qualitative research journal impact factor

Qualitative Research Journal

Issue(s) available: 60 – From Volume: 6 Issue: 1 , to Volume: 24 Issue: 3

• Issue 3 2024
• Issue 2 2024 When intercultural communication meets translation studies: divergent experiences in qualitative inquiries
• Issue 1 2024 Methodological entanglements – public pedagogy research
• Issue 5 2023
• Issue 4 2023
• Issue 3 2023
• Issue 2 2023
• Issue 1 2023
• Issue 4 2022
• Issue 3 2022
• Issue 2 2022
• Issue 1 2022 Critically Exploring Co-production
• Issue 4 2021
• Issue 3 2021
• Issue 2 2021
• Issue 1 2021
• Issue 4 2020 Research and Methodology in times of Crisis and Emergency
• Issue 3 2020 The Practice of Qualitative Research in Migration Studies: Ethical Issues as a Methodological Challenge
• Issue 2 2020
• Issue 1 2020
• Issue 4 2019 Creative approaches to researching further, higher and adult education
• Issue 3 2019
• Issue 2 2019
• Issue 1 2019 Journeys in and through sound
• Issue 4 2018
• Issue 3 2018
• Issue 2 2018 Revisiting ‘Can the Subaltern Speak?’: 30 years later
• Issue 1 2018
• Issue 4 2017
• Issue 3 2017 Bordering, exclusions and necropolitics
• Issue 2 2017
• Issue 1 2017
• Issue 4 2016
• Issue 3 2016 Auto-, duo- and collaborative- ethnographies:
• Issue 2 2016
• Issue 1 2016
• Issue 4 2015 Art practice as methodological innovation
• Issue 3 2015
• Issue 2 2015 Sub-prime scholarship
• Issue 1 2015
• Issue 3 2014
• Issue 2 2014
• Issue 1 2014 Approaches to Researching Masculinities
• Issue 3 2013
• Issue 2 2013 Selected papers from the 2012 Association of Qualitative ResearchDiscourse, Power and Resistance Conference
• Issue 1 2013
• Issue 2 2012
• Issue 1 2012
• Issue 2 2011
• Issue 1 2011
• Issue 2 2010
• Issue 1 2010
• Issue 2 2009
• Issue 1 2009
• Issue 2 2008
• Issue 1 2008
• Issue 2 2007
• Issue 1 2007
• Issue 2 2006
• Issue 1 2006

Conceptualising “the more-than-migrant child”

Using a feminist, post-structural and posthuman theoretical framing the paper argues for elevating the complexity of conceptions of migrant children’s engagements with and…

Incorporating pragmatism in a behaviour change-led climate adaptation project: a collaborative reflection

This article argues the value of integrating pragmatism in applying behavioural science to complex challenges. We describe a behaviour change-led knowledge co-production process…

The power (and caveats) of body mapping as a visual methodology with vulnerable youth

This study aims to explore the NEET (Not in Education, Employment and Training) experiences of young people living in impoverished settings.

Harnessing the potential of translanguaging in Tanzanian secondary education

This study aims to explore motives behind teachers' and students' use of translanguaging and how they use it in Tanzanian public secondary school classrooms.

Fiction-writing and wonder: documenting a collaborative, creative writing process

We articulate cycles of creative storying and data analysis and the wonder that motivated the project by detailing our reading, thinking and writing processes to contribute to the…

Outside the field, inside the home: lessons learned from adapting qualitative research strategies during the COVID-19 pandemic

This collaborative paper presents three case studies on four scholars' experiences with remote data collection. The authors highlight the challenges and strengths of online…

Using data as poetry and text in case study research – poetic representations of adult learner experiences in neighbourhood houses

We argue this method of inquiry better represents the participants' learning, lives and experiences in the formal neoliberal education system prioritising performativity…

Conducting collage elicitation research online: what happens when we remove the scissors and glue?

This autoethnographic article presents the adaptation of collage—an arts-based method traditionally used in face-to-face settings—into an online research tool. It emphasizes the…

“But our worlds are different!”: reflexivity as a tool to negotiate insider–outsider dilemmas

In ethnographic research, negotiating insider–outsider perspectives is essential in order to get closer to the participants’ lives. By highlighting the importance of empathy and…

Negotiating with technology: advancing the virtual in qualitative research methods

This study aims to describe key elements that are critical to virtual qualitative research especially while working with practitioners as participants.

“Online group discussion was challenging but we enjoyed it!” an exploratory practice in extensive reading

While many works have reported adopting exploratory practice (EP) principles in language teaching research, only a few studies have explored the enactment of EP in an online…

Free association and qualitative research interviewing: perspectives and applications

This paper contributes to a dialogue about the psychoanalytic concept of free association and its application in the context of qualitative research interviewing. In doing so, it…

Opportunities and challenges facing LGBTQ+ people in employment in rural England post-pandemic: a thematic analysis

The following study aimed to better understand rural dwelling LGBTQ+ adults’ experiences of the challenges and opportunities facing their working lives in England.

Tell me about your trauma: an empathetic approach-based protocol for interviewing school leaders who have experienced a crisis

In this study, we illuminate how techniques can be incorporated into interview protocols when conducting research with educational leaders who are being asked to discuss their…

Advancing women to leadership in academia: does personal branding matter?

Personal branding is a strategic tool of marketing and communication to define success in organisations. While it constitutes a conscious attempt to commodify self and audit self…

Translanguaging approaches and perceptions of Iranian EGP teachers in bi/multilingual educational spaces: a qualitative inquiry

This study aims to analyze translanguaging practices and beliefs of Iranian English for General Purposes (EGP) teachers and find discrepancies between the practice and perception…

Women leaders' lived experiences of bravery in leadership

The research aims to understand the stories of women leaders who have demonstrated bravery in leadership. By analyzing their lived experiences through storytelling and narratives…

Listening to children's voices: reflections on methods, practices and ethics in researching with children using zoom video interviews

The purpose of this research was to reflect on the enablers, challenges and ethical considerations in conducting qualitative research with young children using online methods. The…

Reflections on a cross-cultural interview study

The aim of this article is to address some aspects of a cross-cultural interview study conducted in a PhD research project. This is done by reflecting on and discussing the…

The use of digital technologies in the co-creation process of photo elicitation

This article approaches the possibilities of photo elicitation as a technique for social research in the landscape of technology-mediated instantaneous interpersonal communication.

