Qualitative Health Research最新文献

The stage is set for a new era of precariousness in modern medicine, driven by the increasing failure of a key pharmaceutical pillar-antimicrobials. In the context of sexually transmitted infections (STIs), the rise of antimicrobial resistance is introducing urgent questions around what might constitute "best practice" in a rapidly evolving scene, including the value of asymptomatic screening (test and treat), and the consequent downstream collateral damage emerging from over-use of our diminishingly effective antimicrobial resources. Drawing on interviews with clinicians, experts, and industry representatives, we examine resistance as a site of emerging and co-constitutive moral, temporal, and economic dilemmas. Such dilemmas, as illustrated in participants' accounts, involve complexities regarding prioritization between competing health demands; doing good work while meeting business requirements; considering trade-offs between visibility and amplifying the problem; difficulties balancing presents and futures; reconciling divergent clinical opinions and expertise; and managing patient subjectivities, while considering the implications of clinical practices for resistance. Importantly, centering dilemmas in context of antibiotic-resistant STIs open greater theoretical scope to consider the challenging spaces that key actors such as clinicians and decision-makers occupy, as they attempt to curb resistance while caring for individuals and the community.

Epistemic injustice is an analytical framework that is used to describe a wrong done to someone in their capacity as a knower. Epistemic injustice is well-documented across the healthcare spectrum, particularly in relation to the patient's capacity to understand, and thus derive meaning from, the experience of illness. This article contributes to the body of scholarship exploring how to achieve pathocentric epistemic justice by way of ethnographic case study. Findings draw on fieldwork conducted at a small, publicly funded chronic pain clinic. At MB clinic, pain care is delivered in a group setting. Patients and doctor exhibit a playful attitude: they lean into uncertainty, tell jokes, and eschew the concept of mastery. This produces an epistemic environment that departs from the kind critiqued in studies wherein epistemic injustice is present. By way of case study, this article provides support for the broad claim that there is a link between playfulness and epistemic well-being. Therefore, playfulness may be applied as a strategy to combat pathocentric epistemic injustice.

Although chronic health conditions and homelessness are prevalent problems in the United States and globally, little research has used the lens of burden of treatment theory to examine the experiences of people facing these challenges simultaneously. This study aimed to illuminate dimensions of treatment burden, which refers to the work of being a patient with chronic conditions, and patient capacity to manage this burden in a sample of people experiencing homelessness and chronic health problems in Buffalo, New York, United States. We completed in-depth interviews with men and women recruited from a homelessness services organization (N = 27) and applied core concepts from burden of treatment theory to our analysis to probe how participants navigated tasks related to treatment and self-care. Using codebook thematic analysis involving three coders, results revealed four interconnected themes of complex coordination, self-monitoring, obtaining and using prescriptions and medical supplies, and communication and explaining health issues, which were confirmed through member checking (N = 6). These dimensions of treatment burden were dynamically impacted by patient capacity factors-which included trauma, medical mistrust, health literacy, and social support-as well as by social determinants of health such as housing and income. Findings support the need for more formal collaboration mechanisms between healthcare providers and social service agencies, active involvement of patients in their health plans, and policies such as Housing First to improve access to stable and affordable housing and social services for people with complex health issues.

Gay and bisexual men (GBM) engaging in chemsex can face various health and well-being-related challenges, the extent of which remains unknown given the limited research in the context of the COVID-19 pandemic. This paper examines the pandemic impacts on the health needs of GBM who engaged in chemsex and their experiences with related services. We applied interpretive description to produce knowledge with direct implications for improving practices and policies. Data were collected between July 2020 and January 2021 using in-depth semi-structured interviews with eight key informants who held chemsex expertise and 13 GBM with chemsex lived experiences. Interviews were transcribed, anonymized, and analyzed thematically, yielding three interrelated themes. First, participants argued that the COVID-19 public health response was heteronormative and moralizing, reinforcing feelings of shame among GBM who engaged in chemsex and further isolating them. This added a layer of stigma and exposed them to increased drug-related risks by obstructing harm reduction practices. Second, participants contended how the pandemic worsened the scarcity and shortcomings of chemsex-specialized services. The mandatory shift to online services made it harder to form meaningful therapeutic relationships, especially given the unique sensitivity and stigma associated with chemsex, further heightened during the pandemic. Third, this online shift simultaneously facilitated access to personalized and culturally sensitive care, especially for those with less urgent needs. Our findings' implications emphasize the importance of adopting a comprehensive approach in chemsex care, integrating both in-person and online methods, to counteract health iniquities reinforced by the pandemic and the institutional responses to it.

