How Do People Who Stutter Experience Ableist Microaggressions? A Mixed Methods Exploratory Study

Speech production difficulties are apparent in people who stutter (PWS). PWS also have difficulties in speech perception compared to controls. It is unclear whether the speech perception difficulties in PWS are independent of, or related to, their speech production difficulties. To investigate this issue, functional MRI data were collected on 13 PWS and 13 controls whilst the participants performed a speech production task and a speech perception task. PWS performed poorer than controls in the perception task and the poorer performance was associated with a functional activity difference in the left anterior insula (part of the speech motor area) compared to controls. PWS also showed a functional activity difference in this and the surrounding area [left inferior frontal cortex (IFC)/anterior insula] in the production task compared to controls. Conjunction analysis showed that the functional activity differences between PWS and controls in the left IFC/anterior insula coincided across the perception and production tasks. Furthermore, Granger Causality Analysis on the resting-state fMRI data of the participants showed that the causal connection from the left IFC/anterior insula to an area in the left primary auditory cortex (Heschl’s gyrus) differed significantly between PWS and controls. The strength of this connection correlated significantly with performance in the perception task. These results suggest that speech perception difficulties in PWS are associated with anomalous functional activity in the speech motor area, and the altered functional connectivity from this area to the auditory area plays a role in the speech perception difficulties of PWS.

Differences in sensorimotor integration mechanisms have been observed between people who stutter (PWS) and controls who do not. Delayed auditory feedback (DAF) introduces timing discrepancies between perception and action, disrupting sequence production in verbal and non-verbal domains. While DAF consistently enhances speech fluency in PWS, its impact on non-verbal sensorimotor synchronization abilities remains unexplored. A total of 11 PWS and 13 matched controls completed five tasks: (1) unpaced tapping; (2) synchronization-continuation task (SCT) without auditory feedback; (3) SCT with DAF, with instruction either to align the sound in time with the metronome; or (4) to ignore the sound and align their physical tap to the metronome. Additionally, we measured participants' sensitivity to detecting delayed feedback using a (5) delay discrimination task. Results showed that DAF significantly affected performance in controls as a function of delay duration, despite being irrelevant to the task. Conversely, PWS performance remained stable across delays. When auditory feedback was absent, no differences were found between PWS and controls. Moreover, PWS were less able to detect delays in speech and tapping tasks. These findings show subtle differences in non-verbal sensorimotor performance between PWS and controls, specifically when action-perception loops are disrupted by delays, contributing to models of sensorimotor integration in stuttering.

Purpose: A limited number of studies have ex- plored attitudes toward people who stutter (PWS) in different cultures. Recent studies have looked at the attitudes of Arab parents toward PWS. The current study explores attitudes reported by Arab teachers from Kuwait and provides a pre- liminary comparison with attitudes reported by teachers from the United States. Method: This study used an English version and an Arabic translation of a 14-item semantic differential (SD) scale (Bur- ley & Rinaldi, 1986) to assess differences in American and Arab teachers' attitudes toward PWS. Results: A majority of Arab teachers from Kuwait reported neutral to positive attitudes toward PWS on the SD scale. However, ~ 1

This work studies the experiences of people who stutter (PWS) with videoconferencing (VC) and VC technologies. Our interview study with 13 adults who stutter uncovers extra challenges introduced by current VC platforms to people who stutter. While some of the challenges are a direct result of the characteristics of stuttering (e.g. people/systems mistaking pauses as end of turn), a bigger yet less visible challenge comes with the significant amount of emotional and cognitive effort required to manage one’s speech and identity over VC, in which people’s existing communication strategies - such as body language and eye contact - are under-supported and their biggest discomfort - such as seeing oneself stutter - are exacerbated by preset features like self view. Overall, our work sheds light on the structural barriers and the opportunities for PWS to engage and enjoy virtual communications via VC technologies.