Culturally responsive and communicative teaching for multicultural integration: qualitative analysis from public secondary school

The aim of this paper is to examine the strategic approach of culturally responsive and communicative teaching (CRCT) through a critical assessment of interracial teachers in…

Unraveling the challenges of education for sustainable development: a compelling case study

Education for sustainable development (ESD) has gained significant attention, but integrating ESD into existing education systems is challenging. The study aims to explore the…

Handle with care; considerations of Braun and Clarke's approach to thematic analysis

The purpose of this paper is to support potential users of thematic analysis (as outlined by Virginia Braun and Victoria Clarke). Researchers with the intention of applying…

Behind my pet's shadow: exploring the motives underlying the tendency of socially excluded consumers to anthropomorphize their pets

Social exclusion is a complicated psychological phenomenon with behavioral ramifications that influences consumers' lifestyles and behaviors. In contrast, anthropomorphism is a…

Using teacher narratives to map policy effects in the Victorian Government International Baccalaureate Primary Years Programme (IB-PYP) context

Government primary schools in Australia increasingly take up the International Baccalaureate's Primary Years Programme (IB-PYP) to supplement government-mandated curriculum and…

Illuminating the path: a methodological exploration of grounded theory in doctoral theses

This article explores challenges faced by doctoral candidates using grounded theory (GT) in their theses, focusing on coding, theory development and time constraints. It also…

Children's voices through play-based practice: listening, intensities and critique

This paper offers a reflection of a research process aimed at listening to young children's voices in their everyday school life through a play-based context in a Scottish school…

It's too late – the post has gone viral already: a novel methodological stance to explore K-12 teachers' lived experiences of adult cyber abuse

The purpose of this scoping rapid review was to identify and analyse existing qualitative methodologies that have been used to investigate K-12 teachers' lived experiences of…

“A balancing act of keeping the faith and maintaining wellbeing”: perspectives from Australian faith communities during the pandemic

The pandemic presented many new challenges is all spheres of life including faith communities. Around the globe, lockdowns took pace at various stages with varying restrictions…

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About the Journal

• Journal Name : Qualitative Research
• Publisher Name : Sara Delamont and Paul Atkinson
• ISSN: 1468-7941
• Impact Factor : 3.096
• Nature : Print and Online

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About Journal

American Journal of Qualitative Research (AJQR)  is a quarterly peer-reviewed academic journal that publishes qualitative research articles from a number of social science disciplines such as psychology, health science, sociology, criminology, education, political science, and administrative studies. The journal is an international and interdisciplinary focus and greatly welcomes papers from all countries. The journal offers an intellectual platform for researchers, practitioners, administrators, and policymakers to contribute and promote qualitative research and analysis.

ISSN: 2576-2141

Call for Papers- American Journal of Qualitative Research

American Journal of Qualitative Research (AJQR) welcomes original research articles and book reviews for its next issue. The AJQR is a quarterly and peer-reviewed journal published in February, May, August, and November.

We are seeking submissions for a forthcoming issue published in February 2024. The paper should be written in professional English. The length of 6000-10000 words is preferred. All manuscripts should be prepared in MS Word format and submitted online: https://www.editorialpark.com/ajqr

For any further information about the journal, please visit its website: https://www.ajqr.org

Submission Deadline: November 15, 2023

Announcement 

Dear AJQR Readers, 

Due to the high volume of submissions in the American Journal of Qualitative Research , the editorial board decided to publish quarterly since 2023.

Volume 8, Issue 2

Current issue.

The COVID-19 pandemic has highlighted and exacerbated the difficult juggling act women in the U.S. have to do between parenting their children and working outside the home. The pandemic has also led to a decline in maternal mental health, particularly among mothers with young children, mothers of color, and those with previous mental health issues. The authors noted these experiences in their own lives as mothers with children and observed them in the lives of the women around them. These observations informed the design of this narrative inquiry study, in which we used semi-structured interviews to explore mothers’ shifting ideas and experiences of mothering, work, and family life during a global pandemic. We used creative analytic practice (CAP) to compose reflexive researcher conversations around the interview data that enabled us to highlight nuances in the data, show more transparently our meaning-making, make visible our researcher subjectivities, show uncertainties about aspects of data interpretation, and create a more accessible data representation.

Keywords: Mothering, COVID-19 pandemic, U.S. women, Narrative inquiry, Creative analytic practice.

The COVID-19 pandemic put France’s healthcare system under extreme tension and led to significant levels of stress among healthcare professionals in general and nurses in particular. Research has shown how these elements affected nurses’ physical and psychological health and manifested as insomnia, anxiety, and depressive syndromes. The present qualitative study aimed to explore the lived experiences of France’s nurses as a function of their level of exposure to the virus and whether they worked in the hospital sector or practiced privately in the community during the pandemic’s first wave. It also sought to describe the resources nurses used to maintain their overall health. We administered 19 qualitative interviews to 19 nurses in the autumn of 2021. The present study revealed that nurses were subjected to significant stress during the pandemic. Our data analysis enabled us to draw out three principal themes: 1) Being on the edge in stormy period ; 2) Personal impact on several levels and 3) Floating together and learning. There were no significant differences between the groups that were subjected to different levels of exposure to COVID-19. All the groups were affected by the pandemic that struck a healthcare system that was already systematically fragile. Nurses were severely tested by the COVID-19 pandemic, but their consciousness of the importance of their role grew, despite questioning what meaning there was to their profession, perhaps even to their lives . The trauma still felt fresh 18 months later, during the interviews, and this cannot be ignored in future healthcare policymaking .

Keywords: COVID-19, nurses, salutogenesis, stressors, health resources.

Annual mammography screening is recommended by the US Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) to reduce mortality through early detection of breast cancer. In rural Appalachia, rates of later-stage breast cancer incidence and mortality are higher than national averages. We explored the ways that providers and staff at breast cancer screening facilities employed novel approaches to overcome patient- and facility-level barriers to access to breast cancer screening in the Appalachian region. We conducted 23 semi-structured interviews with 28 clinical providers and staff of breast health facilities in Appalachia. Themes reflect how limiting features of breast screening facilities influenced access to care; the way patient-level barriers presented challenges to access to breast screening; and that external and regulatory forces presented obstacles to access to care. In addition, the unique geographical and geographical attributes of the Appalachian region shaped access and adherence to mammography screening recommendations. Thematic findings highlight that facilities implemented patient-centered strategies to overcome access-related barriers. Results may inform the ways breast cancer screening facilities address suboptimal access to breast health screening. They may also inform future resource allocations to enable facilities to reach breast cancer screening performance goals.

Keywords: rural health, breast cancer, preventive health care, women’s health.

Paternal parenting affects child development; hence, the father’s absence has a deleterious effect on the male child. The literature on parenting shows limited focus on how parenting impacts children by gender. This qualitative hermeneutic phenomenological study investigated the key question, “How does a father’s absence during childhood influence a man’s subsequent parenting of his son(s)?” An integrated theoretical framework was used to guide the study: Parenting Style Theory, Social-Cognitive Theory, and Bioecological Systems Theory. Nine Trinidadian males aged 20 to 35 years who were parenting sons were recruited to participate using snowball sampling. Data on men’s adverse childhood experiences were gathered using semi-structured interviews. Content and thematic analyses were done using DELVE software. Key findings include the influence of stereotypical cultural constructs, the church’s critical role in addressing childhood trauma, the transmission of father absence across generations, and the relationship between neurodevelopment and adverse childhood experiences. Implications of these findings will benefit child and adolescent advocacy, inform policymaking, aid professional intervention in mental health and education, and strengthen familial systems and ecclesiastical contexts. Future research should explore the lived experiences of men who crave emotional connection with their sons yet struggle with the stereotypical cultural perception of manhood.

Keywords: father absence, brain development, childhood trauma, intergenerational, the transmission of behavior.

