Financial consideration, internal and external influence, personal goal, and educational achievement always influence the decision-making process and behavior of individuals. Using nursing students as the population, the researcher employed the Social Cognitive Career Theory as the theoretical framework to examine the nursing human resources shortages and how would the COVID-19 pandemic influence the experiences, sense of belonging, and career decision-making process of 58 nursing students in South Korea. The researcher categorized the sharing into two groups, which were before the influence of the COVID-19 pandemic, and the changes during the COVID-19 pandemic. The results indicated that financial consideration was the significant reason why South Korean nursing students decided to study nursing regardless of the COVID-19 pandemic. More importantly, almost all participants decided to leave the nursing profession due to the COVID-19 pandemic and the consideration between financial factor and personal sacrifice. The outcomes of this study provided a blueprint for human resources professionals, government leaders, policymakers, school leaders, and hospital managers to reform their current curriculum and human resources planning to overcome the potential human resources gaps in the soon future due to the COVID-19 pandemic. The medical and nursing professions have faced significant human resources shortages for more than a century ,2. Many Although nursing is one of the most popular university majors among both traditional-age and returning students, for various reasons , many students may find that nursing training and education programs do not match their personal goals and expectations . A previAnother study  found thJob nature is another consideration in individuals’ career development in the field of nursing. A recent study  indicateAnother study  indicateHowever, although some students decide to quit nursing programs after commencement, many have no chance to switch to the programs they are interested in due to university regulations and financial limitations. A recent study  indicateA previous study  indicateThis study has three aims. First, the medical and nursing professions have always faced significant human resource shortages due to the growing and aging population across the world. In this study, the researcher examined the situation in South Korea. Although South Korea is one of the developed regions in the East Asia region, medical and nursing professionals are still in high demand. Therefore, it is important to establish and develop ways to attract students to join nursing training and education programs in order to fill the gaps.Second, the experiences, sense of belonging, and career decision-making process of potential student nurses could change due to social, cultural, internal, external, and personal factors. Therefore, it is important to gain an understanding of the experiences and views of nursing students .Last but not least, COVID-19 pandemic is one of the significant environmental influences of the past decade. Environmental factors such as the COVID-19 pandemic may influence the experiences, sense of belonging, and career decision-making process of nursing students. Therefore, this study examines the views and opinions of nursing students who have been impacted by the current COVID-19 pandemic and the recent changes in the medical profession and working environment.In short, this research study was guided by one research question, which was:How the COVID-19 issue influenced the thinking and decision-making process of these nursing students in South Korea?The employment of the qualitative research method ,18,19,20Although the researcher used to plan to collect data information from a single university, feedback and opinions from a certain group of individuals may not reflect the overall performance and situation in the current South Korean environment and society. Therefore, after careful consideration, the researcher decided to expand the population to different nursing schools and universities in order to cover the opinions and voices from a larger population in South Korea ,19.The general inductive approach  has beenThe Social Cognitive Career Theory (SCCT) was originally created by Lent’s team  during tIn order to investigate the study and background, and understand the holistic performance of nursing students’ behaviors and concepts, the Social Cognitive Career Theory (SCCT) has been used for the research ,36,37,38In this case, the researcher employed this SCCT as the lens to understand and explore how the COVID-19 pandemic influenced the experience, sense of belonging, and career decision-making process of nursing students in the South Korean environment.Fifty-eight traditional-age nursing students, regardless of their gender, were invited for this study. All agreed to participate in this study. All the participants were South Korean nations who can speak both Korean and English languages. The participants are currently enrolled at one of the nursing schools within the university system in South Korea. None of them joined any international exchanging programs before the interview sessions. First, the researcher tended to conduct a case study  for a smDue to the COVID-19 Pandemic, face-to-face interactions, interviews, and even focus group activities were strongly discouraged. Therefore, in order to advocate the ideas of social distancing based on the guideline of the South Korean government, the researcher conducted the data collection sessions via online social media application .All participants have voluntarily participated in this study. The general inductive approach  was emplSecond, each participant read the interview questions before the interview session. The participants were invited with an email invitation, content form, and the interview questions. The participants always had at least ten days to read the interview questions before the interview session. Each interview session lasted from 62 min to 89 min. During the interview sessions, the researcher needed to record audio conversations. The participants agreed on the recording.Third, after the data collection, the researcher transcribed the oral information to written transcripts for reporting. After the written transcripts were created, the researcher sent the related transcript to each participant for the member checking procedure ,19,25. AAfter the data collection procedures, more than 600 pages of written transcripts were created based on the semi-structured interviews. Qualitative researchers advocated that large-size data information should be reduced for meaningful themes and subthemes. The researcher followed the recommendation of the general inductive approach  for dataAll the signed and unsigned content forms, agreements, personal contacts, audio recording, written transcripts, computers, and related materials were locked in a password-protected cabinet. Only the researcher had the rights to read the information. After the study was completed, the researcher destroyed and deleted all the related information immediately due to personal privacy ,51,52,53Due to the content forms and agreements, the name, gender, university name, placement information, and place of origin were masked due to privacy. Due to the intensive networking and population in South Korea, the researcher had the responsibility to protect all the rights of the participants. After careful consideration, the years at university, university location, and the career decision after the COVID-19 Pandemic could be shown.All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the University Ethics Committee (WSU/2020/01).During the interview sessions, the participants answered general semi-structured questions that asked for their opinions, feedback, understanding, and perspectives. Although all of the participants had the same university major and regional background in South Korea, their lived stories, family backgrounds, values, and concepts should not be the same. Unlike previous studies with a wider focus and a more general perspective under normal conditions , this stIt was very surprising to find that the COVID-19 pandemic had strongly influenced the experiences, sense of belonging, and career decision-making process of a large number of nursing students in South Korea. The significant results from this study may contribute to an understanding of why such situations arise in the East Asia region, particularly in South Korea.I have no personal achievements … no interests … no goals … no career interests … based on my grades. I wanted to study a major that offered a career with a better salary and benefits … [W]orking in a hospital, especially a large-sized hospital in Seoul, is a way of making money … [T]his is the only reason why I wanted to study nursing … [M]oney was the biggest reason …(P#42)By listening to the lived stories and life experiences of the participants, the researcher identified several important elements that influenced their decision-making process. The findings of this study revealed that all of the participants intended to complete their university nursing degree but would not be joining the nursing profession after graduation. Using the lens of SCCT ,36,37,38I could have selected biology or nursing as my major(s) during high school … I selected nursing because nurses can make more money…I wanted to learn biology as it was my interest … but all I need is money and a salary … I would never pick a major that could not produce money …Another participant stated that she decided to study nursing as her major due to salary considerations:To be honest, I do not want to be a nurse…but I want to receive a nurse’s salary … I do not really care about the treatment of the patients … I care about myself … I care about money and the holidays … I do not have any dreams … this is Korea … I just care about myself and my money…(P#54)Although personal interests, goals, and achievements also played a role in their decisions, financial considerations were ranked highest in this study. For example, one participant shared the following:I can earn a lot of money because I will be working as a nurse in a large hospital … I want to buy a lot of handbags and cosmetic items and a luxury car, and I want to change my cell phone every season … I cannot afford this lifestyle at the moment as I am not rich enough … but once I can earn money as a nurse … I can do something that can satisfy my lifestyle …(P#22)All 58 participants expressed that financial considerations influenced their experiences, sense of belonging, and career decision-making process as nursing students and pre-service nurses. For example, one participant stated that the significant salary she would receive as a nurse would allow her to buy items, such as handbags, to gain both mental and physical satisfaction:I love up-to-date cell phones and computers…at the moment, I do not want to buy any outdated models … I need to change my electronic items each season…I want to become a nurse … [I]t is totally about money…I do not care about the patients … [A]ll I need is the money … I am not an angel or whatever, I am a money girl.(P#34)Many similar views and stories were captured from the interview sessions. For example, another participant stated that a nurse’s salary would allow her to buy cell phones and computers:I can have long holidays and a good salary to pay for my holidays … I plan to have a working holiday after I have worked in a hospital for one or two years … I do not care about how society and communities see me … I have my own life, and my life is about making money with my nursing licence.