SSM. Qualitative research in health最新文献_第7页

Ethnic minority patients' experiences of clinical communication with general practitioners in the United Kingdom: a meta-synthesis of qualitative evidence 英国少数民族患者与全科医生临床交流的经历：定性证据的综合研究

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-30 DOI: 10.1016/j.ssmqr.2025.100660

Sanaa Hyder , Sarah Peters , Dawn Edge , Susan Speer

Rationale

Health inequalities disproportionately affect people from ethnic minority backgrounds. Primary care is usually where patients first access healthcare services and come into contact with healthcare professionals such as General Practitioners (GPs). The quality of communication between patients and GPs can affect patient experience and health outcomes. Research shows that these experiences can be poorer for ethnically minoritised patients. However, a review providing a comprehensive understanding of ethnic minority patients’ GP communication experiences does not exist.

Objective

To synthesise the qualitative evidence on ethnic minority patients’ experiences of clinical communication with GPs in the UK.

Methods

A SPIDER search strategy was used to systematically search the CINAHL Plus, EMBASE, PsycINFO, PubMed, ASSIA, and Web of Science databases for relevant studies. The Critical Appraisal Skills Programme checklist for qualitative studies was used to assess the quality of included studies. Data were synthesised using a meta-ethnographic approach.

Results

Thirty-seven studies were included, capturing experiences of 1140 individuals from ethnic minority backgrounds. Three inter-related third-order constructs were developed to form the ‘on PAR’ model, illustrating patients' GP communication experiences: (i) ‘Perceiving’ GP communication through one's own lens of health, illness, and care; (ii) Communication concerns related to ‘Alignment’ between GP and patient characteristics; and (iii) GP-patient ‘Relationship’ needs for effective communication.

Conclusion

The ‘on PAR’ model depicts that ethnic minority patients' GP communication experiences vary based on intersectional aspects of patients' identities (such as gender, religion and language) and their interplay with GPs' identities, extending beyond reductionist ethnicity-based classifications linked to patients' healthcare experiences and outcomes. Findings may inform doctors' communication training, with regard to providing tailored care to diverse ethnic minority patients.

健康不平等对少数民族背景的人影响尤为严重。初级保健通常是患者第一次获得医疗保健服务并与全科医生（gp）等医疗保健专业人员接触的地方。病人和全科医生之间的沟通质量会影响病人的体验和健康结果。研究表明，对于少数族裔患者来说，这些经历可能更糟糕。然而，对少数民族患者全科医生沟通经历的全面了解尚不存在。目的综合英国少数民族患者与全科医生临床交流经历的定性证据。方法采用SPIDER检索策略，系统检索CINAHL Plus、EMBASE、PsycINFO、PubMed、ASSIA、Web of Science等数据库进行相关研究。定性研究的关键评估技能程序检查表用于评估纳入研究的质量。使用元人种学方法对数据进行综合。结果共纳入37项研究，收集了1140名少数民族个体的经历。开发了三个相互关联的三阶结构来形成“on PAR”模型，说明患者的全科医生沟通经验：(i)通过自己的健康，疾病和护理镜头“感知”全科医生沟通；（ii）与全科医生和患者特征“一致”相关的沟通问题；（iii） gp -患者“关系”对有效沟通的需求。结论“on PAR”模型描述了少数民族患者与全科医生的沟通经历因患者身份（如性别、宗教和语言）的交叉方面及其与全科医生身份的相互作用而有所不同，超出了与患者医疗保健经历和结果相关的还原主义基于种族的分类。研究结果可以为医生的沟通培训提供参考，以便为不同的少数民族患者提供量身定制的护理。

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引用次数: 0

Precarity and pills in a pandemic: online abortion care-seeking in Poland during COVID-19 大流行中的不稳定和药物：2019冠状病毒病期间波兰在线堕胎护理

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-30 DOI: 10.1016/j.ssmqr.2025.100663

R. Nandagiri , E. Coast , J. Strong , K. Footman , L. Berro Pizzarossa , C. Wenham , K. Jelinska

COVID-19 and subsequent policy measures (e.g., lockdowns) impacted abortion care-seeking and provision, including availability and accessibility of care services. We examine the impact of COVID-19 on abortion-seeking in Poland using quantitative and qualitative secondary data from abortion care-seekers’ (n = 8577) online consultations (April–Dec 2020) with an abortion telehealth provider working in Poland.

