Ableism is biased covert behavior or overtly discriminatory actions against people who are disabled. Ableism often involves words and actions that convey an attitude or belief that disabled people are inferior to nondisabled people, irrespective of whether the person holding these views (i.e., private events) is aware that their thoughts are biased or actions are discriminatory. All people have biases that have grown out of their exposure to harmful social norms, models, and observational learning as well as experiences and contingencies. As practitioners, administrators, instructors, and scientists, we are responsible for recognizing our own biases and actively working to alter our words and behavior so that our biases do not manifest in discrimination. This paper describes ableism and its impact on applied behavior analytic (ABA) practices, services, and supports and on the Autistic people we serve. The authors provide a brief discussion of the current efforts to reform ABA services and where they view anti-ableism is situated in the reform ABA movement. Then the bulk of the paper features examples of ableist practices and suggestions for dismantling ableism in ABA practice. Although these suggestions largely have not yet been submitted to empirical investigation, the general paucity of research in this area combined with the ethical directive to avoid discrimination requires practitioners to begin this work while empirical research is in its infancy. The companion article "Ableism in Applied Behavior Analysis: Historical Context of Services for Autistic People" (McComas et al., in press) provides a more in-depth exploration of the historical context of ableism in ABA.
Research in applied behavior analysis (ABA) has established the efficacy of behavioral assessment and intervention strategies based in the application of behavioral principles to issues of social importance. However, there remains a research-to-practice gap in which practitioners do not consistently implement procedures in applied contexts. Implementation science is the study of methods to promote the uptake of interventions into routine practice and uses varied methods to evaluate multiple outcomes of implementation. Qualitative research represent an important approach to the study of implementation, relying on the lived experiences of consumers to understand the contexts in which an intervention might be used. These data should inform intervention design, modification of existing strategies, and strategies to promote sustainability of interventions. In this paper, we describe the field of implementation science and how researchers in this field use qualitative research to promote the wide-spread uptake of intervention. We use this foundation to prepare behavior analysts to use qualitative research in their efforts to address the persistent research-to-practice gap in ABA.
Reproductive autonomy, the power to make decisions about and to control matters related to contraceptive use, pregnancy, and childbirth, is essential for women to attain their sexual and reproductive health and rights. We explored barriers and facilitators of reproductive autonomy among adolescent girls in western Uganda, a region marked by high rates of adolescent pregnancy and HIV prevalence. This qualitative inquiry involved 31 in-school and out-of-school adolescent girls aged 15-19 years, purposively selected from diverse communities within Fort Portal city, western Uganda. Data were collected through individual interviews between September and November 2024 and analysed using framework thematic analysis guided by the three dimensions of reproductive autonomy: decision-making, communication, and freedom from coercion. The findings show an intricate interaction of individual, relational, and structural factors that shape adolescent girls' reproductive autonomy, with commonalities and uniqueness based on schooling status. Key barriers included control by parents and partners in communication and decision-making, limited knowledge of girls on sexual and reproductive health, low self-efficacy to decide and implement decisions, financial dependence, and lack of life basics. Conversely, supportive relationships and schooling emerged as critical facilitators. In conclusion, enhancing reproductive autonomy requires multi-level and multi-faceted interventions to address the barriers while leveraging the facilitators. These should include household economic empowerment, parenting support programmes, and policies that promote universal access to education. DOI: 10.1080/26410397.2026.2683272. We studied what helps and what makes it harder for adolescent girls in western Uganda to make their own free choices about using contraceptives, engaging in sex, getting pregnant, and giving birth. We held interviews with 31 adolescent girls in the age range of 15–19 years from September to November 2024. Eleven girls were attending school while 20 were not. These girls were selected from different communities in Fort Portal city, western Uganda. We found a number of issues that affected these girls’ ability to make decisions about their Sexual and Reproductive Health (SRH). Some of the main challenges were strong influence from parents and sexual partners, limited knowledge of SRH, low confidence to decide and implement decisions, being financially dependent on parents and sexual partners, and lack of basic needs. On the other hand, being in school and having supportive people, such as family members, around the girls helped them to feel more in control and able to decide on SRH matters. To help these girls have more say