(P#12)Based on the lens of SCCT, many of the participants stated that besides allowing them to purchase items that could satisfy their mental and physical needs, a nurse’s salary would also allow them to travel ,36,37,38… [M]aking money is my goal … I don’t care about my patients or my career development … [B]eing a nurse is all about money for my marriage … I want to make more money to buy a house after my marriage … [N]ursing is a good way for girls to make money …(P#3)With the reflection of a previous study , besides… [N]ursing is one of the best occupations to make money…especially for girls in Korea … I want to buy a house for my parents … I will send money to my younger brothers for university … I picked this major because as a girl … I need to find a way to make money … I was thinking about a career in finance … but only a nursing school accepted my application … [I]t is all about money…(P#25)Another participant shared similar opinions about how the development of their nursing career would allow them to have a better life after graduation:... I have a plan with my father already … [A]fter I have gained several years of experience and saved enough money in Seoul … we can invest in a private clinic in the rural community … I already have a plan and timetable … I want to be a boss … I do not want to work for someone … I want to manage the bookkeeping instead of nursing … [M]edical services can be a business …(P#47)Another group of participants expressed that they wanted to build up a small clinic in their rural community as this would be a way to make money and provide health care in their hometown . Based oAll 58 participants strongly believed that financial and profit-making considerations were their priorities when choosing a university major and planning their career development . Using tBased on some previous studies, social status and level are important considerations for many individuals in South Korea in selecting their university major and career development due to traditional Confucian thinking and behavior ,56,57. UA large number of participants stated that being a nurse is one of the best ways for females to escape from poverty as the profession’s selection procedure does not discriminate on the basis of gender. Using the lens of SCCT ,36,37,38I want to reach the upper level of society with my nursing degree and job … I don’t like nursing and I don’t like caring for patients … but I like the social status … perhaps … because many Korean people believe nurses are upper-level individuals in the society … I want to become one of the highest people in the community … again, I do not like patient caring … I like social level and money …(P#33)… I study nursing only because I want to build up to the upper level … I really hate caring for patients … I will tell my supervisor I am a lazy girl … but society needs me as the there is a shortage of nurses … I can find jobs pretty easily … [A]s a registered nurse, I have an advantage in society … I can gain jobs that I like …(P#32)In this study, 56 participants stated that nursing is the way to enter the upper level of Korean society. For example, many expressed the view that once they have gained registered nurse status, they can become members of the upper level in society:… I don’t care about my working environment … I care about how my nursing degree will help me gain a job with less responsibilities … I know nursing is not an easy profession … but I can adjust my workload…I am not here to care for patients … I only want a job so that I can engage in my hobbies and interests after working hours and for the social status I will have as a nurse …(P#41)Another participant shared a similar opinion about how registered nursing status could help her to gain nursing jobs in Korea:It is clear from their comments that many of the participants believed that they would be able to develop their career in nursing as Korean society is thirsty for registered nurses. Many of the participants selected nursing as their career choice due to financial and social status considerations ,36,37,38…I want use my occupation as a nurse as a way to marry a rich organizational leader, as nurses are sexy and attract rich men in the business field … [P]erhaps I can marry a doctor or hospital leader … I don’t want to work as a nurse once I am married … [M]y purpose in choosing to study nursing and enter the profession is to make money … I am not here to care for patients. I am here for the money and social status …(P#38)In addition to financial considerations and their connection to social status and social leveling, another large group of participants believed that their nursing career might help them to have a better marriage and relationships . For exaIn short, using the lens of SCCT ,36,37,38I need to make more money, so I need to become a nurse. Although I really don’t like patient caring … I need to make more money for my dream traveling … and perhaps handbags and some leisure activities … I just hate patient caring and I hate taking care of people …(P#25)Although individuals’ decisions can change due to unforeseen circumstances , many inKorean people like nurses … because they are working in higher status workplaces … such as hospitals … I like this prestige … [I]t is my first priority … in seeking to become a nurse … [I]t is not about the patients …(P#49)Moreover, some participants stated that their occupation as a nurse would allow them to attain higher-level status in South Korean society:I decided to study nursing because I want to make more money and I want to save more money for traveling and shopping … for handbags and leisure activities … The COVID-19 pandemic will not change my mind about this money-making decision … I still want to make money from the medical field … I will start my own clinic … It should be a way to make money …(P#50)However, in this study, under the influences and impacts of the COVID-19 pandemic, only two participants expressed a firm interest in becoming a nurse after graduating from university. Based on the lens of SCCT ,36,37,38… I am sure I will not leave the medical profession … I will use this opportunity to make more money from patients … I have a business mind with a nursing focus … I will enter a hospital … to understand how it operates and patients’ behaviors … [A]fter gaining several years’ experience … I will start my own clinic…but again, I need to make money … [T]he COVID-19 pandemic will not change my focus on money …(P#11)Another participant shared a similar opinion about financial considerations and social status and leveling, stating that the COVID-19 pandemic offers an opportunity to make money due to the increased awareness of and need for personal care and personal hygiene:Their stories reflect the finding of several previous studies that once individuals understand their career perspective, only a few internal and external elements and factors can influence or change their behaviors ,36,37,38… I joined the nursing profession because of the salary. I do not have money to start my clinic in the future…I have to work in a hospital to finance my leisure activities and handbags … Although the salary is very attractive, I have to work for more than 10 h a day … but I do not receive any additional payments even when I work overtime…I disagree with this situation …(P#16)First, due to the influences of the COVID-19 pandemic, many participants stated that the high-risk career pathways in the medical and nursing profession always outweighed their financial needs, demands, and objectives. Using the lens of SCCT ,36,37,38… [M]y hobby is not nursing, caring for patients, or working for society … [M]y hobbies are buying handbags…watching movies … going to a coffee shop and chatting with my friends … [D]ue to this COVID-19 pandemic, many medical professionals need to work overtime with no additional salary … [If] I cannot go to buy a handbag after I finish work, I will not join this profession …(P#39)With the reflection of some previous studies, besides the lack of overtime payments and the workload due to the COVID-19 pandemic and social situation internationally, many participants stated that the long working hours had an impact on their work-life balance ,62. For My goal is to become a sexy nurse K-pop star who can make a lot of money on the stage, TV shows, and movies … [D]on’t you think the gimmick of sexy nurse and K-pop is more attractive than a fat nurse working in a hospital for 30 years? … I want to work in a plastic surgery clinic in the future because I want to take advantage of the free plastic surgery … but for now, I will just follow the K-pop direction after my graduation…(P#51)Many participants indicated that the mandatory and voluntary-based overtime responsibilities in the medical and nursing professions did nothing to increase their interest in working in these professions due to the insignificant salary ,63. AlthI was planning to work just in surgery before I left the hospital … but I don’t think that will work after the COVID-19 pandemic … [M]any hospitals and medical organizations have changed their benefit packages … no more plastic surgery benefits for staff with less than five years’ working experience … I may enter the business industry, for example, promotion or TV show work, with my professional nursing skills.(P#2)The idea of taking advantages and benefits from employers was not confined to one participant. Many expressed a similar view about their intentions. Another participant also shared an idea about how COVID-19 influenced the benefit packages, which impacted their experiences, sense of belonging, and career decision-making process:Many indicated that if they cannot be given additional benefits and advantages in hospitals and organizations, they would be interested in joining other professions . CurrentI am planning to work as a leader or join a leadership team … I do not want to help any patients as I want to lead people and make more money with my skills … Since the COVID-19 pandemic, I have changed my mind somehow … I will not join the nursing profession … [I]nstead, I want to use my nursing and medical skills to start a YouTube channel for health promotion …(P#44)More than 45 participants stated that they did not want to work as assistants to others but as leaders and employers in business teams and companies. More importantly, many indicated that they disliked helping patients with special needs. For example, one participant stated that, in their opinion, helping patients is not a positive work responsibility:I am sure that I am not going to touch those people who are infected with this international virus … I disagree with how the government treats nursing professionals … [W]e are human and we have family members … [W]hy would the government send us to the frontline for the patients? I want to make money and manage people …(P#33)More than half of the participants stated that they did not want to touch patients’ bodies as many patients may be infected by the COVID-19 virus. One participant made this significant comment:… [I]n the first place, I do not have a strong interest in nursing, but I am interested in money, my name, a good position, and a good company … [C]aring for patients and older people is of no interest to me … [A]fter this COVID-19 pandemic, I do not think I will join the nursing profession as I really don’t want to provide care to older people …(P#21)Another participant stated:In conclusion, through the lens of SCCT ,36,37,38The original purpose of this study was to capture the experiences, sense of belonging, and career decision-making process of university nursing students in South Korea. As the COVID-19 pandemic has influenced the medical and social care professions across the world, the researcher sought to discover how the pandemic has influenced the overall performance and perspective of pre-service medical professionals in the field. Using the lens of SCCT ,36,37,38Based on the lens of SCCT, they all stated that they decided to become registered nurses due to financial considerations ,36,37,38Using the lens of SCCT ,36,37,38Individuals’ experiences, sense of belonging, and career decision-making process are usually solidly based on the elements described in SCCT ,36,37,38However, in this study, under the influences and impacts of the COVID-19 pandemic, only two participants expressed a firm interest in becoming a nurse after graduating from university. Based on the lens of SCCT ,36,37,38Although a few participants stated that staying in the medical and nursing professions would offer them business opportunities due to the COVID-19 pandemic, almost all of the nursing students had decided to quit the nursing profession after graduating from university. Several factors emerged from their responses, the main ones being the insignificant salary, unattractive benefits, and nature of the nursing profession . Almost Every study has its own limitations. First, due to the COVID-19 Pandemic and the recommendations of social distancing, no face-to-face interview sessions and focus group activities were conducted ,69,70. ASecond, this study only focused on the problems in the East Asian region, particularly in South Korea . HoweverTo the best of the knowledge, this is one of the very first nursing research studies about the experiences, sense of belonging, and career decision-making process of contemporary nursing students  under thWith the lens of the SCCT ,45,46,47There are two recommendations for the practices. First, the current COVID-19 pandemic may increase the turnover rate and stress of both pre-service and in-service public health professionals in both hospital and clinics environment. Therefore, based on the lens of the SCCT and the perspectives of the participants of this study, policymakers, school leaders, hospital leaders, human resource planners, public health professionals, and researchers should take this study as the opportunity to reform and polish their current human resources planning.Second, based on the results of the current study with the lens of SCCT, many pre-service nursing professionals may not join the nursing profession after university graduation. Therefore, policymakers, government leaders, hospital leaders, and human resources planners should start to recruit and train additional nursing and public health professionals in order to fill up the gaps for the future missing workforce.


