In the process of life course transitions, relations between the self and the world transform, which can according to Hartmut Rosa be framed as resonance. This article focuses on the retirement transition and thus on the exit from gainful employment as one of the central spheres of our world relationship in late modernity. It raises the following questions: How do experiences of resonance change in the course of the retirement transition? Does the loss of gainful employment lead to disruptions or even the absence of resonance in terms of alienation? And which role do dimensions of social inequality, such as gender, income, education or mental health status play for resonance transformations in the transition to retirement? In terms of a reflexive mixed-methods design, this article combines quantitative panel data from the German Ageing Survey (2008–17) with a qualitative longitudinal study from the project “Doing Retiring” (2017–21). Our results show that the transition from work to retirement entails a specific “resonance choreography” that comprises a phase of disaffection (lack of resonance) at the end of one’s working life followed by a liminal phase in which people search for intensified experiences of resonance. We outline practices in which transitioning subjects seek out resonance, and the experiences they make within this process according to their social positions. We thereby find that the desire for resonance tends to be beyond intentional resonance management which manifests in products and services like coaching or wellness. In our conclusions, we discuss how resonance theory and retirement research/life course research can be fruitfully combined, but also highlight the methodological challenges the operationalization of resonance entails. Retiring remains one of the major transitions within an individuals’ life course, and one that entails a variety of changes for the transiting individual: Income and occupational prestige may decrease, but so does work-related stress; similarly, work-related social networks may loosen, but private networks can be strengthened, and time is freed up for formerly neglected or new tasks and activities. The retirement transition is thus likely to initiate transformations of one’s relationships to the social world.resonance (Resonanz) and alienation (Entfremdung). As a counter-term to alienation and a muted-unconnected interaction between world and subject, Rosa defines resonance as a self-effective, uncontrollable mode of relation to the social, material, and transcendent world: I allow myself to be touched and moved , I respond with my own voice , and within this process both I and the other one transform adaptively .In his “Sociology of Our Relationship to the World” (2019), Hartmut Rosa characterizes these relations on a continuum between Theoretically linking Rosa’s conception of resonance to the transition into retirement, we ask: Does the transition to retirement appear as a resonance-sensitive and -evoking life event? Does the parting from employment as one of the axes of resonance in modernity lead to the absence of resonance in terms of alienation? What potentials does this theory offer for retirement research in particular, aging research in general and vice versa? We firstly approach these questions theoretically by outlining the concept of resonance as well as linking it to notions of transitions and the life course. Secondly, we generate empirical research questions from our theoretical considerations, among others: Do specific resonance trajectories or “melodies” emerge across a transition process? How do chrononorms shape experiences of resonance in the transition process to retirement? Do experiences of resonance in the retirement transition vary based on social position? Following a mixed-method design, data from the German Ageing Survey  are circularly contrasted with in-depth findings from three qualitative case studies from the longitudinal project “Doing Retiring” . Finally, we perform a critical discussion of our empirical results in order to emphasize possible heuristic linkages between the study of retirement transitions and Rosa’s concept of resonance.In his book “Resonance. A Sociology of Our Relationship to the World” (2019) Rosa aims to develop a “sociology of the good life”, for which he states that “the quality of a human life  cannot be measured simply according to available options and resources (…) Whether a life is successful or unsuccessful depends on the ways in which world is or can be passively experienced and actively appropriated or adapted” . He therefor goes beyond subjective theories of social identity, but rather places the relation of subject and world in the center, which is moderated by sociocultural conditions. At the same time, self-efficacy and empathy are crucial for individual perspectives on the world .Beschleunigung), e.g., of the pace of life . In addition, Rosa criticizes the hegemonic idea of modernity, namely the striving to expand the share of the world in terms of material goods, new technologies or life events , Rosa sketches resonance as an essential component of human beings. As alienation as a concept seems to be well described in former social theory, he now aims to establish “resonance as a normative and descriptive metacriterion of successful life”  between subject and the world, a momentary, processual emotional and affective experience of being overwhelmed, touched and transformed (affecting (“I let myself be touched by the Other”), emotion and self-efficacy (“We both actively respond with our own voices”), mutual transformation (“I and the Other are now no longer the same as before”) and unavailability or “accommodating” uncontrollability   , 64.Rosa conceptualizes resonance and alienation as co-constitutive: “resonance is only possible against the backdrop of a mute and unfamiliar Other, while, conversely, what is yet mute can only be affected or adaptively transformed on the basis of a prior or deep-seated, dispositional faith in resonance that feeds one’s hopes and expectations of being able to make some segment of world speak” , 190. WiWeltanverwandlung) and the escalation principle of expanding reach or mastery of the world (Weltaneignung).Rosa’s idea of resonance goes beyond prominent sociological approaches focusing on subject-subject-interactions such as recognition  or colleEntfremdungszonen) for the less privileged, as they are less likely to establish vertical axes of resonance  . Additionally, Rosa frames resonance responsivity to be a mostly “female” phenomenon, since in Western culture the traits, that go along with it, like empathy, emotionality, or sensitivity, are associated with being “female.” But given that those cultures are being dominated by rationality and instrumentalization – mostly “male” traits – Rosa emphasizes, that resonance responsivity is being devalued, as are “female” traits (ibid.).For Rosa, capacity or responsivity for resonance are basic human needs, which are however stimulated or dampened within existing social and cultural contexts . For exaDespite a basic critical position toward escalation principles of capitalism Rosa does not describe his “sociology of the good life” as a political program but rather a “compass in contemporary political debates” , 458. HeIn light of this critique, the question arises as to how the descriptive-normative concept of resonance can be brought together with life course research and gerontological theories regarding retirement. In the following section, these approximations of the resonance concept to retirement research will be explored in more detail.processual relation mode, which can be linked to concepts of transitions and taking pathways in the life course. As moments of uncertainty, transitions may enhance resonance but may also lead to anxiety for the passengers, when leaving the labor force entirely. According to porous to experiences of resonance, such as childhood or puberty. Thus, also transitions in older age – like the transition into retirement – bear potential for experiences of resonance but also repulsive or hostile confrontation. The dialectical architecture of the subject-world-relationship in terms of alienation and resonance can be linked to the traditional approach of push and pull factors for retirement decision making. In addition, Rosa describes the sociocultural embeddedness of subject-world-relationships whereas retirement research often underlines social policy frameworks and normative implications for “adequate” timings of retirement. Socioeconomic aspects, like education, and mental health factors like self-efficacy in the resonance theory, are shaping the preconditions and resources of retirees before, during and after retirement. To explore possible fruitful connections between resonance theory and retirement research, we are focusing on the following dimensions:processual nature of the retirement transition, which comprises a specific porosity and uncertainty about retirement as source of alienation or resonance- resonance and the normativity in the retirement transition process- resonance and social inequality in the retirement transition process- resonance and the implications of Although Anthropological transition research has long been concerned with how transitions are being structured as processes of status change. Arnold van Whereas such anthropological models claim to comprise all kinds of transitions equally, specific phase models have been developed to grasp the specificities of the retirement transition. A prominent example is The first phase of “pre-retirement” starts about 3 years before the retirement with still vague ideas about exit the labor force. In this phase, the future time after retirement is perceived positively as a “remote phase”. The “honeymoon phase” starts immediately after one stops working and comprises the first weeks in retirement. Depending on individual health and life situation, retirees enjoy the free time and relief from workload. In the “disenchantment phase”, however, a short period of disillusion follows and first doubts arise about the legitimacy of retirement in everyday life. Depending on their resources, persons may become vulnerable for mental health impairments . Individuals then enter the next “phase of reorientation”, where retirees start to cope with the situation. According to Atchley, the fourth phase can last a relatively long time, depending on individual options and resources. A successful passing of the fourth phase leads over to the “phase of stability”. Here individuals are heading into the longest and most endurable period of retirement. They are aware of their opportunities and limitations in retirement and develop adequate routines and activities, which provide them enjoyment and self-affirmation. In the last “phase of termination” their health decreases significantly and their need of help and care increases. As a result, the role as retirees recedes in the background and daily routines are primally linked to impaired health status and frailty.Obviously, Atchley’s phase model assumes a typical male working biography characterized by transitioning from traditional fulltime employment into retirement. However, in combination the models of van Gennep, Turner and Atchley point to retirement being a dynamic, ambiguous process framed by personal resources, which may entail resonance transformations. This transition requires awareness, reflexivity, evaluation and developing strategies to cope with new roles in order to obviate mental health concerns and social exclusion.If we now combine this process ontology of retirement transitions with the theory of resonance, we can ask: How do experiences of resonance and alienation change during the process of transiting to retirement? Do specific resonance trajectories or “melodies” emerge empirically