SSM. Qualitative research in health最新文献

英文中文

Matrones as accompagnateurs: A model for accompaniment

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-02-26 DOI: 10.1016/j.ssmqr.2025.100541

Meredith Casella Jean-Baptiste , Milenka Jean-Baptiste , Pierre Ricard Pognon , Alison Lutz , Joia Mukherjee , Christophe Millien

Accompaniment is an approach for working with, supporting, and providing needed services to historically marginalized or vulnerable groups. It involves multiple stakeholders going through an experience together in solidarity to achieve a shared goal, ensuring that the vulnerable do not bear the load alone. Despite this, there has been limited research describing accompaniment. Per the existing literature, no study has explored the traditional birth attendant (known as a matrone in Haiti) as an accompagnateur. This paper explores accompaniment as an approach, harnessing the wisdom, connections, and love of matrones serving pregnant women as they labor and give birth. In doing so, this work further operationalizes accompaniment through a conceptual model that describes its various components. Matrones serving pregnant women in the Mirebalais commune of Haiti were purposively and conveniently sampled to participate in focus group discussions. Using thematic analysis, multiple themes emerged. Four themes represent the core components of the accompaniment model: physical support, economic support, emotional support, and advocacy. Four themes represent values that undergird accompaniment: spirituality, compassion, commitment, and conviction. The final theme is the applied, practical aspect of accompaniment: pragmatic solidarity. The layers of the accompaniment model, positions accompaniment as a rubric for programmatic design (core components), philosophical stance (undergirding values), and practice (pragmatic solidarity).

We believe these findings demonstrate an accompaniment model that is practical, moral, value-driven, and can be adapted for use in various programmatic settings. This model can be taught and would support better health outcomes for pregnant women from historically, socially or economically vulnerable groups.

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引用次数: 0

Anticipatory moral distress in machine learning-based clinical decision support tool development: A qualitative analysis

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-02-19 DOI: 10.1016/j.ssmqr.2025.100540

Clare Whitney , Heidi Preis , Alessa Ramos Vargas

Ongoing interest in machine learning systems include the emerging capability to integrate electronic health records to develop clinical decision support (CDS) tools that improve medical care, diagnostics, and therapy. Such CDS tools, which can handle a large quantity of data sources, can advise clinicians and amplify insights on diverse patient risk factors, from physiological challenges to psychosocial vulnerabilities. Despite a growing interest, there are various challenges that hinder the successful use of CDS tools in clinical practice. Among these, a key challenge is hesitance or resistance among end-users to take up tools and integrate their use into practice. The current inquiry applied a framework of the symbolic interaction of participatory experience-based co-design and used an interpretive descriptive approach to analysis of qualitative data, investigating the ethical issues brought to light by clinicians participating in three participatory experience-based co-design focus groups, as a part of the initial development of a CDS tool for detecting risk factors for adverse health outcomes in outpatient obstetric care at a single academically affiliated medical institution. Findings revealed that participants describe their anticipated symbolic relationship with a ML-based CDS tool as either promising or morally distressing. Anticipatory moral distress includes three separate sub-categories: 1) clinical conflict with clinical assessment and judgment, 2) partial conflict with comprehensive clinical considerations, and 3) resource conflict with structural barriers related to care delivery. Future work should include utilizing participatory experience-based co-design with end users to identify relevant context and institution-specific priorities and concerns from the beginning of CDS tool development and to continue co-design throughout the development process.

{"title":"Anticipatory moral distress in machine learning-based clinical decision support tool development: A qualitative analysis","authors":"Clare Whitney , Heidi Preis , Alessa Ramos Vargas","doi":"10.1016/j.ssmqr.2025.100540","DOIUrl":"10.1016/j.ssmqr.2025.100540","url":null,"abstract":"<div><div>Ongoing interest in machine learning systems include the emerging capability to integrate electronic health records to develop clinical decision support (CDS) tools that improve medical care, diagnostics, and therapy. Such CDS tools, which can handle a large quantity of data sources, can advise clinicians and amplify insights on diverse patient risk factors, from physiological challenges to psychosocial vulnerabilities. Despite a growing interest, there are various challenges that hinder the successful use of CDS tools in clinical practice. Among these, a key challenge is hesitance or resistance among end-users to take up tools and integrate their use into practice. The current inquiry applied a framework of the symbolic interaction of participatory experience-based co-design and used an interpretive descriptive approach to analysis of qualitative data, investigating the ethical issues brought to light by clinicians participating in three participatory experience-based co-design focus groups, as a part of the initial development of a CDS tool for detecting risk factors for adverse health outcomes in outpatient obstetric care at a single academically affiliated medical institution. Findings revealed that participants describe their anticipated symbolic relationship with a ML-based CDS tool as either promising or morally distressing. Anticipatory moral distress includes three separate sub-categories: 1) <em>clinical conflict</em> with clinical assessment and judgment, 2) <em>partial conflict</em> with comprehensive clinical considerations, and 3) <em>resource conflict</em> with structural barriers related to care delivery. Future work should include utilizing participatory experience-based co-design with end users to identify relevant context and institution-specific priorities and concerns from the beginning of CDS tool development and to continue co-design throughout the development process.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100540"},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143455016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

