SSM. Qualitative research in health最新文献

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.

Background

Inequities in the incidence and outcomes of first episode psychosis (FEP) for Indigenous peoples are impacted by multiple institutional systems. This study examines Indigenous experiences of these systems to gain an understanding of how to improve institutional responses to FEP inequity.

Methods

Critical race theory informed the methods used. Twenty-three participants participated in four focus group interviews, and thirteen individual interviews, including nine Māori youth and young adults with FEP, ten family members, and four Māori health professionals. Participants were asked about lifetime experiences of institutions (health, social, and criminal-justice). An adapted WHO framework for addressing mental health inequities was used to organize and analyse the first round of structural coding, followed by descriptive and pattern coding.

Results

Two themes were identified. The first theme signposted opportunities for institutional intervention. Participants critique being processed quickly through institutions that are driven by socio-political agendas, namely perceived risk, threat or crisis. Subsequently, opportunities for meaningful intervention were missed. The second theme identified scope for family orientated responses across sectors. Participants described short-term social interventions and institutional structures that focused on individuals rather than families, emphasizing the need to broaden cross-sector scope to structural interventions for families.

Discussion

The findings highlight institutional responses are focused on organisational drivers and downstream issues, that fail to address the fabric of the family social-environmental conditions that maintain Indigenous exposure to psychosis risk and poor outcomes. A pathway to equity would require a shared framework of social responsibility across sectors, that targets structural factors responsive to Indigenous family needs.

The COVID-19 pandemic disrupted family and community support systems that typically nurture pregnancy and birth experiences of migrant Bangladeshi and Sri Lankan women in Australia. Very little is known about how COVID-19 lockdown measures impacted Bangladeshi and Sri Lankan pregnant women living in Australia during the pandemic. Using an intersectional and resilience thinking approach, we explored the social and emotional resilience of Bangladeshi and Sri Lankan pregnant women living in Victoria, Australia during COVID-19 lockdowns. Semi-structured photo-elicitation interviews were conducted in English, Tamil and Bangla and audio-recorded in-person and virtually. Inductive thematic analysis was used to analyse the visual and oral qualitative data produced. Twenty-five Bangladeshi and Sri Lankan-born women were interviewed. Three key themes emerged from data analysis: challenges exacerbated by COVID-19, sources of social resilience, and sources of emotional resilience. Participants were negatively impacted by closed international borders, care for children, financial pressures of temporary residence and their physical and mental health was impacted. Primary sources of social resilience were derived from family, community and healthcare professional support. Photo data produced by participants depicted patterns of emotional resilience to overcome the challenges of social isolation during their pregnancy in lockdown. The visual and oral data highlighted that participants were significantly impacted by social isolation during COVID-19 lockdowns in Australia. Findings from this study can contribute to understanding how social support networks influence maternity during a pandemic and how culturally safe maternal health practices can be reinforced to support the motherhood of migrant women regardless of visa status.

LGBTQA + people are less likely to access mental health care despite an increased risk of adverse mental health outcomes including suicidal thoughts and behaviours. The present study aimed to explore Australian LGBTQA + young people's perceptions of key factors associated with access to suicide prevention services. A qualitative design, utilising inductive thematic analysis, was employed to explore participants' experiences within different service settings. Twenty-seven LGBTQA + young people who had experienced suicidal thoughts and/or behaviours took part in this study. LGBTQA+ and general service accessibility concerns were reported by participants. Themes pertaining to LGBTQA + -inclusive practices were more commonly reported to be a barrier. Whereas visibility of LGBTQA + -inclusive practice was reported to be a key facilitator for service access. These findings indicate that existing concerns of LGBTQA + competency among clinicians more broadly are echoed within mental health and suicide prevention services. Further education for mental health clinicians on the determinants of poor mental health in LGBTQA + young people may improve barriers to access in this population. Specific recommendations are provided to address issues in clinical practice and improve care of LGBTQA + young people.