across a transition process?transitional regimes. They are based on an underlying normative time structure that orchestrates the life course in respective regimes. With Elizabeth chrononormativity, which describes in particular (but not exclusively) perceptions about the “right” time for specific life stages and life course transitions, such as going to school, starting a family, or retiring. These perceptions manifest and stabilize themselves in legal regulations and executive organizations, such as the age-determined school system, the legal right to marry at a certain age, or the statutory retirement age. Identifying one’s own position in this life course allows to ascribe biographical meaning to (life) events, to position oneself, and to construct identities. Despite an increasing de-standardization, such prepositions of an “adequate timing” in the life course hardly lose their individual and societal significance production of social inequalities in retirement transitions with the theory of resonance, we can ask: Do experiences of resonance in the retirement transition vary based on social position, and (how) does this experience contribute to the (re-)production of social inequalities?In order to empirically discuss the issues raised above, we use a mixed-methods research design (MMR) and can thereby consider both qualitative and quantitative data. Unlike classical data triangulation, which aims at describing phenomena with data – as diverse as possible – to validate results and minimize measurement errors , our appn = 632) and from a phase of non-employment (n = 497) as well as transitions from active or non-employment to a reduced-earning-capacity pension (n = 111).Quantitatively, we evaluate four waves (2008–17) of the nationwide representative German Ageing Survey (hereafter: DEAS), which evaluates the life situation of people in the second half of life (40+). Of all respondents who participated in at least two waves, 1.240 experience the transition into retirement during the observation period. In order to reflect the different facets of the transition, the analysis distinguishes between transitions to retirement from active employment . The study follows 30 individuals between the employment and retirement over 3 years with episodic interviews according to For this paper, changes in resonance relations during the transition into retirement are highlighted on the basis of three non-linear but distinct transition processes that deviate from the chrononorms of institutionalized life courses: one transition from full-time employment to unemployment to reduced-earning-capacity pension, one transition from full-time employment to indefinite leave of absence, and one transition from long-term unemployment to reduced-earning-capacity pension. These three trajectories were chosen to highlight the complexities, nonlinearities, and fractures of transition processes that cannot be mapped in such depth from quantitative data. Moreover, transitions that deviate from norms, which could be discursively framed as “failed”, are particularly suited to better understand those very norms and normalities.1. Richard,2. Mia, born in 1955, is married with no children and lives with her husband in a large city in Western Germany. She has a degree and holds a management position in a large, international organization. At the time of the first interview, she has been on leave of absence for about 5 years due to burnout.3. Jan, born in 1965, is married with no children and lives in a small town in Western Germany with his wife. He has had a frail employment history and most recently worked as part of the security staff at a hospital. At the time of the first interview, he has been unemployed for more than 5 years, works in job creation measures, and also receives a reduced-earning-capacity pension due to mental illness, including severe depression.The three case studies can be summarized as follows:The transition into old-age pension is being understood to be a normative transition into retirement. It can nevertheless make a difference if one retires from the status of being actively employed or non-employed. On average, these two groups show similar levels of resonance  and dissonance  prior to the transition to the retirement. However, individuals undergoing the transition from active employment to retirement show a lower average alienation (5.64) experience than individuals making the transition from non-employment (6.21).For individuals who complete the transition into old-age pension from active employment during the observation period, resonant experiences become more frequent and dissonant as well as alienating experiences decrease significantly see . With reRegarding differences between groups, we find, that old-age pensioners do experience less resonance and dissonance as well as more alienation than actively employed individuals. But when controlling for social differentiations, the effect for dissonance and alienation become insignificant, leading to the assumption, that other factors of social differentiation are responsible for the univariately observed differences. The effect of resonance remains significant, but changes its direction, meaning that with controlling for other systematic differences, individuals in active employment do experience less resonance that those in old-age pension. Comparing the non-employed and old-age pensioned, the former seem to experience more dissonance and alienation – also when controlling for social differentiation. In the univariate models no influence of employment status on resonance is found, but with the control variables, it becomes apparent, that old-age pensioners do experience less resonance that the non-employed.The transition into retirement can also be accompanied by other transitions or processes, which also reflect intra-individual transformations of dimensions of social inequalities. With regard to these parallel processes, it becomes apparent that an improvement in subjective or functional health promotes the experience of resonance and, at the same time, considerably weakens the experience of dissonance and alienation, irrespective of the employment situation prior to the transition.As any other transition, the transition into retirement does emerge in the realm of social inequalities. With between estimators we can observe, if there are systematic advantages or disadvantages between social groups in experiencing resonance, dissonance, or alienation. Similar to the intra-individual changes, subjectively as well as functionally healthier individuals mostly tend to experience more resonance and less dissonance as well as alienation than those who are less healthy. Gender and age specific observations indicate that women and younger individuals compared to men and older individuals have a relationship to the world, which is more pronounced in general, meaning, that is at the same time more resonant, dissonant, and alienating. With regard to education we see, that the higher educated do not only experience more resonance, but also more less alienation, while dissonance does not vary with education. Comparing partnered and single individuals, we see, that the latter show lower degrees of resonance and dissonance, but higher degrees of alienation. Since these results are – in contrast to the intra-individual results – significant, we can assume that a relationship transition does affect resonance relations not in the short –, but in the long-term. We do not find any differences between income groups, which is in line with the finding, that also changes in individual income do not affect resonance, dissonance, or alienation. These inter-individual results are mostly the same for both normative transitions.Transformations of Resonance in Normative Transitions).The transition from active or non-employment to reduced-earning-capacity pension is understood to be a non-normative transition into retirement. For this transition, active and non-active employees are combined, even though – as we saw in 5.1 – the pre-transitional situation can make a considerable difference, but the small number of cases does not allow for further differentiation. Comparing the levels of resonance (3.31), dissonance (2.34) and alienation (11.78) of the non-normative transition to those of the normative transitions, we see, that the resonance level of the former is lower than that of the latter. The dissonance level is slightly and the alienation level is considerably higher for the non-normative transition  in the practical process of “doing transitions”, however, remains invisible in the quantitative analysis. Looking at the resonance trajectories in the selected case studies, dissonances and/or losses of resonance at the end of working life are evident all three selected cases. The loss of resonance is often experienced and narrated through bodily affects by the research participants. Both Richard and Mia describe feeling “drained” and having “no energy left.” They also observe a decreasing interest in their work and an increasing affective distancing. Richard describes this process as an “inner emigration”, which he tells it as follows:“I still did my job well, I think, but, how shall I say, I didn’t paint the town red anymore. I did what was necessary, what could be achieved, and I did that all steady. It didn’t bother me as much anymore, the anger that had previously cost me a lot of nerves with the management. I always took it very much to heart. And took a lot of it personally. [...] the drive was missing in the end. It was no longer, “Yes, hurrah, we’ll fight, we’ll do, we’ll do, yes!”, but it was, “Yes, I’ll do it.” And I think that happens to every person who is already inwardly saying goodbye, to the profession.”While the process of affective disengagement, as Richard describes it, is gradual for some, others refer to specific triggers, often characterized by a lack of recognition, a reduction in skills, autonomy, or respect. Mia talks about the moment when her autonomy was curtailed by a new supervisor and she retrospectively “very likely should have made the break”:“And then he said to me, you don’t decide here, we decide when and where this takes place. And that was the first gut punch.”What is being experienced as recognition differs according to setting and social position. While it is painful for Mia as a project manager to be partially deprived of decision-making authority, Jan as a security guard emphasizes simple practices, such as being greeted, which shows him that he is being seen in his professional life and that something – or in this case, specifically, someone – speaks to him:“Good morning, Mr. Meier, have a nice weekend, Mr. Meier, (takes a breath). Where are you going today, well, have fun!’ That does something, like for the psyche.”What is striking in all three cases is that the experienced transformations of resonance on their transitional paths are relatively similar, despite the different social situations and positions they depart from: Mia, the highly educated manager in an international organization, finds herself experiencing similar dissonance and alienation as Richard, the unskilled worker, and Jan in his precarious employment situation.However, looking at the further development of experiences of resonance after the end of working life reveals major differences between the cases – which seem, however, again unrelated to socio-structural inequalities: While Richard very quickly finds a new sphere for experiencing resonance in care activities for others, Mia and Jan find themselves in a largely resonance-less but searching “state of uncertainty” for a longer time, which Mia describes as follows:“Sometimes I feel really good, full of energy, trying to take care of myself. Then sometimes I’m so full of energy that I think, I can still pull something off.  