Qualitative Health Research最新文献

Mobile health (mHealth) interventions are increasingly used to address the challenges of living with HIV and engaging with antiretroviral therapy. A wealth of evidence supports the efficacy of mHealth in supporting living with HIV. Yet, there is a dearth of evidence on how mHealth improves outcomes, which features are effective, and why these work in a particular setting. This study uses stakeholder views, including patients, providers, peer supporters, counsellors, and program directors, to conceptualize how specific mHealth features could interact with contexts of living with HIV and mechanisms that shape engagement with treatment. The study is part of an ongoing research project on engagement with HIV care in Iran. We draw on the perspectives of recently diagnosed and more treatment-experienced patients and their providers, using purposive sampling, conducting 9 focus group discussions with a total of 66 participants, in addition to 17 interviews. Our findings suggest that mHealth designs that feature provider connection, proactive care, and privacy and personalization are expected to dilute the harsh contexts of living with HIV. We build on previously identified socioecological pathways that disrupt antiretroviral therapy in Iran and find that mHealth can enhance the relation between the health system and patients. Our findings suggest that personalized mHealth features and provisions can partially mitigate the compounded impacts of harsh socioecological pathways that impede treatment success in Iran. Our social constructivist study was augmented with realist-informed analysis and could have transferability to similar contexts that trigger similar mechanisms of treatment disruption.

Aboriginal Australians experience a high prevalence of chronic obstructive pulmonary disease (COPD), with high rates of potentially preventable hospitalisations. However, little is known about Aboriginal peoples' experiences of living with COPD and how they navigate health care systems. This study used thematic analysis and Aboriginal methodology to explore Aboriginal peoples' lived experiences of COPD, their health care journey from receiving a diagnosis of COPD to the clinical management, and the impact of COPD on their daily lives. We conducted in-depth semi-structured interviews over a 6-month period with 18 Aboriginal adults diagnosed with COPD from four Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia. Reflexive thematic analysis was employed to ensure rigour. The findings revealed deeply personal and reflective stories shaped by historical, social, and cultural realities of Aboriginal peoples living with COPD. Four themes were identified characterising their experiences. Based on the findings, the following guidance is provided on future COPD care for Aboriginal peoples: Better alignment of existing COPD management with Aboriginal peoples' cultural contexts and perspectives to improve access to culturally safe care; Increased funding for ACCHS to enhance COPD management, such as early detection through case finding and access to ACCHS-led pulmonary rehabilitation; Engaging family members in COPD management and providing culturally centred COPD education that facilitates discussions and builds health literacy and self-management skills; Implementing health promotion initiatives to increase awareness and counteract fear and shame to improve early COPD detection.

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.

parkrun is a free, weekly organized mass participation physical activity event providing a remarkable example of at-scale dissemination, with over 1 million participants and 150,000 volunteers in Australia. This qualitative study draws on stakeholders' experiences to explore how parkrun succeeded with its dissemination and sustainability in Australia. Maximum variation and snowball sampling methods were used to select interviewees representing three parkrun stakeholder groups: parkrun Australia employees; volunteer organizers (event directors and ambassadors); and local external stakeholders (e.g., running clubs and landowners). Semi-structured interviews were conducted with 67 adult stakeholders in two phases (February-May and August-October 2023). We conducted a reflexive thematic analysis of interview data to explore contextual factors and mechanisms of parkrun growth and sustainability. We identify four themes to explain the growth and sustainability of parkrun in Australia: "Belief in an essential parkrun" comprises varied but overlapping ideas of what parkrun is fundamentally about; "Fluidity of movement" reflects the way individuals move freely in and out of the parkrun model, between roles and events; "Organizational and individual evolution" describes individuals' engagement journey and how the organization adapted with growth; and "Shared custodianship" reflects the dispersed leadership and shared responsibility across time, place, and people. These themes illustrate elements of the parkrun model that create broad buy-in, foster stakeholder commitment and longevity, and maximize resources for enhanced reach, dissemination, and sustainability. Our findings contribute practice-based evidence that may inform scale-up and sustainment of similar public health interventions.

COVID-19 impacted many men's intimate partner relationships, with distressed and disrupted partnerships consistently featured in commentaries with linkages to mental health challenges. The current study draws from interviews with 23 Canadian-based men, 19-50 years old, who experienced a break-up during COVID-19. Addressing the research question, "What are the connections between masculinities, men's mental health, and intimate partner relationship break-ups during COVID-19?", three thematic findings were derived: (1) Virtually Together and Growing Apart, (2) Mentally Trapped, and Failing Fast and Slow, and (3) Introspections and Moving On. Virtually Together and Growing Apart describes two contexts wherein men were either challenged by being physically apart from their partner or increasingly estranged while cohabitating with their partner during COVID-19. Mentally Trapped, and Failing Fast and Slow speaks to the stresses of being socially isolated and anxieties about the future with those tensions flowing to and from men's relationships. Featured were fast-tracked endings in terms of many participants knowing early-on the partnership was over, amid drawn out finishes wherein men's relationships gradually ended with the easement of COVID-19 restrictions. Introspections and Moving On varied in that many men were intent on processing and deconstructing all that happened in (and to end) their relationship. Men's learnings were leveraged through accessing professional and peer supports to promote self-growth and purposefully build healthier intimate partnerships. The study findings affirm the need for gender-responsive mental health promotion programs to equip men with relationship skills, while also underscoring the necessity for services dedicated to addressing post-COVID-19 injuries.