The families of children with congenital heart disease experience significant stress as to the care of the child and needto cope with stress. Accordingly, understanding of how families cope and use coping strategies is more important to helpthem better cope with stressful situations caused by caregiving. This study aimed to explore coping strategies used by families in the face of caregiving stress. This qualitative study was conducted on 40 eligible participants from the families of children with congenital heart disease. They wererecruited through a purposive sampling method from those referred to hospitals in Mashhad, Iran. In-depth and semi-structured interviewswere used for data collection from November 2017 to December 2018. The data were analyzed using conventional content analysis,and MAXQDA software (Ver.2010) was used to manage the data encoding process. According to the results, effort to maintain well-being emerged as the main theme which included five categories:“spirituality in caregiving”, “acceptance and adjustment”, “optimism and hopefulness”, “self-control and patience”, and “ management of psychological needs”. Families used various coping strategies including spirituality, acceptance, optimism, patience, and management of psychologicalneeds based on their beliefs, attitudes, abilities, and available resources for coping with caregiving stress. The results can helpthe nurses and health care professionals to develop appropriate educational, supportive, and psychological interventions basedon the family’s needs to cope effectively with caregiving stress. The birth prevalence rate of this disease in North America, Europe, and Asia is reported at 6.9, 8.2, and 9.3 per 1000 live birth, respectively. 6Accordingly, 25-50% of the parents of children with severe CHD reported clinical symptoms of anxiety or depression. 7Regardless of the type of CHD and the child’s age, families experience significant stress in child caregiving, 6which imposes an emotional, financial and family member burden. Moreover, the presence of a child with CHD in the family may lead other siblings to get stressed. 4Therefore, it might affect the whole family. 8The diagnosis of CHD has considerable psychological effects on the parents. 9Systematic review studies on families of children with CHD reported that the family psychosocial coping varies over time, and a successful adaptation to the child’s illness depends on the cohesiveness of the family and their adaptive coping strategies. 11However, these families are diverse by their needs, experiences, amount of support received and ways of coping. 11Some quantitative and qualitative studies were conducted on the coping strategies of families/parents of children with CHD. The results showed that these families used emotion-focused or problem-focused coping strategies, such as avoidance and denial, spirituality, acceptance, maintenance of family integrity, and psychological stability in dealing with stress. 16Caregiving tasks and responsibilities are stressful for caregivers, and the degree of the impact of stress on the caregivers’ life depends on their coping strategies. 17In general, receiving social support was effective in parental coping. 15Moreover, support could be achieved through religious beliefs, faith and spirituality. 10In a study, the parents of children with CHD used positive coping strategies for dealing with the challenges of their child’s illness; however, they required coping-focused support. 16Moreover, some studies revealed variations in mothers’ and fathers’ coping styles. They used adaptive or maladaptive coping strategies. 18and may be associated positively with their psychological quality of life. 19However, cultural beliefs may influence on the appraising of stress, receiving social support and using coping strategies by caregivers. 20Effective coping strategies may reduce distress and improve the ability to tolerate the burden of the disease for parents without affecting them by psychiatric illnesses, 16to the best of our knowledge, there is still a paucity of qualitative research on how these families cope with caregiving stress. 16Given the prevalence of this disease in Iran, it imposes an emotional and economic burden on the family, health system, and society. Moreover, contexts differ in culture, beliefs, religion, and supportive health care systems, which influence the experiences of families towards stress and coping. 20Therefore, it is essential to have a deep and comprehensive understanding of how family cope and use coping strategies in the face of caregiving stress to help them cope better with stressful situations. In this regard, qualitative studies are needed to gain deep insight into the experiences of the families. This study aimed to explore coping strategies used by families of children with CHD in the face of caregiving stress. Although there are studies about coping in families of children with CHD, 21This study was conducted in Imam Reza and Ghaem hospitals affiliated to Mashhad University of Medical Sciences, and Javad Al-Aeme Cardiovascular Hospital in Mashhad, Iran. Imam Reza Hospital in Mashhad is a center in the northeast of Iran due to having a pediatric congenital heart disease department, so children with CHD from other neighboring cities and provinces are referred for treatment. Participants were families of children with CHD who were selected through purposive sampling with maximum diversity in their educational level and socioeconomic status, as well as child’s age and type of CHD.This qualitative study was conducted based on a conventional content analysis approach for gaining a richer understanding of the phenomenon and direct information from the participants without imposing theoretical perspectives or preconceived categories, which generates knowledge based on their unique perspectives. The inclusion criteria were Persian-speaking Iranian families who were taking care of their child with CHD, willingness to participate in the study, no confirmed mental disorders in participants, the child’ age range between 6 months to 11 years, and diagnosis of the child’s CHD at least 6 months before our study. In-depth and semi-structured interviews were used for data collection from 40 participants, including 27 mothers, 8 fathers, 3 siblings, and 2 grandmothers from November 2017 to December 2018. The interviews were performed individually and recorded by the first author at the appropriate time and a private room in pediatric congenital heart wards in the hospital. “When/how was your child’s heart disease diagnosed?” and moved to specific interview questions, such as “What challenges and stressful situations did/do you face with during taking care of your child?”, “How did/do you cope with these difficult and stressful situations?”, “What did/do you do to overcome these challenges?”, “What did/do you do to get calm and relieved?”. Depending on the participant’s response, some questions were also asked for clarification and getting more information to resolve the ambiguities, such as “Can you explain more in details?”, “What do you mean by..?”.The interview started with warm up questions, such as “What problems and stressful situations did/do you face with because of your sister’s/brother’s disease?”, “How did/do you cope with /deal with/overcome the problem and situation?”. The recorded interviews were transcribed in the shortest possible time, and all the transcripts were imported into MAXQDA software  for analysis. Data collection continued until data saturation and the completion of the codes and categories and no new codes were obtained from the data. Overall, 40 interviews  were conducted which lasted between 30-80 mins. It should be noted that there was not any possibility for in-person interview with a child’s sister due to the long distance of the families’ place of residence; therefore, one telephone interview was conducted with her after interviewing the parents. The telephone interview was performed by the first author in 30 min. In this study, 3 participants (siblings) were in the age range of 11-15 years old, and the interview questions were similar to the above-mentioned questions, but they were modified slightly based on their age and understanding: 22The data were collected and analyzed simultaneously. Each interview transcript was read several times to gain a deep understanding of it.Subsequently, the texts related to the participants’ experiences of coping with caregiving stress and using coping strategies were placedin a text to form the analysis unit. Following that, the meaning units were identified and then condensed meaning units and codes wereextracted. Similar codes were placed in the subcategories and then similar subcategories were placed in the category. Then, the themeformed from the categories according to latent content and underlying meaning. Eventually, 182 codes, 13 subcategories, 5 categoriesand a main theme were obtained from data analysis (Graneheim and Lundman’s (2004) qualitative content analysis method with the conventional approach was used to analyze the data. analysis .23Data credibility was obtained through prolonged engagement with the participants and data, member checking by participants’ feedback to the interview text, and sampling with maximum diversity in education and socioeconomic status of participants and the child’s CHD. Dependability was achieved by an external reviewer doing peer-review, so that the texts of some interviews, along with codes, categories, and emerged themes were reviewed and confirmed by three experts in qualitative research who were not on the research team. The confirmability was achieved by audit trial and the transferability of the results was obtained using full description of the context, the process of sampling participants, as well as data collection and analysis.In order to ensure the trustworthiness and rigor of the qualitative data, we used Lincoln and Guba’s (1985) criteria including credibility, dependability, confirmability, and transferability in this study. This study was approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran (IR.MUMS.REC.1396.256). Written informed consent was obtained from all the participants before the interview, and they were informed about how their confidentiality of the data would be preserved. Moreover, they were assured of the right of withdrawal from the study at any time. It should be noted that for participants aged 11-15 years old, written informed consent was obtained from their parents.This study included 40 participants .This category includes three subcategories namely asking God for help, trusting in God’s will, and relief caused by spirituality; it was indicated that religious and spiritual beliefs deeply affect the families’ life, and these beliefs are more highlighted in stressful situations.1.a. Asking God for HelpAlmost all participants asked God for help in difficult situations of caregiving and vowed for their child’s cure and health. “… I don’t know what to do when I see my child is in trouble. I can not do anything about it, so I ask God for helpin these situations and even make a vow” .1.b. Trusting in God's WillThe majority of the participants stated that their child’s illness was God’s will, and they accepted this God-given destiny. Moreover, they were hopeful for child’s healing by God’s help. “…When my child was getting ready to go into the operating room, I asked God: why don’t you show me your miracle?My husband said: this is a miracle that our child can now walk; we cannot do anything because it is God’s will, and whateverGod does we have to accept” .