Qualitative Health Research最新文献

There is concern that a growing number of individuals, especially adolescents, are diagnosing themselves with mental disorders. However, there has been limited empirical research into this phenomenon: why it might happen, what the costs and benefits might be, and what the implications are for anyone who is experiencing distress. To address this, this study used reflexive thematic analysis to explore attitudes toward self-diagnosis of mental disorders as expressed on the discussion website Reddit. From 1195 user comments, five themes were generated: (1) There is tension over who is the expert in diagnosis; (2) Self-diagnosis is a route to self-understanding in an inaccessible system; (3) Teenagers on social media are the problem; (4) Self-diagnosis can become self-fulfilling, and (5) Now no one is believed. Together, these themes highlight that there is considerable anger, derision, and criticism targeted toward people who self-diagnose with mental disorders, and that this is particularly targeted toward adolescents who self-diagnose on or as a result of social media. The findings have important implications for understanding how to support and validate people, particularly adolescents, who (sometimes accurately) use diagnostic language to express how they are feeling.

The concept of emotional labor refers to the regulation and management of emotions within the workplace. This labor may involve a dissonance between the emotions that are internally felt and the emotions that can be externally expressed. The concept of emotional labor can be applied to the emotional management that occurs during research often when directly interacting with research participants. These emotions can have a positive role in building rapport and enabling the researcher to understand the participant's world. But equally, it can lead to emotional strain and potentially have a negative impact on researcher well-being. In this paper, we apply the concept of emotional labor to dementia research. While there has been attention paid to ethical issues in dementia research, this has often focused on the impact on the participant and not the researcher. Within this paper, we first draw on the literature to provide an overview of the role of emotional labor in the research context. Within the literature, we identify nine research scenarios where emotional labor might occur within dementia research. We then present three case studies illuminating our experiences of emotional labor within dementia research. These case studies provide illustrative examples of some of the research scenarios identified in the literature. To synthesize the learning from the literature and our case studies, we propose peer-critiqued recommendations for managing emotional labor in dementia research. We conclude by considering the implications for other health researchers.

The extant literature has scant detail about everyday spiritual practices that aid Indigenous young people. This paper systematically explores Indigenous Spirituality, health, and well-being through Elder-governed yarns conducted via Zoom with 44 Aboriginal Elders, Healers, and Senior and Junior people involved in health and well-being of the Victorian Aboriginal community. These yarns were analyzed through an innovative, constructivist, multi-perspectival discursive grounded theory method. Key findings are that Spirituality is crucial for health and well-being, leading to a clear mind and at-peace "center" in a person. Aboriginal spiritual practices reflect the unique characteristics and essential rhythms of Country. Spiritual development is incremental and increases the obligations and responsibilities a person has to community and Country and leads to increased caring for Country. This paper provides rich detail about practical spiritual techniques to aid Indigenous young people and their kinship networks. It has the potential to shape future policy.

Intimate partner violence (IPV) is associated with a wide range of mental and physical health concerns. Research suggests that many physicians lack knowledge and skills to adequately respond to patients experiencing IPV. In order to better integrate physicians' contributions into intersectoral responses to IPV, we asked stakeholders with expertise and experience related to IPV about the knowledge, skills, attitudes, and behaviors they wanted them to have. Guided by principles of interpretive description, and using a key informant method, we conducted unstructured interviews with 18 stakeholders in IPV-related frontline, managerial, or policy roles in Ontario, Canada. Data collection and analysis proceeded iteratively through 2022; "thoughtful practitioners" outside the research team were recruited at key junctures to provide feedback on formative findings. Stakeholders suggested that "attending to power" should be a core principle for medical practice related to IPV. Attending to power encompassed understanding interactional, organizational, and structural power dynamics related to IPV and purposefully engaging with power, by taking action to empower people subjected to violence. Specific recommendations for practice concerned four focal contexts: relationships between partners, between patients and providers, between providers, and in social systems and structures. Strengthening physicians' capacity to attend to power dynamics relevant to their IPV practice is an important step in both improving medical care for people experiencing IPV and integrating physician contributions into other services and supports.

Actively involving people in self-monitoring and management during their pregnancy is an emerging clinical and social practice. Self-monitoring of blood pressure and self-testing for proteinuria, key diagnostic tests for pre-eclampsia, are becoming commonplace in hypertensive pregnancies. While evidence exists on the acceptability and feasibility of self-monitoring blood pressure, evidence for self-testing for proteinuria in pregnancy is thin, with little knowledge of how it might affect the traditional structures of maternity care. As part of a diagnostic accuracy study on self-testing for proteinuria, pregnant people and healthcare professionals were recruited to a qualitative study to understand their experiences of, and attitudes to, self-testing. Multiple qualitative methods were used, including interviews, focus groups, and free text postcards. A discourse analysis was conducted to understand how self-testing might inform and reshape routine antenatal care. Analysis revealed a tension between the empowering concept of participatory surveillance, which pregnant people and healthcare professionals were broadly positive about, and the adjudications made by healthcare professionals about the candidacy, or suitability, of certain pregnant people to self-test. Candidacy is a framework for understanding what influences access to healthcare for socially disadvantaged groups, including professional judgments that impact access to interventions. While participatory surveillance was felt to have the potential to empower pregnant people in antenatal care, the loss of the traditional clinical gaze was disquieting for some, and pregnant people and healthcare professionals were reluctant to cede professional responsibility.

