SSM. Qualitative research in health最新文献

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.

Introduction

Biographical disruption describes the process by which illness impacts not just on a person's body and their participation in activities, but also on their sense of self. Biographical disruption is often followed by a process of biographical repair in which identity is reconstructed and a new normality is restored. People with persistent physical symptoms (sometimes referred to as medically unexplained symptoms) experience biographical disruption. This can be complicated by lack of explanation and the implication that if the problem is not medical, then it might be the person/psychological. We aimed to examine this tension in people attending a novel “Symptoms Clinic” for people with persistent physical symptoms.

Methods

This study reports an embedded qualitative study in a UK based randomised controlled trial. Data were collected by audio recordings of consultations and semi-structured interviews with patients. We used theoretically informed thematic analysis with regular coding and discussion meetings of the analysis team. This analysis explores the role of intervention components in facilitating biographical repair.

Results

The lack of acceptable explanation for persistent symptoms acted as a block to biographical repair. In the clinic, multi-layered explanations were offered and negotiated that viewed persistent symptoms as understandable entities rather than as indicators of something still hidden. These explanations allowed study participants to make sense of their symptoms and in turn opened new opportunities for self-management. The result was that participants were able to reframe their symptoms in a way that enabled them to see themselves differently. Even if symptoms had not yet improved, there was a sense of being better. This can be understood as a process of biographical repair.

Conclusion

Explaining persistent physical symptoms enables biographical repair.

Background

Pay-it-forward is when an individual receives a gift and is offered the opportunity to donate a gift to another person. This prosocial behavior has been used to develop health interventions, including strategies to increase sexually transmitted disease (STD) testing among men who have sex with men (MSM). Although pay-it-forward has improved service uptake across several settings, the underlying mechanism is unclear. This study aims to assess the participant experience to provide a theoretical basis for how pay-it-forward works among MSM in China.

Methods

MSM participants of a pay-it-forward intervention were recruited from two STD clinics in Guangzhou, China, and underwent semi-structured interviews. Responses were translated verbatim into English. Transcripts were analyzed thematically.

Results

Twenty-four MSM were interviewed. Despite many men feeling detached from other MSM, pay-it-forward engendered hope and solidarity among many participants. From an emotional perspective, reading handwritten postcards from other MSM induced gratitude, warmth, and support. From the perspective of the collective, receiving a free test and donating to other MSM solidified men's connection with the MSM community, even among men not yet out. Donation gave men an opportunity to pass on their gratitude and provide for MSM in need.

Conclusions

Our data suggest that upstream reciprocity and warm glow explained pay-it-forward for some men, but this pathway was often complemented by a pathway aligned with principles of mutual aid. Further qualitative and mixed-methods research is needed to understand the basis for MSM decision-making about donating to support others.