So sometimes I think like that, I would just say lost in transition. That’s kind of my state.”However, the fact that experiences of resonance are processual and changeable can be seen both in biographical narratives and also very clearly in the longitudinal monitoring of the study participants. At different points in the transition process, the interviewees report different experiences of resonance, dissonance, and alienation, and people who lack experiences of resonance at one point in time may find them at a later point in time. Thus, lack of resonance is not a “fate” but arises in the context of relationships as well as in the execution of social practices and is thus changeable in social practices. This is exemplified in Jan’s narratives: while in the first interview he still describes his situation as “cruel”, “hopeless”, and “lonely”, he has found a new source of resonance a year later. Together with his wife, he moves into a communal living project, where he feels comfortable and has arrived, “[...] because they all have the same goal: We want to grow older together, as confidants [...] to share life”.The participants in the qualitative study often experienced the first phase after the end of working life as a quest, which, from a resonance perspective, can be understood as a search for new axes of resonance. This search is not purely intrinsically motivated, but is also societally, hence discursively and normatively, shaped – the study participants, for example, emphasize that they “must” look for new tasks, activities or projects, otherwise they are afraid to fall into inactivity, listlessness and/or depression, which is sometimes captured in the discourse of the “retirement hole”. Jan describes this experience as follows:“Now (A.N. after the end of working life) everything is threatened to go down the drain, all my competencies will dry up then, that’s my feeling about it – and I do want to create.”Mia is also looking for such a creative task. She says about herself, “Actually, I’m looking for a project.” But on the other hand, she is afraid of the obligations creative opportunities always comprise:“On the other hand, I’m incredibly afraid that I’ll fall back into this rat race very quickly. I just don’t want that.”Mia and Jan participate in a range of activities, which promise to enhance resonant relations: Jan talks about “individual therapy, psychosomatic clinics, pilgrimage, meditation, body therapy, choir singing – so you’ve got plenty of options there already” and, after losing his job, he goes directly to a monastery for 6 months. Mia says she, “does more sports, does an Ayurveda treatment, does yoga (…) does mindfulness exercises”, has “hired a woman to coach (her) because (she) was just in such a bad place”, and attends seminars on spirituality to “really engage more with (her)self”. She also tells about singing in a choir:“(I) learned new things. I started singing, something I had totally neglected. So, making music, I’m doing that really intensively, being in the choir, taking singing lessons, that kind of thing. (…) I’ve learned a lot about my own psyche, how that works, about feelings.”However, they both do not find any sustainable experiences of resonance in these activities. Richard, on the contrary, describes himself as having “really arrived” in retirement shortly after the end of his working life. He has tried similar activities as Jan and Mia but has finally arrived at “shopping, doing laundry, writing poetry”, which fills and fulfills his day. He experiences retirement as a phase of slowing down and turning towards the world, which enables him in the first place to reestablish meaningful self-world relationships. Richard recalls:“I thought at the beginning I’d fall into a big hole or something and really need to find new kinds of work. But I didn’t fall into a hole, I went for a walk more often than usual. I enjoyed it.”Recognition for what he does remains important to him. He tells about writing poetry, “And I enjoy it, especially when other people like it too and say, ‘That’s really nice!’” He also places emphasis on the importance of “experiencing new things”, reflecting on one’s own biography, and doing things that were not possible (in terms of time or structure) in the past. Richard now dreams of studying in order to “learn to understand people further.” In terms of the resonance concept, we similarly see a striving for expanding reach of the world: Richard not only wants to write poems, but he also wants other people to read and like them. But when asked about recognition, he responds that all he wants is respect – “not being cautious or anything, but just the normal respect that everyone deserves.”While the qualitative findings provide a detailed insight into the specific transition practices and their meanings for those who are transitioning, we can determine at the quantitative level how specific everyday practices correlate with the experience of resonance, dissonance or alienation, when one is in the phase of retirement. To analyze which everyday practices foster resonance relations, correlation tablesThe formation of resonant relationships in everyday practices, on the other hand, seems to be particularly enhancing for old-age pensioners by attending  events and courses, by using the computer in their free time, by body-related practices such as gardening or sports, by creative practices such as artistic activities or handicraft and DIY work. Most of the correlations between resonance and everyday practices are also found among pensioners with reduced-earning-capacity pension: For them creative practices and gardening do not promote resonance, whereas walking, housework, and crossword puzzles or mental exercises are found to be resonance-enhancing.The extent to which alienation and resonance are interconnected is suggested by the similarity in everyday practices favoring them: the experience of alienation is attenuated by similar everyday practices as the experience of resonance is being enhanced. More precisely, handicrafts, gardening, sports, and attending cultural events are equally alienation-reducing, no matter which form of retirement. Differences between old-age and reduced-earning capacity pension show that the alienation experience of the former is reduced using the computer for leisure activities and of the latter by attending courses or lectures or political events.The everyday practices promoting resonance can be assigned to different resonance axes: politics, art and nature, self-effective work, sports and consumption . It is pAt the same time, none of the everyday practices turned out to be alienation-dynamizing, which could be related to the operationalization of alienation with depressive symptomatology and the association of high depressive symptomatology with a less active everyday life.Social relationships constitute a crucial axis of resonance across the life course, and life course research has pointed to the relevance of “linked lives”  in the s“(…) that I’m retired so early because most men don’t show up, or there aren’t any, or they don’t federalize. Most go the natural way and retire early at 60 (takes a breath) and there from is the way of division (…) and then I have to see here just as a man (takes a breath), early retiree, 52, where I stay (takes a breath) and that is already difficult, to be perceived and understood with like-minded people, that is incredibly (takes a breath) hopeless.”He nevertheless finds some kind of resonant relation with his new house mates in the collaborative living project who, unlike him, are not experiencing retirement transitions, but are just within very different transitions in the life course, e.g., starting a family or moving in together as a young couple.“They are enthusiastic young mothers, young fathers with 30, who simply want to create something. Just like me. I want to create something. For myself, my body, and with others and um with the housing project. Just in a different way with all of my experience.”Richard finds resonance in supporting his wife more than in searching and finding resonance in the form of a new job or an exploration of his self. Asked about changes in his marriage accompanied by his transition out of the workforce, he thus replies:“We treat each other even more appreciatively (…) since I retired and have more time to get things done on the side (…). So, I have the feeling that it has become even warmer than it already was. That is a positive side effect. Yes, I don’t know what it is, but (takes a short breath) maybe because I have time to take care of things. (…) You didn’t have that before at work, it was so stressful or you were stressed and didn’t have time (…) instead to enjoy this free time COMPLETELY consciously. So that’s really becoming aware of what kind of time you have at the moment, that’s – I can’t say it often enough, how happy I am.”In addition to caring for his wife, Richard, who is childless himself, also builds new intergenerational relationships with other children and young people in transition, serving as a mentor for refugee minors and as a read-aloud grandpa. He thus feels as a part of a social community and has the feeling that he “has both feet on the ground” much more than he did during his working life.not tied to resonance transformations. Feeling lonely and experiencing resonance, dissonance, or alienation is interrelated as follows: the lonelier one feels, the lower the experienced resonance and the higher are dissonant and alienating experiences. We additionally see that the correlations of loneliness with resonance, dissonance, and alienation are stronger for reduced-earning capacity than for old-age pensioners, which strengthens our qualitative result, that finding (or not finding) a community is especially pivotal within non-normative transitions.The quantitative analysis of social relationships and loneliness is in line with the qualitative finding of searching for a community. As we already saw for the everyday practices, dissonance is also not attenuated by social relationships see . RegardiIn this paper, we posed the question of whether, and if so, how, resonance experiences according to Rosa are transforming in retirement transitions. At the backdrop of our empirical analyses, we want to summarize the main results:opens spaces of resonance for many people, while at the same time spaces of radical dissonance and alienation – most often caused by work or the reconciliation of work and family/leisure – are closing. The qualitative case studies enrich this finding by suggesting a loss of resonance at the end of working life – illustrated, for example, in phenomena such as “internal resignation”. This suggests a certain phase structure of resonance experiences or a “resonance choreography” throughout the retirement transition, namely a tendency toward losses of resonance at the end of the employment phase, followed by a gain in resonance in the early stages of retirement. This finding is both in line with studies that have hinted at different phases in the retirement transition like Turners (1969) differentiation of a separation, a liminal and an incorporation phase, where the strive for Communitas may represent desire for horizontal resonance axes. Combining First, persons in transition to retirement seem particularly sensitive for unpredictable experiences of resonance and alienation characterized by a balance of fears and hopes for the future. Secondary data analysis of the DEAS suggests that the retirement transition chrononormativity  whether a person transitions from active employment or non-employment to 2) old-age or reduced-earning-capacity pension, 3) when and in which life situation the transition occurs, 4) whether and how a person experiences recognition at the end of his or her working life, and 5) which opportunities to participate in resonant