ap research thematic analysis paper

Find what you need to study

Academic Paper: Discussion and Analysis

5 min read • march 10, 2023

Dylan Black

Introduction

After presenting your data and results to readers, you have one final step before you can finally wrap up your paper and write a conclusion: analyzing your data! This is the big part of your paper that finally takes all the stuff you've been talking about - your method, the data you collected, the information presented in your literature review - and uses it to make a point!

The major question to be answered in your analysis section is simply "we have all this data, but what does it mean?" What questions does this data answer? How does it relate to your research question ? Can this data be explained by, and is it consistent with, other papers? If not, why? These are the types of questions you'll be discussing in this section.

Source: GIPHY

Writing a Discussion and Analysis

Explain what your data means.

The primary point of a discussion section is to explain to your readers, through both statistical means and thorough explanation, what your results mean for your project. In doing so, you want to be succinct, clear, and specific about how your data backs up the claims you are making. These claims should be directly tied back to the overall focus of your paper.

What is this overall focus, you may ask? Your research question ! This discussion along with your conclusion forms the final analysis of your research - what answers did we find? Was our research successful? How do the results we found tie into and relate to the current consensus by the research community? Were our results expected or unexpected? Why or why not? These are all questions you may consider in writing your discussion section.

You showing off all of the cool findings of your research! Source: GIPHY

Why Did Your Results Happen?

After presenting your results in your results section, you may also want to explain why your results actually occurred. This is integral to gaining a full understanding of your results and the conclusions you can draw from them. For example, if data you found contradicts certain data points found in other studies, one of the most important aspects of your discussion of said data is going to be theorizing as to why this disparity took place.

Note that making broad, sweeping claims based on your data is not enough! Everything, and I mean just about everything you say in your discussions section must be backed up either by your own findings that you showed in your results section or past research that has been performed in your field.

For many situations, finding these answers is not easy, and a lot of thinking must be done as to why your results actually occurred the way they did. For some fields, specifically STEM-related fields, a discussion might dive into the theoretical foundations of your research, explaining interactions between parts of your study that led to your results. For others, like social sciences and humanities, results may be open to more interpretation.

However, "open to more interpretation" does not mean you can make claims willy nilly and claim "author's interpretation". In fact, such interpretation may be harder than STEM explanations! You will have to synthesize existing analysis on your topic and incorporate that in your analysis.

Liam Neeson explains the major question of your analysis. Source: GIPHY

Discussion vs. Summary & Repetition

Quite possibly the biggest mistake made within a discussion section is simply restating your data in a different format. The role of the discussion section is to explain your data and what it means for your project. Many students, thinking they're making discussion and analysis, simply regurgitate their numbers back in full sentences with a surface-level explanation.

Phrases like "this shows" and others similar, while good building blocks and great planning tools, often lead to a relatively weak discussion that isn't very nuanced and doesn't lead to much new understanding.

Instead, your goal will be to, through this section and your conclusion, establish a new understanding and in the end, close your gap! To do this effectively, you not only will have to present the numbers and results of your study, but you'll also have to describe how such data forms a new idea that has not been found in prior research.

This, in essence, is the heart of research - finding something new that hasn't been studied before! I don't know if it's just us, but that's pretty darn cool and something that you as the researcher should be incredibly proud of yourself for accomplishing.

Rubric Points

Before we close out this guide, let's take a quick peek at our best friend: the AP Research Rubric for the Discussion and Conclusion sections.

Source: CollegeBoard

Scores of One and Two: Nothing New, Your Standard Essay

Responses that earn a score of one or two on this section of the AP Research Academic Paper typically don't find much new and by this point may not have a fully developed method nor well-thought-out results. For the most part, these are more similar to essays you may have written in a prior English class or AP Seminar than a true Research paper. Instead of finding new ideas, they summarize already existing information about a topic.

Score of Three: New Understanding, Not Enough Support

A score of three is the first row that establishes a new understanding! This is a great step forward from a one or a two. However, what differentiates a three from a four or a five is the explanation and support of such a new understanding. A paper that earns a three lacks in building a line of reasoning and does not present enough evidence, both from their results section and from already published research.

Scores of Four and Five: New Understanding With A Line of Reasoning

We've made it to the best of the best! With scores of four and five, successful papers describe a new understanding with an effective line of reasoning, sufficient evidence, and an all-around great presentation of how their results signify filling a gap and answering a research question .

As far as the discussions section goes, the difference between a four and a five is more on the side of complexity and nuance. Where a four hits all the marks and does it well, a five exceeds this and writes a truly exceptional analysis. Another area where these two sections differ is in the limitations described, which we discuss in the Conclusion section guide.

You did it!!!! You have, for the most part, finished the brunt of your research paper and are over the hump! All that's left to do is tackle the conclusion, which tends to be for most the easiest section to write because all you do is summarize how your research question was answered and make some final points about how your research impacts your field. Finally, as always...

Key Terms to Review ( 1 )

Research Question

Stay Connected

© 2024 Fiveable Inc. All rights reserved.

AP® and SAT® are trademarks registered by the College Board, which is not affiliated with, and does not endorse this website.

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

• How to Do Thematic Analysis | Step-by-Step Guide & Examples

How to Do Thematic Analysis | Step-by-Step Guide & Examples

Published on September 6, 2019 by Jack Caulfield . Revised on June 22, 2023.

Thematic analysis is a method of analyzing qualitative data . It is usually applied to a set of texts, such as an interview or transcripts . The researcher closely examines the data to identify common themes – topics, ideas and patterns of meaning that come up repeatedly.

There are various approaches to conducting thematic analysis, but the most common form follows a six-step process: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing up. Following this process can also help you avoid confirmation bias when formulating your analysis.

This process was originally developed for psychology research by Virginia Braun and Victoria Clarke . However, thematic analysis is a flexible method that can be adapted to many different kinds of research.

Table of contents

When to use thematic analysis, different approaches to thematic analysis, step 1: familiarization, step 2: coding, step 3: generating themes, step 4: reviewing themes, step 5: defining and naming themes, step 6: writing up, other interesting articles.

Thematic analysis is a good approach to research where you’re trying to find out something about people’s views, opinions, knowledge, experiences or values from a set of qualitative data – for example, interview transcripts , social media profiles, or survey responses .

Some types of research questions you might use thematic analysis to answer:

• How do patients perceive doctors in a hospital setting?
• What are young women’s experiences on dating sites?
• What are non-experts’ ideas and opinions about climate change?
• How is gender constructed in high school history teaching?

To answer any of these questions, you would collect data from a group of relevant participants and then analyze it. Thematic analysis allows you a lot of flexibility in interpreting the data, and allows you to approach large data sets more easily by sorting them into broad themes.

However, it also involves the risk of missing nuances in the data. Thematic analysis is often quite subjective and relies on the researcher’s judgement, so you have to reflect carefully on your own choices and interpretations.

Pay close attention to the data to ensure that you’re not picking up on things that are not there – or obscuring things that are.

Here's why students love Scribbr's proofreading services

Discover proofreading & editing

Once you’ve decided to use thematic analysis, there are different approaches to consider.

There’s the distinction between inductive and deductive approaches:

• An inductive approach involves allowing the data to determine your themes.
• A deductive approach involves coming to the data with some preconceived themes you expect to find reflected there, based on theory or existing knowledge.

Ask yourself: Does my theoretical framework give me a strong idea of what kind of themes I expect to find in the data (deductive), or am I planning to develop my own framework based on what I find (inductive)?

There’s also the distinction between a semantic and a latent approach:

• A semantic approach involves analyzing the explicit content of the data.
• A latent approach involves reading into the subtext and assumptions underlying the data.

Ask yourself: Am I interested in people’s stated opinions (semantic) or in what their statements reveal about their assumptions and social context (latent)?

After you’ve decided thematic analysis is the right method for analyzing your data, and you’ve thought about the approach you’re going to take, you can follow the six steps developed by Braun and Clarke .

The first step is to get to know our data. It’s important to get a thorough overview of all the data we collected before we start analyzing individual items.

This might involve transcribing audio , reading through the text and taking initial notes, and generally looking through the data to get familiar with it.

Next up, we need to code the data. Coding means highlighting sections of our text – usually phrases or sentences – and coming up with shorthand labels or “codes” to describe their content.

Let’s take a short example text. Say we’re researching perceptions of climate change among conservative voters aged 50 and up, and we have collected data through a series of interviews. An extract from one interview looks like this:

In this extract, we’ve highlighted various phrases in different colors corresponding to different codes. Each code describes the idea or feeling expressed in that part of the text.

At this stage, we want to be thorough: we go through the transcript of every interview and highlight everything that jumps out as relevant or potentially interesting. As well as highlighting all the phrases and sentences that match these codes, we can keep adding new codes as we go through the text.

After we’ve been through the text, we collate together all the data into groups identified by code. These codes allow us to gain a a condensed overview of the main points and common meanings that recur throughout the data.

Prevent plagiarism. Run a free check.

Next, we look over the codes we’ve created, identify patterns among them, and start coming up with themes.

Themes are generally broader than codes. Most of the time, you’ll combine several codes into a single theme. In our example, we might start combining codes into themes like this:

At this stage, we might decide that some of our codes are too vague or not relevant enough (for example, because they don’t appear very often in the data), so they can be discarded.

Other codes might become themes in their own right. In our example, we decided that the code “uncertainty” made sense as a theme, with some other codes incorporated into it.

Again, what we decide will vary according to what we’re trying to find out. We want to create potential themes that tell us something helpful about the data for our purposes.

Now we have to make sure that our themes are useful and accurate representations of the data. Here, we return to the data set and compare our themes against it. Are we missing anything? Are these themes really present in the data? What can we change to make our themes work better?

If we encounter problems with our themes, we might split them up, combine them, discard them or create new ones: whatever makes them more useful and accurate.

For example, we might decide upon looking through the data that “changing terminology” fits better under the “uncertainty” theme than under “distrust of experts,” since the data labelled with this code involves confusion, not necessarily distrust.

Now that you have a final list of themes, it’s time to name and define each of them.

Defining themes involves formulating exactly what we mean by each theme and figuring out how it helps us understand the data.

Naming themes involves coming up with a succinct and easily understandable name for each theme.

For example, we might look at “distrust of experts” and determine exactly who we mean by “experts” in this theme. We might decide that a better name for the theme is “distrust of authority” or “conspiracy thinking”.

Finally, we’ll write up our analysis of the data. Like all academic texts, writing up a thematic analysis requires an introduction to establish our research question, aims and approach.

We should also include a methodology section, describing how we collected the data (e.g. through semi-structured interviews or open-ended survey questions ) and explaining how we conducted the thematic analysis itself.

The results or findings section usually addresses each theme in turn. We describe how often the themes come up and what they mean, including examples from the data as evidence. Finally, our conclusion explains the main takeaways and shows how the analysis has answered our research question.

In our example, we might argue that conspiracy thinking about climate change is widespread among older conservative voters, point out the uncertainty with which many voters view the issue, and discuss the role of misinformation in respondents’ perceptions.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Measures of central tendency
• Chi square tests
• Confidence interval
• Quartiles & Quantiles
• Cluster sampling
• Stratified sampling
• Discourse analysis
• Cohort study
• Peer review
• Ethnography

Research bias

• Implicit bias
• Cognitive bias
• Conformity bias
• Hawthorne effect
• Availability heuristic
• Attrition bias
• Social desirability bias

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

Caulfield, J. (2023, June 22). How to Do Thematic Analysis | Step-by-Step Guide & Examples. Scribbr. Retrieved April 10, 2024, from https://www.scribbr.com/methodology/thematic-analysis/

Is this article helpful?