In the early 1990s, the spread of HIV among heroin injectors prompted a shift in drug policy internationally, including in France. This led to the emergence of a new policy known as Harm Reduction (HR) and related tools, including needle exchange programmes, opioid substitution therapy programmes to manage illicit opiate consumption, as well as reception facilities and support systems for the most precarious People Who Use Drugs (PWUDs). This new policy is based on the assertion that drugs have always been there and will always be a part of society, and that we have to live with them and not try to eradicate them. Promising PWUD emancipation, the advent of HR was accompanied by the birth of peer-support groups for unrepentant PWUDs, who decided to speak out in the public arena for the first time. Thirty years on, the authors assert that this promise has not lived up to expectations. More specifically, the cohabitation of an institutionalized, bureaucratized HR with the criminalization and stigmatization of drug use has worked against PWUD emancipation. As PWUDs, users of the addiction care system, peer workers and managers of addiction and HR facilities, the authors discuss the tensions between HR and the continued criminalisation and stigmatisation of drug use in France. Using the PWUD internet platform Psychoactif and the related peer-support group, both of which they created, the authors share their experiences and reflect on their practices to propose a renewed model of HR which reconnects with the civic and emancipatory roots of HR: a rights-based model that enables PWUDs to regain their power to act and escape the alienation caused by the stigma of drug use.

People who are homeless are particularly vulnerable to health disparities. Rather than using population statistics to highlight the prevalence or severity of the suffering of people who are homeless, 28 undergraduate students each conducted an in-depth interview with an individual who relied on a local homeless shelter to cope with everyday life. The interview explored the participants' health concerns and strategies for health management. Due to equipment failure and incomplete recording, only 16 interviews are included in this study. The author adopted thematic analysis while focused on preserving the richness of the interactions between the participants who are homeless and the undergraduate students. The author's goal is to provide emic, intimate insights about the struggles and challenges faced by the people who are homeless. The author concluded the study by situating the findings in the larger literature of health disparities experienced by people who are homeless.

This paper presents the results of a research study of people who are blind or low vision about their experiences using wayfinding tools. The results present the accessibility issues when using wayfinding tools and assistive technology to learn about new locations. An online survey followed by a series of interviews was conducted with ten people who identify as blind and six with low vision to learn their opinions and concerns about accessibility of three types of wayfinding tools, digital maps, navigation apps and camera apps.

People who are incarcerated are at heightened risk of overdose upon community reentry. Virtual reality (VR) may provide an innovative tool for overdose prevention intervention in corrections facilities. This mixed methods study sought to understand incarcerated individuals' perspectives on VR for overdose prevention and explore physiological arousal associated with use of VR equipment. Study participants were 20 individuals, stratified by gender, with an opioid use disorder at a county jail. Qualitative interviews assessed acceptability and perceived utility of VR in the jail setting. Thematic analysis indicated high levels of acceptability and potential utility in the following areas: (a) mental health and substance use interventions, (b) community reentry skills training, and (c) communication and conflict resolution skills. Heart rate variability (HRV) data were collected continuously during the interview and during VR exposure to explore whether exposure to the VR environment provoked arousal. Physiological data analyses showed a significant decrease in heart rate (HR) [b = -3.14, t(18) = -3.85, p < .01] and no arousal as measured by root mean square of successive RR interval differences (RMSSD) [b = -0.06, t(18) = -1.06, p = .30] and high frequency-HRV (HF-HRV) [b = -0.21, t(18) = -1.71, p = .10]. This study demonstrated high acceptability and decreased HR response of VR among incarcerated people who use drugs.

