The NVIVO software was used for data analysis. Thematic analysis, as adapted from Morse [15] and Mays and Pope [16, 17] and based on the constant comparative method [1820], was used to analyze for codes (recurrent patterns statements, words or phrases) with similar meaning or interpretation across data set [1823]. During data analysis, audio recordings were transcribed verbatim by the investigator by listening to the audio recordings, transcribing the recordings and comparing them with the field notes. Field notes were checked for important contextual information that improved interpretation of audio-taped data. The transcripts were read carefully while listening to the audio recording so as to correct any areas that needed clarification, to correct spelling or other errors, and to anonymize the transcripts (so that the individual participants could not be identified from the transcripts (by deleting the names, places or significant events in the transcripts). From the field notes, information such as pauses, laughter, looks of discomfort and other contextual information collected were inserted into the transcripts. Once identified, the codes were aggregated into themes (groups of word patterns or phrases with similar meaning). Representative quotes from the individual transcripts were included to illustrate the source of the interpretations of the information from participants, and are presented in the results.

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