SSM. Qualitative research in health最新文献

In the near future, more people with dementia will be living at home within an urban context due to a combination of an increased number of people living with dementia and this past decade's urbanization. A common perception is that home-dwelling people with dementia experience a shrinking world, but emerging research from the UK, Sweden, and the Netherlands has broadened this notion by foregrounding how people with dementia experience neighborhoods as a resource in self-care practices. With this article, we contribute to this emerging body of literature and aim to explore how people with dementia experience the cityscape in relation to the onset and progression of their dementia. This study outlines findings from a 7-month ethnographic study involving 12 home-dwelling people with dementia. Using semi-structured interviews, walking interviews, and photovoice, the study explores how the cityscape of Copenhagen, Denmark, affects the everyday life of home-dwelling people living with dementia. Through thematic analysis, three key themes are identified: interaction with the city's life and space as self-care practices, getting out and about as a way to practice a sense of “being in the world” and the loss of orientation abilities and the changing boundaries of the cityscape. The findings from this study contribute to current discussions concerning how people with dementia experience and perceive city and neighborhood environments.

Qualitative cross-country comparative analysis is a method used to compare qualitative data from two or more countries to generate new insights and understandings for research, policy, and practice. Little is known about what is challenging and/or enjoyable for researchers employing this approach.

This paper reflects on the experiences of 21 researchers who took part in qualitative cross-country comparative analyses for papers that were submitted to a special issue of a peer reviewed journal. We draw on semi-structured interviews with researchers from the UK, Brazil, Japan, Germany, Spain, Australia, Canada, and USA, all of whom are members of the DIPEx International research collaboration.

The cross-country analyses were based on interview studies about various aspects of the COVID-19 pandemic. We explore researchers’ accounts of qualitative cross-country comparative analysis and their perspectives on working in international and interdisciplinary teams. Themes explored include Anglo-centrism, working across disciplines, translation for analysis, and leadership.

We conclude with recommendations for future qualitative cross-country comparative health research endeavours, encouraging more qualitative health research in this sphere. We emphasise the potential of qualitative cross-country comparative research to significantly develop medical sociology and qualitative health research generally, in this case through improving our understanding of complex, potentially global, phenomena, such as experiences of a pandemic.

This paper examines the role of companions in healthcare encounters, focusing on a previously unexamined context: the oncology visit with immigrant patients. By employing a methodological approach that combines elements of Goffman's footing and Conversation Analysis, this study discerns the social dynamics and communicative patterns among doctors, patients, and companions. Our focus on the companion yields an intricate picture of their multifaceted and dynamic participation, highlighting how their roles are not predefined and stable, but rather they are co-constructed and ongoingly negotiated among participants. Specifically, our analysis reveals that while companions initially maintain a peripheral position, aligning with the oncologist's focus on the patient as the primary recipient, they readily engage in active participation when the patient recruits them or when patient recipiency is problematic. As the anamnesis progresses, our investigation highlights the significance of the companion, showing their adept moves in response to the actions of both the patient and the oncologist. Their ability to offer linguistic assistance, insights into the patient's life circumstances, and documentation of previous tests is finely tuned to the developing interaction between the oncologist and the patient. In these ways the companions contribute to a more nuanced understanding of the patient and the overall effectiveness of the visit. The study's findings have significant implications for patient-centered care, particularly in diverse healthcare settings with immigrant patients. By recognizing and leveraging companion participation, healthcare practitioners can create more inclusive and equitable healthcare practices, optimizing their contributions for patient well-being.

Healing gardens, a longstanding feature of medical institutions, have garnered attention from scholars for their health-promoting properties across various stages of research. Through a historical literature review and contemporary case analysis of healing gardens, this research investigates how to achieve therapeutic integration by fostering effective connections between buildings and nature through typological design. Combined with qualitative and design-driven research methodologies, including the use of visualization tools such as drawings, models, and images, six models of building-nature integration in contemporary healthcare architecture are identified. This article bridges a research gap in the field of healing garden design and concludes by demonstrating that “typology” is only a design strategy according to context and building performance. In addition to positions of healing gardens, critical factors such as spatial organization, aesthetics, and sustainability, incorporating elements such as accessibility, readability, comfort, and ecological factors, must be carefully considered to achieve integration.

Background

Hospice palliative care aims to provide timely interventions and holistic care that focusses on quality of life for people who are terminally ill. In the first two years of the Covid-19 pandemic the national political and healthcare contexts changed significantly. Throughout this time hospices had to repeatedly adjust their approach to supporting terminally ill people, many of whom were especially vulnerable to Covid-19.

