Qualitative research in medicine & healthcare最新文献

Background: Worldwide, women, particularly younger and middle-aged (≤65 years), are disproportionately affected by stroke. Although the adoption of healthy lifestyle habits is integral for stroke risk factor modification, little is known about younger adult women who had a stroke or are at high risk of stroke-their lifestyle-related knowledge, behaviors, associated and influencing facilitators, and barriers to support brain health, which this study aimed to address.

Methods: A qualitative interpretivist design was employed that was part of a larger quality improvement mixed-methods study. Data was collected through virtual, semi-structured focus groups. Inductive thematic analysis was performed and analyzed using the intersectionality framework.

Results: A total of 11 women comprised the study sample who were of high stroke risk or had a stroke (mean age 53 years, 54.5 % stroke). A total of six themes emerged from the analysis: (1) lifestyle habits supporting holistic post-stroke recovery, (2) parenting-not being the same mother as before, (3) professional expectations-having to leave career behind and pressures to return, (4) societal expectations of women and permission to self-care, (5) psychological safety and comfort from women-centered interventions, and (6) experience in the healthcare system-not feeling seen, heard, or considered as a woman.

Conclusions: Study findings have implications on three levels: 1) micro, through the development of intensive, long-term educational, behavioral, peer-led, group-based and theory-informed interventions that focus on holistic and incremental lifestyle changes and involve family and social support; 2) meso, through the use of practical tools in clinical practice, integration of motivational interviewing and health coaching, and services for children in health care and school systems, and 3) macro, through the incorporation of case management and psychosocial support in the current model of stroke care.

Background: Qualitative healthcare research often involves emotionally charged topics, such as trauma, illness, loss, moral injury, that profoundly affect researchers as well as participants. Yet the personal and emotional experiences of researchers are frequently excluded from formal training, ethical oversight, and methodological discourse.

Objective: This commentary explores emotional reflexivity as a core methodological, ethical, and pedagogical dimension of qualitative research in health care. It asserts that researcher emotions are vital sources of insight, ethical awareness, and relational depth, particularly in clinical, psychological, and trauma-informed research settings.

Methods: Drawing from feminist standpoint theory, affect theory, and post-qualitative inquiry, this paper synthesizes conceptual literature, cross-disciplinary insights, and a personal fieldwork vignette from qualitative research with Ukrainian military healthcare professionals. Finally, it presents a framework for emotional engagement throughout the research process.

Results and key insights: Emotions shape every stage of qualitative research. When unacknowledged, emotions may contribute to researcher distress or burnout. This commentary highlights the need for emotionally responsive training models, research team practices, and IRB protocols that address participant and researcher vulnerability. It also offers pedagogical strategies and draws parallels to emotionally intensive fields such as counseling, chaplaincy, and medicine.

Conclusion: Emotionally reflexive practice enhances ethical clarity, deepens qualitative rigor, and promotes long-term sustainability in health research careers. As qualitative inquiry continues to shape healthcare policy, education, and practice, researcher emotional engagement must be reimagined as an ethical and methodological asset.

Organizational causes of burnout among mental health providers (MHPs) are extensively documented in the literature. Additionally, several studies have established a relationship between higher burnout rates and poorer patient care. However, it remains unclear whether worse patient care results from organizational causes of burnout, MHP burnout itself, or a combination of both. Therefore, an in-depth qualitative exploration of MHPs' experiences with organizational causes of burnout and their perceptions of how these causes may affect patient care was conducted. Fifty-four MHPs (i.e., social workers, psychologists and psychiatrists) across nine Veteran Health Administration (VA) medical centers participated in semi-structured interviews. Content analysis was used to analyze the data. Findings revealed a complex relationship between organizational factors and individual behaviors influenced by burnout, and their potential impact on patient care. MHPs' acknowledged that their burnout could impact the quality of care provided to Veterans. The behaviors associated with burnout, such as disengagement, lack of empathy, distraction, lack of preparedness, and procrastination, may inadvertently compromise the therapeutic alliance and the overall efficacy of treatment. Findings also indicated that MHP experienced moral distress from the dissonance between the desire to provide high-quality care and the reality of institutional constraints. Additionally, MHP burnout impacted Veterans' trust and engagement with the VA mental health care system. Therefore, addressing burnout requires a multifaceted approach including organizational reforms, support and resources for MHPs, and dedicated support for MHPs to deliver high quality care. Our findings emphasize the critical need for organizational-level interventions that prioritize clinical care over bureaucratic demands.

