Supporting best practice in reflexive thematic analysis reporting in Palliative Medicine: A review of published research and introduction to the Reflexive Thematic Analysis Reporting Guidelines (RTARG).

BACKGROUND: Reflexive thematic analysis is widely used in qualitative research published in Palliative Medicine, and in the broader field of health research. However, this approach is often not used well. Common problems in published reflexive thematic analysis in general include assuming thematic analysis is a singular approach, rather than a family of methods, confusing themes and topics, and treating and reporting reflexive thematic analysis as if it is atheoretical. PURPOSE: We reviewed 20 papers published in Palliative Medicine between 2014 and 2022 that cited Braun and Clarke, identified using the search term 'thematic analysis' and the default 'relevance' setting on the journal webpage. The aim of the review was to identify common problems and instances of good practice. Problems centred around a lack of methodological coherence, and a lack of reflexive openness, clarity and detail in reporting. We considered contributors to these common problems, including the use of reporting checklists that are not coherent with the values of reflexive thematic analysis. To support qualitative researchers in producing coherent and reflexively open reports of reflexive thematic analysis we have developed the Reflexive Thematic Analysis Reporting Guidelines (the RTARG; in Supplemental Materials) informed by this review, other reviews we have done and our values and experience as qualitative researchers. The RTARG is also intended for use by peer reviewers to encourage methodologically coherent reviewing. KEY LEARNING POINTS: Methodological incoherence and a lack of transparency are common problems in reflexive thematic analysis research published in Palliative Medicine. Coherence can be facilitated by researchers and reviewers striving to be knowing - thoughtful, deliberative, reflexive and theoretically aware - practitioners and appraisers of reflexive thematic analysis and developing an understanding of the diversity within the thematic analysis family of methods.

"Your Diet Defines Who You Are, Especially as a Man": Masculinity in Online Media Focused on Healthy Eating for Men.

In contexts marked by neoliberal ideology and a claimed "crisis" in men's health, men are responsibilized to be/come healthy. Eating has long been a gendered practice in Western cultures, and recent cultural shifts have produced ways of eating that are both masculinized and (claimed) healthy. Online healthy eating advice, which encourages and supports men to eat healthily, is an important information source. However, such information draws on, reproduces, and/or disrupts existing meanings about men and eating. To understand contemporary representations of men and healthy eating, we examined 30 online media articles oriented specifically to this topic. Using reflexive thematic analysis from a social constructionist position, we developed two themes: A lad's looks and lifestyle and Mind over matter: The masculine mindset. These themes together told an overarching story that healthy eating is effectively sold to men by drawing on traditional or hegemonic ideals of masculinity and effectively evoking access to an enhanced masculinity through healthy eating. While these representational practices may sell healthy eating to men, with likely positive health benefits, they also reinforce hegemonic ideals of masculinity which can be problematic from a health perspective.

Is thematic analysis used well in health psychology? A critical review of published research, with recommendations for quality practice and reporting.

Despite the persistent dominance of a 'scientific psychology' paradigm in health psychology, the use of qualitative research continues to grow. Qualitative approaches are often based on fundamentally different values from (post)positivistempiricism, raising important considerations for quality, and whether qualitative work adheres to, and is judged by, appropriate publication standards. Thematic analysis (TA) has become a particularly popular method in qualitative health psychology, but poor practice is widespread. To support high quality, methodologically coherent TA practice and reporting, we critically reviewed 100 systematically selected papers reporting TA, published in five prominent health psychology journals. Our review assessed reported practice, and considered this in relation to methodological and quality recommendations. We identified 10 common areas of problematic practice in the reviewed papers, the majority citing reflexive TA. Considering the role of three 'arbiters of quality' in a peer review publication system - authors, reviewers, and editors - we developed 20 recommendations for authors, to support them in conducting and reporting high quality TA research, with associated questions for reviewers and editors to consider when evaluating TA manuscripts for publication. We end with considerations for facilitating better qualitative research, and enriching the understandings and knowledge base from which health psychology is practiced.

Qualitative story completion for counseling psychology research: A creative method to interrogate dominant discourses.

