Physical Education Preservice Teachers' Perceptions About Preparation for Comprehensive School Physical Activity Programs.

PURPOSE: Physical educators may be the responsible people for implementing comprehensive school physical activity programs (CSPAPs) in schools. However, it is unclear whether physical education teacher education (PETE) programs provide the relevant learning opportunities to preservice teachers for CSPAP implementation. The purpose of this study was to understand preservice teachers' perspectives and experiences of CSPAP preparation in their PETE programs. METHOD: Fourteen PETE students from 6 different universities participated and shared their experiences in PETE programs. Data were collected through a short survey, 1 formal interview, field images, document gathering, and an additional survey to follow up the interview. Descriptive statistics, constant comparison, and analytic induction techniques were used to analyze the data. RESULTS: Participants' familiarity with CSPAPs was related to positive opinions about the role of physical educators in CSPAPs. Three common themes were revealed: (a) introducing CSPAP via courses, (b) the lack of programwide hands-on experiences for CSPAP, and (c) limited preparation for social skills with stakeholders. Participants' perceptions of the role of physical educators as physical activity leaders had been expanded during their training. CONCLUSION: The participating PETE programs integrated CSPAP components in the existing courses to introduce CSPAP, while there was a lack of sufficient practical opportunities to learn how to implement (aspects of) a CSPAP. Participants felt they were insufficiently prepared to promote and implement expanded physical activity programming beyond physical education classes in schools. The majority of the PETE preservice teachers wanted more practical CSPAP experiences in their programs.

Willingness to use ADHD Self-Management: Mixed Methods Study of Perceptions by Adolescents and Parents.

Little is known about perceptions surrounding self-management for attention deficit hyperactivity disorder (ADHD), although such interventions appear commonly used and are considered essential components of the chronic care model. Our research is part of a mixed methods study that followed students at high and low risk for ADHD over 11 years. During the final study years, area-representative samples of 148 adolescents (54.8% participation; 97 ADHD high-risk group; 51 low-risk peers) and 161 parents (59.4% participation; 108 parents of high-risk adolescent; 53 parents of low-risk peer) completed a cross-sectional survey on community-identified self-management interventions for ADHD (activity outlets, sleep regulation, dietary restriction, homework help, family rules, and prayer). Respondents also answered open-ended questions addressing undesirable self-management effects, which were analyzed using grounded theory methods. High-risk adolescents expressed significantly lower willingness towards all self-management interventions than did adult respondents, except for increased activity outlets. They also reported lower receptivity towards sleep regulation and dietary restriction than did their low-risk peer group. No gender or race differences in self-management willingness were found, except for higher receptivity to prayer in African American respondents. Cost, perceived ineffectiveness, disruptions to routines, causation of interpersonal conflicts, and reduced future self-reliance were seen as potential undesirable effects. Findings suggest that activity-based ADHD interventions appear particularly acceptable across all demographic and risk groups, unlike sleep regulation and dietary approaches. Further research on self-care effectiveness is needed to incorporate adolescents' viewpoints about ADHD self-management, as interventions may be acceptable to adults, but resisted by adolescents.

Feasibility of School-Based ADHD Interventions: A Mixed-Methods Study of Perceptions of Adolescents and Adults.

OBJECTIVE: Little is known about perceptions surrounding academic interventions for ADHD that determine intervention feasibility. METHOD: As part of a longitudinal mixed-methods research project, representative school district samples of 148 adolescents (54.8%), 161 parents (59.4%), 122 teachers (50.0%), 46 health care providers (53.5%), and 92 school health professionals (65.7%) completed a cross-sectional survey. They also answered open-ended questions addressing undesirable intervention effects, which were analyzed using grounded theory methods. RESULTS: Adolescents expressed significantly lower receptivity toward academic interventions than adult respondents. Stigma emerged as a significant threat to ADHD intervention feasibility, as did perceptions that individualized interventions foster inequality. CONCLUSION: Findings suggest that adolescents' viewpoints must be included in intervention development to enhance feasibility and avoid interventions acceptable to adults, but resisted by adolescents.

A qualitative analysis of women's experiences in single-gender versus mixed-gender substance abuse group therapy.