Background: Uncertainty is pervasive in healthcare and permeates every clinical encounter between patients and medical professionals. Patients with specifically uncertain diagnoses or treatments such as multiple sclerosis (MS) are more likely to respond negatively to a lack of clear information. Research into MS has a narrow focus on scientific issues of uncertainty, such as causal explanations or treatment recommendations. Inquiry into the interplay between various dimensions, contexts, and subjects of uncertainty in a relational practice and institutional context, is scarce. The objective of this research is to investigate the phenomenon of uncertainty as it appears in hospital practice surrounding outpatient care for people with relapsing-remitting multiple sclerosis (RRMS).

Methods: This study followed a phenomenological research design, inspired by the work of Les Todres on embodied enquiry. Fifteen people with a recent (less than one year) diagnosis of RRMS were included and prospectively shadowed during hospital appointments over the course of two years.

Results: The phenomenon of uncertainty is captured as occurring in four different spheres: 1) precarious spaces, 2) elusive technology, 3) hidden expectations, and 4) unsure communication. The image of spheres points to their varied and sometimes opposing (sur)faces when rotated around their axis. The spheres can increase or decrease a sense of doubt, confusion, restlessness, or anxiety in both patients and healthcare providers.

Conclusion: The four different spheres never seem to fully surface, making uncertainty a masked phenomenon. The findings imply a need for an "unveiling" of uncertainty through 1) examining and debating the course of action at the outpatient clinic, 2) reconsidering the promises and perils of technology, and 3) through metacommunication with patients.

Background: Global stroke incidence has been rising among adults 65 years of age or younger. A dearth of research exists exploring and understanding younger and middle-aged adults' lifestyle-related knowledge and habits along with associated facilitators and/or barriers with the adoption, maintenance, and support needs for development of new brain health interventions, which this study sought to address.

Methods: A qualitative study was conducted, followed by virtual, semi-structured focus groups. Data collection and analysis were performed using Goffman's dramaturgical theory to guide the inductive thematic data analysis.

Results: A total of 12 participants comprised the sample. Four themes emerged: 1) Front stage: Life 2.0, 2) Back stage: Unseen and invisible challenges, 3) Scripts and audience reaction: Dualism of social influence; and 4) Setting: Standard of care, but to who's standard?

Conclusion: Findings contributed to a deeper understanding of factors influencing the adoption of healthy habits and approaches to reconceptualize and re-design brain health interventions that meet the needs, preferences, and priorities of this population.

Physician assistants play a major role in healthcare delivery in the United States, yet what we know about how patients perceive the care they receive from PAs is limited. Prior research on patients' impressions of PAs has focused primarily on survey data, limiting the scope of what we can learn about patient impressions to predetermined, quantifiable categories, and has focused on post-visit impressions of a single encounter. In an attempt to better understand patient impressions, we conducted open-ended, semi-structured interviews with 30 participants prior to their medical visit, focusing on general impressions of PAs. Through an analytic process of reflexive thematic analysis, we identified three themes from the interview data: patients are confident in PAs, patients feel valued by PAs, and patients appreciate the openness that PAs create. Through exploration of these themes, we uncovered the ways in which interviewees described PAs as engendering trust and enacting multiple aspects of patient-centered care.

There is a growing emphasis on involving patients and the public in healthcare research. This is especially true in qualitative healthcare research, where partnerships are encouraged between patients with lived experiences and researchers with academic expertise. The rationale is that collaboration can enhance the study's relevance to healthcare users and improve the research quality. However, establishing partnerships can be complex and challenging, requiring negotiation and alignment of expectations. In a qualitative study exploring communication in clinical encounters at a Danish university hospital, we invited patients and relatives to become involved in research. This commentary discusses the challenges, insights, and adjustments to our research design that emerged from the process. Through continuous dialogues with various patients and relatives, we, as researchers, gained a deeper understanding of how to make our research relevant to patients and relatives and how to approach involving patients and relatives in our research. By emphasizing the significance of these dialogues, we aim to demonstrate how aligning expectations and building partnerships with patients and relatives resulted in valuable learning experiences for the researchers and considerably impacted the study's design. Furthermore, we want to highlight that building partnerships requires time, flexibility, and a mutual learning approach to negotiate and align expectations effectively. In this commentary we first review the practice of involving patients and the public in healthcare research and provide an overview of the study's context. Next, we outline our efforts to negotiate and align expectations with patients and relatives, highlighting how new insights led to adjustments to the research design. Finally, we address challenges and the requirements researchers face when involving patients and the public in research partnerships.