Reflexivity in Data Collection: Psychology Students’ Interpretations of Osteoporosis Patient Experiences – A Qualitative Case Study

Reflexivity in Data Collection: Psychology Students’ Interpretations of Osteoporosis Patient Experiences – A Qualitative Case Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Reflexivity in Data Collection: Psychology Students’ Interpretations of Osteoporosis Patient Experiences – A Qualitative Case Study Dilek ALAY, Esra KARAGÖZ, Esin TEMELOĞLU ŞEN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7560544/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objective: In many studies, data collectors' views and observations regarding both the data collection process and patients are often insufficiently represented or integrated into the research framework. This study aimed to investigate the potential impact of psychology students' perceptions of patients, particularly in the context of their participation in the data collection process for a research project. A qualitative content analysis design was used. Data were collected through face-to-face and telephone interviews with 20 participants. The interview protocol was developed based on expert consultation to ensure content validity, and qualitative data were analyzed using MAXQDA 2022 to identify key themes and patterns. Results: The analysis revealed three main themes: illness perception, social support, and barriers to treatment. Patients were aware of their illness and treatment processes and expressed the need for emotional, psychological, instrumental, informational, and companionship support. While they generally reported satisfaction with healthcare providers and institutions, they also faced barriers such as limited access to healthcare, physical and environmental constraints, economic difficulties, and psychosocial challenges. The study showed that qualitative insights from interviews with those interacting with patients aligned with findings from quantitative research, emphasizing the value of integrating diverse methods to capture the complexity of patient experiences. Qualitative research Osteoporosis patients Student evaluations Illness perception Social support Background The growing recognition of patient-centred care in managing chronic illnesses has highlighted the importance of understanding not only patients' lived experiences but also the complex factors that influence data collection in clinical research [ 1 ]. Osteoporosis is a chronic, progressive musculoskeletal disease that significantly impacts quality of life. It requires comprehensive research methods to capture the subjective aspects of illness perception, social support networks, and barriers to treatment adherence [ 2 , 3 ]. The views of data collectors—often frontline personnel in both qualitative and quantitative research—remain underrepresented, despite numerous studies examining patients' self-reported experiences and perceptions [ 4 , 5 ]. The observations and interactions of data collectors during the research process can provide valuable supplementary narratives, offering contextual insights that enhance the primary data obtained from patients. Nevertheless, these reflections are often regarded as peripheral or anecdotal rather than systematically analysed as a source of empirical evidence [ 6 ]. The impact of a researcher's influence on the entire research process is a critical issue often underscored in qualitative studies. It is essential to address concerns regarding the accuracy and applicability of the data collected in scientific research [ 7 ]. Quantitative research allows for a more predictable and mathematical application [ 8 ]. However, researchers may be influenced by their perspectives on the various aspects of quantitative studies. Therefore, researchers need to be conscious of their biases before, during, and after the research process in both quantitative and qualitative research [ 6 , 9 ]. The concept of reflexivity is fundamental in this context, emphasizing the potential of researchers' assessments, beliefs, and judgments to shape the entire research process [ 6 ]. Although social and personality psychologists have emphasized these concepts for a long time, there has been insufficient focus on the reflective attitudes of professionals working with and collecting data from clinical samples [ 10 ]. Research in this field typically examines how a researcher's perception of social roles, such as the gender identity of participants, can influence research outcomes during data collection [ 11 ]. However, it should not be overlooked that it is also critical to consider the potential biases of researchers who collect data from clinically diagnosed individuals. The present study aims to examine the impact of researchers' assessments of the data collection process on the research process in a clinical study. To this end, the study aims to evaluate the assessments of individuals collecting data on patients and diseases using a qualitative design. During the interviews, three themes emerged as critical components of the disease process for osteoporosis patients: how patients perceive their disease, their perceptions of social support, and the barriers they encounter. Details related to these three themes, along with how they are important as critical components of osteoporosis, are discussed below. Illness perception Illness perception refers to how a person mentally represents the disease process using information from different sources [ 12 ]. The self-regulation model (SRM) was developed by Leventhal et al. (1984) to measure illness perception [ 13 ]. The purpose of the SRM is to explain the factors that influence adaptive behaviors related to the treatment process [ 12 ]. Model disease identity, cause, time, outcome, control/ treatability [ 14 , 15 ], emotional dimension, and understandability of illness [ 16 ]. The results of the study, which assessed patients' perceptions of osteoporosis, showed that patients were able to describe the nature and causes of the disease, but had difficulty explaining it from a personal perspective. In addition, patients perceived osteoporosis as a chronic disease with no cure and described it as a condition that minimally affected their daily lives [ 3 , 17 ]. As Leventhal et al. (1992) stated, information and experiences from external sources are expected to influence illness perception [ 12 ]. From this standpoint, illness perception may be shaped by environmental information or experiences, similar to patients who actively collect data. This study, therefore, aims to explore these individuals’ illness perceptions in detail within this context. Social support Social support is a voluntary action that has a positive impact on well-being [ 18 ]. It supports bio-psycho-social recovery and helps to meet a person's needs [ 19 ]. Family, friends, or others provide this information support [ 20 ], togetherness support [ 21 ], instrumental, emotional or physical support [ 22 ]. Social support benefits different age groups, including children [ 23 ], young adults [ 24 ], middle-aged adults [ 25 ], and older adults [ 26 ]. Studies show that it reduces pathologies such as cardiovascular [ 27 ] and helps in the treatment of diseases such as cancer [ 28 ]. In osteoporosis, social support is crucial for well-being and treatment [ 29 , 30 ]. Data collectors’ assessments of patients’ social support levels may significantly affect the data collection process. Accordingly, this study seeks to examine and explain the discrepancies between perceived and observed social support. Patients’ Barriers Patients may face barriers such as economic, geographical, or access issues when seeking treatment. In many regions, patients without sufficient resources may struggle to continue their treatment [ 31 ]. Lack of health insurance or inadequate health policies can also create economic barriers that negatively affect ongoing care. Patients may face additional barriers, such as the location of the hospital [ 32 ] or difficulties in reaching service providers, making access to care more difficult. Patients with osteoporosis may experience physical limitations and severe or chronic pain from fractures, which can reduce their quality of life [ 33 ] and interfere with treatment. The disease can also affect family responsibilities, leading to social isolation [ 34 ] and communication difficulties within family and social circles. Warriner et al (2007) identified barriers to osteoporosis care as a lack of awareness of treatment, economic barriers, and inadequate support from carers and professionals [ 35 ]. In addition, physical challenges such as falls and fractures can exacerbate the disease and hinder recovery [ 36 ] (Smulders et al., 2011). Assessments of barriers encountered by patients may influence the data collection process. Given that osteoporosis patients frequently face numerous barriers, data collectors’ evaluations of these challenges are considered important. Accordingly, this study aims to examine patient barriers from the perspective of data collectors. Current study This study aimed to view patient profiles and illness experiences from the perspective of psychology students involved in data collection in a comprehensive project. In other words, this study aimed to examine the profiles of osteoporosis patients considering evaluations of university student participants. Psychology students may have a more professional perspective of patients because of the education they receive. However, the social assumptions and judgments of data collectors may still make it challenging to achieve this objective [ 6 ]. Therefore, obtaining information about the experiences of people conducting the data collection process will increase their level of awareness of their judgments. The current study aimed to explore the reflexive attitudes of psychology students who participated in the data collection process and to evaluate patients' illness evaluations, perceptions of social support, and barriers from the students' perspective. The central research questions guiding this study are: How do psychology students perceive osteoporosis patients' illness experiences during the data collection process? What social support needs and barriers to care do students identify in their interactions with osteoporosis patients? How do students' reflexive stances and professional training influence their interpretations of patient narratives? By addressing these questions, this study contributes to the broader discourse on enhancing methodological rigor through reflexivity and offers practical insights for integrating reflective practices into clinical research training programs. Methods Design This study uses a phenomenological approach [37]. This method, widely applied in fields such as health, social work, and psychology, seeks to capture individuals’ experiences and is considered the most suitable approach for the objectives of this study. Verbal consent was obtained from all participants in accordance with ethical guidelines. Given the need to document participants' statements, verbal consent was explicitly recorded. Prior to the audio recording of the interview, participants were informed about the study's purpose, confidentiality measures, and their right to withdraw. They were then asked to reaffirm their consent at the beginning of the recording to ensure ethical compliance and transparency. Participants This study included 20 female students in the second, third, and fourth years of the psychology department of a XX university in 2022-2023. The educational data of the students participating in this study were as follows: nine students in the 2nd grade, nine in the 3rd grade, and two in the 4th grade. The inclusion criteria were as follows. 1. Being a student in the psychology department. 2. Receiving foundational training in data collection from the lead author 3. Having participated in data collection with osteoporosis patients in the clinic for the current research. 4. Volunteering to participate in the present study. Data Collection Tools Semi-structured interviews were conducted to answer the questions identified in this study. Before the interview form was created, questions about the experience were researched in the literature and organized in line with the opinions of expert faculty members in the field. As a result, this interview form included questions about students’ experiences, patient characteristics, and details of patients’ disease processes. Within the scope of this study, ten main and probe questions were prepared by the researchers. The first and second authors answered these questions by interviewing the participants. In this direction, 20 volunteer students who met the inclusion criteria were interviewed. The research questions in this study were as follows: What are the patient profiles formed from the perspective of psychology students involved in the data collection? What are the ways in which patients approach treatment from the perspective of psychology students involved in the data collection? How do patients approach themselves from the perspective of psychology students involved in the data collection? What are the important factors in the treatment process of patients from the perspective of psychology students involved in the data collection? What types of psychological and social support do patients need from the perspective of psychology students who have been involved in data collection? Data Collection and Analysis A semi-structured interview consisting of ten main questions and probing questions was used in this study. The interview form was first piloted online with two students, and the questions were finalized with minor changes made in parallel. Students who volunteered for the project were expected to participate in face-to-face or online interviews at the end of two weeks, and the answers of the students who could participate were recorded. At the end of the project, zoom interviews were conducted with volunteers who could not be interviewed face-to-face for various reasons, and these interviews were audio recorded. The interviews, which lasted approximately 20 minutes each, were converted into written documents in a Microsoft Word environment and then parsed in an Excel environment. The separated data were analyzed using the content analysis method of MAXQDA 2022 software. Ethics and Reliability Throughout all stages of this research, care was taken to ensure that ethical principles were not violated, and all relevant ethical rules were followed. The ethics committee approval required for this study was obtained from the XX. Participants were informed