The purpose of this qualitative transcendental phenomenological study was to understand the essence of the shared lived experiences of undergraduate college students with anxiety disorders at two universities in the Southeastern United States. Ellis’s cognitive theory, rational emotive behavior therapy, guided the study which took place at a mid-sized, public nonsectarian university and a small, private liberal arts college. The central research question elicited rich data regarding the shared lived experiences of the study participants. The four research sub-questions address participants’ perceptions regarding the impact of their disorders on their lifestyles and academic performance. A purposeful criterion sample was used to select the participants who completed a questionnaire, open-ended individual interviews, a single focus group interview, and participant journals. Phenomenological reduction was used to create a composite integration of meaning and the essence of the lived experience of the participants. Data results identified five themes: (a) social fears, (b) stressor issues, (c) generational issues, (d) academic performance barriers, and (e) institutional education and accommodation preferences.

Keywords: Alexithymia, anxiety, disorder, qualitative, stressors

School shootings are traumatic events that can lead to anxiety, depression, and post-traumatic stress disorder among students who experience these events. It is important to find effective strategies to help students cope with their return to school, as well as their anxiety and stress levels while on campus. There exists a gap in the literature on the effects of therapy dogs on students who have witnessed a school shooting. This current study used a retrospective mixed-methods survey that was sent to recent graduates of Marjory Stoneman Douglas High School (located in Parkland, Florida) who witnessed the February 2018 shooting. Data were collected to assess how the therapy dogs affected students' willingness to return to school and their stress/anxiety levels while on campus. Identified themes indicated that the therapy dogs helped with anxiety levels, stress levels, and overall moods of Marjory Stoneman Douglas High School students. These findings provide important implications for community leaders and school administrators who want to promote healing and well-being in a community that has experienced violence.

Keywords: Therapy dog, school shooting, community violence.

Identifying the relation between the processes of programming and foreign language writing may lead to new directions for programming language and natural language focused instructional design. The present qualitative case study supported by quantitative data investigated foreign language writing experiences of computer engineering students taking an object-oriented programming course. Forty-five sophomores learning programming and academic English simultaneously in a foundation university in Ankara, Turkey, were selected purposefully for the case study. There were two data sources (students’ opinions and documents) and three data collection tools (a semi-structured interview, a short diary, and a composition. In terms of the findings of the research, four themes were obtained; however, only the use of metacognitive strategies will be explained in detail due to the length of the study. Participants stated that they feel the positive effects of programming experience on the use of self-evaluation strategy and that there are similarities and differences between the processes of programming and foreign language writing. Participants’ views on the effect of programming on foreign language writing did not differ according to their writing and programming performance scores. Participants stated that programming experience may have an effect on the use of metacognitive language learning strategies in the writing process. Upon analyzing participants’ comments, it is understood that programming experience does not hinder the use of metacognitive strategies but has a role in supporting and reinforcing their use. It is suggested that multiple case studies be done for similar views on the effects of programming and that each finding be proven by quantitative studies.

Keywords: programming, foreign language writing, metacognitive strategies.

The significance of participatory decision-making in educational institutions is widely acknowledged as essential in school management and administration. This study aimed to determine how involved teachers are in making decisions in their schools and what role they think they play in shaping different parts of school policies and procedures. It also looked at their perspectives on how decisions made by others are carried out in schools. Semi-structured interviews with 10 secondary school teachers focused on teachers' role in decision-making related to their routine school tasks, strategic decision-making, participatory role in making school decisions, and their willingness to participate in decision-making. This study showed that teachers' low participation is attributed to their shared desire to be involved in school management and administration-related decisions. Teachers expressed that participatory school-based decision-making can promote collaboration and collectivism among the school staff, and it plays a significant role in shaping their work satisfaction and motivation. By gaining insights into teachers' perspectives, this study aims to contribute to the broader understanding of participatory school decision-making in the Rwandan secondary education system and communicate potential improvements for fostering a more collaborative and inclusive educational environment.

Keywords: teachers’ perceptions, qualitative research, decision-making, secondary schools.

One of the major inefficiencies in qualitative research is the accuracy and timeliness of transcribing audio files into analyzable text. However, researchers may now have the ability to leverage artificial intelligence to increase research efficiency through Chat GPT. As a result, this study performs feasibility and accuracy testing of Chat GPT versus human transcription to compare accuracy and timeliness. Results suggest that by using specific commands, Chat GPT can clean interview transcriptions in seconds with a <1% word error rate and near 0% syntactic error rate. Implications for research and ethics are addressed.

Keywords: Chat GPT, artificial intelligence, qualitative research, educational research, transcription

Alcohol misuse on college campuses has been shown to be the cause of physical, socio-emotional, and academic harms. Alcohol is also an issue at Gallaudet University but there is a gap in the literature describing this phenomenon. Using the social ecological model, this qualitative case study explored student perceptions and experiences with alcohol use through interviews with 24 deaf and hard of hearing college students at Gallaudet University. The main themes included: something to do, isolation, coping, communication, “playing catch up with life,” belonging, peer pressure, and university dynamics. The results of this study supported the research on alcohol use in the college environment, showing these themes to also be true at Gallaudet University. As a result, researchers recommend for Gallaudet University and other institutions use the education and interventions shown to be effective in the College Alcohol Intervention Matrix with deaf and hard of hearing students. Researchers also identified themes that were divergent from general college students and specific to the experience of being deaf and hard of hearing. This study highlighted the interpersonal level impact and importance of communication with alcohol and related harms. Researchers recommend further research on the spectrum of communication isolation on alcohol use, related harms, and the social-ecological impact of these experiences. In addition, researchers recommend programming and services to specifically address the issues that occur as a result of isolation, coping challenges, desire to belong, susceptibility to peer pressure, and wanting to catch up on life. It is hoped that the insights gained from this study will be used to inform interventions for deaf and hard of hearing college students, to reduce alcohol misuse, and thus to impact positive change.

Keywords: Deaf, hard of hearing, alcohol, college, university, isolation.

This qualitative study explores the perceived challenges for older adults during the first wave of the COVID-19 pandemic and how they worked on overcoming this adversity. Our sample (n=50), derived from a larger study, includes individuals 60 or older in Puerto Rico and the United States. Data were collected through an online questionnaire between May and August 2020 and analyzed using reflexive thematic analysis. Themes describe resilience through reflection and adaptation, critique of systemic problems and injustices, and reaffirmation of values and what is important. Considering the detrimental effect of the pandemic context on the older population, understanding their experiences and sources of strength can improve how they are supported in future crises.

Keywords: older adults, pandemic, COVID-19, reflexive thematic analysis, qualitative, Puerto Rico.

Qualitative Report

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• Social Psychology
• Cultural Studies

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The set of journals have been ranked according to their SJR and divided into four equal groups, four quartiles. Q1 (green) comprises the quarter of the journals with the highest values, Q2 (yellow) the second highest values, Q3 (orange) the third highest values and Q4 (red) the lowest values.

The SJR is a size-independent prestige indicator that ranks journals by their 'average prestige per article'. It is based on the idea that 'all citations are not created equal'. SJR is a measure of scientific influence of journals that accounts for both the number of citations received by a journal and the importance or prestige of the journals where such citations come from It measures the scientific influence of the average article in a journal, it expresses how central to the global scientific discussion an average article of the journal is.

Evolution of the number of published documents. All types of documents are considered, including citable and non citable documents.