COVID-19 amplified job and financial insecurity and precarity, influencing abortion decision-making. COVID-19 measures like lockdowns limited privacy, exacerbating the need for secrecy as a key element in abortion care-seeking, particularly when at risk of interpersonal violence. Personal support systems, often essential in pregnancy, birthing, and parenting, were altered by COVID-19. The loss of key family members (e.g., wage earners or carers) heightened financial and social vulnerability. This collapsing of support systems and networks during the pandemic, shaped abortion decision-making. Pregnancy during COVID-19 potentially exposed people and their families to greater precarity and forms of structural violence, making it a ‘cliff edge’.

Locating abortion experiences in Poland within macro-level intersections of the pandemic, neoliberal policies, and shifting abortion governance (e.g., further restricting of abortion), we highlight the difficulties in accessing abortion care and support. Shifting away from predominant health or rights framings of abortion, we offer new empirical evidence that explores how the pandemic heightened existing structural violence and precariousness, shaping abortion care-seeking and decision-making.

COVID-19和随后的政策措施（如封锁）影响了堕胎护理的寻求和提供，包括护理服务的可得性和可及性。我们研究了COVID-19对波兰寻求堕胎的影响，使用了来自堕胎求助者（n = 8577）在线咨询（2020年4月至12月）的定量和定性次要数据，这些数据来自于在波兰工作的堕胎远程医疗服务提供者。COVID-19加剧了就业和财务的不安全感和不稳定性，影响了堕胎决策。封锁等COVID-19措施限制了隐私，加剧了对保密的需求，这是寻求堕胎护理的关键因素，特别是在面临人际暴力风险的情况下。个人支持系统通常对怀孕、分娩和养育子女至关重要，但COVID-19改变了这一系统。失去主要家庭成员（例如挣工资者或照顾者）加剧了经济和社会脆弱性。大流行期间支持系统和网络的崩溃影响了堕胎决策。在2019冠状病毒病期间怀孕可能会使人们及其家人面临更大的不稳定和各种形式的结构性暴力，使其成为“悬崖边缘”。我们将波兰的堕胎经验定位于流行病、新自由主义政策和改变堕胎治理（例如，进一步限制堕胎）的宏观层面的交叉点，并强调在获得堕胎护理和支持方面的困难。我们不再以健康或权利为主要的堕胎框架，而是提供新的经验证据，探讨这一流行病如何加剧了现有的结构性暴力和不稳定性，影响了堕胎的求医和决策。

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引用次数: 0

Rethinking participation and knowledge: Reflections on qualitative research in technology development for dementia care 重新思考参与和知识：对痴呆症护理技术发展定性研究的反思

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-29 DOI: 10.1016/j.ssmqr.2025.100664

Nora Weinberger

The past two decades have seen an intensification of research and development in assistive technologies for people living with dementia. While many of these projects emphasize inclusion, participation often takes place under restrictive conditions: through structured evaluations, usability testing, or proxy-based design feedback. This paper argues that such frameworks limit what kinds of knowledge are recognized as valid and what forms of expression are rendered legible. Drawing on multi-site participatory research projects, the author reflects on moments in which inherited benchmarks of coherence, reliability, and evidence strain against the realities of the field. In these spaces of epistemic friction, where memory fragments, timelines collapse, silences carry meaning, names shift, or questions fail to land, what emerges is not less knowledge but knowledge of another kind. These claims are illustrated through four scenes of epistemic friction drawn from the author's fieldwork. The paper develops a methodology of shared presence: a research stance grounded in attunement and epistemic reciprocity, valuing responsiveness over analytic control and relation over extraction. By treating repetition, silence, ambiguity, and reframing as epistemic resources, this orientation contributes to the rethinking of qualitative inquiry in technology development for dementia care. It also addresses technology development more directly, arguing that when such forms of knowledge are ignored, the results are often technically sophisticated but socially unanchored unusable products. The article thus speaks to broader debates about voice, vulnerability, and epistemic responsibility in the context of health, care, and innovation.

