Qualitative Health Research最新文献

Despite the methodological spread of virtual photovoice, alignments to and potential advances for the participatory action research (PAR) and knowledge dissemination (KD) components of in-person photovoice are poorly understood. Detailing the PAR and KD processes, practices, and products drawn from a virtual photovoice study examining men's experiences of and perspectives about equitable intimate partner relationships, the current article offers three thematic findings. The first theme Processes and pragmatics for selecting representative photographs describes adapting established analytics of preview, review, and cross-photo comparisons to categorize and select images from a large collection of participant-produced photographs (n = 714). Specifically, detailed are the reconciling of researchers deciding which images and accompanying narratives to include guided by PAR principles. Theme 2, Democratizing and disrupting in-person PAR with virtual focus group polls (VFGPs), chronicles participant voting through Zoom to collectively decide and subsequently discuss their favorite photographs. While anonymity for the poll was democratizing in terms of participant equality for voting on the photographs, connecting men virtually from diverse locales could differentiate cultural norms. The third theme KD pledges and pitfalls with online photovoice exhibitions details the potential benefits and challenges for reaching diverse end-users. Evident was the importance of marketing and media for driving traffic to the online exhibition, and the centrality of interactivity for fostering engagement to build and adjust photovoice e-health interventions. With virtual photovoice continuing to grow in popularity post COVID-19, this article offers important methodological lessons for adapting and advancing components of in-person PAR and KD.

While the cancer advocacy community has been pivotal in progressing oncology care, supporting young adults with advanced cancer transitioning to palliative care continues to be a complex challenge. Palliative care services may not be offered by healthcare providers or engaged by young people themselves. This is in the face of the recognized value that palliative care can provide young people and their families. The purpose of this study was to explore what cancer advocates can do to support young adults (18-39 years of age) with advanced cancer in their transition to palliative care. A community-based research perspective supported engagement with members of the #AYACSM (Adolescent and Young Adult Cancer Societal Movement) from the United States and Canada through social media. Analysis was guided by a reflexive thematic analysis approach to articulate four action-oriented themes: advocate for advances in the delivery of care; support healthcare provider education; mobilize knowledge and share stories; and leverage technology for advocacy efforts. Young adult cancer advocacy must span the continuum of cancer care from prevention to end-of-life. There exist gaps in advocacy efforts surrounding support for young people in their transition to and the integration of palliative care services. Creative and innovative advocacy approaches are needed. This study also showed opportunities for conducting qualitative research through an existing online community as an approach conducive to community-based research.

Finding suitable long-term care arrangements for older migrants in Europe, including Norway, has been a major concern for healthcare policymakers in the last decade. However, many older people with migrant backgrounds, and to a certain extent their descendants, often prefer that care arrangements are managed within the family. Although caring for family members may be personally satisfying, it can also be a source of distress. This study explores the motivations of care among female family caregivers of older Pakistani migrants within the Norwegian Ahmadiyya community. Our data are derived from a qualitative study including individual and group interviews with 19 female family caregivers. The study participants were aged 25-62 and resided in Norway. The interviews were conducted in Urdu and English and later transcribed verbatim in English. Our findings resulted in four main themes regarding motivations for caregiving: (1) "Who else, if not the family?": care perceived as a family obligation; (2) The divine duty of caregiving; (3) Women are better at caregiving; and (4) "What will people say?": fear of judgments. The intersection of culture, religion, gender, and migration shaped caregiving as a moral practice, and those providing care were considered individuals with high moral identity. The moral identity assigned to the role of family caregivers appears to exacerbate rather than alleviate the care burden on women of migrant origin. Understanding the motivations for caregiving can shed light on ways in which better support can be provided to ethnic minority families with aging members.

Incarcerated populations in Canada face significant health and social challenges during transitions into and out of correctional facilities. These transitions around facilities pose disproportionate barriers to care for people living with HIV. Further research is crucial to comprehend these challenges and reimagine care concepts for people who experience structural marginalization. In this article, experiences of transitions into and out of Alberta correctional facilities for people living with HIV are explored using narrative inquiry. Conducted in a Western Canadian city from 2021 to 2022, the inquiry revolved around two men living with HIV and a history of incarceration. Through co-creating field texts and narrative accounts, their unique experiences of transitions were explored through a collaborative process of analysis. Narrative threads from Bruce and Kyle showcased a lack of narrative coherence and the presence of tensions in their lives, while also emphasizing relational agency. The findings provide avenues for health, social, and justice practitioners who support and care for individuals living with HIV and a history of incarceration to think differently about transitions. By highlighting the importance of attending to the unique identities of individuals and relationships from a position of relational agency, the study advances our understanding of transitions. Recommendations for practice and policy include (a) fostering relational agency among practitioners; (b) challenging conventional views of transitions around correctional settings; (c) incorporating peer-based programming into support services; and (d) reconsidering health, justice, and social systems to better support communities disproportionately affected by high rates of incarceration and HIV.