Aboriginal and Torres Strait Islander people who inject drugs face persistent health inequities, highlighting the need for programs that meet the needs of these groups. This study explored how intersectional stigma and discrimination affect Aboriginal and Torres Strait Islander people's access to quality healthcare. Aboriginal and Torres Strait Islander participants aged ≥18 years who had injected drugs within the past 12 months were recruited from two regional needle and syringe programs (NSPs) and a major city NSP in Queensland, Australia. Participants completed a structured survey and yarned with an Aboriginal researcher and non-Indigenous research assistant about their healthcare experiences. Through a process of reflexive and thematic analysis, three major qualitative themes emerged: participants' social circumstances and mental health challenges made help-seeking difficult and complex; enacted stigma and racism diminished access to health services and the quality of care received; and injecting drug use was associated with disconnection from culture and community. Privileging the expertise and voices of those with lived/living experience is essential for the creation of culturally safe, inclusive, and destigmatising healthcare services for Aboriginal and Torres Strait Islander people who inject drugs.

Background: Captagon (Fenethylline) is an amphetamine type stimulant (ATS) and one of the most popular substances of use in the Middle East. This study aims to describe and analyze the trajectory of captagon use, severity of addiction and withdrawal symptoms and its effect on quality of life from the perspectives of people who use captagon, who receive treatment as well as therapists. Methods: This study took a qualitative approach, using semi-structured, audio-recorded interviews, which were transcribed verbatim, translated to English and coded using Nvivo software for thematic analysis. Results: Data saturation was achieved after interviewing a total of 27 participants (7 therapists and 20 patients using captagon either alone or among other illicit drugs), most of which were male (n = 22). Their ages ranged between 18-48 years (median= 27). Four main themes were identified during the interviews: (1) Definition and sought effects of captagon; (2) the downside of captagon use and withdrawal symptoms associated with captagon use; (3) motivations for captagon use and to treatment; and (4) the impact of Covid-19 on captagon’s use and on treatment. Conclusion: This qualitative study has illustrated for the first time the several challenges and complicating factors that people who use captagon and therapists face in Jordan. Findings call attention to implementing effective interventions to raise public’s awareness of the negative impact of such use, with focus on high-risk groups, address the needs of different users and encourage the use of international treatment guidelines.

Emerging evidences hypothesized that patients with heart failure are susceptible to experience treatment burden. Despite this fact, no attempt was made so far to address this neoteric construct in the sub-Saharan African health care context. Hence, this study aimed to assess patients’ and health care providers’ perspectives on how to decrease treatment burden among patients with heart failure attending the adult cardiac clinic of Tikur Anbessa Specialized Hospital (TASH). An explanatory sequential mixed methods study was conducted at the adult cardiac clinic of TASH, Addis Ababa, Ethiopia from August 01 to September 30, 2021. Simple random and purposive sampling techniques were employed to select participants for quantitative and qualitative studies, respectively. Descriptive analysis was done to summarize the quantitative data. Logistic regression analysis was performed to identify predictors of treatment burden. P value < 0.05 was considered to declare statistical significance. Qualitative data were analyzed by using thematic analysis. A total of 325 patients were enrolled in the quantitative study. For the qualitative study, 14 patients and 11 health care providers (five nurses and six medical doctors) were included. Participants mean global Treatment Burden Questionnaire (TBQ-15) score was 27.22 ± 19.35. Approximately 12% (n = 38) patients indicated high treatment burden (TBQ-15 global score ≥ 59) with a median global score of 63(60–69). Higher education level (adjusted odds ratio [AOR] = 6.66, 95% confidence interval [CI]: 1.16–38.43), presence of two and more comorbidities (AOR = 2.74, 95%CI: 1.02–7.39), daily intake of more than five pills (AOR = 7.38, 95%CI: 2.23–24.41), poor medication availability (AOR = 3.33, 95%CI: 1.33–8.36), presence of medication adverse effects (AOR = 4.04, 95%CI: 1.63–10.03), and higher monthly cost of medication (AOR = 5.29, 95%CI: 1.46–19.18) were predictors of treatment burden. Patients and healthcare providers' propositions were primarily focused on improving self-care management, structural organization of the clinic and hospital, and healthcare system provision. Our findings demonstrated that a substantial proportion of patients faced low levels of treatment burden. This study unveiled that improving self-care management, structural organization of the clinic, and healthcare system provision had paramount importance to reducing treatment burden. Hence, factors affecting treatment burden should be considered when designing tailored healthcare interventions for patients with heart failure.