在过去二十年中，针对痴呆症患者的辅助技术的研究和开发得到了加强。虽然许多项目都强调包容性，但参与往往是在限制性条件下进行的：通过结构化评估、可用性测试或基于代理的设计反馈。本文认为，这样的框架限制了哪些类型的知识被认为是有效的，哪些形式的表达是可读的。借鉴多站点参与性研究项目，作者反映了在连贯性，可靠性和证据压力的继承基准的时刻，对该领域的现实。在这些认知摩擦的空间里，在记忆碎片、时间线崩溃、沉默承载意义、名字变换或问题无法出现的地方，出现的不是更少的知识，而是另一种知识。这些主张是通过作者田野调查中得出的四个认知摩擦场景来说明的。本文发展了一种共享存在的方法：一种基于调谐和认知互惠的研究立场，重视响应而不是分析控制和关系而不是提取。通过将重复、沉默、模糊和重构视为认知资源，这一取向有助于对痴呆症护理技术发展中的定性调查进行重新思考。它还更直接地谈到了技术发展，认为当这种形式的知识被忽视时，结果往往是技术上复杂但社会上不稳定的不可用的产品。因此，这篇文章谈到了关于健康、护理和创新背景下的发言权、脆弱性和认知责任的更广泛的辩论。

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引用次数: 0

Unpacking tensions in community capacity building: A qualitative examination of a co-production process to support children's and adolescents' leisure-time physical activity in public housing areas 解开社区能力建设中的紧张关系：对支持公共住房区儿童和青少年闲暇时间体育活动的合作生产过程的定性检查

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-24 DOI: 10.1016/j.ssmqr.2025.100657

Camilla Bakkær Simonsen , Charlotte Overgaard , Sine Agergaard

Community capacity building is widely regarded as a valuable approach in health promotion and applied across diverse contexts. However, there is a lack of research in applying community capacity building to promote leisure-time physical activity among children and adolescents.

This study aimed to build community capacity to develop leisure-time physical activities for children and adolescents in public housing areas. In this article we examine how participating community stakeholders (municipal employees, social workers, representatives from sports clubs and a sports organization) attribute meaning to a co-production process as part of building community capacity. To explore this, we conducted four focus groups and one individual interview with participating stakeholders and observed 27 co-production workshops. We followed a strategy of reflective thematic analysis and orientated the coding process in Robert Chaskin's (2001) conceptualization of community capacity.

Our analysis shows that the participating stakeholders were more focused on developing activities for children in the area than in building community capacity. The stakeholders’ level of commitment to reach their shared vision was challenged by ambiguities in their roles and responsibilities, competition for resources, and frustrations about the research-based design of the project. As many stakeholders measured success by the number of children participating in the developed activities, they perceived the project as less successful when implementation of activities failed, even if initial community capacities were developed.

This article highlights the importance of future initiatives recognising and addressing the tensions involved in prioritizing community capacity building equally alongside the achievement of specific programme outcomes.

社区能力建设被广泛认为是促进健康的一种有价值的方法，并适用于各种情况。然而，如何应用社区能力建设促进儿童和青少年的休闲时间体育活动，目前还缺乏研究。本研究旨在建立社区能力，以发展公共住房区内儿童及青少年的休闲体育活动。在本文中，我们研究了参与的社区利益相关者（市政雇员、社会工作者、体育俱乐部和体育组织的代表）如何将意义赋予合作生产过程，作为建设社区能力的一部分。为了探讨这一点，我们对参与的利益相关者进行了四个焦点小组和一次个人访谈，并观察了27个合作制作讲习班。我们采用了反思性主题分析的策略，并在Robert Chaskin（2001）的社区能力概念化中定位了编码过程。我们的分析表明，参与的利益相关者更关注为该地区的儿童开展活动，而不是建设社区能力。利益相关者对实现共同愿景的承诺水平受到了他们角色和责任的模糊性、资源竞争以及对项目基于研究的设计的挫折的挑战。由于许多利益相关者以参与已开发活动的儿童数量来衡量项目的成功，他们认为，如果活动实施失败，即使最初的社区能力得到了发展，项目也不太成功。本文强调了未来倡议的重要性，即在实现具体项目成果的同时，承认并解决优先考虑社区能力建设所涉及的紧张关系。

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引用次数: 0

“We are there putting our bodies on the line for others:” Embodied care work of Mexican abortion acompañantes “我们把自己的身体放在了别人的身上”：墨西哥堕胎的具体化护理工作acompañantes

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-18 DOI: 10.1016/j.ssmqr.2025.100654