Minimal research has explored the personal experience of burnout in doctors from any medical speciality. Consequently, we aimed to provide a relatable description and understanding of this globally recognised problem. We employed an interpretative phenomenological analysis (IPA) of face-to-face interviews with seven general practitioners (GPs) in Northern Ireland, having selected interviewees best able to speak about burnout. We sought to understand how these GPs understood their burnout experiences. Our participants' continuous work involved more than their busy weekdays and also working on supposedly off evenings and weekends. In addition, draining intrusive thoughts of work filled most, if not all, of their other waking moments. There was no respite. Work was 'always there.' Being constantly busy, they had no time to think or attend to patients as doctors. Instead, participants were going through the motions like GP automatons. Their effectiveness, efficiency, and caring were failing, while their interactions with patients had changed as they tried to conserve their now-drained energy and empathy. There was no time left for their families or themselves. They now "existed" to continuously work rather than "living" their previous, more balanced lives that at one time included enjoying being a doctor. Worryingly, participants were struggling, isolated, and vulnerable, yet unwilling to speak to someone they trusted. We intend our burnout narrative to promote discussion between medical colleagues and assist in its recognition by GPs and other doctors. Our findings warn against working excessively, prioritising work ahead of family and oneself, and self-isolation rather than seeking necessary support.

Phenylketonuria (PKU) is a rare metabolic condition characterised by an inability to metabolise phenylalanine (Phe), found in many foods. When pregnant with PKU, women must adhere to a strict low-Phe diet. If they do not, foetal abnormalities or pregnancy loss can occur. Pregnancies are therefore closely clinically monitored and dominated by dietary management, leaving little "space" for women's emotional experience. This article explores the emotional impact of PKU during pregnancy and how this effects pre-natal bonding. Based on interviews with six women with PKU, conducted whilst they were pregnant, this article explores their unusual and previously undocumented experience. Image-making during interviews allowed women to uncover aspects of their experience that might otherwise have remained hidden. Interpretative phenomenological analysis of the transcripts and images generated five themes summarising the women's experiences. Some themes reiterated findings from previous studies, for example, the huge cognitive burden associated with PKU pregnancies and the importance of both expert and informal support to successful pregnancy management. However, new understanding also emerged, including rich description of the emotional load of these pregnancies and strategies that women use to manage this. Anxiety about baby safety was central to their experiences, and the effect of this on pre-natal bonding was explored. This article calls for increased formal and informal support for women with the emotional aspects of their PKU pregnancies, for example, the creation of "attachment-aware" services that support women with their anxiety, promoting strong pre-natal attachment and subsequently protecting maternal and infant mental health throughout pregnancy and beyond.

In Belgium, adults with psychiatric disorders can opt for euthanasia under strict conditions. The impact of these euthanasia trajectories on close relatives remains insufficiently studied. This research is the first in Belgium to explore the concrete experiences and support needs of relatives involved in psychiatric-based euthanasia trajectories by means of an in-depth interview study. The interviews with 18 relatives were conducted from March to May 2023 and analyzed using inductive thematic coding. The results reveal the complex and ambivalent emotional and cognitive experiences among relatives. Experiences with euthanasia trajectories varied from positive to negative, marked by shared feelings of surrealism and unreality. This included the farewell process that relatives go through, regardless of whether euthanasia was carried out. While the desired level of involvement varied, everyone sought some degree of recognition and understanding for their complex position during the euthanasia procedure, aiding in a better comprehension and contextualization of the request. The level of actual involvement and support depended on the stage of the euthanasia request, their social network, and the reasons behind the request. There was a demand for transparent communication, more emotional and practical support, and assistance in coping with the emotionally charged process. Specific attention is needed for the emotional and cognitive rollercoaster, even if euthanasia is not ultimately pursued. Future research should employ a longitudinal design to gain deeper insights into relatives' fluctuating experiences and support needs throughout euthanasia trajectories. Seeking greater context diversity and combining perspectives in cluster research can improve understanding of interconnected needs.

Healthcare workers (HCWs) experience occupational stressors that negatively impact emotional well-being and exacerbate turnover intentions. In the wake of the COVID-19 pandemic, the resultant acute care turnover rates have reached an all-time high. In addition, occupational stressors lead to psychological stress, including moral distress, defined as the dissonance between perceiving what the right course of action is and encountering an obstacle to acting accordingly. This qualitative descriptive study explored the perceptions of patient-facing HCWs in acute care hospital settings regarding the workplace stressors they encountered and the role of hospital-based chaplains in addressing emotional well-being and stress with 33 interviews. Findings suggest that HCW frequently experience work-related moral distress and seek relief by interacting with hospital chaplains. Chaplain care, common in American healthcare facilities for the spiritual care of patients, is an easily accessible resource to HCWs. Facilitating chaplain-HCW interactions may be an effective strategy for responding to moral distress and improving healthcare workers' well-being.

While the issue of intimate partner homicide (IPH) has gained increasing focus, research that pinpoints the experiences of women who survived an attempted IPH is limited. Specifically, studies that aim to understand the aftermath of surviving such incidents are scarce. Thus, the aim of the present study was to explore the emotional experience of IPH survivors following the attack. An interpretive phenomenological analysis was used to analyze the narratives of 11 women who had survived an attempted homicide by their partner. Four major themes emerged: Living between dichotomies: A fragmented identity; Embodied fear: A fear that will not go away; The loss of future: A life divided; and The loneliness of surviving the "unsurvivable." Utilizing the ambiguous loss theory to examine the emotional ramifications of IPH indicates that survivors navigate persistent confusion and struggle to comprehend the loss. This involves challenges in moving forward and achieving resolution, conflicting emotions related to the loss, minimal recognition of the grief, and limited support from the social environment.