“… God is great; I comfort myself with these hopeful self-talks. This child is a gift from God; God himself protects my child.If God wishes, my child may live for several years with a single ventricle in the heart, like a person with an eye” . Moreover, some participants believed that in difficult and stressful situations, they should trust in God and ask him for patience:“…When the child is in trouble, we must have trust in God and be strong and faithful to have the power to continue” .“…Sometimes, I can’t take care of my child well; we have to ask God for patience and I believe that God gives the patience to me” .1.c. Relief Caused by SpiritualityThe majority of the participants believed that praying and reciting Holy Quran, especially in stressful situations of caregiving, are relaxing and energetic.“…When my child is in trouble, I have a lot of stress, so I pray; then, my child and I will get so calm. I feel this calmness perfectly” .“…When I am so bored of caregiving, I recite Holy Quran, that makes me feel calm and relaxed and gives me energy to take care of my baby” .One of the coping strategies used by the participants was the acceptance of and adjustment to difficult situations. This category included two subcategories of accepting of the child’s conditions and adjusting to the life conditions which indicate the gradual acceptance and adjustment of participants to the stressful conditions of caregiving.2.a. Accepting of the Child’s ConditionsIt can be assumed that after the denial and anger stages, the participants accepted the reality, the child’s illness, and his/her condition.“…When I found out that my baby had a heart problem, I was very shocked; I could not accept it at all.It was very hard. It took me a long time to cope with this problem. I accepted that I had to raise him with such conditions,and now I have to compromise on my child’s conditions” .2.b. Adjusting to the Life ConditionsSome participants stated that, despite having a sick child in the family, they gradually habituated with the changes and limitations in their lives caused by the child’s illness, and they adjusted themselves to these limitations. “…We have to stay at home in the winter; otherwise, my child will catch a cold. We don’t attendany family reunions and party; it was very hard at first, but then we got used to do it. We entertain ourselves at home by watching TV” .“…I asked my husband to move our house closer to the hospital; then, I could take care of my other son too. However,it was not possible. We must adjust ourselves to our child’s illness and life conditions” .Optimism and hope are other strategies that families used in the face of their problems in life and child’s caregiving. This category included three subcategories, namely optimistic attitudes towards care and life, hopeful about future, and comforting as a source for hope. Having an optimistic attitude reduced the impact of negative thoughts and made the participants hopeful.3.a. Optimistic Attitude Towards Care and LifeOptimism involved having an optimistic attitude toward the improvement of the child and life conditions which is achieved by positive thoughts and emphasizing the positive aspects of life. Some participants were optimistic about their child’s recovery in the future by comparing their child’s condition with other children with even worse conditions.“…I’m not too worried. I feel my child’s condition is better than many other children;my child is going to undergo surgery to get better. I’m praying, so that my baby will be cured and I’m surethat my child will stay alive after surgery” .Some participants considered the positive aspects of their child’s disease and mentioned their positive attitude on life as well as the changes occurred in their life.“…Sometimes, I think that my child’s disease made me and my husband get closer, and he pays moreattention to our life. If it wasn’t for the sake of the child, we were stuck in a routine repetitive relationships with no love” .3.b. Hopeful About the FutureThe child’s gradual recovery and comparison of the child’s condition with other children made the family hopeful about the future and tried to continue the treatment of the child. “…When I see other children with heart disease who are now grown up, I become hopeful and I feel that mychild can be the same, too; I should do whatever I can for my child” .“…Now, I give hope to myself that everything will be OK because my sister is now much better than before” .3.c. Comforting as a Source of HopeThe majority of participants stated the important role of comforting from the spouse, family members, and the physician to make them hopeful and encouraged. “…When I’m tired of caregiving, my husband talks to me more and tries to comfort me by his words; thus, he makes me more hopeful” .“…Once, Doctor A. showed me a child and said: look at that child he had the same disease as your son’s illness,but he’s grown up now, so don’t be upset, God is great and we doctors will help you. Doctor’s words made me hopeful” .This category includes two subcategories, namely trying to be self-controlled in caregiving and being patient in hard conditions of caregiving. Most families tried to be patient and self-controlled to deal with problems caused by caregiving and child’s disease.4.a. Trying to be Self-Controlled in CaregivingSome participants tried to control their behavior in difficult situations of caregiving to keep peace in the family and avoid tension in their family members:“…I get very sensitive when I am tired and nervous about childcare; I try to control myself andnot to beat my children because I will regret later. I don’t want to put my children under tension” .4.b. Being Patient in Hard Conditions of CaregivingThe majority of the participants believed that they should be patient in taking care of their children and tolerate difficult conditions of caregiving.“…Thanks God, I am patient. I believe I have to be patient; sometimes, it may be necessary to stay in hospital forone or two months. I have to tolerate, so that I can take care of my child” .Since these families experience a lot of tension and psychological stress in the caregiving process, they have to manage their psychological needs in order to get calm and satisfy their needs. This category includes three sub-categories, namely seeking support, releasing emotions, and having ability to meet one’s own and family’s psychological needs in the caregiving process which reflect the efforts of families to manage their needs.5.a. Seeking SupportMost participants who were faced with caregiving tension and challenges sought emotional support from the family, physicians, relatives, and friends which would lead to the peace of mind and encouragement.“… My mom supports me a lot. Whenever I’m upset, I call my mom. When I call her, she makes me relaxed and calm by affecting my mood” .“…Dr. A is very emotional; he talks very carefully and calmly. He reassures and supports me emotionally. That’s why I’ve continuedto follow my child’s treatment based on his prescriptions” .5.b. Releasing EmotionsWhen some participants faced with stressful situations in the caregiving process, they used adaptive and maladaptive coping strategies to release their emotions and get relaxed. The most adaptive strategies included keeping oneself busy, spending time out of the house, and taking a shower.“…When my child’s condition gets worse, I get nervous and watch TV to relax, spend time out of home,or read books” .“…When I’m nervous and upset, I don’t let my child feels it because he will get upset and nervous,too. I take a shower or chew gum to get calm” .Some participants used maladaptive coping strategies to release their emotions, such as crying, yelling, and showing aggressive behaviors. “…When I get tired of caregiving, I cry or scream, and shout at my children; in this way, I release myself “ .5.c. Ability to Meet One’s Own and Family Members’ Psychological NeedsSome participants tried to meet their psychological needs using various ways to relax their mind. These strategies included consuming sedative medications, consulting with psychiatrists, and socializing with friends.“…I’m very nervous because of my child’s illness. Sometimes, I take sedative pills that psychiatrist has prescribed.When I get better, I stop taking them” .“…I don’t like to do something when I am confused. I try to refresh my mood by going to the partiesand socializing with friends; it makes me feel good” .Some participants took actions to meet the needs of their other children and pay more attention to them.“…Since I got engaged too much in taking care of my child, I paid less attention to my eldest son, and he got sick.From then on, I try to pay more attention to him, play with him, read bedtime stories, and hug him more” .According to the results of this study, the families of children with CHD used various coping strategies to cope with caregiving stress. These strategies are classified into five categories, namely spirituality in caregiving, acceptance and adjustment to conditions, optimism and hopefulness, self-control and patience, and management of psychological needs. 25The role of spirituality was remarkable in providing emotional support and calmness. 26In a study in Thailand, traditional belief of parents in supernatural or sacred powers was effective to get relief and comfort. 27In a study in Hong Kong, fathers of children with cancer performed religious ceremonies like incense burning and offered gifts to their ancestors after confirming the child’s diagnosis. These ceremonies made them hopeful about their child’s recovery. 