Jack Caulfield

Other students also liked, what is qualitative research | methods & examples, inductive vs. deductive research approach | steps & examples, critical discourse analysis | definition, guide & examples, "i thought ai proofreading was useless but..".

I've been using Scribbr for years now and I know it's a service that won't disappoint. It does a good job spotting mistakes”

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Int J Qual Stud Health Well-being
• v.6(3); 2011

Children's understandings’ of obesity, a thematic analysis

Childhood obesity is a major concern in today's society. Research suggests the inclusion of the views and understandings of a target group facilitates strategies that have better efficacy. The objective of this study was to explore the concepts and themes that make up children's understandings of the causes and consequences of obesity. Participants were selected from Reception (4–5 years old) and Year 6 (10–11 years old), and attended a school in an area of Sunderland, in North East England. Participants were separated according to age and gender, resulting in four focus groups, run across two sessions. A thematic analysis (Braun & Clarke, 2006) identified overarching themes evident across all groups, suggesting the key concepts that contribute to children's understandings of obesity are “Knowledge through Education,” “Role Models,” “Fat is Bad,” and “Mixed Messages.” The implications of these findings and considerations of the methodology are discussed in full.

The Health Survey for England 2009 illustrated that 65.9% of men and 56.9% of women have a body mass index (BMI) higher than 25 kg/m 2 , classing them as overweight, obese (>30 kg/m 2 ), or morbidly obese (>40 kg/m 2 ). Obesity is linked to many chronic illnesses, including type II diabetes, heart disease, and some cancers—specifically bowel and others within the digestive system (Renehan, Tyson, Egger, Heller, & Zwahlen, 2008 ). As a result, the direct cost to the National Health Service (NHS) of treating obesity was estimated to be between £991 and £1,124 million, for the 2001/2002 financial year (McCormick & Stone, 2007 ).

Childhood obesity is of particular concern because obese children are far more likely than children of a normal weight to become obese adults (Alexander & Sherman, 1991 ). The Health Survey for England 2009 showed that between 1995 and 2008, the percentage of overweight and obese girls rose from 25.5 to 29.2% and from 24.5 to 31.4% for boys. This is despite the fact that during the same period reported total energy intake in the United Kingdom (UK) fell by around 20% (Statistics on Obesity, Physical Activity and Diet England, 2006 ). These contradictory figures highlight the complexity of factors contributing to obesity, pointing to issues such as levels of physical activity, which have significantly fallen over the past two decades (Prentice & Jebb, 1995 ).

Many other factors influence incidences of obesity. The negative impact of childhood obesity causes the greatest concern and needs to be further understood. Obese children are more likely to become obese adults and experience increased health problems. Knowler, Pettitt, and Saad ( 1991 ), highlighted the links between childhood obesity and a poor immune system, risk of raised blood pressure, and cardiovascular problems. Studies have also identified that overweight and obese children are more likely to suffer psychological problems associated with low self-esteem, bullying, and social exclusion (Breat, Mervielde, & Vandereycken, 1997 ).

On an international scale, obesity can be seen as a problem of the developed world, a result of economic wealth, high food availability, and low levels of manual labour leading to lower levels of physical activity. This is in conjunction with high levels of car ownership and wide ranging public transport systems adding to the problem. In short, at the heart of obesity lies a homeostatic biological system that works constantly to maintain energy balance to keep the body at a constant weight. This system has not yet adapted to the world in which we currently live because the pace of technological progress has surpassed evolution resulting in a more sedentary lifestyle (Department of Innovation Universities and Skills, 2007). One surprising feature of the geographical distribution of obesity is its increased prevalence in economically and socially deprived areas in the western world, including the focus of this current piece of research, the United Kingdom. This phenomenon is very much a recent development, because historically deprived areas tended to see higher levels of under-nutrition. Brunt, Lester, Davies, and Williams ( 2008 ) illustrate how this situation has now reversed. They found between 1995 and 2005 the gap between obesity levels in the most deprived areas compared to the least (the latter typically having the higher levels) was steadily closing, and that by 2005 obesity levels in the most deprived areas had overtaken those in the least deprived areas, a phenomena that persists today.

The Childhood Measurement Programme (Department of Health and Department for Children, Schools and Families, 2008 ) demonstrated Sunderland in the north-east of England has some of the highest levels of overweight and obese children in the United Kingdom. This same publication also points out the strong positive correlation between areas considered as deprived and levels of obesity in children in Reception (4–5 year olds) and Year 6 (10–11 year olds). Areas of Sunderland are considered to be economically and socially deprived meaning the children who live there can be considered high risk. The statistics relating to Sunderland, where this study took place, demonstrate that 27.8% of Reception-aged children are either overweight or obese and for Year 6 pupils this rises to 38.4%.

The Foresight Report (Department of Innovation Universities and Skills, 2007), tackling obesity, points out that current policies are failing because they do not provide the depth and range of interventions needed. This might lead to positive interventions being ineffective if they are undermined by other areas in society such as social factors and the power of media advertising. The government launched its Healthy Schools Initiative in 2005; however, there has been no substantial reduction in obesity levels since 2005 (Department of Health and Department for Children, Schools and Families, 2008). With this in mind it would seem timely to approach the problem from a different perspective. Effective policies to tackle obesity need to consider all parties involved. However, current policies have been formed using a top down approach i.e., from government, health and education professionals, and even celebrity chefs! Even though these groups are likely to have a broad understanding of the problem from its roots to the long-term consequences, there has been a notable failure to take into consideration the understandings of the individuals at highest risk of obesity, the children themselves. There is growing evidence that interventions incorporating the views of the target population have a greater level of success (Hesketh, Water, Green, Salmon, & Williams, 2005). In the United Kingdom there has been a strong movement to ensure the inclusion of children in decision making particularly in relation to issues that directly affect them such as education, social care, and health (Department of Health, 2002 ; Department of Health and Department for Education and Skills, 2004 ). The collection and dissemination of the understandings of children relating to obesity could provide an insight into why so many strategies are failing. This in turn could lead to the development of policies that can be delivered to provide more successful outcomes.

There is a clear shortage of research examining children's understandings’ of obesity, the studies that have attempted to explore this domain have focused on exploring parent and care giver perceptions (Young-Hyman, Herman, Scott, & Schlundt, 1999), and the understandings of health professionals (Chamberlin, Sherman, Jain, Powers, & Whitaker, 2002 ). More recently studies have considered the understandings of care givers, health professionals, and teachers alongside those of the children themselves (Borra, Kelly, Shirreffs, Neville, & Geiger, 2003; Hesketh et al., 2005). Studies that have examined children's understanding have been focused on body image, overweight versus underweight (Hill & Silver, 1995 ), and peer perceptions of overweight and eating behaviour (Bell & Morgan, 2000 ; Oliver & Thelen, 1996 ), but not on the understandings’ of the children themselves with regards to the causes and consequences of obesity.

Focus groups have proved to be a particularly useful method for collecting data from children, they are most effective with groups of three children and in situations where the children know and like each other. Groups must be carefully selected to ensure the children are comfortable with each other. Talking together in small groups is familiar territory for children because it simulates class work. This method allows the researcher to structure the discussion around themes or topics rather than direct questions. This in turn enables the children to take control of the discussion (Mauthner, 1997 ) with the researcher present to keep things on track. Conducting group discussions in single sex groups can also prove to be more successful because boys are often louder and more willing to talk and this can mean they direct the topic of conversation. It has also been noted the use of some sort of structured activity such as drawing, reading, or sorting cards, can help focus discussion in particular with young children. When discussing diet with children, nutritionists and dieticians regularly use replica food items to help visualise the topic under discussion and photos depicting scenes of physical activity have proved effective in qualitative studies (Hesketh et al., 2005 ).

In summary the objective of this research is to investigate the understandings of a high risk group of children (high risk because of their socio-economic status so determined by their locality), of some of the causes and consequences of obesity, and its links to diet and physical activity. The concepts and themes generated by this research should be used to provide an insight that may inform local policies and interventions that need to be developed to provide a broader and deeper range of options to address this multi-faceted issue.

In order to address the gaps in current literature it was decided this research should focus on identifying themes within the participants understanding. This would provide the researcher with scope for further investigation of the subject in question. It was therefore decided that the most appropriate method of analysis would be a thematic analysis. However, there have been criticisms of this approach in the past due to the lack of clear guidelines for researchers employing such methods. This has subsequently contributed to some researchers omitting “how” they actually analysed their results (Attride-Stirling, 2001 ). It was of upmost importance to the authors in this current study to employ a clear, replicable, and transparent methodology.

Braun and Clarke ( 2006 ) outline a series of phases through which researchers must pass in order to produce a thematic analysis. This procedure allows a clear demarcation of thematic analysis, providing researchers with a well-defined explanation of what it is and how it is carried out whilst maintaining the “flexibility” tied to its epistemological position. The authors in this paper take a position that acknowledges our desire to incorporate the individual experiences of the participants and the meanings they attach to them. However, we also wish to consider the impact of the wider social context on these meanings. Braun and Clarke describe such a position as “contextualist,” sitting firmly between essentialism or realism and constuctionism. Not all theorists describe these two poles of epistemological outlook in the same way; Madill et al. ( 2000 ) refers to them as “naive realist” and “radical relativist.” Methodologies that go hand in hand with this mid-ground position are typically phenomenological in nature, but the flexibility of thematic analysis means that it can also be underpinned by an “in-between” epistemological position. Willig ( 2008 , p. 13) summarises this by explaining a position that argues “while experience is always the product of interpretation and, therefore, constructed (and flexible) … it is nevertheless ‘real’ to the person who is having the experience.” We wish to consider the reality of obesity to the participants, through an exploration of their experiences and the meanings they attach to them, whilst incorporating the broader role society plays in contributing to and shaping the participants meaning making and subsequent understandings.

Participants

Twelve participants were selected through liaising with the school and class teachers, this was particularly important considering the sensitive nature of the research topic and the fact that the participants taking part in this study were children—a vulnerable group. Measures were taken to prevent any of the participants feeling stigmatised. Therefore, under the guidance of the class teachers, the participants approached to take part in the study were carefully selected to ensure no children who may have been made to feel uncomfortable by the discussion were included, and to make sure that the children selected to be in the same focus groups were comfortable with each other. Six (three boys and three girls) were selected from two school years; Reception, aged between 4 and 5 years and Year 6 aged between 10 and 11. The motivation for selecting these age groups was that government statistics relating to childhood obesity are published for these two age brackets. These age groups are viewed as critical points in measuring children's BMI and in monitoring their changing health status. Through looking at these age groups, it may help us to gain an insight into what understandings children arrive at school with (primarily shaped by their experiences set within a home environment) and those that they have later on in their school life when further social influence (school and peers) may play a role in shaping their understandings. Efforts were made to make the sample representative of ethnicities attending the school so a proportionate number of children of Bangladeshi and Afro-Caribbean heritage took part. Participants were not recruited on account of their BMI or weight status. The parents of the children were provided with a study information letter and, in addition, received a phone call from the school's community liaison officer to ensure that parents fully understood the nature of the study because the researcher was aware that for some parents English was not their first language. The phone calls were made in their mother tongue thus allowing the parents to sign the parental assent form with all their queries being answered. Participants were also asked for their verbal consent on the day prior to the study taking place.

The study had received ethical approval from Northumbria University's School of Psychology and Sports Science Ethics Board prior to commencing. The researcher had also been approved by means of an enhanced criminal records background check clearing her to work with children; this approval was required by both the school and the university.