This article considers responsibilities and challenges inherent in the research relationship, from the position of a researcher who is also a counselling practitioner. It draws on my experience of undertaking a qualitative interview-based doctoral research study with adult survivors of childhood sexual abuse, engaging critically with the debates in the research literature concerning researcher-practitioner role boundaries and comparable (and distinct) areas of practice between research and counselling. I suggest that within well-held, monitored boundaries, practitioner identities and contextual knowledge are invaluable to the research relationship and that a collaborative fluidity can operate between researcher and professional (in this case, counsellor) identities rather than them being in conflict. Though the issues addressed here arise from the researcher as counselling practitioner, I believe they have a wider relevance for all qualitative researchers. What happens in the research relationship is complex, involving the various identities (personal and professional selves), emotions, and subjectivities of both researchers and research contributors. Our personhood in research can help to generate rich sources of understanding and at the same time demands our critical reflexivity to interrogate our subjectivities and their influence. In undertaking research which asks individuals to reflect in detail and depth on intimate areas of their lives, researchers need to be prepared for the potential emergence of distress and feel equipped, through training, support, and contextual-based knowledge, to be able to respond appropriately. It calls for reflexive relational competence at the heart of qualitative research.

This paper explores the use of participatory video (PV) in a case study conducted in Arcoverde, Brazil, to address the call for greater participation of individuals with disabilities in health and social care planning and research. PV is grounded in similar concepts to the Disability Rights Movement's principle of "Nothing About Us, Without Us" and serves as a potential collaborative tool for individuals with disabilities to shape their narratives and contribute to research. The study was part of a multi-methods research project on healthcare access, with the PV research focusing on primary healthcare in Arcoverde. The researcher emphasizes the action-oriented and community-based approach, to foster an inclusive environment through workshops, story circles, and video-making. Ethical considerations prioritize informed consent and identity protection. The results underscore the potential empowering impact of PV, fostering community awareness and practical awareness among participants. The discussion emphasizes the ethical considerations, challenges, and the need for reflexivity in participatory video research.

Public awareness campaigns on palliative care aim to tackle limited public knowledge and negative perceptions of palliative care. However, little is known about their public reception. This study examined how existing campaigns are interpreted, evaluated, and engaged with by members of the general public. Three public campaigns, launched in Flanders or the Netherlands between 2020 and 2023, were discussed in 10 focus groups (total of 65 participants). The analysis was guided by Schrøder's multidimensional audience reception model. Our results show that campaigns were interpreted, evaluated, and engaged with in highly divergent ways. People with personal experiences surrounding serious illness were generally more open toward campaign messages, while a sense of personal relevance was lacking for others. Campaigns that centered on the perspectives of seriously ill individuals while portraying them in active and resilient positions were more positively evaluated. Moreover, they were more successful in broadening perceptions of palliative care beyond being hospital-based end-of-life care for severely ill and care-dependent persons. Conversely, materials that neglected the patient's voice while framing palliative care as enabling moments of joy "despite serious illness" generally fortified prior perceptions and were often rejected. Additionally, a preference for highlighting the social context surrounding the patient was repeatedly expressed. We conclude that diversified strategies, optimizing a sense of personal relevance, are needed to more effectively influence public understanding and engagement toward palliative care. Destigmatizing palliative care also involves destigmatizing persons with serious illness, and representing them with an emphasis on their agency and strength is vital to this shift.

