SSM. Qualitative research in health最新文献

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.

Background

Communication is crucial in healthcare settings as patients rely on language to articulate their symptoms and concerns to the doctor. However, language barriers and the sensitive nature of certain subjects often complicate these interactions. Reproductive health is one such subject that poses a challenge in clinical and societal contexts due to its intimate nature. Guided by H·P Grice's Cooperative Principle, maxim of manner, this paper examines the use of circumlocution as a discourse strategy employed by male patients in a doctor-patient interaction in a reproductive health clinic in Kenya.

Methods

Data is drawn from a qualitative study carried out in reproductive health clinic in Nakuru County, Kenya. Using participant observation as a tool, doctor-patient conversations were audio-recorded and transcribed, and discourse analysis adopted as the guiding framework of analysis.

Results

Circumlocution is prevalent in male patients and female parents when discussing reproductive health issues, regardless of the doctor's gender. The use of circumlocution can hinder clear and direct communication, contradicting Grice's maxim of manner emphasizing the importance of clear and concise communication for effective communication. Circumlocution serves as a euphemistic tool for addressing taboo subject. Its use allows patients to approach reproductive health topic indirectly, reducing embarrassment and discomfort.

Major conclusion

There's a need for improved communication strategies in healthcare settings with emphasis on a delicate balance between sensitivity and clarity when discussing reproductive health problems. The work underscores importance of doctors being skilled in deciphering meanings and patients being more direct when discussing reproductive health concerns.

Contribution to knowledge

The study contributes to the broader conversation on effective communication in healthcare especially in men's reproductive health context. It is important to adapt and tailor communication strategies to the cultural and social contexts of male patients and the unique challenges they face.

The COVID-19 pandemic has had wide-ranging implications on the academic community and there have been numerous commentaries on the effects of the pandemic on qualitative health research. However, the vulnerabilities faced by participants and researchers during the pandemic have remained underexplored. Addressing this gap, this reflective article discusses the intersecting challenges and opportunities arising for participants and researchers in qualitative health research during the pandemic through the lens of layered vulnerability. Vulnerability, as a layered concept, provides novel insight to discussions on the effects of the pandemic as it provides a depth of insight into the multifaceted and dynamic nature of vulnerabilities, while considering individual differences and contexts. Reflecting on the research we conducted during the pandemic, we draw out the layers of vulnerability that both participants and researchers faced during the research process, as well as the obligations and strategies we developed to mitigate these vulnerabilities. We discuss the intersectionality of individual characteristics and the digitisation of work and life, including the impact of moving qualitative health research online and the use of creative methodological approaches. Our article highlights how, through engaging with their own vulnerabilities throughout the research process, researchers can develop creative and new solutions for qualitative research which mitigate the increased vulnerabilities participants faced during the pandemic.

Recovery capital is a framework in addiction research aiming to understand substance use disorder recovery holistically by considering individuals' access to resources across the four domains of human, physical, social, and community capital. Each domain is opposed by negative capital. The underrepresentation of women's experiences in substance use research and the limited understanding of substance use treatment's effect on recovery capital limits our understanding of how treatment programs can support women in developing and maintaining recovery capital. This secondary qualitative analysis of data collected from the RENEW study explores the experiences of n = 19 women enrolled in substance use disorder treatment in Connecticut at baseline. Interviews occurred at two time points three months apart between February 2020 and April 2021 and discussed participants' experiences with treatment and the resources they have access to early in recovery. Thematic analysis identified four main themes related to recovery capital development. First, the direct effects of treatment, defined as clinical pathways to recovery capital, promoted resource growth primarily in the domains of human and physical capital. Second, non-clinical pathways, including indirect effects of treatment, facilitated maintenance of treatment-related improvements in human, social, and community capital. Third, interactions between domains promoted recovery capital resource growth across domains. Finally, goals and expectations for treatment motivated resource development across study time points. This study's findings have important implications for operationalization of the recovery capital framework and highlight the importance of more robust integration of non-clinical interventions to improve the experiences of women in treatment for substance use disorders.

Syringe Services Programs (SSPs) provide evidence-based services like drug use equipment to prevent infectious disease, overdose prevention education, and naloxone distribution to people who use drugs (PWUD). However, inadequate funding threatens provision of these interventions. This study aimed to document how the current funding landscape impacted determinants of SSP implementation, particularly describing financial and staffing barriers, facilitators, and proposed strategies, using qualitative methods informed by three implementation research frameworks. We interviewed 20 leaders of SSPs in the United States using a semi-structured interview guide. Participants described how structural stigma against PWUD led to insufficient and restrictive funding, and burdensome reporting for SSPs. This resulted in harming program implementation outcomes like reach, fidelity, and sustainability. Inadequate funding also led to insufficient staffing and subsequent staff stress, burnout, and turnover. Taken together, these barriers threatened the implementation of evidence-based interventions that SSPs provided, ultimately harming their ability to effectively address health outcomes like infectious disease transmission and opioid overdose mortality within their communities. Interviewees described how upstream policy strategies like political advocacy might address structural stigma at the federal level. Participants also highlighted state-level efforts like harm reduction–centered funding, technical assistance and capacity-building, and clearinghouse programs that may facilitate better implementation and health outcomes. A more robust understanding of the relationship between financial barriers, facilitators, and strategies on implementation and health outcomes represents a novel and vital area of research within harm reduction literature.

