SSM. Qualitative research in health最新文献

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.

This paper presents the findings of a qualitative study conducted in Italy about a peculiar online health community named #TERAPIADOMICILIARECOVID19 (#TDC19), which, since April 2020, has assisted people with COVID-19 with early-at-home therapy delivered by volunteer doctors, free of charge for patients. The aim of the paper was to analyse patients' motivations and strategies when negotiating risk in the context of this choice. Findings showed that patients' choices were the outcome of a process that forms an entangled ecology of care involving several dimensions, crossing micro, meso and macro levels: a) the process of knowledge-building by assessing mass-media, ascertaining the best protocol and recalling previous experiences with similar diseases; b) the experience of feeling abandoned by general practitioners (GPs) and healthcare institutions; c) the positive encounter with #TDC19's posts of gratitude written by people who were cured by #TDC19 doctors. In the end, patients' choice was not a leap of faith; they negotiated and balanced out the perceived risks associated with COVID-19 and with the possible available choices (GPs, do-it-yourself, #TDC19-doctors) based on a strategy that chiefly encompassed a blend of rational and in-between logics.

Persons with sickle cell disease exhibit high levels of distress, which has been documented with validated measures. However, there has been little qualitative investigation of the sources of distress in the lives of persons with sickle cell or the strategies they use to manage different sources of distress. Our study sought to: (1) identify sources of distress for persons with sickle cell, (2) explore management strategies for different sources of distress, (3) inform content development of the future mobile phone application, and (4) incorporate patient voices in the design and development phases of the future mobile phone application. In this manuscript, we present findings for the first objective. Using convenience sampling, we recruited participants with sickle cell (n = 11) from a home visit program at The Ohio State University Wexner Medical Center between February and July 2021. One team member conducted one-on-one semi-structured interviews with participants. We coded and analyzed all transcripts. Participants identified clinical encounters in the emergency department and intermediate care center to manage acute pain flares as the most profound source of distress. Our analysis identified four themes: (1) Pain has performative features, (2) Stigma and racism surround care, (3) Sickle cell is a neglected disease, and (4) Participants lack control over their pain management plan. Researchers may wish to consider how these settings can foster distress, and providers may wish to adopt participant recommendations to reduce distress associated with seeking pain treatment in acute care settings.

Nonadherence to physicians’ recommendations can have a detrimental impact on patient health, to say nothing of the financial cost to the already unsustainable Canadian healthcare system. This comparative study aimed at gaining a deeper understanding of the factors influencing adherence to prescribed medications and lifestyle change recommendations among First Nations patients and patients of European ancestry. In-depth, face-to-face interviews were conducted with 40 participants in Northern British Columbia, Canada. Interviews were transcribed and qualitatively analyzed. Results show that medical adherence derives from an interaction between personal factors and situational or external factors. A comparative analysis revealed that a disproportionate number of First Nations patients faced situational barriers that impeded with medical adherence. These factors include geographical isolation, lack of access to a regular doctor, negative healthcare experiences, and financial constraints. Analyzed through a postcolonial interpretive lens, the research findings highlight the need to reduce systemic barriers within the healthcare system and the wider social context, especially among First Nations patients living in remote communities.