about the purpose of this study, their roles in the study, and the recording of the interviews, and their consent was obtained. This study was conducted in accordance with the principles of the Declaration of Helsinki. Results The data obtained from the students' interviews were categorized under the following meta-themes: patient profiles, relatives' approaches to the treatment process, patients' evaluations of the disease/treatment process, patients' social support needs, and patients' barriers. Table 1 details the sub-themes of these categories. Insert Table 1 Here Patient Profiles The patient profiles and characteristics are presented in Table 2. When Table 1 was examined, the emphasis on patient profiles from students' perspectives was categorized as underage, personality traits, accompanying individuals, and gender. The results indicated that many of the patients were female (n=16) and elderly (n=10). It was also observed that patients commonly came either with a relative (n=16) or alone (n=12). Regarding personality traits, participants were most frequently described as kind or moderate (n=5), soft-faced (n=3), or warm (n=3). Insert Table 2 Here Patients’ Evaluations on Disease/Treatment Processes The results regarding patients' evaluations of the illness and treatment processes were categorized according to Leventhal's Self-regulatory Model (SRM) [1]. This model includes five cognitive domains: identity, timeline, consequences, perceived cause, control/treatability, non-cognitive domain, and emotional dimension, which were later incorporated [16]. These categories were used to assess individual reactions to the perceived threat of illness. Additionally, the category of hospital-doctor satisfaction was included because it influences patients' treatment processes, as noted in the literature [38, 39]. This is frequently encountered in content. -Identity: Illness identity, a cognitive domain, refers to how individuals perceive and experience symptoms of their disease [1]. This domain includes patients' views on how their self-perception aligns with that of their illness. In this context, patients discussed either ignoring/rejecting or rejecting the disease and its impact on their lives. Their perspectives are detailed below: I do not have a disease (P1) “Yes, I will live with it, but I can learn to keep up with it, and it won't be such a challenging thing for my life” like they approach illness positively. (P5) It was observed that patients demonstrated two distinct perspectives: either accepting or denying their illness. Patients who accepted their condition generally exhibited a more positive orientation toward the treatment process. -Timeline: This includes the perceived timeline of the illness [1]. Opinions on the expected or perceived duration of the disease were also included. Some of these views are as follows: … they both believed that the treatment would last a lifetime. I thought maybe it was because they were too old now. (P16) …I mean, like, “It won't get better; I'm going to live like this anyway.” (P5) According to these views, students perceive the duration of osteoporosis to be lifelong. People with this disease perceived that the disease was incurable and that it would be with them until they died. -Consequences: This cognitive category includes physical/functional, personal, social, and economic factors expected to be affected by the disease [40]. Students’ views on the consequences of the disease as perceived by the patients were included. Some of these views are as follows: “I learned my value afterward, you know, my value thanks to this disease. I pay more attention to myself, and I consider myself valuable.” (P2) One thing I would like to say is that there is nothing that would affect their lives so much because it seems like they only use their illnesses as an excuse for themselves. For example, “I have something like this on my foot, so I can't do such things”, but they can do other things. (P15) Participants’ experiences with different types of patients, whether they began to appreciate life more or resorted to excuses, appeared to influence the outcomes of patients’ perspectives on their illness. -Perceived cause: Factors that are responsible for disease onset of the disease [40]. This includes the patients' perceptions of the reasons for the development of the disease. Obviously, it is a little bit due to nutrition, which is what they think. (P3) For example, she said that the reason for her illness was that her grandson was constantly shaking her leg on his knee, like putting her on her feet and shaking her. (P13) According to Participant 3, the cause of the disease was diet, while Participant 13 stated that he thought the patient had this disease because of various physical movements. -Control/treatability: This cognitive factor also includes beliefs that a disease can be controlled or treated [15]. Accordingly, the patients’ perceptions of the control/treatability of the disease differed. The findings indicate that while some participants perceived the disease as treatable, others emphasized its uncertainty and adopted a more fatalistic outlook. Some of these views are as follows: He was very positive. He was aware of the importance of treatment. He knew that his life would be difficult without treatment. (P14) However, even though they find medication useful, I don't think they believe that they will be cured and get rid of the illness. I think they see medication as a factor that suppresses pain to make their lives easier. (P7) -Emotional and social dimension: Finally, this dimension, which is considered a non-cognitive factor, includes perceptions of the emotional representation created by the disease and is additionally considered together with social components. Accordingly, the students’ opinions were as follows. People who did not have family members or friends, or who did not have enough support, said that they got through the illness more severely. (P11) Yes, including the treatment, generally I think the treatments were going well, the dates, at least in the patients I did, you know, only one of them had a fall, he had a lot of high anxiety recently. The treatments of the others were going well. Therefore, they could not make any bad comments. (P17) They seemed uncomfortable being on medication constantly and a lot (P18). Based on these findings, social support appears to exert a positive influence on patients, whereas medication use and fear of falling are associated with negative effects. -Hospital and doctor satisfaction: Students stated that patients were generally satisfied with their current choice of hospital and doctor, especially for osteoporosis, and that they evaluated this positively during the treatment process. Some opinions on this issue are as follows. Most patients were satisfied with the approach of the doctors and the hospital. Their attitudes also positively affected the treatment process (P1). They trusted and respected the doctors, and this trust increased their belief in the treatment and their ability to live with this disease. (P19) In line with these opinions, it was understood that patients' satisfaction with the hospital and doctors in general regarding the treatment processes came to the forefront. Their satisfaction can also positively contribute to treatment. Social Support Needs of Patients The multifactor structure of social support [41, 42] was used to determine the social support needs of the patients. The need for social support was evaluated using five categories of social support. These are psychological, informational, emotional, instrumental, and accompaniment supports. -Psychological support: This includes the view that patients need professional psychological support. Some views on this topic are as follows: Of course, if there is psychological support, it is free of charge; you know, at least a therapy support can help them change their perspective on the disease and make faster progress in the treatment process. It may help them to make faster progress and reach a point where they can sell more. (P13) As a result of patients’ interview experiences with students, psychological support needs may emerge in parallel with the stress experienced during the illness and the emotional requirements of the treatment process. -Informational support: Information about the disease and treatment processes was included. Regarding the need for informational support, there are opinions on the need for patients to know about the disease and its consequences. I believe it would be beneficial to make this a group therapy session, which could enhance communication among patients. This increased interaction might raise awareness and consciousness about the disease as it becomes a more prominent topic of discussion. Unlike other conditions, such as high blood pressure or osteoporosis, often casually managed with daily medication, osteoporosis deserves focused attention. By bringing together individuals who share this condition, we can foster conversations, increase understanding, and ultimately raise awareness about osteoporosis. I think this approach would be highly useful. (P3) The patient understands what needs to be done and is willing to do it. (P8) I think they should get support in terms of nutrition. Some of them were malnourished. (P20) In addition, it is important for patients to be aware of their treatment processes and proper nutrition/diabetes-appropriate nutrition. -Emotional support: In addition to professional support, participants discussed the need for emotional support that prioritizes patients' feelings. Participants stated that patients' feelings and thoughts should be taken into consideration and given importance: When you support their feelings, their thoughts, or their decision-making, you know, without overthinking. They gave answers quickly. It was as if no one had ever asked them about their feelings and thoughts before. Maybe I could have prioritized these factors. That seemed a bit important to me, to be honest. It was as if they had never thought about it before. (P4) Most of them do not have emotional sharing anyway, and they find it awkward and uncomfortable to talk about it. Therefore, when working with these patients, I would try to make emotional expression comfortable for them. (P19) According to these views, the patient should not keep his/her emotional experiences to himself/herself but should be together with people with whom they can share their emotional experiences. -Accompaniment support: This type of support includes the needs of patients regarding the availability of people to talk to them, accompanying their treatment process, or taking care of them. I think it is very important to have the full support of the family, friends, etc. (P2) It would be good if patients who cannot leave their homes or who have difficulty in coming would be taken from their homes by ambulance and someone would accompany them to the hospital and take care of their information and document works. (P7) Participants emphasized the importance of a companion for the continued mental and physical health of patients, whether they are relatives or not. Instrumental support: These views were included in this support category, which deals with the needs related to environmental and concrete factors: ...and some money (P9) ...Economic support is always their own money, their earnings, or a pension. I don't know, something, or at least their economic comfort around them can support them. (P13) Financial support answers to the question of need were considered instrumental. According to these responses, the instrumental support required for the treatment process includes economic support. It was emphasized that patients needed financial aid during the disease process. Patients’ Barriers The subthemes of access to treatment, environmental, economic, psychosocial, and physical barriers were created to detail the barriers to patients in the illness process. -Access to treatment: Here, patient barriers to accessing treatment are addressed. This access was expressed in an abstract rather than in a physical/environmental access. The students talked about their access to treatment as follows: They said that they sometimes forget when to take their medication and have difficulty keeping track of it (P6). But in general, this hospital process tires people out, coming and going to the hospital. (P9) Apart from that, accessibility to treatment. I mean, from where, for example, they at least come to our hospital. I don't know because our hospital is a good one in Istanbul, even in Turkey, they come with the intention that we can be even better, they pay certain prices for this, their hours go on the road, or they do something. (P13) Not being able to find an appointment. (P20) Participants highlighted that patients may face various challenges during the treatment process, which can be physically and emotionally demanding. -Environmental barriers: External factors were examined in the environmental barrier category. Here, there were opinions, especially on physical access, that is, transportation, with participants stating that patients had difficulties in physically reaching the hospital: Difficulties in reaching the hospital. (P7) Problems, such as transportation. It can be solved. (P9) -Economic barriers: The economic barriers faced by the patients during the treatment phase are mentioned here. Participants mentioned drug costs, high food prices, and patients' financial difficulties. The cost of medicine (P6) They said they were having financial difficulties now. (P9) Yes, I mean, yes, it makes sense, for example, in the questions we ask, Do you eat meat? And they say, “How can we buy meat? I mean, if we can afford it, once a month, once a year. That's how it usually is.” (P3) -Psychosocial barriers: Psychosocial barriers include the common social and psychological barriers faced by patients during the disease process. Here, factors such as familial and personality effects have been discussed. Participants indicated that patients experiencing family problems, loneliness, or social isolation face barriers that negatively impact the treatment process. Also, social isolation is very high, and he doesn't leave the house. (P13) They said that stress factors in the family were effective in their illnesses. One of them said that she was stressed because she could not marry off her child; one said that she was stressed because of her husband. (P11) There seemed to be no one they could relate to emotionally and intellectually about their illness. (P18) According to these views, patients face obstacles when trying to cope with other responsibilities and problems in the family during the treatment process, which affects their reluctance, stress, and sadness. -Physical barriers: The last barrier, physical barriers, was used as a factor that included the physical difficulties experienced by patients during the disease process. The students mentioned the following physical barriers. Also, the pains in their bodies, because of the illness, “I have a pain.” They were experiencing discomfort about fractures. (P10) Exercise. They were not doing anything, like “I should do it, but I have a lot of pain...”