The focus groups all took place in the same quiet room at the school and were conducted by the principal investigator (referred to herein as the researcher). On arrival, the researcher introduced herself and provided name badges for the participants. The researcher briefly explained to the participants that she was there to talk to them about food and exercise. The researcher also explained to the participants that she wanted them to assume that she knew nothing, they were not being tested, and she was only interested in hearing what they had to say—not whether they were right or wrong. Verbal instructions were provided to the participants and they provided verbal assent prior to the recording commencing. A series of questions were developed by the research team, these were designed to keep the focus group sessions on track whilst exploring issues relevant to the research question. The sessions started initially with a discussion centred on the replica food items laid out on the table. Participants were asked to use the replica food and pick out healthy foods and make what they thought would be a healthy lunch. They were asked to explain why it was healthy and what made it healthy. Participants were then asked about foods they liked and why they liked them. In addition, they were asked about the sorts of things they normally ate at home and in school and things they liked to eat. Once conversation had dwindled concerning the replica food the researcher introduced the laminated picture cards, and the discussion moved to physical activity with the researcher encouraging the participants to explore the relationship between diet and exercise. Questions focussed on what activities they thought were healthy (as the images depicted activities that were both physical and sedentary; that is, one image of somebody running another of somebody playing computer games). The participants were asked about what sorts of activities they liked doing and what made those activities good for them. They were asked what activities they regularly engaged with, the sorts of sports their parents and siblings took part in, and the activities they did as families. The themes of discussion were encouraged around the two elements pertinent to any strategy looking to reduce obesity: healthy eating and physical activity. Furthermore, questions also probed at what the participants thought the benefits were of following a healthy lifestyle and what the consequences were of not following one. They were also asked what advice they would give somebody who wanted to be healthier and how important it was to them to be healthy. The focus group guide was intended to provide a structure but not rigidly dictate the line of questioning. The researcher included prompts and encouraged participants to expand on their initial responses and followed up on notions that the participants raised themselves. The sessions on the first day lasted between 20 and 30 min, ending when the participants input was insufficient to continue. At the end of each session the researcher read out the participant debrief and provided each participant with a parental debrief information sheet to take home.

In order to strengthen the analysis process and gather the most appropriate data, the researchers reviewed the recording made on the first day and reflected on the procedures employed in the focus groups. Similar approaches of reviewing data to informing further data collection are used in methods such as grounded theory and it was felt that doing so would strengthen the current study. The decision was made not to use the props (replica food and cards) used on the first day in the second round of focus groups, as at times they had proved to be a distraction to the participants. As an alternative, Reception children were given colouring pens and paper to focus their attention. Year 6 focus groups were run again allowing for free discussion, following on from issues and understandings they had raised in the initial session. The second round of focus groups, other than the changes already detailed above, followed the same sequence as they had on day one and lasted around 30 min. The recordings were transcribed combining the recordings from both days creating four transcripts, one for each group.

Data analysis

The data collected from all the focus groups was transcribed by the principal investigator, during this process the initial thoughts and ideas were noted down as this is considered an essential stage in analysis (Riessman, 1993 ). The transcribed data was then read and re-read several times and, in addition, the recordings were listened to several times to ensure the accuracy of the transcription. This process of “repeated reading” (Braun & Clarke, 2006 ) and the use of the recordings to listen to the data, results in data immersion and refers to the researcher's closeness with the data. Following on from this initial stage and building on the notes and ideas generated through transcription and data immersion is the coding phase. These codes identified features of the data that the researcher considered pertinent to the research question. Furthermore, as is intrinsic to the method, the whole data set was given equal attention so that full consideration could be given to repeated patterns within the data. The third stage involved searching for themes; these explained larger sections of the data by combining different codes that may have been very similar or may have been considered the same aspect within the data. All initial codes relevant to the research question were incorporated into a theme. Braun and Clarke (2006) also suggest the development of thematic maps to aid the generation of themes. These helped the researchers to visualise and consider the links and relationships between themes. At this point any themes that did not have enough data to support them or were too diverse were discarded. This refinement of the themes took place on two levels, primarily with the coded data ensuring they formed a coherent pattern, secondly once a coherent pattern was formed the themes were considered in relation to the data set as a whole. This ensured the themes accurately reflected what was evident in the data set as a whole (Braun & Clarke, 2006 ). Further coding also took place at this stage to ensure no codes had been missed in the earlier stages. Once a clear idea of the various themes and how they fitted together emerged, analysis moved to phase five. This involves defining and naming the themes, each theme needs to be clearly defined and accompanied by a detailed analysis. Considerations were made not only of the story told within individual themes but how these related to the overall story that was evident within the data. In addition, it was highly important to develop short but punchy names that conveyed an immediate indication of the essence of the theme. The final stage or the report production involved choosing examples of transcript to illustrate elements of the themes. These extracts clearly identified issues within the theme and presented a lucid example of the point being made.

The thematic analysis process that was applied to the transcripts elicited key concepts that were evident in the data. These themes are viewed as essential in determining the understandings of all the participants. These categories have been labelled as “Knowledge through Education,” “Role Models,” “Fat is Bad,” and “Mixed Messages.” There are of course aspects of the participants’ understandings that overlap across these categories. This, however, should be viewed as a good interpretation of understandings and attitudes in general, which are never made up of isolated concepts but are all relative to each other.

Knowledge through education

This theme is defined by the ability of all the participants to understand the roles of diet and physical activity. This is, in part, likely to be defined by different levels of education that the two age groups represented have, but nothing conclusive can be drawn given the relatively small sample size. The impact of their education on their knowledge will be demonstrated through evidence from the transcript.

All participants in the reception age group expressed the ability to name and identify different food items from the replica food. When they were asked to prepare a healthy lunch from the food items, they were able to point out food that would typically be classified as healthy.

I: No none of it is real! So what have you put in your healthy lunches girls? You tell me what you have got. *: Apple, I've got pasta, egg, cracker, grapes, bun and cheese. Girls reception Open in a separate window

However, despite displaying that they “know” what healthy means there is evidence of confusion, and it would seem the concept of something being “good” for them is interpreted to be things they like to eat. This suggests that they don't yet fully understand the concept of “healthy” food.

I: And why's rice healthy? *: Because it's nice. I: What healthy food do you eat? *: Chips Boys reception Open in a separate window

Their definition of healthy is centred on food they believe will make them grow for which fruit is highlighted as being particularly important. However, they also attribute this property to the food that makes up their personal diets. This understanding might result from being told to eat so they grow up to be big and strong. It is important to consider younger children's understandings are likely to be primarily shaped by their home environment, where the emphasis is often on how much children are eating as opposed to what they are eating.

I: Why is a banana important? *: Because it makes you strong so you can grow you have to have fruit so you can grow. I: Can you tell me then girls, we have found all these things that are good, as an example can you tell me, sausage, why is sausage good? *: Because it makes you feel strong. Girls reception Open in a separate window

This understanding of the reception-aged girls represented in this study of eating so they can grow up to be strong is also evident with the boys in the same age group. However, the reception boys also place great importance on the necessity of exercise to develop strength, this demonstrates another aspect in their knowledge.

I: What about this one here, swimming, who likes swimming? *: Me *: Me *: Me I: And why is swimming good for you? *: Cos it makes you strong. Boys reception Open in a separate window

It is fair to say Year 6 groups relished the opportunity to express their knowledge. They were able to identify and name different food groups and discuss different types of physical activity; what's more they understand the link between the two in relation to obesity. It seems other influences have impacted on the children's understandings’ such as school and extracurricular groups.

*: This is a banana. I: Ok why's a banana healthy? *: Because it's got seeds inside, because it's a fruit. Girls year 6 Open in a separate window

The ability to identify a particular fruit by one of its universal characteristics shows a deeper level of understanding and suggests that a higher degree of learning. In fact it is explicitly stated that this nutritional knowledge has been gained at school.

I: So do you know the different groups of food like carbohydrates, I heard you say protein and dairy before? *: Done it in science. Girls year 6 Open in a separate window

Moreover, it isn't just a nutritional knowledge they have developed through education. They appear well versed in the concept of a balanced diet and also understand the importance of a balanced lifestyle in relation to physical activity. They are able to articulate the notion of a balanced, healthy lifestyle through a consideration of the consequences of over eating and not exercising.

I: So what happens to you if all you do is you do watch TV and play the computer, eat the food that you told me was the bad food, what would happen to you? *: You would have a miserable life. *: Get fat, teeth will fall out. Girls year 6 Open in a separate window

In the case of the Year 6 boys who took part in this study, it is apparent that although a great deal of their knowledge has come through education at school, other avenues have helped them develop different aspects of their understandings. In this case it seems to be through taking part in activities, typically sport outside of school, or and more uniquely to this group through the influence of their fathers.

*: I would say my dad likes fish so I eat fish loads. *: My dad likes chicken, so he gives me chicken cos after school I do sport, like boxing, he gives me a sandwich with loads of different toppings in cos meats a muscle maker and vegetables is like an energy maker, so if you eat those you will get fitter and healthier. Boys year 6 Open in a separate window

It is evident where the ability exists, or is encouraged, to apply knowledge they have in a context relevant to their own lives, the knowledge becomes embedded in their understandings; it is applicable to them and, therefore, moves from being written on the board in school to being important to their own existence. This is exhibited by those participants, in particular the boys who participated, who have an involvement in sport. Having a motivation to understand nutrition and exercise leads to a desire to apply it because they comprehend the potential benefits. This aspect within the initial theme of knowledge through education leads directly on to the next theme of role models. The key difference between these two themes is the first relates to information that is directly and intentionally meant to inform the children about healthy lifestyles in an institutional setting, while the second theme is typified by understandings that are formed through interactions with other people.

Role models

The application of knowledge gained through education is often facilitated by role models such as family members who reiterate this information through example. Role models play an important role in the concepts described by all the groups, for example, the older boys reported that their fathers helped encourage healthy behaviours, above and beyond the nutritional knowledge in the previous theme.

*: Like sometimes on an afternoon my dad goes to the gym, then there is these tracks outside, and I practice every day on my 100 meter sprint and I can do it in 12 seconds, and when I started doing it I was 21 second, so I keep practicing. Boys year 6 Open in a separate window

This demonstrates some of the participants’ understandings have developed by examples set for them by significant individuals in their lives. This is evident in the younger children's understandings in a less explicit manner; the example below demonstrates good health behaviours can be established through everyday behaviour exhibited by role models.

I: What about this one, walking to school? … Why is it good for you? *: Because me and my mam walk to school and its good. Girls reception Open in a separate window

There is some evidence that examples set to the girls who took part in this study, at home and by other role models, can encourage behaviours or ideals that are not beneficial to the girls health. Girls appear to look up to older female family members who aspire to be skinny.

*: I like to be skinny, my nana does as well, and she wants to be skinny because she's fat now but I still love her. Girls reception Open in a separate window

They also appear to have developed unrealistic ideas about weight loss and the consequences in terms of treatment. Viewing hospital treatment as a solution to obesity, demonstrates a lack of understanding about the role of lifestyle behaviours in the condition. This may also suggest that these participants don't appreciate the importance of lifestyle behaviours in the onset of obesity.

*: Guess what, I seen this film right the boy was fat right, his legs was right down to the bottom, he had a fat tummy, I was hiding cos I hated him, he was horrible, he will have to go to hospital, he was fat. Girls reception I: So what would you tell somebody if you pretend that I was really, really fat, what would you tell me to do. *: Go to the doctors … hospital, operation. Girls reception Open in a separate window

There was some evidence that the older girls in this study had a more balanced outlook on what sort of body shape was healthiest, because they were aware of the negative health consequences associated with being underweight. It is interesting, however, that they are aware that maintaining a healthy lifestyle may be a challenge and this may result in a barrier to adopting healthier practices.