over their SRH, the findings emphasise efforts at different levels of society and from different people with whom they regularly interact. Such efforts could include helping families improve their incomes to financially support the girls, supporting parents on how to communicate with the girls, and making sure all girls can get education. L’autonomie reproductive, c’est-à-dire le pouvoir de prendre des décisions et de maîtriser les questions relatives à la contraception, à la grossesse et à l’accouchement, est essentielle pour la santé et les droits sexuels et reproductifs des femmes. Nous avons étudié les obstacles et les facteurs favorisant l’autonomie reproductive chez les adolescentes dans l’ouest de l’Ouganda, une région marquée par des taux élevés de grossesse chez les adolescentes et de prévalence du VIH. Cette étude qualitative a porté sur 31 adolescentes, scolarisées ou non, âgées de 15 à 19 ans, sélectionnées à dessein dans plusieurs communautés de la ville de Fort Portal, dans l’ouest de l’Ouganda. Les données ont été recueillies au cours d’entretiens individuels entre septembre et novembre 2024, puis examinées à l’aide d’une analyse thématique cadrée, guidée par les trois dimensions de l’autonomie reproductive: la prise de décision, la communication et l’absence de coercition. Les résultats montrent une interaction complexe de facteurs individuels, relationnels et structurels qui façonnent l’autonomie reproductive des adolescentes, avec des points communs et des spécificités selon leur statut scolaire. Les principaux obstacles comprenaient la domination des parents et des partenaires dans la communication et la prise de décision, les connaissances limitées des jeunes filles en matière de santé sexuelle et reproductive, leur faible capacité à décider et à mettre en œuvre des décisions, leur dépendance financière et le manque de ressources de base. À l’inverse, les relations de soutien et la scolarisation sont apparues comme des facteurs facilitateurs essentiels. En conclusion, l’amélioration de l’autonomie reproductive exige des interventions à plusieurs niveaux et à plusieurs volets pour lever les obstacles tout en tirant parti des facteurs facilitateurs. Ces interventions devraient inclure l’autonomisation économique des ménages, des programmes de soutien aux parents et des politiques qui favorisent l’accès universel à l’éducation. La autonomía reproductiva (AR), el poder para tomar decisiones sobre cuestiones relacionadas con el uso de métodos anticonceptivos, el embarazo y el parto, y controlarlas, es esencial para que las mujeres puedan realizar su salud y derechos sexuales y reproductivos. Exploramos los obstáculos y facilitadores de AR entre las adolescentes en el oeste de Uganda, una región marcada por altas tasas de embarazo en la adolescencia y prevalencia de VIH. Esta investigación cualitativa involucró a 31 adolescentes de 15 a 19 años, en la escuela y fuera de la escuela, seleccionadas intencionalmente de diversas comunidades de la ciudad Fort Portal, en el oeste de Uganda. Entre septiembre y noviembre de 2024, se realizaron entrevistas individuales para recolectar datos, que fueron analizados utilizando el análisis temático guiado por las tres dimensiones de AR: toma de decisiones, comunicación y libertad de coerción. Los hallazgos muestran una interacción compleja de factores individuales, relacionales y estructurales que influyen en la AR de las adolescentes, con similitudes y singularidades basadas en la situación de escolarización. Los principales obstáculos eran dominio de los padres y parejas en la comunicación y la toma de decisiones, conocimiento limitado de las niñas sobre salud sexual y reproductiva, baja autoeficacia para tomar decisiones y aplicarlas, dependencia financiera y falta de conceptos básicos de la vida. En cambio, las relaciones y escolarización de apoyo surgieron como facilitadores esenciales. En conclusión, a fin de mejorar la AR se necesitan intervenciones multinivel y multifacéticas para abordar los obstáculos a la vez que se aprovechan los facilitadores, por ejemplo: empoderamiento económico del hogar, programas de apoyo a padres y políticas que promuevan el acceso universal a la educación.
Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.
Behavior analytic considerations of the role of parents in child-focused interventions are moving from a focus on parent adherence to concepts such as parent involvement, concordance, and collaboration. Despite this shift, little empirical work has canvassed the perspectives and experiences of behavior analysts or parents to support knowledge development in this important area of behavior analytic practice. The current study explored the experiences of two behavioral clinicians who are parents of children who have received behavioral intervention, with the aim of informing clinical work with parents. An interpretative phenomenological analysis (IPA) case study approach was applied, with interviews as the data collection method. Outcomes of the analysis highlight that for participants, the involvement of parents in behavior-analytic interventions relies on successfully navigating a continuum of expertise toward balancing whose knowledge holds more weight across the intervention context. Experiential themes generated in this study emphasize that clinicians who practice humility, listen actively, and value lived experience in establishing and delivering interventions will have the most success meaningfully involving parents in interventions for their children. Clinical implications of these findings are discussed, as well as future research directions.