practices open up for him or her (or not). Even when our quantitative results show, that neither increases in income nor differences between income groups lead to more experiences of resonance. Disposition and spaces for resonance experiences are framed by contextual, sociostructural and cultural conditions such as connotations of masculinity and femininity or cohort-specific perceptions  Empirical results have shown that experiences of resonance do not just happen (or disappear) “naturally” in the transition to retirement but emerge from people’s engagement in ceptions . In our arrangement of cumulated and clustered transitions occurring in sequence or parallelly, hence in temporal and interpersonal relation to each other, for example the transition to grandparenthood, partnership transitions, or relocation. In terms of resonance theory, the observation of a single transition falls short of identifying any transformations of the relationship between subject and world. Hence, it is not enough to think relationality in the life course only between different people’s lives, as in the life course research concept of “linked lives” (2) Our results explicate the relationality of the retirement transition . Transitions, it becomes apparent, are linked between people – for example, the retiring person and their employer or partner – but also among themselves: We can see this relationality both quantitatively and qualitatively, since resonance transformations rarely arise from one transition alone, but from an d lives” , but alsAs the qualitative case studies indicate, the phase directly before and after the end of working life is marked by a search for constellations of practices in axes in which experiences of resonance emerge. This search leads the study participants to a “market” of resonance-promising oases, that has established itself around the transition to retirement – ranging from senior traveling over adult education centers, from (psycho)therapy or counseling to volunteering, choirs, hiking associations and mindfulness workshops. Speaking with resonance theory, participating in such commercialized practices can be understood as attempts to purposefully appropriate the social world and intentionally create experiences of resonance. However, such “simulations of resonance” are often doomed to fail, since resonance is characterized by unavailability – it cannot be purposefully planned or  organized, as we see in the cases of Mia and Jan. Where people experience resonance is thus partly arbitrary. What seems to be central for experiencing resonance, however – following both the theoretical assumptions as well as the empirical material – is deceleration with retirement: Slowing down allows for adaptive world transformation and thereby transcending the self.Based on the results outlined above, we want to call attention to the importance of Rosas concept of resonance and its transformation in transition to retirement. As “the sphere of work is thus multiply charged with resonance” , 236, thFinally, however, we would also like to address some criticisms of the resonance concept and limitations of this paper. First, some difficulties arise in measuring resonance, or rather our attempt to operationalize Rosa’s abstract resonance theory and thus make it fruitful for empirical retirement research. In our mixed-methods research design it becomes apparent that the operationalization and analysis of experiences of resonance differ between quantitative and qualitative data, each rendering different aspects of these experiences (in-)visible. The individual scales in the quantitative secondary data can only represent the complexity of the relationship to the world – if at all – in a fragmentary and thus highly abbreviated way. Moreover, it is hardly possible to adequately operationalize the ambivalence inherent to the concept – the dialectical relationship between resonance and alienation as well as their dissonant intermediate forms – with existing survey data, as we saw quite clearly in the results concerning dissonance, especially when analyzing everyday practices. Even though the detection of experiences of resonance seems easier in the qualitative data at first, the difficulty of translating, for example, bodily-affective experiences of resonance into linguistic articulations becomes apparent here. Interestingly, it is easier to verbalize aspects of alienation than experiences of resonance. Empirical research on resonance therefore arguably requires complementary other, non-linguistic methods, such as those used in ethnographic methodologies, visual procedures, and especially affect analyses. In this context, Robert Second, even though Rosa hints towards questions of social inequalities – namely how the ability to experience resonance differs depending on one’s social position and how it changes across the life course, he in large parts avoids a detailed argumentation on the connection between resonance and social inequalities. This may in part be due to Rosa’s rejection of the resource-orientation of the sociology of social inequalities. But he himself does not get out of this logic either, when stating, that the educational system – and thus higher education – promotes higher resonance capacities for privileged social groups , 453. WeIntegrating the concept of resonance in the life course approach, we can on the one hand (re)negotiate successful aging, since resonance theory makes us sensitive to not solely regard the distribution of socio-economic resources but rather the distribution of resonance dispositions and capacities. With cumulative advantage/disadvantage theory CAD;  we couldBased on the results of the qualitative data, for example on everyday practices and the search movement for resonance, we can formulate further new questions for a theoretical and empirical approach to resonance: How, for example, is the social acceleration that Rosa proclaims related to a pluralization of transitions noted by reflexive transition research? Can we understand the design and ritualization of transitions as an expression of desire for resonance? What method (olog)ic approaches, such as ethnographic approaches, might help establish a “research architecture” related to resonance and transitions? If we operationalize resonance: does it represent a depended or independent variable and outcome for transition processes like retirement? How can we understand retirement decision-making and adjustment to retirement from the perspective of resonance theory? Which role plays voluntary of exit the labor force? How distinct is the theoretical differentiation between dissonant/resonant experiences and alienation? How can Rosas dialectical approach be linked to ambivalence or changing perceptions of resonance axes over time? Is it possible to state from a reflexive research perspective that resonance and the search for responsivity are basic human needs?Concluding we would like to highlight, that resonance as a lifelong process offers the possibility to understand the transformational potential of transitions openly and in terms of a good life. It remains open, how resonance can be reflexively developed through its “empirical friction” on the phenomenon of transitions. The openness – e.g., towards temporal, material, and spatial dimensions of social life – inherent in resonance theory makes it appealing especially for reflexive transition research: A practice-theoretical and relational interpretation of the resonance concept in the sense of doing resonance by doing transitions, as we propose in this paper, opens up space – for resonant and dissonant discourses.


The concept of One Health originated with the German pathologist Rudolf Virchow in the late 19th century but has become a global movement only in the past 2 decades .Mycobacterium leprae  is not feasible at this point of time due to presence of a zoonotic reservoir in some areas” and that “studies to understand the mode of zoonotic transmission and its overall epidemiological significance will be needed” [We have described the anomaly that is apparent in Hansen’s disease being recognized as a zoonotic disease in the USA, a non-endemic country where few people have contact with wild armadillos, but not in Brazil, an endemic country where contact with armadillos is common. We accept the prime role of person-to-person transmission in sustaining Hansen’s disease endemicity in Brazil, where the new case detection rate has not changed substantially over the past 10 years, from 20 new cases per 100,000 in 2009 to 14 per 100,000 in 2018 [ needed” . Eradica needed” .M. leprae and its persistence within armadillos [M. leprae strains infecting humans and animals [This research needs to be transdisciplinary, under the umbrella of One Health, encompassing social and anthropological research to understand community practices in relation to contact with wild armadillos , ecologimadillos ,12,29, a animals ,17. A be animals , but is  animals .M. leprae through contact with armadillos and in protecting the ecological richness of diverse and fragile ecosystems. The aim of this Viewpoint is to stimulate debate in Brazil, leading ultimately to a shift in public health policy. This is not a trivial task and will involve persuading many stakeholders including scientists and politicians. As a first step, we propose that public health authorities and medical associations in Brazil concerned with Hansen’s disease give serious consideration to updating guidelines in accordance with a One Health approach and consistent with WHO Global Hansen’s Disease Strategy 2021–2030.In the meantime, national programs to reduce endemicity and ultimately eliminate the disease from these countries should not ignore existing evidence for zoonotic transmission. From a One Health perspective, this approach is short sighted, both in terms of informing health professionals and the population about the risk of infection by


Familiarity is important for persons living with dementia who participate outside home.When familiarity is challenged, such participation may be difficult. This ethnographicstudy clarifies how familiarity is experienced by persons with dementia in performingactivities and visiting places, and how familiarity contributes to maintainingparticipation outside home. Nine participants were interviewed in their home and whilevisiting familiar places. Data were content analysed using a constant comparative method.The findings suggest that persons with dementia experience familiarity as continuous andwhole, through occurrences that support personal territories. Landmarks and objectsenhance the experience of familiarity. Familiarity that is continuously challenged mayrender participation outside home fragile. In Switzerland, 151,000 persons are living with dementia, of which about 80% are living athome, with support of home health and community services . DementiFamiliarity is important in supporting people to participate outside home . InneurFear of getting lost and being embarrassed deters persons with dementia from going topreviously familiar places that now feel unfamiliar . TherefoHowever, familiarity is not just attached to the environment or places but includesoccupations performed in places regularly visited, creating what is called ‘familiar livedand practiced places’ . FurtherRecent studies In sum, familiarity is an important but understudied aspect in support of persons withdementia maintaining participation outside home by navigating and reaching places, andengaging in activities. The familiar becoming unfamiliar may restrain people with dementiafrom such participation. Familiarity is also challenged by recurrent urban renewal and aprogression of cognitive decline in early-to-medium stages of dementia. However, there isa knowledge gap in how people with dementia experience familiarity in places