Transgender and gender diverse youth and young adults (TGDY) experience higher mental health morbidity, including self-harm, suicide ideation, and suicide attempts, as compared to cisgender peers. Support from family members is associated with improved mental health outcomes for TGDY. However, little is known about the process that caregivers who consider themselves supportive undergo and how caregiver-youth relationships evolve through a TGDY's gender journey. Through a reflexive thematic analysis of 14 interviews conducted with caregivers of TGDY from April–July 2022, we sought to understand how caregivers who considered themselves supportive of TGDY navigated shifting relationships with themselves, their children, and their communities. Applying theories of Ambiguous Loss and Thriving Through Relationships, findings coalesced around several themes including reflecting on change, re-negotiating interpersonal relationships, and educating through relationships. The gender journeys of TGDY required caregivers to navigate relationships with self (feeling loss and wrestling with worry for their child), negotiate relationships with others (disclosing to extended family and social networks), and educate themselves and others through relationships (connecting through personal narratives from other families, parents supporting parents, learning to advocate for their child). The process of caregivers learning to support their children was facilitated through profound intrapersonal and interpersonal reflection, connection, and community. Understanding this process is important to inform educational interventions and programs that help caregivers learn to support and advocate effectively for TGDY.

This study explored African migrant women's clay ingestion experiences during pregnancy against a backdrop of health risks warnings in order, to inform public health interventions by the UK Food Standards Agency and Public Health England, now known as the UK Health Security Agency. An interpretative phenomenological approach (IPA) was utilized, and data were collected with a total of 30 participants through individual in-depth interviews and one focus group discussion. Findings showed clay ingestion is a fluid and widely accepted cultural practice among African communities with most participants having been socialized into ingestion during childhood, through family influences and current social networks in their adulthood. Vomiting, nausea, spitting, appetite challenges, and cravings were cited as the main reasons for clay ingestion during pregnancy. With strong claims regarding its effectiveness, clay was ingested every day by most participants, and at times in large quantities despite the potential health risks. This calls for innovative and culturally sensitive public health interventions starting with the inclusion of clay ingestion health risk messages in maternal health nutrition information within antenatal settings. This can be done as part of multilevel interventions informed by life course approaches, which also consider community health messages and an enabling regulatory policy framework focusing on clay sold for human ingestion.

The school is an ideal setting to promote children's health and is an equitable way to reach children in early developmental years. Healthy children are stronger learners and wholistic health approaches taken in schools can help children thrive. Interventions in the school are strengthened when school, home, and community work together, yet many interventions have not reported the school and community connection and influence. The purpose of this study was to determine if and how the intervention, APPLE Schools, has impacted the community environment. One community in Alberta, Canada was chosen as a case study. An instrumental case study approach was taken, and data generation was guided by focused ethnography. Data were generated through community partner interviews (n = 17) and document analysis. Reflexive thematic analysis was used to analyze data. Results were represented by three main themes and demonstrated APPLE Schools created impact beyond the school setting through a stepped approach: 1) Foundation: establishes a healthy school culture; 2) Action: tying the work of schools and communities together; and 3) Impact: changes in school practices ripple out to promote health in the community. This research provides compelling evidence that comprehensive school health approaches can impact community environments outside the school and result in stronger health promoting practices both within and outside the school.

Tobacco smoking is a leading cause of early death. In 2022, New Zealand legislated to introduce three previously untried tobacco ‘endgame’ policies aimed at reducing demand for cigarettes and restricting supply. This study aimed to determine how a key stakeholder group, NZ adults with no intent or low belief that they could stop smoking by 2025, understood proposals to restrict nicotine in combustible tobacco and the number of tobacco retailers to a very low level, annually raise the age of purchase, set minimum prices, and ban filters.

The Affective Propositional Evaluation model was used to analyze participants' comprehension of the policies. That model and discourse analysis worked well for distinguishing which policies were familiar to participants and for determining participants' understanding. Responses and discourse on the novel policies (denicotinization, sinking lid on age of purchase, filter ban), the semi-familiar policy (reducing the number of retailers), and most familiar minimum pricing policy differed qualitatively. Compared to familiar policies evaluative judgements of the novel policies were often inconclusive. If approval of a novel policy was expressed, propositional evaluations suggested that approval was for the intent (to prevent young people from smoking) rather than the means to achieve it. The results complement the ‘endgame’ policy literature, adding the strength of feelings towards, and nuances of doubt about, the potential effects and unintended consequences and provides useful information for formulating metrics for future evaluation of ‘endgame’ policies.