1
|
Friedmann Z, Kinkel HT, Kühner C, Zsolnai A, Binder A, Mick I. Shaping and shifting schemas on supervised injectable opioid treatment: findings from a cross-sectional qualitative study in two German treatment facilities. Addict Sci Clin Pract 2024; 19:45. [PMID: 38802962 PMCID: PMC11129426 DOI: 10.1186/s13722-024-00475-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Supervised injectable opioid treatment (SIOT) is a promising alternative for people living with opioid use disorder (OUD) who have not sufficiently benefitted from oral opioid substitution treatment. Yet, SIOT utilization remains limited in Germany. We propose that this is due to beliefs, or schemas, on SIOT among people living with OUD. Drawing from medical sociology and social psychology, this study explores the emergence and evolution of such schemas on SIOT. METHODS We conducted semi-structured interviews with 34 individuals currently in or eligible for SIOT in two German outpatient treatment facilities and paralleled an inductive qualitative content analysis with the exploration of individual cases. RESULTS The analysis revealed that peer-to-peer interaction and individuals' practical experiences in therapy are crucial in constructing and changing idiosyncratic and shared schemas of SIOT. When facing ambiguous information, cognitive strategies like subtyping served to mitigate uncertainty. CONCLUSION This research has important practical implications for integrating experiential knowledge into clinical care and improve information sharing among people living with OUD. A nuanced understanding of the complex network of informal advice-seeking and -giving among people living with OUD is indispensable to adequately expand treatment modalities of proven effectiveness.
Collapse
Affiliation(s)
- Zoe Friedmann
- Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany.
| | - Hans-Tilmann Kinkel
- Praxiskombinat Neubau, Schwerpunktpraxis für Suchtmedizin (outpatient clinic for addiction medicine), Ruschestraße 103, 10365, Berlin, Germany
| | - Claudia Kühner
- Schwerpunktpraxis für Suchtmedizin Stuttgart (outpatient clinic for addiction medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Andreas Zsolnai
- Schwerpunktpraxis für Suchtmedizin Stuttgart (outpatient clinic for addiction medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Annette Binder
- Universitätsklinikum Tuebingen, Sektion Suchtmedizin und Suchtforschung (addiction medicine and addiction research department, Medical University Hospital Tuebingen, University of Tuebingen), Calwerstraße 14, 72076, Tuebingen, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
2
|
Paulus TM, Grubbs H, Rice-Moran R, Lester JN. How student healthcare providers in a communication skills course respond to standardized patient resistance. Soc Sci Med 2023; 337:116309. [PMID: 37879265 DOI: 10.1016/j.socscimed.2023.116309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
Encountering and responding to patient resistance can be especially challenging for student healthcare providers. Navigating who ultimately holds the authority to know and understand a health concern, make recommendations for a course of action, and accept or resist these recommendations are all part of how epistemic authority is negotiated in medical settings. The purpose of this paper is to systematically examine how student providers enrolled in a communication skills course at an American university responded to standardized patient resistance. The data for this study were 121 video-recorded and transcribed final objective structured clinical examinations from the fall 2019 course. We used discourse analysis informed by principles of conversation analysis to identify several discursive strategies used by the students, including: 1) asking for clarification; 2) expressing uncertainty and offering to gather additional resources; 3) aligning with and offering an account for the resistance; 4) recommending a new course of action; and 5) confronting the resistance. Our findings point to the value of including instruction for both student healthcare providers and standardized patients on how to respond to resistance they encounter in ways that may help improve healthcare outcomes.
Collapse
Affiliation(s)
- Trena M Paulus
- East Tennessee State University, Research Division, Department of Family Medicine, Quillen College of Medicine, PO Box 70621, Johnson City, TN, 37614, USA.
| | - Heather Grubbs
- East Tennessee State University, Research Division, Department of Family Medicine, Quillen College of Medicine, PO Box 70621, Johnson City, TN, 37614, USA.
| | - Renee Rice-Moran
- Department of Curriculum and Instruction, Clemmer College, East Tennessee State University, 402 Warf-Pickel Hall, Johnson City, TN, 37614, USA.