andactivities, how they cope with losing familiarity and how familiarity or unfamiliarity maycontribute to participation outside home.The study aim is to clarify how familiarity is experienced by persons with dementiaperforming activities and visiting places outside home, including describing how theyexperience the characteristics of familiarity, and how familiarity might contribute tomaintaining participation.This ethnographic study reports on research undertaken as part of the ‘life outside homefor people with dementia’, an international project lead by Karolinska Institutet inSwedenRecruitment proceeded via memory clinics, day-care centres and the Alzheimer Association.Inclusion criteria were as follows: over 65 years old, a community-dwelling adult with adementia diagnosis from a memory clinic and the capacity to give informed consent . We usedSignificant others were present when needed to provide support during the home-basedinterview, as people with early-to-moderate stage of dementia generally are able torespond to clear and unequivocal questions, in a familiar setting . ParticiWe recruited nine participants . in a coData collection constituted two types of interviews: a two-phase sit-down, face-to-face,home-based interview  and a waData collection was conducted by the first author and audio recorded. The home-basedinterview aimed to exchange information about the study (aims and roles) and our mutualinvolvement, to build trust, and to get an impression of the person’s situation. Questionsin the interview guide were about participants’ interests, routines, activities, andparticipation outside home and about familiar places. The first (home-based) interviewlasted between 60 and 90 min. We invited significant others to stay for the firstinterview; Georges’ wife stayed for the whole interview and Charles’ wife was present onlyfor the first 30 min. Other participants did not choose to have a significant other takepart. At the end of the home-based interview, we discussed where we would go for themobile interview in the next few days or week. We conducted from one to three mobileinterviews with the participants, adding up to a total of nine home-based interviews and15 walking interviews.For the mobile interviews, participants chose where they wanted to go, with the conditionthat it be a familiar place, part of their habits or routines. The aim of walk-alonginterview was to get participants to talk freely about ongoing experiences of familiarity,while taking the first author to familiar places. The interviews were open-format informalconversations, creating a relaxed, friendly atmosphere. Direct questions were asked aboutplaces (e.g. why did you choose to take me here? What makes this place familiar to you?),finding one’s way (e.g. how do you know where you are?) and activities performed . Participantsoften pointed to specific landmarks, or told stories about places, as if they were a ‘tourguide’. We stopped to discuss experiences and feelings of being in or going to familiarplaces, with probing questions regarding the experiences , such asThe analysis was performed parallel to data collection in this ethnographic researchprocess . The traTranscripts and field notes were read several times to immerse oneself in theparticipants’ experiences and get a grasp of important aspects and feelings generated.InitialWe used an iterative process to compare emerging themes with the theoretical framework ofthis study ,thus enriching the analysis . To refifamiliarity is experienced in acontinuous way, as a whole and through occurrences; (b) familiarity isenacted through a personal territory and (c) landmarks and objects in theexperience of familiarity. The first theme explains how participants experiencefamiliarity; the second explains how the experience of familiarity is maintained inparticipation outside home, by enacting it in a territory and the third explains the role oflandmarks and objects. Although the themes stand alone, they are experienced by participantssimultaneously in the situations they live.The findings are presented in three themes: (a) Iknow my city’; for Edith, it was part of a routine: ‘It is something sousual that it is an automatism’; for Henri, familiarity provided a sense ofsecurity, social belonging and well-being: ‘It’s super familiar, I’m safe, peopleare nice to me and I’m good’ and Paul expressed it as a cohesive whole:‘It’s a whole, not pieces’. The metaphor of a ‘whole’ to qualifyfamiliarity does not mean it was homogenous. A ‘whole’ could include various items,ingredients or elements, like a hamburger that would be eaten whole; it contains meat,bread, cucumber and sauce, but is one complete object.For participants with dementia, familiarity was an embedded part of their everydayactivities outside home. They took familiarity for granted and continued out-of-homeactivities without consciously thinking about it. They walked streets or paths, took turnsand did their usual activities in places they reached. Their experience of familiarity wasimplicit, obvious in a way that had participants say: ‘Of course it’s familiar’.Familiarity was embedded in everything they did and everywhere they went, offering acontinuous experience of participation outside home. A ‘continuous experience’ hererelates to the concept of continuity : identifBut hey, I go to the cafe, and then I go shopping,and then I go home to cook’. Edith was very clear about her shopping routine.Storytelling was triggered by being and doing in that same place; it included the narratorembedded in the place (café in the city), time and continuous experience (identity), sothat she would always recognise that place (in her discourse). The familiar place (café)was thus narrated, historicised and included other persons (sister-in-law). The experienceof familiarity is situated in the place and as such is part of experiencing the place as a‘whole’, supporting the feeling of continuity of one’s own identity, as described in thetransactional perspective theory.Interestingly, this idea of familiarity being metaphorically qualified as a ‘whole’ isreported by other participants through stories. They tell about the places we visited,grounded in their personal and familial histories; they include other persons, familymembers or friends. These stories include moving to and reaching the peculiar locations –‘getting there’ – and doing specified activities, making it a story about a ‘whole’. Thestories were embedded in the places, accentuating the relation between the person and theplace, in situations and ‘whole’. For them, stories gave meaning to places and supportedtheir experience of familiarity. When Edith went shopping in the city, we stopped at acafé and she told that she would always expect to meet her sister-in-law in that place.That café had been a rallying place for the two sisters-in-law for decades and was part oftheir twice-weekly routine: ‘No, I cannot get lost, it’s in mygenes! I was born in this city’. Although there were roadworks in a streetclose to her home, she did not falter, continuing as if this was not an issue, just afeature that can change in a high number of occurrences she has used to build theexperience of familiarity in her city. Other features of those occurrences would change –like the weather (snow or ice in the street), time of the day and a different grocerycashier – sometimes bringing challenges to the experience of familiarity. Anita reported achallenging experience in one occurrence: ‘When it’s raining, it’s all gray andblurry so I’m not sure where I’m going. Once, I went out, it was not for long, it wascold and wet, I could not see where I was going, so it was a friend with her dog whofound me and accompanied me back home’. When the streets were underconstruction, Charles, who was going to the barber shop up the street, ended up at thegrocery store because he had to take a detour to circumvent the roadworks, and forgotwhere he was initially going. Again, Anita, who regularly went to her familiar groceryshop, experienced an embarrassing experience when she put more items in her cart than shehad money to pay for. In this occurrence, when she arrived at the counter, the usual ladywas not there: ‘I cried at the counter, because I didn’t have enough money. […]And it was an unfamiliar person at the counter, but she helped me get everything out ofthe cart. It was so embarrassing’. In these examples, the experience offamiliarity was dependent on specific situations, and familiarity may fluctuate over timeand occurrences.Furthermore, participants experienced familiarity as situations were repeated over time,that is, going to the same place repeatedly, like grocery shopping in the same store. Eachoccurrence of the same repeated situation would be slightly different, for example, due tothe weather, the ingredients needed to be bought or being accompanied by a family member.Everyday life situations would thus be specific and unique for the participants, andrepeating the same situation supported the sensation of continuity. So, participants foundthemselves in repeated one-time occurrences holding various features that over time builta recognition of the place as familiar and whole, supporting a continuity of experience.Again Edith said, as we strolled the streets: ‘Yes, I will run in the forest or ride a bike. In fact, I’malways outside for hours. My territory is not just around the house, it’s the forest andbeyond, to the river [name of the river]. Since they took away my driving license, Ibike instead’. David explained that he had always been very active outside,that it was part of his identity and his way of participating, while we walked in hisforest instead of running. David referred to those familiar places as ‘his’ territory thathe was able to define, naming the river. Experiencing his territory as familiar supportedhis participation outside home, allowing him to walk, run or bike through it, without fearof getting lost, as long as he stayed in his personal territory.As presented above, participants experienced repeated one-time occurrences with variousfeatures in building familiar places that were recognised as such. In their experiences,these familiar places are not separated from one another, but rather form territories inwhich participants may safely navigate, participate and do activities, without gettinglost or embarrassed. These territories, specific to the individual, could be seen aspersonal. The successions of places and activities in the personal territory arerepeatable one-time occurrences, enacted by participants in everyday life, and holdingindividual meaning. For example, David was used to doing a lot of sports and he needed toexercise everyday: ‘I can find myself all of a sudden in a place that will be …, all of asudden I don’t know where I am and well I say “I’m lost” but then I think a little, Ilook a little on the right, I look a little on the left, and so on, but yes, suddenly Isee where I am, I have seen a landmark and that’s it’. The personal territorywas understood here as being an agglomerate of familiar places that not only belong tothem  but also to which they belong, in atransactional view of people and places, co-constructing each other in the experience offamiliarity. Thus, familiarity was continuously experienced by participants as a personal‘whole’ territory made of familiar places, enabling participants to move inside theirterritory in a fluent, flowing and safe manner, while still able and supported in takingrisks.Sometimes, participants may even take the risk of getting lost in that territory. Edithsaid she has travelled in the city (her familiar territory) every day for more than 30years: ‘I need to make an effort, …sometimes my wife helps me and comes with me the few first times I go back hiking. Idon’t remember which chalet I need to drive to, they all look the same in the spring,but then when I get there, after a couple of times, I get this feeling of rightness, offamiliarity, and I can start hiking again’. Changing features in familiarplaces, like roadworks, time of no-use or any difference in occurrences could unbalance aparticipant’s experience of familiarity. These disturbances in the experience offamiliarity might be linked to the vulnerability of persons with dementia in maintainingparticipation outside home. It might also support a participant’s sensitivity to changesin familiar places.As seen before, the experience of familiarity was challenged in some occurrences due tofeatures in the situation that unbalanced the participant’s experience. These challengescreated temporary fluctuations in an otherwise familiar territory. For example, Henri hadto stop hiking in the mountains during the winter, a lapse of use. The place had becomeunfamiliar in winter, and he had to ask his wife to go with him the first time he wentback to find the chalet where he starts hiking: ‘Oh yes, I am free in the forest, and if I lose myself, it does notmatter, I come out on one side and I find my way. My family has always had this forest,I grew up there, so ..’