This issue of the Research Digest will focus on how climate change (or the climate emergency, as it has been declared in the UK) affects the mental health of children and young people. Although we may, or may not, see evidence of this in our consulting rooms, concerns about the future of the planet are consistently reported in the media, and exist in some form in our own lives and those of our patients. It is, unfortunately, the wider context in which our work takes place, and a reality we all share. It is therefore important that we as therapists have an awareness, and openness, to this issue, so we can be alive to it in our clinical work, should it emerge.
The review begins with two papers that look at the literature on the impact and implications of climate change for young people’s mental health, and their perceptions of this issue. Lawrance et al. (2022) describe it as a ‘risk amplifier’, arguing that its impact is ‘particularly acute for those groups already disadvantaged within and across countries’, while Clemens et al. (2022) give evidence of the direct and indirect mental health consequences of climate change. They conclude that it is ‘a serious threat to children and adolescents’ mental health’.
The following two sections of the review attempt to separately consider ways in which we may, as clinicians, encounter the effects of climate change in our work. Initially, papers that look at the thoughts and feelings of young people regarding climate change are included, with the idea that this may give a general sense of how they think about this issue. Findings from these papers are mixed, with Lee and Barnett (2022) reporting that adolescents somewhat distance themselves from the issue, tending to view others as responsible for both the problems and solutions when it comes to climate change. Lee et al. (2020) found that younger children were more concerned about climate change, and children in more developed countries generally seemed less troubled and less willing to take action. In contrast, Sciberras and Fernando (2022) found that concern regarding climate change was more likely to increase with age, while Thompson et al. (2022) and Lawrance et al. (2020) reported that adolescents tend to be very engaged and emotionally affected by climate change. In perhaps the most ambitious piece of research included in this review, Hickman et al. (2021) surveyed 10,000 16–25-year-olds across ten countries and found that – ‘Climate anxiety and dissatisfaction with government responses are widespread in children and young people in countries across the world and impact their daily functioning’, with 59% reporting being very or extremely worried about this issue.
The next section includes research which looks at the mental health outcomes for children and young people whose lives are directly affected by climate change or linked natural disasters. Cunsolo Willox et al. (2013) looked at the effects of climate change on the mental health of the Inuit population in Labrador, Canada (which include changes in weather, snow, and wildlife and vegetation patterns), and named it as an additional mental health stressor for families, linked to a variety of negative outcomes. Dean and Stain (2010) found increased levels of emotional distress in Australian adolescents living through a prolonged drought, while Bokszczanin (2007) found that 18% of 11–21-year-olds sampled met all diagnostic criteria for PTSD, 28 months after a flood in southwestern Poland. Interestingly, Sugg et al. (2019) found that there was a significant increase in the use of a US based crisis text line during anomalously warm weather conditions, indicating a link between rising air temperatures and poorer mental health.
The final section of the review includes two research papers that consider how mental health clinicians can support children and young people in the face of the climate emergency. Ojala (2013) found that a ‘meaning-focussed’ approach (as opposed to ‘problem-focussed’ or ‘de-emphasising the threat’) was most helpful in work with young people with climate anxiety, while van Nieuwenhuizen et al. (2021) advised mental health clinicians to ‘respond to this existential crisis by addressing research gaps in this area, obtaining relevant clinical training, educating their communities, and joining and supporting young people in their advocacy efforts.’ Perhaps the final point could be interpreted as emphasising the need for therapists to be appropriately in touch with this issue, and be alongside patients in their concerns.
As before, a glossary of the research terminology that appears in this issue of the Research Digest is included at the end.
Reviews
The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications
Emma L. Lawrance, Rhiannon Thompson, Jessica Newberry Le Vay, Lisa Page & Neil Jennings
International Review of Psychiatry, Taylor & Francis, 2022, volume 34(5): 443–498, doi: 10.1080/09540261.2022.2128725
Converging global evidence highlights the dire consequences of climate change for human mental health and wellbeing. This paper summarises literature across relevant disciplines to provide a comprehensive narrative review of the multiple pathways through which climate change interacts with mental health and wellbeing. Climate change acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. The disruptive influence of rising global temperatures and extreme weather events, such as experiencing a heatwave or water insecurity, compounds existing stressors experienced by individuals and communities. This has deleterious effects on people’s mental health and is particularly acute for those groups already disadvantaged within and across countries. Awareness and experiences of escalating climate threats and climate inaction can generate understandable psychological distress; though strong emotional responses can also motivate climate action. We highlight opportunities to support individuals and communities to cope with and act on climate change. Consideration of the multiple and interconnected pathways of climate impacts and their influence on mental health determinants must inform evidence-based interventions. Appropriate action that centres climate justice can reduce the current and future mental health burden, while simultaneously improving the conditions that nurture wellbeing and equality. The presented evidence adds further weight to the need for decisive climate action by decision makers across all scales.