28In a study, mothers raised their patience through prayer and attending the religious ceremonies. Applying religious teachings and believing in patience were effective strategies in providing optimal care. 26In a study on Iranian Muslim patients with chronic disease, spirituality meant relationship with God, trust in God, spiritual satisfaction, and strong religious beliefs as believing in God’s mercy and omnipotence. 29The above-mentioned points indicate the importance of spirituality and religious beliefs as coping strategy in the face of caregiving stress in different cultures and religions. Although religious practices and ceremonies are more commonly used in non-western cultures, 30it is important to consider the cultural and religious context of individuals in their ability to cope with stress.In the present study, spirituality played an important role when families faced stressful situations in caregiving. Spiritual beliefs and religious practices were effective in creating relief, calmness and giving energy, patience, as well as hope for the child’s recovery. It can be said that the religious culture of Iranian society has caused spirituality to be seen in their speech, behavior, and beliefs. Moreover, they use it as an important strategy in coping with stress. The results of studies in other cultures also showed that believing in God, God’s will, and His help as well as praying were important factors for coping with stress in parents of children with heart diseases and chronic diseases. 31The results of a study revealed that mothers also accepted the limitations and new conditions over time after experiencing emotional ups and downs. 26In a study, Thai families of children with CHD believed that their child’s heart disease was caused by “Karma” based on their Buddhist beliefs. Therefore, they tried to accept the child’s disease by adjusting their minds for minimizing stress. 27It seems that in different cultures families adjust themselves to their child’s disease by various ways based on their beliefs, so they gradually adjust their lifestyle.Participants in this study needed time to accept their child’s disease and adjust to limitations caused by the child’s illness in their life. In a study, some mothers tended to accept their child’s condition in the process of adaptation to their child’s heart disease. 32In other studies, the families employed optimism and lack of concern for the future as a strategy for coping with the child’s heart disease. 16In a study, some mothers lost hope, and it was hard for them to stay positive in the face of their child’s critical condition, which is inconsistent with our study. 33Optimism about treatment and future led the families to gain hope and create a happy and calm home environment; also, hope played an important role in coping with difficult conditions; 34moreover, the progress in child’s recovery was a positive experience for the family. 24In addition, family members’ sympathy and hopeful sentences had a great effect on the parents. 35These findings highlight the importance of the efforts of the nurses and other health professionals in helping families towards adopting positive thinking and optimistic attitude, and encouraging them to strengthen their hope in the caregiving process.In our study, optimism and hope for the child’s recovery and life were among the coping strategies which were effective in continuation of caregiving and treatment of the child. Optimism can influence physical and psychological well-being by improving adaptive behaviors and a healthy lifestyle. 36In a similar study, mothers attempted to resist hard feelings despite their worries about the future of their child’s disease. 31Moreover, in a study, self-control had a positive effect on mental health which improved the ability to manage behavioral responses to stressful situations. On the other hand, individuals with low self-control tended to use unhealthy coping strategies. 37Culture may influence the perceived difficulty of situations, so it may be effective in coping with the situation. 30In our study, the participants tried to tolerate difficult conditions of caregiving, control themselves, and behave patiently with the child and family members. These actions may result from the sense of commitment and responsibility towards taking care of the child and other family members to maintain a calm atmosphere in the family. Creating a peaceful environment may have positive effects on the physical and psychological health of the family members. In a study, self-restraint was one of the dimensions of commitment to care and was considered as a strategy to cope with caregiving situation which was related to patience and tolerance. 38Since culture can influence the perceived social support, 30sources of support can be various due to diversities in the health systems and available sources in different societies and cultures. According to a study, European Americans seek for social support more frequently than Asians and Asian Americans. 39In a study in Iran, high perceived social support in patients was related to marital status and the importance of religiosity in Iranian Muslim culture. 40It seems that in Iranian culture, support is more provided by family members and relatives, and other sources of social and professional support play fewer roles, which can be due to the lack of awareness and access to these sources. Providing social and professional support may be very important in the families’ ability to meet their needs in child caregiving.In the present study, families sought emotional and social support from their husband/wife, family, physicians, and relatives to get calm and satisfy their psychological needs. In other studies, in addition to the above-mentioned sources of support, the families received support from their peers, online support groups, other sources in the hospital, workplace, and the community. 16which were consistent with our study. Furthermore, in our study, some participants used other coping strategies such as watching TV, reading books, spending time out of home as distracting techniques for releasing emotions. In a study, parents used distracting techniques (i.e. going out for dinner or playing card) to reduce worrying thoughts while their child was staying in cardiac intensive care unit. 33In a study, mothers of children with CHD felt more relieved by releasing emotions when they met other families in the same situation. 8Coping strategies which reduce emotional distress through venting emotions and engagement in distracting activities are referred to as emotion-focused coping. Cultural values are predictors of emotion-focused/avoidant coping which are much more common in non-western cultures. 30Nurses and other health care professionals may help the families by assessing the situations and teaching them adaptive coping strategies. In this study, the participants used different coping strategies in stressful situations of caregiving. Some participants used maladaptive (negative) coping strategies like crying and aggression to release their emotions. In a study, parents of children with CHD used maladaptive coping strategies, such as denying, worrying, crying, and adopting aggressive behavior with medical staff, 16Coping strategies in which people try to solve their challenges by modifying or managing the problem are referred to as problem-oriented coping. 30In a study, some parents experienced feeling isolated and difficulty sleeping in coping with challenges that had led to depression and suicidal thoughts; this is inconsistent with our study. 16However, in our study, parents faced challenges in devoting time and paying attention to themselves and other family members, as well as managing their routine activities. In the present study, the participants used some strategies to manage their family, and their own psychological needs, including the consuming sedative medications, consulting with psychiatrists, paying attention to other family members, and socializing with friends. In similar studies, the families tried to cope with their conditions using different strategies, including trying to increase their own physical and mental health, devoting time to regain their energy, paying attention to their other children, trying to improve their relationships, using proactive problem solving, and being strong and proactive through work. The present study revealed the coping strategies used by families in the face of caregiving stress. These results can help the nurses and health care professionals to design educational, supportive, and psychological interventions, along with coping strategies used by families, for making families’ efforts more effective in coping with caregiving stress and maintaining their well-being. Therefore, it may facilitate the caregiving process.The strength of our study was the exploration of the experiences of all family members including parents, siblings and grandmothers, whereas other studies had focused on mothers’ or parents’ experiences. The limitation of this study was that the results may not be generalized because the participants were in a particular geographical region, and nature of the qualitative research method limits the generalizability. Another limitation could be using a telephone interview with a child’s sister because the participant may not have fully shared her experiences via telephone, and it could be different from the other interviews.The present study showed that the families of children with CHD used a variety of coping strategies including spirituality, acceptance, optimism, patience, and managing psychological needs based on their beliefs, attitudes, abilities, and available resources in the face of caregiving stress. It is important that nurses and other health care providers be aware of it. Accordingly, they can develop appropriate interventions to help the families cope effectively with stressful situations, and the challenges they face in their child caregiving. Moreover, they may provide the families with appropriate educational programs to strengthen the families’ ability and management skills regarding coping with caregiving stress and challenges based on the needs and priorities of families. It is suggested that effective interventions should include implementation of supportive programs, psychological counseling, family-centered empowerment programs, introduction of social support services, and regular interaction with healthcare providers . The effectiveness of the above-mentioned interventions on coping with caregiving stress in the families is recommended to be examined in future studies.


