-19 pandemic was further limited. The purpose of this qualitative study employing an interpretative phenomenological analysis was to understand the mental health of Black women with endometriosis-related symptoms during the COVID-19 pandemic and how having the illness during the pandemic might have impacted individuals in this population. The strong Black woman schema and biopsychosocial model were the theoretical foundations for the study. Data …


Religiosity, Daily Rosary, And Well-Being Of Catholics In College During The Pandemic, Michael Raul Rios Jan 2023

Religiosity, Daily Rosary, And Well-Being Of Catholics In College During The Pandemic, Michael Raul Rios

Walden Dissertations and Doctoral Studies

Before and since the Coronavirus pandemic, college students suffered from increasing rates of mental health conditions affecting their well-being. Researchers have requested more studies on prayer as a strategy to address well-being issues. The purpose of this anonymous online survey study (N = 59) was to discover if there were any associations between religiosity and well-being, daily Rosary frequency and well-being, and if daily Rosary frequency mediated an association between religiosity and well-being of Catholic students in college in the United States during the pandemic in 2021. Participants were recruited via social media, listservs, email, one nationwide organization, the Walden …


Occupational Burnout Factors Among Correctional Mental Health Providers, Morgan Gruhot Jan 2023

Occupational Burnout Factors Among Correctional Mental Health Providers, Morgan Gruhot

Walden Dissertations and Doctoral Studies

Burnout rates of correctional employees are higher than employees in the general public. The purpose of this study was to identify how occupational factors impact burnout rates among correctional mental health workers. Grounded in the job-demands theoretical model, this study compared burnout rates among mental health staff within county jails and state prisons. Burnout was measured using the Maslach Burnout Inventory and Occupational factors were measured using the Areas of Work life Survey and Pandemic Experience and Perception Survey. Data was analyzed using IBM SSPS software to address multiple a priori directional research questions. Research questions considered how occupational factors …


Organizational Strategies And Best Practices For Telehealth Delivery During Covid-19, Maria D. Mejia Jan 2023

Organizational Strategies And Best Practices For Telehealth Delivery During Covid-19, Maria D. Mejia

Walden Dissertations and Doctoral Studies

Organizational Strategies and Best Practices for Telehealth Delivery during COVID-19


Moral Injury Themes Involving Criminal Recklessness Among Adults With Alcohol Use Disorder, Sandra Starch Jan 2023

Moral Injury Themes Involving Criminal Recklessness Among Adults With Alcohol Use Disorder, Sandra Starch

Walden Dissertations and Doctoral Studies

Moral injury (MI) can emerge following transgressive acts against one’s deeply held moral beliefs. Its symptomology involves individual psychological, spiritual, behavioral, and social spheres. It has primarily been studied within the military and in a few select civilian populations. This descriptive phenomenological study involved exploring MI themes among adults with alcohol use disorder (AUD) who had engaged in criminally reckless acts. Data collected from semi-structured interviews with eight participants were coded and analyzed, leading to six major themes revealing the symptomology of MI. Responses from study participants supported Festinger’s theory of cognitive dissonance via their descriptions of alcohol abuse cycles …


Parents’ Perceptions Of The Traits, Characteristics, And Circumstances Of Modern-Day Mass Shooters, Matt Talbot Jan 2023

Parents’ Perceptions Of The Traits, Characteristics, And Circumstances Of Modern-Day Mass Shooters, Matt Talbot

Walden Dissertations and Doctoral Studies

There is little research on parents’ perceptions about the traits, characteristics, and circumstances ascribed to mass shooters and the sources of information shaping these perceptions. Understanding parents’ beliefs about mass shooters and mass shootings can serve to inform approaches to training and education and recommendations for media reporting on such events. Evidence-based knowledge helps parents become more equipped to serve as early interventionists for those who may be moving along a pathway of violence. Application of Gerbner’s cultivation theory frames the process by which media sources shape perceptions. In this phenomenological qualitative study, semi structured interviews were conducted with 19 …


Parents’ Perceptions Of The Traits, Characteristics, And Circumstances Of Modern-Day Mass Shooters, Matt Talbot Jan 2023

Parents’ Perceptions Of The Traits, Characteristics, And Circumstances Of Modern-Day Mass Shooters, Matt Talbot

Walden Dissertations and Doctoral Studies

There is little research on parents’ perceptions about the traits, characteristics, and circumstances ascribed to mass shooters and the sources of information shaping these perceptions. Understanding parents’ beliefs about mass shooters and mass shootings can serve to inform approaches to training and education and recommendations for media reporting on such events. Evidence-based knowledge helps parents become more equipped to serve as early interventionists for those who may be moving along a pathway of violence. Application of Gerbner’s cultivation theory frames the process by which media sources shape perceptions. In this phenomenological qualitative study, semi structured interviews were conducted with 19 …