I: What about the other end of the scale, you know if you've got overweight being fat on this side what about being underweight at this end? *: It's bad cos you're all bony and you can't do anything cos you're not strong enough, you're weak. *: So you need to be in the middle. I: Is it easy to stay in the middle? *: No, because sometimes you can't be bothered to eat well and exercise. Girls year 6 Open in a separate window

Within the theme of role models, there was some evidence of a difference between the genders in terms of available role models. The participating boys often cited football heroes as people whom they looked up to and aspired to be like. This highlights the role of the celebrity in providing a role model for today's children; the evidence from the participants in this study may suggest that typically boys look to footballers and other sporting heroes. It can be argued that such individuals do not always provide a strong moral code; they are seen as following a healthy lifestyle in terms of diet and exercise. It would seem that the female participants in this study often looked up to celebrities who weren't so explicitly seen to be following healthy lifestyles, or a sense of caution was attached to following healthier behaviours.

*: Yeah like Wayne Rooney. I: And why is he fit? *: Cos he's good at footballing. I: Do you think that they have to eat special food? *: Yes I: And what special food do they have to eat? *: Bananas and apples. Boys reception *: Actually you can put weight on running cos muscle weighs more than fat so you can put weight on—like Katie Price she put on 10 pounds cos she started running. Girls year 6 Open in a separate window

Another interesting aspect of the notion of role models’ is that the girls were more concerned with how they appeared in a physical sense; it was particularly striking that the Year 6 boys identified unhealthy behaviour in their female peers attributing this to a desire to be like models.

*: Yes, she wants to be a model so she starves herself, her mam gives her a big packed lunch and she puts most of it in the bin, she's like that skinny then she walks out of the dinner hall. Boys year 6 Open in a separate window

There were many aspects of the transcript that highlighted participants were aware that being underweight was as worrying as being overweight. However, across the board they were far more critical of individuals who were overweight and discussed wide ranging consequences for these individuals, this leads on to the next theme evident in the analysis.

There was a united consensus that being fat was something to avoid, that it was a bad thing, and had typically negative consequences. Elements of this theme have been demonstrated throughout the discussion of the previous two themes; however, this illustrates how their understanding impacts on their attitudes toward obesity.

*: Like all the fat goes through your blood and stuff. *: Like sugar, like all the sugar goes through your blood if you eat too much of it would clog up your arteries and you might die. Boys year 6 I: Like how? What would happen to you? Is something going to happen straight away or is it something that's going to happen to. *: You would get rotten teeth and you would not be as strong as you would be if you ate healthy and stuff. *: You could die. Girls year 6 *: Because fat would be horrible. *: Because it's bad for you, because it looks bad. *: Because people call you big fat. Girls reception Open in a separate window

In addition to the health issues and those relating to physical attractiveness were the issues of bullying and social exclusion, which seemed to play a big role in the children's understandings of what it would be like to be overweight. The stigma attached to being overweight is evident as participants often started giggling when talking about people being overweight.

I: Is it important to eat things that are good for you? *: Laughter I: What do you think happens to you if you eat lots of these biscuits? *: Fat I: And what good would stop you from getting fat, or would help you not be fat? *: Giggling Boys reception Open in a separate window

Inability to have a successful career and even death were understood to be the results of obesity. Participants felt people who were overweight were in some way bad or an embarrassment. There was even a sense of fear toward people who they considered overweight, indicating that they would avoid being seen with somebody who was obese.

I: So … so what do you think about being fat, like if you see somebody in the street who looks like they are not very healthy do you think? *: They can't do much, like most of the things you want to do in life, like swimming, jogging. *: Jobs when you grow older. Girls year 6 *: Like if my parents were proper massive and I went to the town with them I would just say they took me to the town and I don't know them. Boys year 6 Open in a separate window

It is clear that the participants’ understanding is that obesity is a very negative issue. However, there is also evidence that they understand the complexity of the condition and are also aware being underweight maybe as much of a problem. The older children in this study seemed to understand that it is a complex issue and fully grasped the concept of moderation. They often refer to the fact that you can have a small amount of things that maybe classified as unhealthy, as long as you don't eat them all the time or balance them out with exercise.

I: And what sort of things for eating well? *: Like fruit and vegetables. *: Some Sugar. *: If you eat vegetables and fruit and you might get back to underweight. *: And you want to be in the middle. *: You need a bit of fat on you. Girls year 6 Open in a separate window

This category of Fat is Bad highlights an issue that clouds all the children's understandings of issues surrounding obesity and that is of conflicting messages. This notion of mixed messages forms the final theme evident in the data.

Mixed messages

The evidence presented here would suggest the information intended to educate and inform children is often met with equal amounts of contradictory or confusing messages and behaviours. The result of this is easily demonstrated by comparing what the children know they should be doing with what they actually talk about doing. For the majority of the participants their knowledge did not always match with their described behaviour, their food preferences often overriding their knowledge. This was perhaps not so surprising; knowledge does not by any means dictate behaviour.

I: Do you have breakfast most mornings? Do you normally have some breakfast, what do you normally have for breakfast? *: Miss I have chocolate cookies. I: What did you have for your tea last night? *: I just had for my supper. I: What did you have last night for your supper? *: Err sandwiches, cake and I: What about what did you have last night for your tea? *: Pizza Girls reception I: You eat two, two pieces of fruit? *: Yes, cos my mam chops it into two halves. Boys reception Open in a separate window

Conflict existed in a number of forms in the understandings expressed by the participants. It is worth reiterating that the younger girls who participated believed treatment for obesity was to go to the hospital and have an operation—something they have picked up from a TV documentary—this conflicts with diet and exercise education they receive at school. Other participants gave more specific and direct examples of receiving contradictory information. This ranged from conflicts in direct health messages to conflicting information and action between school and home. They felt that at times it was difficult to know which information was the right information, not only was it conflicting but it was forever changing.

*: And people say if you make fruit smoothies its healthy for you but it said in the news something about being obese again it said that if you drink a smoothie one a day you'll put on 13 pounds, that's nearly a stone in a year. Boys year 6 I: What about at home? You know if you're taught all this stuff at school what happens when you go home? Do Mum and Dad teach you the same things or is it different? *: Different I: And why is it different? *: I eat more sweets. Girls year 6 Open in a separate window

In addition to this, older children also pointed out they felt that healthy lifestyle information wasn't always delivered in the correct manner, there was a belief that stigmatising people who were overweight was negative. There was an awareness that there is a psychological aspect to overeating, and in some individuals it is this that needs to be addressed. Moreover, there was a feeling again demonstrated solely by the older participants that being overweight/obese could be difficult to rectify and maintaining a healthy weight could be a challenge.

*: So you need to be in the middle. I: Is it easy to stay in the middle? *: No, because sometimes you can't be bothered to eat well and exercise. Girls year 6 I: Do you think it's quite easy to lose weight? *: Yes *: Well for some people. *: If you put your mind to it, it is. I: No go on cos everyone's got different ideas. *: You can't just lose weight quickly. *: Cos my dad when he was young he was obese so he told me, but he's sort of addicted really. *: Addicted to what. *: Addicted he cannot stop but he's trying. *: He cannot stop what. *: Eating when he was young, he like learnt now he's saying to me about being fit cos he tells me about what happened when he was young so I try it. Boys year 6 Open in a separate window

This understanding of the complex nature of the obesity problem, coupled with the confusion and conflict in both the information and behaviours the participants are exposed to, can help explain some of the barriers to individuals adopting a healthier lifestyle.

Comprehensive understanding

The results detailed above highlight some important findings as to how children understand obesity in terms of some of its causes and consequences. It was particularly clear that knowledge, often imparted in a school setting, is getting through to the children who participated in this study. However, it appears equally evident that this knowledge in many cases does not transfer to behaviour. Further examination of the results allows us to explore the potential reasons behind the knowledge-behaviour gap.

Role models by their nature provide examples for both the children's beliefs and their behaviour. There are a wide variety of potential role models for children from parents, teachers, peers, and celebrities. What seems particularly important, in terms of being a positive role model with regards to healthy lifestyles, is that children have an opportunity to view the process of being healthy. In this study, this was typified by the examples of the Year 6 boys who participated in sport with their fathers. It appears this close and active relationship allows the knowledge that has been started at school to grow. Allowing children the opportunity to apply their knowledge and see the steps taken by a role model to get or stay fit help translate this knowledge into behaviour. What is interesting, however, is that it seems passive behaviours by role models can have the same impact. It was the case with these participants that the effect of passive knowledge transfer seemed to be more negative, but that is by no means to say that passive behaviours by role models will not also encourage positive lifestyle behaviours in other cases. The most obvious example of this within this data set was the seemingly implicit messages that the girls received about being skinny. There was not an overtly explicit attempt on the behalf of the role models described here to encourage a “skinny” ideal; however, messages seemed to reach the participants that would indicate this is the case. The key difference between these active and passive role models appears to come from whether the role models place focus on the process; taking part in sport (in the example of the older boys) or outcome being skinny (in the example of the girls). Focus on the action of being physically active or enjoying a healthy diet in the case of these participants produces a healthier outlook on maintaining a healthy body weight. When that focus is on the outcome—the weight loss or the weight gain—there seems to be less concern for actually “being healthy” in terms of body weight and lifestyle. This notion about process and outcome is intrinsically linked to the theme of Fat is Bad.

It is interesting to note that whilst the children expressed an understanding of fat as a component of diet and were able to identify high fat foods and their link to obesity, the focus was on fat as an outcome and not so much about it as input. It is a well-documented fact that fat is a requirement of a balanced diet. The participants were able to recite in great detail the consequences of becoming fat but were not so forthright about the processes involved in becoming fat. It can be suggested that by focussing on the process of becoming fat and understanding the need for fat in moderation and being physically active it may help to discourage fat becoming the output. This may also help to draw away the focus from physical appearance that is so closely tied to the stigma attached to being overweight and place it on living a healthy lifestyle and being healthy.

The key finding of this study is that it is evident that children receive contradictory messages when it comes to following a healthy diet and taking part in exercise. The research presented here highlights children's understandings of some of the causes of obesity and the consequences of becoming overweight. However, it is equally evident that this information has reached them on a knowledge level but has not or cannot be fully translated into behaviour. It appears that central to this problem are the multiple discourses that exist around diet and exercise. Whilst government campaigns may impart facts and figures and provide advice on changes that can be made, there are a whole host of other sources to contend with. There is an undoubted role played by the media both in terms of active advertising campaigns for junk food or sedentary games and the passive portrayal of unattainable body shapes and sizes in magazines and by celebrity culture. However, more than this, health messages are competing against a variety of cultural values, social, and personal norms that may well go against messages that encourage certain behaviours. What is more is that ultimately individuals have the power and autonomy to make their own choices about diet and exercise. Stakeholders need to ensure that people are in a position to make an informed decision and not one where their judgement is clouded by an array of contradicting messages. There is also a responsibility to ensure that individuals are able to act on advice given and to provide advice that is relevant and tailored to individual circumstances. It is easy to understand why parents on a low income may struggle to incorporate “5 a day” into their families diets when they perhaps don't have access to a car and the nearest shop selling fresh fruit and vegetables is several miles away. Ensuring people know that frozen fruits and vegetables are just as good and, in some cases better, is a far more useful and usable message.

Comparisons with past research

The objective of this study was to explore children's understandings of obesity in terms of diet and physical activity; the children included were considered high risk because of their socio-economic status. To meet this objective, focus group data was analysed using thematic analysis. This analysis produced key themes pertaining to the understandings of the participants. There is not a wealth of prior research in this domain and it was for this reason thematic analysis was chosen to analyse the data. The method proved to be particularly useful in generating these exploratory data that are discussed here in relation to previous findings.

The theme of knowledge has previously been identified by Hesketh et al. ( 2005 ) in terms of information and awareness that is pertinent to children's perceptions of healthy eating, activity, and preventing obesity. Increasing knowledge relating to diet and physical activity cannot prevent obesity but it can encourage children to make informed choices.