While working in educational settings remains the second largest area of professional emphasis for Board Certified Behavior Analysts (BCBAs), there is a scarcity of research about how these professionals are prepared to provide services and supports in school-based placements. We investigated perceptions of school-based behavior analysts about their levels of preparation and confidence in applying their understanding of knowledge areas specific to school-based practice (i.e., multidisciplinary teaming, Individual Education Program teams, educational curricula and assessments, grade level benchmark standards and alternate standards for students with extensive support needs, educational law, and case law). Our focus was on identifying facilitators and barriers to effective school-based practice within their initial preparation. Additionally, we investigated how these professionals continued their education in these areas after receiving their initial credential. A total of 116 BCaBAs, BCBAs, or BCBA-Ds across each major geographic area of the United States completed a 26-item survey containing closed and open-ended questions. Most respondents perceived their initial behavior analysis training as providing no or minimal preparation in specific areas related to provision of services in educational settings. Those who had received supervised fieldwork in school settings rated their confidence in application of these areas in their practice higher than those who lacked such experience. Many respondents indicated that they had pursued or planned to seek additional training in these areas. They also identified facilitators and barriers to preparation for effective school-based practice. We discuss the results, implications for systems change, professional practice, and areas of future research. The online version contains supplementary material available at 10.1007/s40617-024-01028-7.
This study aimed to assess the impact of a brief web-based intervention for female college students with high-risk drinking on current drinking habits, as well as future intention and awareness regarding abstaining from alcohol during pregnancy. This quasi-experimental study recruited female college students with high-risk drinking and assigned them to either an intervention group (n=23) or a control group (n=23) based on availability and preference. The intervention group received a brief web-based session (30 minutes) focused on alcohol use prevention for future pregnancies and monitored their daily drinking using a mobile app for 1 month. Outcome measures included the Alcohol Use Disorders Identification Test, variables derived from the Theory of Planned Behavior (attitude, subjective norms, and intention) related to pregnancy, drinking refusal self-efficacy, and alcohol outcome expectancies. Data were analyzed using repeated-measures analysis of variance (ANOVA). There were significant changes in the mean differences from baseline scores between the groups with respect to positive attitudes toward drinking during pregnancy (t=-2.59, p=.013) and intentions to abstain from drinking during pregnancy (t=2.35, p=.005). Repeated-measures ANOVA demonstrated a significant interaction between group and time for both attitude (F=6.69, p=.013) and intention (F=8.58, p=.005). In addition, a significant improvement in drinking refusal self-efficacy was observed (t=2.49, p=.016). The brief web-based intervention significantly improved attitudes toward drinking during pregnancy, intentions to abstain from drinking during pregnancy, and drinking refusal self-efficacy, highlighting both the effectiveness and importance of this intervention.
In the evolving field of applied behavior analysis, there is a growing recognition of the value that qualitative research brings to understanding and improving interventions (Burney et al., Perspectives on Behavior Science, 46, 185-200, 2023; Leif et al., Journal of Applied Behavior Analysis, 57(3), 542-559, 2024). Our group of academics and practicing behavior analysts aim to share our journey towards incorporating qualitative approaches in our research and practice, underscoring their importance and application in enhancing our scientific endeavors. This article will guide readers through the process of qualitative inquiry, from thinking of words as data through to an introduction to qualitative inquiry methods and how to collect and analyze data. We then discuss some of the ethical considerations around qualitative research (researcher reflexivity, centering participant voice and cultural responsivity) and conclude with highlighting the value of mixed methods research, as we work towards enhancing the social validity of behavior-analytic interventions. Through sharing this journey, we are hoping our behavior-analytic peers will recognize that the path to including qualitative approaches in their research is not daunting and will lead to valuable insights into how we meet the needs of those we serve.
The field of behavior analysis has grown rapidly in recent years, as evidenced by a marked increase in the demand for certified behavioral professionals. Despite this growth, the field of applied behavior analysis continues to face challenges in effectively disseminating behavior analysis to non-behavioral professionals and laypeople. Effective dissemination efforts are critical for moving the field forward; however, the existing literature does not include any structured resources, supports, or activities for instructors and supervisors related to this topic. This paper includes resources, supports, and sample activities to support instructors and supervisors in training novice behavior analysts in dissemination-related skill domains. Specifically, we identify and describe dissemination-related skill domains and provide recommendations for supporting novice behavior analysts in developing these skills, provide structured and specific resources (e.g., sample instructional activities, assignments, and discussion prompts) for instructors and supervisors who train novice behavioral professionals, and offer recommendations for embedding dissemination-related content into existing university program and supervision structures.