(P13) Also, they can't walk long because their bones hurt and they get tired (P20). As can be understood from the students’ opinions above, patients with osteoporosis are especially uncomfortable with the physical pain caused by the disease. In addition to these pains, the fact that patients are in certain fatigues due to age and fear of fracture also stands out as a physical obstacle. In addition to psychosocial, economic, and environmental factors, it has also been observed that patients experience physical difficulties in this process. Discussion This study aimed to qualitatively analyze the perceptions of students who collect data on patients and develop patient profiles based on these perceptions. The data collection process involved psychology students who voluntarily supported this ongoing research project. The study sought to understand how students’ perceptions of patients may influence the data collection process and to explore the potential impact of their value judgments on the research. Participants mostly described the patient profiles they interacted with as "polite and mild-mannered, elderly women." While these patients were generally perceived as having warm, helpful, and gentle personality traits, some were noted, although rarely, as exhibiting more abrasive traits. Most patients visited the hospital, accompanied by a relative, but a significant number of patients came alone. This led to the consideration that the presence or absence of family members or friends may affect a patient's mental health and illness. Participants reported that "People who don't have family members or friends or who don't receive enough support seem to struggle more with their illness." A study by Ievers-Landis et al. (2003) demonstrated that family and friend support can influence preventive and therapeutic behaviors related to osteoporosis, supporting the views expressed by the participants in this study [ 29 ]. Three main themes emerged from the interviews. The first theme was related to participants' perceptions of how patients assessed their illnesses. Regarding illness perception, patients were aware that their illness was chronic and was more physically affected by its consequences. However, the way patients perceive their illness also leads them to take better care of themselves. Patients expressed that they perceived nutritional and social factors as the causes of their illness and believed that the illness could be controlled. However, there were both positive and negative views of treatability. Regarding emotional and social support, environmental support positively influences the illness/treatment process [ 29 ]. These findings regarding social support are consistent with those reported in the literature. Similarly, it is worth noting that the participants observed that patients who came with a companion or expressed that they had close support experienced their illness less severely. However, patients were anxious and uncomfortable with the use of medication. Studies support these findings [ 3 , 17 ]. In the present study, relevant findings were similarly perceived by the data collectors. Finally, this theme revealed that patients were highly satisfied with the hospital and doctors, which had a positive effect on their treatment. Studies have supported a high level of satisfaction among patients with their hospitals and doctors [ 43 , 44 ]. However, to our knowledge, no study has examined the opinions of professional candidates collecting data, as in our study, regarding patient satisfaction with hospitals and doctors. Nonetheless, many satisfaction studies from the patients’ perspective highlight that patients with osteoporosis are highly satisfied with these processes [ 39 ]. This finding is consistent with those reported in the literature. Under the theme of the social support needs of osteoporosis patients, the needs of these patients were examined from the participants' perspective. Psychological support should be provided to address the stress experienced by patients due to their illness and their emotional needs during the treatment process. In addition, attention has been drawn to the need for information and support regarding the treatment process and proper nutrition. This need can be met through appropriate information-sharing and support. In one interview, a patient expressed, "If I'm happy, I don't have any pain," indicating that some patients need emotional support. Participants emphasized that patients should not become emotionally withdrawn and should have environments where they can share their thoughts and feelings. It was suggested that those who accompanied the patient should include family members, friends, and/or professional service providers. Additionally, it was observed that the patients needed financial support in terms of instrumental support. One study found that the social support received by elderly patients with osteoporosis was positively related to their quality of life. The study found that elderly patients with osteoporosis scored lower in terms of financial assistance, social networks, and experiences or emotional support where the individual felt understood and respected, compared to other elderly patients. Elderly osteoporosis patients scored lower in terms of physical function, bodily pain, health, vitality, emotional or physical role, social functioning, and mental health than other elderly patients [ 45 ]. These results support the findings of this study. Under the theme of illness barriers, participants emphasized that the act of coming to the hospital itself was challenging for patients, indicating that this process could be exhausting and that patients might encounter appointment barriers. A study found that patients with osteoporosis faced barriers, such as long appointment waiting times [ 39 ]. Similarly, patients experienced issues accessing treatment, such as obtaining or following up on medications. Patients could face various environmental, economic, psychosocial, and physical barriers, such as transportation to the hospital, cost of medications, financial difficulties in maintaining a treatment-appropriate diet, loneliness, isolation from family and social environments, and other family-related barriers. These issues can make patients reluctant, stressed, or sad. Participant P4 highlighted this by saying, "They have pains in their daily lives. I think that's what challenges them the most." Patients were disturbed by the physical pain caused by the illness, experienced fear of fractures, and were in a state of fatigue, along with the impact of aging. One study found that patients with osteoporosis and pain had a high fear of falling and fractures, which decreased their physical performance [ 46 ]. Moreover, pain in patients with osteoporosis can lead to the need for long-term care [ 2 ] and negatively affect their quality of life [ 2 , 47 ]. In a study conducted on osteoporosis patients by Smulders et al. (2011), physical barriers such as fear of falling and fractures were considered significant [ 36 ]. These studies support the findings of the present study. The data obtained and analyses conducted in this study indicate that findings similar to those from quantitative research on patients can also be achieved qualitatively and indirectly through participants who interviewed patients. This suggests that when direct access to patients is not possible, information regarding illness perception, social support, barriers, and needs can be gathered through interviews with data collectors, providing guidance for policymakers. Moreover, the consistency of these findings from the evaluators’ perspective underscores a distinctive aspect of this study. This qualitative research was conducted based on observations from the first phase of a larger project, and the findings are critically important as they offer a theoretical foundation for future quantitative studies and research on patients with osteoporosis. Strengths, Limitations, and Further Research In the literature review, no similar study directly comparable to this study was found. This highlights the unique aspects and limitations of the current study. Furthermore, the fact that the interviewers were psychology students may have given them an advantage in terms of interview skills, but their perceptions of patient assessment may have been influenced by their psychology-based education. The fact that all of the students conducting the interviews were female may also indicate another limitation. Additionally, the limited number of participants in this study and the varying number of patient observations may have led to heterogeneity in the relationship between experiences. However, the participants stated that they had the opportunity to observe each other during patient interviews, which may have enabled them to overcome this potential limitation. Therefore, researchers should conduct studies with individuals who have worked on similar or related topics. Similar studies conducted by researchers suggest that the needs of patients in the healthcare system can be identified more quickly and scientifically, particularly for policymakers. Conclusion This study provides a novel contribution to the literature by qualitatively examining the reflections of psychology students who were actively engaged in data collection processes involving osteoporosis patients. The findings underscore the value of incorporating observer perspectives—particularly those of trained but non-clinical personnel—in exploring patient experiences, illness perceptions, and the multifaceted needs of individuals living with chronic conditions such as osteoporosis. The three primary themes identified—illness perception, social support needs, and barriers to care—mirror findings from prior quantitative studies, suggesting that proxy observations may serve as a viable methodological alternative when direct access to patients is limited. Moreover, this study highlights the nuanced ways in which students' professional training and subjective interpretations intersect with data collection processes, revealing both the promise and potential biases inherent in such qualitative approaches. Overall, the integration of indirect qualitative data into broader research frameworks may enhance the comprehensiveness of patient-centered inquiries and inform the development of more responsive, multidimensional healthcare policies and interventions. Declarations Clinical trial number: not applicable. Ethics approval and consent to participate Throughout all stages of this research, care was taken to ensure that ethical principles were not violated, and all relevant ethical rules were followed. The ethics committee approval required for this study was obtained from the İstanbul University Ethics Committee for Social and Humanities Research. This study was conducted in accordance with the principles of the Declaration of Helsinki. Verbal consent was obtained from participants before and during the recordings. Consent for publication Participants were informed about the purpose of this study, their roles in the study, and the recording of the interviews, and their consent was obtained. Disclosure statement The author(s) reported no potential conflict of interest. Data availability statement The participants of this study did not give written consent for their data to be shared publicly; therefore, due to the research's sensitive nature, supporting data were unavailable. Not applicable Competing İnterests The authors declare that they have no competing interests. AI declaration AI was utilized solely during the proofreading stage. Declaration of funding: This work was carried out under the 1001 program funded by TUBITAK (Prn. 122K918). The funder has no role in the design or preparation of the manuscript for submission to the journal. Acknowledgements We thank all the students who shared their perspectives on the project and patients' needs. Authors' contributions: Conceptualization and design of the study: Esin Temeloğlu Şen, Dilek Alay, and Esra Karagöz. Data acquisition: Dilek Alay and Esra Karagöz. Analysis and interpretation of data: Esin Temeloğlu Şen, Dilek Alay, and Esra Karagöz. Drafting and revising the manuscript: Esin Temeloğlu Şen and Dilek Alay. References Leventhal H, Phillips LA, Burns E. The common-sense model of self-regulation (CSM): A dynamic framework for understanding illness self-management. J Behav Med. 2016;39(6):935–46. 10.1007/s10865-016-9782-2 . Catalano A, Martino G, Morabito N, Scarcella C, Gaudio A, Basile G, et al. Pain in osteoporosis: From pathophysiology to therapeutic approach. Drugs Aging. 2017;34(10):755–65. 10.1007/s40266-017-0492-4 . Besser SJ, Anderson JE, Weinman J. How do osteoporosis patients perceive their illness and treatment? Implications for clinical practice. Arch Osteoporos. 2012;7(1–2):115–24. Schwille-Kiuntke J, Rüdlin SL, Junne F, Enck P, Brenk-Franz K, Zipfel S, Rieger MA. Illness perception and health care use in individuals with irritable bowel syndrome: Results from an online survey. BMC Fam Pract. 2021;22(1):154. 10.1186/s12875-021-01499-5 . Valentine TR, Presley CJ, Carbone DP, Shields PG, Andersen BL. Illness perception profiles and psychological and physical symptoms in newly diagnosed advanced non-small cell lung cancer. Health Psychol. 2022;41(6):379–88. 10.1037/hea0001192 . Jamieson MK, Govaart GH, Pownall M. Reflexivity in quantitative research: A rationale and beginner’s guide. Soc Pers Psychol Compass. 2023;17(4):e12735. Gürbüz S, Şahin F. Sosyal bilimlerde araştırma yöntemleri: Felsefe–yöntem–analiz. 5. baskı. Ankara: Seçkin Yayıncılık; 2018. Karaca S. Bilimlerde araştırma yöntemleri. Ankara: Gazi Kitabevi; 2021. Lazard L, McAvoy J. Doing reflexivity in psychological research: What’s the point? What’s the practice? Qual Res Psychol. 2017;17(2):159–77. 