Voice

Members of the national steering committee for tobacco control in Ghana were interviewed on various aspects of the FCTC as part of a larger study investigating smoking prevalence, tobacco control and tobacco industry activity in Ghana [11 (link)]. All 28 members of the committee were contacted initially by telephone to book an appointment for the interview. Face to face interviews were then carried out with consenting individuals using a semi-structured interview guide (see Appendix 1). Interviews were conducted in English, and covered current and potential policies for tobacco control in Ghana, awareness of the FCTC, specific achievements resulting from the FCTC, and the challenges, if any, of implementing the key elements of the FCTC. The latter included price and tax measures, protection from tobacco smoke exposure, regulation of tobacco product disclosure, packaging and labelling of tobacco products, education, communication, training and public awareness (media campaigns), demand reduction measures concerning tobacco dependence and cessation services, illicit trade, sales to and by minors, provision of support for viable alternative livelihoods, and research, surveillance, and exchange of information. Interviews were carried out between January and May 2008, and normally lasted between 45-60 minutes. All interviews were audio-recorded using a digital voice audio-recorder and transcribed verbatim by the researcher. The study was approved by the committee for human research and ethics of the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana as well as the local ethics committee of the University of Nottingham, UK.

The study was reviewed and approved by the University of Melbourne Behavioral and Social Sciences Human Ethics Subcommittee, the University of Melbourne Human Research Ethics Committee, and the Victorian Aboriginal Health Service research subcommittee and Board of Directors in 2010. The methodology of the study and broader PhD program was grounded in Aboriginal scholar Lester-Irabinna Rigney’s three interrelated research principles that included privileging Aboriginal voices, political integrity, and resistance as the emancipatory imperative [31 , 32 ]. It also utilised Maori researcher Sir Mason Durie’s concept of research at the interface of Indigenous knowledge and science [33 (link)], with the design of the study also located in the field of psychology and public health.
Independent t-tests and pearson correlations were conducted to examine our hypotheses that: (1) client’s with personal experiences of child removal from natural family would report greater posttraumatic stress symptom severity in comparison to those who did not experience removal; (2) experiences of racism would be associated with greater posttraumatic stress symptom severity; and, (3) contrary to consistent findings in the worldwide PTSD literature, male Aboriginal help-seeking clients would report greater trauma symptom severity than female Aboriginal help-seeking clients. An exploratory analysis was also conducted to examine associations between trauma symptom severity and a range of strengths and cultural determinants of wellbeing from the subscales of the ARRQ (Gee, 2016), including: cultural identity, cultural practices, spirituality, community connection, opportunities in community, communal mastery, and safety. Hierarchical regression analysis was used to examine our hypothesis that (4) total strength scores would moderate the relationship between trauma exposure and trauma symptom severity, after controlling for financial distress. We also conducted an exploratory hierarchical regression analysis to investigate the contributing role of trauma exposure, stressful life events, and resilience in predicting trauma symptom severity, after controlling for financial distress.

Quantitative data were analyzed using IBM SPSS (version 27). Descriptive statistics (i.e., means, standard deviations [SD], frequencies, percentages) were computed to describe the sample at baseline. Following this, data were checked for approximately normal distribution4, univariate (z-score greater than 3 or less than − 3) and multivariate outliers (p-value < 0.01 on the Mahalanobis Distance Test), and sphericity. In cases where outliers were identified, sensitivity testing was performed (with and without outliers) to affirm consistent trends in the data and then outliers were removed on a variable-by-variable basis to enhance homogeneity and maximize statistical power. Repeated measures analysis of variance [51 ] were conducted to examine changes across time points (baseline [week 0], post-intervention [week 8], follow-up [week 16]) in physical and psychological outcomes. Of note, data were not nested based on wave or instructor, no adjustments were made, and a higher type I error probability was set (i.e., an uncorrected significance level of 0.05) to decrease the risk of missing a potentially beneficial effect of yoga5. The effect size of these changes was computed with partial eta squared ( ${\eta }_p{}^2$ ; small effect = 0.01, medium effect = 0.06, large effect = 0.14).
To analyze the qualitative data, interviews were transcribed verbatim and uploaded into NVivo (version 12) where they were subsequently analyzed by one author (EM) using conventional content analysis [52 (link)]. First, EM read each transcript several times to immerse herself in the data. Next, EM coded transcripts, created labels reflecting key ideas, and sorted the codes into higher-order categories. At this point, the author sent the coding scheme to another author (AW) who had reviewed the transcripts several times and challenged EM’s thoughts and interpretations. Following this, EM generated definitions for each category and selected exemplar quotes from the data to illustrate findings from the interviews. The penultimate coding scheme was then sent to all authors, each of whom was involved in the study design, intervention delivery, and/or data collection, to review and approve. Following this, EM revisited all raw data to ensure participants voices were accurately represented and the coding scheme was finalized. To promote rigor and trustworthiness, several steps recommended in the literature were followed [53 (link)]. The two authors who conducted the interviews (EM, KE) and one author who conducted the content analysis (EM) kept reflexivity journals and continuously (re-)examined their own perspectives and how they might influence interpretations. A critical friend (AW) challenged interpretations and sought to ensure the results represented participants’ voices and all authors critically reviewed the findings, and finally, category descriptions and exemplar quotes are available and presented herein to provide transparency.