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Evolution of the total number of citations and journal's self-citations received by a journal's published documents during the three previous years. Journal Self-citation is defined as the number of citation from a journal citing article to articles published by the same journal.

Evolution of the number of total citation per document and external citation per document (i.e. journal self-citations removed) received by a journal's published documents during the three previous years. External citations are calculated by subtracting the number of self-citations from the total number of citations received by the journal’s documents.

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Ratio of a journal's items, grouped in three years windows, that have been cited at least once vs. those not cited during the following year.

Evolution of the percentage of female authors.

Evolution of the number of documents cited by public policy documents according to Overton database.

Evoution of the number of documents related to Sustainable Development Goals defined by United Nations. Available from 2018 onwards.

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Founding Editor:

Michael W. Firmin , Cedarville University

Wayne A. Babchuk, University of Nebraska--Lincoln

Yuchun Zhou, Ohio University 

Managing Editor:

Alexis Chavez , University of Nebraska--Lincoln  

Associate Editors:

Mark A. Giesler , Saginaw Valley State University

Debbie Miller ,  University of Nebraska--Lincoln

Bernadro Pohl, University of Houston - Downtown

Tiffany Young, Doane University

Copy Editor:

Paige Hespe ,  University of Nebraska--Lincoln

Editorial Board:

Kimberly Acquaviva , George Washington University

Kimberly Baker, University of Northern Iowa 

Andrea Bingham , University of Colorado

Jessika Boles , Vanderbilt University

Eileen Boswell, University of Nebraska-Lincoln

L. Ebony Boulware , Johns Hopkins University

Huan Chen , University of Florida

Megan Powell Cuzzolino, Harvard University

Elizabeth Dore , Radford University

Jazlin Ebenezer , Wayne State University

Kassandra Engfer, Hawaii Pacific University

Jennifer Esposito , Georgia State University

Cecilia Fernandez , University of Michigan

Priva Fischweicher , Barry University

Abe Flanigan , Georgia Southern University

Janice Fournillier , Georgia State University

Kathleen Gilbert , Indiana University

Robin Goldberg-Glen , Widener University

Petter Grahl Johnstad , Hordaland County Municipality

Lauren Gulbas , Dartmouth College

Jennifer Hall , University of Lynchburg

Suejung Han , Illinois State University

Anne Hornak , Central Michigan University

Nancy Hornberger , University of Pennsylvania

Joseph Hruby , Baldwin-Wallace College

Lee Humphreys , Cornell University

Robert S. Isherwood , Slippery Rock

Suzie Jones , Utah State University

Christina Kim, Cedarville University

Effie Kritikos , Northeastern Illinois University

Maria E. Lozano , Columbia University

Tiffani N. Luethke , University of Nebraska at Kearney

Jose Martinez, Seymour Community Schools (Indiana)

Judy Meloy , Castleton State College

James Morton , University of Alaska Fairbanks

James L. Olive-Liebhart, University of Dayton

Laura Parson , North Dakota State University

Erin Partridge , Notre Dame de Namur University

Analay Perez , University of Nebraska - Lincoln

Robin Phelps-Ward , Clemson University

Lubomir Popov , Bowling Green State University

Tobin Richardson , KSM Consulting

Mary Romero , Arizona State University

Carolyn Rouse , Princeton University

Diane Ryndak , University of Florida

Kennedy Saldanha, Eastern Michigan University 

Rachel M. Schmitz, Oklahoma State University

Hong-Chi Shiau , Shih-Hsin University (Taiwan)

Ruslan Slutsky , University of Toledo

Maureen V. Spelman , North Central University

Deborah Skinstad, Stellenbosch University 

William Stevens , University of Chicago

Tony L. Talbert , Baylor University

Herb L. Thompson III , University of Nebraska at Omaha

Ashley Thrasher , Western Carolina University

Dorothy Valcarcel Craig , Middle Tennessee State University

Mark Warren , Harvard University

Leah E. Wickersham , Texas A & M University

Lindy B. Williams , Cornell University

Chelsea Wooding , National University

Victoria Zascavage , Xavier University

Journal of Ethnographic & Qualitative Research (JEQR) is a quarterly, peer-reviewed periodical, publishing scholarly articles that address topics relating directly to empirical qualitative research and conceptual articles addressing topics related to qualitative. The journal has been assigned ISSN #1935-3308. It is indexed with ERIC and EBSCO (H.W. Wilson, Social Science Full Text, Psychology and Behavioral Sciences, SocINDEX, and Academic Search Complete). Additionally, we intend to pursue abstract indexing with PsychInfo and other indexing organizations. An example of a published JEQR article is Researching Violence: Conducting Risky Fieldwork in Dangerous Spaces Across Latin America and the  Caribbean .

JEQR is a printed journal available for subscription at university libraries. Inquiries, including permission for reprints, should be sent to [email protected] . The journal (ISSN 1935-3308) accepts unsolicited manuscripts from all scholars, with prompt feedback regarding their status for potential publication.

Beyond typical fair-use federal guidelines, permission is granted for the photocopying of single articles for use by university faculty in non-profit contexts, including library reserve use or reading packets. This assumes that no profit is made from the copying and permission has been obtained from the article's respective lead author. PDF files of JEQR articles are provided to authors which reasonably may be shared at their discretion for teaching and limited scholarly purposes, provided the non-profit parameters indicated above. JEQR articles may not be reprinted elsewhere without express consent from the journal's executive editor.

JEQR gratefully acknowledges peer-review assistance from the Editorial Board. In the spirit of open academic inquiry, views expressed in the articles represent the respective authors and are not necessarily endorsed by the editors or related universities .

Among other quality research conferences, potential JEQR authors are encouraged to first present their papers at the Ethnographic & Qualitative Research Conference. EQRC began at the University of Massachusetts (Amherst), moving to Teachers College, Columbia University in New York City. Subsequent sponsors included Duquesne University (Pittsburgh), State University of New York (Albany), and Cedarville University (Greater Dayton area, Ohio). EQRC possesses a long and rich tradition as a forum for dissemination of scholarly ideas in the qualitative research tradition. The conference is usually held in February, with the call for papers issued in fall semester. Visit www.eqrc.net for details.

In addition to EQRC, the journal also publishes juried papers from a number of other quality conferences, following independent peer-review by JEQR staff and its review board members.  Please notify the JEQR editor if you are aware of other qualitative research conferences that may desire affiliation with the journal.

JEQR also welcomes submissions of all manuscripts that have not been presented at conferences. Although authors often benefit from the feedback received through conference presentation, it is not an explicit or implicit requirement for JEQR publication and the editorial staff welcome all original manuscripts that are not simultaneously under other journal publication consideration or review .

Barriers to Adopting Healthy Lifestyle and Health Promotion among Ethnic Minority Bedouin Women in Southern Israel: A Qualitative Study

• Published: 29 May 2024

Cite this article

• Rasmiya Abu Rabia 1 , 2   na1 ,
• Samira Alfayumi-Zeadna   ORCID: orcid.org/0000-0002-7904-414X 1   na1 ,
• Tova Hendel 1 &
• Ilya Kagan   ORCID: orcid.org/0000-0002-2298-0308 1  

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A healthy lifestyle is a crucial step in disease prevention and management, as well as a significant predictor of health promotion. Yet, despite an increase in chronic morbidity among Bedouin women in southern Israel, little research has been conducted on their health behaviors. Therefore, the aim of this study is to examine barriers to adopting a healthy lifestyle and health promotion among ethnic minority Bedouin women in southern Israel.