“This year is not about carrying the heaviest burden”- a qualitative study on Black women’s postpartum experiences

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-02-16 DOI: 10.1016/j.ssmqr.2025.100536

Noelene K. Jeffers , Lauren A. Arrington , Ebony Marcelle , Erin C. Snowden , Lauren M. Aslami , Caitlin N. Mensah , Christina X. Marea

There is a growing literature that seeks to understand Black women/birthing people’s postpartum experiences, particularly in the context of structural, political and historical exclusion of Black people in the United States. The overarching goals of this manuscript were to explore Black women’s postpartum experiences, how racism impacts the postpartum year, and for those insights to reimagine a model of postpartum care that enables Black birthing people to achieve that vision of wellness. We conducted four focus groups with 23 self-identified Black women in the Washington DC metropolitan area who had given birth in the prior two years. Participants attributed the intense overwhelm that characterizes the postpartum period to the historical legacy of slavery, the Jim Crow era, and the enduring “strong Black woman” racial trope. Most participants reported receiving only one postpartum care visit amidst unmet care needs. Structural barriers like transportation, minimal paid leave, and crowded and racially segregated healthcare systems contributed to feelings that postpartum care and wellness were inaccessible. Racist encounters with healthcare providers and fears of family policing sometimes led to care avoidance as a means of mitigating harm while simultaneously motivating attempts to seek racially and culturally concordant care. Participants also shared the ways in which they resisted racism while also rejoicing in mothering and child(ren). Our findings demonstrate an urgent need to reimagine postpartum care to address the enduring impact of the historical context, the manifestations of racism, and the structural ways that postpartum is neglected, while also promoting wellness and joy.

{"title":"“This year is not about carrying the heaviest burden”- a qualitative study on Black women’s postpartum experiences","authors":"Noelene K. Jeffers , Lauren A. Arrington , Ebony Marcelle , Erin C. Snowden , Lauren M. Aslami , Caitlin N. Mensah , Christina X. Marea","doi":"10.1016/j.ssmqr.2025.100536","DOIUrl":"10.1016/j.ssmqr.2025.100536","url":null,"abstract":"<div><div>There is a growing literature that seeks to understand Black women/birthing people’s postpartum experiences, particularly in the context of structural, political and historical exclusion of Black people in the United States. The overarching goals of this manuscript were to explore Black women’s postpartum experiences, how racism impacts the postpartum year, and for those insights to reimagine a model of postpartum care that enables Black birthing people to achieve that vision of wellness. We conducted four focus groups with 23 self-identified Black women in the Washington DC metropolitan area who had given birth in the prior two years. Participants attributed the intense overwhelm that characterizes the postpartum period to the historical legacy of slavery, the Jim Crow era, and the enduring “strong Black woman” racial trope. Most participants reported receiving only one postpartum care visit amidst unmet care needs. Structural barriers like transportation, minimal paid leave, and crowded and racially segregated healthcare systems contributed to feelings that postpartum care and wellness were inaccessible. Racist encounters with healthcare providers and fears of family policing sometimes led to care avoidance as a means of mitigating harm while simultaneously motivating attempts to seek racially and culturally concordant care. Participants also shared the ways in which they resisted racism while also rejoicing in mothering and child(ren). Our findings demonstrate an urgent need to reimagine postpartum care to address the enduring impact of the historical context, the manifestations of racism, and the structural ways that postpartum is neglected, while also promoting wellness and joy.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100536"},"PeriodicalIF":1.8,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Why ‘inclusive policymaking’ is needed during crises: COVID-19 and social divisions in Austria

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-02-13 DOI: 10.1016/j.ssmqr.2025.100539

Isabella M. Radhuber , Katharina Kieslich , Katharina T. Paul , Gertrude Saxinger , Sebastian Ferstl , David Kraus , Stephen Roberts , Natália Varabyeu Kancelová , Barbara Prainsack

During the COVID-19 pandemic, calls for unity from politicians and public health experts contrasted sharply with the rising social divisions between vaccinated and unvaccinated people. Through 127 in-depth qualitative interviews conducted at two time points (October 2020 [n = 72], October 2021 [n = 55]) in Austria, a country with high vaccine hesitancy, this paper explores how and why deepening social divisions around vaccination occurred. Our findings emphasise the political determinants of health shaping these divisions at key moments of the pandemic. Respondents pointed to: 1) the divisive nature of public health policymaking during the vaccine rollout, and 2) how this created fertile ground for right-wing populist parties to exploit social divisions for their own gain. We argue that inclusive (i.e., non-divisive) policymaking is essential during crises to enhance public health interventions —and to address and prepare for ongoing and future global crises like disease outbreaks and the climate emergency.