Celina M. Doria

In this paper, I explore the embodied care work of Mexican abortion activists, known as acompañantes. To do so, I draw on Latin American feminist understandings of poner el cuerpo and cuerpos insurgentes to demonstrate how the activists' bodies are intimately entangled with their accompaniment practice. This paper examines the following research question: How is care embodied by abortion activists in Mexico? Centering the bodily knowledge of 25 abortion activists in Mexico, I identify five central themes that demonstrate the embodied experience of abortion accompaniment: (1) Body as a tool; (2) The physical labor of accompaniment; (3) The emotional toll of accompaniment; (4) Body on the line; and (5) Body and/as territory. In doing so, I show how abortion activists engage their politicized bodies as sites of power and resistance to provide a form of insurgent care work for individuals’ seeking abortion that resists state violence. As such, I argue that the activists offer an alternate form of care to bodies that have been alienated and violated by the state.

在本文中，我探讨了墨西哥堕胎活动家的具象化护理工作，称为acompañantes。为了做到这一点，我借鉴了拉丁美洲女权主义者对“权欲者”和“权欲者”的理解，以展示活动家的身体是如何与他们的伴奏实践密切纠缠在一起的。本文探讨以下研究问题：关怀是如何体现在堕胎活动家在墨西哥？以墨西哥25名堕胎活动家的身体知识为中心，我确定了五个中心主题，展示了堕胎陪伴的具体体验：(1)身体作为工具；(2)伴奏的体力劳动；(3)陪伴的情感代价；(4)身体上线；(5)主体和/或领土。在此过程中，我展示了堕胎活动家如何将他们政治化的身体作为权力和抵抗的场所，为寻求堕胎的个人提供一种反抗国家暴力的反叛护理工作。因此，我认为活动人士为那些被国家疏远和侵犯的身体提供了另一种形式的照顾。

引用次数: 0

Access to and quality of contraceptive healthcare for undocumented immigrant women in California 加州无证移民妇女获得避孕保健的机会和质量

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-18 DOI: 10.1016/j.ssmqr.2025.100655

Rebecca Woofter , May Sudhinaraset

Immigrants have lower rates of contraceptive use compared to non-immigrants. Undocumented immigrants face multiple barriers to healthcare and often experience poor-quality healthcare, yet few studies have examined contraceptive healthcare in this population. This study aimed to explore access to and quality of contraceptive healthcare among undocumented immigrants. Twenty-four in-depth interviews were conducted between April and July 2022 with Asian and Latinx undocumented immigrant women of reproductive age living in California within the United States. Interviews were inductively coded and themes were identified through thematic analysis. Most participants were aged 25–29, had college degrees, and were Deferred Action for Childhood Arrivals (DACA) recipients. All participants had ever used some form of contraception including condoms. Access to contraceptive healthcare was primarily impacted by knowledge about contraception, health insurance coverage, and knowledge about using health insurance. Participants who accessed contraceptive healthcare described a range of experiences, including those that were judgmental or dismissive, cursory or impersonal, or person-centered. This study highlights barriers to contraceptive healthcare and aspects of poor-quality contraceptive healthcare among undocumented immigrants, even in a highly-educated sample of mostly DACA recipients living in an inclusive state. Undocumented immigrants with lower socioeconomic status, without the protection of DACA, and living in more exclusive state policy climates may face additional barriers to contraceptive healthcare and worse quality of care. Efforts are needed to improve contraceptive education, consistent health insurance coverage and knowledge, and to ensure person-centered contraceptive healthcare for undocumented immigrants. These efforts will help work towards reproductive justice in this population.

与非移民相比，移民的避孕药具使用率较低。无证移民在医疗保健方面面临多重障碍，往往经历低质量的医疗保健，但很少有研究对这一人群的避孕保健进行调查。本研究旨在探讨无证移民避孕保健的可及性和质量。在2022年4月至7月期间，对居住在美国加利福尼亚州的亚洲和拉丁裔无证移民育龄妇女进行了24次深度访谈。访谈采用归纳编码，主题通过主题分析确定。大多数参与者年龄在25-29岁之间，拥有大学学位，并且是“童年来美暂缓遣返计划”（DACA）的接受者。所有参与者都曾使用过包括避孕套在内的某种避孕手段。获得避孕保健的机会主要受到避孕知识、健康保险覆盖面和使用健康保险知识的影响。获得避孕保健的参与者描述了一系列的经历，包括那些判断或轻蔑，粗略或非个人的，或以人为中心的。这项研究强调了避孕保健的障碍和无证移民中质量差的避孕保健方面，即使在大多数DACA接受者的高学历样本中生活在一个包容性的国家。社会经济地位较低的无证移民，没有DACA的保护，生活在更排外的国家政策环境中，可能面临避孕保健的额外障碍和更差的护理质量。需要努力改进避孕教育、始终如一的健康保险覆盖面和知识，并确保为无证移民提供以人为本的避孕保健。这些努力将有助于在这一人口中实现生殖公正。