Harm reduction, when applied to drug use, prioritizes improving patient-centered health outcomes and reducing drug-related harm. In order for harm reduction strategies to be adopted by people who inject drugs (PWID), they need to be promoted, accessible, and accepted in that population and the community-at-large. While PWID face stigma at multiple levels, less is known about how stigma influences uptake and acceptance of harm reduction services and strategies among PWID. We aim to characterize the stigmatizing experiences PWID have had related to harm reduction and the role of stigma in influencing their acceptance and adoption of harm reduction services and strategies. A qualitative study using in-person, semi-structured interviews. We recruited hospitalized participants, age 18 and over, with a history of injection drug use. We developed an interview guide asking about various aspects of stigma and participants' experiences with naloxone, syringe service programs, fentanyl test strips, HIV and hepatitis C testing, and any other harm reduction strategies. Key themes were generated using a thematic analysis. We reached thematic saturation at 16 participants. PWID reported multi-level stigma related to harm reduction from themselves, the public, the healthcare system, and the legal and carceral systems. Themes were grouped into four main categories: internalized, interpersonal, intervention, and structural stigma. Stigma across all of these domains negatively impacted the ability of PWID to access harm reduction resources. Positive, non-stigmatizing experiences from others, such as syringe service programs and peer navigators, countered historically negative experiences and promoted greater education and comfort about using harm reduction resources among PWID. To expand the reach of harm reduction services, it is critical to develop interventions that can reduce the stigma against PWID and harm reduction.

IntroductionThis study explored the extent to which an interactive computer play system, Bootle Blast, supports motor learning in a clinical context and examined clinicians’ perceptions of their therapeutic role in the system’s use as an intervention tool.MethodsIn this observational sequential explanatory mixed methods study, five children with cerebral palsy [mean age 9.4 years (SD, 0.5), Gross Motor Function Classification System Levels I–III] used Bootle Blast during a single video-recorded therapy session with their treating clinicians (physical therapists, occupational therapists, and therapy assistants). Children played one Bootle Blast mini game independently (without clinician involvement) before clinicians carried out therapy sessions with the game as per usual care. The type and extent of motor learning strategies (MLS) delivered by Bootle Blast and clinicians were rated from video recordings by a trained assessor using the 22-item Motor Learning Strategies Rating Instrument. Semi-structured interviews with clinicians were conducted to gain insights into MLS use and clinicians’ perceived role during Bootle Blast use. Interviews were audio recorded, transcribed verbatim, and analyzed independently by two researchers using thematic analysis. Quantitative and qualitative data were merged and reported using narrative and joint display approaches.ResultsBootle Blast provided eight MLS, with clinicians adding or enhancing another eight. Four themes reflected clinicians’ perspectives: (1) Bootle Blast disguises therapy as play, (2) clinicians give Bootle Blast the human touch; (3) home use of Bootle Blast is promising; and (4) Bootle Blast is not always the right fit but some shortcomings could be addressed. Agreement was found for nine MLS and disagreement for four MLS when quantitative and qualitative findings were merged.DiscussionBootle Blast delivers several MLS as part of game play and clinicians can enhance and provide additional MLS to suit the child's needs/abilities. Further game refinements that were identified in this study may optimize its clinical use.

