Qualitative Health Research最新文献

Approximately 2500 people receive electroconvulsive therapy (ECT) annually in the United Kingdom; however, there is growing evidence of long-term adverse effects. Few studies have focused on people's experience of ECT, particularly over the long term. The experience of ECT is known to be complex, requiring qualitative exploration. Therefore, this study aimed to explore the long-term adverse experiences of ECT, including psychological impacts, meaning-making, and coping. Narrative analysis considered thematic, structural, and performative elements of seven people's stories. Themes were explored across the timeline of participants' experiences. Before ECT, participants felt misinformed regarding ECT and misunderstood by healthcare professionals. They noticed immediate changes in their cognition, memory, and mood after ECT. Returning home was important in participants' discovery of differences. Long-term impacts were loss (of ability, memory, humanity, and connection), the realization that ECT had been damaging, and understanding ECT to have caused brain damage. The extensive nature of loss experienced by participants was comparable to the concept of ambiguous loss. They experienced a lack of follow-up care and denial of their experiences, which could contribute to psychological iatrogenic harm. Participants coped with adverse experiences by using prompts and strategies and connecting with others. Further research is needed into the adverse long-term effects of ECT, especially considering cognitive effects, memory loss, and how these contribute to a changed sense of self. Service development is urgently required, especially for ECT follow-up care.

An ostomy is a life-changing procedure. Individuals who have ostomy surgery must adjust to changes post-operation, some of which involve changes to communication and managing social situations. The purpose of this project was to create an evidence-based communication guide for people with ostomies while transitioning to life after surgery and serve as a reference for the creation of communication guides for similar chronic illnesses. Emphasizing co-production, the first stage of the project, referred to as Pre-Design, included a needs assessment through qualitative interviews with (n = 27) individuals who have had an ostomy for at least a year. In the second stage of the project, Co-Design, our team used information gathered from the interviews with participants to create a rough draft of our communication guide. In the last stage, called Post-Design, we invited seven participants from the Pre-Design stage and recruited eight new participants (n = 15) to take part in both interviews and focus groups to evaluate the proposed communication guide. We reflect on both the strengths and weaknesses of the proposed communication guide based on feedback gathered from ostomates, followed by a discussion of the benefits of incorporating and applying this guide into practice. Results suggest that there are benefits to co-production as a method for healthcare delivery and multiple needs for guidance related to salient social situations for people with ostomies. These results can be applied to create evidence-based communication guidance for other relevant health contexts.

Most qualitative health research is subject to ethics review and approval by a research ethics committee (REC). While many studies have identified the challenges that current ethics review practices pose to qualitative health research, there is currently a call to move the research focus from the shortcomings of ethics review practices to the possibilities for improvement. The aim of this grounded theory study was to identify possibilities for improvement of current ethics review practices which can count on endorsement from qualitative health researchers and members of REC alike. To this end, we developed interventions for improving review practices through a comparative analysis of qualitative health researchers' experiences with review practices and REC members' discussions about how their review practices operate. Data collection proceeded by means of problem-centered interviews with seven qualitative health researchers and three focus group discussions with 14 REC members in Germany. Our analysis shows two overarching dimensions in the ethics review practice related to the distribution of responsibility for ethically legitimate research and the reasons for ethical concerns about qualitative health research studies. While there was disagreement about concrete suggestions for improvement, our analysis shows that researchers and REC members pursue three shared overarching aims: increasing expertise in qualitative methods among REC members and researchers, improving communication between researchers and RECs, and tailoring ethics review procedures to qualitative health research. We conclude that researchers and REC members need to promote collaboration and collegiality to ensure ethically appropriate review practices for qualitative health research.

A crucial consideration in the presentation of findings within intimate partner violence (IPV) research is the protection of participant identities. While it is necessary to center survivors' voices, it is equally important to provide layers of anonymity, especially in smaller rural settings where "everyone knows everyone," and where it is thus difficult to guarantee confidentiality for interlocutors. One such way to protect identity is the use of composite narratives: extracting data from several interviews and blending narrative details into one individual story that highlights cross-cutting themes. The purpose of this paper is to examine the affordances of using composite narratives in presenting research findings from rural survivors of IPV. In addition to providing necessary anonymity, this paper also illustrates how composite narratives can showcase ethnographic specificity and utilize the methodological concept of "narrative shock" to enhance empathy, awareness, intervention, and training around IPV for a wide audience.

Despite growing evidence that women with bipolar disorder (BD) diagnoses are at a particularly increased risk for perinatal mental and physical health complications, our understanding of their experiences and support needs from pre-conception to early postnatal years is still in its early stages. To address this gap, a qualitative study was carried out employing a constructivist grounded theory approach to identify the underlying processes shaping women's journeys to motherhood in the context of BD. In-depth, semi-structured online interviews were conducted with 10 mothers worldwide with a pre-existing diagnosis of BD and a first child under 5 years of age. Mothers' experiences revolved around a constant interplay between vulnerability and adaptability, leading to the development of the substantive theory of adaptability as a journey. This study proposes that becoming adaptable constitutes a process, with the concept of "projecting adaptability" being influential in this journey. Characterized by the interconnected elements of self-awareness of vulnerability, perceived support from external sources, and ownership of experiences, the ability to envision an adaptable version of oneself along with understanding the path to achieving it played a significant role in women's experiences. Overall, there is a need for a more dynamic understanding of these experiences, providing appropriate support rather than viewing women as simply vulnerable or adaptable. Further research is necessary to explore the transferability of this theoretical framework, especially among mothers from diverse socio-economic backgrounds.