Aim

The aim of this paper was to explore hospice patients, carers, staff and senior managers stories to identify how changing pandemic narratives affected their understanding of hospice palliative care as timely, holistic and supporting quality of life.

Methods

Narrative analysis of in-depth interviews with patients, carers, staff and senior managers (n = 70) recruited from hospices across the West-Midlands, UK, in 2020–22.

Findings

We identified four ‘pandemic narratives’ (reaction; revision; resilience; (re)normalisation) in the participants' accounts of hospice palliative care support in the first two years of the pandemic. In each narrative we explore how Covid-19 and the associated pandemic guidance affected what quality of life was understood to be; how what was considered to be timely care could change during the palliative care journey; and, how different ideas of holistic care were emphasised as the hospice and wider healthcare context changed.

Conclusion

This is the first-time stories about the first two-years of the Covid-19 pandemic from hospice patients, carers, staff and senior managers have been analysed together. We identified how the pandemic brought an existential challenge to ideas of what hospice palliative care is and could be. Our findings suggest that ‘living with covid’ will continue to affect hospice palliative care's ideals of timeliness of care, holistic support, and quality of life left.

The Canadian HIV pre-exposure prophylaxis (PrEP) guidelines recommend both daily and on-demand dosing for gay, bisexual, and queer men (GBQM), meeting additional risk criteria. However, limited research explored how GBQM implement pausing, on-demand, discontinuation, and resumption of PrEP, including the contextual factors affecting decision-making. Using a relationally situated implementation science framework, we examined how GBQM tailor PrEP use to changing social and sexual circumstances. We conducted 109 longitudinal interviews with current and former PrEP users from Ontario (n = 18) and British Columbia (n = 20), Canada, at three time points between 2020 and 2022. We identified three dynamic PrEP use trajectories: pausing, on-demand, and stopping. Pausing involved brief breaks followed by a return to daily use during heightened sexual activity. Others followed the 2-1-1 on-demand schedule, while some stopped PrEP with plans to resume if social and sexual circumstances change. During the COVID-19 pandemic, participants paused PrEP when sexual activities decreased, restarting daily use when sexual engagements resumed. Others paused due to relationship changes or sexual inactivity, resuming PrEP in anticipation of sex. On-demand PrEP was adopted to manage side effects or save costs. Some stopped PrEP for sustained periods due to monogamy, private insurance loss, side effects, or low perceived HIV risk. Participants expressed concerns regarding lack of information on these strategies, relying on online sources or peers for guidance. Most participants obtained enough PrEP knowledge to adapt use appropriately. Comprehensive education campaigns on adaptable PrEP use effectiveness and strategies to discontinue and resume PrEP for clinicians and GBQM should be implemented.

Recently, the Danish Health Authority began recommending vaccinating children aged 2–6 years against seasonal influenza, underscoring the pivotal role of children in its transmission dynamics within the wider population and the need to protect vulnerable population groups after COVID-19. Under a third followed the recommendation. For the routine Danish childhood vaccine program coverage is usually well above 90%.

Through a qualitative in-depth study with 28 key informants during the 2022/2023 influenza season, we investigated the barriers and facilitators of parents' decision-making for vaccinating their children against influenza. We found that parents' decision-making was influenced by a range of factors that present barriers or facilitators at the individual or collective levels, depending on personal antecedents and family situations. We also gained insights on how COVID-19 mass vaccination shaped parents’ attitudes and awareness toward influenza vaccination, explaining why many parents who fully complied with the COVID-19 recommendations elected to opt out of influenza.

The implications of these findings extend beyond the concrete context of parent's decision-making regarding influenza vaccination, contributing to our understanding of vaccine confidence in at least two ways. First, the limited public controversy regarding childhood influenza vaccination allows for a perspective onto low vaccine uptake that does not resort to the usual framing of a well-defined “crisis”. Second, the interaction between COVID-19 vaccination and the childhood influenza vaccination reveals how the massive pressure on parents to vaccinate themselves and their children against COVID-19 contributed to an erosion of vaccine confidence in general.

In this commentary paper we reflect on our experiences of conducting two qualitative public health projects in Leicester UK around health inequalities and marginalised groups during the Covid 19 pandemic in 2020 and 2021. To contextualise the commentary, we first provide information about Leicester and how and why it was disproportionately affected by the pandemic, as well as describing the origins, aims, and methodologies of the two projects. In the second half, we describe and evaluate some of the adaptations we made to our studies and conclude with suggestions for future qualitative community health research as we adapt to the post-pandemic research landscape.