{"title":"Why ‘inclusive policymaking’ is needed during crises: COVID-19 and social divisions in Austria","authors":"Isabella M. Radhuber , Katharina Kieslich , Katharina T. Paul , Gertrude Saxinger , Sebastian Ferstl , David Kraus , Stephen Roberts , Natália Varabyeu Kancelová , Barbara Prainsack","doi":"10.1016/j.ssmqr.2025.100539","DOIUrl":"10.1016/j.ssmqr.2025.100539","url":null,"abstract":"<div><div>During the COVID-19 pandemic, calls for unity from politicians and public health experts contrasted sharply with the rising social divisions between vaccinated and unvaccinated people. Through 127 in-depth qualitative interviews conducted at two time points (October 2020 [n = 72], October 2021 [n = 55]) in Austria, a country with high vaccine hesitancy, this paper explores how and why deepening social divisions around vaccination occurred. Our findings emphasise the political determinants of health shaping these divisions at key moments of the pandemic. Respondents pointed to: 1) the divisive nature of public health policymaking during the vaccine rollout, and 2) how this created fertile ground for right-wing populist parties to exploit social divisions for their own gain. We argue that inclusive (i.e., non-divisive) policymaking is essential during crises to enhance public health interventions —and to address and prepare for ongoing and future global crises like disease outbreaks and the climate emergency.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100539"},"PeriodicalIF":1.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exercising an individualized process of agency in restoring a self and repairing a daily life disrupted by fibromyalgia: A narrative analysis

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-02-09 DOI: 10.1016/j.ssmqr.2025.100538

Anne Marit Mengshoel , Merja Sallinen , Julius Sim , Birgitte Ahlsen

Objective

Fibromyalgia is a chronic condition that has major impact on people's lives. This study examines individuals' illness trajectories, with a particular focus on daily life experiences and self-managing.

Methods

Narrative interviews were conducted, asking participants to story their daily life experiences from illness onset to the present, and to reflect on the future. Embedded in their storying were experiences of recently being diagnosed, navigating daily life in the face of illness, and participating in a self-management intervention. The data underwent a narrative analysis.

Results

In keeping with the idiographic focus of narrative research, two individuals' stories were chosen to portray an individualized process of self-managing illness in daily life. The storylines ‘Resuming prior self and life’ and ‘Taking life and self in new direction’ illuminate how individuals with differing illness trajectories and life situations autonomously apply resources available to them in their lives. They make sense of illness by bringing together their own lifeworld experiences of stress and factual knowledge and, through a process of individual agency, discover and try out what is right to do in their own life in the face of chronic illness.

Conclusions

These two storylines illustrate that a self-managing process is an individual process nested in the person's social context. Self-management encompasses an individualized process of agency in remaking daily life and reconstructing a sense of self.

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引用次数: 0

The rural risk of digital exclusion: A case study of municipal digital health and social care services in Denmark

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-02-05 DOI: 10.1016/j.ssmqr.2025.100537

Barbara Fersch, Egon Bjørnshave Noe, Annette Aagaard Thuesen, Beate Langer

Digital solutions have the potential to contribute to a stronger inclusion of the rural population in health and welfare services in times of a more scattered infrastructure. However, in Denmark where there is a strong push towards a digitalization of these services, the demographic profile of the rural population, being older and with lower levels of education, implies that a large part of the population in digitally vulnerable positions resides here. In this article, we therefore focus on the risk of digital exclusion in rural areas. Drawing on interviews with frontline professionals involved in the provision of (partly) digitalized services and a volunteer, and on insights from a stakeholder workshop, we provide an investigation of both the mechanisms of digital exclusion and of how these are (at least partly) mitigated in the context of the provision of digital services by health and social care units of two Danish rural municipalities. Drawing on the concept of digital capital, we identify several preconditions and contextual aspects, such as cognitive impairment, that in combination with missing digital capital leads to digital exclusion, and we show how social capital such as family and acquaintances mitigates digital exclusion and the lack of a high enough level of digital capital in various ways. We demonstrate the analytical potential of digital capital and the capital perspective, as it both can open-up practice-oriented insights as well as clarify how the individual's opportunities for acquiring or compensating missing digital capital are related to societal inequalities.