Report of the intergovernmental panel on climate change: implications for the mental health policy of children and adolescents in Europe – a scoping review
Vera Clemens, Eckart von Hirschhausen & Jörg M. Fegert
European Child & Adolescent Psychiatry, Springer, 2022, volume 31: 701–713, doi: 10.1007/s00787-020-01615-3
Climate change is a worldwide challenge. Its consequences do encompass severe threats not only for the existence and somatic health, but also for the mental health of children and adolescents. Mental health can be impaired by three types of consequences. Direct consequences of climate change, such as natural disasters and indirect consequences, such as loss of land, flight and migration, exposure to violence, change of social, ecological, economic or cultural environment. Moreover, the increasing awareness of the existential dimension of climate change in children and adolescents can influence their well-being or challenge their mental health. Consequences of climate change for somatic health may interact with mental health or have psychological sequelae in children and adolescents. Based on the estimates by the United Nations Intergovernmental Panel on Climate Change, we have summarized current data on these differential pathways as to how climate change affects the mental health of children worldwide through selective literature research on Pubmed. Mental health sequelae of direct and indirect consequences of climate change, increased awareness and physical health problems caused by climate change are presented. We give insights into special vulnerabilities of children and adolescents and identify high-risk groups. As the “Fridays for Future” movement has been initiated in northern Europe, we will discuss these results with a focus on children and adolescents in Europe. The results indicate that climate change is a serious threat to children and adolescent mental health. Children´s rights, mental health and climate change should not continue to be seen as separate points; instead, they need to be brought together to address this major challenge determining the future of our children and their descendants.
Children and young people’s thought and feelings regarding climate change
Adolescents’ Representations of Climate Change: Exploring the Self-other Thema in a Focus Group Study
Katharine Lee & Julie Barnett
Environmental Communication, Taylor & Francis, 2022, volume 16(3): 408–423, doi: 10.1080/17,524,032.2021.2023202
Research on social representations of risks has indicated that the self-other thema underpins representations of several threats. This focus group study, conducted with adolescents aged 11–14 in the UK, explored the ways in which the self and other were positioned in relation to climate change causes, impacts, and solutions. We found that the self and other were constructed and deployed differently, serving to present the self more positively than the other, depending on the focus of discussion. Responsibility for causing climate change was placed with other countries rather than the UK. The impacts of climate change were argued to be more severe for other people in other countries and to threaten the far future more than the present. Others – the UK government and older generations – were deemed straightforwardly responsible for resolving climate change, whilst explanations and justifications for participants’ own actions were more complex. We discuss the implications of our findings for climate change communication.
Adolescents’ thoughts and feelings about the local and global environment: a qualitative interview study
Rhiannon Thompson, Helen L. Fisher, Lindsay H. Dewa, Tania Hussain, Zaina Kabba & Mireille B. Toledano
Child and Adolescent Mental Health, ACAMH, 2022, volume 27(1): 4–13, doi: 10.1111/camh.12520
Background: Despite a recent increase in engagement with environmental issues among young people, their impact upon adolescent mental health and wellbeing is not yet fully understood. Therefore, this study aimed to explore adolescents’ thoughts and feelings about current environmental issues.
Methods: Semi-structured interviews were conducted with a convenience sample of 15 UK-based adolescents aged 14–18 years (66.7% female). Transcripts were inductively thematically analysed by the interviewing researcher and two adolescent co-researchers, with priority given to the co-researchers’ impressions to strengthen interpretations of the personal experiences of the interviewees.
Results: Six themes were identified: the local environment, efficacy, challenging emotions, information, hindrances and perceptions of the future. The local environment was found to affect adolescents positively and negatively. Factors including greenspace and fresh air had a positive impact, and factors including noise and litter had a negative impact. Most participants reported feeling disempowered to personally influence environmental problems but were engaged with them and felt that trying to make a difference was beneficial for their wellbeing. Adolescents largely reported negative expectations about the environment’s future.