| | - Jessica N Lester
- Department of Counseling and Educational Psychology, School of Education, 201 North Rose Avenue, Indiana University, Bloomington, IN, 47405-1006, USA.
| |
Collapse
|
3
|
Tian X, Zhang S. Expert or experiential knowledge? How knowledge informs situated action in childcare practices. Soc Sci Med 2022; 307:115195. [PMID: 35810691 DOI: 10.1016/j.socscimed.2022.115195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
The study examines how alternative health information affects the professional authority of doctors. Drawing on in-depth interviews with mothers in Hong Kong and focusing on child-rearing practices, we find that mothers glean expert knowledge from doctors and experiential knowledge from online resources, social networks, and direct observations. Despite the prevalence of information online and traditional Chinese remedies, mothers do not use experiential knowledge to challenge doctors. Instead, they self-interpret medical advice and set self-determined courses of action based on their own practical situations. Generally, they dichotomize child-rearing and caring issues into medical versus non-medical domains to which they apply expert and experiential knowledge, respectively. How a condition is categorized depends on whether their individualized experiential knowledge is adequate to allow them to manage the health of their child. This study concludes that mothers with alternative health information still respect professional authorities in clinical interactions, which accords with previous sociological studies, but mothers often consider expert knowledge overly generic, so they take initiative to translate generic health-related knowledge into individualized knowledge for their child and determine their own course of action. Our theoretical contribution is to bring situational concerns into the debate of professional authority by revealing how the accumulation of experiential knowledge informs situated action.
Collapse
Affiliation(s)
- Xiaoli Tian
- Department of Sociology, The University of Hong Kong, China.
| | - Sai Zhang
- Department of Sociology, The University of Hong Kong, China
| |
Collapse
|
4
|
Held BS. Making sense of charges of scientism in psychology and beyond: Logical and epistemological implications. THEORY & PSYCHOLOGY 2022. [DOI: 10.1177/09593543221088555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Charges of scientism in mainstream psychology are on the rise among theoretical psychologists, yet not much attention has been paid to the diverse meanings and applications of the term “scientism.” In examining scientism’s relation to such contrast classes as pseudoscience, bad science, and antiscience, I focus on whether allegations of psychology’s scientism are made with the goal of supplementing mainstream ontological and epistemological frameworks and their methodological implications, or supplanting them altogether. The former suggests supplying a mainstream that is seen as thinly conceived with essential missing nutrients, whereas the latter suggests overturning a mainstream that is seen as irreparable and/or irredeemable in its disregard of lived experience. In light of the scientific reform sought by theoretical psychologists, many of whom now turn to the humanities for remedy, I question whether applying the term “scientism” to mainstream psychology is likely to help in achieving theorists’ disciplinary goals, and I suggest alternatives.
Collapse
|
5
|
Romero NC, Cisneros-Caceres MJ, Granadillo E, Aragao E, Romero-Sandoval A, Barbosa C, Barreto de Oliveira AL, Rodriguez A, Pinheiro GP, Cruz A, Cooper P, Ferreira da Silva MR. Health workers' perspectives on asthma care coordination between primary and specialised healthcare in the COVID-19 pandemic: a protocol for a qualitative study in Ecuador and Brazil. BMJ Open 2021; 11:e052971. [PMID: 34725080 PMCID: PMC8561830 DOI: 10.1136/bmjopen-2021-052971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Asthma is a common long-term disorder and strategies to improve asthma control are still a challenge. Integrated delivery of health systems is critical for effective asthma care: there is limited information on experiences of care coordination for asthma from Latin America, especially on perspectives of health personnel and in the context of the COVID-19 pandemic. METHODS AND ANALYSIS This protocol details a qualitative approach to analyse health workers' perspectives of healthcare coordination for asthma control during COVID-19 pandemic in Ecuador and Brazil, at primary and specialised levels, through in-depth semistructured interviews using a video communications platform. The analysis will identify knowledge and perspectives based on coordination of clinical information, clinical management and administrative coordination. Theoretical sampling will be used to obtain approximately equal numbers of women and men within each level of healthcare; data saturation will be used to determine sample size. Transcripts will be analysed using content-coding procedures to mark quotations related to major topics and subthemes included in the interview guide, and narrative analysis will be based on a theoretical framework for healthcare coordination to identify new themes and subthemes. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethics committees of Hospital General Docente Calderón, Quito, Ecuador; and Universidade Federal da Bahia, Salvador, Brazil. The findings of this study will be disseminated through peer-reviewed articles, conference presentations and condensed summaries for key stakeholders and partners.