There is a scarcity of health human resources worldwide. In occupational therapy (OT), physical therapy (PT), and speech-language pathology (S-LP), attrition and retention issues amplify this situation and contribute to the precarity of health systems. Therefore, we aimed to investigate retention strategies for rehabilitation professionals in Quebec. We present an analysis from individual interviews with rehabilitation professionals and focus groups with stakeholders. We used purposeful sampling (maximum variation approach) to recruit participants from Quebec, Canada. We conducted interviews with 51 OTs, PTs, and S-LPs (2019-2020) and four focus groups with managers, professional education programs, professional associations, and regulatory bodies (2022). Cultural-historical activity theory provided the theoretical scaffolding for these interpretive description studies. Inductive and deductive approaches and constant comparative techniques were used for data analysis. Five sets of retention strategies were developed: (1) ensuring that work aligns with values; (2) improving alignment of work parameters with needs and interests of rehabilitation professionals; (3) modifying physical, social, cultural, and structural aspects of a workplace; (4) addressing how the profession is governed; and (5) offering informal and formal benefits. Multi-systemic retention strategies with intersectoral partnerships were deemed essential to effectively change rehabilitation professionals' work and work environments and to increase public awareness of the added value of rehabilitation professionals. Our findings emphasize a critical need to design targeted, multi-systemic retention strategies to influence the work experiences of rehabilitation professionals and to ensure the availability of OTs, PTs, and S-LPs for present and future rehabilitation needs.

Relatives are increasingly recognized as important in the care of people with a serious mental health condition, such as major depressive disorder, bipolar disorder, or schizophrenia. Research indicates that in providing care, relatives use so-called treatment pressures, such as persuasion, interpersonal leverage, inducements, or threats, to promote the treatment compliance of their family member. This grounded theory study investigated why relatives use treatment pressures by analyzing the experiences of relatives of people with a serious mental health condition before, during, and after mental health crises of their family member. We conducted 11 semi-structured, problem-centered interviews with such relatives in Germany between October 2019 and January 2020. Our analysis showed that the key category of relatives' experiences is a predicament characterized by feeling responsible to take action while experiencing a limited range of action. Relatives' perceived responsibility to take action had three dimensions: relatives' worries about their family member and other members of the family, societal norms and expectations, and the transfer of responsibility from the mental healthcare system to relatives. The limitation of relatives' scope of action also had three dimensions: their family member's opposition to treatment, legal criteria for involuntary commitment or treatment, and their dependency on mental healthcare professionals and the mental healthcare system. We reconstructed three different ways in which relatives may deal with this predicament: assuming responsibility for their family member's treatment, which involved exerting treatment pressures, staying out of their family member's mental health-related matters, and focusing on their own well-being.

As the global population of patients undergoing maintenance hemodialysis continues to grow, more than half are experiencing the psychological distress associated with learned helplessness, a condition potentially linked to adverse outcomes such as depression and suicidal ideation. However, the triggers contributing to learned helplessness in these patients remain poorly understood. This study employs an interpretative phenomenological approach to explore the experiences and triggers of learned helplessness among 26 maintenance hemodialysis patients across five hospitals in China. The analysis of participants' narratives reveals that learned helplessness in these patients is influenced by a combination of physiological, psychological, and social factors. Physical discomfort and psychological changes contribute to their sense of helplessness. Despite seeking support from family and healthcare providers, their distress often goes unnoticed. Additionally, the social stigma of being perceived as a "special group" further exacerbates their learned helplessness. Based on the findings, the following recommendations are provided to effectively mitigate learned helplessness: Healthcare professionals must reduce symptom burden, provide psychological assessment and support, and assist in rebuilding positive patient cognition. It is also crucial to enhance connections between patients, their families, and social support groups, reduce misunderstandings and stigmatization, and strengthen community support systems.