SSM. Qualitative research in health最新文献

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.

Context

Despite efforts to enhance equity, disparities in early palliative care (PC) access for historically minoritized patients with advanced breast cancer (ABC) persist. Insight into patient and clinician perspectives are needed to inform future models aimed at improving equity in PC access and outcomes.

Objectives

To explore qualitative barriers and facilitators to early PC access in an urban setting with Black and Latina women with ABC.

Methods

In this qualitative descriptive study, we conducted one-on-one interviews with Black and Latina women with ABC (N = 20) and interdisciplinary clinicians (N = 20) between February 2022 and February 2023. Participants were recruited from urban academic and community cancer clinics. Transcripts were analyzed using an inductive coding and thematic analysis approach.

Results

Barriers identified by both patients and clinicians included lack of communication between oncology, PC, and primary care teams, limited understanding of PC among patients and non-PC clinicians, language and health literacy-related communication challenges, and racism and marginalization, including implicit bias and lack of diverse racial/ethnic representation in the supportive care workforce. Facilitators identified by both patients and clinicians included patient-to-patient referrals, support groups breaking cultural stigma on topics including self-advocacy and PC, referrals from trusted providers, and community organizations’ abilities to overcome challenges related to social determinants of health, most specifically logistical and financial support.

Conclusions

Patients and clinicians reported similar barriers and facilitators to PC access, most commonly through the lens of care coordination and communication. These findings will inform future adaptation of a culturally and linguistically care model to improve access to early PC services for Black and Latina women with ABC.

Interest in ending a pregnancy outside the formal healthcare sector, also known as self-managed abortion (SMA), is expected to increase in the wake of the overturning of Roe v Wade. However, there is little social scientific research on public perceptions of SMA, particularly regarding opinions around legality and criminalization. We seek to fill this gap in this paper by drawing on 54 in-depth interviews with a mixed-gender sample (men, women, nonbinary) recruited from eight U.S. states with the most restrictive abortion laws. Our analysis finds that most participants believed that SMA should not be illegal or criminalized largely due to two overarching justifications: (1) due to a belief that people should have a right to their own bodily autonomy even in the case of potential self-harm and (2) the belief that criminalizing SMA would be against public health goals. Further, many are concerned that making SMA illegal will lead to unfair or even cruel punishment. However, an underlying thread connecting both support and opposition to SMA legality and criminalization is the assumption that SMA is inherently harmful or dangerous, indicating a lack of lay awareness about the safety and efficacy of SMA using medication abortion pills. These findings indicate the power of medicalization and a valuing of medicalization as a social good, as many believe that behaviors occurring within the healthcare system are inherently safer, more justified, and more moral.

Transvaginal mesh (TVM) surgeries were introduced as an innovative treatment for stress urine incontinency (SUI) and/or pelvic organ prolapse (POP) in 1996. Years after rapid adoption of these surgeries into practice, it emerged that TVM-associated adverse events were uncommon but potentially severe. This initiated global action, including an Australian Commonwealth Government Senate Inquiry, in 2017. This inquiry was both a causal factor in, and surrounded by, a significant epistemic shift towards recognition of women's own accounts of their experience. The Inquiry generated copious data, mostly publicly available. There has been no systematic investigation of how professional stakeholders—clinicians, health services, regulators and manufacturers—contributed to the epistemic environment of this inquiry.

Method

We analysed 42 submissions made by professional stakeholders to this inquiry, and documents from 5 public hearings. We used framework analysis methods, applying deductive and developing inductive codes from the documents, and charting patterns across the documents.

Our aim was to map:

1. Professionals’ contribution to the epistemic environment of this inquiry;

2. How professional actors constructed TVM-associated problems and proposed potential solutions; and,

3. The relevance of conflicts of interest in TVM-associated harms.

Results

We categorised the reasoning of professionals into two groups:

a. Contesting the significance of, or evidence for, TVM-associated harms; and

b. Denying or minimising conflict of interest.

Professionals’ advocacy regarding policy solutions emphasised incremental change, aiming to retain TVM procedures to treat SUI and, under certain conditions, POP.

Conclusion

Contestation regarding harms led to a testimonial quietening of TVM-affected women's interests. The close and normalised relationship between treating professionals and TVM manufacturers may have created a conflicted environment for practice. It seems unlikely that self-regulation will be adequate to ensure that harms are minimised, conflicts of interests well-managed, and patients' interests are the first priority when innovative surgical treatment options become available to practice.

