Qualitative Health Research最新文献

Nationally, diabetes is the eighth leading cause of death. The crisis deepens in South Carolina, where the state ranks sixth in adult diabetes prevalence. The burden is even greater in rural counties. Understanding storytelling themes and modalities is a novel approach in crafting culturally tailored messaging for the prevention and management of diabetes. This qualitative study examined the experiences of diabetes through the lens of Southern Gothic. Nineteen African Americans, all with a diagnosis of diabetes and residents of a town in rural South Carolina, were recruited and interviewed. Interviews were examined for narratives and organized thematically by Southern Gothic storytelling modalities. Interviews revealed stories of shock, fear, the grotesque, isolation, helping one's neighbor, and sacrifice in the diagnosis and ongoing management of diabetes. This study revealed numerous opportunities in research, public health, and community health nursing to tailor diabetes messaging and interventions designed to improve diabetes outcomes in rural communities.

Since 2022, a global mpox outbreak in non-endemic countries, including Canada, has spread rapidly, mainly affecting gay, bisexual, and queer men (GBQM). With mpox primarily transmitted through sexual and close physical contact, concerns emerged over the replication of early responses to HIV/AIDS, which was initially labeled as a "gay disease," perpetuating ongoing negative stereotypes and discrimination against GBQM. To prevent potential social and health-related stigmatization, institutional actors, including public health authorities, community-based organizations (CBOs), and clinical bodies, collaborated to provide guidance and promote culturally informed responses. We aimed to examine how health institutional collaborations were formed and maintained as challenges emerged during Canada's mpox outbreak response. We conducted 30 online individual interviews and six small focus groups with 48 CBO practitioners, public health personnel, and clinical providers across Canada. Data were analyzed using institutional ethnography and actor-network theory, through indexing, which involves categorizing and consolidating categories. We mapped four interrelated networks of coordination: assembling the network through existing HIV infrastructures; co-developing public health messaging to increase cultural sensitivity to GBQM's lived experiences; negotiating vaccine eligibility criteria to reflect community realities; and mobilizing networks to deliver vaccines in GBQM community-friendly settings. Regional differences in public health infrastructure influenced the development of coordination, messaging, and access to care. Findings highlight how relational infrastructures developed for HIV were reactivated and repurposed during the mpox response. Investing in and maintaining strong community and public health relationships outside of crisis periods can improve future responses to health emergencies affecting GBQM communities and other marginalized populations.

The concept of saturation was originally developed within grounded theory. It has since been extended and widely adopted as a marker of rigor throughout qualitative health research. Although saturation can prove useful, there are growing concerns regarding its uncritical adoption as a universal standard of high-quality analysis. While this critique is not new, we ground our argument within the concept of epistemic injustice, to contend that the inappropriate use of saturation risks enacting epistemic injustice by marginalizing certain forms of data and certain methodologies. This, in turn, limits what can be known about health and illness, with the potential to cause material harm and produce and sustain health inequities. First, we introduce the concept of epistemic injustice, following which we provide an overview of saturation to describe the different models, discuss their contingent nature, and call attention to the underlying positivist logic embedded in saturation. Next, we analyze the exclusionary effects of saturation in qualitative health research through the lens of epistemic injustice. We conclude with recommendations for a more context-sensitive and reflexive engagement with saturation, and a shift away from procedural adherence to checklist-based standards that enforce its use in academic knowledge production.

Men are an important, yet understudied, population in body image research. Body image is an important contributor to mental health and is pertinent to all genders. While research exists identifying major influences on men's body image, what has been studied less is the way that men perceive, and subsequently narrate, their experiences with body image over their lifetimes. Consequently, the current study examines the way that men narrate their body image experiences through emerging adulthood, subsequently identifying prominent communicative influences. Eight men in the emerging adult age range (18-25 years old; M = 24 years old) participated in semi-structured interviews, and transcripts were coded using three-tier iterative analytical process. Results revealed two narrative styles in which participants narrated their experiences: The Family Fit journey and the Social Son journey. Findings are discussed in light of social learning theory, noting implications for future research and practical application.

Minimal research has examined culturally nuanced healing experiences across national landscapes, highlighting the need for a comprehensive understanding of culturally relevant healing experiences for survivors of gender-based violence (GBV). This paper explores these experience among 136 survivors of GBV across seven global contexts. Using the Clinical Ethnographic Narrative Interview-Trauma, after reflecting on their healing journey, survivors shared advice for others healing from GBV. Using the Comparative Ethnographic Narrative Analysis Method, we found shared, culturally distinct, and nuanced themes in this advice, including actions to promote healing, building a positive self-concept, and finding strength. Findings underscore the importance of contextually sensitive and survivor-informed approaches in social and health services, urging more tailored healing strategies after GBV. Findings also demonstrate the importance of analyzing cultural nuance in qualitative research themes to allow more culturally relevant survivorship care.