This study, as have others (Hesketh et al., 2005 ; Borra et al., 2003 ; Musaiger, Mater, Alekri, & Mahdi, 1991 ), identified misunderstandings in children's knowledge as barriers to healthful behaviour. It might be useful to address this issue, particularly with younger children who are developing their knowledge. Previous literature has identified young children often consume their recommended daily intake of fruit but fall well short when it comes to vegetables (Dennison, Rockwell, & Baker, 1998 ). Government campaigns encourage people to eat five portions of fruit and vegetables a day ( www.5aday.nhs.co.uk ); however, nutritionists would encourage three portions of vegetables and two of fruit—fruit having high sugar content. There was no evidence in the transcripts that any of the children were aware of or understood this distinction. This needs further investigation; however, education should encourage an understanding of fruit and vegetables as separate entities to help increase the consumption of vegetables (Gibson, Wardle, & Watts, 1998 ).

The evidence in this study suggests children grasp the causes of obesity, overeating, and low levels of physical activity; however, there was a general lack of understanding of the underlying physiological processes. There was a limited understanding of the concept of energy balance or that there might also be medical reasons for the obesity. Bell and Morgan ( 2000 ) demonstrated providing medical explanations for obesity can have a positive effect on children's attitudes to obese individuals. Overweight individuals were generally stigmatised by the participants in this study, so providing better medical information could help to alleviate these negative attitudes. It is fair to say those children who did have more in-depth knowledge of obesity were more sympathetic in their considerations of overweight individuals acknowledging the difficulty in making lifestyle changes.

The influence of parents concerning diet and exercise behaviours is well documented (Prout, 1996 ). Hesketh et al. (2005), Borra et al. (2003), and Young-Hyman et al. ( 2000 ) consider parental influence to be a determining factor in children's attitudes and understandings of obesity. It is clear this influence can be as detrimental as it can be beneficial. Previous research (Borra et al., 2003 ) argues interventions need to be developed that consider the role of the parent. Children cannot be expected to apply the information they receive at school to themselves if it is not reiterated at home. Nutritional education and physical education have not formed a core or extensive part of school curriculums in the United Kingdom in previous years, and there is now a generation of young parents who do not have the skills to attractively present appropriate foods (Tuttle & Truswell, 2002 ) or who regularly take part in sport themselves. The impact of this on their children's behaviour is that they don't always have examples of healthy behaviour to model their own on.

Of particular importance was the finding that children feel that they often receive mixed and contradicting messages. This is of great relevance when considering the development of policies and strategies that can be more effective. More over this backs up the findings of Dorey and McCool ( 2009 ) who conclude that nutritional messages evident in health promotion and advertising were often perceived by child audiences to be ambiguous. The authors warn that these contradictory messages could potentially serve to weaken the trustworthiness viewers have in health promotion initiatives. This really points to a key area in which health professionals can target efforts to tackle obesity. Clarity and consistency in healthy messages and recommendations are central to helping people take on board and act on the information they receive. Contradiction allows room for people to question the advice given and when effort is required to make a change in behaviour that change is less likely to be made if there is reason to doubt the accuracy of information. Furthermore, coherent messages need to consider person specific factors that may inhibit behaviour change; when individuals are encouraged to behave in a certain way but the constraints of day-to-day life lead to another, the results are confusion and hostility to the initial message (Owens & Driffill, 2008 ).

Procedural issues

The main methodological issue arising was participants from Reception struggled to engage fully in conversation, and the sessions followed a structure more a kin to an interview (i.e., question and answer). It was difficult to encourage responses that were longer than a few words; often one word responses were given. There is the potential to gain some very useful information from children in this age group; however, it can be a long and time-consuming process to elicit enough information to make the analysis process worthwhile. The length of the sessions also must be kept relatively short because attention spans are not long lasting; this was a finding similar to that of Miller ( 2000 ). The replica food items selected to help provide structure to the focus groups were useful and did provide a catalyst for discussion; however, for very young children (i.e., those in Reception) they resemble toys too closely, this then leads to them becoming more of a distraction, hindering the discussion. The use of the picture cards and pens and paper as suggested by Backett and Alexander ( 1991 ) provided a more a suitable means of structuring focus groups for young children.

There were at times issues with certain members of the groups making themselves heard more than others, thus the researcher had to encourage those happier to sit back and let others take the lead (Kirk, 2007 ). However, through a little encouragement all participants appeared comfortable talking with each other and participated equally, a result of the careful selection process. It also appeared to be beneficial speaking to boys and girls separately, with the boys often more excitable in their discussion style in comparison to the girls. It also facilitated the identification of some important issues, for example, the Year 6 boys identified eating behaviours present in the Year 6 girls that the girls themselves did not discuss.

Implications for the future

The Foresight Report (Department of Innovation Universities and Skills, 2007 ), in tackling obesity, points out that current policies are failing because they do not provide the depth and range of interventions needed. This present study has determined that central to children's understandings of the causes and consequences of obesity are the concepts of knowledge, the opportunity to apply this knowledge to their own lives, and the existence of role models to set an example. There exist certain myths and misconceptions that need to be addressed and children need to believe they can trust the health messages they receive because they are aware some messages are misleading or forever changing.

The key to this issue seems to be children learn by example, they can have all the knowledge in the world provided to them through an institution such as a school but this information needs to be supported by life at home. This provides evidence that campaigns need to target parents to tackle childhood obesity; this is an issue that policy makers are already aware of ( National Institute for Health and Clinical Excellence, 2006 ). However, this means health messages delivered to the general public need to be clearer and avoid ambiguity. There needs to be careful considerations of the context in which health messages are received, taking into account the understandings of the target population (Hesketh et al., 2005).

There were some issues raised in the focus group that were beyond the scope of this particular study. There was a representation of different ethnic minorities in the groups, and slight differences in the understandings of these different groups were identified. Further research should investigate the understandings of different minority groups to see if ethnicity influences or results in divergent concepts. Future study also needs to look at strategies that enable children to apply healthy lifestyle information to their own lives.

Children spend, on average, a quarter of their waking lives in schools; therefore, schools can be seen as an effective environment and source to help encourage healthy lifestyles. However, that leaves three quarters of a child's time in which they are out of the control of the school environment. Strategies must be developed to unite the teaching at school with practices in the home. This supports the conclusions of Hughes, Sherman, and Whitaker ( 2010 ) who write that strategies need to be framed in a manner that makes low income mothers feel more supported in addressing issues their children may have with their weight. Ensuring that approaches to encourage healthy lives take on a holistic format will also help to provide consistent and realistic role models. There needs to be a concerted effort from within society to develop role models who have a healthy relationship with food and exercise. These seem to already exist for young boys in the form of sporting heroes but seem in short supply for young girls who already consider that being healthy is the ideal but then look to surgery as a form of weight loss. Lieberman, Gauvin, Bukowski, and White ( 2001 ) highlight the importance of role models and peer influence in the onset of disordered eating in young girls and this needs to be seriously taken into account when sending out messages that being overweight is bad, girls need to be aware that being underweight also has severe health consequences.

In conclusion, the time children spend eating and taking part in physical activity out of school is likely to be the biggest challenge to preventing the continuing obesity problems in the United Kingdom, and this is where current strategies appear to be failing. Children understand obesity and its contributing factors in terms set out to them by those people they consider role models. It is only by helping these role models to provide consistent and reliable information by setting suitable active examples and by being aware of the impact of their passive actions that we can begin to address the problem of obesity.

Acknowledgements

The authors would like to thank Sunderland Children's Centres and Back on the Map for their support in facilitating this research.

Conflict of interest and funding

The author have not received any funding or benefits from industry or elsewhere to conduct this study

• Alexander M. A., Sherman J. B. Factors associated with obesity in school children. Journal of School Nursing. 1991; 7 :6–10. [ PubMed ] [ Google Scholar ]
• Attride-Stirling J. Thematic networks: An analytical tool for qualitative research. Qualitative Research. 2001; 1 :385–405. [ Google Scholar ]
• Backett K., Alexander H. Talking to young children about health: Methods and findings. Health Education Journal. 1991; 50 (1):34–38. [ Google Scholar ]
• Bell S. K., Morgan S. M. Children's attitudes and behavioural intentions towards a peer presented as obese: Does a medical explanation for the obesity make a difference. Journal of Paediatric Psychology. 2000; 25 (3):137–145. [ PubMed ] [ Google Scholar ]
• Borra S. T., Kelly L., Shirreffs M. B., Neville K., Geiger C. J. Developing health messages: Qualitative studies with children, parents, and teachers help identify communications opportunities for healthful lifestyles and the prevention of obesity. Journal of the American Dietetic Association. 2003; 103 (6):721–728. [ PubMed ] [ Google Scholar ]
• Braun V., Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006; 3 (2):77–101. [ Google Scholar ]
• Breat C., Mervielde I., Vandereycken W. Psychological aspects of childhood obesity: A controlled study in a clinical and non clinical sample. Journal of Paediatric Psychiatry. 1997; 22 (1):59–71. [ PubMed ] [ Google Scholar ]
• Brunt H., Lester N., Davies G., Williams R. Childhood overweight and obesity: Is the gap closing the wrong way? Journal of Public Health. 2008; 30 (2):145–152. [ PubMed ] [ Google Scholar ]
• Chamberlin L. A., Sherman S. N., Jain A., Powers S. W., Whitaker R. C. The challenge of preventing and treating obesity in low-income, preschool children: Perceptions of WIC Health Care Professionals. Archives of Pediatrics & Adolescent Medicine. 2002; 156 :662–668. [ PubMed ] [ Google Scholar ]
• Dennison B. A., Rockwell H. L., Baker S. L. Fruit and vegetable intake in young children. Journal of the American College of Nutrition. 1998; 17 (4):371–378. [ PubMed ] [ Google Scholar ]
• Department of Health. Listening, hearing and responding: Department of Health Action Plan—Core principles for the involvement of young people. London: Author; 2002. [ Google Scholar ]
• Department of Health and Department for Children, Schools and Families. National Childhood Measurement Programme: results from the 2006/07 school year. The Information Centre. 2008. Retrived April 10, 2008, from http://www.ic.nhs.uk/pubs/ncmp0607 .
• Department of Health and Department for Education and Skills. The national service framework for children, young people and maternity services (executive summary) London: Author; 2004. [ Google Scholar ]
• Department of Innovation Universities and Skills. Foresight-tackling obesities: Future choices and project report. London: Government Office for Science; 2007. [ Google Scholar ]
• Dorey E., McCool J. The role of the media in influencing children's nutritional perceptions. Qualitative Health Research. 2009; 19 (5):645–654. [ PubMed ] [ Google Scholar ]
• Gibson E. L., Wardle J., Watts C. J. Fruit and vegetable consumption, nutritional knowledge and beliefs in mothers and children. Appetite. 1998; 31 :205–228. [ PubMed ] [ Google Scholar ]
• Hesketh K., Water E., Green J., Salmon L., Williams J. Healthy eating, activity and obesity prevention: A qualitative study of parent and child perceptions in Australia. Health Promotion International. 2005; 20 (1):19–26. [ PubMed ] [ Google Scholar ]
• Hill A. J., Silver E. K. Fat, friendless and unhealthy: 9-year old children's perception of bodyshape stereotypes. International Journal of Obesity and Related Metabolic Disorders. 1995; 19 :423–430. [ PubMed ] [ Google Scholar ]
• Hughes C. C., Sherman S., Whitaker R. How low-income mothers with overweight preschool children make sense of obesity. Qualitative Health Research. 2010; 20 :465–478. [ PubMed ] [ Google Scholar ]
• Kirk S. Methodological and ethical issues in conducting qualitative research with children and young people: A literature review. International Journal of Nursing Studies. 2007; 44 :1250–1260. [ PubMed ] [ Google Scholar ]
• Knowler W. C., Pettitt D. J., Saad M. F. Obesity in Pime Indians: Its magnitude and relationship with diabetes. American Journal of Clinical Nutrition. 1991; 53 :15435–15515. [ PubMed ] [ Google Scholar ]
• Lieberman M., Gauvin L., Bukowski W., White D. Interpersonal influence and disordered eating behaviours in adolescent girls. The role of peer modelling, social reinforcement, and body-related teasing. Eating Behaviour. 2001; 2 :215–236. [ PubMed ] [ Google Scholar ]
• Madill A., Jordan A., Shiley C. Objectivity and reliability in qualitative analysis: realist, contextualist and radical constructionist epistemologies. British Journal of Psychology. 2000; 91 :1–20. [ PubMed ] [ Google Scholar ]
• Mauthner M. Methodological aspects of collecting data from children: Lessons from three research projects. Children and Society. 1997; 11 :16–28. [ Google Scholar ]
• McCormick B., Stone I. Economic costs of obesity and the case for government intervention. Obesity Reviews. 2007; 8 (1):161–164. [ PubMed ] [ Google Scholar ]
• Miller S. Researching children: Issues arising from a phenomenological study with children who have diabetes mellitus. Journal of Advanced Nursing. 2000; 31 (5):1228–1234. [ PubMed ] [ Google Scholar ]
• Musaiger A. O., Mater A. M., Alekri S. A., Mahdi A. E. Knowledge and attitudes of Bahraini adolescents towards obesity. Journal of Consumer Studies and Home Economics. 1991; 15 :321–325. [ Google Scholar ]
• National Institute for Health and Clinical Excellence. Obesity guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. 2006. Clinical Guidelines. [ PubMed ] [ Google Scholar ]
• Oliver K. K., Thelen M. H. Children's perceptions of peer influence on eating concerns. Behavior Therapy. 1996; 27 :25–39. [ Google Scholar ]
• Owens S., Driffill L. How to change attitudes and behaviour in the context of energy. Energy Policy. 2008; 36 :4412–4418. [ Google Scholar ]
• Prentice A. M., Jebb S. A. Obesity in Britain: Gluttony or sloth? British Medical Journal. 1995; 11 :437–439. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Prout A. Families, cultural bias and health promotion. London: Health Education Authority; 1996. [ Google Scholar ]
• Renehan A. G., Tyson M., Egger M., Heller R. F., Zwahlen M. Body-mass index and incidence of cancer: A systematic review and meta-analysis of prospective observational studies. Lancet. 2008; 371 :569–578. [ PubMed ] [ Google Scholar ]
• Riessman C. K. Narrative analysis. London: Sage; 1993. [ Google Scholar ]
• Statistics on Obesity, Physical Activity and Diet England. The NHS Information Centre. 2006. Retrieved October 2010 from http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/obesity/statistics-on-obesity-physical-activity-and-diet-england-2006 .
• The Health Survey for England. Body mass index (BMI) by gender, updated tables including 2008 data. The NHS Information Centre. 2009. Retrieved March 2010 from http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-r elated-surveys/health-survey-for-england .
• Tuttle C., Truswell S. Childhood and adolescence. In: Mann J., Truswell S., editors. Essentials of human nutrition. Oxford: Oxford University Press; 2002. [ Google Scholar ]
• Willig C. Introducing qualitative research in psychology. 2nd ed. England: OUP; 2008. [ Google Scholar ]
• Young-Hyman D., Herman L. J., Scott D. L., Schlundt D. G. Care giver perception of children's obesity-related health risk: A study of African American families. Obesity Research. 2000; 8 :241–248. [ PubMed ] [ Google Scholar ]