Collapse
Affiliation(s)
- Natalia Cristina Romero
- School of Medicine, International University of Ecuador, Quito, Ecuador
- Department of Medicine, Red Groups in Latin America and Africa, Barcelona, Spain
| | | | - Emily Granadillo
- School of Medicine, International University of Ecuador, Quito, Ecuador
| | - Erika Aragao
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Adriana Romero-Sandoval
- Department of Medicine, Red Groups in Latin America and Africa, Barcelona, Spain
- School of Basic Sciences, International University of Ecuador, Quito, Ecuador
| | - Carolina Barbosa
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | | | | | | | - Alvaro Cruz
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Philip Cooper
- School of Medicine, International University of Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St George's University of London, London, UK
| | | |
Collapse
|
6
|
de Graaff MB, Bendien SA, van de Bovenkamp HM. 'Like a fish on dry land': an explorative qualitative study into severe asthma and the impact of biologicals on patients' everyday life. J Asthma 2021; 59:980-988. [PMID: 33625306 DOI: 10.1080/02770903.2021.1888976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
RESULTS Findings show how our respondents experience a high burden of disease (breathlessness, fatigue, exacerbations, loss of family, friends and employment) and treatment (oral corticosteroids' side-effects, dependency, life-style changes). Treatment with biologicals is relatively new for respondents. They mention to be cautious in their embrace of biologicals and in expressing hope for the future. Respondents who react to treatment with biologicals experience relief of both the burden of disease and treatment. They aim to regain their social life and societal participation, a contrast to those for whom biologicals prove ineffective. Biologicals' burden of treatment is experienced as low and minor side-effects are mentioned by three respondents. Respondents appear relatively unconcerned about the lack of knowledge concerning the long-term effects of biologicals.Conclusions: Effective treatment with biologicals is generally experienced as a cautiously optimistic next step in a much longer and complex process of living with severe asthma. The practical lessons we draw point to managing patients' expectations and the need to pay attention to patients not eligible for treatment with biologicals.
Collapse
Affiliation(s)
- M B de Graaff
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - S A Bendien
- Department of Pulmonology, Haga Teaching Hospital, The Hague, the Netherlands
| | - H M van de Bovenkamp
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
7
|
Menichetti J, Gerwing J, Borghi L, Gulbrandsen P, Vegni E. Saying "I Don't Know": A Video-Based Study on Physicians' Claims of No-Knowledge in Assisted Reproductive Technology Consultations. Front Psychol 2021; 11:611074. [PMID: 33510688 PMCID: PMC7835634 DOI: 10.3389/fpsyg.2020.611074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/15/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction The assisted reproductive technology (ART) field deals with consistent and predictable gaps in knowledge. Expressing lack of knowledge with a sentence like “I don’t know” can be challenging for doctors. This study examined physicians’ negative epistemic disclaimer “non lo so” in Italian ART doctor-couple interactions. In particular, it aimed to reveal specific features of “non lo so”: function, topic, temporality, responsibility, and interactional aspects. Methods This was a video-based observational study. We used microanalysis of face-to-face dialogue to analyze 20 purposively selected triadic consultations from a corpus of 85. This inductive analysis focused on the function, the content (topic and temporality) and some selected interactional aspects of the “non lo so”, quantifying and capturing the interaction between these qualitative features. Results We found 82 doctors’ “non lo so” in the corpus (mean = 4.4; range = 0–15). We discovered three main functions of this expression: propositional (n = 73/82), relational (n = 6/82), discursive (n = 3/82). The most frequent topics raising doctors’ “non lo so” were costs (n = 11/82), treatment-related aspects (n = 10/82), and timing issues (n = 9/82). In more than half of the cases (n = 44/82), present issues emerged. The majority (n = 70/82) of “non lo so” was framed using the “I,” with doctors’ taking personal responsibility. Patients played a role in these expressions from doctors: Patients initiated more than one third of them, and in one fourth of the cases, patients followed up immediately. Conclusion Our findings may be related to characteristics of the specific field of ART. Doctors in this setting must frequently express a direct lack of knowledge to their patients, and when they do, they mean it literally. Patients contribute to such disclosures, and their responses suggest that they find them acceptable, showing that they may expect limitations in their potential to conceive.