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引用次数: 0

Youths' strategies for HIV status disclosure in rural Kenya and Uganda: “You can't just trust everyone” 肯尼亚和乌干达农村青少年艾滋病状况披露策略：“你不能相信所有人”

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-17 DOI: 10.1016/j.ssmqr.2025.100650

Jason Johnson-Peretz , Anjeline Onyango , Cecilia Akatukwasa , Fredrick Atwine , Lawrence Owino , Titus M.O. Arunga , Marilyn Nyabuti , Janice Litunya , Jane Kabami , Florence Mwangwa , Moses R. Kamya , Diane Havlir , Theodore Ruel , James Ayieko , Carol S. Camlin

Background

HIV status disclosure is influenced by social values, roles, and rules people take on and adapt, aligned with developmental transitions and cultural expectations. Understanding motivations for disclosure among adolescents and young adults with HIV (AYAH) is important for promoting HIV care engagement.

Methods

A cluster-randomized controlled trial in 28 rural communities in Kenya and Uganda tested an intervention to improve viral suppression and health outcomes among AYAH 15–24 years of age. A longitudinal qualitative study embedded within the trial aimed to identify the intervention's mechanisms of action via semi-structured interviews with n = 111 AYAH, providers (n = 45), and selected family members. Analysis for this paper focused on motivations and barriers to disclosure among AYAH, with attention to targets/confidants, contexts, and communication strategies.

Results

Social roles and expectations influenced HIV status disclosure motivations among AYAH, including filial piety towards parents, spontaneous reciprocity with friends, and conscientiousness towards school supervisors. Women tended to prefer disclosure before marriage. Younger men tended to prefer disclosure after marriage, but older male youth looking for seroconcordance in a partner were willing to disclose before marriage. Medication bottles or pills often provided a contextual opening for disclosure conversations. Disclosure of antiretroviral therapy (ART) use appeared to present more significant hurdles than disclosure of HIV status alone.

Interpretation

Encouraging not only HIV status but treatment disclosure may facilitate support for ART adherence. Tailoring disclosure strategies to particular target-confidant types may help youth disclose more easily and validate their social values and chosen ties while supporting successful care engagement.

艾滋病毒状况披露受到人们接受和适应的社会价值观、角色和规则的影响，与发展转变和文化期望相一致。了解感染艾滋病毒的青少年和年轻成人（AYAH）披露信息的动机对于促进艾滋病毒护理参与非常重要。方法在肯尼亚和乌干达的28个农村社区进行了一项集群随机对照试验，测试了一项干预措施，以改善15-24岁AYAH患者的病毒抑制和健康结果。在试验中嵌入了一项纵向定性研究，旨在通过与n = 111名AYAH、提供者（n = 45）和选定的家庭成员的半结构化访谈来确定干预措施的作用机制。本文的分析重点是AYAH的动机和披露障碍，关注目标/知己，语境和沟通策略。结果社会角色和社会期望影响青少年HIV感染状况披露的动机，包括对父母的孝顺、对朋友的自发互惠和对学校主管的责任心。女性倾向于在结婚前开诚布公。年轻男性倾向于在婚后透露自己的秘密，而年长的男性则倾向于在婚前透露自己的血型。药瓶或药片通常为开诚布公的谈话提供了一个语境上的开端。披露抗逆转录病毒治疗（ART）的使用情况似乎比单独披露艾滋病毒状况带来更大的障碍。不仅鼓励艾滋病毒状况，而且鼓励披露治疗情况可能有助于支持抗逆转录病毒疗法的坚持。针对特定的目标知己类型定制披露策略可能有助于青少年更容易地披露并验证他们的社会价值观和选择的关系，同时支持成功的关怀参与。

