The role of computer software in the analysis of qualitative data: efficient clerk, research assistant or Trojan horse?

Fidelity, pragmatism and the "grey line" in between-exploring the delivery of a pragmatic physical activity randomised controlled trial-a secondary analysis

BACKGROUND

Intervention fidelity in health services research has been poor with a reported lack of understanding about what constitutes pragmatic adaptation of interventions and what constitutes failure to maintain intervention fidelity. However, the challenges facing those delivering such interventions have not been thoroughly explored. The aims of this study were to critically explore the challenges in maintaining fidelity experienced by physiotherapy staff and support workers when delivering a complex intervention for older people living with frailty.

METHODS

This study is a secondary analysis of data from a process evaluation of a large randomised controlled trial (RCT). The process evaluation employed qualitative methodologies with mixed methods including a variety of data collection methods, including participant observation, semi-structured interviews and documentary analysis. Thematic analysis was used to make sense of the data.

RESULTS

Many therapy staff felt ongoing confusion about what was acceptable to adapt and what needed to follow the protocol exactly. We found that some therapy staff were able to embrace the challenges of pragmatically adapting interventions while maintaining intervention fidelity, others stuck rigidly to the protocol and failed to adapt interventions where it was necessary.

CONCLUSION

It was clear that the understanding of fidelity and pragmatism was poor. While pragmatic trials are vital to replicate real world clinical practice, further guidance may need to be developed in order to guide the level of adaptation that is acceptable before fidelity is undermined.

"Stuck between a Rock and a Hard Place": How Mental Health Nurses' Experience Psychosocial interventions in Irish Mental Health Care Settings

WHAT IS KNOWN ON THE SUBJECT?: Psychosocial interventions (PSI) are recognized and recommended internationally as they primarily focus on improving a client's mental health and preventing relapse. Limited qualitative studies focus on the similarities and differences on offering PSI in practice across many countries. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This manuscript provides readers with qualitative findings of mental health nurses' (MHNs) experiences of using PSI in practice and the need for regular clinical supervision to increase MHNs confidence and enhance the offering of PSI. MHNs want PSI guidelines for the offering of these skills to their client groups across practice settings. MHNs require work release from practice to attend supplementary training on PSI so that they can do their job adequately. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study sheds light on the similarities and differences on PSI in Irish mental health services. It also highlights what MHNs recognize as important for PSI to be implemented. Clinical supervision and the development of PSI guidelines are necessary so that MHNs feel confident delivering these skills. They also need ongoing work release from practice to attend supplementary PSI training to provide best evidence to enhancing client experiences and positive PSI recovery outcomes. ABSTRACT: Description The paper will report on the interview data of trained MHNs' experiences of using PSI within the Irish context. This observational data will be reported elsewhere (Smyth et al. 2020-under review). Introduction This research is conducted when the current reform of Irish mental health governance demands clarification of key psychosocial skills (PSI) required for mental health nurses (MHNs) to embrace recovery-orientated ways of working. There is limited evidence about this important topic in Ireland and across countries. Aim To explore PSI-trained MHNs' experiences of using PSI within Ireland. Method A multiple case study methodology was used and situated within an interpretive paradigm. Data were gathered using semi-structured interviews with 40 PSI-trained MHNs. Findings Three overarching themes developed from the analysis. These included (a) PSI-trained MHNs' understanding and use of PSI; (b) facilitating factors supporting the use of PSI by PSI-trained MHNs; and (c) obstacles limiting the use of PSI by PSI-trained MHNs. Discussion MHNs recognize that regular clinical supervision is required to increase their confidence, along with PSI guidelines for the offering of these skills across practice settings. MHNs also need work release to attend supplementary training on PSI so that they can do their job adequately. Implications for practice This study suggests that MHNs are often stuck between a rock and a hard place when delivering PSI in practice. MHNs need to be aware that this can affect client outcomes. Relevance statement This research identified a gap in knowledge within the Irish context but also across the world on this important topic. MHNs need access to regular clinical supervision, PSI guidelines and ongoing PSI training to feel confident in order to keep abreast of the changes happening in mental health practice and research.

Data Analysis Software in Qualitative Research: Preconceptions, Expectations, and Adoption

Research shows that more and more qualitative researchers now use computer software for qualitative data analysis. However, concerns, problems, and misunderstandings continue among developers themselves and researchers about its merits, their preconceptions, expectations, and adoption of the technology. This article examines the role of computer-assisted qualitative data analysis software focusing on the methodological issues surrounding program use and identifies the factors that result to unrealistic expectations of the innovation as a methodology in itself. The secondary aim is to help guide both the expert and novice qualitative critical care researchers on their decision making whether to use or not to use computer-assisted qualitative data analysis software in their studies. A brief review of 2 very common and widely used qualitative data analysis software packages will be presented. A section on making good use of supervision and mentorship in conducting a qualitative inquiry is included. Implications for its adoption and to qualitative research as a whole will be discussed.

Efeitos dos Softwares de Análise de Dados Qualitativos na Qualidade de Pesquisas

Resumo O objetivo deste estudo é descrever os efeitos dos softwares de análise de dados qualitativos (Qualitative Data Analysis Software [QDAS]) na qualidade das pesquisas qualitativas, segundo a perspectiva de pesquisadores. O que motivou esta pesquisa foi a divergência de opiniões com relação aos efeitos dos QDAS na qualidade das pesquisas qualitativas. O aporte teórico foi construído com base nas literaturas de critérios de qualidade de pesquisas qualitativas, estratégias de promoção de qualidade e adoção de QDAS. Os dados foram coletados por meio de entrevistas semiestruturadas com dez pesquisadores com experiência de análise sem e com o uso QDAS. A técnica de análise utilizada foi a análise de conteúdo apoiada pelo uso do software ATLAS.ti®. Os resultados evidenciaram que o uso dos QDAS pode potencializar seis das sete estratégias de qualidade consideradas, com destaque para a melhoria da coerência do pesquisador. Os critérios de qualidade mais beneficiados pelo uso foram a confirmabilidade e a credibilidade. Como desvantagem do uso dos QDAS, emergiu a questão do distanciamento do pesquisador dos dados. Os resultados desta pesquisa contribuem para o enriquecimento da discussão sobre os efeitos dos QDAS nas pesquisas e fomentam o uso dos softwares. JEL Code: L86, C9, B41.