Collapse
Affiliation(s)
- Julia Menichetti
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jennifer Gerwing
- Health Services Research Unit - Akershus University Hospital, Lørenskog, Norway
| | - Lidia Borghi
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit - Akershus University Hospital, Lørenskog, Norway
| | - Elena Vegni
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
| |
Collapse
|
8
|
Cheung MMY, Saini B, Smith L. Integrating drawings into health curricula: university educators' perspectives. MEDICAL HUMANITIES 2020; 46:394-402. [PMID: 31826925 DOI: 10.1136/medhum-2019-011775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
The literature has identified promising findings regarding the application of arts-based initiatives to enhance healthcare professional (HCP) training. Research shows that drawings offer a window into the authentic, insider view of health and illness, with potential to be a platform for healthcare student and HCP learning. In addition, drawings may also have a place in health communication. Our previous work provides support for the educational application of patients' drawings in bringing HCPs closer to the patient's lived experience. Subsequently, this study aimed to explore university educators' opinions regarding the implementation of drawings as an educational tool for higher education healthcare students. The objective of this study was to explore pathways for using drawings as an art form in an educational context, and provide recommendations for developing curricula and resources for further evaluation. Findings from focus group interviews with nine university educators revealed support for the use of drawings as a novel medium as they offer rich insights into the patient's perspective while encouraging creative and critical thinking. Key perceived benefits were that drawings foster student appreciation of (1) the holistic impact of illness, (2) the importance of patients' priorities and (3) the value of learning from the patient. Patients' drawings of their experiences would offer needed opportunities for students to explicitly reflect about the 'person' holistically rather than view the patient as a 'biomedical problem'. Shifting students' perspectives and possible assumptions to be better aligned with and appreciative of the patient's experiences was noted as central to adopting a person-centred approach to healthcare practice. Our findings suggest that incorporating drawings, or indeed other art forms, as educational tools would be a valuable addition to the health curricula.
Collapse
Affiliation(s)
- Melissa Mei Yin Cheung
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
9
|
Henderson JN, Carson LD, Tomette A, Hass A, King K. Diabetes-by-Proxy: Virtual Embodiment of Disease by Oklahoma Choctaw Parents of Children with Type 1 Diabetes. Med Anthropol Q 2020; 35:25-42. [PMID: 32524666 DOI: 10.1111/maq.12581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022]
Abstract
Childhood type 1 diabetes is increasing globally and requires meticulous at-home care due to risks for fatal outcomes if glucose levels are not continuously and correctly monitored. Type 1 diabetes research has focused on metabolism and stress measurements confirming high parental worry levels. However, research on caregivers' management strategies has lagged. We show parents' intense, all-encompassing work to preempt a disastrous drop in their child's glucose as a stress-path to the virtual embodiment of their child's condition. That is, parents acquire diabetes-by-proxy. Our findings derive from four and half years of ethnographic research with the same 19 families in the Choctaw Nation of Oklahoma. These parents were exceptionally engaged as caregivers and distressed by the potentially fatal outcome of type 1 diabetes mismanagement. Diabetes-by-proxy names the parents' experience and validates clinical attention to them as they cope with their crucial caregiving commitment.
Collapse
Affiliation(s)
- J Neil Henderson
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center.,Duluth campus Memory Keepers Medical Discover Team, University of Minnesota Medical School
| | - Linda D Carson
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center
| | - Alisa Tomette
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center.,Duluth campus Memory Keepers Medical Discover Team, University of Minnesota Medical School
| | - Amanda Hass
- Duluth campus Memory Keepers Medical Discover Team, University of Minnesota Medical School
| | - Kama King
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center
| |
Collapse
|