Qualitative story completion (SC) research involves the novel qualitative application of a technique previously used in quantitative research and clinical assessment, in which participants write stories in response to a story "stem" designed by the researcher. The resulting stories are analyzed to identify patterns of meaning using conventional qualitative analytic approaches such as thematic analysis. In place of the more typical self-report methods used in qualitative research, such as interviews or focus groups, the method provides a categorically different way to explore a topic, one which can offer new understandings to counseling psychology researchers. In particular, SC's capacity to illuminate social discourses makes it particularly useful for understanding the potential ways in which socially marginalized populations are understood in therapeutic spaces as well as for understanding how clients of all kinds may make sense of therapeutic interactions. This article provides an introduction to qualitative SC, explaining the method and its origins, and offering practical guidance about how to use it. The method is illustrated with examples from the existing SC literature and a hypothetical study focused on understandings of mental health difficulties in the workplace. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"You Worry, 'cause You Want to Give a Reasonable Account of Yourself": Gender, Identity Management, and the Discursive Positioning of "Risk" in Men's and Women's Talk About Heterosexual Casual Sex.

Heterosexual casual sex is routinely depicted as a physically, socially, and psychologically "risky" practice. This is the case in media accounts, psychological research, and other academic work. In this article, we examine 15 men's and 15 women's talk about casual sex from a discursive psychological stance to achieve two objectives. Firstly, we confirm the categories of risk typically associated with casual sex but expand these to include a domain of risks related to (gendered) identities and representation. Men's talk of risk centered on concerns about sexual performance, whereas women's talk centered on keeping safe from violence and sexual coercion. The notion of a sexual reputation was also identified as a risk and again manifested differently for men and women. While women were concerned about being deemed promiscuous, men displayed concern about the quality of their sexual performance. Secondly, within this talk about risks of casual sex, the participants' identities were identified as "at risk" and requiring careful management within the interview context. This was demonstrated by instances of: keeping masculinity intact in accounts of no erection, negotiating a responsible subject position, and crafting agency in accounts of sexual coercion-in the participants' talk. We argue that casual sex, as situated within dominant discourses of gendered heterosexuality, is a fraught practice for both men and women and subject to the demands of identity representation within co-present interactions.

Indigenous (Maori) sexual health psychologies in New Zealand: Delivering culturally congruent sexuality education.

Indigenous (Maori) psychologies of sexual health occur at the cultural nexus of Indigenous and Western knowledge, colonising influence and intervention. Formal school-based sexuality education holds potential to intervene in this psychological space by decolonising notions of Maori sexuality, relationships and reproduction. This research utilises an Indigenous feminist (Mana Wahine) methodology and interviews with 43 Maori participants (26 women and 17 men). We explore how Maori knowledges (matauranga Maori), responsive to the surrounding colonising context, were interwoven through four themes: relationships, reproductive responsibility, open conversations about sexuality and contraceptive education. Indigenous knowledges can contribute to good sexual health psychologies for all.

Referral to an Acute Child and Adolescent Inpatient Unit: The Experiences and Views of Community Mental Health Referrers.

Admission to an acute mental health inpatient unit is a significant event for a young person. The interface between inpatient and community teams negotiating the admission and later discharge can be fraught. To understand how to improve the transition between inpatient and community care, we interviewed 48 community clinicians about their experiences of engaging with an acute child and adolescent mental health inpatient unit. Through thematic analysis, we identified management of risk was a central issue. Participants wanted more time in hospital, and more communication and collaboration. They expressed appreciation, but some gave intense descriptions of dissatisfaction. The analysis suggests avenues to improve communication and experience, recognizing the (felt) power differential between inpatient and referring community clinicians. Managing the power dynamics requires inpatient clinicians to use active inquiry to bring forward community clinicians' views and be mindful of the risk of community clinicians experiencing communication as criticism.

Unpacking the "Pleasures" and "Pains" of Heterosexual Casual Sex: Beyond Singular Understandings.

Discussions of heterosexual casual sex are often imbued with (gendered) assumptions regarding the motives for, and drawbacks of, such a practice. The pulls of casual sex are often depicted as sexual gratification and the drawbacks relayed in terms of physical risk, for example, sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) transmission. Most of the research in this area has largely focused on undergraduate university students or "emerging adults" in North America, using primarily quantitative methodologies. We build on this work and a small but growing amount of qualitative research to unpack the complex psychoemotional and experiential dimensions of casual sex. We report on a critical thematic analysis of interviews with 30 ethnically diverse women and men (aged 18 to 46) in New Zealand about their experiences of heterosexual casual sex to achieve two things. First, we demonstrate the complexity with which women and men discussed their casual sex experiences, highlighting how the practice was varied, contradictory, and multifaceted, and played in a localized way during the conversation. Second, we illustrate how this talk was governed by contemporary Western discourses of intimate relationships and the shape of (gendered) heterosexuality. We conclude that casual sex research must always consider the broader sociocultural context, as well as the interpersonal context, within which any sexual relating is situated.