Exploring The Definition Of Resilience: A Convergent Parallel Mixed Methods Study In Adults Over The Age Of 65, Sara J. Blessington Jan 2023

Exploring The Definition Of Resilience: A Convergent Parallel Mixed Methods Study In Adults Over The Age Of 65, Sara J. Blessington

Antioch University Dissertations & Theses

The definition of a word helps us understand its context and how it is meant to be used in daily life or research. When a word lacks a universal definition, it is hard to know how to use it. “Resilience” is that type of word. The resilience community in psychological research does not have a concrete, universal definition for this word. It takes on whatever characteristics are useful to the investigator. This study began with seeking a universal definition for the domain known as resilience. This study used a convergent parallel design with adults aged 60 and older living independently …


Meeting The Client Halfway: A Relational Revision To Account For Intra-Actions In Psychotherapeutic Space, Lara Pirro Jancetic Jan 2023

Meeting The Client Halfway: A Relational Revision To Account For Intra-Actions In Psychotherapeutic Space, Lara Pirro Jancetic

Antioch University Dissertations & Theses

This post-qualitative study branching from new-materialist, post-humanist epistemology and ontology examines relationality through the lens of three different theories: agential realism, John Shotter’s communication theory, and relational mindfulness. These theories each describe the dynamics involved in relationships, how they each make sense of these dynamics, and what they entail for human relations. Using a post-qualitative diffractive methodology, this study examines these theories and how they intersect to bring about new insights in our understanding of relationships and how this information can support therapy practice. The results are a series of nine principles of orientation, which were applied to marriage and …


The Human-Canine Bond: Levels Of Stress Among Military Spouses During Deployments, Angela L. De Leon-Muniz Jan 2023

The Human-Canine Bond: Levels Of Stress Among Military Spouses During Deployments, Angela L. De Leon-Muniz

Walden Dissertations and Doctoral Studies

Previous research has found that deployment may impact military spouses’ emotional wellbeing and attachment with family members. There remains a critical gap in the literature regarding difference in stress levels between military spouses who own canines and those who do not. The theoretical foundations for this study were Bowlby’s attachment theory and Bowen’s family systems theory. Research questions included exploring the relationships between (a) pet canine ownership, deployment length of time, and military spouses’ stress levels, and (b) pet canine owners’ pet attachment and stress experienced, when their significant others are deployed. The sample comprised 82 spouses with deployed military …


Experience Of Established Mental Health Counselors Working With Adults Who Have Intellectual Disabilities, Margarete Denk Jan 2023

Experience Of Established Mental Health Counselors Working With Adults Who Have Intellectual Disabilities, Margarete Denk

Walden Dissertations and Doctoral Studies

Individuals with disabilities make up the largest minority population in the United States. Individuals with intellectual and developmental disabilities (I/DD) make up a significant portion of this population, yet there are limited studies addressing counseling with the I/DD population. The Council for Accreditation of Counseling and Related Educational Programs has addressed the need for disability competence in their upcoming 2024 standards. The purpose of the phenomenological study was to describe lived experiences of established counselors working with adult clients diagnosed with an I/DD. A descriptive phenomenological approach was used along with the social model of disability. The study involved six …


Mothers Of Children With Disabilities: Perceptions Of Online Peer Mentoring Support, April S. Felder Jan 2023

Mothers Of Children With Disabilities: Perceptions Of Online Peer Mentoring Support, April S. Felder

Walden Dissertations and Doctoral Studies

There has been a trend of increased diagnoses of childhood disabilities in the United States. Mothers who care for a child diagnosed with disabilities typically experience increased parental obligations and maternal mental health deficits that often go undiagnosed or untreated, resulting in adverse events. Researchers found that peer mentoring is an effective, nonclinical resource for addressing these mothers’ intervention needs but have not established alternative ways to increase access and delivery. The purpose of this generic, qualitative study was to explore how mothers of children with disabilities perceive online peer mentoring as an intervention resource for stress and coping. Lazarus’s …


Experience Of Established Mental Health Counselors Working With Adults Who Have Intellectual Disabilities, Margarete Denk Jan 2023

Experience Of Established Mental Health Counselors Working With Adults Who Have Intellectual Disabilities, Margarete Denk

