Qualitative Health Research最新文献

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.

Recruitment for qualitative research can have an added level of complexity when working with vulnerable populations, as stigma and confidentiality may play an important role in participants' willingness to engage. For example, people with HIV and other stigmatizing conditions may prefer to use a pseudonym to maintain confidentiality and may be discouraged from participation if asked to produce proof of diagnosis with a stigmatized condition. However, efforts to respect participant privacy and minimize burden while providing compensation for their time may leave studies vulnerable to infiltration by ineligible individuals who are motivated by the compensation. This article describes how efforts to respect the unique concerns of a vulnerable and stigmatized population, people who considered breastfeeding while living with HIV, resulted in the enrollment of non-eligible individuals in an in-depth interview study. We describe how the breach was discovered and the subsequent actions taken to balance study integrity with meeting the privacy needs of the target population. This example illuminates how scientific validity can be threatened by enrollment of individuals misrepresenting a target population, and the importance of developing approaches to ensure that vulnerable target populations can be reached while respecting privacy needs.

This analytic autoethnography explores the rehabilitation journey of a spinal cord injury (SCI) survivor who is also a movement scientist. Drawing on personal bodily experiences, daily logs, and critical reflections over five years, the study analyzes how standardized rehabilitation protocols may fail to address individual needs. Three main themes emerged: the need for personalized stretching protocols that consider postural variations; overlooked biomechanical and procedural limitations in robotic gait therapy; and the underutilization of cardiovascular training despite its potential in chronic SCI management. These insights, grounded in both lived experience and movement science, point to systemic blind spots in SCI rehabilitation. By combining subjective embodiment with theoretical reasoning, this study contributes practitioner-informed critiques that may support more adaptive and patient-centered approaches in neurological rehabilitation practice.

Despite a changing social landscape including technological advancements, increasing commercial influence on parenting practices, and a continued push for parents to return to paid labor, studies on breastfeeding support usually position support as a people-based endeavor. This framing does not adequately address the complex, changing nature of support and how it is shaped by a range of human and non-human actors. This paper offers a research agenda for future qualitative/mixed-methods breastfeeding support research that can better account for the diverse forces that constitute breastfeeding support. I first provide a rationale for this paper's contribution to conceptualizing support by reviewing breastfeeding support literature. I then outline a conceptual framework in which researchers can investigate the relations of human and non-human actors that create environments in which parents feel supported to breastfeed. In extending similar theorizations of family practices, including "more-than-human" encounters with infant feeding, this paper calls attention to the complex nature of breastfeeding support, conceptualizing how support comes to matter in a "more-than-human" world. Positioning breastfeeding support as embodied, relational, and emergent, I propose new understandings about the relations of support required to sustain breastfeeding practices and call for greater awareness of the sociomaterial environment in which breastfeeding support is produced or excluded. This has implications for future qualitative breastfeeding support studies and the implementation of breastfeeding support provision.

Although grief is an unavoidable aspect of the human experience, it remains largely unspoken in the workplace, including healthcare. Physicians, in particular, minimize their grief due to professional norms and broader societal discourses, often viewing it as trivial or incomparable to the suffering they witness at work. This study examines how physicians narrate their grief to see which discourses are represented, enacted, and sometimes resisted in clinical practice. Physicians (n = 12) and residents (n = 5) from Atlantic Canada participated. Two rounds of interviews, 6 months apart, were conducted. Critical discourse analysis was utilized to make sense of the language participants use to describe their grief experiences. Two dominant discursive framings were identified: grief as an interference and grief as an invitation for meaning making. For many, navigating professional responsibilities while experiencing grief generated tensions and contradictions, evoking feelings of disequilibrium and frustration. For some, however, grief prompted deep self-reflection, leading to a shift in mindset or a realignment of values. Residents grappled most with the discursive boundaries of grief expression, unsure about when and with whom it might be acceptable. More experienced physicians articulated greater ease in discussing grief, often framing it as a source of deepened wisdom. Participants' discursive framing of grief appeared to change alongside their maturation as physicians, suggesting that status and hierarchy influence the extent to which physicians feel empowered to engage in grief-positive discourse. Formal education and institutional support to foster "grief literate" clinical environments could play a valuable role in supporting physician well-being.

While men's mental health help-seeking has received increased clinical and research attention, little information exists regarding men's perspectives and experiences of peer support and mutual help for mental health challenges. Drawing on qualitative photovoice interviews with 65 men living in Canada (M = 37; SD = 15.5 years), thematic analyses were conducted to explore the gendered barriers to men's mental health peer support. Two inductively derived themes were identified. Dual paradoxes fuelling men's silence revealed a complex interplay of tensions and alignments with traditional masculine norms, often leading to concealment and therefore inaction. Men struggled to reach out to male peers, despite their willingness to help others and broader societal encouragement to seek help. Relational masculine norms driving misaligned support revealed risks and vulnerabilities for men seeking peer support, with concerns about asking for too much or over-disclosing when opportunities arose. Men's requests for support were often implicit or vaguely defined, which contributed to their unmet support needs, despite well-intentioned efforts from peers. When men did receive support, it was often conditional and contextually bound within acceptable masculine milieus. Findings highlight how men's intentions and actions toward mental health peer support can be constrained by perceived normative masculine identities and relations. To reify the potential of men's peer support, gendered barriers must be thoughtfully considered and addressed to promote men's mental health and informal help-seeking.