Dingoes are an Australian icon with cultural, as well as ecological, value, yet defining a dingo is complicated by hybridisation with domestic dogs. Northern Australia is a high-risk zone for the arrival of rabies, a disease which affects dogs (including dingoes) and people. In a rabies outbreak, Aboriginal and Torres Strait Islander peoples who live in this region would want dingoes protected. We visited the Northern Peninsula Area (NPA), Queensland, in 2018–2019 and surveyed Aboriginal and Torres Strait Islander residents about how they define dingoes, using pictures from camera traps previously placed and operated in the area. We found that dingo definition was based on characteristics traditionally associated with the iconic dingo  but hybrid features, such as curled tail or a lack of white points, were also acceptable features. Local definitions are important when designing and implementing management plans so that actions are supported by local communities, and our findings are a useful guide for identifying dingoes in the NPA so that, in the event of a rabies outbreak, locally valued dingoes could be identified and protected.Dingo classification and management is complicated by hybridisation with domestic dogs. Northern Australia is a relatively high-risk zone for a rabies incursion, and in the event of an incursion, Aboriginal and Torres Strait Islander peoples who reside in this region would prioritise the protection of dingoes. Therefore, the classification of dingoes in this context is important. Twelve pictures of canids with features associated with both dingoes and domestic dogs from camera traps in the Northern Peninsula Area (NPA), northern Queensland, were shown to Aboriginal and Torres Strait Islander rangers (n = 3), biosecurity officers (n = 2), environmental health workers (n = 2), and residents (n = 39) in the NPA. Nearly all pictures (10/12) were classified as dingo or domestic dog (none as hybrid) and two were inconclusive . Dingoes were consistently identified as medium to large-framed dogs, with a long nose, pointed ears, narrow abdomen, a bushy or feathered tail, and smooth coats of a single base colour. Some hybrid features were acceptable, including sable coats, lack of white tail tip or feet, and curled tail. These findings are a preliminary guide for identifying canids in the NPA region for whom management might be controversial. Building on this approach via further consultation with residents is needed to inform rabies response policy. Our approach using locally acquired camera trap pictures could also be extended to other regions in which dingoes have value but their management is controversial. Understanding how people classify wild animals is an essential first step in determining the values which people assign to a wild animal, and is critical to planning and implementing conservation or management strategies . DecisioCanis dingo, C. lupus dingo, and C. familiaris due to disagreements over their taxonomy and relationship with domestic dogs (C. familiaris), with whom they can interbreed [Management of the dingo in Australia is an example in which scientific classification causes controversy. Dingoes are variously referred to as terbreed ,3,4. Disterbreed ,6. In thterbreed ; consequterbreed . Howeverterbreed . As suchNorthern Australia is considered a high-risk zone for a canine rabies incursion due to its abundant domestic dog populations in remote communities, dingo populations, its proximity to rabies-endemic Southeast Asia, and the recent spread of rabies in Indonesia ,11,12. AIn remote Indigenous communities in Northern Australia, most domestic dogs roam freely ,16 and, In this study, we explored how dingoes are defined by residents in remote Australian Indigenous communities in Northern Australia for the purposes of management to reduce disease risk, focusing on the Northern Peninsula Area (NPA) of Queensland. We specifically aimed to provide a preliminary characterisation of NPA residents’ definition of a dingo to inform Australian rabies incursion policy. We acknowledge parallels between the imposition of such classificatory systems and colonial practices of Indigenous assimilation ,24. HoweThree visits were made to the study region in 2018 and 2019. The study methods were approved by the Human Research Ethics Committee at the University of Sydney (Project No: 2018/451) and all methods were carried out in accordance with relevant guidelines and regulations.The Northern Peninsula Area is a local government area in northwestern Cape York, Queensland . It covehttp://www.reconyx.com.au/, accessed 22 February 2019) at sites within 5 km of NPA communities between May 2017 and May 2018  had existing relationships with relevant stakeholder groups in the study region ), developed over the previous 6 years through research focused on preparedness for a rabies incursion ,30,31,32May 2018 . This prResearchers developed a face-to-face questionnaire informed by discussions with the stakeholder group members , in whicParticipants from stakeholder groups included Land and Sea Rangers (n = 3), biosecurity officers (n = 2), and EHWs (n = 2). All were residents who were Aboriginal or Torres Strait Islander people, male, and between 18–60 years old.Picture 8 was the most readily categorised as a dingo by all stakeholder group participants, due to its tan-coloured coat, face shape, pointed ears, white feet and nose, and bushy tail, and was described as the archetype dingo totem associated with some NPA clans. Pictures 3, 5, and 9 were also unequivocally categorised as dingoes. Group members recognised the animal in Picture 3, with several commenting, “this one’s famous round here”. They stated that they see two or three dingoes with similar curly tails in the local area, and that curly-tailed dingoes live throughout the northern Cape York Peninsula and down the west coast. They thought that this feature was the result of breeding between wild dingoes and one or more domestic dogs in the 1990s. In contrast, group members stated that dingoes around Ussher Point  have tails “almost as straight as a normal dog”. The grey colouration of the dingo in Picture 5 was reportedly due to age—participants stated that the coat would have been tan when the dingo was younger. The red colouration of the animal in Picture 9 was also considered typical of dingoes in the NPA. Head, body, and tail shape were considered the typical defining features of the dingoes in Pictures 3, 5, 8 and 9.Stakeholder group members used behaviour and apparent gait (as far as can be assessed in a still image) to categorise dingoes when phenotype was equivocal. Some said Picture 2 was a domestic dog due to its colour (black and tan) but when told that this dog was seen in the company of dingoes, they decided that he was most likely a hybrid but would be classified as a dingo in the NPA. Black-coated dingoes were considered relatively new in the region. Most group members were adamant that Picture 7 was a domestic dog but some were uncertain due to the way in which it appeared to be moving . Location did not appear to be useful when classifying dingoes because both dingoes and unaccompanied (free-roaming) domestic dogs are seen in the bush.Even though contextual features were removed from the pictures, some of the stakeholders drew on their knowledge of the local dingo and dog populations in explaining how to categorize some of the canids in the sample. For example, rangers told us that dingoes are “getting pretty brave” because they are seen more frequently along the roads around the communities than they were 2–3 years ago. They attribute this to an increase in waste food thrown from cars by residents. They also see dingoes feeding on turtle carcasses at the local refuse site, as well as horse carcasses or even foals whilst a mare is foaling. Despite this perceived increase in the frequency of dingo activity around communities, rangers also stated that dingoes are scared of domestic dogs, and all groups agreed that a dingo and a domestic dog are unlikely to be seen together.All other pictures  were unequivocally categorised as domestic dogs due to floppy ears, patchy coat colour, or domestic breed appearance .A total of 39 residents participated in, and completed, the questionnaire survey. All age groups were represented and more male (73%) than female residents were surveyed . Particip < 0.01, Overall agreement about picture classification between community residents was high  and the 95% CI of the proportion of residents who selected “dingo” did not overlap the 95% CIs of the proportions of those who selected “hybrid” or “domestic dog”, Some pictures were unequivocally (Picture 3) or predominantly  classified as “dingo” by residents (Fleiss’ κ = 0.74 (p < 0.001) and the 95% CI of the proportion of residents who selected “domestic dog” did not overlap the 95% CIs of the proportions of those who selected “hybrid” or “dingo”; Some pictures were unequivocally  or predominantly  classified as “domestic dog” by residents , both dogs had bi-colour coats which are seen in the “Kelpie” breed of domestic dog.Unlike the participants from the stakeholder groups, residents did not mention gait or behaviour when classifying dingoes and did not comment on the presence of the additional dog in Picture 6b. Instead, throughout all the pictures, they used ears, face, head, body, and tail shapes and coat colours to justify their choices.Throughout all pictures, participants’ proportions of classifications as “dingo”, “hybrid”, and “domestic dog” were 0.42, 0.13, and 0.45, respectively.There are varied examples of how people in different Indigenous communities sometimes distinguish types of dogs, for example, as dingoes and domestic dogs, or “camp dogs” and “wild dogs” , yetIt was apparent that respondents could base their definition of what a dingo is on phenotype and that this was generally sufficient to reach a majority opinion. Whilst we included one picture of a dog (Picture 8) in this survey that had the phenotypic characteristics that could be associated with a “pure” dingo ,34, and Whilst this phenotypic approach to dingo classification in the NPA allowed for acceptance of some features of hybridisation, not all animals with the constant shape and size features associated with dingoes in this study were classified as dingoes. In these cases, other features associated with hybridization—including patchy coat colour, thin tail, and floppy ears—were present, and participants classified these as domestic dogs. Only two animals were inconclusively classified by residents, and disagreement appeared to be due to a coat colour that participants associated with a domestic breed (Kelpie) even though the body shape was compatible with a dingo. In this study, we did not investigate how the classification of dingoes changes with time and place, although discussion with stakeholder group members about the black and tan dog, as well as the dingo with the curly tail (with an accepted history of breeding with a domestic dog), suggested that that dingo status in the NPA is a fluid construct with acknowledged regional variation. Sightings of dingoes with black coats had only occurred recently in the NPA, and curly-tailed dingoes had appeared within living memory. Various coat colours, including black, have been documented historically in other parts of Australia , and alsResidents rarely classified dogs in the pictures as hybrids and no dogs were majority classified as hybrids by residents. This might reflect the pictures selected for inclusion in the study, or it could reflect a reluctance of residents to use this term. The concept of hybridisation and its application in defining identity can be controversial beyond the sensitivities around managing an animal that has cultural value for these communities ,38. ArguManaging interactions between scientific and Indigenous knowledge systems and understanding how dingoes are defined by local residents would be important during a rabies response in Northern Australia . An effeThe results of this study focus on a pragmatic approach to classifying dingoes from the perspective of local residents so that dingoes can be identified and managed in a way that supports residents’ socio-cultural values during a biosecurity response to rabies in northern Queensland. In this way, local knowledge systems can be understood, which might otherwise be difficult to access. Indigenous residents in northern Queensland demonstrated agreement in their classification of dingoes and, although this is specific to this region, our approach could be used in other regions to expand understanding of how different communities classify dingoes. The results are preliminary and we note that community consultation is essential to build on these results. Decisions that could have social and cultural impacts require community consultation, otherwise trust in management authorities is eroded.


