Qualitative research in medicine & healthcare最新文献

Self-injury is associated with significant psychological distress and functional impairments, including difficulties with self-care. However, little is known about how individuals engaging in self-injury perceive and manage self-care in their daily lives. This study aimed to explore the lived experiences of self-care among individuals receiving psychiatric treatment for self-injury and to identify factors that support or hinder self-care capacity. Twelve participants were recruited from a psychiatric outpatient clinic and semi-structured interviews were conducted focusing on participants' perceptions of self-care, its relationship with self-injury, and factors influencing self-care. Reflexive thematic analysis was conducted to identify patterns and themes. The analysis revealed four themes: i) Why should I choose self-care?, highlighting motivational challenges rooted in low self-worth and the need for meaning; ii) Self-care is a difficult choice for me, reflecting how emotional variability, uncertainty about self-care, and dichotomous thinking hinder decision-making; iii) Self-care is beyond my control, emphasizing struggles with planning, routines, and the interplay of emotional states and self-care behaviors; and iv) Support can both help and hinder self-care, illustrating the critical yet complex role of external support. Findings highlight the multifaceted challenges individuals face in managing self-care and its intersection with self-injury. Clinical implications include the need for tailored, person-centered interventions that address barriers to self-care. Recognizing the dual role of self-injury-as both a barrier to and a risky form of self-care-may enhance treatment approaches for this population.

Nonsuicidal self-injury disorder (NSSI-D) is presently a condition for further study in the Diagnostic & Statistical Manual of Mental Disorders (DSM-5-TR) (American Psychiatric Association, 2022). While previous studies focused on NSSI-D through the lens of experts, there is a shortage of research that explores the potential impact of NSSI-D from the perspective of those most directly affected - individuals with NSSI lived experience. The present study aimed to expand this limited literature and provide a more enhanced and nuanced understanding of the potential implications and consequences of NSSI-D from lived experience viewpoints. Adults with lifetime NSSI history (N = 38) completed a semi-structured interview that surveyed perspectives on NSSI-D, including the meaning of officially recognizing NSSI-D, potential impacts of receiving an NSSI-D diagnosis, and the impact of NSSI-D on one's decision to speak with a clinician. Results from our thematic analysis of the interview data suggested opinions about NSSI-D and its potential impact were generally positive (e.g., increased awareness, understanding, and validation, increased comfort with disclosing NSSI behavior, positive impacts on treatment, and improved functioning). Participants also highlighted potential concerns about the potential consequences of NSSI-D (e.g., negative self-perception, increased stigma, and concerns about the necessity and utility of NSSI-D), and some expressed neutral/indifferent opinions about NSSI-D. Overall, results provide valuable insights regarding potential implications and consequences of official recognition and diagnosis of NSSI-D and have relevant implications for client-clinician interactions. Results also highlight the importance and value of amplifying lived experience perspectives.

Suicide risk has consistently increased over the past 2.5 decades, despite growing awareness and tailored programs aimed at combating this epidemic. Suicide prevention initiatives include ensuring 24/7 access to crisis hotlines, encouraging individuals to seek mental health care, and reducing access to lethal means among high-risk populations. A recent area of focus is the physician's office, as research shows that nearly half of those who die by suicide had seen a primary care physician within one month of their death. However, primary care physicians do not consistently inquire about suicide risk among their patients. This study presents findings from 15 interviews with family medicine residents at a U.S. military hospital. Participants identified gaps in three key areas of training: i) foundational knowledge (e.g., risk assessment flow, available tools and resources, and therapeutic skills), ii) training program structure (e.g., timing, exposure, and effectiveness), and iii) training culture (e.g., fostering courage and support). Residents recognized their central role in suicide prevention and were eager to address perceived gaps in their knowledge. They also shared their ideal training environment, which would support learning and skill development. This paper offers clear and actionable recommendations for family medicine residency programs to advance the suicide prevention agenda.

Military veterans are one of the most researched groups in healthcare in the United States. This population has extremely high rates of suicide attempts and completions. Despite increasing research focus, millions of dollars in funding, and being designated as a high clinical priority, rates of suicidal behavior continue to rise among veterans. Veterans are extremely concerned about this trend and critical of some suicide prevention projects. This study engaged 20 veterans who are connected to individuals within the military community who have attempted or completed suicide. Through semi-structured interviews, participants expressed a profound sense of disconnection from existing policies, treatments, and strategies aimed at preventing veteran suicide. During the course of the interviews, participants posed their own questions: Why is the public really concerned about veteran suicide? Why won't the public recognize its part in the veteran suicide epidemic? Why won't the medical industry listen and collaborate with us? This study underscores the critical need for all stakeholders involved in veteran suicide prevention to reflect on these concerns and to incorporate veterans' insights into future prevention strategies, creating a more responsive and effective approach.