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引用次数: 0

Uncovering clinicians' inquiry-based and impression-based efforts to tailor information in oncology consultations: A focus group study 揭示临床医生基于询问和基于印象的努力，以定制肿瘤咨询信息：焦点小组研究

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-16 DOI: 10.1016/j.ssmqr.2025.100652

A. Van Ooijen , S.R. Dalhuisen , I. Henselmans , H.W.M. van Laarhoven , J.C.M. van Weert , E.M.A. Smets

Tailoring of health-related information is recommended to address cancer patients' diverse information needs and abilities to understand and process information. While tailored information can improve patients' satisfaction, recall of information and emotional wellbeing, little is known about how oncology clinicians tailor information during consultations. This study examined Dutch oncology clinicians' perceptions and experiences with tailoring of information to individual cancer patients' information needs and cognitive abilities during clinical consultations. Focus group and dyadic interviews were conducted involving 25 clinicians (physicians and clinical nurse specialists). Results show that clinicians interpret information tailoring as a multifaceted act: it occurs in dialogue, involves clinicians and patients, and includes assessing and adjusting of information. Furthermore, two pathways to tailor information emerged: 1) tailoring based on inquiry, which refers to adjusting information based on patients' stated needs and cognitive abilities (e.g., providing requested information), and 2) tailoring based on impressions, referring to the adjusting of information based on assumptions about patient characteristics and behavior (e.g., streamlining information for emotional patients). Last, clinicians mentioned contextual and interpersonal challenges like cultural differences, language barriers, and clinical regulations. Clinicians thus use inquiry-based and impression-based approaches to provide information that is sensitive to patients' (assumed) individual needs and abilities, interaction dynamics and the clinical setting. To ensure that information is accurately tailored, clinicians are encouraged to verify assumptions with patients and be attentive to patients’ cultural backgrounds and possible language barriers. Future research should observe how information is tailored in real clinical interactions and how patients perceive these efforts.

建议定制与健康相关的信息，以满足癌症患者不同的信息需求以及理解和处理信息的能力。虽然量身定制的信息可以提高患者的满意度、对信息的回忆和情绪健康，但人们对肿瘤临床医生在会诊期间如何定制信息知之甚少。本研究考察了荷兰肿瘤临床医生在临床咨询过程中根据癌症患者的信息需求和认知能力定制信息的看法和经验。对25名临床医生（内科医生和临床护理专家）进行了焦点小组和二元访谈。结果表明，临床医生将信息定制解释为一个多方面的行为：它发生在对话中，涉及临床医生和患者，包括评估和调整信息。此外，还出现了两种定制信息的途径：1)基于询问的定制，即根据患者陈述的需求和认知能力调整信息（例如，提供所要求的信息）；2)基于印象的定制，即基于对患者特征和行为的假设调整信息（例如，为情绪情绪化的患者简化信息）。最后，临床医生提到了环境和人际挑战，如文化差异、语言障碍和临床法规。因此，临床医生使用基于询问和基于印象的方法来提供对患者（假设的）个人需求和能力、互动动态和临床环境敏感的信息。为了确保信息准确，鼓励临床医生与患者一起验证假设，并注意患者的文化背景和可能的语言障碍。未来的研究应该观察信息是如何在真实的临床互动中被定制的，以及患者如何看待这些努力。

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引用次数: 0

Caring About Value: A grounded theory of the quest to move towards higher value care in hospitals 关心价值：在医院寻求更高价值护理的基础理论

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-14 DOI: 10.1016/j.ssmqr.2025.100653

Zephanie Tyack , Michelle J. Allen , Ian Scott , Katrina L. Campbell , Roy M. Kimble , Anne B. Chang , Steven M. McPhail

Caring About Value: A grounded theory of the quest for higher value care in hospitals.

The global pursuit of ‘value’ in hospitals continues amid rising healthcare costs. Traditionally, value in this context has focused on costs and benefits. Extending constructivist grounded theory using a therapeutic landscape lens, we explore value in hospitals not only as places of caring but also as workplaces where professional hierarchies and specialisation dictate what is considered to be ‘of value’. Through this approach, we develop a grounded theory of Caring About Value. Drawing on interviews with 47 staff and patients, 24 field visits, and 14 documents from three large metropolitan public hospitals in Australia, findings depict a three-stage dynamic social process through which people in hospitals move towards higher value care. These stages are: (1) Triggering consciousness; (2) Balancing competing priorities and values; and (3) Keeping up with the changing landscape. Two core concerns, caring about value and attending to power, shape value judgements about the spectrum of care from low to high value and underpin the theory. The Caring About Value theory can be used to transcend entrenched value judgements in hospital structures and systems, reduce inequities, and guide the redesign of hospitals and therapeutic landscapes. The theory may be useful for recruiting, supporting, retaining and elevating the status of individuals and teams best placed to do this, recognising that system transformation requires multifaceted actions beyond individual efforts.