Conclusion: The UK adolescents interviewed appeared to be very engaged and emotionally affected by a perceived lack of care towards the environment, locally and globally. It is therefore imperative to amplify young people’s voices and involve them in influencing environmental policy, for the benefit of young people and the planet. Further research should quantify the extent to which environmental issues affect young people’s mental health and identify factors that could prevent or alleviate distress.
Young Persons’ Psychological Responses, Mental Health and Sense of Agency for the Dual Challenges of Climate Change and a Global Pandemic
Emma Lawrance, Neil Jennings, Vasiliki Kioupi, Rhiannon Thompson, James Diffey & Ans Vercammen
The Lancet Planetary Health, Elsevier, 2022, volume 6(9): e726-e738, doi: 10.1016/S2542-5196(22)00172–3
Background: The COVID-19 pandemic and climate change are both significant and pressing global challenges, posing threats to public health and wellbeing. Young people represent a particularly vulnerable group to the distress both crises appear to engender, but we currently lack an understanding of the varied psychological responses to both issues, and their links with mental health conditions and feelings of agency.
Methods: We conducted an online survey in August – October 2020 targeting a diverse sample of young people (16–24 years, N = 530) in the United Kingdom.
Findings: While UK youth reported more life disruption and concern for their future due to the COVID-19 pandemic, climate change was associated with significantly greater distress overall, particularly for individuals with low levels of generalised anxiety. COVID-19 was more associated with feelings of anxiety, isolation, disconnection, and frustration; distress around loss and grief; and effects on quality of life. Climate change was more likely to evoke interest and engagement, guilt, shame, anger, and disgust; and distress associated with guilt, feeling responsible and media coverage. Agency to address climate change was associated with greater climate distress, but COVID-related distress and agency were unrelated.
Interpretation: COVID-19 and climate change are affecting the wellbeing of young people in distinct ways, with implications for health service, policy and research responses. There is a need for mental health practitioners and policy makers to account for the complex relationship between climate agency, distress and mental wellbeing in young people.
Youth perceptions of climate change: A narrative synthesis
Katharine Lee, Nathalia Gjersoe, Saffron O’Neill & Julie Barnett
WIRE’s Climate Change, Wiley, 2020, volume 11(3): e641, doi: 10.1002/wcc.641
Despite the scale of the predicted impact of climate change on future generations, most of the academic literature investigating perceptions of climate change relates to adults or young adults rather than children and adolescents. In this review, we synthesize literature relating to 8- to 19-year-old’s perceptions and understandings of climate change, in order to identify trends and inconsistencies, potential gaps in knowledge, and directions for future research. A comprehensive search strategy identified 51 international studies, using quantitative (n = 36), qualitative (n = 9), and mixed methods (n = 6). The included studies date from 1993 to 2018. The analysis outlines levels of reported belief and concern about climate change and perceptions of its causes and consequences. It also details reported perceptions of viable solutions to climate change and notions of responsibility for implementing these. Scientifically accurate knowledge generally increased with age, although misconceptions persisted across the age range. In some studies, younger children expressed greater concern and were more willing to take action than older adolescents. Levels of belief, concern, and willingness to take action were lower in the United States, United Kingdom, and Australia than in other countries. In conclusion, we discuss potential explanations for these age and place-related differences, examining the age-related findings in the context of concepts and theories in developmental psychology. We outline the limitations of our review and the reviewed studies, and note potential avenues for future research and implications for educational policy and practice.
Climate change-related worry among Australian adolescents: an eight-year longitudinal study
Emma Sciberras & Julian W. Fernando
Child and Adolescent Mental Health, Wiley, 2022, volume 27(1): 22–29, doi: 10.1111/camh.12521
Background: Worry about climate change may be associated with poorer mental health but also with greater political engagement. We determined trajectories of climate change-related worry over adolescence and whether these were associated with depression symptoms and greater engagement with news and politics in late adolescence.
Methods: At ages 10–11, 12–13, 16–17 and 18–19 years, adolescents participating in the Kindergarten cohort of the Longitudinal Study of Australian Children rated their worry about climate change. At age 18–19 years, participants reported on depression symptoms and engagement with news and politics. Latent profile analysis determined trajectories of climate change-related worry across all time points (N = 2244). Linear regression analyses examined the association between trajectories and outcomes at 18–19 years.