'Basically, it's sorcery for your vagina': unpacking Western representations of vaginal steaming.

Vaginal steaming made global headlines in 2015 after its promotion by celebrity Gwyneth Paltrow. One of many female genital modification practices currently on offer in Anglo-Western nations - practices both heavily promoted and critiqued - vaginal steaming is claimed to offer benefits for fertility and overall reproductive, sexual or even general health and wellbeing. We analysed a selection of online accounts of vaginal steaming to determine the sociocultural assumptions and logics within such discourse, including ideas about women, women's bodies and women's engagement with such 'modificatory' practices. Ninety items were carefully selected from the main types of website discussing vaginal steaming: news/magazines; health/lifestyle; spa/service providers; and personal blogs. Data were analysed using thematic analysis, within a constructionist framework that saw us focus on the constructions and rationalities that underpin the explicit content of the texts. Within an overarching theme of 'the self-improving woman' we identified four themes: (1) the naturally deteriorating, dirty female body; (2) contemporary life as harmful; (3) physical optimisation and the enhancement of health; and (4) vaginal steaming for life optimisation. Online accounts of vaginal steaming appear both to fit within historico-contemporary constructions of women's bodies as deficient and disgusting, and contemporary neoliberal and healthist discourse around the constantly improving subject.

"I think gorilla-like back effusions of hair are rather a turn-off": 'Excessive hair' and male body hair (removal) discourse.

Men's hair removal practices are becoming mainstream, seen as a consequence of changing masculine norms and men's relationships to their bodies. This is often presented as a straightforward 'shift' from men's ideal bodies as naturally hairy, to increased hairlessness, and the consequence on men's body concerns as inevitable. This paper analyses qualitative survey data from Aotearoa/New Zealand using critical thematic analysis, and describes three themes. Two themes capture contradictory ideas: that men's body hair is natural, and that men's body hair is unpleasant. A third theme introduces the concept of 'excess' hair, which allowed sense-making of this contradiction, mandating men's grooming of 'excessive' hair. However its vagueness as a concept may provoke anxiety for men resulting in hair removal. This paper adds to a body of research demonstrating a cultural transition: the ways changing masculinities, increased commodification of male bodies, and shifting gender roles impact on men's hair removal practices.

"Aren't labels for pickle jars, not people?" Negotiating identity and community in talk about 'being gay'.

Understanding how people in any given population think about and experience their sexuality is fundamental to developing and implementing good health policy, research, and practice. Yet despite several decades of focus on sexual identity and HIV risk within health research, gay men as a category are often treated in an uncomplicated way. This article reports on focus group discussions held with 45 gay and other men who have sex with men in New Zealand to identify how they talked about issues of gay identity and gay community/ies. The men negotiated and renegotiated their gay identity and being gay was reported as just one part of most men's lives. Many men did not like to be labeled as gay and downplayed aspects of their gay identity. Only a few men proclaimed being gay. Men reported very mixed experiences with the gay community/ies. Understanding how men experience being gay, provides information vital to enhancing policy, research and practice responses to gay men's health issues. A major challenge for health service provision to appropriately engage with men who have sex with other men but resist being labeled as gay was identified.

"It feels so good it almost hurts": young adults' experiences of orgasm and sexual pleasure.

Orgasm is a "goal" of much sexual activity, and a source of potentially intense pleasure and fulfillment, yet can be fraught with difficulty or distress. Relatively little social science research has explored people's experiences around, and their meanings related to, orgasm, and indeed other sexual pleasures, especially with young adults. This study aimed to provide a rich exploration of the meanings associated with orgasm and sexual pleasure during sex with a partner, to understand the social patterning of orgasm experience. A qualitative survey was used to collect data from 119 sexually experienced British young adults (81% women, mean age 20, 92% heterosexual). A descriptive form of thematic analysis that prioritizes participants' meanings and experiences was used to identify and explore patterns in the data. Five main themes are reported here: (a) orgasm: the purpose and end of sex; (b) "it's more about my partner's orgasm"; (c) orgasm: the ultimate pleasure?; (d) orgasm is not a simple physiological response; and (e) faking orgasm is not uncommon. These (mostly not gendered) themes demonstrate the complex and contradictory meanings around orgasm, and reveal meaning to be dependent on situation and context. However, they do resonate strongly with widespread discourses of sexuality that prioritize heterosexual coitus, orgasm, and orgasm reciprocity.