10.1080/14780887.2017.1400144 . Steltenpohl CN, Siegel JA, Klement K. Workshop–Increasing researcher transparency and reflection through positionality statements: Lessons from qualitative research. In: Society for the Improvement of Psychology Science 2021 Meeting; 2021. Available from: https://osf.io/e5t36/ Rosenberg S, Tilley PM. A point of reference’: The insider/outsider research staircase and transgender people’s experiences of participating in trans-led research. Qual Res. 2021;21(6):923–38. Leventhal H, Diefenbach H, Leventhal EA. Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cognit Ther Res. 1992;16(2):143–63. Leventhal H, Nerenz DR, Steele DJ. Illness representations and coping with health threats. In: Baum A, Taylor SE, Singer JE, editors. Handbook of psychology and health: Vol. IV. Social psychological aspects of health. Hillsdale: Erlbaum; 1984. pp. 219–52. Diefenbach H, Leventhal H. The common-sense model of illness representations: Theoretical and practice considerations. J Soc Distress Homeless. 1996;5(1):11–39. Hale ED, Treharne GJ, Kitas GD. The common-sense model of self-regulation of health and illness: How can we use it to understand and respond to our patients'. needs? Rheumatol. 2007;46(6):904–6. 10.1093/rheumatology/kem060 . Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D. The revised illness perception questionnaire (IPQ-R). Psychol Health. 2002;17(1):1–16. https://doi.org/10.1080/08870440290001494 . Edelstein E, Werner P, Dresner-Pollak R, Tordjman K, Jaffe A, Toledano Y, et al. Illness perceptions among osteoporotic men and women: Correlates and gender differences. J Mens Health. 2012;9(3):168–75. Hupcey JE. Clarifying the social support theory–research linkage. J Adv Nurs. 1998;27(6):1231–41. Işıkhan V. Cancer and social support. Community Soc Work. 2007;18(1):15–29. Kim TH, Connolly JA, Tamim H. The effect of social support around pregnancy on postpartum depression among Canadian teen mothers and adult mothers in the Maternity Experiences Survey. BMC Pregnancy Childbirth. 2014;14:162. 10.1186/1471-2393-14-162 . Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310–57. Logsdon MC, Koniak-Griffin D. Social support in postpartum adolescents: Guidelines for nursing assessments and interventions. J Obstet Gynecol Neonatal Nurs. 2005;34(6):761–8. 10.1177/0884217505281855 . Slykerman RF, Thompson JM, Pryor JE, Becroft DM, Robinson E, Clark PM, Wild CJ, Mitchell EA. Maternal stress, social support, and preschool children's intelligence. Early Hum Dev. 2005;81(10):815–21. 10.1016/j.earlhumdev.2005.05.005 . Tanzer M, Avidan G, Shahar G. Does social support protect against recognition of angry facial expressions following failure? Cognition Emot. 2013;27(7):1335–44. 10.1080/02699931.2013.782266 . Kats D, Patel MD, Palta P, Meyer ML, Gross AL, Whitsel EA, et al. Social support and cognition in a community-based cohort: The Atherosclerosis Risk in Communities (ARIC) study. Age Ageing. 2016;45(4):475–80. 10.1093/ageing/afw060 . Liao J, Muniz-Terrera G, Head J, Brunner EJ. Dynamic longitudinal associations between social support and cognitive function: A prospective investigation of the directionality of associations. J Gerontol B Psychol Sci Soc Sci. 2018;73(7):1233–43. 10.1093/geronb/gbw135 . Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, et al. Breast cancer and social environment: Getting by with a little help from our friends. Breast Cancer Res. 2016;18(1):54. 10.1186/s13058-016-0700-x . Hinzey A, Gaudier-Diaz MM, Lustberg MB, DeVries AC. Breast cancer and social environment: Getting by with a little help from our friends. Breast Cancer Res. 2016;18(1):54. Ievers-Landis CE, Burant C, Drotar D, Morgan L, Trapl ES, Kwoh CK. Social support, knowledge, and self-efficacy as correlates of osteoporosis preventive behaviors among preadolescent females. J Pediatr Psychol. 2003;28(5):335–45. 10.1093/jpepsy/jsg023 . Wang CX, Yang FX, Zhu XH, Yu GJ. Investigation on mental state, quality of life, and social support of female patients with osteoporosis. Chin J Rehabil. 2008;23:250–2. Kalender N, Çiçek HS. Barriers to management of chronic diseases. Turkiye Klin J Nurs Sci. 2014;6(1):46–53. Yetim B, Çelik Y. Access to healthcare: The issue of unmet needs. J Community Soc Work. 2020;31(2):423–40. 10.33417/tsh.630479 . Akyüz G. Pain and quality of life in osteoporosis. Turk J Fam Physician. 2010;1(4):11–5. McClement SE, Chochinov HM. Hope in advanced cancer patients. Eur J Cancer. 2008;44(8):1169–74. 10.1016/j.ejca.2008.02.031 . Warriner A, Curtis JR, Saag KG. Challenges in defining and improving osteoporosis quality of care. Clin Exp Rheumatol. 2007;25(47):142–6. Smulders E, van Lankveld W, Laan R, Duysens J, Weerdesteyn V. Does osteoporosis predispose to falls? A study on obstacle avoidance and balance confidence. BMC Musculoskelet Disord. 2011;12(1):1. 10.1186/1471-2474-12-1 . Rose P, Beeby J, Parker D. Academic rigour in the lived experience of researchers using phenomenological methods in nursing. J Adv Nurs. 1995;21(6):1123–9. Ramos-Vera C, Saintila J, Calizaya-Milla YE, Acosta Enríquez ME, Serpa Barrientos A. Relationship between satisfaction with medical care, physical health, and emotional well-being in adult men: Mediating role of communication. J Prim Care Community Health. 2022;13:21501319221114850. 10.1177/21501319221114850 . Barańska A, Religioni U, Drop B, Bogdan M, Kłak A, Warunek A, et al. Assessment of the level of satisfaction with medical care of patients treated in osteoporosis clinics as an indicator of the quality of medical care. Int J Environ Res Public Health. 2022;19(12):7343. 10.3390/ijerph19127343 . Farquharson B, Johnston M, Bugge C. How people present symptoms to health services: A theory-based content analysis. Br J Gen Pract. 2011;61(585):267–73. 10.3399/bjgp11X567090 . House JS. Social support and social structure. Sociol Forum. 1987;2(1):135–46. Available from: http://www.jstor.org/stable/684531 Cutrona CE, Russell DW. Type of social support and specific stress: Toward a theory of optimal matching. In: Sarason BR, Sarason IG, Pierce GR, editors. Social support: An interactional view. New York: Wiley; 1990. pp. 319–66. Savaş E, Bahar A. Evaluation of the satisfaction levels of inpatients in the University of Gaziantep Medical Faculty Hospital. Gaziantep Med J. 2011;17(1):24–8. Tezcan D, Yücel MH, Ünal UB, Edirne T. Patient satisfaction in a tertiary health care organisation. Pamukkale Med J. 2014;7(1):57–62. Ma L, Li Y, Wang J, Zhu H, Yang W, Cao R, et al. Quality of life is related to social support in elderly osteoporosis patients in a Chinese population. PLoS ONE. 2015;10(6):e0127849. 10.1371/journal.pone.0127849 . Hübscher M, Vogt L, Schmidt K, Fink M, Banzer W. Perceived pain, fear of falling, and physical function in women with osteoporosis. Gait Posture. 2010;32(3):383–5. 10.1016/j.gaitpost.2010.06.018 . Özsoy-Ünübol T, Akyüz G, Mirzayeva S, Güler T. Evaluation of pain, quality of life, and patient satisfaction in parenterally treated patients with postmenopausal osteoporosis. Turk J Phys Med Rehabil. 2020;66(3):262–70. 10.5606/tftrd.2020.4114 . Tables Tables 1 and 2 are available in the Supplementary Files section Additional Declarations No competing interests reported. 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09:24:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":829246,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7560544/v1/f138c79f-516a-4a5f-8b48-24087a2f106f.pdf"},{"id":92394791,"identity":"328cfbf8-b645-4271-9e44-010cf19ecc7e","added_by":"auto","created_at":"2025-09-29 09:16:18","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":17781,"visible":true,"origin":"","legend":"","description":"","filename":"60294ResearchMaterials3857491220250720.docx","url":"https://assets-eu.researchsquare.com/files/rs-7560544/v1/74f22733e44088eb4f857543.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reflexivity in Data Collection: Psychology Students’ Interpretations of Osteoporosis Patient Experiences – A Qualitative Case Study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe growing recognition of patient-centred care in managing chronic illnesses has highlighted the importance of understanding not only patients' lived experiences but also the complex factors that influence data collection in clinical research [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Osteoporosis is a chronic, progressive musculoskeletal disease that significantly impacts quality of life. It requires comprehensive research methods to capture the subjective aspects of illness perception, social support networks, and barriers to treatment adherence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe views of data collectors\u0026mdash;often frontline personnel in both qualitative and quantitative research\u0026mdash;remain underrepresented, despite numerous studies examining patients' self-reported experiences and perceptions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The observations and interactions of data collectors during the research process can provide valuable supplementary narratives, offering contextual insights that enhance the primary data obtained from patients. Nevertheless, these reflections are often regarded as peripheral or anecdotal rather than systematically analysed as a source of empirical evidence [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe impact of a researcher's influence on the entire research process is a critical issue often underscored in qualitative studies. It is essential to address concerns regarding the accuracy and applicability of the data collected in scientific research [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Quantitative research allows for a more predictable and mathematical application [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, researchers may be influenced by their perspectives on the various aspects of quantitative studies. Therefore, researchers need to be conscious of their biases before, during, and after the research process in both quantitative and qualitative research [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The concept of reflexivity is fundamental in this context, emphasizing the potential of researchers' assessments, beliefs, and judgments to shape the entire research process [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although social and personality psychologists have emphasized these concepts for a long time, there has been insufficient focus on the reflective attitudes of professionals working with and collecting data from clinical samples [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Research in this field typically examines how a researcher's perception of social roles, such as the gender identity of participants, can influence research outcomes during data collection [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, it should not be overlooked that it is also critical to consider the potential biases of researchers who collect data from clinically diagnosed individuals. The present study aims to examine the impact of researchers' assessments of the data collection process on the research process in a clinical study. To this end, the study aims to evaluate the assessments of individuals collecting data on patients and diseases using a qualitative design. During the interviews, three themes emerged as critical components of the disease process for osteoporosis patients: how patients perceive their disease, their perceptions of social support, and the barriers they encounter. Details related to these three themes, along with how they are important as critical components of osteoporosis, are discussed below.\u003c/p\u003e\n\u003ch3\u003eIllness perception\u003c/h3\u003e\n\u003cp\u003eIllness perception refers to how a person mentally represents the disease process using information from different sources [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The self-regulation model (SRM) was developed by Leventhal et al. (1984) to measure illness perception [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The purpose of the SRM is to explain the factors that influence adaptive behaviors related to the treatment process [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Model disease identity, cause, time, outcome, control/ treatability [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], emotional dimension, and understandability of illness [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe results of the study, which assessed patients' perceptions of osteoporosis, showed that patients were able to describe the nature and causes of the disease, but had difficulty explaining it from a personal perspective. In addition, patients perceived osteoporosis as a chronic disease with no cure and described it as a condition that minimally affected their daily lives [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs Leventhal et al. (1992) stated, information and experiences from external sources are expected to influence illness perception [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. From this standpoint, illness perception may be shaped by environmental information or experiences, similar to patients who actively collect data. This study, therefore, aims to explore these individuals\u0026rsquo; illness perceptions in detail within this context.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSocial support\u003c/h2\u003e\u003cp\u003eSocial support is a voluntary action that has a positive impact on well-being [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It supports bio-psycho-social recovery and helps to meet a person's needs [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Family, friends, or others provide this information support [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], togetherness support [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], instrumental, emotional or physical support [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Social support benefits different age groups, including children [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], young adults [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], middle-aged adults [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and older adults [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Studies show that it reduces pathologies such as cardiovascular [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and helps in the treatment of diseases such as cancer [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In osteoporosis, social support is crucial for well-being and treatment [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eData collectors\u0026rsquo; assessments of patients\u0026rsquo; social support levels may significantly affect the data collection process. Accordingly, this study seeks to examine and explain the discrepancies between perceived and observed social support.