Results: Thirteen per cent (n = 290) of adolescents had high persistent worry. The largest proportions had moderate (n = 559, 24.9%) or increasing worry (n = 546, 24.3%), followed by persistent low worry (n = 376, 16.8%), slightly decreasing worry (n = 297, 13.2%) and steeply decreasing worry (n = 176, 7.8%). Adolescents with high persistent worry had higher depression symptoms at age 18–19 years compared to the moderate group, while those with increasing worry did not. The high persistent and increasing worry groups reported greater engagement with news and politics across several measures.
Conclusion: This is the first study to track climate-related worry and outcomes in young people across adolescence. A substantial number of Australian adolescents experience high or increasing worry about climate change, which is associated with greater societal engagement.
Young People’s Voices on Climate Anxiety, Government Betrayal and Moral Injury: A Global Phenomenon
Caroline Hickman, Elizabeth Marks, Panu Pihkala, Susan Clayton, Eric R. Lewandowski, Elouise E. Mayall, Britt Wray, Catriona Mellor & Lise van Susteren
The Lancet Planetary Health, Elsevier, 2021, volume 5(12): e863-e873, doi: 10.2139/ssrn.3918955
Background: Climate change has important implications for the health and futures of children and young people, yet they have little power to limit its harm, making them vulnerable to climate anxiety. This is the first large-scale investigation of climate anxiety in children and young people globally and its relationship with perceived government response.
Methods: We surveyed 10 000 children and young people (aged 16–25 years) in ten countries (Australia, Brazil, Finland, France, India, Nigeria, Philippines, Portugal, the UK, and the USA; 1000 participants per country). Invitations to complete the survey were sent via the platform Kantar between May 18 and June 7, 2021. Data were collected on participants’ thoughts and feelings about climate change, and government responses to climate change. Descriptive statistics were calculated for each aspect of climate anxiety, and Pearson’s correlation analysis was done to evaluate whether climate-related distress, functioning, and negative beliefs about climate change were linked to thoughts and feelings about government response.
Findings: Respondents across all countries were worried about climate change (59% were very or extremely worried and 84% were at least moderately worried). More than 50% reported each of the following emotions: sad, anxious, angry, powerless, helpless, and guilty. More than 45% of respondents said their feelings about climate change negatively affected their daily life and functioning, and many reported a high number of negative thoughts about climate change (eg, 75% said that they think the future is frightening and 83% said that they think people have failed to take care of the planet). Respondents rated governmental responses to climate change negatively and reported greater feelings of betrayal than of reassurance. Climate anxiety and distress were correlated with perceived inadequate government response and associated feelings of betrayal.
Interpretation: Climate anxiety and dissatisfaction with government responses are widespread in children and young people in countries across the world and impact their daily functioning. A perceived failure by governments to respond to the climate crisis is associated with increased distress. There is an urgent need for further research into the emotional impact of climate change on children and young people and for governments to validate their distress by taking urgent action on climate change.
Mental health impact of environmental change and natural disasters
Climate change and mental health: an exploratory case study from Rigolet, Nunatsiavut, Canada
Ashlee Cunsolo Willox, Sherilee L. Harper, James D. Ford, Victoria L. Edge, Karen Landman, Karen Houle, Sarah Blake & Charlotte Wolfrey
Climatic Change, Springer, 2013, volume 121: 255–270, doi: 10.1007/s10584-013-0875-4
As the impacts from anthropogenic climate change are increasing globally, people are experiencing dramatic shifts in weather, temperature, wildlife and vegetation patterns, and water and food quality and availability. These changes impact human health and well-being, and resultantly, climate change has been identified as the biggest global health threat of the 21st Century. Recently, research is beginning to indicate that changes in climate, and the subsequent disruption to the social, economic, and environmental determinants of health, may cause increased incidences and prevalence of mental health issues, emotional responses, and large-scale sociopsychological changes. Through a multi-year, community-led, exploratory case study conducted in Rigolet, Nunatsiavut, Labrador, Canada, this research qualitatively explores the impacts of climate change on mental health and well-being in an Inuit context. Drawing from 67 in-depth interviews conducted between January 2010 and October 2010 with community members and local and regional health professionals, participants reported that changes in weather, snow and ice stability and extent, and wildlife and vegetation patterns attributed to climate change were negatively impacting mental health and well-being due to disruptions in land-based activities and a loss of place-based solace and cultural identity. Participants reported that changes in climate and environment increased family stress, enhanced the possibility of increased drug and alcohol usage, amplified previous traumas and mental health stressors, and were implicated in increased potential for suicide ideation. While a preliminary case study, these exploratory findings indicate that climate change is becoming an additional mental health stressor for resource-dependent communities and provide a baseline for further research.