To let hair be, or to not let hair be? Gender and body hair removal practices in Aotearoa/New Zealand.

Research and anecdotal evidence suggest women continue to remove body hair, and there is some evidence for cultural changes in men's hair removal practices. This paper reports on data collected using an online mix-methods survey from 584 New Zealanders between the ages of 18-35 (mean age 26, 48.9% male, 50.6% female). The data demonstrated that substantial proportions of both women and men in Aotearoa/New Zealand remove body hair from many sites. However, gendered differences remain, and a key dimension of gendered difference appears in the concept of flexible choice around body hair removal or retention. This was seen in the difference between perceived acceptability of having body hair (81% for men, 11% for women). These findings suggest that although men, like women, are now coming under some pressure to remove body hair, there is still a great difference in men and women's capacity to choose whether to bow to it.

Gay men's explanations of health and how to improve it.

Little is known about the health views of gay men. In this article we report on how gay men explained health and the ways they discussed how health for gay men can be improved. We conducted a thematic analysis of data collected from 45 gay men in 11 focus groups and identified that health was mainly explained in individual terms, as were the ways to improve health (personal health care services and health promotion). The second way health was explained drew on social and community factors, with the societal acceptance of gay men being reported as essential for health improvements. These individual and social/community approaches were in tension; overall, the individualized approaches dominated. In line with other theorizing in health, we argue that appropriate policy and service provision to meet the health needs of gay men require greater acknowledgment of the social and community explanations of health and ways of improving health.

"We have friends, for example, and he will not get a vasectomy": imagining the self in relation to others when talking about sterilization.

OBJECTIVE: The relatively recent interest in critical men's health research has largely focused upon men's experiences of managing or preventing ill health. There has been limited discussion on the decision making that men engage in with health practices that are not constructed as immediately imperative for their own well-being-such as vasectomy. Much of the research on vasectomy has tended to focus on the individualized decision making men, which can often decontextualize the process. This article seeks to address some of these absences. METHODS: This article reports on data from semistructured interviews with 28 men who had had vasectomies (16 with children, 12 without). Data were analyzed using Wetherell and Edley's synthetic approach to discourse analysis. RESULTS: Talking about vasectomy provided an opportunity for men to make sense of the self and the decision making processes within a complex and relational understanding of masculinities. Rather than an individualized decision making process, many of the men's accounts were reliant on stories of other men who the participants could be compared against. CONCLUSIONS: Men made sense of an "optional" health decision in relation to other men (both real and imagined), in order to help justify delays, or other "trouble" in the decision making processes. Men's health initiatives and research may need to take this relational component of health decision-making into account.

Gay men talking about health: are sexuality and health interlinked?

Defining and describing health has traditionally been the role of medical experts. Although a rich literature has recently established the importance of lay accounts of health, one important gap relates to gay men's accounts of health. Data from 11 focus groups involving 45 gay men were thematically analyzed to investigate gay men's views of health. Two contrasting positions on a possible relationship between sexuality and health-there is no link or there is a definite link-were identified. In addition, five key ways gay men talked about health were identified: health is the absence of disease, is functional ability, is fitness and exercise, is psychological, and is multifaceted. Although there are similarities in the ways gay and other men talk about health, important differences exist, which suggest that issues of sexuality need to be considered by health policy and service planners so that responsive health services can be provided.

Female genital cosmetic surgery: a critical review of current knowledge and contemporary debates.

Female genital cosmetic surgery procedures have gained popularity in the West in recent years. Marketing by surgeons promotes the surgeries, but professional organizations have started to question the promotion and practice of these procedures. Despite some surgeon claims of drastic transformations of psychological, emotional, and sexual life associated with the surgery, little reliable evidence of such effects exists. This article achieves two objectives. First, reviewing the published academic work on the topic, it identifies the current state of knowledge around female genital cosmetic procedures, as well as limitations in our knowledge. Second, examining a body of critical scholarship that raises sociological and psychological concerns not typically addressed in medical literature, it summarizes broader issues and debates. Overall, the article demonstrates a paucity of scientific knowledge and highlights a pressing need to consider the broader ramifications of surgical practices. "Today we have a whole society held in thrall to the drastic plastic of labial rejuvenation."( 1 ) "At the present time, the field of female cosmetic genital surgery is like the old Wild, Wild West: wide open and unregulated"( 2 ).