关心价值：医院追求更高价值护理的基础理论。在医疗成本不断上升的背景下，全球对医院“价值”的追求仍在继续。传统上，这种情况下的价值主要集中在成本和收益上。我们使用治疗景观镜头扩展建构主义理论，探索医院的价值，不仅作为护理场所，而且作为专业等级和专业化决定什么被认为是“有价值”的工作场所。通过这种方法，我们发展了一个有根据的关心价值的理论。根据对47名工作人员和患者的采访，24次实地访问，以及来自澳大利亚三家大城市公立医院的14份文件，研究结果描绘了一个三个阶段的动态社会过程，通过这个过程，医院里的人们转向更高价值的护理。这些阶段是：(1)触发意识；(2)平衡竞争的优先事项和价值观；(3)紧跟形势变化。对价值的关注和对权力的关注这两个核心问题，塑造了对从低价值到高价值的关爱范围的价值判断，并支撑了这一理论。关心价值理论可以用来超越医院结构和系统中根深蒂固的价值判断，减少不公平，并指导医院和治疗景观的重新设计。该理论可能有助于招募、支持、保留和提升最适合这样做的个人和团队的地位，认识到系统转型需要超越个人努力的多方面行动。

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引用次数: 0

‘All eyes were on me.’ A narrative study of patients' and the Public's reactions to narcolepsy symptoms and disease 所有的眼睛都盯着我。病人的叙述性研究和公众对嗜睡症症状和疾病的反应

IF 2.5 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health

Pub Date : 2025-10-11 DOI: 10.1016/j.ssmqr.2025.100649

Jan Hlodak , Andrea Madarasova Geckova , Zuzana Dankulincova Veselska , Eva Feketeova

Background

Narcolepsy is a chronic neurological disorder that causes excessive daytime sleepiness, cataplexy and nocturnal sleep disruptions with parasomnia. General knowledge about the disease is usually lacking in the population, which can cause preconceived notions and disparagement based on the disease symptomatology.

Methods

A qualitative study using narrative semi-structured interviews with 25 narcolepsy patients was conducted. Expert-validated interview guides ensured methodological rigor. Transcripts were inductively coded to create a codebook, followed by deductive thematic analysis to identify key patterns and insights.

Results

This paper focused on identifying the reactions of patients and their surroundings to the symptoms and on the received diagnosis. Throughout the interviews we identified five major topics: what people think about the symptoms; how they react to them; patients being in the spotlight; how patients perceive the reactions of others; and how the families and surroundings react to the disease diagnosis.

Conclusion

Narcolepsy is little known in the general and clinical public, which causes problems with delayed diagnostics or misdiagnoses, as well as with social burden in the everyday surroundings of the patient. The findings from this study may be beneficial for spreading awareness about the disease and its impact in clinical and general settings.

发作性睡病是一种慢性神经系统疾病，可导致白天过度嗜睡、发作和夜间睡眠中断并伴有睡眠异常。人们通常缺乏对这种疾病的一般知识，这可能导致先入为主的观念和基于疾病症状的轻视。方法采用叙述半结构化访谈法对25例发作性睡病患者进行定性研究。经过专家验证的面试指南确保了方法的严谨性。对转录本进行归纳编码，创建一个密码本，然后进行演绎主题分析，以确定关键模式和见解。结果本研究重点是识别患者及其周围环境对症状的反应和诊断结果。在整个采访过程中，我们确定了五个主要主题：人们对症状的看法；他们对他们的反应；病人在聚光灯下；病人如何感知他人的反应；以及家庭和周围环境对疾病诊断的反应。结论发作性睡病在普通和临床公众中鲜为人知，给患者的日常生活环境带来了延误诊断或误诊等问题和社会负担。这项研究的结果可能有利于传播对该疾病的认识及其在临床和一般环境中的影响。

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