Mental health impact for adolescents living with prolonged drought
John G. Dean & Helen J. Stain
The Australian Journal of Rural Health, Wiley, 2010, volume 18(1): 32–37, doi: 10.1111/j.1440–1584.2009.01107.x
Background: A 2004 study showed adolescents living in rural Australia were aware of the impact of drought on self, family and community, but did not report levels of emotional distress higher than adolescents of similar age and gender in the Australian community. It was proposed that the rural lifestyle had helped adolescents build resilience for managing this environmental adversity.
Objective: To re sample adolescents from the same rural area and determine if this resilience remained after ongoing drought three years later.
Design: A mixed methods approach using focus groups and a self-report questionnaire.
Setting: Government Central Schools within the Riverina region of New South Wales.
Participants: Male and female adolescents (n = 111) aged 11–17 years completed the self-report questionnaires, while some adolescents (n = 61) within this group also participated in focus groups.
Main outcome measure: The Strengths and Difficulties Questionnaire and a Drought and Community Survey for Children comprised the self-report survey.
Results: Adolescents reported significantly higher levels of emotional distress than those in the previous study (t (191) = 2.80, P < 0.01) and 12% of adolescents scored in the clinical caseness range. Thematic analysis showed consistency with the previous study as well as new themes of grief, loss and the impacts of global climate change.
Conclusions: Results indicate a reporting of lesser well-being than was reported by a comparable group of young people four years earlier. A preventative intervention with a focus on family and community is recommended to address the mental health of adolescents enduring a chronic environmental adversity such as drought.
PTSD symptoms in children and adolescents 28 months after a flood: Age and gender differences
Anna Bokszczanin
Journal of Traumatic Stress, Wiley, 2007, volume 20(3): 347–351, doi: 10.1002/jts.20220
The present study examined the prevalence and predictors of posttraumatic stress disorder symptoms (PTSD) in a sample of 533 students (aged 11 to 21), 28 months after the 1997 Flood in southwestern Poland. The results show that 18% of the participants met all diagnostic criteria for PTSD. Based on hierarchical multiple regression analyses, PTSD criteria symptoms were positively correlated with the degree of exposure to trauma experienced during the disaster. A three-way interaction of trauma, age, and gender showed that more PTSD symptoms were observed among the younger participants and girls than among the older boys. The results confirm the need of research testing culturally sensitive implementation of mental health programs for young victims of disasters, taking into account their age and gender.
Crisis support-seeking behavior and temperature in the United States: Is there an association in young adults and adolescents?
Margaret M Sugg, P Grady Dixon & Jennifer D Runkle
Science of The Total Environment, Elsevier, 2019, volume 669: 400–411, doi: 10.1016/j.scitotenv.2019.02.434
Background: Mounting evidence demonstrates the relationship between high temperatures and adverse mental health outcomes. Yet, no study has examined the influence of temperature on crisis support-seeking behavior among youth in large urban areas.
Methods: Crisis Text Line (CTL) is a text messaging service that provides crisis interventions for support-seeking individuals for a range of mental-health outcomes in the United States. We applied a distributed lag non-linear modeling technique to assess the short-term impacts of daily maximum and minimum temperature on crisis-related events in four metropolitan locations in the USA.
Results: There were multiple positive associations in three of the four study locations that demonstrate crisis help-seeking behavior increased during anomalously warm conditions.
Conclusions: This study suggests that there is a significant association between high minimum or maximum temperatures and crisis help-seeking behaviors in young adults and adolescents in urban areas in the United States.