ORIGINAL RESEARCH article

A thematic analysis investigating the impact of positive behavioral support training on the lives of service providers: “it makes you think differently”.

• 1 Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
• 2 Acquired Brain Injury Ireland, Co., Offaly, Ireland
• 3 Future Directions CIC, Greater Manchester, United Kingdom

Positive behavioral support (PBS) employs applied behavioral analysis to enhance the quality of life of people who behave in challenging ways. PBS builds on the straightforward and intuitively appealing notion that if people know how to control their environments, they will have less need to behave in challenging ways. Accordingly, PBS focuses on the perspective of those who have behavioral issues, and assesses success via reduction in incidences of challenging behaviors. The qualitative research presented in this report approaches PBS from a different viewpoint and, using thematic analysis, considers the impact of PBS training on the lived experience of staff who deliver services. Thirteen support staff who work for a company supplying social care and supported living services for people with learning disabilities and complex needs in the northwest of England took part. Analysis of interviews identified five major themes. These were: (1) training: enjoyable and useful; (2) widening of perspective: different ways of thinking; (3) increased competence: better outcomes; (4) spill over into private lives: increased tolerance in relationships; and (5) reflecting on practice and moving to a holistic view: “I am aware that people…are not just being naughty.” These themes evidenced personal growth on the part of service providers receiving training. Explicitly, they demonstrated that greater awareness of PBS equipped recipients with an appropriate set of values, and the technical knowledge required to realize them.

Introduction

Positive behavioral support (PBS) is the application of applied behavioral analysis (ABA) ( Baer et al., 1968 ; Allen et al., 2005 ). Hence, researchers define PBS as “the scientific study of behavior change, using the principles of behavior, to evoke or elicit a targeted behavioral change” ( Furman and Lepper, 2018 , p. 104) in people with challenging behaviors. Its primary goal is to enhance the quality of life of people who behave in challenging ways ( LaVigna and Willis, 2005 ). Hence, a key focus is individual environments. These can be adapted so that challenging behavior is less necessary. Particularly, through the acquisition of more socially effective alternative behaviors, where people are motivated to replace inappropriate, stigmatizing, or destructive ways of responding ( LaVigna and Willis, 2005 ).

The core idea that PBS builds on is straightforward and intuitively appealing: if people know how to control their environments, they will have less need to behave in challenging ways ( Hassiotis et al., 2014 ). PBS imparts this knowledge via instruction, and considers the efficacy of training from the point of view of quality of life of the person behaving in challenging ways, and in terms of reduction in incidences of challenging behaviors (e.g., McClean et al., 2005 ; Walsh et al., 2018 ). In this context, behaving in challenging ways refers to “Culturally abnormal behavior of such intensity, frequency and duration that may put the person or others physical safety in jeopardy or seriously limit the use of community activities” ( Emerson, 2001 , p. 7).

PBS is an important treatment framework in the field of learning disability ( Hassiotis et al., 2014 ; Gore et al., 2019 ). PBS is also a useful approach for those working with teenagers and young adolescents, groups for whom challenging behaviors can have a serious impact on the services that they receive ( Bohanon et al., 2006 ). An important pathway through which challenging behaviors can negatively affect service delivery is via the staff who deliver the services. As such, staff welfare is of fundamental importance ( Williams and Glisson, 2013 ).

Traditionally, expert opinion rather than user-perceptions has driven behavioral interventions ( LaVigna and Willis, 2005 ). In contrast, some theorists switch the focus of PBS to person-focused training of stakeholders (i.e., McClean et al., 2005 ; Grey and McClean, 2007 ), for example, the person presenting with challenging behavior, their families, and service providers. From this perspective, those people impacted by the behavior are paramount – rather than passive recipients of instruction from an “expert.” Stakeholders are active participants in assessment, determining intervention strategies, evaluation of these strategies, and thinking about what outcomes might influence service user’s quality of life ( World Health Organization, 2006 ). In working environments where resources are scarce, even when the benefits of staff training appear evident, justifying incumbent costs can prove difficult ( Dench, 2005 ). In this context, acknowledging the central role of stakeholders with regard to the implementation of PBS ( Dench, 2005 ), it is vital that researchers consider the impact of PBS training on those who deliver the support.

The present study explored how training in PBS affected the lived experience of those receiving training. Thus, it adopted the view that training is a “collaborative project” to which people commit themselves and meaning making is understood as residing between people rather than within individuals. Previous research in PBS has tended to focus on the impact of PBS on incidents of challenging behavior ( Walsh et al., 2018 ). An important, and yet unanswered, question was whether those trained to deliver PBS, with a view to improving the lives of others, experienced any benefit from such training in their own lives.

Materials and Methods

Approach to data collection.

This study, consistent with Braun and Clarke (2006) , used thematic analysis in an open-ended way, to investigate how participants experienced the impact of PBS training in both their professional and private lives. The researchers employed a purposive sampling strategy whereby they engaged with a service provider who delivers PBS training to staff as part of their on-going professional development.

Ethical Protocol

The study received full ethical approval from the Manchester Metropolitan University (MMU) ethics committee. All participants provided written informed consent. The study brief informed them that they were free to withdraw at any time, should they wish to do so. Participants consented to the recording of interviews, which were subsequently anonymized and transcribed. Interviews were stored on a password-protected (encrypted) computer, which housed all data.

Interview Process

Participant interviews occurred in their place of work on a prearranged and mutually agreed day. Interviews were semi-structured; a guide provided a loose structure within which to explore the topics of interest. The central question was “what impact has PBS training in the lives of those who receive it?” Where appropriate, the interviewer prompted participants to expand on relevant and interesting responses.

Participants

Purposeful sampling is a widely used technique in qualitative research whereby those cases most likely to be information-rich on the point of interest are selected in order to effectively use limited resources ( Patton, 2002 ). To this end, only staff who had received PBS training were recruited. All staff approached for participation were over the age of 18 and all were permanent employees. The researchers sent an email to potential staff participants requesting volunteers to take part in interviews with regard to their experience of PBS training. A similar advertisement appeared also notice boards in common areas. Respondents participated without incentives. Thirteen participants were interviewed for the purpose of this study. As the goal of the study was to gain a depth of understanding on the point of interest (i.e., participants’ experience of PBS training), through the recruitment of a homogenous 1 sample, data such as mean age etc. are not reported as it might convey the unwarranted impression of generalizability and quantitative robustness.

The service provider delivering the training in PBS was a Community Interest Company providing social care and supported living services for people with learning disabilities and complex needs in the northwest of England. The company is a value-based, high-quality social care provider whose goal is to enable meaningful living among clients. The service provider works with people across a range of environments to provide a continuum of support ranging from a few hours of home care to 24/7 supported living services, and higher levels of support in residential services. All clients are over the age of 16. Supported individuals may have a mental health diagnosis, autism, complex health, profound multiple disabilities, be young people in transition, or have a learning disability, forensic history, acquired brain injury, or dementia.

The company has embedded PBS within service provision. In addition to training staff in PBS, the company has a PBS lead who ensures that staff training remains current. The company also has trained active support champions who facilitate the application of learning to practice.

All staff receive 3-day induction training, which includes consideration of autism, communication, and positive behavioral support. All managers have a level 2 training day covering PBS key components, values, theory, and process. Managers learn also how to develop individual PBS plans, which include functional assessment. PBS plans are evidence based, with 80% of the plan being proactive in order to ensure the achievement of good client outcomes. Training emphasizes that all behavior is for a reason.

All staff receive active support training. This outlines that participation and engagement represent meaningful activities that anybody can engage. The service provider has PBS champions that support staff practically in their job, ensuring that active support is embedded as part of the culture. This role ensures the people supported are empowered in their environment regardless of their ability and actively participate and engage in every part of their life.

Additionally, the company distributes Monthly Newsletters to staff as an additional teaching aid. These share good news stories including information on telecare and other technology designed to give people more choice and control over their lives. Alongside this, training facilitators provide further specialist training. Finally, teams use a training DVD produced by service users to embed staff training.

