Qualitative research in medicine & healthcare最新文献

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.

To better understand adolescent experiences of menstruation, the CODE Red project was initiated to examine period poverty and menstruation stigma. As part of the project, a survey was posted online through Qualtrics, and the link was posted to social media sites. One hundred and eighty-seven individuals completed the open-ended questionnaire between January and August 2022. The individuals are based in the United States, with most coming from northeastern Indiana. Using an iterative analysis, the data were analyzed using the theory of memorable messages. Three themes emerged supporting memorable messages: the negative cycle of self, talk silence breeds silence, and my mom wasn't there. The study concludes that grin n' bear it and silence are the predominant types of memorable messages first-time menstruators' experience Moreover, first-time menstruators experience self-silencing and other-silencing. Implications include that silence negatively impacts the mother-daughter relationship and that attention should be paid to the importance of communication before menarche.

Non-suicidal self-injury is a concerning and prevalent behavior, particularly among adolescents and university students. Most theoretical models focus on the role avoidance plays in self-injury but, there is no consensus on what is being avoided. The aim of this study was to gain insight from individuals with lived experience of self-injury to better understand the role of avoidance in NSSI. Thirty-five interviews were conducted with individuals with lived experience of NSSI (18 - 44 years) and analyzed using reflexive thematic analysis. Three themes were developed to address our aim: active not passive; a short term distraction; externalizing inner turmoil. Our analysis suggests that avoidance is not a term that resonates with individuals with lived experience of NSSI. The theoretical and methodological implications of these findings are that we need to use language that resonates with individuals with lived experience and improve the way avoidance is conceptualized.

The following is an ethnographic study of a multiple sclerosis (MS) support group. This study underscores the importance of access to counternarratives for individuals with chronic illness and disabilities through organizational structures such as support groups. This work can help those with disabilities/chronic diseases, such as MS, because it provides a space for discussing the communicative forces that shape individual experiences of living with disability and chronic illness. Thus, this study seeks to understand how pharmaceutical representatives' and doctors' grand medical narratives influence the communication of MS support group attendees and their construction/performance of self. This study shows that participation in support groups provides a space to renegotiate identity in which new forms of self can develop external to the dominant discourse. The support group becomes a space where counternarratives of empowerment develop in the face of master narratives.

Leadership is increasingly recognized as important in medicine. Physician leadership impacts healthcare delivery and quality. Little work has been done to determine how physician leadership in practice aligns with established models in leadership theory. We conducted 40 semi-structured, 50-minute interviews of physicians who had achieved the rank of professor in our school of medicine and were serving, or had served, in leadership positions. We used an inductive content analysis approach to identify content categories, with leadership emerging as one such category. Subsequently, for the present study, we performed a secondary analysis of the data. To do this, we reviewed all transcripts, seeking to identify if and how participants discussed leadership in relation to success in academic medicine. Following identification of sub-categories related to leadership, we performed qualitative content analysis. We then used a deductive content analysis approach to determine how participants' discussions of leadership aligned with major leadership theories. Then, the principal investigator conducted a secondary inductive content analysis revealing leadership themes that were synthesized into a new model of physician leadership. Twenty-nine participants spontaneously discussed leadership and leadership-related topics as important to their own academic success and comprised the present study cohort. Participants identified contributors to leadership success that aligned with multiple major leadership theories, including leadership traits, skills, behaviors styles, and situational leadership. None of the leadership theories aligned completely with our physician leaders' discussions, suggesting an alternate leadership framework was operating. Further analysis revealed a new model of leadership comprised of the "Four Cs of Physician Leadership": character, competence, caring, and communication. Our participant group of academic physicians identified leadership capabilities as being important in their academic success. While they discussed leadership in ways that fit to varying degrees with the major leadership theories, their discussions revealed a novel, more holistic leadership framework. Further work will be beneficial to determine if this model of leadership is specific to physicians or is more generalizable.

Schema therapy expands traditional cognitive-behavioral models, weakening early maladaptive schemas and schema modes while strengthening adaptive modes. This study investigated participant experiences of schema therapy for eating disorders, focusing on schema modes and the eating disorder voice, how these maintained disordered eating, and how therapy helped. Semistructured online video interviews with clients receiving schema therapy for eating disorders (N=10) were analyzed using interpretative phenomenological analysis. Four group experiential themes were developed: (1) adverse experiences, typically in childhood and adolescence, (2) interpersonal relationships, especially with primary caregivers and the benefits of a good therapeutic relationship, (3) self-awareness of schema modes and the eating disorder voice and their impact on participants' eating disorders, and (4) recovery using schema concepts, including finding one's inner child, better self-management, and ambivalence about recovering. Overall, schema therapy was perceived as beneficial, specifically regarding participants' awareness of their inner child, development of their eating disorder, and awareness of their eating disorder voice. Participants expressed a growing positive sense of agency, connecting with their inner child's needs and developing a connection to their healthy adult mode. They also felt that schema therapy had equipped them with the tools to strengthen their healthy adult mode, while simultaneously weakening their maladaptive modes.

Non-suicidal self-injury (NSSI) is the deliberate damage caused to one's own body tissue, without the intent to die. Voluntary disclosure of one's NSSI can catalyze help-seeking and provision of support, although what informs the decision to disclose NSSI is not yet well understood. There is currently no existing framework specific to the process of NSSI disclosure, and the aim of this study was to assess the fit between factors involved in the decision to disclose NSSI and two broader frameworks of disclosure: the Disclosure Decision-Making and Disclosure Processes models. A directed content analysis was used to code interview transcripts from 15 participants, all of whom were university students aged between 18 and 25 (M = 20.33, SD = 1.88), with 11 identifying as female. All participants had lived experience of NSSI which they had previously disclosed to at least one other person. All codes within the coding matrix, which were informed by the disclosure models, were identified as being present in the data. Of the 229 units of data, 95.63% were captured in the existing frameworks with only 10 instances being unique to NSSI disclosure. Though factors that inform the decision to disclose NSSI largely align with the aforementioned models of disclosure, there are aspects of disclosure decision-making that may be specific to NSSI.

Metaphors play a significant role in how cancer is experienced and discussed. This study delves into the utilization of metaphors by women bloggers grappling with colorectal and gynecological cancers. By focusing on cancer types less represented in mainstream media, we aim to shed light on cancer cultures associated with body areas often considered taboo. Our findings reveal that widely recognized expressions and stories about cancer, such as the metaphors of battle and narratives promoting optimism and heroism in the face of illness, are deeply ingrained. However, a notable discovery is the prevalence of personification alongside these conventional expressions. Personifying cancer endows it with human characteristics, providing an outlet for bloggers to express their fear and frustration, including articulating feelings of sadness and anger, diverging from narratives centered on heroism and positive thinking. Furthermore, our analysis reveals a significant emphasis on death, underscoring that despite advancements in treatment, bloggers still perceive cancer as highly lethal. Personification can serve both detrimental and therapeutic purposes for bloggers and for societal perceptions of cancer survivorship, both reinforcing and opposing dominant Western discourses surrounding the illness. These findings enrich our understanding of cognitive and cultural tools used to describe cancer within contemporary Western society.