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePatients’ Barriers\u003c/h3\u003e\n\u003cp\u003ePatients may face barriers such as economic, geographical, or access issues when seeking treatment. In many regions, patients without sufficient resources may struggle to continue their treatment [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Lack of health insurance or inadequate health policies can also create economic barriers that negatively affect ongoing care. Patients may face additional barriers, such as the location of the hospital [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] or difficulties in reaching service providers, making access to care more difficult. Patients with osteoporosis may experience physical limitations and severe or chronic pain from fractures, which can reduce their quality of life [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and interfere with treatment. The disease can also affect family responsibilities, leading to social isolation [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and communication difficulties within family and social circles. Warriner et al (2007) identified barriers to osteoporosis care as a lack of awareness of treatment, economic barriers, and inadequate support from carers and professionals [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In addition, physical challenges such as falls and fractures can exacerbate the disease and hinder recovery [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] (Smulders et al., 2011).\u003c/p\u003e\u003cp\u003eAssessments of barriers encountered by patients may influence the data collection process. Given that osteoporosis patients frequently face numerous barriers, data collectors\u0026rsquo; evaluations of these challenges are considered important. Accordingly, this study aims to examine patient barriers from the perspective of data collectors.\u003c/p\u003e\n\u003ch3\u003eCurrent study\u003c/h3\u003e\n\u003cp\u003eThis study aimed to view patient profiles and illness experiences from the perspective of psychology students involved in data collection in a comprehensive project. In other words, this study aimed to examine the profiles of osteoporosis patients considering evaluations of university student participants. Psychology students may have a more professional perspective of patients because of the education they receive. However, the social assumptions and judgments of data collectors may still make it challenging to achieve this objective [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, obtaining information about the experiences of people conducting the data collection process will increase their level of awareness of their judgments. The current study aimed to explore the reflexive attitudes of psychology students who participated in the data collection process and to evaluate patients' illness evaluations, perceptions of social support, and barriers from the students' perspective.\u003c/p\u003e\u003cp\u003eThe central research questions guiding this study are:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow do psychology students perceive osteoporosis patients' illness experiences during the data collection process?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat social support needs and barriers to care do students identify in their interactions with osteoporosis patients?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow do students' reflexive stances and professional training influence their interpretations of patient narratives?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eBy addressing these questions, this study contributes to the broader discourse on enhancing methodological rigor through reflexivity and offers practical insights for integrating reflective practices into clinical research training programs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study uses a phenomenological approach [37]. This method, widely applied in fields such as health, social work, and psychology, seeks to capture individuals’ experiences and is considered the most suitable approach for the objectives of this study.\u003c/p\u003e\n\u003cp\u003eVerbal consent was obtained from all participants in accordance with ethical guidelines. Given the need to document participants' statements, verbal consent was explicitly recorded. Prior to the audio recording of the interview, participants were informed about the study's purpose, confidentiality measures, and their right to withdraw. They were then asked to reaffirm their consent at the beginning of the recording to ensure ethical compliance and\u0026nbsp;transparency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included 20 female students in the second, third, and fourth years of the psychology department of a XX university in 2022-2023. The educational data of the students participating in this study were as follows: nine students in the 2nd grade, nine in the 3rd grade, and two in the 4th grade. The inclusion criteria were as follows.\u003c/p\u003e\n\u003cp\u003e1. Being a student in the psychology department.\u003c/p\u003e\n\u003cp\u003e2. Receiving foundational training in data collection from the lead author\u003c/p\u003e\n\u003cp\u003e3. Having participated in data collection with osteoporosis patients in the clinic for the current research.\u003c/p\u003e\n\u003cp\u003e4. Volunteering to participate in the present study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemi-structured interviews were conducted to answer the questions identified in this study. Before the interview form was created, questions about the experience were researched in the literature and organized in line with the opinions of expert faculty members in the field. As a result, this interview form included questions about students’ experiences, patient characteristics, and details of patients’ disease processes. Within the scope of this study, ten main and probe questions were prepared by the researchers. The first and second authors answered these questions by interviewing the participants.\u003c/p\u003e\n\u003cp\u003eIn this direction, 20 volunteer students who met the inclusion criteria were interviewed. The research questions in this study were as follows:\u003c/p\u003e\n\u003cp\u003eWhat are the patient profiles formed from the perspective of psychology students involved in the data collection?\u003c/p\u003e\n\u003cp\u003eWhat are the ways in which patients approach treatment from the perspective of psychology students involved in the data collection?\u003c/p\u003e\n\u003cp\u003eHow do patients approach themselves from the perspective of psychology students involved in the data collection?\u003c/p\u003e\n\u003cp\u003eWhat are the important factors in the treatment process of patients from the perspective of psychology students involved in the data collection?\u003c/p\u003e\n\u003cp\u003eWhat types of psychological and social support do patients need from the perspective of psychology students who have been involved in data collection?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection and Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA semi-structured interview consisting of ten main questions and probing questions was used in this study. The interview form was first piloted online with two students, and the questions were finalized with minor changes made in parallel. Students who volunteered for the project were expected to participate in face-to-face or online interviews at the end of two weeks, and the answers of the students who could participate were recorded. At the end of the project, zoom interviews were conducted with volunteers who could not be interviewed face-to-face for various reasons, and these interviews were audio recorded. The interviews, which lasted approximately 20 minutes each, were converted into written documents in a Microsoft Word environment and then parsed in an Excel environment. The separated data were analyzed using the content analysis method of MAXQDA 2022 software.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics and Reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThroughout all stages of this research, care was taken to ensure that ethical principles were not violated, and all relevant ethical rules were followed. The ethics committee approval required for this study was obtained from the XX. Participants were informed about the purpose of this study, their roles in the study, and the recording of the interviews, and their consent was obtained. This study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe data obtained from the students\u0026apos; interviews were categorized under the following meta-themes: patient profiles, relatives\u0026apos; approaches to the treatment process, patients\u0026apos; evaluations of the disease/treatment process, patients\u0026apos; social support needs, and patients\u0026apos; barriers. Table 1 details the sub-themes of these categories.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInsert Table 1 Here\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Profiles\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient profiles and characteristics are presented in Table 2. When Table 1 was examined, the emphasis on patient profiles from students\u0026apos; perspectives was categorized as underage, personality traits, accompanying individuals, and gender. The results indicated that many of the patients were female (n=16) and elderly (n=10). It was also observed that patients commonly came either with a relative (n=16) or alone (n=12). Regarding personality traits, participants were most frequently described as kind or moderate (n=5), soft-faced (n=3), or warm (n=3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInsert Table 2 Here\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients\u0026rsquo; Evaluations on Disease/Treatment Processes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results regarding patients\u0026apos; evaluations of the illness and treatment processes were categorized according to Leventhal\u0026apos;s Self-regulatory Model (SRM) [1]. This model includes five cognitive domains: identity, timeline, consequences, perceived cause, control/treatability, non-cognitive domain, and emotional dimension, which were later incorporated [16]. These categories were used to assess individual reactions to the perceived threat of illness. Additionally, the category of hospital-doctor satisfaction was included because it influences patients\u0026apos; treatment processes, as noted in the literature [38, 39]. This is frequently encountered in content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Identity:\u003c/strong\u003e Illness identity, a cognitive domain, refers to how individuals perceive and experience symptoms of their disease [1]. This domain includes patients\u0026apos; views on how their self-perception aligns with that of their illness. In this context, patients discussed either ignoring/rejecting or rejecting the disease and its impact on their lives. Their perspectives are detailed below:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI do not have a disease (P1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, I will live with it, but I can learn to keep up with it, and it won\u0026apos;t be such a challenging thing for my life\u0026rdquo; like they approach illness positively. (P5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIt was observed that patients demonstrated two distinct perspectives: either accepting or denying their illness. Patients who accepted their condition generally exhibited a more positive orientation toward the treatment process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Timeline:\u003c/strong\u003e This includes the perceived timeline of the illness [1]. Opinions on the expected or perceived duration of the disease were also included. Some of these views are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip; they both believed that the treatment would last a lifetime. I thought maybe it was because they were too old now. (P16)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;I mean, like, \u0026ldquo;It won\u0026apos;t get better; I\u0026apos;m going to live like this anyway.\u0026rdquo; (P5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to these views, students perceive the duration of osteoporosis to be lifelong. People with this disease perceived that the disease was incurable and that it would be with them until they died.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Consequences:\u003c/strong\u003e This cognitive category includes physical/functional, personal, social, and economic factors expected to be affected by the disease [40]. Students\u0026rsquo; views on the consequences of the disease as perceived by the patients were included. Some of these views are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I learned my value afterward, you know, my value thanks to this disease. I pay more attention to myself, and I consider myself valuable.\u0026rdquo; (P2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOne thing I would like to say is that there is nothing that would affect their lives so much because it seems like they only use their illnesses as an excuse for themselves. For example, \u0026ldquo;I have something like this on my foot, so I can\u0026apos;t do such things\u0026rdquo;, but they can do other things. (P15)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants\u0026rsquo; experiences with different types of patients, whether they began to appreciate life more or resorted to excuses, appeared to influence the outcomes of patients\u0026rsquo; perspectives on their illness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Perceived cause:\u003c/strong\u003e Factors that are responsible for disease onset of the disease [40]. This includes the patients\u0026apos; perceptions of the reasons for the development of the disease.