Autoethnography is an increasingly used method to promote individual and group reflexivity in research, not the least in healthcare. However, autoethnography's uptake among practitioners is impeded by the fact that it has not been adequately adapted to practitioner settings from its academic origins. This article analyzes the experience of a research team comprised of practitioners/surgeons and social scientists using primarily oral-based autoethnographic practices to promote reflexive collaboration in a longitudinal research and innovation project on selection and training of surgical residents. Based on our case of innovative adaptation and application of autoethnography, which we term autoethnorality, several modifications in autoethnographic practice are suggested to make it more amenable to practitioner settings. These include adopting the collaborative and analytic forms of autoethnography and developing oral-based modalities for autoethnographic practice. The case also shows how these strategic choices along with successive adoption of autoethnographic practices can facilitate the resolution of tensions deriving from the differing timeframes, skillsets, and interests of practitioners on the one hand and academic researchers on the other, as well as paradigmatic differences in theory of science between the medical and social sciences. A table summarizing the advantages and disadvantages of different strategic choices and adaptations regarding autoethnography along with actionable recommendations is presented.

Heart disease at an early or middle age is critical, especially when accompanied by an acute cardiac event with or without sudden cardiac arrest (SCA). Owing to this situation, patients describe changes in their health-related quality of life as well as in their future plans and goals. This study examined changes in ideas of a good life due to heart disease treated in an acute hospital. In our study, 16 patients aged 30-59 years were included. Among them, four had SCA, seven myocardial infarction, and five other serious cardiac conditions, such as cardiac arrhythmia. Advanced chronic heart failure was noted in five, and four had implantable cardioverter defibrillators. Phenomenological semi-structured interviews of 50-100 min each were conducted with a purposive sample and analyzed using interpretative phenomenological analysis. The ideas of a good life and changes in future lifestyle following a serious heart disease were reported by patients. These experiences were summarized into five superordinate themes: "My bodily trust is gone," "Simply living a modest life," "Actively shaping my life again," "Being more in contact with relevant people," and "Grateful for the gift of my new life." Living a more modest life and actively shaping life again are two new aspects of the ideas of a good life. Further studies should be conducted in cardiac patients with lower disease burden and young patients with congenital heart disease, with a focus on sex-specific issues.

Advanced multimorbidity is the term used to describe when someone has multiple chronic conditions including those which are associated with palliative care needs. People living with advanced multimorbidity have to coordinate and undertake lots of different tasks related to their chronic conditions, and this can lead to them feeling overburdened, and disengagement from treatment regimes. In this study, we sought to explore how this "treatment burden" was experienced by people with advanced multimorbidity and their caregivers. We adopted a focussed ethnographic approach, in which patient/carer dyads (six groups of two, recruited from an emergency department) took part in two semi-structured interviews and kept a participant-led journal of treatment burden experiences. We also offered to observe any burdensome activities, although only one such session was conducted. A reflexive thematic analysis of the data was conducted by a single researcher, in which data were coded both inductively and through the lens of Burden of Treatment Theory, plus two theories of uncertainty (Total Uncertainty and Uncertainty Tolerance). The types of patient work were split between practical tasks (such as taking medicines or going to hospital) and cognitively burdensome activities (such as symptom surveillance and planning ahead). Burden of Treatment Theory was useful in understanding how work was distributed between patients and their relational networks. We found that multidimensional uncertainty mediated the balance between workload and capacity, and we propose a conceptual model of this relationship alongside a suggestion for how interventions can be used to manage uncertainty and burden.

Entrance to university is marked by significant changes and challenges that can impact mental health and well-being. This study investigated the determinants of psychological distress, coping strategies used, and the availability of support systems among university students in a non-Western country through the lenses of self-determination theory. The thematic analysis of 16 in-depth interviews revealed several academic, socio-demographic, and situational factors crucial in facilitating or impeding university students' sense of self-determination and, consequently, their psychological distress. The study uncovered students' relative preference for avoidance coping mechanisms, the limited presence of perceived formal support systems in higher education institutions, and a clear reliance of students on informal sources of support to buffer the effects of distress. Moreover, it was evident that students perceived their higher education settings as leaning toward being controlling rather than autonomy-supportive. Implications for promoting well-being among university students are discussed.

A growing amount of evidence shows the positive impact of arts-based interventions in dementia care. Existing studies focus on the impact of such interventions on individuals with dementia, yet there is little known about contextual factors influencing the impact of such practices. Contextual factors include personal and relational processes, such as the collaboration between staff, family members, and artists. It also includes making specific organizational choices about the way in which arts and care organizations structure and organize their collaboration. The study aimed to investigate contextual factors influencing the potential impact of health care clowning for persons with dementia. Through multi-country participatory action research (PAR) into health care clowning in dementia care, this study engaged artists (health care clowns), staff, family members, and representatives from four long-term dementia care facilities and three health care clowning organizations. The presented findings show that for arts-based interventions to have sustainable impact within the context of long-term dementia care, focusing on the intervention itself is not enough. Additional time and space are needed for implementation of the intervention and good collaboration on the work floor. The results of this study demonstrate that elements in the PAR process such as open dialogue and arts-based research methods can create communicative spaces which can serve as a catalyst for effective implementation of arts-based practices in long-term dementia care. Elements of the PAR process can therefore be regarded as a form of successful boundary work and in the future could be applied when implementing arts-based interventions in care settings.