This qualitative study was based on data collected through focus groups during June and July 2021. Participants included 44 Bedouin women aged 18–55. Focus groups were recorded and transcribed. Transcriptions were thematically analyzed and coded using the ecological model.

We found multiple barriers at various levels that prevent Bedouin women from adopting a healthy lifestyle and health promotion. At the individual level, such factors included the impact of financial limitations on healthful nutrition, as well as a lack of awareness or knowledge regarding healthy lifestyle and health promotion. At the organizational level, barriers include a lack of clinics, accessibility, and availability of health services and cultural incompatibility of the health services. At the community level, impediments to a healthy lifestyle include inaccessibility to sports facilities and suppression of physical activity. At the public policy level, participants, especially those living in unrecognized villages, described difficult living conditions related to environmental and social neglect as affecting their health status and ability to maintain a healthy lifestyle.

Study findings emphasize the need for policymaking and a systemic approach to address health disparities and ensure equal health promotion for the Bedouin population.

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Data Availability

Anonymized data are available from the corresponding author on reasonable request.

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Acknowledgements

We express our gratitude to the women who participated in this study, as well as to the Israel National Institute for Health Policy Research for their grant support. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

This study was supported by a grant from the Israel National Institute for Health Policy Research (Grant #R84/2020). The funding source was not involved in this study’s design.

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Rasmiya Abu Rabia and Samira Alfayumi-Zeadna contributed equally to this work.

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Nursing Department, School of Health Sciences, Ashkelon Academic College, 78211, Ashkelon, Israel

Rasmiya Abu Rabia, Samira Alfayumi-Zeadna, Tova Hendel & Ilya Kagan

Clalit Health Services, Southern Region, 84417, Be’er-Sheva, Israel

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Rabia, R.A., Alfayumi-Zeadna, S., Hendel, T. et al. Barriers to Adopting Healthy Lifestyle and Health Promotion among Ethnic Minority Bedouin Women in Southern Israel: A Qualitative Study. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-02022-z

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Published on 29.5.2024 in Vol 26 (2024)

Long-Term Emotional Impact of the COVID-19 Pandemic and Barriers and Facilitators to Digital Mental Health Tools in Long-Term Care Workers: Qualitative Study

Authors of this article:

Original Paper

• Leticia González-Spinoglio 1 , MSc   ; 
• Anna Monistrol-Mula 1, 2 , MSc   ; 
• Cecilia Vindrola-Padros 3 , PhD   ; 
• Salvatore Aguilar-Ortiz 1 , PhD   ; 
• Bernat Carreras 4 , MSc   ; 
• Josep Maria Haro 1, 2, 5 , PhD   ; 
• Mireia Felez-Nobrega 1, 2 , PhD  

1 Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut Sant Joan de Déu, Barcelona, Spain

2 Centre for Biomedical Research on Mental Health, Madrid, Spain

3 Department of Targeted Intervention, University College London, London, United Kingdom

4 Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, Barcelona, Spain

5 Departament de Medicina, Universitat de Barcelona, Barcelona, Spain

Corresponding Author:

Josep Maria Haro, PhD

Research and Development Unit, Parc Sanitari Sant Joan de Déu

Institut Sant Joan de Déu

C/Dr Antoni Pujada 42

Sant Boi de Llobregat

Barcelona, 08830

Phone: 34 93 640 63 50

Email: [email protected]

Background: The overall pandemic created enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. Despite this, most of the available evidence on professional well-being during COVID-19 has exclusively focused on frontline health care workers.

Objective: This study aimed to identify the long-term psychological needs of LTCWs derived from the COVID-19 pandemic and to explore barriers and facilitators related to digital mental health tools. This is part of a project that seeks to develop a digital mental health intervention to reduce psychological distress in this population group.

Methods: We performed a qualitative study with a rapid research approach. Participants were LTCWs of the autonomous community of Catalonia. We conducted 30 semistructured interviews between April and September 2022. We used a qualitative content analysis method with an inductive-deductive approach.

Results: The period of the pandemic with the highest mental health burden was the COVID-19 outbreak, with almost all workers having experienced some form of emotional distress. Emotional distress persisted over time in more than half of the participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, the feeling that pandemic times are not over, and poor working conditions that have remained since then have been the most frequently expressed determinants of such emotions. Potential barriers and facilitators to engagement with digital tools were also identified in terms of previous experience and beliefs of the target population, possibilities for the integration of a digital tool into daily life, preferences regarding the level of guidance, the possibility of social connectedness through the tool, and privacy and confidentiality. The identified factors may become especially relevant in the context of the pandemic remission phase.

Conclusions: More than 2 years after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees’ well-being. Considering factors that act as barriers and facilitators for the use of digital mental health tools, it is important to develop tailored tools that could offer valuable support to this population during and after a pandemic.

Introduction

Long-term care facilities, such as nursing homes and other assisted living facilities, have been hit particularly hard by the COVID-19 pandemic. By February 2021, approximately 41% of the global COVID-19-associated mortality occurred in long-term care residents [ 1 ]. In Spain, the COVID-19 outbreak entailed especially tragic consequences, mainly caused by the precariousness of these care systems [ 2 ]. According to data from the Spanish Ministry of Health, 27,359 long-term residents died between April 6 and June 20, 2020, which represents approximately 70% of the total COVID-19 deaths. Long-term care workers (LTCWs) have been constantly exposed to anguish and death, have witnessed the social isolation and loneliness of residents due to health restrictions, and have experienced a drastic increase in their working demands [ 3 - 5 ]. Consequently, the mental health and well-being of this population group have been compromised, with clinically relevant levels of stress, anxiety, and depression increasing to nearly 60% from March 2020 to June 2020 [ 4 ].

As we approach the third year of the pandemic, health and care workers continue to respond to uncertainties, potential new waves, and the long-term effects of COVID-19. Importantly, recent evidence highlights increased concerns for burnout in this population [ 6 ], which can ultimately jeopardize the quality of health care as well as patient safety [ 7 ]. While mounting evidence has assessed the mental health experiences, views, and needs of care professionals during the early stages of the pandemic, there is scarce knowledge about the long-term emotional impact. This information is crucial to develop tailored interventions in response to their emotional demands.

Digital mental health tools (DMHTs) are a promising strategy to mitigate psychological consequences in the context of a long-lasting pandemic since they can be delivered remotely, avoiding the risk of transmission of the infection [ 8 ]. Yet, low levels of user engagement have been recognized as important barriers that may compromise the efficacy and scalability of interventions [ 9 ]. Increasing (prepandemic) evidence is beginning to unravel key factors that influence user engagement and the effectiveness of engagement strategies. For instance, positive prior experiences with mental health services and technology, digital literacy, the credibility of content, guidance within the intervention, increased social connectedness, a greater number of engagement features, reminders, and tailored feedback have been identified as potential facilitators for promoting engagement or effectiveness of digital interventions [ 10 - 13 ]. Nonetheless, these are general features reported in studies that included a wide range of different populations (eg, refugees, general population, people who are homeless, and people with a diagnosis of mental disorders), and it is well recognized that understanding the settings and population’s needs (eg, COVID-19 pandemic and long-term care facility characteristics) is a key factor for user engagement and intervention implementation success [ 14 ].

