Qualitative research in medicine & healthcare最新文献

In the two decades since the advent of Web 2.0, scholars of cybersuicide have identified many beneficial and harmful uses of the internet. However, the discursive meanings interactionally created by suicide website users have scarcely been attended to. The present study uses the theory and method of cultural discourse analysis (CuDA) to arrive at meanings about place that radiate from online communication among users of SuicideForum.com (SF), a pro-recovery website. Analyses of 2,119 posts across 131 threads reveal two overarching discursive themes. The first speaks to problematic discourses about place, including the role of placelessness and entrapment in the genesis of suicidality and its affective states, leading to further diminution of experiential worlds. The second theme taps into participants' notions of what constitutes safe spaces, such as the presence of empathetic others who respect one's timetable for personal disclosure, and the freedom to experiment with new ways of inhabiting the world. The study has numerous implications for clinical practice, including recasting psychological disturbances in terms of self-world relations and reconsidering involuntary psychiatric hospitalization in light of forum participants' preoccupation with entrapment.

During pregnancy, women sometimes choose certain practices based upon the experience of their family and/or their vicinity to anticipate complications that may occur during childbirth. The main objective of this study is to understand the motivations and perceptions of pregnant women on lay knowledge in the prevention of complications related to childbirth among a sample of Congolese women. We conducted this study at N'djili Referral Hospital in Kinshasa, Democratic Republic of Congo, using a qualitative phenomenological survey and indepth face-to-face interviews. We interviewed seven women on the phenomenon of lay knowledge practice in the prevention of maternal difficulties and analyzed the data using thematic coding. We provided a consent form to the participants and were careful not to include identifying information. Three main themes emerged: i) discussion of complications related to pregnancy and delivery, ii) perceptions about lay knowledge in preventing complications related to childbirth, and iii) suggestions from participants about using lay knowledge in healthcare settings. Based upon data collected, we argue that lay knowledge about pregnancy can be integrated into formal antenatal training when appropriate and, in doing so, we can build trust among pregnant women toward professional medical instruction.

This study examined openness and topic avoidance in interpersonal communication about ovarian cancer. Guided by the uncertainty management theory, the researchers analyzed qualitative data from 28 ovarian cancer patients/survivors and found openness and topic avoidance to be complex communication behaviors which are connected to patients/survivors' uncertainty. Participants appraised uncertainty about disease prognosis and effectiveness of treatments as a threat; thus, they avoided topics such as treatment side effects and fears about death and disease recurrence to manage such uncertainty. Furthermore, findings showed that communication about ovarian cancer is layered with degrees of openness and avoidance relative to respective audiences and changing illness trajectories. Overall, the findings indicate connections between interpersonal communication about ovarian cancer and uncertainty management practices, suggesting that intervention efforts should help cancer patients/survivors and relational others practice sensitivity when discussing topics such as death and dying.

Despite potential to capture rich contextual information, observation remains an underutilized data collection method. This paper provides a practical guide for using observation to understand complex issues in healthcare settings. Observation is a qualitative data collection method comprised of viewing and documenting phenomena in the usual environment. Drawing on our recent work using observation to better understand personal protective equipment use among healthcare personnel, we describe when to consider collecting data via observation, how to prepare and perform observation, and how to analyze resulting data. Observation data are documented in field notes that contain detailed information about setting, participants, and activity associated with the topic of interest. Field notes can be analyzed alone or triangulated with other types of data using theoretical or conceptual frameworks or by identifying themes. Observation is a valuable data collection method for health services researchers to identify key components involved in a topic of interest, a vital step in forming relevant questions, measuring appropriate variables, and designing effective interventions. Used with other methods or alone, observation yields the detailed data needed to address context-specific factors across a wide range of healthcare research topics and settings.

This study was designed to identify the sources of social support and the perceived psychosocial benefits people diagnosed with cancer experience at a community-based cancer wellness organization. Semi-structured, in-depth interviews were conducted with 31 people diagnosed with cancer who regularly used services at a community-based cancer wellness organization. Two themes were identified related to the sources of social support that participants experienced at the community-based cancer wellness organization: i) participants reported that individuals at the center (e.g., staff and volunteers) provided support, and ii) participants perceived the organization as a source of support. Further, four themes emerged related to participants' perceptions of the psychosocial benefits of social support experienced at the community-based cancer wellness organization including i) reduced feelings of social isolation; ii) acceptance at the center in contrast to stigmatizing experiences elsewhere; iii) validation of new identity; and iv) experiences of relaxation and stress relief. The study findings demonstrate that community-based cancer wellness organizations can be a source of connection, acceptance, validation, and stress relief to people diagnosed with cancer.

An interprofessional group of healthcare practitioners sought a new approach to the early detection, prevention, and resolution of "difficult cases" in the inpatient care context. An action research project addressed this need by developing a narrative re-framing tool that helped reveal entrenched assumptions regarding the root causes of difficult cases in the hospital. The intervention method that emerged from the project - the Difficult Case Consultation (DCC) - is a theoretically-grounded process that helps teams to analyze and address complex communication problems in interprofessional healthcare contexts. Collaborative processes grounded in theory have proven to be the most successful when seeking to optimize healthcare team communication. The article describes the collaborative development of the DCC, presents two cases illustrating the process, and describes systemic factors that exacerbated the emergence of difficult cases in the inpatient context.

Patient involvement has often been defined and examined on the basis of conceptual theoretical frameworks. This article explores patient involvement contextually and locally, in encounters between patients and healthcare professionals in cardiac rehabilitation in Denmark. With inspiration from institutional ethnography, the goal is to unpack what involvement actually implies in rehabilitation activities. The analysis provides micro-sociological insights into how patient involvement is constituted and institutionally conditioned and shows how textually mediated ruling relations regulate activities and interactions, shaping patient involvement in local practices. The analysis reveals how patient involvement primarily relates to healthcare professionals involving patients in health knowledge. It explores how national guidelines and local instructions for healthcare professionals frame understandings of patient needs and problems. The concluding discussion highlights how patients have limited opportunities to influence their own care process. It also points out how it is left to the individual healthcare professional to solve contradictions between institutionally defined tasks and the ambition of patient involvement.

Parents of children suffering from a life-limiting medical condition struggle with difficult existential questions. Our objective was to understand why those parents' interactions with the medical world were so different, ranging from hostile to collaborative, with the themes of identity, spirituality and serenity. A grounded theory design based on the narrative identity framework was used to interview sixteen parents. Three categories emerged: i) Parents in the Almighty category delegate all their power to God or medicine and are the most suffering parents as they do not author their life; ii) Parents in the Me category make every decision on their own causing much anxiety, and they become rebarbative to the medical world; iii) Parents in the Guide category take advice from others, while remaining the authors of their stories and are the most serene parents. Understanding and recognizing these categories can have a major impact on communication with those families.

Personalised methods of predicting breast and ovarian cancer risk through genetic testing increasingly demand a person's understanding and critical appraisal of risk-related information, as well as decision-making and acting upon disclosure of a positive test result. The current study aims at understanding health literacy (HL) among persons at risk of developing familial breast-ovarian cancer (FBOC) from a bottom-up perspective-incorporating their viewpoints into the research process. Its qualitative design integrates an ethnographic-narrative approach and findings from 10 narrative interviews with women who have undergone genetic testing, analysed by using reflexive grounded theory. The collected data reveal the entanglement of the women's perceptions concerning the risk of getting ill, their identity, and their strategies of managing health. The analysis of this interplay provides an empirical basis for approaching HL in its communicative dimension, considering individuals' understandings of health and illness, and emphasizing the role of critical HL.