Ableism is broadly defined as a set of behaviors and attitudes or, in behavior-analytic terms, as private events, deeply embedded within societal norms (Friedman & Owen, 2017). This paper explores the concept of ableism and its relation to applied behavior analytic services, with a particular focus on its implications for services provided to Autistic people. The purpose of the paper is neither to criticize nor to offer apologies for applied behavior analysis (ABA), but rather it is to aid the reader in understanding ableism by describing the context in which applied behavior analytic interventions were designed to attenuate some of the severe behavior that was distressing for the Autistic person and their caregivers (e.g., parents, staff). Examples of such behavior included self-injury, aggression, and extreme social withdrawal which were characteristic of individuals diagnosed as Autistic in the early days of ABA. The authors trace the evolution of ableism in ABA through to the present day, in which the heterogeneity in behavioral expression and needs of people diagnosed as Autistic are perhaps greater than ever, and some of those needs continue to go unaddressed. This paper, along with its companion article, "Ableism in Applied Behavior Analysis: A Beginner's Guide to Understanding and Dismantling Ableism in Practice with Autistic People," have incorporated both the limited available research regarding ableism in ABA-related services and lived experiences of some of the authors and other Autistic people whom the authors have provided services.
Adolescent pregnancy is a global issue. In adolescent pregnant women, health practices which are the activities that positively influence maternal, foetal, and neonatal health can be associated with various socio-demographic, psychological, and environmental factors. These can impact the outcomes of the pregnancy and the well-being of both mother and foetal. This study aims to identify health practices and associated factors among adolescent pregnant women. A cross-sectional study was conducted at a tertiary-care hospital. The sample of the study was calculated using a known population sample equation. A total of 128 pregnant women participated including 55 adolescents and 73 adult pregnant women. Data were collected using the 'Participant Description Questionnaire' and the 'Health Practice Questionnaire-II (HPQ-II)'. The research data analysed in this study were obtained from pregnant women who attended an antenatal follow-up clinic and who obtained informed consent to participate in this study. Data analysis was performed using SPSS for Windows Version 22.0 (IBM Corporation, Armonk, New York, USA). Comparative statistical analyses employed the independent sample t-test and the one-way analysis of variance (ANOVA) test; kwhen a difference was detected by ANOVA, the source of this difference was identified using the Tukey test. The Pearson correlation test was used to identify relationships between pairs of continuous variables. The average total HPQ-II score among adolescent pregnant women was 110.6 ± 14.3 compared to 121.3 ± 12.2 among adult pregnant women. Average total HPQ-II scores differed significantly between adolescent and adult pregnant women (p < 0.001). Average total HPQ-II scores among adolescent pregnant women differed significantly according to income level (p < 0.05) and prenatal care status (p < 0.001) while it was significant differences between HPQ-II scores and education level (p < 0.05), health insurance status (p < 0.001), and employment status (p < 0.05) in adult pregnant women. The reported health practices among adolescent pregnant women were poor than those among adult pregnant women in this study. Additionally, as income level increased, health practices among adolescent pregnant women also improved. Moreover, adolescent pregnant women who regularly attended antenatal follow-ups maintained better health practices. Additionally, adult pregnant women who had completed high school or higher education, were employed, and had health insurance exhibited better health practices. Therefore, it is recommended that the frequency of follow-ups for adolescent pregnant women be increased, that their health practices be evaluated, and that education and counselling services be provided that are tailored to their needs. Within the scope of the study, adolescent pregnant women had less access to healthcare services than adult pregnant women.
In behavior analysis, the concept of reflexivity as it relates to stimulus equivalence is well-studied and understood. However, reflexivity as defined through qualitative inquiry also holds value for behavior analysts to promote rigor, transparency, and equity in research. We propose turning foundational behavior-analytic skills inward to observe one's own behavior and to determine why we do what we do in our research and practice, including a consideration of epistemology and axiology. The act of considering qualitative reflexivity can help behavior-analytic researchers and practitioners examine how their individual perspectives, subjectivities, and biases may inform their subsequent observable behavior related to research. Although we suggest the benefits of qualitative reflexivity for all research contexts, engagement in this process is particularly important when considering work with marginalized communities. A process of self-reflective guidance should be utilized by behavior analysts to consider qualitative reflexivity regarding power structures, historical impact, and decision-making processes. Reflecting and questioning assumptions about whose voices are privileged in the research context is fundamental for all researchers and can be explored in behavior analysis through this process of qualitative reflexivity.