The present study of women with substance use disorders used grounded theory to examine women's experiences in both the Women's Recovery Group (WRG) and a mixed-gender Group Drug Counseling (GDC). Semi-structured interviews were completed in 2005 by 28 women in a U.S. metropolitan area. Compared to GDC, women in WRG more frequently endorsed feeling safe, embracing all aspects of one's self, having their needs met, feeling intimacy, empathy, and honesty. In addition, group cohesion and support allowed women to focus on gender-relevant topics supporting their recovery. These advantages of single-gender group therapy can increase treatment satisfaction and improve treatment outcomes.

Preparedness of rural physicians for bioterrorist events in Florida.

OBJECTIVES: Human-induced public health emergencies such as the anthrax bioterrorism event and the terrorism events of September 11, 2001 in the United States have increased awareness of the nation's vulnerability to large-scale emergencies. Scant attention has been given to preparing physicians in sparsely populated areas for public health emergencies. This study introduces a conceptual model developed from participants' responses that can be used to improve our understanding of rural physicians' preparedness regarding public health emergencies such as a bioterrorism event. The conceptual model is valuable because it illustrates some areas of question, concern, and future inquiry regarding bioterrorism preparedness. METHODS: This study used a qualitative research approach and grounded theory methods for data analysis. Semistructured interviews were conducted among six rural physicians in Florida. Florida was considered a particularly appropriate location given that the state was an initial site of the 2001 anthrax attacks. In addition, approximately half of Florida's counties are considered rural. RESULTS: The findings of this study suggest that not all rural physicians in Florida believe that they are adequately prepared for a bioterrorism event. The conceptual model elements--cognitive, clinical, expectation, and simulation--emerged from an analysis of participant responses. CONCLUSIONS: According to participant responses and the formulation of the conceptual model it may be postulated that preparedness may be effectively achieved if physicians are aware of the possibility of bioterrorism through education and seminars, able to suspect and recognize an event when it occurs, and institute appropriate medical management.

Critical challenges and impediments affecting rural physicians during a public health emergency.

OBJECTIVE: Disaster preparedness has become a health policy priority for the United States in the aftermath of the anthrax attacks, 9/11, and other calamities. It is important for rural health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine the barriers impeding rural physicians from being prepared for a human-induced disaster such as a bioterrorist attack. METHODS: This study employed a qualitative methodology using key informant interviews followed by grounded theory methods for data analysis. Semistructured interviews were conducted with 6 physicians in the state of Florida from federally designated rural areas. RESULTS: The interview participants articulated primary barriers and the associated factors contributing to these barriers that may affect rural physician preparedness for human-induced emergencies. Rural physicians identified 3 primary barriers: accessibility to health care, communication between physicians and patients, and rural infrastructure and resources. Each of these barriers included associated factors and influences. For instance, according to our participants, access to care was affected by a lack of health insurance, a lack of finances for health services, and transportation difficulties. CONCLUSIONS: Existing rural organizational infrastructure and resources are insufficient to meet current health needs owing to a number of factors including the paucity of health care providers, particularly medical specialists, and the associated patient-level barriers. These barriers presumably would be exacerbated in the advent of a human-induced public health emergency. Thus, strategically implemented health policies are needed to mitigate the barriers identified in this study.

Willingness to use ADHD treatments: a mixed methods study of perceptions by adolescents, parents, health professionals and teachers.

Little is known about factors that influence willingness to engage in treatment for attention deficit/hyperactivity disorder (ADHD). From 2007 to 2008, in the context of a longitudinal study assessing ADHD detection and service use in the United States, we simultaneously elicited ADHD treatment perceptions from four stakeholder groups: adolescents, parents, health care professionals and teachers. We assessed their willingness to use ADHD interventions and views of potential undesirable effects of two pharmacological (short- and long-acting ADHD medications) and three psychosocial (ADHD education, behavior therapy, and counseling) treatments. In multiple regression analysis, willingness was found to be significantly related to respondent type (lower for adolescents than adults), feeling knowledgeable, and considering treatments acceptable and helpful, but not significantly associated with stigma/embarrassment, respondent race, gender and socioeconomic status. Because conceptual models of undesirable effects are underdeveloped, we used grounded theory method to analyze open-ended survey responses to the question: "What other undesirable effects are you concerned about?" We identified general negative treatment perceptions (dislike, burden, perceived ineffectiveness) and specific undesirable effect expectations (physiological and psychological side effects, stigma and future dependence on drugs or therapies) for pharmacological and psychosocial treatments. In summary, findings indicate significant discrepancies between teens' and adults' willingness to use common ADHD interventions, with low teen willingness for any treatments. Results highlight the need to develop better treatment engagement practices for adolescents with ADHD.