Data Analysis

This study used thematic analysis ( Braun and Clarke, 2006 ). This required the transcription of interview recordings and followed coding stages. Initially, the authors read and re-read transcripts in order to identify potential themes, which they then forwarded to the lead author. The second level of analysis involved both the first and last authors reviewing these initial codes. They considered particularly how to retain the diversity of the initial codes, while producing overarching elements, higher level sub-themes. The research question, the impact of PBS training in the lives of participants, informed this process. At the third stage, analysis conducted by the first and last authors identified quotes that were congruent with the overarching themes. Next, the authors reviewed themes prior to defining and naming them. Finally, once themes were finalized, by the first and last authors, the write-up of the report began.

The analysis produced five themes.

Training: Enjoyable and Useful

Almost all participants reported that the training that they received was both enjoyable and useful. Illustrative examples appear below.

One participant stated:

MOLLY: I really enjoyed the course and everything and it did make me understand a little bit more.

Participants highlight the enjoyment that they derive from their PBS training course and they explicitly tie this enjoyment to their capacity to internalize it.

ANN: Just listen. Enjoy it. You’ll take something from it even if you do not realize that you do. You think back to what it actually was and you realize that you did take a lot from it.

Widening of Perspective: “Different Ways of Thinking”

In their accounts, most participants highlighted how their perspectives broadened following PBS training.

CATH: “ This is a different way of thinking and getting staff to think differently.”

Participants gave examples of changes in their thinking such as exploring why a person might be upset (Molly), looking for triggers (Maria) being more aware of the possibilities for support in a given moment (p1, Ann) and many participants noted a widening of perspective:

ZOE: “ I see it differently now when somebody is getting anxious. We only see people for a short time. Not that we would leave anybody anxious but it makes you think differently. Thinking outside the box.”

“Increased Competence: Better Outcomes”

A third theme is perceptions of increased competence, and the role of increased competence in promoting better client outcomes.

HEATHER: “ I know what to do in a certain situation whereas some people who hadn’t had it wouldn’t know what to do.”

Participants noted more detailed understanding of triggers (Freya) and better ability to read the communicative intent of clients (Molly). One participant reported that clients “ don’t get to that agitated point like you can prevent it from happening because you know that the reason they are, like, representing the challenging behavior is that they want something or something’s annoyed them.” (Ann).

Other participants reported better outcomes for clients as a result:

ROBIN: “ One person I support has been with [service provider] for 11 years and has always been supported 1:1. I would say roughly he was having 3 incidents a week. (Since PBS was introduced) he has been going out on his own now for 2 months on local walks, walking 2 miles. I don’t think we have had incidents in 2 months. PBS has made it easier, the paperwork side, trying to show staff they wouldn’t be at fault. The staff were scared. I was 5, 6 years ago, but when you come to think about it, it’s better for the person.”

Spill Over Into Private Lives: Increased Tolerance in Relationships

Many participants describe the impact PBS training made in their lives beyond the workplace. Participants say they can apply the principles directly with their family members.

MARIA: “ At home, my children … will come to talk to me, they need attention, and I say ‘I’m talking on the phone, you have to wait’, but now, instead of shouting at them I give them attention but not stop, ask them to write it and come to me, then I will tell you what to do.... To know that there is a reason for any behavior, and how to handle it.”

MAUREEN: “ It (PBS training) has impacted on outside as my partner has high anxiety levels. I have looked at triggers, I have tried to reduce his anxieties using PBS and the techniques.”

ANN: My sister, my middle sister, she’s got learning disabilities. So, like, cos it is simple things like you have got to recognize that most of the challenging behavior is because they are trying to communicate something. Even that feel good factor, or they are just doing it to release some stimulation. But you just need to realize that there is a reason behind all of it, is not there? It’s not just the naughty child, or whatever people use as an excuse.

In terms of indirect impact on participants’ private lives, they spoke about being less judgmental and more effective in their close personal relationships after PBS training:

MARIA: I apply it in my everyday life, especially to be non-judgemental.

ZOE: Yes, because when I had the training we talked about when you have a bad day how you would react, and how your partner would (react) to you…(as a result) I tried something different.

Deeper Understanding of People

Participants reflected on a theme that their philosophy of people had changed. For example, they noted a different attitude to behaviors outside work.

HEATHER: “ I’m aware of people when I’m out (outside of work) that they have got behavioral problems and they’re not just being naughty.”

Commensurate with this change in philosophy is a different or deeper understanding of how people need to be treated.

ANN: It’s encouragement, rather than punishment. That’s what I have taken from it, less telling off and more understanding and encouragement .

Traditionally, expert opinion rather than user-perceptions has driven behavioral interventions ( LaVigna and Willis, 2005 ). Training in PBS is important because it switches focus to the training of stakeholders. The impact of PBS training on staff has been under researched ( Dench, 2005 ). Dench (2005) argues that organizational best practice means that personal development should link to institutional goals and that training evaluation should include qualitative perspectives. It was therefore vital to consider the impact training in PBS has on staff from a qualitative point of view. Staff are key stakeholders and active participants in assessment, determining intervention strategies, evaluation of these strategies, and thinking about what outcomes might affect service user’s quality of life. Vygotsky regarded learning as the ingrowing of lived experience into personal meaning, an outside-in approach ( Frawley, 1997 ). This outside-in perspective lends itself readily to a consideration of how being trained in PBS influences the lived experience of those receiving training. Our results show, within the cohort sampled, that the impact on individuals was overwhelmingly positive.

Specifically, the participants in our research reported that PBS training was enjoyable. This was the case at both emotional and cognitive levels, where training represented both participant’s experience as well as its environmental context ( Wankel, 1993 ). Thus, consistent with Dench (2005) , enjoyment constituted a framework for further embedding training content. Participants also described a widening of perspective – this experience is consistent with the person-based focus advocated by PBS. Moreover, a widening perspective is congruent with the approach advocated by educationalists who build on Vygotsky’s legacy to move education and training away from a focus on test performance to addressing individual capabilities in a grounded and creative manner (e.g., Craft et al., 2008 ).

PBS training is perhaps best conceived as a “collaborative project”, an aggregate of actions that are directed toward an aim. However, at the same time, a project is not equated with its aim, “a unit of educative work in which the most prominent feature was some form of positive and concrete achievement”. Participant 8 spoke about a client who had shifted from three incidents of challenging behavior per week pre PBS training to a position where the client is now going out, unaccompanied, for 2-mile walks.

When a project manages to achieve relatively permanent changes in the social practices of a community, it evolves from being a social movement into an institution. This fits well with Dench (2005) , who argues that best practice in training leads to an integration between human resource development and management policies and processes. There was evidence that this was indeed the case with our participants. For example, one participant expressed a desire to have all staff undergo PBS training at induction, and for the implementation of annual refresher training. Participants described also how the benefits of PBS training have “spilled over” into their private lives. Specifically, people who received training described how their marital, sibling, and parental relationships improved. Increased self-efficacy ( Bandura, 1997 ) is a key factor in how individuals’ personal development opportunities link to specified organizational goals.

Our final theme pertained to the deeper understanding of people whom participants describe because of their training. Several of those interviewed made reference to moving beyond considerations based around ideas of people “being naughty” and reflected on a move to a more holistic approach, where their attitude was significantly less judgmental, efficacious, and increasingly tolerant [e.g., “I apply it in my everyday life, especially to be non-judgemental. To know that there is a reason for any behavior and how to handle it” ( Gore et al., 2013 )].

These themes all appear to link with the concept of perceived control, and perceptions of personal control are key to managing both work and home environments in positive ways. According to Bandura (1997) , knowing how to develop and exercise efficacy is a useful basis for well-being enhancement. Social norms convey standards of conduct, when participants adopt these, as they clearly did in the present study, a self-regulatory system consistent with these standards emerges ( Bandura, 1986 ). From an organizational perspective, this last point is key. Training staff in PBS produced elevated perceptions of increased control. Such perceived control is of benefit to both the individuals and their organization ( Bandura, 1997 ). In the current climate, where resources are scarce, all expenditure, including that on training, must, and should, be fully justified. The results of the current study clearly suggest that training staff in PBS offers benefits at the level of service provision as well as at both personal and corporate levels.

Limitations and Future Research

The present paper identified the importance of perceived control. This is an important finding, which requires cautious interpretation because researchers define perceived control in different ways ( Chipperfield et al., 2012 ). Some employ the classic definition, which refers to beliefs about influence. Other theorists prefer a liberal interpretation that denotes perceived control as a psychological state of control. The emphasis with this delineation is whether individuals feels “in or out of” control. The former conceptualization focuses on specific outcomes, whereas the latter is broad and general. This distinction is one which might usefully be considered in future studies. Of importance will be investigating the extent to which vocational training increases perceived control across life domains. The implicit assumption within the present paper was that the benefits were broad (extended beyond practice to family and relationships generally). However, this is difficult to establish without further consideration of different contexts/situations.

In addition, other factors limit the generalizability of findings presented in this report. Specifically, conclusions derive from a small-scale qualitative study centering on a single service provider. Consequently, it is unclear whether the observed benefits extend across service providers and organizations. This is something that subsequent studies should investigate. This could include evaluation of similar service providers, service providers generally, and extend eventually to consider the benefits of occupational training. Clearly, if research evidences that training benefits both clients and practitioners, this from a vocational and practical perspective indicates that it necessitates resourcing.

Noting the limited scope of the current study, further work could examine the outcomes using larger samples and relevant objective psychometric measures, for example, scales assessing perceived control, self-efficacy, and well-being. Longitudinal analysis might establish causal relationships and reveal whether benefits sustained over time. Furthermore, larger samples allow the testing of predictive relationships and the development of models.

Acknowledging these limitations, readers should best consider the study findings in terms of transferability rather than in terms of generalizability. It is also necessary to put on the record the specific interests of the author and research team, which may have inadvertently influenced both the content and findings presented in this report. In particular, their interest and in the service provider and the accompanying community psychology project.

PBS training equips those who receive it with a set of values, as well as the technical knowledge required to realize those values ( Walsh et al., 2018 ). An important goal of PBS training, in common with training in all fields, is that the training is internalized by those who receive it in order to widen their perspectives and contribute positively to wider institutional and societal well-being. There is evidence that the training has been internalized, in Vygotsky’s sense of the inter-psychological becoming the intra-psychological. Staff understand themselves as having benefitted from PBS training and they believe this benefit extending beyond their professional lives. This perceived gain speaks to the importance of training. Particularly, it evidences the positive impact it has on both the lives of those who receive it as well as on the lives of those around them. As such, PBS training fits with a holistic approach to service provision that is mindful of the importance of caregiver well-being in addition to client well-being (see MacDonald and McGill, 2013 ). In sum, what the themes identified in this research evidence, and share, is growth on the part of those who received training in PBS.

Ethics Statement

The study received full ethical approval from MMU ethics committee. Participants were advised that they were free to withdraw at any time, should they wish to do so. All interviews were recorded with the permission of participants and they were later anonymized and transcribed. Anonymized interviews were stored on a password-protected computer for later analysis.

Author Contributions

NDa, S-JS-L, and SR collected data. All authors participated in thematic analysis. RW, BM, and NDa wrote up the final report with feedback and contribution from all authors.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

1. Homogenous on the point of interest – PBS training.

Allen, D., James, W., Evans, J., Hawkins, S., and Jenkins, R. (2005). Positive behavioural support: definition, current status and future directions. Tizard Learn. Disabil. Rev. 10, 4–11. doi: 10.1108/13595474200500014

CrossRef Full Text | Google Scholar

Baer, D. M., Wolf, M. M., and Risley, T. (1968). Current dimensions of applied behavior analysis. J. Appl. Behav. Anal. 1, 91–97. doi: 10.1901/jaba.1968.1-91

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory . Upper Saddle River, NJ: Prentice Hall.

