Qualitative research in medicine & healthcare最新文献

Effective strategies to closing the knowledge gap on cervical cancer and pap screening are needed to increase screening rates and create a greater demand for services in Nigeria. Using the PEN-3 Cultural Model, this paper facilitates understanding of cultural influences on women's decision to screen for cervical cancer. The study draws on qualitative interviewing to explore women's experiences with pap testing and to describe how cervical cancer prevention is perceived, communicated, and utilized in the population. Data consisted of interviews generated from a purposeful sample of 63 adult female participants. An iterative approach was used to abductively synthesize data to identify themes. Analyses produced three themes: knowledge and relational motivation, risk and barrier perceptions, and getting the word out. Findings highlight the potential in applying culturally centered approaches to promoting cervical cancer prevention in underserved populations.

Veterinarians are expected to care for animals while managing clients' emotions and dealing with stress, depression, burnout, anxiety, suicidal ideation, and other mental health struggles that accompany their profession. Through an open-ended qualitative survey of 124 alumni of a southeastern U.S. vet school, this study was designed to provide a rich, holistic examination regarding veterinarians' management of emotional labor. The investigation found that although veterinarians felt overwhelmed, frustrated, powerless, and fearful, they were institutionally expected to suppress these feelings, which they did by focusing on logic and facts over emotions and by reframing negatives into positives. The study also showcases how participants, by staying neutral and strong for themselves and clients, engaged in double-faced emotion management, newly applying this concept to veterinary medicine. Participants coped with emotional labor demands by turning backstage, where they sought support, allowed themselves to get emotional, engaged in self-care, and decided to enact tangible changes. Some participants were unable to truly find peace backstage, however, due to an entrenched veterinarian identity, lack of communication skills, or preexisting mental health struggles that made it difficult to disengage from their emotions. This study largely supports the claim that emotional labor may be worsening some vets' preexisting stressors and mental health struggles and recommends that veterinary programs universally incorporate training that targets development of interpersonal communication competence, emotional labor, and wellbeing and their ability to decompress backstage.

Background: The United Kingdom has recruited Filipino nurses since the late 1990s to meet the country's healthcare needs. Currently, over 40,000 Filipinos are working in the National Health Service, and it is suggested that 36 % of all known healthcare worker (HCW) deaths from COVID-19 within the first two-month period (March and April 2020) were Filipinos, despite accounting for 8 % of the NHS nursing workforce. There was a clear disparity in social media exposure between the celebrated heroism of Filipino HCW and the coverage of disproportionate death rates within the Filipino HCW community in the UK. This study aimed to explore the lived experiences of Filipino nurses in the UK during the COVID-19 pandemic.

Methods: A qualitative study was conducted using interpretative phenomenological approach (IPA). Six nurses were recruited using purposive and snowball sampling, and interviews were transcribed verbatim and analyzed using IPA.

Findings: Drawing on interview data, two themes are presented: inescapability and relentlessness of COVID-19 and "It's sink or swim": psychological welfare.

Interpretation: Filipino nurses experienced the COVID-19 pandemic as an all-consuming phenomenon, as they were perceived as the embodiment of threat and placed at disproportionate risk perpetuated by racial, systemic, and political factors. Despite this, they had no choice but to battle through, engaging in culturally specific ways of coping.

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.