The diagnosis of a childhood brain tumor impacts the psychological well-being of parents who experience high levels of post-traumatic stress. To understand the etiology of trauma through this unique healthcare experience, a journey mapping exercise was undertaken with parents of children with brain tumor. Data were collected in an online focus group and by written responses. Framework analysis and research poetry were used to map experiences of traumatization and trauma-informed care across time. Nine mothers mapped their experience of their child's brain tumor care describing their needs and responses. Findings are presented by eight milestones, supported by research poetry composed of participant quotes titled: "I must be wrong," "All the fear, no answers," "Paper Thin," "Happy but Terrified," "The Rest of Him," "Less Than," and "Into Our Destiny." Throughout the trajectory of care, parents reported traumatic events and moments of helplessness attributed to the healthcare received, contributing to unrelieved distress. Increased transparency in communication between clinicians and parents fostered increased trust and psychological safety within healthcare services. Understanding the traumatization that occurs across the trajectory of care can inform service improvements and early linkage to specialized support. This study contributes novel understanding of traumatization for parents of children with brain tumor and depth in understanding of emotional components through the presentation of research poetry.

Caregivers of persons living with dementia experience significant losses as they witness the progressive cognitive decline and personality changes of their loved ones while managing substantial caregiving responsibilities. This results in pre-death grief, which is a multifaceted response to the losses experienced. Although pre-death grief is traditionally conceptualized as an intrapersonal and dyadic phenomenon, this study examines how social environments shape caregivers' grief experiences. Through semi-structured interviews with 33 dementia caregivers in Singapore, we identified 11 distinct domains that influence grief experiences: self, persons with dementia, family, domestic workers, friends, workplaces, fellow caregivers, health and social care services, public, policy, and social-cultural contexts. Our findings reveal that pre-death grief emerges through multifaceted interactions across these domains rather than solely through individual psychological processes. Caregivers navigate personal sacrifices and other losses while experiencing validation and invalidation of the losses across different social contexts. Particularly notable is the previously unexplored role of domestic workers, who significantly influence the caregivers' grief experiences by redistributing the caregiving burden and providing emotional sustenance. The findings supplement dominant theoretical frameworks that primarily focus on intrapersonal or dyadic processes, suggesting instead that pre-death grief in dementia caregiving is fundamentally a social process. This perspective has significant implications for developing more comprehensive support systems that address the socially embedded nature of grief rather than focusing exclusively on individual coping strategies. By understanding pre-death grief as socially situated, we can better support caregivers throughout their dementia caregiving journey.

Eating disorder (ED) recovery narratives provide valuable insights into the recovery process. While existing research identifies key turning points in ED recovery, most studies focus on majority populations, neglecting the experiences of minoritised individuals. This study aimed to explore the turning points in ED recovery among diverse individuals and examine the role of symbolic objects in understanding recovery processes. English-speaking adults with lived experiences of ED who identify as part of underserved groups were recruited for an adapted photovoice study involving individual interviews (n = 11) and two subsequent focus group discussions (n = 4 per group). Participants shared objects symbolising their recovery journeys. Using reflexive thematic analysis, we generated three themes: (1) Up, Down, and Around: Recovery was described as non-linear, with positive and negative turning points; (2) Growing awareness and readiness of recovery; and (3) From feeling disconnected to belonging. The findings show that recovery was often non-linear for these individuals, with social belonging and identity integration being crucial. The study also illuminates how everyday objects can be used as a research method to encapsulate turning points in recovery by representing progress and offering motivation. The findings are also consistent with minority stress theory which shows how one's mental health intersects with social stressors and marginalisation.

Research indicates a positive correlation between residential treatment duration and residents' positive outcomes. Between 2015 and 2019, a New Zealand residential drug rehabilitation service noted a rise in premature program exits, leading to an in-depth investigation into the individual and therapeutic community factors that impact residents' completion of the 18-week program. The aim of the study was to understand how to enhance support mechanisms that promote longer treatment stays with the view to improving well-being outcomes. The authors conducted a two-phase, mixed-methods study. They applied quantitative secondary data analysis to data collected between 2015 and 2019 from 796 participants and did follow-up qualitative data collection in 2023, where 15 former residents participated in focus groups. Six were then randomly selected to participate in an in-depth interview. This article reports findings from the interviews of that study. The aims of this article are threefold. The authors introduce data from a New Zealand drug rehabilitation service as a case for using ChatGPT to support AI-assisted thematic narrative analysis. Steps in the analysis are detailed through a reproducible prompting process. Second, the authors present findings highlighting factors influencing residents to leave treatment and those that influenced them to stay. The authors position AI as a complementary tool for qualitative data analysis that enhances methodological rigor and practical applications in addiction research.