SSM. Qualitative research in health最新文献

Home dying is a policy indicator of ‘quality dying’ in many high-income countries, but there is evidence that people living in areas of higher deprivation have a reduced likelihood of dying at home. However, there is limited research which centres the views and experiences of people living with both socioeconomic deprivation and serious advanced illness. We deployed visual methods to address this gap in knowledge, focusing on barriers to, and experiences of, home dying for people experiencing poverty and deprivation in the UK. We used photovoice and professional documentary photography between April 2021 and March 2023 with eight participants with serious advanced illness, six of whom had died by the end of the study. We also worked with four bereaved family members to create digital stories. This produced a large volume of multi-modal data which we analysed using a thematic, iterative, interpretive approach. Key findings included the high costs of dying at home, the nature and impact of which were conveyed by images such as a heating thermostat set to low. Images also expressed how for some participants, the environment inside and outside the home was experienced as oppressive and alienating because of cramped, materially poor social housing, as well as urban noise, crime, mould and damp, and a lack of access to outside space. Nevertheless, the home environment was important to all participants, particularly as a site to support the continuation of their identity and autonomy, and some were explicit about wanting to remain at home for as long as possible. This study provides unique insights regarding the significant policy shift needed to improve the extent and experience of home dying for the growing number of people dying in the context of financial hardship and deprivation both in the UK, and elsewhere.

Children can experience significant violence from teachers and peers in schools. Growing evidence from low-and-middle-income country settings shows the potential for interventions in schools to reduce violence and improve school environments, however these tend to act in siloes and address particular subsets of violence. Further, little is known about how to prevent teacher sexual violence, a particularly sensitive form of violence. We conducted a qualitative semi-ethnographic study in two primary schools in Luwero District, Uganda in 2017. Methods included participant observation, 21 semi-structured interviews with school staff and a range of participatory methods with children aged 8–16 years. The study employed a child protection referral protocol, and 16 children received follow-up healthcare and/or counselling services.

Teacher-perpetrated sexual violence occurred in both schools, and at times through sexualised corporal punishment. The boundaries around teacher sexual violence, corporal punishment and emotional violence, and peer violence, were often blurred as they influenced and shaped each other in practice. Drawing on feminist theory, our analysis reveals how interconnected forms of violence occur within overlapping forms of gender, institutional and generational inequality. There is potential for school interventions to address teacher sexual violence and other forms of violence as interconnected, by moving beyond siloes and addressing gendered, institutional school contexts that give rise to violence.

This article offers the case of cystic fibrosis (CF), a multi-system disease, to illustrate how individuals with chronic illness cultivate and apply embodied knowledge to optimize their well-being. We identified three interrelated processes that occur when disease chronicity and menstrual cyclicity meet: 1) knowledge production with a period-tracking app; 2) application of embodied knowledge to manage life with menstrual-related CF symptoms; 3) cultivation of the body-self as a menstruating woman with CF. These dynamic processes capture how cis-gender women with CF attune to their bodies, navigate their illness, and situate themselves within their lifeworlds. Genetic conditions like CF are apt for studying these processes because adults have managed their disease for decades, with longitudinal experience that often exceeds that of their clinicians. Our evidence elucidates the co-constitutive nature of chronic disease, gendered subjectivity, and biological processes in flux. We explored the menstrual cyclicity of chronic disease symptoms by having 72 participants track their CF symptoms across 4 menstrual cycles on a customized period-tracking app. We performed semi-structured interviews with 20 participants to understand how they interpreted these cyclical CF symptoms. We learned that digital tracking attuned participants to monthly fluctuations in CF symptoms. They applied this knowledge to manage their lives and shape their sense of self. We argue that women with CF produce distinct embodied knowledge during their reproductive years, shaping their illness experience, disease management, overall health, quality of life, and selfhood. The dynamics we describe may reflect broader patterns by which women with other chronic illnesses experience their bodies and understand themselves in the world.

This study builds on calls to explore the tensions and dynamics of intraprofessional collaboration and boundary work. It reaches beyond the literature describing the micro-level strategies deployed by physician subgroups to establish legitimacy and defend jurisdictions in the face of health care re-organization. Specifically, it offers a view of how macrosocial imperatives shape intraprofessional boundaries, relations, and the possibilities for collaboration. Drawing on empirical data from a case study of intraprofessional collaboration in caring for patients with diabetes - a clinical context in which patients commonly receive care from family physicians (FPs) and specialist physicians (SPs) – Foucault's concept of governmentality and the sociology of the professions are employed to make visible the sociohistorical construction of intraprofessional collaboration within discourses of evidence-based medicine, and its implications for the [re-]negotiation of professional jurisdictions and restratification of the medical profession. This analysis contributes to the intraprofessional literature through two analytical moves. First, it outlines the discursive mechanisms through which the meso-level deployment of the referral-consultation process provides an arena for SPs to maintain and reinforce their position of influence at both the micro-level of daily clinical work and across broader health care delivery. Second, it provides an understanding of how the transmission of governmental rationality in diabetes occurs through the social relations between SPs and FPs, making the restratification of medicine possible without tension or conflict.

