Qualitative Health Research最新文献

Borderline personality disorder (BPD) is typically conceptualized as a disturbance of self-experience. Recent dimensional shift in diagnosis validates the need for conceptual clarity and nuanced understanding of self-impairments. However, these impairments are often examined in isolation from relational contexts, resulting in overly static depictions. A phenomenological approach, focusing on lived experience, offers deeper insight into how self, others, and time interrelate in BPD. This study involved 24 hospitalized individuals with BPD (aged 18-29, 83.3% female) who were interviewed using a modified Life Story Interview. We employed a data-driven, inductive, phenomenological thematic analysis to explore the structure of BPD narrative identity. Two superordinate themes emerged as constituting the core of BPD narrative identity: self and the other. Self-experience is marked by identification with one's harmful past, a sense of disconnected present identities, and anticipated unpredictability. Complementarily, the experience of others revolves around a felt sense of ever-present and anticipated hostility, the overintensity of intimacy, and the influence of others on one's self-experience. This indicates that self- and other-experience are inherently linked, co-creating recurrent dynamics that hinder one's development. Lived-experience data illuminate the close-cycled, past-devoted temporal dynamics of self and interpersonal functioning. BPD narrative identity appears paradoxically rigid in terms of its unchanging self- and other-processing patterns, even though its explicit manifestation seems highly changeable. This reveals a diminished capacity for self-transcendence and active self-modification, which may disclose mechanisms underlying symptom maintenance. Incorporating subjective accounts of self and interpersonal functioning may enhance the accuracy of diagnostic criteria and improve their clinical utility.

Screening-associated distress, or "scanxiety," is a recognized challenge for individuals at risk of cancer diagnosis or recurrence, particularly for those with Li-Fraumeni syndrome (LFS), a cancer predisposition syndrome with high lifetime cancer risks. Despite the benefits of early detection, individuals with LFS report emotional and logistical burdens associated with intense screening. Existing research lacks a relational perspective on how distress manifests or is managed during the process of screening, especially within families affected by inherited cancer syndromes like LFS. Adults enrolled in the National Cancer Institute's longitudinal LFS study completed interviews about screening experiences for themselves and for loved ones (e.g., parents, children, and non-LFS partners). Transcripts were analyzed using team-based thematic analysis. Eighteen participants (89% female, 89% with a cancer history, median = 47 years) completed interviews. Approximately half (56%) had children and all except one (94%) had one or more first-degree relatives with a cancer history. Participants reported a range of distress reactions related to pragmatic aspects, and the potential results, of recommended cancer screening that often surpassed concerns about personal results. Participants reported that distress regarding loved ones' screening manifested along two common dimensions; participants expressed concern for family members' screening results, and they attended to family members' emotional distress in response to their own and their loved one's screening. To manage this distress, participants evaluated their family's emotional well-being, masked their own concerns to protect others, and created narratives that normalized cancer screening as a regular feature of daily life.

Current evidence shows that waiting for a child's solid organ, stem cell, or bone marrow transplant can cause social, emotional, and psychological suffering for children and their families. Despite waiting being a central theme, little research has investigated what families do while they are waiting in hospital and home settings and what daily life looks like in these contexts. This narrative ethnographic study explored what waiting may look like for parents of children waiting to receive a solid organ, stem cell, or bone marrow transplant drawing on the notion of space-time. Six parents from four different families participated in interviews and observations that explored the questions: How do parents wait on a daily basis and what does waiting look like in the hospital and home? Our narrative analysis suggested that the structure, rhythms, and flow were complex and diverse in the hospital and home space-time. Inpatient space-time could afford parents comfort by having expectations managed, while unpredictability of outpatient space-time caused immense stress. Waiting at home was a paradox in that it could be busy, monotonous, and isolating. Findings contribute to conceptual and practical work exploring how parents do waiting for their child's transplant on a daily basis and how they can be supported when they enter into unfamiliar illness narratives.

The one-child policy has shaped the life trajectories of millions of only children in China. As this cohort ages into mid-life, providing end-of-life care to their aging parents is becoming a critical social issue. Their lived experiences and sociopolitical context likely lead to distinctive end-of-life caregiving experiences; however, to date no existing literature has investigated this phenomenon. This study uses a convenience sample of 15 adult only children who provided at least one month of end-of-life care leading up to their parents' death to explore their caregiving process. This study uses thematic analysis to present findings. The emergent caregiving process encompasses four phases of interdependence depicted through the metaphor of charting a sailing voyage: (1) Sailing Out of the Harbor: Continued Interdependence and Life Routes; (2) Navigating Back to the Harbor: Inverted Interdependence and Shifting Life Emphasis; (3) The Collapsing Harbor: Decoupling Interdependence and Preparation for Bereavement; and (4) The Navigator's and Harbor's Reconstruction: The Divergent Interdependence and Social Life. Three turning points sequentially connect the four phases: (1) realizing the severity of the illness and shifting to prioritize caregiving; (2) sensing the impending death; and (3) death of and farewell to the parent(s). The parent-child relationship anchors the process, while sociocultural context and illness progression drive the process forward. Practitioners can provide competent psychosocial care in response to the unique dynamics of interdependence and caregiving stress in individual cases. Advocacy for death education and policies that promote hospice and palliative care are recommended.

