1
|
Chen L, Zhou Y. Symptom management experiences of Chinese individuals with Crohn's disease: A longitudinal descriptive qualitative study. Res Nurs Health 2024. [PMID: 38564311 DOI: 10.1002/nur.22386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/13/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
Individuals diagnosed with Crohn's disease, a chronic lifelong condition, experience a dynamic or fluctuating process of developing symptom management behavior. However, less clear is how these individuals respond to and manage their symptoms over time. The aim of this study was to longitudinally explore the symptom management experiences of individuals with Crohn's disease in China. A longitudinal qualitative design was used. Eighteen individuals with newly diagnosed Crohn's disease were purposely selected. Semi-structured interviews were conducted on four occasions over a 12-month period. Interviews at each time point were transcribed and coded using conventional content analysis. Afterward, data analyses of each time point were compared longitudinally to form a holistic understanding. Three themes and eight subthemes emerged from the analysis: (1) disclosing symptoms strategically: voluntary disclosure, reluctance to disclose, no need to disclose; (2) decreasing vigilance in symptom prevention: preventing symptoms stringently, preventing symptoms discriminatively, preventing symptoms with decreased diligence; and (3) increasing autonomy in symptom treatment: actively seeking medical advice, self-treatment and self-observation. The participants were inclined to keep symptoms hidden from relatives and friends and showed a downward trend in actively disclosing physical discomfort to medical staff within the course of 1 year. The participants' attention to symptom prevention declined, but the enthusiasm and independence to eliminate symptoms on their own increased over time. Nurses could implement targeted interventions according to the characteristics of different periods to assist individuals with Crohn's disease in managing symptoms effectively, reducing symptom burden and improving their quality of life.
Collapse
Affiliation(s)
- Lingxi Chen
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
2
|
Lin S, Chen S, Tu Q, Xu X, Xie S, Yang B, Zhang Q, Chen L. Barriers and facilitators to the formation of professional identity among nursing students: A four-year longitudinal qualitative study. NURSE EDUCATION TODAY 2024; 134:106087. [PMID: 38232627 DOI: 10.1016/j.nedt.2023.106087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Nursing professional identity (NPI) is essential for nurses to develop their nursing profession. It reflects the competencies consistent with the professional practices of nurses and contributes to them providing better healthcare and public health. The formation process of NPI started with undergraduate nursing education and continued throughout the nursing career. OBJECTIVE To explore nursing students' perceptions of facilitators and barriers to the formation of NPI during their study. METHODS A 4-year longitudinal, qualitative research design with yearly semi-structured interviews undertaken from 2019 to 2022. The reflexive thematic analysis methodology was applied for the data analysis. RESULTS Ninety-three nursing students were recruited, joining a group or individual interview. The four-year nursing baccalaureate program revealed a dynamic formation process of NPI: "Outsider of nursing", "Entering the nursing courses", "Building nursing competence", and "Thinking and acting like a nurse". A total of 12 themes were identified to present the barriers and facilitators to the NPI formation at different stages. Specifically, the six barriers include conflict between their ideals and reality, sociocultural stereotypes about nursing, the negative impact of COVID-19, the pre-internship concerns, struggling to meet expectations, and potential danger and discrimination in the healthcare settings. The enablers were: self-motivation and inner belief towards the nursing profession, the power of role models, the improvement of nursing capacity, well integration into the healthcare professional teams, understanding of the clinical environment, and recognition and encouragement from others. CONCLUSIONS The formation of nursing students' NPI is an ever-changing process, with various intrinsic and extrinsic influences during their four-year study. Nursing educators are suggested to prepare and develop students' professional comportment in their theoretical and clinical practice to develop their professional identity as a nurse.
Collapse
Affiliation(s)
- Shuanglan Lin
- Nursing College of Chongqing Medical University, Chongqing, China
| | - Shucheng Chen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Qiang Tu
- Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Xinyu Xu
- Nursing College of Chongqing Medical University, Chongqing, China
| | - Shiqi Xie
- Nursing College of Chongqing Medical University, Chongqing, China.
| | - Bing Yang
- Department of Nursing, Stomatological Hospital of Chongqing Medical University, Chongqing, China.
| | - Quanzhi Zhang
- School of Nursing, Harbin Medical University, Heilongjiang Province, China
| | - Liping Chen
- Nursing College of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
3
|
Roncal-Belzunce V, Atares L, Escalada G, Minobes-Molina E, Pamies-Tejedor S, Carcavilla-González N, García-Navarro JA. First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention. Rev Esp Geriatr Gerontol 2024; 59:101453. [PMID: 38103438 DOI: 10.1016/j.regg.2023.101453] [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: 12/27/2022] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. OBJECTIVE To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. METHODS This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. DISCUSSION Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community. TRIAL REGISTRATION NCT05605392.