According to students’ background and setting, we decided to implement three broad and interrelated strategies to enact the intervention built on the TGfU pedagogical features. Data were collected through Game Performance Assessment Instrument, knowledge questionnaire, enjoyment, perceived competence and intention to be physically active scales and semi-structured interviews. Quantitatively, Friedman’s χ2 was used to explore differences in the variables and Wilcoxon’s Z post-hoc comparisons were performed to determine: (a) first–second and first–third assessment differences; and (b) second–third assessment differences. Qualitatively, data were open and axial coded line-by-line and incident-to-incident in sub-themes. The quantitative results show no significant differences between the two periods (p > 0.05). However, there were improvements after both periods compared with the first assessment (p < 0.05). The qualitative information supported that the pedagogical strategies implemented could be key to explain the similarities between the two practice volumes. In conclusion, the amount of practice should not be considered as the only variable in the design of interventions with TGfU.The purpose of the present work was to explore whether fourth-grade physical education students improved their game performance, knowledge and psychosocial variables with Teaching Games for Understanding (TGfU) to a greater extent after an eight-lesson period in comparison to a 14-lesson period. The study followed a mixed-methods approach in which the design consisted of a first assessment, a second assessment after Lesson 9 (eight-lesson period) and a third assessment after Lesson 16 (14-lesson period). A TGfU floorball intervention was carried out between assessments. The participants ( Traditionally, physical education classes are characterised by short instructional units, mainly because of the multi-activity model, which remains the dominant approach in elementary education . The numTGfU was designed as a resistance to participants’ perceived dissatisfaction with the technique-based lessons . This kian intervention volume of greater than eight hours appears to be a common cut point for greater positive support for the use of a game centered approach in the development of decision making and skill execution variables”.TGfU has been highlighted as an example of constructivist approaches to learning . AccordiAfter making a review of TGfU articles written in English, from double-blind and peer-review journals and published until July 2019, there were 16 studies that enacted a TGfU instructional unit in school setting. Intervention exposure was between 4 and 32 lessons with a duration of approximately 1 h. Considering only the investigations with a short unit, the interventions had a positive association with 71.43% of tested game performance-related variables, 75% of knowledge variables and 90.91% of psychological variables ,13,14,15Given the relevance of the environment in the process of teaching–learning, it is necessary not only to focus on intervention volume as a key variable, but on the relationship among a multitude of interacting variables in such social situation . In otheIn summary, the scarce differences in effectiveness between high-low volume interventions and the multifaceted interaction among teaching–learning variables would support the use of short TGfU units, since the predominance of such instructional interventions in most physical education programmes. The purpose of this work was to explore whether fourth-grade physical education students improved their game performance, knowledge and psychosocial variables with TGfU to a greater extent after an eight-lesson period in comparison to a 14-lesson period, while playing floorball. The hypothesis was that there would be no differences between the 8- and 14-lesson periods in game performance, knowledge and psychosocial variables. The possible no differences between unit lengths were explored through the participants’ perceptions in order to go further trying to understand the quantitative results.The study followed a mixed-methods approach in which the design consisted of a first assessment, a second assessment after Lesson 9 (eight-lesson period) and a third assessment after Lesson 16  were in their fourth year of elementary education. They were distributed into two classes, consisting of 13 boys and 27 girls in total. The socioeconomic status of the students attending the school was low-to-moderate. All participants took part in all the floorball lessons. However, none of the students had either played team games or had any previous knowledge or practical experience with the TGfU approach. The previous sport experiences of three students were limited to recreational swimming programmes. All the students, the parents and the teacher were informed of the protocol and blinded to the study aim. The parents and the teacher signed an informed consent form before the investigation and the students agreed to participate. The main author’s University Research Ethics Committee approved the study, which was performed in accordance with the Helsinki Declaration.The children  warm-up; (b) skill practice; and (c) game.In the country of the study, TGfU is not part of the physical education and teacher education curriculum. The regular physical education teacher had no experience of TGfU. Consequently, another teacher, who was familiar with and had practised TGfU, implemented the lessons. This teacher was 30 years old. He had five years of physical education teaching experience in different schools, in two of which he had taught using TGfU.According to students’ background and setting, we decided to implement three broad and interrelated strategies built on TGfU pedagogical features : (1) aliTo improve the teacher’s knowledge of TGfU, he was asked to attend a 30-h instruction carried out by the authors, 3 h per week for 10 weeks, following six procedures. First, we explained the pedagogical features of TGfU highlighted in this intervention . Second,Three blinded TGfU experts were asked to determine, quantitatively  and qualitatively, whether the lessons were designed in accordance with the three TGfU pedagogical features . The TGfThe teacher conducted the intervention following the same pedagogical features, aims, contents and remaining lesson characteristics described . The iniWe used two procedures to verify that the teacher applied the lessons following the three TGfU pedagogical features. First, a TGfU expert researcher, blinded to the study aim, observed the footages of the lessons on the pedagogical features. Second, we repeated the same procedure as with the expert but using in vivo observation. Both the TGfU expert and we confirmed that the teacher achieved all the features in all the lessons.Each student was recorded for 10 min in the Lessons 1, 10 and 17, playing a game of 4 versus 4 on a 28 m × 15 m rink area. We used the game performance assessment instrument  to asseThe students completed the three following questionnaires individually and anonymously in Lessons 1, 10 and 17. The second author explained that they were not tests and that the students should complete them in the teacher’s absence.n = 3), cover (n = 3), support (n = 3) and skill execution (n = 3), with four response options  stand still, (b) run toward the opponents’ goal, (c) run toward my goal, or (d) wait to receive a pass”). The students required about 25 min to complete the questionnaire in writing.Knowledge: We designed an ad-hoc questionnaire from the contents addressed in the lessons and in collaboration with the teacher, following the proposal of French and Thomas . The queEnjoyment and perceived competence: Students completed the enjoyment and perceived competence scale . This inIntention to be physically active: Students completed the intention to be physically active scale . This inThe students and the teacher were interviewed twice during this study, at the end of the 8- and 14-lesson periods. Although all the interviews addressed the same topics, the focus of the questions and the language differed depending on the interviewee (students or teacher). Specifically, we organised the two focus groups of the two assessments with the students to explore their perceptions (20 participants each). The first and last authors claimed that all the students participated by means of promoting their involvement. The teacher was interviewed individually after the students’ interviews. The students’ interviews lasted approximately 60 min, and 20 min in the case of the teacher. Data were collected using a digital audio-recorder. The interview questions targeted the students and the teacher’s perceptions of the preceding lesson to identify students’ possible improvements and examine their views after each intervention period in depth. The focus groups began with pre-established questions about game performance, knowledge and psychosocial variables . Subsequently, the moderator began a group discussion, using questions to explore the meanings of the statements in greater depth.2 was used to explore significant differences in the variables. Subsequently, Wilcoxon’s Z post-hoc comparisons were performed to determine: (a) possible significant first–second and first–third assessment differences (intra-period differences); and (b) possible significant second–third assessment differences (inter-period differences). The alpha level was set at p < 0.05. In addition, we calculated the effect sizes using the partial Cohen’s w. Given the number of students and a medium w , we only improved it, but where we really learned it was in the [8-lesson period]”;“The improvement was greater in the [14-lesson period], although in the [8-lesson period], the impact was greater because they went from nothing to everything, but they learned more with the [14-lesson period]”.The students believed that the learning progression increased their ability to understand game situations. They granted considerable importance to the content of the lessons were related so that what they practised in one lesson served them for the following one: “The classes of [the teacher] are related to each other, because first, he teaches us how to score and then what to do to be able to score”“It’s all related. It was all together, if one day you learned something, the next day you practised it”“You can see the effort we made when planning the relationship between contents, they have learned logically”“I would prefer to use [TGfU] because it is more logical and goes lesson-by-lesson, relating contents to learn to play”.Consequently, the students showed that the alignment of the structure of the lesson allowed them to learn because, initially, the teacher explained the tasks, they practised “game form”; then, they answered questions, practised “drills-for-skill development” and “returned to game form”; and, finally, they learned how to be skilful in the game. Indeed, they learned “why” before “how”, so that they transferred skills within lessons: “[The teacher] does not tell us when we have to lose the mark, we do it and then he asks us”“[The teacher] explained the tasks to us, but he didn’t say what to do during the game, and we learned through the questions. Besides, it’s all related”.Along the same lines, the teacher mentioned:“With the questions at the end you reinforce and anchor what you are working on”.