In this context, this study aimed to identify the long-term psychological needs of LTCWs as well as explore barriers and facilitators in relation to DMHTs. These findings will be used to inform and guide the development of a digital intervention to reduce psychological distress in this population group. The effectiveness of the psychological digital intervention will be tested through a randomized clinical trial (ClinicalTrials.gov NCT05526235).

Study Design, Sampling, and Participants

This qualitative study was conducted with a phenomenological orientation, in which we used a rapid research approach. In time-sensitive contexts, such as a pandemic, rapid appraisals allow us to collect and analyze data in a targeted and iterative way within limited time frames and, consequently, adapt and design expedient interventions for improving health care [ 15 ]. For reporting purposes, we adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist [ 16 ].

Semistructured interviews were conducted with workers from long-term care facilities (including nursing homes and other long-term care facilities), who were on duty during the pandemic in the autonomous community of Catalonia. For the recruitment of participants, we contacted several long-term care facilities and presented the project to each representative. Once the facility agreed to participate, the managerial staff shared the study information sheet among their employees (via their usual official means of communication). When needed, the researcher conducted informative talks (in person or via teleconference) with LTCWs in order to disseminate the study and resolve doubts, if any. A total of 6 long-term care facilities from the metropolitan area of Barcelona participated in the study.

Ethical Considerations

Ethics approval was provided by the Fundació Sant Joan de Déu Ethics Committee, Barcelona, Spain (PIC 214-21). Participants were fully informed about the objectives and procedures of the study prior to signing the informed consent. The data set was pseudoanonymized, and personal data were stored separately and securely on institution servers.

Data Collection

Interviews were conducted between April and September 2022. They were individual, by videoconference, and lasted between 25 and 40 minutes. The interview guide (provided in Multimedia Appendix 1 ) was reviewed by 2 experts in quality-of-life research to ensure its adequacy, and it was then tested with the first 2 interviews. No adaptations had to be made. The interview guide related to the digital mental health section was based on the framework developed by Borghouts et al [ 11 ]. Participants were given the option of conducting the interview in Spanish or Catalan, according to their preferences. Two researchers (AM-M and LG-S) conducted the interviews. Both are female PhD candidates. AM-M conducted the interviews in Catalan (8/30, 27% interviews), and LG-S conducted the interviews in Spanish (22/30, 73%). Both interviewers were previously trained in qualitative interview methods. Participants were informed of the interviewers’ educational and professional background, and no working or personal relationship existed between participants and interviewers. All interviews were audio recorded, and the main points were documented in real-time notes. At the conclusion of each interview, the emerging findings were synthesized using a RREAL (Rapid Research Evaluation and Appraisal Lab) Sheet (provided in Multimedia Appendix 2 ). The RREAL Sheet is a flexible working document, normally presented as a table, designed for the collection, synthesis, reporting, and analysis of data [ 17 ]. It enhances familiarization with the data and facilitates analysis while data collection is still ongoing [ 15 , 17 ]. First, a table organized by categories was designed using the interview script as a guide, and we piloted or amended this RREAL Sheet during initial data collection. Then, after each interview, we registered the key data obtained using real-time notes. In instances where pertinent details were absent, we referred to the audio recordings for further clarification. Importantly, the categories represented in the table were modified whenever considered necessary during data collection. Finally, the RREAL Sheet was used to guide an in-depth analysis [ 17 ]. The sample size was determined by thematic saturation [ 18 ].

Data Analysis

We used a qualitative content analysis method with an inductive-deductive approach. We performed a 1-page table that summarized the core components registered on the RREAL Sheet to identify key themes [ 17 ]. Once key themes and specific issues (subthemes) were recognized, we selected quotes from the interviews that could exemplify these themes. Investigator triangulation ensured that the themes reflected the full range and depth of the data.

Sample Characteristics

A total of 30 LTCWs participated in the study. The mean age was 44 (SD 11.4) years, most of our sample were women (n=26, 87%), and one-third (n=10, 33%) were from foreign nationalities. The vast majority of the participants were geriatric nursing assistants (n=17, 57%), followed by nurses (n=5, 17%). A more detailed description of the sociodemographic and occupational characteristics of the sample can be found in Table 1 .

a Director (n=1), occupational therapist (n=1), social worker (n=1), and cleaning staff (n=1).

Impact of COVID-19 on LTCWs’ Mental Health

Almost all participants identified the COVID-19 outbreak as the worst period for their mental health and reported having experienced emotional distress during this stage. The main emotions expressed were fear, helplessness, abandonment, loneliness, and sadness. Less frequently expressed emotions also included frustration, anger, uncertainty, and exhaustion. Five themes emerged as the main perceived determinants of these emotions:

• Unexpected and sudden nature of the crisis: Most participants expressed problems related to facing something new and completely unknown for which they were not prepared and its consequences. The reported main causes of distress were lack of information and knowledge, shortage of materials and human resources, problems with institutional organization, and the constant change of protocols and having to readjust to them.
• High exposure to emotional anguish and death: Half of the participants referred to high exposure to death and emotional anguish. They mainly mentioned the high mortality among residents and the helplessness of witnessing their isolation due to suspended family visits and reduced interactions resulting from health restrictions. Several participants also referred to the emotional anguish caused by the deaths of colleagues, family members, or friends as well as seeing the anguish in their colleagues on a daily basis.
• Fear of infection: Almost half of the participants mentioned the strong fear of infecting themselves, residents, and family members as well as the potential consequences of infection (eg, the severity of the disease and death).
• Moral distress: Many workers reported feelings of hopelessness, expressing that nothing they did for the residents in terms of care was enough. This was accompanied, in many cases, by a sense of loss of control of the situation during their caregiving duties.
• Lack of support: Many workers referred to a lack of recognition and support from authorities (both at the workplace and from the overall health authorities).

Textbox 1 provides an overview of these themes with example quotes for supporting data.

Unexpected and sudden nature of the crisis

• “We were not prepared; it came from one moment to the next.” [REPICAL (Reducing the psychosocial impact of the Covid-19 pandemic on workers of assisted living facilities)-007]
• “I also had to guide others in my charge, about things that I did not know either.” [REPICAL-004]
• “The protocols that we received were not clear...We were all in a drifting boat.” [REPICAL-008]
• “Overnight we were alone with co-workers. We were very lost; we did not have personal protective equipment and we did not know how to act. There were 4 of us and we managed as best as we could.” [REPICAL-026]

High exposure to emotional anguish and death

• “The worst thing I experienced was seeing so many residents die in such a short time, people who were fine and the next day they were gone.” [REPICAL-019]
• “We were not aware of the magnitude of this until residents began to die, they began to die one after the other, 4 or 5 per day (when before maybe one died every 2 months).” [REPICAL-026]
• “Seeing the loneliness in the residents affected me a lot, seeing that they were going to die alone, that they were not able to be with their family. It also affected me to see my co-workers, the most cheerful ones, defeated.” [REPICAL-021]
• “I felt so helpless seeing the isolated residents. We were asked not to have contact with them, but they needed someone to hold their hand.” [REPICAL-030]