From the onset of chronic illness, a variety of challenges emerge-challenges that both persist and evolve as life progresses. For young adults living with chronic illness, the age-specific difficulties of becoming ill while young form a foundation that shapes their experience of illness in enduring ways. This paper draws on a series of in-depth qualitative interviews with 33 young adults (aged 19-29 years old) living with a range of chronic illnesses, including fatigue syndromes, auto-immune diseases, and neurological conditions. Participants demonstrated an emergent chronic consciousness of how others perceived their health, which created a series of fraught affective tussles centered on relational recognition and feared judgment. This article explores the difficulties and concerns participants had when communicating the nature and realities of illness; the emotional toll of attempting to avoid attention and judgment from others regarding their conditions; and the ways in which others could productively and sensitively acknowledge participants' illness experiences. We demonstrate that the process of learning how to navigate these issues was one important way that participants began to integrate their illness (and its implications) into their emerging sense of self and adult life.

In researching experiences and understandings of suicide bereavement across diverse communities in Scotland, we expected to hear difficult, distressing, and painful narratives. However, one of the 31 in-depth qualitative interviews that we conducted was particularly and unexpectedly jarring. In this narrative, Freya explained how her ex-partner took his life after she escaped from his domestic abuse. This narrative produces a deep sense of discomfort in the interviewer, as her expectations about suicide bereavement are disrupted. Taking this discomfort as a starting point, we explore what this jarring encounter tells us about dominant and absent narratives of suicide. We interrogate how this narrative of suicide within the context of domestic violence perpetration bumps up against dominant narratives of a "male suicide crisis" and "relationship breakdown," through which men are positioned solely as "victims." Drawing on perspectives from feminist, affective, and reflexive qualitative research, critical suicide studies, and an abductive approach to analysis, we explore how attending to uncomfortable feelings that are generated within the research encounter can enable us to develop more complex, nuanced, and messy understandings of suicide.

For the past years, Ecuador has been transitioning away from a hospital-based model of mental healthcare to one that is community-centred. However, challenges associated with hospital-based models endure, notably financial burden faced by those with severe mental health problems (SMHPs) due to labour market discrimination. Employment access for this group is often disregarded in policy planning, despite evidence of its benefits on mental health. Huertomanías, an urban garden initiative in Ecuador founded in 2015, works with individuals with SMHPs, providing work, income, and social inclusion. A case study using a participatory approach was carried out to explore factors that impact the recovery of people with SMHPs. Twelve participants engaged in diverse stages of the research, where several participatory activities were conducted including cognitive mapping, a photovoice project, and interviews. The analysis employed a thematic approach leading to four categories of impact within the urban garden: autonomy (financial and personal), interpersonal relations and relation with the environment, mental health, and family dynamics. A final category of impact was established encompassing external factors (family support and public policy and healthcare services) that influence recovery. Findings suggest that the urban garden promotes autonomy and active participation within society, improves mental health, and transforms family dynamics. Further, this study highlights the importance of community-based mental healthcare (CBMHC), emphasising the need of public policies and healthcare in promoting autonomy through employment and community-centred services. Lastly, the study contributes insights into recovery experiences and CBMHC benefits, informing programme development and similar initiatives in Latin America.

This article explores understandings of health and risk in relation to club drug use, through in-depth interviews with young adults (n = 35) using club drugs in Oslo, Norway. In contemporary society, negotiations around physical health are at the center of people's perceptions of everyday life. From a sociological perspective, risk perceptions and health perspectives can be seen as affecting the use of various club drugs and the meaning given to these phenomena. The aim of this study is to explore how young adults perceive drug use and health and how they relate to health perceptions in their clubbing experiences. At the theoretical level, the article aims to develop risk denial theory as outlined by Peretti-Watel, by proposing a fourth risk denial technique in addition to scapegoating, self-confidence, and comparison between risks. This fourth technique is described as Compensating behaviors and shows how young adults' emphasis on health both in talk and action is important for understanding their behaviors. The participants describe what they did and emphasized in their talk that this was important. Findings demonstrate how the compensating behaviors consist of both actions and talk; they talk about exercise, use of supplements, and fluid replacement; this is a risk denial technique that arguably also works as a form of harm reduction from below. The study offers insights into how and why young adults use club drugs and explores how they legitimize such use.

Public health restrictions to protect physical health during the COVID-19 pandemic had unintended effects on mental health, which may have disproportionately affected some potentially vulnerable groups. This scoping review of qualitative research provides a narrative synthesis of new mothers' perspectives on their mental health during COVID-19 pandemic restrictions through pregnancy to the postpartum period. Database searches in PubMed, CINAHL, and PsycINFO sought primary research studies published until February 2023, which focused on new mothers' self-perceived mental health during the pandemic (N = 55). Our synthesis found that new mothers' mental health was impacted by general public health restrictions resulting in isolation from family and friends, a lack of community support, and impacts on the immediate family. However, public health restrictions specific to maternal and infant healthcare were most often found to negatively impact maternal mental health, namely, hospital policies prohibiting the presence of birthing partners and in-person care for their infants. This review of qualitative research adds depth to previous reviews that have solely examined the quantitative associations between COVID-19 public health restrictions and new mothers' mental health. Here, our review demonstrates the array of adverse impacts of COVID-19 public health restrictions on new mothers' mental health throughout pregnancy into the postpartum period, as reported by new mothers. These findings may be beneficial for policy makers in future public health emergency planning when evaluating the impacts and unintended consequences of public health restrictions on new mothers.