This is a pivotal time for researchers in applied behavior analysis (ABA) to embrace intersectional qualitative methods as ABA has faced criticism for its use of aversive procedures, emphasis on compliance, and focus on normalization, which can be detrimental to autistic individuals and other marginalized groups. It is imperative ABA shifts and adjusts to remain relevant and meaningful to the people we aim to support while encouraging social justice for all. Intersectional qualitative inquiry allows us to uncover how systems of privilege and oppression affect those who experience them: that is, how an individual's interactions with these systems produce their learning history. Better understanding an individual's learning history by examining intersectionality through qualitative inquiry allows us to integrate social justice and equity more deeply into ABA work. Applied behavior analysts must critically evaluate their practices and adopt approaches that respect and acknowledge the lived experiences of individuals, especially those from marginalized communities. This conceptual manuscript outlines considerations for embracing intersectional qualitative inquiry, including ways to begin thinking intersectionally that align with behavior analysis and of how intersectionality applies to each stage of the research process.
As artificial intelligence (AI) based applications rapidly expand in capability and accessibility, graduate programs in applied behavior analysis (ABA) must adapt their pedagogical models to harness their benefits while mitigating risks. This article examines the integration of large language models (LLMs) in ABA education, highlighting how faculty can support student learning while preserving academic integrity. The article examines practical strategies for integrating AI into conceptual and performance-based assessments, emphasizing approaches that maintain strong instructional standards, promote ethical use, and require authentic demonstration of competence. Examples drawn from ABA coursework demonstrate how LLM applications can be thoughtfully incorporated, and recommendations are offered for clarifying appropriate LLM application use, prompt engineering, and rubric-based grading. In addition, the article discusses the importance of proactive policy development, including behavioral contracts and assessment tools, to set clear expectations. Future directions include adaptive learning platforms, virtual clients powered by LLMs, and competency-mapping dashboards that track progress across a student's academic trajectory.
Premature pregnancy among adolescents remains a critical public health challenge, particularly among ethnic populations in low-resource settings. Health literacy has been identified as a key determinant of reproductive decision-making and preventive behaviors. This study aims to assess the levels of health literacy and examine their association with pregnancy prevention behavior among ethnic students in northern Thailand. A cross-sectional study was conducted with 128 in-school ethnic adolescent girls, using validated instruments to measure health literacy across three domains: basic, interactive, and critical health literacy, and pregnancy prevention behavior. Descriptive statistics, Pearson's correlation, and multiple linear regression were used to analyze the data. The participants exhibited moderate overall health literacy, with high scores in decision-making skills but relatively low scores in basic and interactive literacy. Pearson's correlation analysis revealed that critical literacy was positively associated with prevention behavior (r = 0.336, p < 0.001), while interactive literacy showed a negative correlation (r = -0.247, p < 0.001). Multiple regression analysis further confirmed these associations. Critical literacy significantly predicted pregnancy prevention behavior (β = 0.438, p < 0.001), whereas interactive literacy had a significant adverse effect (β = -0.568, p < 0.001). The model explained 17.8% of the variance in behavior (R 2 = 0.178). The findings underscore the importance of critical health literacy in fostering preventive behaviors among ethnic adolescents. Tailored interventions should emphasize evaluative and judgmental skills while addressing culturally rooted communication challenges. These insights may inform inclusive reproductive health policies in ethnic and underserved communities.