Long term cancer survival is increasingly prevalent, and the consequences are of sociological and clinical interest. In this paper we deploy the concept of wrangling to emphasise the everyday tussle of survivorship and processes of navigating pathways through what can be an unwelcoming environment. From 2020 to 2022 81 interviews were conducted with people, Māori and non-Māori, throughout Aotearoa New Zealand identified as exceptional cancer survivors, living with a diagnosis of cancer from four to 37 years. Categories of wrangling discussed by participants included wrangling with the public drug-buying agency in Aotearoa New Zealand, wrangling between private and public healthcare systems, subaltern wrangling and wrangling across regions. Wrangling could be driven by the person with the cancer diagnosis, undertaken on behalf of that person by others including family and health professionals, and undertaken by the community. We argue that for most people with long-term cancer survival wrangling is a social practice, but the capacity to succeed in that practice is dependent on a range of factors, including levels of economic, cultural, and social capital. The concept of wrangling provides a contrast to an overemphasis in the survivorship literature on cancer as an individual experience; one largely disconnected from the art and practice of managing (often unwieldy and flawed) systems of care.

This article investigates the complex ways that social conditions and illness experiences interact with cancer in a marginalised population. Drawing on the theoretical framework of syndemics, we explore how people living in circumstances of homelessness and severe substance use in Denmark experience and manage their cancer illness. We draw upon qualitative, partly longitudinal, interviews with marginalised people with current or previous cancer illness. Participants suffered from a wide range of physical and mental conditions alongside their cancer illness and substance use. Adverse interactions between these conditions delayed, complicated, or hindered both the cancer diagnosis and the cancer treatment of participants. Surprisingly, for some, the cancer diagnosis also contributed to temporary periods of stability. Nevertheless, disadvantaged social conditions of chaotic, unwanted housing conditions, fragile social relations and social isolation worked to aggravate participants' cancer trajectories and general life situation. Participants' cancer experiences were cases of syndemic suffering that took on a distinct direction in which cancer created cyclical rounds of suffering due to the many late effects of the illness and treatment. The article demonstrates how marginalised people’s cancer experiences are inextricably linked to, and shaped by, the social and health inequities characterising their lives.

Home dying is a policy indicator of ‘quality dying’ in many high-income countries, but there is evidence that people living in areas of higher deprivation have a reduced likelihood of dying at home. However, there is limited research which centres the views and experiences of people living with both socioeconomic deprivation and serious advanced illness. We deployed visual methods to address this gap in knowledge, focusing on barriers to, and experiences of, home dying for people experiencing poverty and deprivation in the UK. We used photovoice and professional documentary photography between April 2021 and March 2023 with eight participants with serious advanced illness, six of whom had died by the end of the study. We also worked with four bereaved family members to create digital stories. This produced a large volume of multi-modal data which we analysed using a thematic, iterative, interpretive approach. Key findings included the high costs of dying at home, the nature and impact of which were conveyed by images such as a heating thermostat set to low. Images also expressed how for some participants, the environment inside and outside the home was experienced as oppressive and alienating because of cramped, materially poor social housing, as well as urban noise, crime, mould and damp, and a lack of access to outside space. Nevertheless, the home environment was important to all participants, particularly as a site to support the continuation of their identity and autonomy, and some were explicit about wanting to remain at home for as long as possible. This study provides unique insights regarding the significant policy shift needed to improve the extent and experience of home dying for the growing number of people dying in the context of financial hardship and deprivation both in the UK, and elsewhere.

Children can experience significant violence from teachers and peers in schools. Growing evidence from low-and-middle-income country settings shows the potential for interventions in schools to reduce violence and improve school environments, however these tend to act in siloes and address particular subsets of violence. Further, little is known about how to prevent teacher sexual violence, a particularly sensitive form of violence. We conducted a qualitative semi-ethnographic study in two primary schools in Luwero District, Uganda in 2017. Methods included participant observation, 21 semi-structured interviews with school staff and a range of participatory methods with children aged 8–16 years. The study employed a child protection referral protocol, and 16 children received follow-up healthcare and/or counselling services.

Teacher-perpetrated sexual violence occurred in both schools, and at times through sexualised corporal punishment. The boundaries around teacher sexual violence, corporal punishment and emotional violence, and peer violence, were often blurred as they influenced and shaped each other in practice. Drawing on feminist theory, our analysis reveals how interconnected forms of violence occur within overlapping forms of gender, institutional and generational inequality. There is potential for school interventions to address teacher sexual violence and other forms of violence as interconnected, by moving beyond siloes and addressing gendered, institutional school contexts that give rise to violence.