This research undertakes a thematic analysis of discussion threads on social media forums to determine women's perceptions of quality of obstetric care under TRICARE Prime and TRICARE Select. Following an open coding process and thematic analysis, themes arose regarding obstetric care as experienced by active-duty women as well as female spouses of active-duty members. Themes surrounding active-duty perceptions of quality of obstetric care concerned proximity to care deferred deliveries, lack of care options, deficient on-base care, better civilian care experiences, and lamenting having less options than spouses. Spouses generated themes of positive connotation with TRICARE Select, including low costs, freedom of choice, and proximity to care and negative connotation with TRICARE Prime, such as difficulty getting care, process bureaucracy, and deficient care. Ample evidence pointed to a strong spouse preference for TRICARE Select over TRICARE Prime, but there was not enough evidence to indicate if active-duty women were pursuing out-of-pocket care to circumvent TRICARE Prime restrictions. Overall, women's discussions point to a need to improve the Military Health System and concerningly suggest active-duty women are confined to care within a system plagued with issues that impact obstetric care.

When patients' embodied experiences cannot be conveyed to clinicians in real-time, the challenges of reaching a shared understanding between patient and clinician are enhanced. In this study, we explore how patients with chronic musculoskeletal pain manage the situation of knowing that they regularly experience pain, yet exhibit minimal signs of it during clinical consultations. Utilizing a multimethod, conversation analysis approach and an interactional perspective, this paper analyzes 10 naturally occurring consultations at a specialized rehabilitation clinic in Norway. The analysis shows that patients account for the absence of pain by referring to i) specific events, ii) pain tolerance, and iii) pain periods. Such accounts were typically triggered by null findings (i.e., the absence of findings in technological and physical tests) in the physical examination and clinicians' positive summaries of patients' bodily conditions. Patients resist clinicians' positive stance by accounting for absent pain, cautiously challenging the clinicians' epistemic stance. If clinicians do not pursue patients' accounts, this might lead to a misalignment between patient and clinician which can obstruct efforts to reach a shared understanding of the pain. These findings may have general relevance for clinical consultations where patients' symptoms are difficult to measure and validate biomedically. Understanding how patients account for absent pain can enhance clinician-patient communication and improve clinicians' understanding of patients' everyday circumstances and thereby improve the outcome of consultations.

While research has highlighted potential age-related differences in risk factors for non-suicidal and suicidal self-injury ((N)SSI), studies on such distinct risk factors among older adults are scarce. The present study addresses this gap by gaining insights into the experiences of psychogeriatric experts who work with older adults who engage in (N)SSI. In total, nine experts were interviewed about factors associated with (N)SSI in older adults. The responses were thematically analyzed using the biopsychosocial framework. We located a range of biological, psychological, and social factors contributing to (N)SSI, which largely align with previous findings regardless of age. Nonetheless, according to the experts cognitive and physical decline, advancing age, various experiences of loss, and social isolation were observed as particularly significant risk factors for older adults. These results emphasize the need for tailored preventive measures, interventions, and screening tools to address the unique challenges faced by older adults at risk of (N)SSI. Additionally, future research should investigate (N)SSI experiences in older age with a more diverse sample, including mapping the perspective of older adults themselves, healthcare providers, and other informants, to enhance our comprehension of this phenomenon among older adults.

Individuals who are higher-weight and low-income may disproportionately experience weight and income stigmas in healthcare experiences compared to lower-weight, higher-income individuals. The ways that weight and income stigmas interact in healthcare should be better understood in order to provide better, less stigmatizing care to higher-weight, low-income patients. This study assesses how patients manage stigmatizing experiences in both healthcare and everyday experiences and how that impacts health seeking and stigma management behaviors through semi-structured interviews with 11 higher-weight (Body Mass Index ≥30), low-income adults (≥18 years of age) in an Atlantic Canadian province. Participants took part in two interviews that focused on healthcare experiences and both positive and negative places/spaces. The two face-to-face interviews for each participant (total 21 interviews) were audio-recorded and professionally transcribed verbatim. The transcripts were analyzed using thematic analysis to identify recurring concepts and patterns within the data. Two major themes emerged from the data, uptake of stigmatizing, neoliberal health messaging and coping with stigma. Coping with stigma included subthemes control over stigmatizing experiences and stoicism in the face of stigma. The findings suggest that individuals understand their health and wellness through a neoliberal lens and that they deploy strategies of control and stoicism to cope with the stigmas they face.

Sexual minority youth are more likely to engage in Non-Suicidal Self-Injury (NSSI) than their heterosexual peers, and sexual minority women demonstrate greater risk of NSSI than their sexual minority male counterparts. However, a lack of research exists on NSSI among young sexual minority women, particularly their NSSI disclosure experiences. We used a descriptive-interpretive, qualitative design with semi-structured interviews to examine young sexual minority women's lived experiences disclosing NSSI and of others' responses to these disclosures. The sample included 65 sexual minority women aged 14-30 recruited via paid social media advertising from across the U.S. We performed an inductive thematic analysis of transcripts from 58 participants (89%) who reported a history of NSSI. Participants shared reasons for disclosure (wanting help, communicating distress) or nondisclosure (cultural stigmas), types of disclosure (accidental/involuntary, and direct/voluntary), and recipients of a disclosure (friends, partners, mental health providers, and parents). They also described responses to, and feelings after, NSSI disclosure, revealing two themes: i) Unhelpful/stigmatizing responses (based on fear, anger, and apathy) and ii) Helpful/destigmatizing responses (expressions of concern, emotional support, and alternative coping strategies). Overall, young sexual minority women's disclosure experiences were consistent with those of other populations, highlighting the need to further reduce stigma about NSSI, as well as sexual minority identities, and provide universal education promoting helpful responses to NSSI disclosure.