Moral distress

• “We had to take measures that, while necessary, we knew were not good for the residents.” [REPICAL-003]
• “No matter what we did, people kept dying.” [REPICAL-004]
• “We saw that they were unwell and we could not help them...we wanted to address everything, but we could not.” [REPICAL-028]

Fear of infection

• “I even moved and lived in the residence for a while, so as not to infect the residents.” [REPICAL-019]
• “I had to isolate myself at home and I could not be with my child because I was afraid of infecting him. I also used to think: if something happens to me and my husband, who will take care of my child?” [REPICAL-023]

Lack of support

• “What I felt most was abandonment.” [REPICAL-002]
• “Feeling of helplessness of not being able to do anything and not having help from anyone.” [REPICAL-010]

In relation to their current emotional state, over half of the participants expressed some type of persistence of emotional distress over time. Among all participants, a minority reported maintaining intense distress, and a significant portion expressed only some improvement since the outbreak. The emotions most often mentioned were fatigue and nervousness, followed by anger and sadness. Three themes emerged as the main determinants of the persistent emotional distress:

• High workload: Long shifts due to staff shortages and coping with postcrisis backlog.
• Pandemic times are not over: Fatigue and residual discomfort from being under stress for so long as well as the feeling of not being able to completely move forward from COVID-19 due to the nature of their work.
• Still poor working conditions: Although the pandemic clearly highlighted the precariousness of these health care systems, some participants claimed that no measures have been taken to address this situation and that, as a result, working conditions remain poor. Relatedly, LTCWs felt that there is an overall failure in learning from the lessons of the COVID-19 pandemic.

Textbox 2 provides an overview of these themes with example quotes for supporting data.

On the other hand, among those participants who expressed a noticeable improvement over time in their emotional discomfort, hope and relief were the most commonly mentioned emotions. Improvement was associated with an increased sense of control over the situation, confidence in vaccines, decreased measures of isolation, and the feeling of regaining prepandemic working dynamics.

High workload

• “I am overwhelmed. In 2020, they increased my working hours. I was told it would only be during the state of emergency, but I am still not doing my usual schedule. In addition, people have left the workforce, and they have not hired more. I do not have as much time as I would like for other things.” [REPICAL-004]
• “Many projects were stopped because of the pandemic and now they have to be ready overnight. The workload is unreal.” [REPICAL-001]
• “Now we are facing our patients’ pathologies that were neglected during these two years. I am exhausted.” [REPICAL-005]

Pandemic times are not over

• “I am tired and burned out from dragging on for so long in tension, needing it to be over and it will not end.” [REPICAL-003]
• “Everyone has moved on, but I am still there: with the masks, the protective equipment, the heat.” [REPICAL-031]
• “During the crisis, we were alert at night in case a co-worker called us for help, and we always called each other; now I keep waking up even if they do not call me.” [REPICAL-026]

Still poor working conditions

• “With the pandemic, deficits that already existed in our field have come to light, and the thing is that nothing has changed, it’s just going back to the old ways. Nothing has been learned.” [REPICAL-002]

Digital Mental Health Tools

Previous experience and beliefs.

Almost all participants reported having no previous experience with DMHTs and emphasized their lack of confidence in their own digital skills. Nonetheless, the vast majority reported believing that such tools could be helpful in improving their mental health. The minority who reported not having confidence in digital tools mainly referred to their preference for personal, face-to-face contact.

Integration Into Daily Life

When participants were asked about what characteristics a DMHT should have to make it easy for them to integrate it into their daily lives, the majority of participants referred to the importance of accessibility: “easy to use,” “intuitive,” “didactic,” and “visual.” Some respondents also highlighted the importance of flexibility in using the tool in a time-convenient manner as well as being able to access from a mobile phone.

Level of Guidance and Social Connectedness

Regarding the level of guidance or support when using DMHTs, the majority of our sample reported preferring a guided intervention via a coach rather than a self-guided tool, expressing that the figure of a coach generates more confidence in the intervention and a greater sense of “closeness” despite the lack of in-person contact. Others mentioned the possibility of combining both modalities based on preference or demand. As for the profile of the coach, the most frequently mentioned professional role was a psychologist. However, rather than a professional role, most participants placed greater emphasis on the coach’s personal characteristics and skills, mainly highlighting empathy, active listening, receptivity, dynamism, and the ability to inspire confidence. As for the type of communication with the coach, the most preferred modality was videoconferencing, followed by telephone contact, and finally written messages. Some also mentioned the possibility of combining modalities, depending on the content and personal needs. Most of the participants preferred to accessing the content of the tool in stages or organized in modules rather than having it all available from the beginning. They indicated that this organization in modules would increase learnability by helping them navigate the tool in a more structured manner. Regarding content, some participants spontaneously emphasized the importance of having specific mental health content tailored to their needs rather than broad or general information. In addition, most noted that a reminder system, such as alarms, would be useful to aid engagement. Finally, regarding the possibility of being able to communicate with other users of the tool, a majority expressed that it would be a good idea, while a smaller group had doubts, and a few stated they would not use this option even if available.

Privacy and Confidentiality

Most participants reported that they would trust confidentiality protection mainly on the premise that when such an intervention is implemented within the context of a research study and with institutional backing, confidentiality should already be guaranteed. Among the few who expressed concerns, these were related to data privacy (sharing data with third parties), mentioning their concern about a possible link with social networks and the use of private data for advertising. On the other hand, almost all participants preferred nonanonymity with the figure of the coach to further “humanize” the intervention and increase confidence.

Principal Findings

Our results showed that the worst stage of the pandemic in terms of mental health was the outbreak, with almost all workers experiencing some form of emotional distress. The main emotions that participants expressed during this stage, as well as their determinants, are consistent with those reported by other national and international studies conducted on frontline health care workers during the first wave of the pandemic [ 3 - 5 , 19 - 22 ].

Importantly, our results showed that perceived emotional distress, main emotions, and their determinants changed over time. We found that almost half of the sample reported an improvement in their emotional discomfort over time, expressing hope and relief. This improvement was associated with a greater feeling of control over the situation, confidence in vaccines, decreased measures of isolation, and the feeling of regaining prepandemic working dynamics. Nonetheless, more than 2 years after the outbreak, emotional distress persisted for over half of the sample. Fatigue and nervousness were the main expressed emotions, which were determined by a high workload, the feeling that pandemic times are not over, and sustained poor working conditions. This result is consistent with other epidemiological studies, which showed that poor mental health outcomes among health care workers tend to persist over time [ 23 - 25 ] and that the main symptoms of poor mental health tend to change with the different COVID-19 stages as well [ 26 ].