Residents in persistent poverty areas experience higher cancer mortality due to social determinants of health that negatively affect multiple factors, including health behaviors. This study aimed to characterize demographic, clinical, and social determinant of health factors among survivors of cancer in persistent poverty areas using electronic health record (EHR) data-including an embedded social risk screener and natural language processing (NLP) of social work notes-to inform community-engaged adaptation of lifestyle interventions. EHR data from a large multispecialty group practice were extracted for patients with cancer residing in zip codes inclusive of persistent poverty areas targeted for a health behavior intervention and receiving care between January 2018 and November 2023. Self-reported social determinant of health data were obtained using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) and through NLP of social histories from a social work visit. We identified 2672 unique patients with cancer, of whom 578 (21.6%) had PRAPARE data and 1597 (59.8%) had social history data available for analysis. The most common cancers among survivors (n=1420, 53.1% female; n=1299, 48.6% Black individuals; mean age 65.2, SD 13.7 years) included breast (n=536, 20.1%), prostate (n=400, 15%), and lymphoid or hematopoietic (n=323, 12.1%) cancer. Among survivors in persistent poverty areas (n=509, 19%; all with a high Social Vulnerability Index), 34.6% (176/509) were single, 55.4% (282/509) had Medicare coverage (with only 73/509, 14.3% having private insurance), 36.5% (186/509) had obesity, 63.9% (325/509) had hypertension, and 31.2% (159/509) had diabetes. Of survivors in persistent poverty areas with PRAPARE data, 15.8% (19/120) lacked transportation, 4.2% (5/120) lived with housing insecurity, and 6.7% (8/120) felt unsafe where they lived. Innovative EHR and NLP approaches identified several socioeconomic and safety-related challenges along with opportunities for health behavior interventions to leverage Medicare coverage and target multiple comorbidities when adapting interventions for survivors of cancer living in persistent poverty areas.
Qualitative research is a common methodology used in fields such as education and medicine, but it is less common in behavior analysis. To explore the current use of qualitative approaches in behavior analysis, we conducted a scoping review aligned with recommendations from Arksey and O'Malley (2005) and Levac et al. (2010) across eight influential behavior-analytic journals to answer the research question: What are the characteristics of qualitative research in behavior-analytic journals? The search and screening resulted in 38 articles meeting the inclusion criteria across five of the eight journals. Data were charted and presented across basic publication metrics, qualitative approaches, study aims, and population or data source information. Most of the included articles were published in Behavior Analysis in Practice, utilized multiple methods, involved interviews with caregivers of individuals with disabilities or professionals in applied behavior analysis, and were analyzed using thematic analysis. Recommendations and resources for future qualitative research in behavior analysis are presented.
High-quality teaching is foundational for producing high-quality behavior-analytic practitioners and researchers. This manuscript explores how behavior analysts can incorporate qualitative assessment methods in both formal educational settings (e.g., behavior-analytic coursework) and supervisory experiences that prepare behavior analysts to enter the field. In particular, we focus on the integration of qualitative methods to evaluate social validity, metacognition, and learning outcomes. Integrating qualitative methods in coursework and supervision holds the potential to enhance learner's self-understanding and insight, while also allowing instructors and supervisors to better customize pedagogical choices to their students and trainees. Strategies to incorporate qualitative data collection and analysis are provided. The application of qualitative techniques could help to promote culturally responsive practices in the classroom and in supervision. In reflecting on the implementation of qualitative techniques with the teaching of behavior analysis, elements of qualitative analysis are likely already in use, but the field has not yet fully explored or acknowledged the role these sources of data play in instruction.
Motivating operations alter the value of a consequence and increase or decrease the current likelihood of behavior that has previously been followed by that consequence. Unconditioned motivating operations do not require a learning history to alter the effectiveness of a reinforcer, whereas conditioned motivating operations (CMOs; reflexive, transitive, and surrogate) require a learning history to alter the effectiveness of consequences and occur frequently in clinical practice. This paper reviews applied and basic research on CMOs published since Langthorne and McGill, Behavior Analysis in Practice, 2, 22-31, (2009) and translates key findings into practical guidance for clinicians. In addition, research on CMOs is integrated into clinical examples and practice guidelines to assist practitioners with the successful identification and integration of CMOs into behavior-analytic interventions. Potential implications of this paper include improved accuracy in identifying the motivating variables that influence challenging behavior, enhanced selection of function-based treatments, and greater precision in arranging antecedent conditions to strengthen appropriate alternative behavior.
The convergence of many shifts within and outside the field of behavior analysis have led to an important conclusion: now more than ever before, qualitative behavior analysis as a distinct branch of behaviorism is warranted, useful, and necessary. This article explores what qualitative behavior analysis could be, and do, within the field of behavior analysis. An outline of how qualitative behavior analysis can fit within the broader field is provided. Ways in which qualitative behavior analysis can be considered consistent with radical behaviorism are discussed, alongside a consideration of tenets which discriminate qualitative behavior analysis as a unique branch of the broader behavior analytic field. In advancing a call for qualitative behavior analysis, we invite the field to consider and discuss how, and why, a qualitative branch to our science might bring value, and ameliorate some of the big issues facing behavior analysis today.