SSM. Qualitative research in health最新文献

Although discussion of reminiscence is prevalent in dementia care research, few studies have examined what actually occurs in these interactions, and how they are structured. This study examined how reminiscence activities are structured and negotiated in a care home environment. Informal one-to-one reminiscence interactions between people living with dementia and professional carers were transcribed from a larger video dataset. We used Conversation Analysis to examine reminiscence sequences in a novel relational approach that explored the interactional practices used by carers and people living with dementia. We identified divergences between manualised practice recommendations and observed interactional practices, such as the rarity of open questions, and frequent use of closed questions. This was contrary to current practice recommendations. These and other divergences demonstrate the value of interactional research in informing reminiscence practice and training manuals. By examining how reminiscence operates in practice, our approaches to conducting such activities can be more empirically informed. Our findings can be used to advise and guide those doing reminiscence work in care home settings, and improve the inclusiveness of reminiscence interactions. Through incorporating empirically informed techniques that both carers and people with dementia use in practice, we can facilitate interactions around memories which are supportive of people with dementia's identity.

Black and Hispanic adolescents in New York City experience high rates of pregnancy and sexually transmitted infections. A comprehensive understanding of the complexity of adolescent sexual health and family planning decisions and experiences can provide insights into the sustained disparities and inform practice, policy, and future research. The goal of this study was to explore and analyze this complexity, centering Black and Hispanic adolescent mothers as the experts on sexual and reproductive experiences from pre-pregnancy through parenting. As part of formative research for a human-centered design study, we interviewed 16 Black and Hispanic adolescent mothers living in New York City. Using situational analysis, we mapped relationships, discourse, and social structures to explore the various factors that inform adolescent sexual health decisions, in particular choices about contraception. Situational analysis found that, besides interpersonal factors, organizations and non-human elements like social media and physical birth control devices affected adolescent family planning in three social arenas: home, healthcare, and school. Within and across these arenas, adolescents lacked consistent sexual health education and contraceptive counseling and faced gendered expectations of their behaviors. Participants described parents and healthcare providers as most responsible for providing sexual health counseling yet described parents as uncomfortable or overreactive and healthcare workers as paternalistic and biased. A consideration of the many factors that inform sexual health decision-making and recognition of adolescents’ desire for parents and healthcare providers to be a source of education can address health disparities and promote adolescent sexual health and wellbeing.

When police personnel suffering from work-related psychological injuries seek support and recognition from their organization, a complex dynamic can unfold. This may even be experienced as morally injurious, thus adding to the initial psychological injury. This article delves into this issue in the context of Dutch police personnel, analyzing the narratives of 13 (former) police officers through the theoretical framework of Moral Injury, (mis)recognition, and bureaucracy. Their stories reveal that these officers, having learned to view their organization as their ‘blue family’, yearned for support and recognition, while inherent bureaucratic constraints prevented the police organization from offering genuine recognition. The result was an isolating and existence-denying experience. Bureaucratic logic tends to make the police organization approach recognition-seeking officers as suspects obligated to prove their ‘sick status,’ while it simultaneously creates tendencies to ‘sanitize’ the organization from their illness. Such an interaction becomes a Sisyphean struggle for officers, igniting a 'solidified fight mode' in them and worsening their feelings of misrecognition. Ultimately, this dynamic may be characterized as morally injurious. These findings emphasize the importance of recognition, especially for officers dealing with psychological injuries, and allow us to distinguish between affirmative recognition (perpetuating unhealthy post-injury dynamics) and transformative recognition (changing them toward meaningful change). This study thus advances the understanding of how organizations can both hinder and promote recognition and support, underscoring the pivotal role of transformative recognition to foster healing from the initial psychological injury and prevent moral injury in the injury's aftermath.