Based on the 2017 Canadian Survey on Disability, more than two million Canadians 15 years of age or older are living with a mental health-related disability. Subsequently, access and delivery of mental health services in Canada, more specifically in Ontario, have shifted to a shared responsibility between healthcare providers and the individual client's informal caregivers. Unfortunately, the role of the caregiver has been historically underappreciated and undervalued, leaving caregivers with few supports to help them manage and cope with caregiving responsibilities. This paper reports the results of a qualitative descriptive study that explored the lived experiences of caregivers who are providing care to an adult family member who is living with a mental illness in Windsor-Essex County, Ontario. Twenty-one participants volunteered to be interviewed for this study via telephone or online on Microsoft Teams. All interviews were audio-recorded and transcribed verbatim. Data analysis followed Braun and Clarke's framework for reflexive thematic analysis. Four themes were identified from the 21 interviews: 1) personal impact of being a caregiver, 2) stress associated with navigating the system, 3) complexity of the caregiving burden, and 4) caregivers as buffers of the failings of the system. Results demonstrate that caregiving is a stressful responsibility and, without sufficient supports, can impair the wellbeing of both the caregiver and the care recipient. As such, apart from recognizing informal caregivers as partners in the care of persons living with mental illness in the community, there is also a need to acknowledge that they, too, require supports to ensure that their health and well-being are not compromised in providing care to their loved one(s).

Much research exists on conflict of interest in high-performance sport in the global North. Yet, the research conducted particularly into US college football—a fairly unique social site of athletic labor given that the fact that enormous revenue is produced by professionalized work that is not compensated—is largely quantitative in nature. In this study, we conducted semi-structured qualitative interviews with twenty-five former power five football players Based on our conversations with former college football players in order to interrogate in a more granular way how and why conflict of interest undermines health and safety in the sport. We found that the well-being of college football players is consistently jeopardized because of the financial imperatives that shape the sport and compromise the care players receive from medical practitioners beholden to the team's ‘need’ to win at all costs. In addition to the inherent concerns this raises about the state of medicine in college athletics, we would also contend that the experiences of the players we spoke to offer a crucial intervention into the debate over ‘exploitation’ in college sport. While exploitation is generally understood in economic terms based on the question of how and to whom the value produced through the commodity spectacle of college sport is distributed, we contend that it should also be understood in terms of the attendant harms. The testimony in this article contributes to the literature on conflict of interest principally by providing some of the most rich and evocative available testimony about how and why conflict of interest occurs and what the implications are for the players whose care is compromised by it.

1 This study investigates how information and communication technology (ICT) facilitated older adults’ home modification to encompass pre-pandemic activities, as well as the health implications of this transition. Using a sample of 24 adults (65+) who lived in the Toronto area during the first summer of the pandemic (May 2020–August 2020), we conduct a qualitative thematic analysis of interviews about daily life, health, and ICT use. We employ difference of means and proportions tests using De Jong Gierveld 6-item loneliness scores to contextualize qualitative findings. We identified four qualitative themes encompassing a sense of loss of in-person socializing, ICT use to adapt routines and socializing to the home, and impacts on mental and physical health. Older adults adapted their homes into an activity place, although ICT was not key to this transition for everyone. Longing for third places suggests spatial agency is important for emotional well-being.

Delivery in well-equipped facilities is important to prevent the major causes of maternal mortality. Social and structural barriers are well established across low-resource contexts; less understood is the interaction between the psychological dimensions of behavior and a pregnant woman's environment to either facilitate or hinder facility delivery. We conducted formative research applying the behavioral design approach to explore this context shaping decision-making and behavior of pregnant women, and others with influence, in Grand Cape Mount, Liberia. In-depth interviews (n = 58) were conducted in 2021 with pregnant and postpartum women, family members, facility-based providers, trained traditional midwives, community health assistants, and community leaders. Our findings highlight that while most women intend to deliver in a facility, poverty compounds difficulties at each step of the continuum of care, with the cumulative impact making facility-based delivery more difficult for lower-income, rural women to achieve. Delivering in a facility requires extensive planning and saving to overcome these difficulties and we present insights into the context contributing to a series of delays across the course of a woman's pregnancy – from initial care seeking through preparing and seeking care for childbirth, to arriving and receiving care at the facility. Our findings reveal the importance of delays earlier in pregnancy, as poor families have to weigh trade-offs of various aspects of planning and saving more carefully while also faced with chronic scarcity and competing demands for attention. Behavioral solutions that support women to make these difficult decisions and empower communities to address local challenges are still sorely needed.