“The most decisive thing is to bring the contents closer to the real situation of the game and the questions, so they understood what they have done”.Furthermore, the students acknowledged that the rules helped them understand what they had to do in the game:“I have to intercept because that gives us 2 points and that’s why I know it’s important”.“In the lesson of defence of the pass, if we intercepted a pass, we summed 2 points, and that’s why we did it”.The participants shared the importance of performing tasks at an appropriate level of difficulty, focusing on a single goal per lesson. The structure of the lesson allowed them to learn little by little: “[The teacher] goes little by little, because we play, he asks us, we play again and he asks us until we understand it”.“He was going slowly so we could understand it better. When we were in the circle, he would ask us questions and then we would play to improve”.“Because all the tasks of each lesson were designed to learn the same thing, they gradually learned logically”“All the time spent on planning the lessons was worth it so that they would then gradually learn logically”.In particular, the students acknowledged that the rules were helpful, making it easier for them to meet the challenge in each task, which was related to the importance of the content. They had to pay attention and engage during the task presentations: “As each player has to cover one, it is easier and, at first, we understand why it is important”.“It was very important to shoot from the centre, that’s why the defenders couldn’t get into our area so it would be a little easier”.In addition, the students commented that, in “teaching for understanding” and “review and closure”, the teacher posed questions that were easy to understand and asked them in different ways until everyone understood the reflection. The use of meaningful examples aided students to remember the key learning behaviours: “When we are in the circle and we do not understand, he helps us with examples. For example, the crab”.“For example, every day, he asks one thing and it becomes clear. If someone didn’t understand, he asked it differently”.The teacher indicated that this was one of the most complex aspects to carry out because it was essential for all the students to understand what he intended to teach before moving on to the next lesson: “As we knew that they had no previous experience, the questions had to be very simple. This is one of the most difficult parts”.“The part of the questions is complex, you have to adapt them on the go and change them, first you have to know the children and be clear about what you want to teach”.Finally, the contents provided them with an achievable challenge, that is, neither very easy nor very difficult, but demanding effort. They valued the importance of thinking rather than other proficiencies: “Before, we always repeated things and we got bored and now with [the teacher], we learn a different thing every day, we have to think and later this helps us to play”.“As we practised a lot, it was easy in the end”.The teacher’s comments were consistent with the students’ comments, although he acknowledged that the assessment games were more complex than the lesson games: “As the level of difficulty was adapted to the students’ level, with 8 lessons, they learned many things, but in the evaluation, I could not observe those improvements”.“Although they have had to think about the game, the tasks were at their level because everyone understood them. However, the evaluation was more difficult because there were not so many rules”.However, five students and the teacher acknowledged that, during the 14-lesson period, the students were bored because they had been playing the same game for nine weeks: “I get a little bored always playing the same game”.“Overall they have enjoyed themselves because they have been improving and playing more, but many of them have gotten very tired and bored”.Both the students and the teacher stated that the lessons allowed them to establish relationships with the teammates, showing that learning is not only an individual action but is also influenced by collective experiences. They performed more complex interactions because they involved meanings, expectations and emotions (relationships as members of teams): “We now know how to play as a team, lose and win, and not get angry if we lose. We all play together and we play as a team”.“If you know to dribble, but your team doesn’t know to take the ball, it’s clear that you’re going to lose, so you have to help them to learn it”.“I think the tasks made them think. They planned among themselves what to do”.“They have improved mostly in decision-making because they talked a lot to each other, telling the teammates where to place themselves. More in attack than in defence”.These comments suggested that the students assumed that playing floorball includes the presence of others.They also agreed in highlighting the positive relationships established with the new teacher, his personality, predisposition, concern and attention as well as his pedagogical practices: “He teaches us to pay more attention to him and to the rest of the teachers to be a good class and not to complain about us”.“We would like to continue practising because [the teacher] has made us like the game more. He was always willing to help us”.The teacher was surprised at the positive effect of his relationship with the students: “Outside of the school, a father told me that his son was having a great time. Every time his son came home from physical education, he would tell him what he was doing and that it was because of me”.“I think my relationship with them was important to make them more autonomous and to like physical education”.The structure of lesson and the game, in particular, were other key elements, apart from social relationships, to help their engagement and favour their perceived competence, enjoyment and intention to be physically active. “There are games, and we learn within the game, in the same game, every day we play and learn more things”.“We would like to continue receiving the classes the same way as [the teacher] uses because there are many games. We will miss this way of teaching”.The teacher also highlighted the game’s potential to foster such attitudes: “I was told they had fun because they were always playing”.“They want to keep practising; what has influenced the most is the [TGfU], the game is indifferent, the model in which everyone can play is what makes them want to continue practising”.Finally, unlike the teacher, only the students expressed the novelty of practising a new game  unknown to them: “We want to continue practising because it is a game that we have never played”.“I’d like to keep practising because it was a new game”.The purpose of this work was to explore whether fourth-grade physical education students improved their game performance, knowledge and psychosocial variables with TGfU to a greater extent after an eight-lesson period in comparison to 14-lesson period, while playing floorball. The results confirm the hypothesis, as there were no differences between the two periods. Specially, our findings, in both 8- and 14-lesson periods, were consistent with previous studies that also found improvements in short and long interventions e.g., ,6,17,19),17,196,1As in previous aligned TGfU interventions, this study also showed significant improvements in both the 8- and 14-lesson periods ,32. In cIn relation to rule constraints, the teacher acknowledged that the games in the assessment interventions were more complex than those of the lessons, as in the former there were no constraints. That lack of restrictions could reduce the students’ ability to make decisions . This waWith regard to the psychosocial variables, this work also showed significant improvements in both the 8- and 14-lesson periods in enjoyment, perceived competence and intention to be physically active as in prior studies ,12,20,22To sum up, the interrelated nature of the overlapping elements among the variables that influenced the teaching–learning process  provides further evidence that the social environment is a key aspect in such process. This context permeated what and how students learn . The greAccording to the quantitative and qualitative results, the amount of practice should not be considered as the only variable in the design of interventions with TGfU. The qualitative results supported that the pedagogical strategies implemented could be key to explain the similarities between the two practice volumes. Considering that the educational curriculum requires short-term interventions, we recommend paying special attention to the interaction between the alignment of contents progression and lesson structure, the implementation of achievable challenging tasks and the promotion of social relationships according to students’ background. In other words, TGfU interventions should not separate the length of the unit from the TGfU pedagogical features . Those v