This article uses the concept of compassionate deception to understand the complexity and duality at stake when health professionals and family members lie when caring for people with dementia. Drawing on ethnographic fieldwork at two Danish nursing homes, we argue that compassionate deception conceptually illustrates the fine balance we observed of using lies and deception, while simultaneously acting with recognition and care towards residents. Ethical standards in dementia care do not recommend lying. Nonetheless, based on the practices and perspectives of health professionals and family members we direct ethnographic attention towards the intersections of caring and lying. Focusing on everyday social interactions and negotiations in the nursing home context, this study emphasizes the delicate balance between employing lies and deception, and fostering recognition in the context of dementia care. The study underlines the importance of taking the mundane care practices, the interpersonal relationships, as well as the work conditions and institutional pressure of health professionals into account when discussing care ethics in dementia.

This study seeks to understand how healthcare providers perceive systemic- and individual-level factors affecting rural patients' access to care and how this information impacts providers’ approach to cancer screening and prevention recommendations. Over a six-month period in 2021, we conducted semi-structured interviews with primary care providers, nurse navigators, and community health workers affiliated with a regional health system to better understand their perceptions of cancer control in rural communities. Thematic analysis was conducted to identify key themes and develop a conceptual framework to describe the pathway between information-gathering and care coordination – as well as how trust affects these relationships. We found that provider beliefs about barriers facing rural patients influence care recommendations and patient interactions. These beliefs and subsequent interactions affect trust between providers and patients, which influences whether rural patients are willing to believe providers, their adherence to care recommendations, and the information patients are willing to share with providers.

Background

Many pregnant individuals with opioid use disorder (OUD) spend time in jail, yet access to standard of care medications for OUD (MOUD) in jail is limited. Though qualitative studies of non-incarcerated pregnant and non-pregnant incarcerated individuals with OUD demonstrate complexities that must be considered in delivering effective care, studies with pregnant, incarcerated patients with OUD are lacking.

Methods

We conducted semi-structured qualitative interviews from October 2020–November 2021 with pregnant and postpartum people with OUD who were currently or previously in jail in Florida, Maryland, Ohio, and Virginia. Interview guides incorporated understandings of the power dynamics of incarceration and gendered expectations of motherhood. We analyzed transcripts using descriptive phenomenology to identify themes around experiences of treatment or withdrawal in jail and upon release.

Results

We interviewed 32 women, 23 pregnant and nine postpartum. Some received MOUD in jail and others endured withdrawal. All participants expressed concern for their babies. Five themes emerged: 1)lack of counseling or accurate information about MOUD in pregnancy; 2)absent, delayed, or coercive care in jail; 3)experiences of stigma and discrimination from staff and caregivers; 4)structural barriers to safe transitions and continuing MOUD; and 5)the destructive presence of child protective services for care continuity. These factors all influenced their ability to recover.

Conclusions

Jails must provide OUD care that is attentive to pregnancy physiology, pregnancy-stigma, reentry needs, and patients’ fetal-newborn concerns. Tailoring care specific to pregnancy and postpartum context can improve recovery success, reduce overdose, and promote intergenerational equity.

Food insecurity is a growing global concern, with millions of people suffering from hunger and malnutrition every day. Street-connected children are disproportionately vulnerable to food insecurity due to their living conditions and social status. However, little is known about their food insecurity experience, particularly in low- and middle-income countries. This study, therefore, aims to address this gap by examining the food insecurity experiences of street-connected children in Jimma, Ethiopia. This qualitative study was conducted from July to September 2021, and involved children living on the streets in various parts of Jimma city. In this study, we utilized interviews, focus group discussions, and field observations to investigate food acquisition strategies, hunger experiences, coping mechanisms, and challenges in food access among these children. Our findings indicate that street-connected children struggle to secure adequate, safe, and stable food, encountering pervasive hunger. Their limited resources and income exacerbate their dietary challenges. Their lack of food access not only represents a major challenge in their day-to-day lives but is also central to the various vulnerabilities and adversities they face. Moreover, their persistent hunger complicates their ability to improve their living conditions and exit from the street life. In conclusion, the study underscores the urgent need for focused attention on alleviating food insecurity among street-connected children, particularly in low-income countries.