Analysis of critical incidents and shifting perspectives: transitions in illness careers among adolescents with ADHD.

Adolescence represents a developmental period during which the severity of mental health problems for children with attention deficit/hyperactivity disorder (ADHD) might change. It is a time when teens are consolidating their self-identity and possibly questioning the label of an ADHD diagnosis, treatment, and types of interventions. In this study we investigated the shared critical events related to help seeking reported by 8 teenagers with ADHD, their mothers, and their teachers and how the reported events and constructed shared focus on specific problems might explain teenagers' transitions in their illness careers. Data collected through a qualitative application of the experience sampling method illuminated diverse illness career transitions, including continuing treatment, transitioning from being treated to untreated or from being untreated to treated, and remaining untreated. Our findings support a model of shifting perspectives on illness and wellness among adolescents with ADHD, rather than a progression of adaptation to a chronic disorder.

Validity and validation in the making in the context of qualitative research.

In this article, I focus on two ways of conceptualizing validity and validation, by using reductionist and (e)pistemological approaches, respectively. I question some common understandings of reductionist validation and describe an (e)pistemological standpoint that provides an alternative to reductionist views. In addition, I argue that validity and validation, as concepts, are tools rather than reflections of truth. Furthermore, fallibility, which is embedded in all views of validity and validation, can be compensated with pluralism, as well as acceptance, coexistence, and collaboration with the Other.

What "Dr. Mom" ordered: a community-based exploratory study of parental self-care responses to children's ADHD symptoms.

Little is known about family initiated self-care interventions in response to symptoms of attention deficit/hyperactivity disorder (ADHD), and how self-care may co-exist with professional treatments. This paper explores parental self-care strategies for children with hyperactivity or attention problems, and examines factors and domains that influence their use from the mixed method perspective. As part of a longitudinal cohort study of ADHD detection and service use, caregivers of a representative US community sample of 266 children at high risk for ADHD completed a questionnaire that assessed five self-care strategies (behavior modification, coping, diet, over-the-counter medication use and religious practices), and made open-ended inquiry about discipline changes in response to behavioral concerns. Questionnaire responses were analyzed using logistic regression approaches. Open-ended answers were open coded; secondary analysis followed Spradley's model of domain analysis. Quantitative findings showed that behavior modification was the most commonly tried self-care strategy, followed by coping, diet, and religious practices. Over-the-counter trial was least common. The parents of professionally treated children were more likely to have employed behavior modification, coping strategies and over-the-counter medications than the parents of untreated children. Two-thirds of parents had changed their disciplinary action within three domains that were identified through qualitative analysis, including changes related to (a) the prevention of disciplinary problems (e.g., sustain eye contact, activation, consistency, clear instructions), (b) the solution of disciplinary problems (e.g., time-outs; privilege removal), and (c) parental coping associated with disciplinary problems (e.g., control own emotions, become less judgmental and more tolerant, and develop more appropriate expectations). These findings suggest that self-care strategies are commonly employed and appear to co-exist with professional treatment. Therefore, healthcare providers should actively explore parents' use of such strategies as some of them may interfere with prescribed treatments (e.g., over-the-counter) or absorb parental resources without likely benefit (e.g., diet).

Exploring help-seeking for ADHD symptoms: a mixed-methods approach.

OBJECTIVE: Gender and race differences in treatment rates for attention-deficit/hyperactivity disorder (ADHD) are well documented but poorly understood. Using a mixed-methods approach, this study examines parental help-seeking steps for elementary school students at high risk for ADHD. METHODS: Parents of 259 students (male/female, African American/Caucasian) identified as being at high risk for ADHD completed diagnostic interviews and provided detailed accounts of help-seeking activities since they first became concerned about their child. Help-seeking steps (n=1,590) were analyzed using two methods: inductive analysis based on grounded theory, and deductive quantitative analysis of coded data derived from application of the network-episode model, merged subsequently with demographic and other characteristics. RESULTS: The inductive analysis revealed unique parental perceptions of their children's sick role and of the agents of identification and intervention for each of the four groups. Deductive analysis showed significant variations by race and gender in consultation experiences, in the person or entity being consulted and in the transactions occurring in the consultation, and in illness careers. CONCLUSION: ADHD symptoms are interpreted as having different implications for the sick role and the intervention, dependent on a child's gender and race. Educational interventions need to address cultural stereotypes contributing to inequitable access to treatment.