Qualitative Health Research最新文献

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.

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.

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.

Experience-based co-design (EBCD) is a qualitative form of participatory action research supported by a toolkit providing guidance and recommendations. The toolkit is intentionally non-prescriptive, allowing EBCD practitioners the freedom to flex the approach to cater to the needs of their specific populations and contexts. For less experienced researchers, the lack of specificity can be a challenge when navigating activities such as data analysis, particularly as wider literature provides limited insights to methods, processes, methodological critique, and lessons learned. Despite increasing use of EBCD, few practitioners publish details of their methods, processes, or decision-making for how they adapt EBCD for their studies, focusing more often on findings and outcomes. This can impact understanding and development of rigor in EBCD literature. In this methodology paper, we respond to this gap by providing a case example and step-by-step guide for application of reflexive thematic analysis to EBCD, with consideration of reflexivity, a conceptual framing for interpreting experiences, opportunities for greater participant involvement, and strengths and challenges of using reflexive thematic analysis within EBCD.

During the COVID-19 pandemic, there were months of delay in deploying community pharmacies for the National COVID-19 Vaccination Programme in Ireland. We aimed to explore what may have accounted for this delay between 15th December 2020 (publication of policies) and 14th June 2021 (commencement of community pharmacy-based vaccination). We carried out a multi-method qualitative case study that involved engaging with 11 stakeholders, reviewing 246 documents, and conducting semi-structured interviews with 11 policy elites. Using reflexive thematic analysis, we developed three themes. The first provides evidence that the delay was, in part, due to operational barriers related to the logistical and safety aspects of the Programme. The second, on the other hand, presents a perspective that the delay was unreasonable as it was based on perceived deficits in community pharmacies. Finally, the third highlights the inability of the pharmacy profession to influence health policy due to a lack of strategic and cohesive leadership and the dominance of the medical profession. Overall, we argue that the delay can be explained by a complex interplay between technical, socio-political, institutional, and regulatory factors, underpinned by a chronic lack of strategic direction for pharmacy in the Irish health system.

Alberta is home to one of Canada's fastest growing populations of Black people, driven by an influx of African immigrants to major metropolitan areas such as Edmonton and Calgary. As the Black population in Alberta continues to grow, it is crucial to the well-being of these communities that we understand their health service needs. Black women are a vulnerable group within the Black population due to inequities in social determinants of health such as access to healthcare. In Canada, little is known about the healthcare access experiences of Black women despite reported disparities in their health outcomes. As such, we undertook a qualitative study to examine access to health services for Black women in Alberta. Semi-structured interviews were completed with 30 Black women from Edmonton and Calgary. We applied intersectionality as an analytical framework to guide our understanding of how interconnected social processes shape Black women's experiences of accessing healthcare. Following our thematic analysis, we identified two major barriers to healthcare access: patient-provider discordance and negative healthcare encounters. We identified two key facilitators: positive patient-provider dynamics and individual and social network strengths. Our findings suggest that Black women have distinct experiences of accessing the healthcare system which are best understood as a confluence of their race, gender, and other aspects of their personhood.

Schizophrenia, a mental disorder characterized by delayed onset, high relapse rates, and significant disability, ranks among the top 20 contributors to the global burden of disease and poses a substantial public health challenge. Effective self-management is crucial for the recovery of individuals with schizophrenia, with medication experience playing a vital role. However, the underlying mechanisms and logical relationships remain elusive, hindering the development of effective self-management and enhancement strategies from the perspective of medication experience. This research aimed to illuminate these aspects by conducting semi-structured interviews to delve into the impacts of medication experience on self-management behaviors among individuals with schizophrenia. The goal was to elucidate the role of medication in self-management and to identify potential barriers and facilitators via patient narratives. We employed interpretive phenomenological analysis to examine interview transcripts from 12 participants diagnosed with schizophrenia. This analysis yielded three superordinate themes: "Medicine isn't just medicine," "Experience is a catalyst for action," and "Action shaped by experience." We discuss these themes in the context of existing literature and theoretical frameworks and propose specific recommendations, such as motivational interviewing for clinicians, tailored psycho-educational programs, and supportive systems respecting patient autonomy. This study offers a contextual understanding of the medication experience for individuals with schizophrenia, enhancing our knowledge of self-management behaviors and how they can be promoted in this population.

With the escalating number of people diagnosed with chronic disease globally, research aimed at supporting their adjustment and coping is invaluable. Reconstructing a sense of self is core to the psychosocial adjustment of people with chronic disease (PwCD), and meaning making is central to their coping with the diagnosis. Despite the growing number of PwCD living productive lives, their identity work is underexplored. This article reports on an in-depth multiple case study that explored the identity work of PwCD from a meaning-making perspective. Data were gathered from three cases using semi-structured interviews, document analysis, and diaries. Data analysis entailed interpretative phenomenological analysis and flexible pattern matching. Three themes describe participants' identity work process: First, they narrate a broken identity, having experienced identity disruption, discontinuity, and loss; second, they envision an ideal identity through existential reflection; and third, they reconstruct a meaningful identity. Reconciling the broken self with an ideal self leads to the construction of a meaningful self. The meaningful self is conceptualized in participants' application of Frankl's meaning-making principles, as they constructed a purposeful self (creative), a connected self (experiential), and a determined self (attitudinal). The article discusses the implications for helping professionals and organizations in supporting PwCD as they work toward rebuilding a meaningful self, facilitating their identity work in the search of a meaningful self.

Medical congresses play a pivotal role in the continuing medical education of healthcare professionals (HCPs), particularly in light of the rapid advancements in medical knowledge and technology. Notwithstanding, little is known about the internal dynamics of such events and how they contribute to the learning processes in communities of health professional practice. This study aims to uncover and elucidate what motivates HCPs to participate in medical congresses and how they experience their participation through a qualitative study. Attending six in-person medical congresses in Western Europe in 2023, we collected data through a combination of ethnographic methods including 69 in-situ interviews, 17 in-depth interviews, and extensive participant observations. We analyzed the role of the physical environment, participant motivation, interdisciplinarity, and participant diversity for medical congress attendance, ultimately identifying four types of congress participants: Explorers, Newcomers, Drivers, and Updaters, each characterized by unique patterns of professional experience and engagement within the professional communities. Our findings elucidate the complex motivational landscape of medical congress participants, where the desire for learning is routinely complemented by the pursuit of peer recognition. Our insights and the qualitative typology of medical congress participants introduced have the potential to optimize continuous medical education and shape the structure of future medical congresses by shedding light on the evolving needs of HCPs in diverse medical fields.

Guillain-Barré syndrome is a rare neurological condition. Research has increased our understanding of the etiology, prognosis, and effective medical treatment of the illness. There is a lack of understanding regarding the psychological effects and what could help patients. This study aimed to begin to address this using constructivist grounded theory. Eleven interviews were conducted with participants who had received a diagnosis of Guillain-Barré syndrome in the preceding 4 years. The model that emerged identified two key processes: "Loss, determination, and adjustment" and "The unknown." "Receiving support," "Obtaining knowledge," and "Experiencing hope" assist in navigating these psychological effects. The findings emphasize the all-encompassing effects of Guillain-Barré syndrome, illustrating the need for rehabilitation professionals to alleviate uncertainty and foster practices that could facilitate patients' navigation through the illness. Recommendations for further research are provided.