.Furthermore, as expected, the familiar personal territory for persons living withdementia might be the neighbourhood, in walking distance to the house. But for someparticipants, we went further away, either driving or walking. Henri, who lives in theAlps, wanted to write an article in his village journal on churches in the surroundingmountains. So, he drove to seven churches to take pictures; when there, he told us thestories he wanted to write about. Henri had regularly visited these churches as a boy,hiking with his family and as a retiree. These churches were familiar, but well outsidehis direct neighbourhood. The same can be said for Samuel, whose family has owned a patchof forested land for a long time. He used to run, bike and hike in that forest, as we didtogether: ‘Here I go to the chalet we seethere, by car, I park in front of ... .ah I don’t always know the names of the chalets,but I park and then I walk on the paths in the mountains, that’s my life ... sometimesmy wife comes with me, but often she lets me go alone. The mountain is beautiful, fromthe spring, I go to walk’. The chalet acted as an anchor, a familiar referencehe knew to return to.Some environmental features were recognised by participants as reference points, likelandmarks or spatial anchor points. Some participants used familiar landmarks, like Henriwith the chalet where he parked to go hiking: ‘Charles regularly went walking in and around his village, going from one fountain toanother, where the clearest and freshest water was. He always took a flask with someabsintheThis study sought to clarify how familiarity might be experienced by persons with dementiaand give light to how familiarity might contribute to maintaining participation whilevisiting places where occupations are performed outside home. The findings suggest thatpeople with dementia experience familiarity as continuous, through occurrences that sustainfamiliarity in personal territories with facilitating landmarks and objects. In fact, placesare constantly shaped by how people interact and actively engage in activities . As AndrMany studies have considered participation outside home to be restricted little by little,over time, to eventually only cover the neighbourhood, for example, a familiar space inwalking distance from home . HoweverIn addition, our results propose that territories hold familiar landmarks that supportpeople with dementia to participate outside home . As landIn our findings, familiar objects are more important than expected; bringing them out ofthe house might not be trivial, as they could create a lifeline between the familiar placeof home and familiar places outside home, or be an anchor to home. Having familiar objectswhen going out could be necessary for practical reasons or from habit , but objects can hold other meanings and contribute toparticipation . Our finAs explored before, participation outside home for persons with dementia can be fragilewhen familiarity is challenged. Familiar places are continuously changing due to how peopleinteract with them, as they engage in familiar occupations outside home. Although we did notinvestigate potential relationships with cognitive function in this study, challenges tofamiliarity happened to most participants in diverse situations. Losing familiarity might bea common experience for persons with dementia, can happen suddenly, triggered by smallchanges in the environment  and is lAll participants had been living in the same housing for a long time (15–62 years).Mobile interviews were conducted in only familiar environments, as in the inclusioncriteria. This may have partially limited the exploration of challenges to familiarity andhow people with dementia cope in unfamiliar environments. All interviews were conducted inFrench, and the language criteria may have limited the scope of the results. Still,participants had a varied cultural background, as some immigrated when young, reflectingthe state of the older population in Switzerland.Although participants were living in familiar surroundings, they struggled to explicitlyspeak about familiarity. This might be due to familiarity being taken for granted,implicit in nature and enacted . ParticiAnother limitation to this study is that the type and stage of dementia was notidentified beyond the screening done by using MoCA. Collecting more information on thecognitive functional level and type of dementia of participants might have given a betterinsight on the difficulties that participants might have been facing during theinterviews, especially with such a big range of MoCA score (9–27). Still, the aim of thisstudy was to clarify how persons living with dementia experienced familiarity throughtheir perception rather than focussing on familiarity as a cognitive construct.Participants with dementia experienced familiarity as continuous, a ‘whole’, expressed inpersonal territories with facilitating landmarks and objects. Still, familiarity maycontinuously be challenged, making participation outside home fragile. Even taking intoconsideration the complexity of each situation outside home, it is difficult to understandor predict how familiar places and activities become unfamiliar, as the relationship betweenthe person and the environment changes constantly. This fluctuation might be pictured as agap, a hole or a rift in familiarity, but characterising the experience is uncertain; thiswas not the focus of this study. More studies are needed to describe and explain thedisruption of continuity in experiencing familiarity outside home.


Nigeria has the second highest number of people living with HIV (PLWH) globally, and evidence-based approaches are needed to achieve national goals to identify, treat, and reduce new infections. Youth between the ages of 15–24, including young men who have sex with men (YMSM), are disproportionately impacted by the Nigerian HIV epidemic. The purpose of this study was to inform adaptation of evidence-based peer navigation and mHealth approaches  to the local context within iCARE Nigeria, a multi-phase study designed to investigate combination interventions to promote HIV testing and care engagement among youth in Nigeria.To elicit expert and community perspectives, a local group of advisors from academia, community, and governmental sectors provided feedback on intervention adaptation, which then informed a series of focus groups with stakeholders in Ibadan, Nigeria. Focus group data were collected over a period of three days in December of 2018. Participants in focus groups included YMSM and HIV-positive youth in care ages 16–24, and HIV service providers from local AIDS service organizations (ASO). Groups were stratified by HIV serostatus, gender, and stakeholder type. Focus group sessions were conducted using a semi-structured interview guide, audio-recorded, transcribed verbatim, and analyzed using a content analysis approach.Local experts recommended intervention adaptations specific to the status of peer navigators as volunteers, peer characteristics , and intervention characteristics and resources . Five focus group discussions with stakeholders, including 27 participants were conducted to elicit feedback on these and other potential adaptations. Youth participants (n = 21) were mean age 20 years (range = 16–24); 76% HIV-positive, 76% men and 48% MSM. Service providers (n = 6) represented both HIV prevention and care services. Participants across stratified subgroups reported largely positive perceptions and high perceived acceptability of both mHealth and peer navigation strategies, and echoed the recommendations of the advisory group for volunteer-based navigators to promote altruism, with a low navigator-peer ratio (1:5). Participants emphasized the need to incorporate minimal mobile data use strategies and popular social media platforms among YMSM  for widespread access and reach of the interventions.In Ibadan, Nigeria, stakeholders support the adaptation of combined mHealth and peer navigation strategies to promote HIV testing and care engagement among high-risk youth. Recommended adaptations for the local context reflect concerns about the feasibility and sustainability of the intervention and are expected to improve accessibility and acceptability. Nigeria has more than 1.9 million people living with HIV/AIDS . In 2018The United Nations defines youth as individuals aged 15–24 in recognition of the developmental risks to health and well-being of mid-to-late adolescence and young adulthood . Among yThere are also critical challenges to promote treatment engagement and viral suppression among youth living with HIV (YLH) in Nigeria. According to UNAIDS , NigeriaPeer support interventions are recommended by the WHO as a strategy that provides many benefits for youth across the HIV care continuum  and shifTechnology-based strategies have emerged as a promising approach to HIV-related interventions, particularly among youth, with a growing body of evidence suggesting efficacy –26. mHeaSocial media outreach is an evidence-based mHealth strategy to promote HIV testing, although it has not been evaluated among YMSM in SSA. It is based on theories of empowerment education, social cognitive theory and natural helping by peers . ImplemeIn sum, while there is an urgent need to curb the HIV/AIDS epidemic among Nigeria’s youth, particularly YMSM, evidence-based approaches that hold promise have not been systematically evaluated in the country. The Intensive Combination Approach to Rollback the Epidemic in Nigerian Adolescents (iCARE Nigeria) is an initiative to adapt and test two combination interventions, each of which include peer navigation and mHealth components, to promote HIV testing and HIV treatment, respectively, among youth in Nigeria. The HIV testing intervention, focused on YMSM, combines social media outreach with peer navigation to promote testing and linkage to HIV care, while the HIV treatment intervention, focuses on all YLH, and combines an SMS medication reminder approach, TXTXT, with peer navigation to promote HIV treatment engagement. We conducted formative research to adapt these intervention approaches to the Nigerian environment prior to planned feasibility and efficacy studies.The iCARE Nigeria study is a collaborative partnership between investigators at Northwestern University and Ann & Robert H. Lurie Children’s Hospital (Lurie Children’s) in Chicago, Illinois, in the United States (U.S.) and from the College of Medicine (COM), University of Ibadan (UI), and University College Hospital (UCH), Ibadan, Nigeria. Our approach to adaptation of the peer navigation and mHealth approaches was drawn from best practices for adaption of public health interventions , as wellOur