Background: The right to refuse medical treatment, held by all competent adults and unaltered by pregnancy status, is a central tenet of respectful maternity care. This right is well established in case law, midwifery and obstetric ethical guidance and health policy. However, when pregnant women decline recommended care, concerns about maternal and fetal safety can lead to conflict. Clinicians may feel their own autonomy is challenged and also grapple with ethical and medico-legal concerns. Processes to guide clinicians when women decline recommended care are rare and unstudied. Aim: This thesis set out to support women’s rights in maternity care by investigating the research question: Could a documentation and communication process support pregnant women’s rights to decline recommended maternity care? Methods: A sequential, explanatory mixed-methods study was undertaken in a Brisbane (Australia) tertiary maternity hospital where a structured process, the Maternity Care Plan (MCP), had been established to guide communication and documentation when women declined recommended care. The first stage of the study was quantitative and mapped the scope and use of the MCP process via a retrospective cohort study of women with MCPs. Results of the quantitative stage then informed selection of participants for the qualitative phase of the study which involved thematic analysis of in-depth semi-structured interviews with women, midwives, and obstetricians. Within the qualitative phase, two layers of thematic analysis were undertaken. The first layer of thematic analysis was descriptive, and focused on participant’s experiences of the MCP process, while the second layer applied a more critical and feminist lens, foregrounding the underlying values and attitudes that drove care when pregnant women declined to follow professional advice. Findings: The retrospective cohort study included 52 women with MCPs and concluded that the MCP process enabled clinicians to provide care outside of hospital policies but was used rarely, for a narrow range of situations and with significant variation in its application. These results were then followed up in interviews with nine women, twelve midwives, and nine obstetricians. The descriptive thematic analysis of interviews found that obstetricians felt protected and reassured by the structured documentation and communication, while other clinicians felt reassured by the perception of obstetric authorisation. This, in turn, protected women’s access to maternity care. However, inconsistencies in the implementation of the MCP process, and fragmented care, diminished both the utility of the process and women’s access to it. While the MCP process provided a symbol of respect for maternal autonomy, the larger forces of patriarchy and medical hegemony remained largely unchallenged. The feminist thematic analysis then identified both supportive and punitive interactions between women and clinicians, depending on whether the woman’s birth intentions were perceived by individual clinicians to transgress norms of patienthood and motherhood. Key conclusions and implications: Although the MCP process was only partially and indirectly successful in supporting women’s right to refuse recommended care, a refined process has the potential to be woman-centred and effective. A new process, termed the ‘Personalised Alternative Care and Treatment’ (PACT) planning process, could provide a systems-level response to situations where women decline recommended care. The policy, practice, education and research measures that would underpin the PACT planning process are described, including the incorporation of the woman’s own account into documentation, establishing flexible pathways to initiate the PACT process and adding the failsafe of a Respectful Maternity Care Advocate. Additional research is now needed to assess the acceptability and utility of the PACT process.

IntroductionAI-powered conversational agents have proven effective in alleviating psychological distress, however, concerns about autonomy and authentic psychological development remain, especially in youth during critical stages of identity and resilience formation. Despite the increasing use of AI technologies, there is a significant gap in well-being literacy within educational systems. This gap leaves young adults ill-prepared to navigate the complexities of real world challenges, contributing to rising rates of anxiety, stress, and depression. Furthermore, the lack of AI literacy can exacerbate psychological distress, negatively impacting academic performance and overall well-being. As young adults actively engage with AI, efforts should focus not on resisting technological progress but on fostering their development as users who are capable, aware, and ethical in addressing their contextual well-being needs.This study aims to extend the understanding of the factors influencing well-being and determine how to harness artificial intelligence for contextual well-being from a human-centred perspective.Methods and analysisThe research is an exploratory sequential mixed methods Study, combining semi-structured interviews and an electronic Delphi study (eDelphi) to gather insights for consensus building. The study adopts a pragmatism paradigm with a foresight approach, ideal for addressing the dynamic, evolving intersection of AI and well-being. Interpretative phenomenological analysis, reflective thematic analysis and descriptive statistical analysis will be used accordingly. Medical students (aged 18–30) were selected as a social microcosm study cohort representing youth.Ethics and disseminationThis study was approved by the University College Dublin Human Research Ethics Committee (HREC); Reference: LS-C-24-375-Xie-Cullen.The outcomes of the study will be communicated through publications in peer-reviewed journals, presentations at academic conferences.