Clinical considerations
Coping with Climate Change among Adolescents: Implications for Subjective Well-Being and Environmental Engagement
Maria Ojala
Sustainability, MDPI, 2013, volume 5(5): 2191–2209, doi: 10.3390/su5052191
The objective of this questionnaire study was to investigate how Swedish adolescents (n = 321) cope with climate change and how different coping strategies are associated with environmental efficacy, pro-environmental behavior, and subjective well-being. The results were compared to an earlier study on 12-year-olds, and the same coping strategies, problem-focused coping, de-emphasizing the seriousness of the threat, and meaning-focused coping, were identified. As in the study on children, problem-focused and meaning-focused coping were positively related to felt efficacy and environmental behavior, while de-emphasizing the threat was negatively related to these measures. As expected, the more problem-focused coping the adolescents used, the more likely it was that they experienced negative affect in everyday life. This association was explained by the tendency for highly problem-focused adolescents to worry more about climate change. In contrast, meaning-focused coping was positively related to both well-being and optimism. When controlling for well-known predictors such as values and gender, meaning-focused and problem-focused coping were independent positive predictors of environmental efficacy and pro-environmental behavior, while de-emphasizing the threat was a negative predictor of pro-environmental behavior. The results are discussed in relation to coping theories and earlier studies on coping with climate change
The Effects of Climate Change on Child and Adolescent Mental Health: Clinical Considerations
Adrienne van Nieuwenhuizen, Kelsey Hudson, Xiaoxuan Chen & Alison R. Hwong
Current Psychiatry Reports, Springer, 2021, volume 23(12): 88, doi: 10.1007/s11920-021-01296-y
Purpose of Review: We review recent literature on the effects of climate change on child and adolescent mental health and discuss treatment and engagement by clinicians.
Recent Findings: Climate change affects child and adolescent mental health in many intersecting ways, including as a social and ecological determinant of health, a threat amplifier, and a source of trauma and distress. Single extreme weather events contribute to significant negative mental health consequences; however, subacute and chronic climate events also have mental health sequelae. Furthermore, awareness of the climate crisis is associated with emotional distress. Young people with pre-existing mental illness and lacking social support may be at elevated risk for climate change-related mental health effects. Climate activism is associated with resilience and positive development, but may also be a source of increased stress, particularly for marginalized youths.
Summary: Climate change can affect the mental health of children and adolescents in complex and diverse ways. Sources of coping and resilience also vary greatly between individuals. Mental health clinicians must respond to this existential crisis by addressing research gaps in this area, obtaining relevant clinical training, educating their communities, and joining and supporting young people in their advocacy efforts.
Glossary
Convenience sample – a sample that is ‘convenient’ to the researcher, usually by being easy to contact or reach.
Descriptive statistics – describe, show, and summarise the basic features of a dataset found in a given study.
Distributed lag non-linear modelling – a statistical method commonly implemented to estimate an exposure–time–response function, when it is suggested that the exposure effect is nonlinear.
Exploratory case study – a study that seeks to answer the question ‘what’ or ‘who’, and may be a preliminary project that will lead to a larger study in the future.
Focus group study – a study that utilises a form of group interview, capitalising on communication between research participants in order to generate data.
Hierarchical multiple regression analysis – a form of regression analysis that allows the addition of independent variables at separate stages.
Inductive – an approach which aims to generate meanings from data, in order to identify patterns and relationships to build a theory.
Latent profile analysis – a categorical latent variable approach that focuses on identifying latent subpopulations within a population, based on a certain set of variables.
Linear regression analysis – a regression model that allows you to identify which variables impact on a topic of interest, and can be used to model and predict the relationship between variables.
Mixed method study – where qualitative and quantitative data collection and analysis are combined within one study.
Narrative review – a thorough and critical overview of previously published research on the author’s specific topic of interest. It can also be referred to as a literature review.
Narrative synthesis – an approach to the systematic review and synthesis of findings from multiple studies that relies primarily on the use of words and text to summarise and explain the findings of the synthesis.
Pearson’s correlation analysis – a measurement of the strength and direction of a relationship between two linear variables.
Qualitative study – a study that uses data that is descriptive and relates to a phenomenon that can be observed but not measured.
Quantitative study – a study that uses data that is in a numerical form.
Semi-structured interviews – a qualitative data collection strategy, where the researcher asks set, open ended questions.
Thematic analysis – a method for analysing qualitative data that involves identifying and analysing repeated patterns.
Disclosure statement
No potential conflict of interest was reported by the author(s).