The Montessori method applied in nursing homes is a person-centered approach targeting the enhancement of autonomy, well-being, and quality of life for older adults with dementia. Despite its potential in the aging field, its operationalization remains unclear in the context of institutionalization. This study aims to outline the method\'s components and adoption factors using a behavior change intervention framework among professionals from a French institution demonstrating a high level of method application. We employed a qualitative descriptive approach based on thematic analysis. Nine professionals from the same institution underwent a semi-structured individual interview within the facility. The findings were modeled using the Behavior Change Intervention Ontology. We obtained a final framework defining the intervention, mechanisms of action, exposure, contextual factors, and behavioral outcomes. The method is based on values, principles, and techniques such as facilitation, choice, meaningful activities, environmental adjustments, and specific tools. Applied continuously to residents, families, and professionals, its implementation is influenced by several contextual factors leading to practice changes at various levels. This study constitutes both a theoretical and practical contribution, providing a better definition of the method and the key factors influencing its appropriation.

Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting.
HOW THE STUDY WAS PERFORMED AND STATISTICAL TESTS USED: A qualitative case study approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies.
THE MAIN FINDINGS: An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service\'s role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating.

Microaggressions are brief, commonplace indignities expressed through verbal or behavioral means. In China, microaggressions have proliferated with the wide implementation of education protection policies for disabled children (including learning in regular classes (LRC), special school education (SSE), and home-delivery education (HDE)), resulting in severe consequences. However, related issues have not been discussed yet.
This study explores concrete forms of microaggressions that disabled children have experienced under three educational policies.
We took a qualitative phenomenological approach and used semi-structured interviews to collect data. 22 disabled children, their guardians, and eight educators from three compulsory education schools in Jinan, China, were included in this study.
Microaggressions are categorized into three types: microassaults, microinsults, and microinvalidations. In LRC, typical microaggressions include the microassaults of refusal, extra requirements, avoiding needs, and accusations; the microinsults of labeling, differential patronization, and over-protection; and the microinvalidation of suspicion. In SSE, typical microaggressions include the microassaults of refusal, belittling, hiding, and ignoring; the microinsults of assumptions of low intelligence, ignoring, and distancing; and the microinvalidation of suspicion. In HDE, typical microaggressions include the microassaults of denial of privacy and denial of expression; and the microinsults of infantilization and blame.
The microaggressions that disabled children experience under educational policies produce serious disciplinary effects. To eliminate microaggressions, it is necessary to publicize the new disability rights paradigm, engage disabled children and their families in participation in the political process, develop demand-oriented assessment criteria, and standardize educators\' discretion.

Background Out-Of-Pocket Expenditure (OOPE) directly reflects the burden of health expenses that households bear. Despite the availability of social security schemes providing healthcare benefits, a high proportion of Indian households are still incurring OOPE. In order to recognize the reasons behind OOPE, a comprehensive understanding of people\'s attitudes and behavior is needed. Methodology By purposive sampling, 16 in-depth interviews were conducted using an interview guide in the catchment area of urban and rural health centers of a tertiary healthcare hospital. Interviews were conducted in Marathi and Hindi and were audio tape-recorded after taking informed consent. The interviews were transcribed and translated into English, followed by a thematic analysis. Results Although most participants knew that government hospitals provide facilities and experienced doctors, inconvenience and unsatisfactory quality deter them from utilizing government facilities. A few had experiences with government schemes; almost all concur that the formality and procedure of claiming insurance are cumbersome and all have had bad experiences. Cost of medications and consultation accounted for the majority of the healthcare expenditures. While some participants had benefitted from insurance, few regretted not enrolling in one. Conclusion The awareness regarding government schemes was derisory. Government-financed health insurance schemes and their utilization are crucial to reducing OOPE. Efforts should be made to increase accessibility to public healthcare services. Nevertheless, there is potential to redress the barriers to improve scheme utilization.