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引用次数: 0

The arrhythmia of bodily urgency: Using rhythmanalysis to understand the organisation of care people living with dementia experience within acute hospital wards

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-01-28 DOI: 10.1016/j.ssmqr.2025.100535

Andy Northcott, Paula Boddington, Katie Featherstone

This article posits Henri Lefebvre's concept of Rhythmanalysis as a novel methodology for observing and understanding the everyday life of the hospital ward and its consequences. To do so we draw on observational data taken across three multi-site studies of acute NHS hospital wards in England and Wales (22 wards across 12 hospitals) between 2015 and 2023. Our analysis of the rhythms of the ward, and of the arrhythmias patients can produce, allow us to develop a detailed and embodied perspective of how the ward is experienced by the many different actors within it. In this paper, we focus on one particular group, people living with dementia, considering how they fit both within and outside the rhythms of the ward, and the dressage used by staff to maintain those rhythms. We conclude by discussing rhythmanalysis as a means to observe and record otherwise underseen aspects of hospital care which can provide a means for researchers to better understand relationships of power, personhood and dignity, and their consequences, within clinical environments.

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引用次数: 0

An exploration of discrimination in healthcare for young women in Scotland: An intersectional study

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-01-27 DOI: 10.1016/j.ssmqr.2025.100534

Laura Tinner , Ana Alonso Curbelo

引用次数: 0

Couple dynamics and interaction needs with healthcare professionals in long-term neurological rehabilitation: A hermeneutic qualitative study

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-01-25 DOI: 10.1016/j.ssmqr.2025.100530

Alexa von Bosse , Peter König , Eva Jansen

Background

Acquired neurological diseases significantly alter the dynamics between patients and their caregiving relatives, particularly spouses. This study investigates how these disorders impact the patient-spouse relationship and assesses the role of healthcare professionals in shaping these dynamics during long-term rehabilitation.

Methods

We conducted three comprehensive, in-depth sequential analyses that focused on (1) patients, (2) spouses, and (3) both partners within their relationship. Using a dynamic interactionist approach, narrative interviews with couples provided insights from both partners on relationship dynamics. Data analysis followed the documentary method, emphasizing socio-genetic type building to classify patient, caregiver, and relationship types.

Results

We identified four patient types, four caregiver types, and three relationship types, each with distinct social interaction patterns and specific rehabilitation needs. Our model, based on symbolic interactionism and Baxter's Relational Dialectics Theory, underscores the fluid and evolving nature of these roles. Patients and caregivers can transition between different types due to the chronic nature of the disorder and the social context of rehabilitation. Recognizing these shifts is essential for addressing relational and social aspects in therapy.

Conclusion

The findings highlight the necessity of acknowledging the dynamic and varied needs of patients and caregivers as well as the relationship dynamics. By understanding relationship types and interactions, healthcare professionals can develop personalized therapeutic strategies that enhance patient- and family-centred care, vital for improving rehabilitation outcomes.

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引用次数: 0

How health promotion prevents itself from tackling health inequalities. A critical analysis of Dutch health promotion's paradigm through its handbooks (1995–2022)

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-01-23 DOI: 10.1016/j.ssmqr.2025.100533

Ilse Dijkstra , Bart Penders , Klasien Horstman

Health inequalities are a central concern within the field of health promotion. Yet, for over four decades, research has consistently shown that socioeconomic health inequalities in Western Europe persist and, on some measures, even have widened. Explanations are typically sought in the behaviours or personal characteristics of ‘unhealthy populations’ or in neoliberal policies. However, the role that health promotion itself, through its central theories, methods and assumptions, plays in the persistence of health inequalities is rarely considered. This study addresses this gap: it explores how health promotion's paradigm informs professionals to reduce health inequalities. Since paradigms are conveyed through handbooks, we conducted a qualitative content analysis of multiple editions of three key handbooks used in Dutch graduate health promotion education, published between 1995 and 2022. Using Science and Technology Studies's notion ‘paradigm’ and the theoretical lens of formal, hidden, and null curricula from Critical Education Studies, we show that Dutch health promotion professionals have been socialised into a remarkably consistent paradigm for three decades. This paradigm, which draws heavily from socio-cognitive psychological models, teaches professionals to prioritise individual behaviour change and not to challenge sociopolitical actors whose actions contribute to ill-health. Justifications remain limited to considerations such as convenience, ease and cost-effectiveness. The handbooks that convey this paradigm continue to be used in Dutch graduate education, training the health promotion professionals of the future. We argue that, at least in the Netherlands, the prevailing paradigm of health promotion is a significant, yet overlooked, factor in the persistence of health inequalities.

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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SSM. Qualitative research in health

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