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eObviously, it is a little bit due to nutrition, which is what they think. (P3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFor example, she said that the reason for her illness was that her grandson was constantly shaking her leg on his knee, like putting her on her feet and shaking her. (P13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to Participant 3, the cause of the disease was diet, while Participant 13 stated that he thought the patient had this disease because of various physical movements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Control/treatability:\u003c/strong\u003e This cognitive factor also includes beliefs that a disease can be controlled or treated [15]. Accordingly, the patients\u0026rsquo; perceptions of the control/treatability of the disease differed. The findings indicate that while some participants perceived the disease as treatable, others emphasized its uncertainty and adopted a more fatalistic outlook. Some of these views are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHe was very positive. He was aware of the importance of treatment. He knew that his life would be difficult without treatment. (P14)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHowever, even though they find medication useful, I don\u0026apos;t think they believe that they will be cured and get rid of the illness. I think they see medication as a factor that suppresses pain to make their lives easier. (P7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Emotional and social dimension:\u003c/strong\u003e Finally, this dimension, which is considered a non-cognitive factor, includes perceptions of the emotional representation created by the disease and is additionally considered together with social components. Accordingly, the students\u0026rsquo; opinions were as follows.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePeople who did not have family members or friends, or who did not have enough support, said that they got through the illness more severely. (P11)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYes, including the treatment, generally I think the treatments were going well, the dates, at least in the patients I did, you know, only one of them had a fall, he had a lot of high anxiety recently. The treatments of the others were going well. Therefore, they could not make any bad comments. (P17)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThey seemed uncomfortable being on medication constantly and a lot (P18).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBased on these findings, social support appears to exert a positive influence on patients, whereas medication use and fear of falling are associated with negative effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Hospital and doctor satisfaction:\u003c/strong\u003e Students stated that patients were generally satisfied with their current choice of hospital and doctor, especially for osteoporosis, and that they evaluated this positively during the treatment process. Some opinions on this issue are as follows.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMost patients were satisfied with the approach of the doctors and the hospital. Their attitudes also positively affected the treatment process (P1).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThey trusted and respected the doctors, and this trust increased their belief in the treatment and their ability to live with this disease. (P19)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn line with these opinions, it was understood that patients\u0026apos; satisfaction with the hospital and doctors in general regarding the treatment processes came to the forefront. Their satisfaction can also positively contribute to treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Support Needs of Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe multifactor structure of social support [41, 42] was used to determine the social support needs of the patients. The need for social support was evaluated using five categories of social support. These are psychological, informational, emotional, instrumental, and accompaniment supports.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Psychological support:\u003c/strong\u003e This includes the view that patients need professional psychological support. Some views on this topic are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOf course, if there is psychological support, it is free of charge; you know, at least a therapy support can help them change their perspective on the disease and make faster progress in the treatment process. It may help them to make faster progress and reach a point where they can sell more. (P13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAs a result of patients\u0026rsquo; interview experiences with students, psychological support needs may emerge in parallel with the stress experienced during the illness and the emotional requirements of the treatment process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Informational support:\u003c/strong\u003e Information about the disease and treatment processes was included. Regarding the need for informational support, there are opinions on the need for patients to know about the disease and its consequences.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI believe it would be beneficial to make this a group therapy session, which could enhance communication among patients. This increased interaction might raise awareness and consciousness about the disease as it becomes a more prominent topic of discussion. Unlike other conditions, such as high blood pressure or osteoporosis, often casually managed with daily medication, osteoporosis deserves focused attention. By bringing together individuals who share this condition, we can foster conversations, increase understanding, and ultimately raise awareness about osteoporosis. I think this approach would be highly useful. (P3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe patient understands what needs to be done and is willing to do it. (P8)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI think they should get support in terms of nutrition. Some of them were malnourished. (P20)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn addition, it is important for patients to be aware of their treatment processes and proper nutrition/diabetes-appropriate nutrition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Emotional support:\u0026nbsp;\u003c/strong\u003eIn addition to professional support, participants discussed the need for emotional support that prioritizes patients\u0026apos; feelings. Participants stated that patients\u0026apos; feelings and thoughts should be taken into consideration and given importance:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhen you support their feelings, their thoughts, or their decision-making, you know, without overthinking. They gave answers quickly. It was as if no one had ever asked them about their feelings and thoughts before. Maybe I could have prioritized these factors. That seemed a bit important to me, to be honest. It was as if they had never thought about it before. (P4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMost of them do not have emotional sharing anyway, and they find it awkward and uncomfortable to talk about it. Therefore, when working with these patients, I would try to make emotional expression comfortable for them. (P19)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to these views, the patient should not keep his/her emotional experiences to himself/herself but should be together with people with whom they can share their emotional experiences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Accompaniment support:\u0026nbsp;\u003c/strong\u003eThis type of support includes the needs of patients regarding the availability of people to talk to them, accompanying their treatment process, or taking care of them.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI think it is very important to have the full support of the family, friends, etc. (P2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIt would be good if patients who cannot leave their homes or who have difficulty in coming would be taken from their homes by ambulance and someone would accompany them to the hospital and take care of their information and document works. (P7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants emphasized the importance of a companion for the continued mental and physical health of patients, whether they are relatives or not.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstrumental support:\u003c/strong\u003e These views were included in this support category, which deals with the needs related to environmental and concrete factors:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e...and some money (P9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e...Economic support is always their own money, their earnings, or a pension. I don\u0026apos;t know, something, or at least their economic comfort around them can support them. (P13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFinancial support answers to the question of need were considered instrumental. According to these responses, the instrumental support required for the treatment process includes economic support. It was emphasized that patients needed financial aid during the disease process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients\u0026rsquo; Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe subthemes of access to treatment, environmental, economic, psychosocial, and physical barriers were created to detail the barriers to patients in the illness process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Access to treatment:\u003c/strong\u003e Here, patient barriers to accessing treatment are addressed. This access was expressed in an abstract rather than in a physical/environmental access. The students talked about their access to treatment as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThey said that they sometimes forget when to take their medication and have difficulty keeping track of it (P6).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBut in general, this hospital process tires people out, coming and going to the hospital. (P9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eApart from that, accessibility to treatment. I mean, from where, for example, they at least come to our hospital. I don\u0026apos;t know because our hospital is a good one in Istanbul, even in Turkey, they come with the intention that we can be even better, they pay certain prices for this, their hours go on the road, or they do something. (P13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNot being able to find an appointment. (P20)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants highlighted that patients may face various challenges during the treatment process, which can be physically and emotionally demanding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Environmental barriers:\u003c/strong\u003e External factors were examined in the environmental barrier category. Here, there were opinions, especially on physical access, that is, transportation, with participants stating that patients had difficulties in physically reaching the hospital:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDifficulties in reaching the hospital. (P7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eProblems, such as transportation. It can be solved. (P9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Economic barriers:\u003c/strong\u003e The economic barriers faced by the patients during the treatment phase are mentioned here. Participants mentioned drug costs, high food prices, and patients\u0026apos; financial difficulties.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe cost of medicine (P6)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThey said they were having financial difficulties now. (P9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYes, I mean, yes, it makes sense, for example, in the questions we ask, Do you eat meat? And they say, \u0026ldquo;How can we buy meat? I mean, if we can afford it, once a month, once a year. That\u0026apos;s how it usually is.\u0026rdquo; (P3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Psychosocial barriers:\u003c/strong\u003e Psychosocial barriers include the common social and psychological barriers faced by patients during the disease process. Here, factors such as familial and personality effects have been discussed. Participants indicated that patients experiencing family problems, loneliness, or social isolation face barriers that negatively impact the treatment process.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAlso, social isolation is very high, and he doesn\u0026apos;t leave the house. (P13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThey said that stress factors in the family were effective in their illnesses. One of them said that she was stressed because she could not marry off her child; one said that she was stressed because of her husband. (P11)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere seemed to be no one they could relate to emotionally and intellectually about their illness. (P18)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to these views, patients face obstacles when trying to cope with other responsibilities and problems in the family during the treatment process, which affects their reluctance, stress, and sadness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Physical barriers:\u003c/strong\u003e The last barrier, physical barriers, was used as a factor that included the physical difficulties experienced by patients during the disease process. The students mentioned the following physical barriers.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAlso, the pains in their bodies, because of the illness, \u0026ldquo;I have a pain.\u0026rdquo; They were experiencing discomfort about fractures. (P10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExercise. They were not doing anything, like \u0026ldquo;I should do it, but I have a lot of pain...\u0026rdquo;(P13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAlso, they can\u0026apos;t walk long because their bones hurt and they get tired (P20).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAs can be understood from the students\u0026rsquo; opinions above, patients with osteoporosis are especially uncomfortable with the physical pain caused by the disease. In addition to these pains, the fact that patients are in certain fatigues due to age and fear of fracture also stands out as a physical obstacle. In addition to psychosocial, economic, and environmental factors, it has also been observed that patients experience physical difficulties in this process.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to qualitatively analyze the perceptions of students who collect data on patients and develop patient profiles based on these perceptions. The data collection process involved psychology students who voluntarily supported this ongoing research project. The study sought to understand how students\u0026rsquo; perceptions of patients may influence the data collection process and to explore the potential impact of their value judgments on the research.