Walden Dissertations and Doctoral Studies

Individuals with disabilities make up the largest minority population in the United States. Individuals with intellectual and developmental disabilities (I/DD) make up a significant portion of this population, yet there are limited studies addressing counseling with the I/DD population. The Council for Accreditation of Counseling and Related Educational Programs has addressed the need for disability competence in their upcoming 2024 standards. The purpose of the phenomenological study was to describe lived experiences of established counselors working with adult clients diagnosed with an I/DD. A descriptive phenomenological approach was used along with the social model of disability. The study involved six …


Generalized Anxiety Disorder Symptoms Stratified By Age In Primary Care, Robin E. Mccoy Jan 2023

Generalized Anxiety Disorder Symptoms Stratified By Age In Primary Care, Robin E. Mccoy

Walden Dissertations and Doctoral Studies

Little is known as to the age-related presentation of somatic complaints of those diagnosed with generalized anxiety disorder in primary care settings. A retrospective medical records review sought to identify the affective symptoms of generalized anxiety disorder (GAD) by age as recorded by primary care providers and to test the association of these symptoms by age. Guided by Engle’s (1977) biopsychosocial (BPS) model, a large administrative claim database system was used to derive a sample of 1,336, including 500 patients diagnosed with generalized anxiety disorder between 2018 to 2021. Binary logistics regression, one-way ANOVA, chi-square, correlation, and logistical regression with …


Occupational Burnout Factors Among Correctional Mental Health Providers, Morgan Gruhot Jan 2023

Occupational Burnout Factors Among Correctional Mental Health Providers, Morgan Gruhot

Walden Dissertations and Doctoral Studies

Burnout rates of correctional employees are higher than employees in the general public. The purpose of this study was to identify how occupational factors impact burnout rates among correctional mental health workers. Grounded in the job-demands theoretical model, this study compared burnout rates among mental health staff within county jails and state prisons. Burnout was measured using the Maslach Burnout Inventory and Occupational factors were measured using the Areas of Work life Survey and Pandemic Experience and Perception Survey. Data was analyzed using IBM SSPS software to address multiple a priori directional research questions. Research questions considered how occupational factors …


Behavioral Health Leadership Strategies To Increase Telehealth Engagement, Ramona Singletary-Robertson Jan 2023

Behavioral Health Leadership Strategies To Increase Telehealth Engagement, Ramona Singletary-Robertson

Walden Dissertations and Doctoral Studies

One of the challenges brought on by the recent COVID-19 pandemic has been the promotion and use of telehealth services. While recent data from Medicare has depicted an increase in this new service delivery modality (over 4,000%), there has been a stark disparity in the use of telehealth services in lower socioeconomic demographics, such as rural and underrepresented communities, and among Medicare recipients. Equitable, consistent, and optimal service expansion of the telehealth modality requires therapists and leaders of behavioral health organizations to develop and deploy creative tactics to remedy this disparity. In this case study, leaders of Miss Emma's Behavioral …


Family-Level Antecedents Of Children's Patterns Of Reactivity To Interparental Conflict: Testing The Reformulation Of Emotional Security Theory Jan 2023

Family-Level Antecedents Of Children's Patterns Of Reactivity To Interparental Conflict: Testing The Reformulation Of Emotional Security Theory

Faculty, Staff and Student Publications

Guided by emotional security theory, this study examined the family-level antecedents of children's reaction patterns to interparental conflict in a sample of 243 preschool children (M age = 4.60 years; 48% Black; 16% Latinx; 56% girls) and their parents in the Northeastern United States. Behavioral observations of children's responses to interparental conflict over two annual measurement occasions assessed their tendencies to exhibit four patterns of defending against threat: secure (i.e., efficiently address direct threats), mobilizing (i.e., high reactivity to potential threat and social opportunities), dominant (i.e., directly defeat threat), and demobilizing (i.e., reduce salience as a target of hostility). …


An Updated Look At Mental Health Services In American Public And Private Prisons, Lieren E. Tyira Dec 2022

An Updated Look At Mental Health Services In American Public And Private Prisons, Lieren E. Tyira

Student Theses

People residing in American prisons have the legal right to mental health care while incarcerated (Justia, 2021). This is important, as the prevalence of mental disorders is high in this population (Prins, 2014), and incarceration is a psychologically damaging experience, which hinders a person’s success at rehabilitation. Numerous of issues related to the mental health services (MHSs) in both public and private prison facilities have been reported in recent years, which warrants systematic exploration. The little existing research comparing the presence of MHSs in these facilities has produced mixed results, it uses out-of-date datasets, and none has explored MHSs in …


Les Facteurs Qui Influencent L'Émergence D'Un Sentiment D'Injustice Suite À Un Accident Du Travail, Michael J. L. Sullivan, Manon Truchon, Pierre Coté, Marie Achille Dec 2022

Les Facteurs Qui Influencent L'Émergence D'Un Sentiment D'Injustice Suite À Un Accident Du Travail, Michael J. L. Sullivan, Manon Truchon, Pierre Coté, Marie Achille

Rapports de recherche scientifique

De nombreuses études ont rapporté que des niveaux élevés de sentiment d’injustice sont associés à un rétablissement problématique chez les personnes souffrant d’un large éventail de problèmes débilitants de santé et de santé mentale. On en sait peu actuellement sur les facteurs déterminants du sentiment d’injustice dans les suites immédiates d’un accident du travail, ou sur les facteurs déterminants des changements dans le sentiment d’injustice.