Using Multi-Sensory Environments (MSEs) with People with Dementia

Utilizing action research, the clinical application of a Multi-Sensory Environment (MSE) in the field of old age psychiatry was explored and developed over a four-year time span. This article reports on factors identified as mediating against its use as reported by clinical staff. Conceptual and theoretical considerations considered of utility beyond the study’s context are presented. Expectancy of outcomes, the predilection of individual members of staff to engage in this form of therapy and the influence of an organization’s orientation towards such therapy are highlighted as specific areas for attention.

"Being-in-the-world-of-care": the lived experiences of older people receiving community aged care packages in Queensland

The lived experiences of older people living in Queensland who were receiving a Community Aged Care Package (CACP) were explored using Heidegger's interpretive hermeneutical phenomenological approach. A number of key themes were identified including the importance these older people placed on personal autonomy and the central significance of relationships. The comprehensive understanding developed revealed that the meanings of care experiences can significantly alter the older person's lived experiences and personal identity. This understanding can enhance the development of care practices that are more likely to support the older person's active participation in care and their own life choices.

Patient-centred infertility care: a qualitative study to listen to the patient's voice

BACKGROUND High-quality care for patients faced with infertility should be patient-centred. Few studies have provided in-depth insights into the patient's perspective on care and, to the best of our knowledge, no study has provided a model of the complex concept 'patient-centred infertility care'. Therefore, a qualitative study aimed at understanding 'patient-centred infertility care' from the patient's perspective was conducted. METHODS Fourteen focus group discussions were organized with patients (n = 103) from two European countries to find out about patients' positive and negative experiences with infertility care. Content analysis of the transcripts and analysis of patients' priority lists were conducted. RESULTS The patient-centredness of infertility care depends on 10 detailed dimensions, which can be divided into system and human factors, and there is a two-way interaction between both kinds of factors. System factors, in order of patient's priority, are: provision of information, competence of clinic and staff, coordination and integration, accessibility, continuity and transition and physical comfort. Human factors, in order of patient's priority, are: attitude of and relationship with staff, communication, patient involvement and privacy and emotional support. CONCLUSIONS This study provides a detailed patient's description of the concept 'patient-centred infertility care' and an interaction model that aids understanding of the concept. Fertility clinics are encouraged to improve the patient-centredness of their care by taking into account the detailed description of the dimensions of patient-centred infertility care, and by paying attention to both system and human factors and their interaction when setting up 'patient-centred improvement projects'.

Patients' experiences of daily living with a pacemaker: a grounded theory study

The purpose of this study was to examine patients' experiences of daily living with a pacemaker. A total of 13 pacemaker patients (seven women) aged 22-82 (mean = 59.2) years were interviewed. The informants had had a pacemaker from 0.5 to 33 (mean 13.1) years. The grounded theory method was the basis for collection and analysis of the data. The results of the analysis of the semi-structured interviews showed that variations in 'perceived social participation' and 'emotional state', the two core categories, were related to four qualitatively different ways of experiencing daily living after pacemaker implantation.

Inductive creation of an annotation schema for manually indexing clinical conditions from emergency department reports

Evaluating automated indexing applications requires comparing automatically indexed terms against manual reference standard annotations. However, there are no standard guidelines for determining which words from a textual document to include in manual annotations, and the vague task can result in substantial variation among manual indexers. We applied grounded theory to emergency department reports to create an annotation schema representing syntactic and semantic variables that could be annotated when indexing clinical conditions. We describe the annotation schema, which includes variables representing medical concepts (e.g., symptom, demographics), linguistic form (e.g., noun, adjective), and modifier types (e.g., anatomic location, severity). We measured the schema's quality and found: (1) the schema was comprehensive enough to be applied to 20 unseen reports without changes to the schema; (2) agreement between author annotators applying the schema was high, with an F measure of 93%; and (3) the authors made complementary errors when applying the schema, demonstrating that the schema incorporates both linguistic and medical expertise.

Living with a young person who wets the bed: the families' experience

After allergic disorders, bed-wetting is the most common chronic condition of childhood. It can seriously diminish the quality of life of young people and their families, having an impact on day-to-day activities, family holidays and the young person's willingness and ability to stay away from home with friends and wider family. In this ethnographic study, family members describe the practical and social consequences of bed-wetting, both for themselves and for the family, and the methods that they have employed to encourage the bed-wetting to stop. Most of these methods have little chance of success. Many families' feelings of helplessness and isolation are reinforced by lack of help from healthcare professionals, although the professional's intention to be helpful is rarely questioned. The nature of the families' experiences illustrates the urgent need for adopting a new professional approach to the support of these families, which is based on the principles of 'family nursing'.

Getting the focus and the group: enhancing analytical rigor in focus group research

In the literature on focus groups, far more attention has been devoted to how groups are organized and conducted than to issues of analysis. Although exploitation of group dynamics is touted as a virtue of focus groups, there is very little guidance in the literature with respect to how differences between group and individual discourse impact the analysis and interpretation of focus group data. In this article, the authors describe analytical challenges inherent in the interpretation of focus group data and suggest approaches for enhancing the rigor of analysis and the reliability and validity of focus group findings.