\u003c/p\u003e\u003cp\u003eParticipants mostly described the patient profiles they interacted with as \u003cem\u003e\"polite and mild-mannered, elderly women.\"\u003c/em\u003e While these patients were generally perceived as having warm, helpful, and gentle personality traits, some were noted, although rarely, as exhibiting more abrasive traits. Most patients visited the hospital, accompanied by a relative, but a significant number of patients came alone. This led to the consideration that the presence or absence of family members or friends may affect a patient's mental health and illness. Participants reported that \u003cem\u003e\"People who don't have family members or friends or who don't receive enough support seem to struggle more with their illness.\"\u003c/em\u003e A study by Ievers-Landis et al. (2003) demonstrated that family and friend support can influence preventive and therapeutic behaviors related to osteoporosis, supporting the views expressed by the participants in this study [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThree main themes emerged from the interviews. The first theme was related to participants' perceptions of how patients assessed their illnesses. Regarding illness perception, patients were aware that their illness was chronic and was more physically affected by its consequences. However, the way patients perceive their illness also leads them to take better care of themselves. Patients expressed that they perceived nutritional and social factors as the causes of their illness and believed that the illness could be controlled. However, there were both positive and negative views of treatability. Regarding emotional and social support, environmental support positively influences the illness/treatment process [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These findings regarding social support are consistent with those reported in the literature. Similarly, it is worth noting that the participants observed that patients who came with a companion or expressed that they had close support experienced their illness less severely. However, patients were anxious and uncomfortable with the use of medication. Studies support these findings [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In the present study, relevant findings were similarly perceived by the data collectors. Finally, this theme revealed that patients were highly satisfied with the hospital and doctors, which had a positive effect on their treatment. Studies have supported a high level of satisfaction among patients with their hospitals and doctors [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. However, to our knowledge, no study has examined the opinions of professional candidates collecting data, as in our study, regarding patient satisfaction with hospitals and doctors. Nonetheless, many satisfaction studies from the patients\u0026rsquo; perspective highlight that patients with osteoporosis are highly satisfied with these processes [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This finding is consistent with those reported in the literature.\u003c/p\u003e\u003cp\u003eUnder the theme of the social support needs of osteoporosis patients, the needs of these patients were examined from the participants' perspective. Psychological support should be provided to address the stress experienced by patients due to their illness and their emotional needs during the treatment process. In addition, attention has been drawn to the need for information and support regarding the treatment process and proper nutrition. This need can be met through appropriate information-sharing and support. In one interview, a patient expressed, \u003cem\u003e\"If I'm happy, I don't have any pain,\"\u003c/em\u003e indicating that some patients need emotional support. Participants emphasized that patients should not become emotionally withdrawn and should have environments where they can share their thoughts and feelings. It was suggested that those who accompanied the patient should include family members, friends, and/or professional service providers. Additionally, it was observed that the patients needed financial support in terms of instrumental support. One study found that the social support received by elderly patients with osteoporosis was positively related to their quality of life. The study found that elderly patients with osteoporosis scored lower in terms of financial assistance, social networks, and experiences or emotional support where the individual felt understood and respected, compared to other elderly patients. Elderly osteoporosis patients scored lower in terms of physical function, bodily pain, health, vitality, emotional or physical role, social functioning, and mental health than other elderly patients [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. These results support the findings of this study.\u003c/p\u003e\u003cp\u003eUnder the theme of illness barriers, participants emphasized that the act of coming to the hospital itself was challenging for patients, indicating that this process could be exhausting and that patients might encounter appointment barriers. A study found that patients with osteoporosis faced barriers, such as long appointment waiting times [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Similarly, patients experienced issues accessing treatment, such as obtaining or following up on medications. Patients could face various environmental, economic, psychosocial, and physical barriers, such as transportation to the hospital, cost of medications, financial difficulties in maintaining a treatment-appropriate diet, loneliness, isolation from family and social environments, and other family-related barriers. These issues can make patients reluctant, stressed, or sad. Participant P4 highlighted this by saying, \u003cem\u003e\"They have pains in their daily lives. I think that's what challenges them the most.\"\u003c/em\u003e Patients were disturbed by the physical pain caused by the illness, experienced fear of fractures, and were in a state of fatigue, along with the impact of aging. One study found that patients with osteoporosis and pain had a high fear of falling and fractures, which decreased their physical performance [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Moreover, pain in patients with osteoporosis can lead to the need for long-term care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and negatively affect their quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. In a study conducted on osteoporosis patients by Smulders et al. (2011), physical barriers such as fear of falling and fractures were considered significant [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. These studies support the findings of the present study.\u003c/p\u003e\u003cp\u003eThe data obtained and analyses conducted in this study indicate that findings similar to those from quantitative research on patients can also be achieved qualitatively and indirectly through participants who interviewed patients. This suggests that when direct access to patients is not possible, information regarding illness perception, social support, barriers, and needs can be gathered through interviews with data collectors, providing guidance for policymakers. Moreover, the consistency of these findings from the evaluators\u0026rsquo; perspective underscores a distinctive aspect of this study. This qualitative research was conducted based on observations from the first phase of a larger project, and the findings are critically important as they offer a theoretical foundation for future quantitative studies and research on patients with osteoporosis.\u003c/p\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eStrengths, Limitations, and Further Research\u003c/h2\u003e\u003cp\u003eIn the literature review, no similar study directly comparable to this study was found. This highlights the unique aspects and limitations of the current study. Furthermore, the fact that the interviewers were psychology students may have given them an advantage in terms of interview skills, but their perceptions of patient assessment may have been influenced by their psychology-based education. The fact that all of the students conducting the interviews were female may also indicate another limitation. Additionally, the limited number of participants in this study and the varying number of patient observations may have led to heterogeneity in the relationship between experiences. However, the participants stated that they had the opportunity to observe each other during patient interviews, which may have enabled them to overcome this potential limitation. Therefore, researchers should conduct studies with individuals who have worked on similar or related topics. Similar studies conducted by researchers suggest that the needs of patients in the healthcare system can be identified more quickly and scientifically, particularly for policymakers.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a novel contribution to the literature by qualitatively examining the reflections of psychology students who were actively engaged in data collection processes involving osteoporosis patients. The findings underscore the value of incorporating observer perspectives\u0026mdash;particularly those of trained but non-clinical personnel\u0026mdash;in exploring patient experiences, illness perceptions, and the multifaceted needs of individuals living with chronic conditions such as osteoporosis. The three primary themes identified\u0026mdash;illness perception, social support needs, and barriers to care\u0026mdash;mirror findings from prior quantitative studies, suggesting that proxy observations may serve as a viable methodological alternative when direct access to patients is limited. Moreover, this study highlights the nuanced ways in which students' professional training and subjective interpretations intersect with data collection processes, revealing both the promise and potential biases inherent in such qualitative approaches. Overall, the integration of indirect qualitative data into broader research frameworks may enhance the comprehensiveness of patient-centered inquiries and inform the development of more responsive, multidimensional healthcare policies and interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThroughout all stages of this research, care was taken to ensure that ethical principles were not violated, and all relevant ethical rules were followed. The ethics committee approval required for this study was obtained from the İstanbul University Ethics Committee for Social and Humanities Research. This study was conducted in accordance with the principles of the Declaration of Helsinki. Verbal consent was obtained from participants before and during the recordings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were informed about the purpose of this study, their roles in the study, and the recording of the interviews, and their consent was obtained.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) reported no potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants of this study did not give written consent for their data to be shared publicly; therefore, due to the research's sensitive nature, supporting data were unavailable. Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting İnterests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAI declaration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAI was utilized solely during the proofreading stage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of funding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was carried out under the 1001 program funded by TUBITAK (Prn. 122K918). The funder has no role in the design or preparation of the manuscript for submission to the journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the students who shared their perspectives on the project and patients' needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization and design of the study: Esin Temeloğlu Şen, Dilek Alay, and Esra Karagöz. Data acquisition: Dilek Alay and Esra Karagöz. Analysis and interpretation of data: Esin Temeloğlu Şen, Dilek Alay, and Esra Karagöz. Drafting and revising the manuscript: Esin Temeloğlu Şen and Dilek Alay.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLeventhal H, Phillips LA, Burns E. The common-sense model of self-regulation (CSM): A dynamic framework for understanding illness self-management. J Behav Med. 2016;39(6):935\u0026ndash;46. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10865-016-9782-2\u003c/span\u003e\u003cspan address=\"10.1007/s10865-016-9782-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCatalano A, Martino G, Morabito N, Scarcella C, Gaudio A, Basile G, et al. Pain in osteoporosis: From pathophysiology to therapeutic approach. Drugs Aging. 2017;34(10):755\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40266-017-0492-4\u003c/span\u003e\u003cspan address=\"10.1007/s40266-017-0492-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBesser SJ, Anderson JE, Weinman J. How do osteoporosis patients perceive their illness and treatment? Implications for clinical practice. Arch Osteoporos. 2012;7(1\u0026ndash;2):115\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchwille-Kiuntke J, R\u0026uuml;dlin SL, Junne F, Enck P, Brenk-Franz K, Zipfel S, Rieger MA. Illness perception and health care use in individuals with irritable bowel syndrome: Results from an online survey. BMC Fam Pract. 2021;22(1):154. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12875-021-01499-5\u003c/span\u003e\u003cspan address=\"10.1186/s12875-021-01499-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eValentine TR, Presley CJ, Carbone DP, Shields PG, Andersen BL. Illness perception profiles and psychological and physical symptoms in newly diagnosed advanced non-small cell lung cancer. Health Psychol. 2022;41(6):379\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/hea0001192\u003c/span\u003e\u003cspan address=\"10.1037/hea0001192\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJamieson MK, Govaart GH, Pownall M. Reflexivity in quantitative research: A rationale and beginner\u0026rsquo;s guide. Soc Pers Psychol Compass. 2023;17(4):e12735.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026uuml;rb\u0026uuml;z S, Şahin F. Sosyal bilimlerde araştırma y\u0026ouml;ntemleri: Felsefe\u0026ndash;y\u0026ouml;ntem\u0026ndash;analiz. 