L’objectif principal de cette recherche était d’identifier les déterminants du sentiment d’injustice dans les premières semaines suivant un accident du travail. L’échantillon de participants comprenait 187 personnes (92 hommes et 95 femmes) ayant subi une …


Therapists’ Demonstrated Multicultural Competence In Treating Latinx Immigrants, Dulce Diaz Benitez Dec 2022

Therapists’ Demonstrated Multicultural Competence In Treating Latinx Immigrants, Dulce Diaz Benitez

Graduate Theses and Dissertations

Studies suggest that health disparities occur when people from marginalized communities receive care that is inadequate based on their cultural needs (USDHHS, 2011). Multicultural competence (MCC) models have been proposed to provide a framework of the competencies that therapists should develop to work with multicultural populations (Sue et al., 1992). Researchers have questioned the validity of measures, which are mostly based on therapist self-report (Cartwright, 2008). The multicultural case conceptualization ability task has been used in previous studies as a measure of demonstrated cultural competence using a vignette to assess case conceptualization abilities (Ladany et al., 1997). However, it has …


Exposure To Unpredictability And Mental Health: Validation Of The Brief Version Of The Questionnaire Of Unpredictability In Childhood (Quic-5) In English And Spanish, Natasha G. Lindert, Megan Y. Maxwell, Sabrina R. Liu, Hal S. Stern, Tallie Z. Baram, Elysia Poggi Davis, Victoria B. Risbrough, Dewleen G. Baker, Caroline M. Nievergelt, Laura M. Glynn Nov 2022

Exposure To Unpredictability And Mental Health: Validation Of The Brief Version Of The Questionnaire Of Unpredictability In Childhood (Quic-5) In English And Spanish, Natasha G. Lindert, Megan Y. Maxwell, Sabrina R. Liu, Hal S. Stern, Tallie Z. Baram, Elysia Poggi Davis, Victoria B. Risbrough, Dewleen G. Baker, Caroline M. Nievergelt, Laura M. Glynn

Psychology Faculty Articles and Research

Unpredictability is increasingly recognized as a primary dimension of early life adversity affecting lifespan mental health trajectories; screening for these experiences is therefore vital. The Questionnaire of Unpredictability in Childhood (QUIC) is a 38-item tool that measures unpredictability in childhood in social, emotional and physical domains. The available evidence indicates that exposure to unpredictable experiences measured with the QUIC predicts internalizing symptoms including depression and anxiety. The purpose of the present study was to validate English and Spanish brief versions (QUIC-5) suitable for administration in time-limited settings (e.g., clinical care settings, large-scale epidemiological studies). Five representative items were identified from …


Understanding The Mental Health Impact And Needs Of Public Healthcare Professionals During Covid-19 In Pakistan : A Qualitative Study, Waqas Hameed, Anam Shahil Feroz, Bilal Iqbal Avan, Bushra Khan, Zafar Fatmi, Noreen Afzal, Hussain Jafri, Mansoor Ali Wassan, Sameen Siddiqi Nov 2022

Understanding The Mental Health Impact And Needs Of Public Healthcare Professionals During Covid-19 In Pakistan : A Qualitative Study, Waqas Hameed, Anam Shahil Feroz, Bilal Iqbal Avan, Bushra Khan, Zafar Fatmi, Noreen Afzal, Hussain Jafri, Mansoor Ali Wassan, Sameen Siddiqi

Community Health Sciences

Objectives: A dearth of qualitative studies constrains in-depth understanding of health service providers' perspectives and experiences regarding the impact of COVID-19 on their mental health. This study explored the mental health impact and needs of of public sector healthcare workers during COVID-19 who working in secondary-level and tertiary-level healthcare settings of Pakistan.
Design: An exploratory qualitative study.
Setting: Twenty-five secondary-level and eight tertiary-level public hospitals of Sindh and Punjab provinces of Pakistan.
Participants: In-depth interviews were conducted with 16 health service providers and 40 administrative personnel. Study data were analysed on NVivo V.11 using the conventional content analysis technique.
Results: …