The launch of ChatGPT in November 2022 accelerated discussions and research into whether base large language models (LLMs) could increase the efficiency of qualitative analysis phases or even replace qualitative researchers. Reflexive thematic analysis (RTA) is a commonly used method for qualitative text analysis that emphasizes the researcher's subjectivity and reflexivity to enable a situated, in-depth understanding of knowledge generation. Researchers appear optimistic about the potential of LLMs in qualitative research; however, questions remain about whether base models can meaningfully contribute to the interpretation and abstraction of a dataset. The primary objective of this study was to explore how LLMs may support an RTA of an interview text from health science research. Secondary objectives included identifying recommended prompt strategies for similar studies, highlighting potential weaknesses or challenges, and fostering engagement among qualitative researchers regarding these threats and possibilities. We provided the interview file to an offline LLM and conducted a series of tests aligned with the phases of RTA. Insights from each test guided refinements to the next and contributed to the development of a recommended prompt strategy. At this stage, base LLMs provide limited support and do not increase the efficiency of RTA. At best, LLMs may identify gaps in the researchers' perspectives. Realizing the potential of LLMs to inspire broader discussion and deeper reflections requires a well-defined strategy and the avoidance of misleading prompts, self-referential responses, misguiding translations, and errors. Conclusively, high-quality RTA requires a human, comprehensive familiarization phase, and methodological competence to preserve epistemological integrity.

Heart failure is a complex, progressive syndrome with significant impacts on quality of life and daily functioning. This study aimed to understand the self-care experiences of community-dwelling adults with heart failure in Australia while also portraying the context and impact of these experiences on participants. We focused on patients' accounts of self-care, irrespective of their alignment with existing definitions or guidelines. A qualitative approach using in-depth interviews was chosen to capture the richness of lived experience. Nine participants with heart failure were recruited through advertisements distributed by community heart support organizations and social media to take part in a one-to-one online or telephone interview. Data were analyzed using reflexive thematic analysis informed by a critical realist perspective. Three themes were developed, offering insight into how participants experienced self-care: "self-care as balancing the visibility and invisibility of living with heart failure," "self-care as developing understanding and being (mis)understood," and "self-care as navigating relationships." This study shows that people with heart failure use self-care in ways that differ from traditional clinical expectations. The findings suggest that current heart failure management approaches may be missing crucial aspects of how people actually live with this condition. Participants were equally concerned with managing their social identity, maintaining family relationships, and integrating self-care into their existing life routines. Effective interventions need to address these broader concerns, not just clinical outcomes.

In this essay, I offer my take on contemporary matters relevant to the existing, emerging, and imagined intersections between qualitative health research (QHR) and generative artificial intelligence (GenAI). The essay's central argument is that the increasing reliance on GenAI in QHR is eroding scholarly craftspersonship and should be challenged. In order to present and justify this argument, I posit five coordinated observations: The growing body of literature on using GenAI in qualitative research is reducing qualitative research to coding and pattern recognition; the turn to GenAI disincentivizes reading and stultifies qualitative health researchers; the infatuation with GenAI amplifies the process of McDonaldization of QHR; the time that GenAI saves us isn't being used to become better researchers; and our tendency to humanize GenAI may dehumanise us, whereas craftspersonship is a state of being human. Grounding on such observations, I make a case for embedding a techno-negative stance called neo-luddism in the political culture of QHR. I suggest that this might be an urgent task, for the relation of cruel techno-optimism that some qualitative researchers have established with GenAI can rapidly lead to their own obsolescence. Needless to say, no GenAI has been purposely employed to craft this article.

Literature on racism suggests that Black physicians are acutely aware of how systemic racism influences the health and quality of care of their patients while being targets of that same racism. In other words, they are both observers and recipients of how systemic racism permeates US medicine. Yet, there exists no phenomenological inquiry which centers their experience to make known the systemic depth of racism on the experiences of Black primary care physicians. The goal of this study was to understand the lived experiences of Black primary care physicians and their perspectives on racism. We conducted a qualitative study based on hermeneutic phenomenology to examine the lived experiences of Black primary care physicians and their perspectives for advancing anti-racist actions in US medicine. Purposeful sampling was used to recruit primary care physicians identifying as Black or African American. In-depth, semi-structured interviews of one-hour duration were conducted virtually. A six-stage data analysis process for hermeneutic phenomenology was followed to convey their lived experiences. This study yielded a rich description of lived experiences of Black primary care physicians in the US and provides insights into participants' ambition to pursue medicine as a career path as well as past and current experiences in practicing medicine. This description culminated in recommendations that the medical community can act upon to address the legacy of racism across the continuum of medical education to practice.

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.

Electronic health records (EHRs) have become ubiquitous in clinical practice. Given the rich biomedical data captured for a large panel of patients, secondary analysis of these data for health research is also commonplace. Yet, there are many caveats to EHR data that the researchers must be aware of, such as the accuracy of and motive for documentation, and the reason for patients' visits to the clinic. The clinician-the author of the documentation-is thus central to the correct interpretation of EHR data for research purposes. In this study, I interviewed 11 physicians in various clinical specialties to bring attention to their view on the validity of research using EHR data. Qualitative, in-depth, one-on-one interviews were conducted with practicing physicians in inpatient and outpatient medicine. Content analysis using a data-driven, inductive approach to identify themes related to challenges and opportunities in the reuse of EHR data for secondary analysis generated seven themes. Themes that reflected challenges of EHRs for research included (1) audience, (2) accuracy of data, (3) availability of data, (4) documentation practices, and (5) representativeness. Themes that reflected opportunities of EHRs for research included (6) endorsement and (7) enablers. The greatest perceived barriers reflected the intended audience of the EHR, the interpretation and meaning of the data, and the quality of the data for research purposes. Physicians generally expressed more perceived challenges than opportunities in the reuse of EHR data for research purposes; however, they remained optimistic.