5. baskı. Ankara: Se\u0026ccedil;kin Yayıncılık; 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaraca S. Bilimlerde araştırma y\u0026ouml;ntemleri. Ankara: Gazi Kitabevi; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLazard L, McAvoy J. Doing reflexivity in psychological research: What\u0026rsquo;s the point? What\u0026rsquo;s the practice? Qual Res Psychol. 2017;17(2):159\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/14780887.2017.1400144\u003c/span\u003e\u003cspan address=\"10.1080/14780887.2017.1400144\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSteltenpohl CN, Siegel JA, Klement K. Workshop\u0026ndash;Increasing researcher transparency and reflection through positionality statements: Lessons from qualitative research. In: Society for the Improvement of Psychology Science 2021 Meeting; 2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/e5t36/\u003c/span\u003e\u003cspan address=\"https://osf.io/e5t36/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosenberg S, Tilley PM. A point of reference\u0026rsquo;: The insider/outsider research staircase and transgender people\u0026rsquo;s experiences of participating in trans-led research. Qual Res. 2021;21(6):923\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeventhal H, Diefenbach H, Leventhal EA. Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cognit Ther Res. 1992;16(2):143\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeventhal H, Nerenz DR, Steele DJ. Illness representations and coping with health threats. In: Baum A, Taylor SE, Singer JE, editors. Handbook of psychology and health: Vol. IV. Social psychological aspects of health. Hillsdale: Erlbaum; 1984. pp. 219\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiefenbach H, Leventhal H. The common-sense model of illness representations: Theoretical and practice considerations. J Soc Distress Homeless. 1996;5(1):11\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHale ED, Treharne GJ, Kitas GD. The common-sense model of self-regulation of health and illness: How can we use it to understand and respond to our patients'. needs? Rheumatol. 2007;46(6):904\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/rheumatology/kem060\u003c/span\u003e\u003cspan address=\"10.1093/rheumatology/kem060\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D. The revised illness perception questionnaire (IPQ-R). Psychol Health. 2002;17(1):1\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/08870440290001494\u003c/span\u003e\u003cspan address=\"10.1080/08870440290001494\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEdelstein E, Werner P, Dresner-Pollak R, Tordjman K, Jaffe A, Toledano Y, et al. Illness perceptions among osteoporotic men and women: Correlates and gender differences. J Mens Health. 2012;9(3):168\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHupcey JE. Clarifying the social support theory\u0026ndash;research linkage. J Adv Nurs. 1998;27(6):1231\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIşıkhan V. Cancer and social support. Community Soc Work. 2007;18(1):15\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim TH, Connolly JA, Tamim H. The effect of social support around pregnancy on postpartum depression among Canadian teen mothers and adult mothers in the Maternity Experiences Survey. BMC Pregnancy Childbirth. 2014;14:162. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1471-2393-14-162\u003c/span\u003e\u003cspan address=\"10.1186/1471-2393-14-162\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLogsdon MC, Koniak-Griffin D. Social support in postpartum adolescents: Guidelines for nursing assessments and interventions. J Obstet Gynecol Neonatal Nurs. 2005;34(6):761\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0884217505281855\u003c/span\u003e\u003cspan address=\"10.1177/0884217505281855\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSlykerman RF, Thompson JM, Pryor JE, Becroft DM, Robinson E, Clark PM, Wild CJ, Mitchell EA. Maternal stress, social support, and preschool children's intelligence. Early Hum Dev. 2005;81(10):815\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.earlhumdev.2005.05.005\u003c/span\u003e\u003cspan address=\"10.1016/j.earlhumdev.2005.05.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTanzer M, Avidan G, Shahar G. Does social support protect against recognition of angry facial expressions following failure? Cognition Emot. 2013;27(7):1335\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/02699931.2013.782266\u003c/span\u003e\u003cspan address=\"10.1080/02699931.2013.782266\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKats D, Patel MD, Palta P, Meyer ML, Gross AL, Whitsel EA, et al. Social support and cognition in a community-based cohort: The Atherosclerosis Risk in Communities (ARIC) study. Age Ageing. 2016;45(4):475\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ageing/afw060\u003c/span\u003e\u003cspan address=\"10.1093/ageing/afw060\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiao J, Muniz-Terrera G, Head J, Brunner EJ. Dynamic longitudinal associations between social support and cognitive function: A prospective investigation of the directionality of associations. J Gerontol B Psychol Sci Soc Sci. 2018;73(7):1233\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/geronb/gbw135\u003c/span\u003e\u003cspan address=\"10.1093/geronb/gbw135\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHavranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, et al. Breast cancer and social environment: Getting by with a little help from our friends. Breast Cancer Res. 2016;18(1):54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13058-016-0700-x\u003c/span\u003e\u003cspan address=\"10.1186/s13058-016-0700-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHinzey A, Gaudier-Diaz MM, Lustberg MB, DeVries AC. Breast cancer and social environment: Getting by with a little help from our friends. Breast Cancer Res. 2016;18(1):54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIevers-Landis CE, Burant C, Drotar D, Morgan L, Trapl ES, Kwoh CK. Social support, knowledge, and self-efficacy as correlates of osteoporosis preventive behaviors among preadolescent females. J Pediatr Psychol. 2003;28(5):335\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jpepsy/jsg023\u003c/span\u003e\u003cspan address=\"10.1093/jpepsy/jsg023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang CX, Yang FX, Zhu XH, Yu GJ. Investigation on mental state, quality of life, and social support of female patients with osteoporosis. Chin J Rehabil. 2008;23:250\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalender N, \u0026Ccedil;i\u0026ccedil;ek HS. Barriers to management of chronic diseases. Turkiye Klin J Nurs Sci. 2014;6(1):46\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYetim B, \u0026Ccedil;elik Y. Access to healthcare: The issue of unmet needs. J Community Soc Work. 2020;31(2):423\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.33417/tsh.630479\u003c/span\u003e\u003cspan address=\"10.33417/tsh.630479\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAky\u0026uuml;z G. Pain and quality of life in osteoporosis. Turk J Fam Physician. 2010;1(4):11\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcClement SE, Chochinov HM. Hope in advanced cancer patients. Eur J Cancer. 2008;44(8):1169\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejca.2008.02.031\u003c/span\u003e\u003cspan address=\"10.1016/j.ejca.2008.02.031\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWarriner A, Curtis JR, Saag KG. Challenges in defining and improving osteoporosis quality of care. Clin Exp Rheumatol. 2007;25(47):142\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmulders E, van Lankveld W, Laan R, Duysens J, Weerdesteyn V. Does osteoporosis predispose to falls? A study on obstacle avoidance and balance confidence. BMC Musculoskelet Disord. 2011;12(1):1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1471-2474-12-1\u003c/span\u003e\u003cspan address=\"10.1186/1471-2474-12-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRose P, Beeby J, Parker D. Academic rigour in the lived experience of researchers using phenomenological methods in nursing. J Adv Nurs. 1995;21(6):1123\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamos-Vera C, Saintila J, Calizaya-Milla YE, Acosta Enr\u0026iacute;quez ME, Serpa Barrientos A. Relationship between satisfaction with medical care, physical health, and emotional well-being in adult men: Mediating role of communication. J Prim Care Community Health. 2022;13:21501319221114850. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/21501319221114850\u003c/span\u003e\u003cspan address=\"10.1177/21501319221114850\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarańska A, Religioni U, Drop B, Bogdan M, Kłak A, Warunek A, et al. Assessment of the level of satisfaction with medical care of patients treated in osteoporosis clinics as an indicator of the quality of medical care. Int J Environ Res Public Health. 2022;19(12):7343. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph19127343\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19127343\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFarquharson B, Johnston M, Bugge C. How people present symptoms to health services: A theory-based content analysis. Br J Gen Pract. 2011;61(585):267\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3399/bjgp11X567090\u003c/span\u003e\u003cspan address=\"10.3399/bjgp11X567090\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHouse JS. Social support and social structure. Sociol Forum. 1987;2(1):135\u0026ndash;46. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.jstor.org/stable/684531\u003c/span\u003e\u003cspan address=\"http://www.jstor.org/stable/684531\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCutrona CE, Russell DW. Type of social support and specific stress: Toward a theory of optimal matching. In: Sarason BR, Sarason IG, Pierce GR, editors. Social support: An interactional view. New York: Wiley; 1990. pp. 319\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSavaş E, Bahar A. Evaluation of the satisfaction levels of inpatients in the University of Gaziantep Medical Faculty Hospital. Gaziantep Med J. 2011;17(1):24\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTezcan D, Y\u0026uuml;cel MH, \u0026Uuml;nal UB, Edirne T. Patient satisfaction in a tertiary health care organisation. Pamukkale Med J. 2014;7(1):57\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMa L, Li Y, Wang J, Zhu H, Yang W, Cao R, et al. Quality of life is related to social support in elderly osteoporosis patients in a Chinese population. PLoS ONE. 2015;10(6):e0127849. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0127849\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0127849\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eH\u0026uuml;bscher M, Vogt L, Schmidt K, Fink M, Banzer W. Perceived pain, fear of falling, and physical function in women with osteoporosis. Gait Posture. 2010;32(3):383\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.gaitpost.2010.06.018\u003c/span\u003e\u003cspan address=\"10.1016/j.gaitpost.2010.06.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Ouml;zsoy-\u0026Uuml;n\u0026uuml;bol T, Aky\u0026uuml;z G, Mirzayeva S, G\u0026uuml;ler T. Evaluation of pain, quality of life, and patient satisfaction in parenterally treated patients with postmenopausal osteoporosis. Turk J Phys Med Rehabil. 2020;66(3):262\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5606/tftrd.2020.4114\u003c/span\u003e\u003cspan address=\"10.5606/tftrd.2020.4114\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Qualitative research, Osteoporosis patients, Student evaluations, Illness perception, Social support","lastPublishedDoi":"10.21203/rs.3.rs-7560544/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7560544/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003e\u0026nbsp;In many studies, data collectors' views and observations regarding both the data collection process and patients are often insufficiently represented or integrated into the research framework. This study aimed to investigate the potential impact of psychology students' perceptions of patients, particularly in the context of their participation in the data collection process for a research project. A qualitative content analysis design was used. Data were collected through face-to-face and telephone interviews with 20 participants. The interview protocol was developed based on expert consultation to ensure content validity, and qualitative data were analyzed using MAXQDA 2022 to identify key themes and patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The analysis revealed three main themes: illness perception, social support, and barriers to treatment. Patients were aware of their illness and treatment processes and expressed the need for emotional, psychological, instrumental, informational, and companionship support. While they generally reported satisfaction with healthcare providers and institutions, they also faced barriers such as limited access to healthcare, physical and environmental constraints, economic difficulties, and psychosocial challenges. The study showed that qualitative insights from interviews with those interacting with patients aligned with findings from quantitative research, emphasizing the value of integrating diverse methods to capture the complexity of patient experiences.\u003c/p\u003e","manuscriptTitle":"Reflexivity in Data Collection: Psychology Students’ Interpretations of Osteoporosis Patient Experiences – A Qualitative Case Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-29 09:16:13","doi":"10.21203/rs.3.rs-7560544/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-07T16:12:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T14:37:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289250365230894459287898554381729247006","date":"2025-11-06T08:50:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T07:38:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-18T06:57:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T15:23:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T14:18:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2025-09-09T14:14:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"781539af-3a60-426e-b258-bf9aac78393c","owner":[],"postedDate":"September 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-15T11:38:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-29 09:16:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7560544","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7560544","identity":"rs-7560544","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}