Understanding vaccination decision-making processes is vital for guiding vaccine promotion within pandemic contexts and for routine immunization efforts. Vaccine-related attitudes influencing individual decision-making can be affected by broader cultural and normative contexts. We conducted 73 qualitative interviews with adults in China (n = 40) and Germany (n = 33) between December 2020 and April 2021 to understand COVID-19 vaccination intentions and preferences, and we analyzed transcripts using a five-step framework approach. During early analysis, we identified moral considerations in line with the tenets of the Model of Moral Motives (MMM) as a recurrent theme in the data. The MMM guided further analysis steps, particularly with its distinction between motives that are proscriptive (focus on avoiding harm by inhibiting "bad" behavior) and prescriptive (focus on actively seeking positive outcomes). Proscriptive vaccination arguments that compelled vaccination in our data included avoiding negative attention, being a law-abiding citizen, preventing harm to others, and protecting one's country. Prescriptive motives focused on self-efficacious behavior such as protecting the health of oneself and others via widespread but voluntary vaccination, prioritizing elderly and predisposed individuals for vaccination, and favoring a fair and equitable distribution of vaccines at the global level. In the interviews in China, both lines of arguments emerged, with a general tendency toward more proscriptive reasoning; interviews conducted in Germany tended to reflect more prescriptive motives. We encourage research and vaccine promotion practice to reflect moral considerations when aiming to understand public health preventive behavior and when developing tailored health promotion campaigns.

As online health communities become important platforms for people with depression to express themselves, digital narratives provide a lens for understanding their identity work. Drawing on the communication theory of identity (CTI), this article explored the members' identity reconstruction by analyzing their narratives posted in a Chinese online depression community. The four levels of identities constructed by the members include "laggard" and "pioneer" at the personal layer, "idler" and "fighter" at the enacted level, "stress-maker" and "escaper" at the relational layer, and support providers and receivers at the communal layer. These identities at different levels usually interact in the narratives, showing that identity gaps exist among the members. The study shows that the members' autobiographical accounts of depression entail multiplicities and ambivalences, denying the dominant and stigmatizing representation of it by common sense and the media as a reductionist downward and one-way experience that is valueless and offers no possibility for personal growth. The findings regarding the communal level of identity show that narratives can help the narrators to create bonds of solidarity of an experience that is often marginalized.

Taste and smell are of direct importance in most social interactions. Radical disruptions in these senses can, therefore, substantially disrupt sociality. This paper focuses on the experiences of a particular type of disruption: persistent chemosensory dysfunctions after COVID-19. We conducted semi-structured interviews with 30 patients undergoing treatment for chemosensory dysfunctions and analyzed the ways in which their experiences have influenced social relations and activities, particularly regarding food and eating. The findings reveal that these dysfunctions have made the participants markedly aware that food and eating are pivotal to full participation in social life. As is smell, both surrounding smells and the perception of one's own smell, with dysfunctions leading to several social consequences. Such problems are handled through both avoidance behavior and adaptations. While adaptations facilitate interactions, they come at the cost of feeling a burden to others or not fully appreciating an event (e.g., a shared meal). Social support is of great importance, ranging from minor practical assistance, such as a friend checking if the milk is sour, to the profound emotional relief felt from empathic treatment and recognition that the problems are real. Here, healthcare professionals can play a vital role, even in the (perceived) absence of clinical effectiveness of the treatment. The experiences expressed are partially in line with other manifestations of Long COVID and with chemosensory dysfunctions due to other illnesses, but only partially, since this is a patient group with needs and experiences that are unique, in that sociality is so strongly affected solely by disruptions in sensory abilities.

How do people who are blind or visually impaired experience learning to use a long cane? This question is of paramount importance for planning and delivering rehabilitation programs and orientation and mobility (O&M) training. Until now, research into learning to use a long cane has focused primarily on technical and professional aspects, paying little attention to the lived experience of the learning activities that are offered in the field of O&M. This extensive qualitative study adopts a lifeworld phenomenological approach and sets out to examine the pedagogical processes within rehabilitation, focusing on the learning experiences of people with impaired vision. The methods used included participant observation during O&M training sessions and recurrent narrative interviews with three research subjects. The results show that learning to use the long cane has perceptual, existential, and social dimensions which are intertwined processes that relate to mind and body, body-world relations, and human existence and society. Learning to use a long cane has in this study been interpreted as embedded with cultural meaning about disability. Further, the habitual use of the cane promotes adaptation to visual impairment but also to build new body-world relations. The lifeworld theory and its methodology have contributed to theoretical evidence and rigor throughout. The results bring new interpretations to the field of O&M and are a relevant basis and valuable for pedagogical rehabilitation as it highlights the importance of taking the individual's lifeworld and needs into consideration when teaching someone how to use a long cane.

Journey maps are graphic representations of participant, user, customer, or patient experiences or "journeys" with a particular phenomenon, product, business, or organization. Journey maps help visualize complex pathways and phases in accessible, digestible ways. They also capture emotions, reactions, and values associated with the processes participants undergo, complemented by images or quotes from participants. Here, we outline the foundations of journey maps in research and in practice settings. Our goal is to describe journey maps to researchers new to the product and emphasize the novelty and utility of journey maps as visual products from qualitative research particularly in a health setting. To explore journey maps-including their benefits, drawbacks, and relevance-we discuss examples including our own process for designing a journey map of food insecure Veterans' experiences using qualitative, in-depth interviews and supported by member checking. Our journey map depicts food insecurity as a repetitive process, a unique contribution given that many journey maps are designed with discrete starting and stopping points. We conclude by discussing the novelty of journey maps as innovative products that researchers can use to identify opportunities for process improvements and innovation using multiple data sources or methods.