Introduction

Health workers negative attitudes and stigma are often reported as one of the greatest barriers for disabled people to access healthcare. Interventions have been developed in response, and preliminary results often show promising effect on changing health workers' negative attitudes. However, this does not include longer-term, qualitative follow up to explore how health workers change their behaviour post-intervention.

Methods

This qualitative study examined trainees perspectives on a disability training implemented in Ghana in 2017 and 2021. Interview participants had taken part in at least one training session in the Northern, Savannah, or Greater Accra Region. Semi-structured interviews (n = 32) were conducted, transcribed verbatim, and analysed thematically.

Results

Five key themes were identified relating to i) individual and ii) community and system level change. These included: 1) Awareness raising to address stigma and human rights; 2) Prioritisation and positive discrimination; and 3) healthcare workers can be empowered to challenge social norms; 4) Disability training should reach the broader community and 5) Accessibility interventions should compliment training.

Discussion

There are several positive features of providing disability training to health workers and expanding the scope of the intervention to focus on other community leaders and features of an accessible health system. While this helps demonstrate the need to expand disability training for health workers, further research is needed to demonstrate disabled peoples' perspectives on the changes they experience in their care after health workers’ training.

The COVID-19 pandemic has highlighted how ethnic minority groups are disproportionally affected by health crises and the potential for community engagement to provide equitable public health information and services. Policymakers, practitioners, and academics have presented community engagement as a way to improve the access and uptake of health services, including vaccination, but the role of community members for health promotion is rarely questioned. We examine ‘community vaccine champions’, who have been acting as advocates, promoting engagement among ethnic minority groups for COVID-19 vaccination in different communities across the United Kingdom. Our research explores how champions working with minoritised groups have experienced and confronted the challenges brought on by the pandemic. Participants were invited to participate in this study as they worked with or for the Black or South Asian community (i.e., community leader, faith leader, or a public or allied health professional) and were working or had worked to increase COVID-19 vaccine uptake. From April 2021 until May 2022, we conducted 12 semi-structured interviews lasting 45–60 min via video call. The interviews were inductively coded and analysed following a discourse approach to health communication, where a focus is made to draw out underlying messages and talking points.

Our findings highlight the range of different types of champions, who have a variety of roles within their respective community groups. Champions proved adaptive in taking on new positions to promote vaccination, with limited training and preparation, and found that being ‘grassroots’ actors positioned them well to both address local needs and to help build trust between authorities and their communities. A major issue that champions found was the use of ethnic minority classifications and how to address misinformation. Classifications were seen as a problem in how relevant data was collected, as well as in assigning blame to certain groups. Champions also stressed the influence of media and social media misinformation on vaccine decision-making. Still, our informants cautioned taking action based on simplistic assumptions about how misinformation negatively affects vaccine uptake. We conclude by setting out the need for ongoing community support for health issues and the challenges of community engagement for vaccine promotion in a pandemic setting.

Background

There is a global shortage of nurses and new strategies are required to recruit, support and retain this staff group. Organisational culture can have a significant impact on staff wellbeing and commitment. Recent years have seen attempts to foster a compassionate culture across healthcare systems. However, little is known about how nurses initiate self-care and how they feel cared for by their organisation, particularly in times of acute stress and need.

Aims

This paper aims to address the research question, ‘In what ways do nurses experience compassion (or not) during times of acute stress?’, identifying where and how compassionate acts were enacted by individuals, within teams or organisations.

Methods

Semi-structured interviews were conducted with 50 UK National Health Service (NHS) nurses in a longitudinal qualitative study (between March 2020 and September 2022).

Results

Three themes were derived from our narrative analysis including: (1) Learning and practising self-compassion; (2) The presence and absence of interpersonal compassion; and (3) Organisational (non) compassionate acts. Findings indicate that self-compassion requires permission and discipline, often being unfamiliar terrain for nurses. Interpersonal compassion can buoy nurses during challenging times but can often be absent across teams. Nurses’ experiences of organisational acts of compassion were limited, and they often felt de-valued, unsupported and replaceable.

Conclusions

Compassionate acts are enacted across three levels (self, team and organisation). To retain staff, particularly in acutely stressful or challenging situations, organisations, and those responsible for nursing management and policy need to foster a systems-based approach to compassionate culture.