Google Scholar

Bandura, A. (ed.) (1997). Exercise of personal and collective efficacy in changing societies. Self-efficacy in changing societies (Cambridge, England: Cambridge University Press), 1–45.

Bohanon, H., Fenning, P., Carney, K. L., Minnis-Kim, M. J., Anderson-Harriss, S., Moroz, K. B., et al. (2006). Schoolwide application of positive behavior support in an urban high school: a case study. J. Posit. Behav. Interv. 8, 131–145. doi: 10.1177/10983007060080030201

Braun, V., and Clarke, V. (2006). Using thematic analysis in psychology. Qual. Res. Psychol. 3, 77–101. doi: 10.1191/1478088706qp063oa

Chipperfield, J. G., Newall, N. E., Perry, R. P., Stewart, T. L., Bailis, D. S., and Ruthig, J. C. (2012). Sense of control in late life: health and survival implications. Personal. Soc. Psychol. Bull. 38, 1081–1092. doi: 10.1177/0146167212444758

Craft, A., Chappell, K., and Twining, P. (2008). Learners reconceptualising education: widening participation through creative engagement? Innov. Educ. Teach. Int. 45, 235–245. doi: 10.1080/14703290802176089

Dench, C. (2005). A model for training staff in positive behaviour support. Tizard Learn. Disabil. Rev. 10, 24–30. doi: 10.1108/13595474200500017

Emerson, E. (2001). Challenging behaviour: Analysis and intervention in people with severe intellectual disabilities . Cambridge, England: Cambridge University Press.

Frawley, W. (1997). Vygotsky and cognitive science . London: Harvard University Press.

Furman, T. M., and Lepper, T. L. (2018). Applied behavior analysis: definitional difficulties. Psychol. Rec. 68, 103–105. doi: 10.1007/s40732-018-0282-3

Gore, N. J., McGill, P., and Hastings, R. P. (2019). Making it meaningful: caregiver goal selection in positive behavioral support. J. Child Fam. Stud. 28, 1–10. doi: 10.1007/s10826-019-01398-5

Gore, N. J., McGill, P., Toogood, S., Allen, D., Hughes, J. C., Baker, P., et al. (2013). Definition and scope for positive behavioural support. Int. J. Posit. Behav. Support 3, 14–23.

Grey, I. M., and McClean, B. (2007). Service user outcomes of staff training in positive behaviour support using person-focused training: a control group study. J. Appl. Res. Intellect. Disabil. 20, 6–15. doi: 10.1111/j.1468-3148.2006.00335.x

Hassiotis, A., Strydom, A., Crawford, M., Hall, I., Omar, R., Vickerstaff, V., et al. (2014). Clinical and cost effectiveness of staff training in positive behaviour support (PBS) for treating challenging behaviour in adults with intellectual disability: a cluster randomised controlled trial. BMC Psychiatry 14, 1–10. doi: 10.1186/s12888-014-0219-6

LaVigna, G., and Willis, T. (2005). A positive behavioural support model for breaking the barriers to social and community inclusion. Tizard Learn. Disabil. Rev. 10, 16–23. doi: 10.1108/13595474200500016

MacDonald, A., and McGill, P. (2013). Outcomes of staff training in positive behaviour support: a systematic review. J. Dev. Phys. Disabil. 25, 17–33. doi: 10.1007/s10882-012-9327-8

McClean, B., Dench, C., Grey, I., Shanahan, S., Fitzsimons, E., Hendler, J., et al. (2005). Person focused training: a model for delivering positive behavioural supports to people with challenging behaviours. J. Intellect. Disabil. Res. 49, 340–352. doi: 10.1111/j.1365-2788.2005.00669.x

Patton, M. Q. (2002). Qualitative research and evaluation methods . 3rd Edn. Thousand Oaks, CA: Sage Publications.

Walsh, S., Dagnall, N., Ryan, S., Doyle, N., Scarbrough-Lang, S., and McClean, B. (2018). Investigating the impact of staff training in positive behavioural support on service users’ quality of life. Learn. Disabil. Pract. 21, 25–29. doi: 10.7748/ldp.2018.e1902

Wankel, L. M. (1993). The importance of enjoyment to adherence and psychological benefits from physical activity. Int. J. Sport Psychol. 24, 151–169.

Williams, N. J., and Glisson, C. (2013). Reducing turnover is not enough: the need for proficient organizational cultures to support positive youth outcomes in child welfare. Child Youth Serv. Rev. 35, 1871–1877. doi: 10.1016/j.childyouth.2013.09.002

World Health Organization (2006). Quality of care: A process for making strategic choices in health systems . World Health Organization.

Keywords: positive behavioral support (PBS), training, thematic analysis, staff experience, challenging behavior

Citation: Walsh RS, McClean B, Doyle N, Ryan S, Scarborough-Lang S-J, Rishton A and Dagnall N (2019) A Thematic Analysis Investigating the Impact of Positive Behavioral Support Training on the Lives of Service Providers: “It Makes You Think Differently”. Front. Psychol . 10:2408. doi: 10.3389/fpsyg.2019.02408

Received: 11 January 2019; Accepted: 09 October 2019; Published: 29 October 2019.

Reviewed by:

Copyright © 2019 Walsh, McClean, Doyle, Ryan, Scarborough-Lang, Rishton and Dagnall. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: R. Stephen Walsh, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

• How it works

Thematic Analysis – A Guide with Examples

Published by Alvin Nicolas at August 16th, 2021 , Revised On August 29, 2023

Thematic analysis is one of the most important types of analysis used for qualitative data . When researchers have to analyse audio or video transcripts, they give preference to thematic analysis. A researcher needs to look keenly at the content to identify the context and the message conveyed by the speaker.

Moreover, with the help of this analysis, data can be simplified.  

Importance of Thematic Analysis

Thematic analysis has so many unique and dynamic features, some of which are given below:

Thematic analysis is used because:

• It is flexible.
• It is best for complex data sets.
• It is applied to qualitative data sets.
• It takes less complexity compared to other theories of analysis.

Intellectuals and researchers give preference to thematic analysis due to its effectiveness in the research.

How to Conduct a Thematic Analysis?

While doing any research , if your data and procedure are clear, it will be easier for your reader to understand how you concluded the results . This will add much clarity to your research.

Understand the Data

This is the first step of your thematic analysis. At this stage, you have to understand the data set. You need to read the entire data instead of reading the small portion. If you do not have the data in the textual form, you have to transcribe it.

Example: If you are visiting an adult dating website, you have to make a data corpus. You should read and re-read the data and consider several profiles. It will give you an idea of how adults represent themselves on dating sites. You may get the following results:

I am a tall, single(widowed), easy-going, honest, good listener with a good sense of humor. Being a handyperson, I keep busy working around the house, and I also like to follow my favourite hockey team on TV or spoil my two granddaughters when I get the chance!! Enjoy most music except Rap! I keep fit by jogging, walking, and bicycling (at least three times a week). I have travelled to many places and RVD the South-West U.S., but I would now like to find that special travel partner to do more travel to warm and interesting countries. I now feel it’s time to meet a nice, kind, honest woman who has some of the same interests as I do; to share the happy times, quiet times, and adventures together

I enjoy photography, lapidary & seeking collectibles in the form of classic movies & 33 1/3, 45 & 78 RPM recordings from the 1920s, ’30s & ’40s. I am retired & looking forward to travelling to Canada, the USA, the UK & Europe, China. I am unique since I do not judge a book by its cover. I accept people for who they are. I will not demand or request perfection from anyone until I am perfect, so I guess that means everyone is safe. My musical tastes range from Classical, big band era, early jazz, classic ’50s & 60’s rock & roll & country since its inception.

Development of Initial Coding:

At this stage, you have to do coding. It’s the essential step of your research . Here you have two options for coding. Either you can do the coding manually or take the help of any tool. A software named the NOVIC is considered the best tool for doing automatic coding.

For manual coding, you can follow the steps given below:

• Please write down the data in a proper format so that it can be easier to proceed.
• Use a highlighter to highlight all the essential points from data.
• Make as many points as possible.
• Take notes very carefully at this stage.
• Apply themes as much possible.
• Now check out the themes of the same pattern or concept.
• Turn all the same themes into the single one.

Example: For better understanding, the previously explained example of Step 1 is continued here. You can observe the coded profiles below:

Make Themes

At this stage, you have to make the themes. These themes should be categorised based on the codes. All the codes which have previously been generated should be turned into themes. Moreover, with the help of the codes, some themes and sub-themes can also be created. This process is usually done with the help of visuals so that a reader can take an in-depth look at first glance itself.

Extracted Data Review

Now you have to take an in-depth look at all the awarded themes again. You have to check whether all the given themes are organised properly or not. It would help if you were careful and focused because you have to note down the symmetry here. If you find that all the themes are not coherent, you can revise them. You can also reshape the data so that there will be symmetry between the themes and dataset here.

For better understanding, a mind-mapping example is given here:

Reviewing all the Themes Again

You need to review the themes after coding them. At this stage, you are allowed to play with your themes in a more detailed manner. You have to convert the bigger themes into smaller themes here. If you want to combine some similar themes into a single theme, then you can do it. This step involves two steps for better fragmentation. 

You need to observe the coded data separately so that you can have a precise view. If you find that the themes which are given are following the dataset, it’s okay. Otherwise, you may have to rearrange the data again to coherence in the coded data.

Corpus Data

Here you have to take into consideration all the corpus data again. It would help if you found how themes are arranged here. It would help if you used the visuals to check out the relationship between them. Suppose all the things are not done accordingly, so you should check out the previous steps for a refined process. Otherwise, you can move to the next step. However, make sure that all the themes are satisfactory and you are not confused.

When all the two steps are completed, you need to make a more précised mind map. An example following the previous cases has been given below:

Define all the Themes here

Now you have to define all the themes which you have given to your data set. You can recheck them carefully if you feel that some of them can fit into one concept, you can keep them, and eliminate the other irrelevant themes. Because it should be precise and clear, there should not be any ambiguity. Now you have to think about the main idea and check out that all the given themes are parallel to your main idea or not. This can change the concept for you.

The given names should be so that it can give any reader a clear idea about your findings. However, it should not oppose your thematic analysis; rather, everything should be organised accurately.

Does your Research Methodology Have the Following?

• Great Research/Sources
• Perfect Language
• Accurate Sources

If not, we can help. Our panel of experts makes sure to keep the 3 pillars of Research Methodology strong.

Also, read about discourse analysis , content analysis and survey conducting . we have provided comprehensive guides.

Make a Report

You need to make the final report of all the findings you have done at this stage. You should include the dataset, findings, and every aspect of your analysis in it.

While making the final report , do not forget to consider your audience. For instance, you are writing for the Newsletter, Journal, Public awareness, etc., your report should be according to your audience. It should be concise and have some logic; it should not be repetitive. You can use the references of other relevant sources as evidence to support your discussion.  

Frequently Asked Questions

What is meant by thematic analysis.

Thematic Analysis is a qualitative research method that involves identifying, analyzing, and interpreting recurring themes or patterns in data. It aims to uncover underlying meanings, ideas, and concepts within the dataset, providing insights into participants’ perspectives and experiences.

You May Also Like

Discourse analysis is an essential aspect of studying a language. It is used in various disciplines of social science and humanities such as linguistic, sociolinguistics, and psycholinguistic.

The authenticity of dissertation is largely influenced by the research method employed. Here we present the most notable research methods for dissertation.

Struggling to figure out “whether I should choose primary research or secondary research in my dissertation?” Here are some tips to help you decide.

USEFUL LINKS

LEARNING RESOURCES

COMPANY DETAILS

• How It Works