Fatigue, nervousness, and emotional exhaustion, which may occur in response to chronic work stressors, are common signs of burnout [ 27 , 28 ]. Fatigue, which is not only linked to lower job satisfaction and increased rates of absenteeism [ 29 ], can also impair concentration and slow reaction times, elevating the risk of workplace accidents or fatigue-related incidents [ 30 ]. The assessment of the determinants of such emotional distress provides valuable input into potential intervention strategies to respond to such calls. Multifaceted interventions with a holistic approach and implemented in a timely manner are needed to protect the mental health and well-being of these workers during and after the pandemic. Similar to recommendations and claims made for the health care workforce, interventions for care workers should also be targeted at the organizational or institutional level via systematic support and at the individual level by implementing psychological interventions for those workers with emotional distress [ 29 , 31 , 32 ]. It is not enough that the institutions have been reactive to the pandemic with concrete measures to deal with a sudden crisis. They need to implement long-lasting workplace changes to improve working conditions and promote the long-term well-being of their staff. At the individual level, offering tailored digital psychological interventions using cognitive behavioral therapy is a promising option for workers experiencing emotional distress [ 29 ].

Since digital mental health interventions can represent a promising individual-level strategy to improve the mental health of LTCWs, we identified several barriers and facilitators for their successful engagement in the context of the COVID-19 remission phase.

Not only did almost all participants deny having any previous experience in the use of DMHTs, but almost a half of them also spontaneously referred to their lack of skills in the use of digital tools. This is a potential barrier that may be linked to the mean age of the sample (44, SD 11.4 years), since previous studies found that younger people have higher adherence to this type of intervention than older people [ 33 , 34 ]. Despite this lack of experience, the vast majority of participants reported believing that using DMHTs could be helpful in improving their mental health. This is an important facilitator since people’s expectations and preconceived beliefs about whether a tool will be effective positively influence experience and engagement [ 35 - 37 ]. In this regard, addressing the expectations and beliefs of the target population before developing a DMHT (or as an early step during the development process) could help identify and consequently manage early barriers [ 37 ].

Most participants highlighted the importance of accessibility when using a DMHT. Similar to previous studies [ 9 , 37 ], we found that achieving “user-friendly” tools is a key facilitator for engagement. In addition, participants also highlighted the importance of flexibility, which would enable them to use the tool according to their needs and changing working shifts .

Regarding the level of guidance or support, the majority of participants reported a preference for a guided intervention with a human coach rather than a self-guided tool, which is also in line with findings from previous studies [ 11 , 37 ]. Increased support may enhance and extend engagement in DMHTs. In the context of a pandemic, where social contact may be limited, this feature becomes even more relevant. Reminder systems are also important facilitators since they could prevent forgetfulness and encourage users to stay committed [ 37 ]. Furthermore, satisfaction with the type of content and the manner the materials are offered is critical to engagement. Interestingly, most of our participants express a preference for the tool’s content to be delivered in stages or modules, aiming to enhance learnability and facilitate structured navigation. Additionally, some participants underscore the significance of receiving personalized content that fits their needs or interests. Therefore, addressing user needs is key to preventing dropouts and ensuring sustained engagement [ 9 ]. In turn, most of our sample expressed that having the possibility to communicate with other users of the tool would be beneficial. Prior to the pandemic, social connectedness through DMHTs had proven to be not only a facilitator for engagement [ 38 ] but also a tool with therapeutic value per se [ 39 ]. In the current context, where social interactions have changed, this possibility could be even more relevant.

Finally, most participants in our study reported a high level of trust in confidentiality. This places significant responsibility on those developing mental health interventions through DMHTs. Research has indicated that the transmission of data to third parties by mental health smartphone apps is prevalent, thereby denying users an informed choice regarding whether or not to accept such sharing [ 40 ]. This issue may be a consequence of most DMHTs existing outside of health care regulation and also falling outside of health care privacy legislation [ 9 ]. A clear and transparent written privacy policy should always be available to inform users about how their data are going to be used.

At this juncture, it is crucial to contemplate the transferability of our findings to other work environments and populations. Although our research focused on a specific group in a particular context, the emerging themes and shared emotional experiences might resonate in similar situations. The fluctuation in perceptions over time provides a dynamic perspective that can be insightful for understanding long-term impacts in the context of future global pandemics. On the other hand, the impact of variables such as age or digital skills, perceived as potential barriers to the adoption of DMHTs, could be extrapolated to other populations, such as informal carers. The preference for guided interventions and the significance of accessibility and flexibility, among other variables, are also elements that might have broader applications in the design of DMHTs. It is imperative to acknowledge that each work environment and demographic group has its own unique characteristics, and the direct application of our results may necessitate adjustments. Nevertheless, by presenting these findings in a detailed and transparent manner, we aim to provide valuable insights that can guide future research and intervention strategies in diverse settings.

Limitations

This study acknowledges certain limitations that are crucial for contextualizing and evaluating the robustness of the findings. First, we did not account for participants’ preexisting mental health conditions (prior to COVID-19) when we assessed mental health needs. This could bear significant implications, as individuals with preexisting mental disorders are particularly vulnerable to the mental health threat of the pandemic. Second, the uneven gender distribution in our sample, with only 4 men, poses a limitation in terms of generalizing findings to this group. While our sample was not centralized in a single location, it is worth noting that all participating centers are located in the metropolitan area of Barcelona, which may limit the generalizability of our findings to the broader Catalonia region. Future studies should use more heterogeneous samples. Finally, inherent in qualitative research, there may be a potential for selection bias since workers were to some extent self-selected.

Conclusions

We identified that the worst stage of the pandemic in terms of LTCWs’ mental health was the COVID-19 outbreak, in which all workers reported having experienced some form of emotional distress. We also identified a persistence of emotional distress over time in more than a half of the participants, with fatigue and nervousness being the most frequently expressed emotions. This suggests that, although many workers significantly improved their psychological discomfort, mental health problems in this group are still relevant even more than 2 years after the pandemic outbreak. Future studies are needed to determine the factors that promote or hinder resilience among this underrepresented population group in order to shape implementation strategies to promote well-being. Finally, this study also identified new barriers and facilitators to engagement with DMHTs during the remission phase of the COVID-19 pandemic. These findings provide key information for the development of tailored digital mental health interventions among LTCWs.

Acknowledgments

This work was supported by the Instituto de Salud Carlos III (CD20/00036 to MF-N) and by la Fundació La Marato TV3 (202114 to JMH). The funding bodies had no role in study design, data collection and analysis, interpretation of data, or writing the manuscript.

Data Availability

The data sets generated during and analyzed during this study are available from the corresponding author on reasonable request.

Authors' Contributions

LG-S conceptualized the study, conducted methodology, performed formal analysis, and drafted the original manuscript. AM-M conducted methodology and performed formal analysis. CV-P contributed to conceptualization and methodology. SA-O and BC contributed to conceptualization. JMH conceptualized the study, contributed to methodology, and acquired funding. MF-N conceptualized the study, conducted methodology, managed project administration, and participated in writing, reviewing, and editing. LG-S, AM-M, CV-P, SA-O, BC, and JMH participated in reviewing and editing.

Conflicts of Interest

None declared.

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Abbreviations

Edited by T Leung; submitted 24.03.23; peer-reviewed by A AL-Asadi, P Petri-Romao, S Rennick-Egglestone; comments to author 19.01.24; revised version received 08.02.24; accepted 14.02.24; published 29.05.24.

©Leticia González-Spinoglio, Anna Monistrol-Mula, Cecilia Vindrola-Padros, Salvatore Aguilar-Ortiz, Bernat Carreras, Josep Maria Haro, Mireia Felez-Nobrega. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.05.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.