Mental health professionals stigmatize mental illness, which has significant ramifications for public health and policy. Within this domain, there is a lack of comprehensive research on relative stigma, emotions, and behaviors and an absence of literature that can guide research on these topics. The current study sought to address these limitations. Unstructured interviews were conducted with 22 mental health professionals, and data were analyzed using a grounded theory approach. The current study identified a collection of mental disorders (e.g., borderline personality disorder), stereotypes (e.g., dangerousness), emotion-related responses (e.g., fear), and behaviors (e.g., helping) as being key to the relative stigmatization of mental illness by mental health professionals. The results also suggested that professional context and familiarity with mental illness decrease the stigmatization of mental illness by mental health professionals. These variables and constructs were combined to form a grounded theory of mental health professionals stigmatizing mental illness. The current study has implications for the direction of future research on the stigmatization of mental illness by mental health professionals and interventions that strive to mitigate this type of stigmatization.

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce's intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution.

Pakistan has extremely poor breastfeeding indicators: fewer than half of infants under 6 months are exclusively breastfed, only 20% of infants are breastfed within the first hour of life, and nearly half are never fed colostrum. The country's high infant morbidity and mortality is in part due to this suboptimal infant feeding. A network of lady health workers (LHWs) employed by the government facilitate maternal and child health programs, including breastfeeding support in their communities. This study describes LHWs' perspectives and experiences regarding breastfeeding. We conducted semi-structured interviews with 14 LHWs and used thematic qualitative analysis to code and analyze the data. Our research revealed that LHWs use their role as members of the community and involve influential members of the family to build trust. Frequent home visits beginning prenatally help them address misconceptions about infant feeding. While they have strong knowledge about the benefits of breastfeeding and the importance of colostrum, they demonstrate gaps in their knowledge regarding breast conditions, the safe preparation of human milk substitutes, the physiology of milk production, and supporting mothers who are separated from their baby. Future training should address these areas where LHWs lack knowledge to help mothers facilitate early and exclusive breastfeeding. With adequate training, LHWs are uniquely positioned to use their role as trusted members of the community to effectively counsel families on the importance of breastfeeding and support the clinical needs of women during the perinatal time.

This study explored the manifestations of intersectional structural stigma and stigma-reducing strategies in the context of health among a diverse group of persons experiencing homelessness in the southwest United States. Purposive sampling was used to recruit youth (ages 12-17), young adults (ages 18-24), adults (ages 25 years old or older), women with children, veterans, and males over 60 years old who self-identified as homeless. Grounded theory was applied, and thematic analysis was conducted using data collected from seven focus groups (n = 76 participants). A model of intersectional stigma was adapted from the Health Stigma and Discrimination Framework. This adaptation depicts pathways for addressing intersectional stigmatization experienced by individuals with multiple intersecting identities across the interpersonal, organization, and community levels not explicitly addressed in the Health Stigma and Discrimination Framework. At the interpersonal level, participants indicated they experienced stigmatizing behaviors and practices by service providers due primarily to their identities related to economic or unhoused statuses, gender, age, and mental health. Facilitators of intersectional stigma were identified through organization practices and processes. Multiple stigmatized identities due to social beliefs also facilitated stigmatization at the community level. Health outcomes influenced by stigmatization were also identified. Despite the stigmatization they experienced, participants discussed stigma-reducing strategies related to community assets, medical care, and destigmatizing practices by service providers.

There is a scarcity of qualitative research focusing on the implementation of infection prevention and control (IPC) guidance in low-income countries. This study aimed to address this gap by exploring the perspectives of healthcare workers (HCWs) regarding the implementation of IPC guidance at the healthcare facility level in Uganda. The study also sought to generate a theoretical understanding of the processes involved in implementing IPC guidance in these settings. This robust qualitative research employed a design based on constructivist grounded theory methodology, conducting individual interviews with 13 frontline health workers such as doctors, nurses, nurse interns, and laboratory staff. The key findings of the study revealed that HCWs undergo a process of 'striving for improved practice' in their efforts to implement IPC guidance. This process involved four phases: recognising the importance of IPC, playing a role, encountering challenges, and overcoming challenges. However, achieving full implementation proved difficult due to various individual and organisational barriers presented by the low-income setting. HCWs employed improvisation as a means to overcome these obstacles. Additionally, the study identified enabling factors that facilitated the implementation of IPC guidance within these settings. This study is significant as it applies robust qualitative research methods to provide valuable evidence of HCWs' perspectives on an important topic in an under-researched context, with findings transferable to similar settings.

Both post-qualitative inquiry and Mad methodologies sit on the fringes of qualitative health research, although their potential for creating new knowledges and practices is increasingly recognised. In this article, we explore the possibilities created by bringing these approaches together within research led by, or centring, mental health service users and survivors. We outline and reflect on a workshop undertaken with peer support workers to map affective intensities within mental health assemblages. We suggest the tensions between post-qualitative and Mad research approaches hold potential for mental health research, and qualitative health research more broadly, bringing together theory and the experiences of service users/survivors to think-feel-become otherwise in relation to health care, peer support, and activism.