Qualitative Health Research最新文献

Narrative medicine is an interdisciplinary field that merges storytelling with medicine. Its distinctive feature lies in the integration of evidence-based medicine and a patient-centered care approach, prioritizing the individual over the disease. In recent years, narrative medicine has gained exponential significance. However, despite the growing interest in this field, there is a notable paucity of systematic studies exploring narrative medicine from the patient's and their caregivers' perspective. This literature review employs the PRISMA 2020 guidelines to analyze research studies focusing on the impact of narrative medicine on the illness experience of patients and their caregivers. A comprehensive search was conducted across databases: MEDLINE, PsycINFO, EBSCO Psychological and Behavioral Science, the Cochrane Library, and CINAHL. Two authors independently assessed the eligibility of the studies and extracted the data. There are employed keywords related to "Narrative Medicine" and "Narrative-Based Medicine" appearing in the titles or abstracts of works up to February 2024. Through a process of screening and data extraction from the initial pool of 724 articles, 58 full-text articles were assessed and 42 studies meeting the inclusion criteria were identified and critically analyzed. Despite methodological heterogeneity that may limit generalizability, the review highlights a positive impact of narrative medicine on patient and caregiver perspectives. Additionally, patient and caregiver narratives not only positively influence their well-being but also highlight their concerns and their requirements. This review addresses methodological limitations and suggests future research directions to bridge gaps in the literature. Challenges such as methodological heterogeneity and the paucity of standardized protocols persist.

In Lebanon, personal narratives around recovery from mental illness are seldom researched. With the series of crises Lebanon is going through, determining what recovery means to its citizens is imperative. We used a grounded theory approach to explore how patients in Lebanon conceptualize recovery from mental illness. We interviewed 10 inpatients from a tertiary center in Lebanon, analyzing the transcriptions using Straussian grounded theory methodology. We approached three participants again for feedback interviews to consolidate and receive feedback on the emerged theory. We synthesized the BLINC (Balance, Liaising, Insight, Niche, and Contentment) theory, which suggests that to achieve recovery, the person must be in balance with their behavioral system. This is achieved through trusting their close observers, appraising their mental state, connecting to their environment, accepting time, unifying their units of self, and fitting enough into the sociocultural milieu. When balance is achieved, people can liaise different aspects of themselves, attain insight, and find their niche. The desired outcome of recovery is contentment. BLINC is consistent with evolutionary psychiatry principles and the Lebanese local culture. It offers a pragmatic framework to provide culturally appropriate mental health care in Lebanon. Recommendations for clinical practice are outlined which can be implemented in existing patient-doctor interactions as well as existing therapy orientations.

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.

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.

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.

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.

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.

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.

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.

Interviews are central to the health ethnographers' toolkit. In this article, we offer a critical engagement with methodological literature coupled with reflective examples from our own research, in order to articulate the value of the ethnographic interview in health research. We contribute to literature on ethnographic interviews in two ways: by decoupling ethnographic interviews from the necessity of accompanying participant observation, and by outlining an ethnographic disposition towards interviewing. We define the seven key epistemic dispositions underpinning the ethnographic interview. These are humility, a readiness to revise core assumptions about a research topic, attentiveness to context, relationality, openness to complexity, an attention to ethnographic writing, and a consideration of the politics and history of the method. The strength of an epistemic understanding of the ethnographic interview is that it offers flexibility for developing a diverse array of interview techniques responsive to the needs of different research contexts and challenges. Ethnographic interviews, we show, contribute to the study of health through a richly explorative, responsive, contextualised, and reflexive approach.