BACKGROUND: Biological fathering, especially in patrilineal societies, was traditionally acceptable only in the context of marriage to the mother of the child. Many men were polygynous, often staying in one household with all their wives and children. However, this phenomenon has been on the decline in recent times, mainly due to Christianity, which encourages monogamy while frowning on polygyny. The Ghanaian family has for the past few years been undergoing changes due to migration, urbanization, and industrialization. With an increase in non-marital births and the dissolution of marital unions, multi-partner fertility is likely to increase. Contemporary Ghanaian perspectives on the circumstances that lead men to engage in paternal multi-partner fertility, otherwise referred to in this study as serial fathering, are scanty, hence this study examines the factors that lead to serial fathering among Ghanaian men.
METHODS: The study employed the qualitative method, using in-depth interviews with twenty (20) serial fathers and a focus group discussion with seven (7) women.
RESULTS: It was found that factors such as the attitude of women in relationships, the duolocal post-marital residential pattern, and the age at first birth are some of the reasons why some men father children with multiple partners.
CONCLUSIONS: The study concludes that both situational and personal factors account for the phenomenon of serial fathering amongst men in Prampram, Ghana, and these factors bring about distinctions in serial fathering as occurring either within or outside of marriage.
In Ghana, men are increasingly having children with numerous women, whom they refer to as their \"baby mamas.\" Contemporary Ghanaian viewpoints on the factors that motivate males to engage in this behavior are minimal. Consequently, this study examines the factors that predispose Ghanaian men to father children by multiple women. In-depth interviews with twenty (20) serial fathers and a focus group discussion with seven (7) women from Prampram, a suburb of Accra, Ghana, were utilized in this qualitative study. The results of the study show that men had children with different women due to the negative attitudes of women, which pushed them to frequently change partners. The lack of a friendly relationship with in-laws, duolocal residence patterns, the non-observance of marriage rites, the young age of the first birth, and a continual need for companionship and sexual satisfaction were all factors that contributed to the practice. If these factors are addressed, it is anticipated that the prevalence of \"baby mamas\" in Ghanaian society will decrease significantly. This study also shows that family therapists and counselors should consider involving male clients\' spouses when counseling them about having many \"baby mamas.\"

BACKGROUND: Pig farming in Hong Kong differs markedly from other places in the world, with a highly urbanised population, the majority of pigs being imported for slaughter, and limited on-farm veterinary support. Little is known about the barriers and attitudes of pig farmers in Hong Kong and their expectations of a new pig health and production management service provided by veterinarians. We collected qualitative and quantitative data to 1) describe pig farms, 2) identify barriers to pig farming in Hong Kong and 3) describe the perceptions of the new service. Thematic analysis was conducted to identify barriers and attitudes.
RESULTS: Eight and nine out of 38 pig farmers agreed to participate in the qualitative and quantitative components, respectively. All farms were farrow-to-finish farms with a median of 2800 (range 950 to 7000) pigs per farm. Three themes were identified during the interview analysis and could be ranked based on their importance to the farmers: the regulatory environment (Theme 1), veterinary support structures (Theme 2), and the sustainability of the pig industry (Theme 3). Farmers expressed dissatisfaction with the regulation of the industry and veterinary services on offer within Hong Kong. However, farmers did note that the provision of a new pig health and production management service was as a positive development. The public perception of pig farming, market forces, and competition from mainland pig farmers have resulted in sustainability challenges for the industry.
CONCLUSIONS: Farmers identified very specific local systems and challenges unique to pig farming in Hong Kong. The lack of veterinary support was one of these challenges and although a certain level of scepticism towards the new pig health and production service was expressed, farmers indicated their interest and listed areas where they would benefit from improved veterinary support. Prior experiences of veterinary services clouded farmers perceptions of the usefulness of a new service. To be successful in this environment, clear communication about the goals, role and limitations of the new on farm service is crucial, as is the alignment with the needs of farmers. Despite the small sample size, the qualitative methodology used allows us to assume that these themes give a general idea of what Hong Kong farmers\' concerns and attitudes are.