investigative team distilled key components of each intervention approach from peer-reviewed literature and implementation guides a priori, with a particular focus on distinguishing between core intervention characteristics or behavior change techniques, and other intervention elements that would be potentially adaptable to cultural, social, or logistical conditions . We thenKey stakeholders included YMSM (including HIV-negative/status unknown and HIV-positive young men in separate groups), YLH (including both young men and young women in separate groups), and representatives of AIDS Service Organizations (ASOs). The YMSM and YLH represented potential intervention participants. Focus groups with stakeholders were stratified based on HIV serostatus, gender, and/or stakeholder type. Participants were known to the study investigators in Ibadan as clinic patients or youth seeking HIV preventative services and were selected and approached purposively by them, based on representativeness of the population. Focus groups were held at the Institute of Infectious Disease Institute, College of Medicine, University of Ibadan (IDI/CoMUI) over a 3-day period, December 18–20. Ibadan is the third-largest city in Nigeria and thus reflects a mid-size urban environment. Group discussions were facilitated in English by at least one investigator from Nigeria and one from the US in each group, using a semi-structured interview guide. The YMSM groups were facilitated by a team of one male and one female-identified facilitator , the YLH groups by two female facilitators  and the ASO group by two male facilitators , who are all faculty members at their respective academic institutions with training in qualitative data collection. A notetaker was also present in each group to record contemporaneous notes. Notetakers were drawn from bachelor’s or master’s prepared iCARE study staff of the IDI/CoMUI, who received training for note taking and qualitative data collection in preparation for these tasks. The interview guide included questions related to experiences with HIV testing, linkage to care, and treatment (among YLH and YMSM) to contextualize the interventions, followed by specific questions about the proposed intervention components (per recommendations by the expert advisors), and the role of staff training, including what types of training were most important ; community-based organizations focused on human rights issues  and youth reproductive health; a legal consultant, and collaborating medical providers and investigators at partner universities in the largest city in Nigeria, Lagos, which is in the south and Jos, a mid-size city, which is in the north. The legal expert on the panel advised on intervention design in the context of the Same-Sex Marriage Prohibition Act, i.e., to avoid incriminating staff or participants. Advisory group members were drawn from local community-based organizations serving youth and YMSM, in particular, and academic institutions in Ibadan, as well as from national youth sexuality and health and a national youth advocacy organization. Collaborators from partner universities were medical providers with expertise in HIV prevention and care.The basic core elements of each intervention approach, drawn from published literature and implementation guides a priori by the investigative team, are listed in We sought feedback from local experts on the aspects of each intervention that were potentially adaptable to the local culture see . AdaptabFor the mHealth strategies, intervention characteristics were most pertinent. For the TXTXT medication reminder intervention, the primary intervention characteristic for adaptation was considered to be the content of the “canned” encouraging messages. Advisors suggested a review of messages by the peer navigators to update and adapt them for saliency to local youth.For social media outreach, intervention characteristics for adaptation included the choice of social media platform(s) as well as the choice of health education topics for social media messaging. Advisors recommended the use of Instagram, Twitter, WhatsApp and Grindr as their impression of the most popular among YMSM. Also, they recommended incorporating safety measures and training in human rights for the peer navigators in the HIV testing intervention given the criminalization of homosexuality in Nigeria. Advisors further recommended reviewing platforms carefully for consumption of data and using those that were most data efficient.Following the feedback sessions with experts, five focus groups  were then held with a total of 27 stakeholders. All youth who expressed interest in participation consented for participation and completed the entire focus group session. Youth participants (n = 21) were mean age 20 years (range = 16–24); 76% HIV-positive (n = 16), 76% men (n = 16) and 48% MSM . Service providers (n = 6) represented both HIV prevention and care services. One focus group consisting of young women living with HIV (n = 5) was not captured via audio recording due to equipment failure, and therefore only the contemporaneous notes were used for subsequent analysis. Focus group sessions lasted approximately 2 hours.Participants were asked their opinions on intervention strategies, with a focus on acceptability, key characteristics, recommendations, and perceived challenges. Participant comments are grouped below as related to peer navigation and mHealth intervention components and quotes are identified by group type . Content analysis revealed that, overall, the intervention strategies were perceived as universally acceptable, feedback was largely positive, and recommendations largely supported those provided by the expert advisory group. Participants noted the intervention components  were useful (5 of 5 focus groups), familiar (5), desirable (4), and were perceived as impactful (4) and needed (5).Specifically, for the peer navigation interventions, participants understood and were familiar with the concept of a peer navigator, which they also called a “supporter” or a “peer supporter.” Focus group participants unanimously agreed that peer navigation was a useful strategy that appealed to them, indicating high acceptability. Participants highlighted trust, confidence, honesty, as well as common experiences and attitudes as important characteristics in peer navigators. They also discussed desired characteristics of assigned peers, including personality , age, HIV-status, and sexual orientation:Because we know what we are feeling… we have the same feelings, so we know how we are…. We can share more ideas than what we are going through… We know that since we are both, we are all in the same shoes. So, that is a good idea. (YLH young men’s group)We start with qualities having trust and confidence in people, if I get to a community and I am not practicing what I am preaching… the person must be a role model, trust always there for me, people in the community need people that can trust so you don’t push them, very accommodating, another thing is influence the decision of peers really matters a lot (ASO group)For MSM-identified participants, they felt peer navigators should also be from the MSM community:If the person is in the community, there’s going to be a very big, like a large, big bond that is going to be established between the peers and the Peer Navigator.In terms of other characteristics, participants had mixed opinions on whether or not the peer navigator should be the same or opposite sex, living with HIV, or if the HIV status was not important as long as the peer navigator was well informed about HIV. Participants discussed the importance of the peer navigator’s age and agreed that peers should be somewhat older and more mature with salient lived experience, yet cautioned against peers that are parental or “too old.” Discussions centered around finding the balance between a peer who is mature, yet does not seem old:I think inasmuch as I want to listen to somebody that is my age that understands what’s going on currently, I would also want to listen to somebody that has seen a lot of other things that I have not seen. So, I think it should be a combination, but I think it should be tilted towards the young side; but still within the large, wide age range. I don’t know…people don’t tend to go for the older people—it would be ridiculous to make your peer your daddy In terms of intervention characteristics, although many ranges were discussed, ultimately the ratio of peer-to-navigator was thought to be best at 4 to 5 peers per navigator. This was uniformly agreed to in all focus groups:I can’t chat for more than four people at a time…I actually thought about it like how. Let me just say five. For now five. For now, maybe later run sha four [“Maybe four later” in colloquial Nigerian English]. In terms of employment status, participants across groups generally agreed that volunteer navigators would be better than employees, with a caveat regarding coverage of basic costs they may incur. For example, one person said:Ok. I think that, like he said, passion is the main thing that should drive anyone that wants to be part of the project, because if you are enticing the person with money, you will not get the best out of the person. But if it is…if it’s passion-driven, then you are assured of the best from whoever that is going to volunteer. (YMSM HIV-negative/unknown group)Another participant outlined the caveat for this:If you look at basically, it’s…there are a lot of costs involved in maybe messaging, calling and all of that. So, I think, inasmuch as we want to say it is voluntary and all of that, a lot of people still have issues with finances. So, I think, if -maybe not paying, like paying as per wage-…I think helping them with cost, like to deal with the cost of the job is also another thing. Then, asides that, payment doesn’t necessarily have to be in cash; there could be other things you could do—certifications, certain privileges they have as a result of the work they are doing and all that kind of things. I think it’s very important when people see things from beyond money perspective (YMSM HIV-negative/unknown group)Participants were asked about necessary training components for peer navigators. All groups discussed the need to train peer navigators on basic HIV prevention, treatment, and health promotion information:I think that one of the things the Peer Navigator should learn is effects of ARV, because if they eventually get positive clients, they…you know, depending on the person, they might experience so many things. The Peer Navigator should equip himself with information, because when you have information, you can… prepare for everything; Participants in one focus group highlighted the role of religious beliefs that may impact the work of a peer navigator. Participants stressed the importance of understanding these beliefs and providing information in support of continuing medication and treatment for HIV. To illustrate, this participant describes how people may test positive but believe that they can be cured via church or their religious beliefs:Because there are a whole lot of stories I’ve heard about people we are in Nigeria; we are very religious in this nation that when somebody tests positive and they just tell you when next you see them maybe you’re like following them up they’ll tell you “I’ve gone to the church and my pastor tells me that I’ free. So, I don’t have HIV in my bloodstream again.” And some people will tell you that “it’s the blood of Jesus that is running in my vein.” So, the blood of Jesus does not contain virus and the likes. Participants discussed beyond training, that peer navigators should be knowledgeable about resources and understand how to refer peers to mental health support, medical services, food services, have access to condoms, lubricant, and HIV test kits (for the HIV testing intervention). One participant stated, and others in the group agreed, about the importance of peer navigators distributing condoms:give them [peer navigators] condoms, lubricants, able to encourage safe sex habits; like that’s also very important…like, give them condoms. Because one of the reasons why people don’t use condoms is because there is no condom, or they are shy to buy it outside. (ASO group)With regard to the mHealth interventions, when asked about daily personalized text message reminders to promote medication adherence, participants responded positively and unanimously supported the idea:I actually support the SMS, because I myself, I am very frequent with SMS a lot. If you go with calling. People will feel like who is this person calling. That keeps calling you everyday. And for SMS…luckily my phone, there is a way I can hide a particular SMS from a person. You won’t be able to see it. I go with the SMS. Once the SMS enters, the phone will just ring. But calling…people will feel who is this person calling. If he calls you in the morning and call you at night…they will say who is this person? They might even get provoked one day and would just collect the phone from me. At least I want to know that person. But with the SMS that one nobody will know the person. Just check your phone. (YLH young men’s group)Despite supporting the text messaging intervention, participants had concerns about barriers including lack of airtime on mobile phones, cracked screens on mobile phones that limit ability to read SMS, loss or theft of phones, and concerns around privacy/confidentiality of the SMS.I support the SMS because it will be on your phone and you need to check. And again, for subscription issue, not everyone can afford that. (ASO group)I foresee a challenge especially young people some of these young people are minors still supervised by the parents, ask who sent you this message, how safe are these young ones, compose messages that does not expose them had to change some of my messages at a point Two focus groups mentioned engaging parents and caregivers with text messages to remind youth living with HIV to take medication. In the young women’s group, one participant was concerned that a parent or caregiver might forget to deliver the message or even check the messages at all. In the second group, all participants felt like engaging parents was a good idea, yet some had preferences for receiving SMS themselves:Will that SMS reminders be to you or may be to a parent that’s going to release you to come?Although they have our contacts, they still have our parents. They still have to tell our parents but it is advisable to send it to them…what I’m saying is that it is advisable to send it to the students, some students will just ignore. But, if you send it to parents, parents will remind you that you are to come, but as for me, I prefer the student. (YLH young men’s group)Focus group participants were also asked about pre-programmed SMS encouraging responses. Participants like the idea of using emoticons or the phrases “thumbs up,” “good going,” and “good job”. Participants also suggested using coded language that would match the reminder SMS:make it more fun with our own jargons have you kissed your pillow tonight, have you said your prayer tonight ……especially for young persons …………the other part to it when they get that you have to get a feedback from them and an encouraging response what kind of response? Ride on, if he says no, prayer is the key. If he says yes, ride on. (ASO group)Finally, participants were asked to provide feedback on the social media outreach strategy with a particular focus on identifying common websites used and any potential perceived challenges. Prior to starting the discussion about social media outreach, facilitators asked a general question about what could be done to increase HIV testing. In one focus group participants immediately suggested utilizing social media due to widespread acceptability:Facilitator: But to increase the number of young people testing now, what do you think we need to do?Participant: Ah…probably…well, maybe the use of these applications we use─ give them more information…Facilitator: What applications?Participant: Grindr, Facebook, or any other sourceFacilitator: For HIV testing?Participant: Yes, to make them aware─Participants reported that Facebook is a very common platform and suggested its use in outreach:Facebook messenger is like number one…So I think apart from Grinder, Facebook is also another important place. But Facebook doesn’t give you any pop-ups like that too. Participants indicated the ubiquitous nature of Grindr use among YMSM, in particular:Facilitator: let me say it this way: out of…if we say out of…if we put down on the average, if we put down ten people who are YMSM, how many people would be comfortable with Grindr…who will be familiar with Grindr, out of ten?Participant1: at least 8Participant2: 8 people, and then the remaining will definitely not have a phone[everyone bursts into laughter]Facilitator: So practically everybody who has a phone knows of Grindr. Aside from endorsing the use of social media platforms and listing the most commonly used sites, participants also stressed privacy and safety in using social media for outreach. These concerns stemmed largely from YMSM who wanted to ensure their privacy would be protected. In this exchange, participants discuss a blogger who breached the privacy of a Facebook group and posted private messages from YMSM online, exposing their identity:Participant 1: really that place…I think…to me, I think it’s not secure, because, you know, Facebook doesn’t have the security─ for MSM, I’m saying…one can successfully…Participant 2(interrupts): one group on Facebook─ they had issues lately when somebody updated his sexual experience and then a blogger took the message and then posted it online. So, since when…So I think the guy…Facilitator: with his identity?Participant 2: Yes. So since then they took the account of the Admin of the group and then the group was sort of secured to an extent—you can’t be in the group unless somebody adds you…unless like a member of the group adds you… (YMSM. HIV-positive group)Participants shared that they preferred phones that had biometric security features such as thumbprint locks. However, this was also countered saying that friends or family will just ask that you unlock your phone so they can use it. Participants stated they used apps that concealed their messages and pictures received in order to maintain privacy of their social media use.In this study, we sought feedback to adapt evidence-based peer navigation and mHealth approaches to promote HIV testing and HIV treatment engagement, respectively, among youth at-risk of and living with HIV in Nigeria. Local experts helped to identify points of adaptation, while community stakeholders provided feedback on both the feasibility and acceptability of the intervention approaches, as well as the adapted elements.Our local experts recommended adaptations to peer navigation for both the HIV testing and treatment interventions that largely reflect concerns about feasibility and sustainability. Recommendations to use volunteers who receive a stipend, instead of employees who earn a salary, reflects a concern about resources to sustain the interventions over time. Furthermore, while prior HIV treatment interventions, in particular, have adopted a 1:10 ratio of navigator-peers , this waRecommendations regarding peer navigator characteristics and matching of navigator to peers reflect the potential salience of identity and related experiences , as well as the importance of gender and religion in the local culture for reaching and successfully intervening with the focal groups of youth. Among YMSM specifically, there were concerns about the risk to peer navigators given the criminalization of homosexuality, thus the recommendation for human rights training to promote their safety.Comments from stakeholders in focus groups validate key aspects of peer navigation and mHealth intervention approaches. Much like the local experts, they agreed that common experiences and understanding among peers may help to promote both HIV testing as well as treatment engagement, which is consistent with recommendations for HIV-related intervention with youth  and YMSMRegarding the mHealth components of each intervention, stakeholders largely endorsed the ubiquity of both text messaging and social media use among the focal groups of youth, i.e., HIV-positive and YMSM respectively, with some feasibility caveats. Concerns about these approaches included confidentiality on the one hand, and potential limitations to technology access among some youth due to cost of both devices and data, on the other. Both text messaging and social media messaging present opportunities for breaches of confidentiality of HIV and/or YMSM status. Thus, they recommended approaches to promote access, as well as to protect confidentiality .Additional comments by focus group participants highlight recommended delivery mechanisms, message content, and platforms. While some participants suggested messages might be delivered to parents or caregivers in addition to, or instead of, the youth themselves, this suggestion was not widespread and may undermine a core characteristic of the TXTXT intervention: to support youth empowerment and self-management. Participants largely endorsed another core characteristic of the TXTXT intervention, personalization of messages, indicating that these may increase both salience of the messages and confidentiality. Finally, focus group participants endorsed the primary social media platforms suggested by local advisors, including WhatsApp and Grindr to reach YMSM, as well as Facebook.A key recommendation of stakeholders was appropriate training of peer navigators, particularly in confidentiality and professionalism, but also in the medical management of HIV infection to counter commons myths. This was perceived as ensuring promotion of positive relationships between navigator and peers, as well as confidence in recommended actions.Limitations for this study include the single-session feedback session with our advisory group, which may have limited the breadth and depth of expert advice, the relatively small sample size for focus group feedback and technical problems with the focus group recording among HIV-positive young women, which may have limited coverage of salient themes related to each intervention among the sample as a whole, and young women in particular. In reviewing detailed notes recorded for the young women’s group, we did not find additional salient themes, although notes are not as comprehensive as verbatim transcripts. In addition, conducting the focus groups in English may have limited the contributions of some youth who speak English as a second language. While the limited sample size did not allow us to reach saturation in subgroups, consistency in findings across these groups suggests cross-group saturation of themes. In addition, the high level of correspondence between recommendations of local experts and stakeholders reinforced confidence for saturation of themes.We conclude that in Ibadan, Nigeria, local experts and stakeholders support adaptation of mHealth and peer navigation strategies to promote HIV testing and care engagement among high-risk youth. Recommended adaptations reflect concerns about feasibility and sustainability, as well as effectiveness and safety in the local context, which are necessary to maximize accessibility and acceptability. The adapted interventions are being investigated at multiple clinical research sites across Nigeria.S1 Table(DOCX)Click here for additional data file.S1 File(DOCX)Click here for additional data file.S1 Fig(TIF)Click here for additional data file.