OBJECTIVE: Early marriage is prevalent in Iraq, but the factors related to this behavior, especially people\'s attitudes about it, have not been well studied. It has been proven that early marriage seriously threatens young girls\' lives and health. This study aimed to explore the perception of people about early marriage in the Iraqi Kurdistan region.
METHODS: A qualitative method was employed to carry out this study in 2020. Data were collected through 16 focus group discussions in different health centers in Erbil, Iraq. Each focus group included 8-12 participants who had the experience of early marriage. The transcripts of the focus groups were analyzed through the six methodological activities of Van Manen. The trustworthiness of the data was confirmed by using qualitative data evaluation criteria.
RESULTS: Different themes and subthemes regarding the ideal age of marriage, attitudes toward marriage, reasons for early marriage, advantages and disadvantages of early marriage, and practice of early marriage in the community emerged from focus group discussions. Most participants identified early marriage as inappropriate social behavior that should not be practiced. Reasons for early marriage included poor economic status, protection of girls and boys, low educational level, and respect for old traditions of the community. Divorce and violence against women were the main disadvantages of early marriage.
CONCLUSIONS: There is a generally negative attitude towards early marriage, and the practice\'s disadvantages and health and psychological consequences are well recognized in Iraqi Kurdistan Region. However, different social, traditional, economic, educational, and religious factors encourage early marriage in the region. Further research is recommended in other governorates in the area to have a more precise and representative idea about the topic.

BACKGROUND: Due to the increasing pressure on hospitals to enhance the quality of services, the participation of physicians in accreditation programs has become more important than ever. The present study was conducted to describe challenges of physicians\' participation in hospital accreditation programs in Iran using a qualitative approach.
METHODS: We conducted interviews with 11 managers, 9 physicians and 8 experts in the field of hospital accreditation. Interviewees were selected through purposive snowball sampling. In-depth unstructured and semi-structured interviews were conducted for data collection. The data obtained were analyzed in ATLAS.ti using the conceptual framework method.
RESULTS: The results of this study extracted 3 main themes including: cultural, organizational and behavioral factors. Also, this study found 12 sub-themes and 57 items. Sub-themes in the cultural domain were motivation, patient demand, mutual trust and evaluation system. The organizational domain consisted of seven sub-themes, including high workload, understanding the role of quality management unit, unrealistic accreditation, nature of accreditation, empowerment of physicians in the field of quality, effective communication, resource constraint. Sub-themes in the behavioral dimension were ambiguity in the role and uncertainty about how to participate in accreditation program.
CONCLUSIONS: Physicians\' participation in accreditation programs can be increased through culture building and proper training about accreditation activities in the medical community.

Purpose: To describe parents\' views of family-centered care at a pediatric intensive care unit. Design and Methods: A qualitative descriptive study with a deductive and inductive approach was conducted based on the principles of family-centered care. Inclusion criteria were parents of children cared for at a pediatric intensive care unit for at least 48 h. Parents of children who died during the hospital stay were excluded. The sample consisted of spontaneous responses from 70 parents to five open questions in the EMpowerment of PArents in THe Intensive Care questionnaire, which was completed at discharge. The spontaneous responses were analyzed using thematic analysis. Results: The analysis of the parents\' statement illuminated that partnership, the essence of family-centered care, appeared incomplete. Partnership was particularly evident regarding parents\' experiences of being treated with empathy and respect. It also seemed prominent in situations where the professional team provided support to the child, parents, and family. Based on the parents\' statements there was potential for development of the family-centered care approach in aspects such as decision-making concerning care and treatment, as well as improving person-centered communication on order to capture parents\' experiences and needs in the highly technological pediatric intensive care unit environment. Conclusions: Although in general parents were satisfied with the care, areas for improvement were identified such as participation in decision-making about care and treatment as well as person-centered communication. The results can contribute to future quality improvement interventions focusing family centered care at pediatric intensive care units.

To explore how nurses experienced working in a newly organized COVID-19 ward with high-risk patients during a new and unknown pandemic.
A qualitative explorative study using a phenomenological-hermeneutic approach.
Semi-structured individual telephone interviews were conducted in June-July 2020 with 23 nurses working in COVID-19 wards from three regional hospitals in Denmark. The nurses had been transferred from other departments at their hospital to the newly organized COVID-19 wards. Data analysis was influenced by Paul Ricoeur\'s theory of narrative and interpretation, including three analytical levels: naïve reading, structural analysis and critical interpretation and discussion.
During the structural analysis four themes were generated: (a) Challenging and uncertain situation, but also a positive experience (b) Professional and personal development (c) Lack of nurses\' rights during a pandemic (d) Reward in itself or a desire for financial reward.