Collapse
Affiliation(s)
- Victoria Roncal-Belzunce
- Spanish Society of Geriatrics and Gerontology, C. Príncipe de Vergara, 57-59, 28006 Madrid, Spain; Department of Health Sciences, Public University of Navarra, 31006 Pamplona, Spain
| | - Laura Atares
- Spanish Society of Geriatrics and Gerontology, C. Príncipe de Vergara, 57-59, 28006 Madrid, Spain.
| | - Gema Escalada
- Spanish Society of Geriatrics and Gerontology, C. Príncipe de Vergara, 57-59, 28006 Madrid, Spain
| | - Eduard Minobes-Molina
- Spanish Society of Geriatrics and Gerontology, C. Príncipe de Vergara, 57-59, 28006 Madrid, Spain; Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Família, 7, 08500 Vic, Spain
| | - Sandra Pamies-Tejedor
- Spanish Society of Geriatrics and Gerontology, C. Príncipe de Vergara, 57-59, 28006 Madrid, Spain
| | - Nuria Carcavilla-González
- Spanish Society of Geriatrics and Gerontology, C. Príncipe de Vergara, 57-59, 28006 Madrid, Spain; Department of Health Sciences, Public University of Navarra, 31006 Pamplona, Spain
| | | |
Collapse
|
4
|
Jung W, Vogel M, Figuracion KCF, Byun E, Thompson H. The Perceived Meaning of Traumatic Brain Injury for Older Adults: A Longitudinal-Multiple Case Study. Rehabil Nurs 2024; 49:14-23. [PMID: 38156950 DOI: 10.1097/rnj.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
PURPOSE The aim of this study was to explore the perceived meaning of traumatic brain injury (TBI) over the first-year postinjury among older adults and to explore if and how meaning changes. DESIGN A longitudinal multiple-case study design was used. METHODS Semistructured face-to-face interviews were completed at 1 week and 1, 3, 6, and 12 months postinjury. Transcripts were analyzed using inductive thematic analysis. RESULTS Fifty-five interviews were conducted with 12 participants. Four themes were identified: gratitude, vulnerability and dependence, slowing down and being more careful, and a chance for reflecting on life. Most participants' perceptions of their TBI remained either consistently positive or negative over the first-year postinjury. CLINICAL RELEVANCE Nurses should elicit and support patients' positive illness perceptions regarding their brain injury, which can contribute to a higher quality of life. For those patients with negative illness perceptions, nurses should provide resources in order to support coping and resilience following brain injury. CONCLUSIONS This study is the first study to explore individual perceptions over time of the meaning made from experiencing TBI among older adults. Findings can serve as a foundation for tailored supportive interventions among older adults following TBI to maximize quality of life.
Collapse
Affiliation(s)
- Wonkyung Jung
- RESILIENCE Center, School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Mia Vogel
- Center for Public Health Systems Science, Institute for Clinical and Translational Science, Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Karl Cristie F Figuracion
- School of Nursing, Alvord Brain Tumor Center, Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Eeeseung Byun
- Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Hilaire Thompson
- Department of Biobehavioral Nursing & Health Informatics, School of Nursing, Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| |
Collapse
|
5
|
Khougar A, Baba Ahmadi P, Ranjbar H, Ahadi M, Ahadi P. Exploring the varied manifestations of structural violence in the lives of children on the autism spectrum and their families: a qualitative longitudinal study in Kurdistan, Iran. Int J Equity Health 2023; 22:263. [PMID: 38110989 PMCID: PMC10729435 DOI: 10.1186/s12939-023-02078-z] [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: 07/23/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND There are many dimensions regarding autism that are closely connected to social structures, policies, and power dynamics, silently impacting the well-being of individuals within the autism spectrum. This research aims to explore these overlooked aspects using a theoretical framework called "structural violence." METHODS The study was conducted in Kurdistan, Iran, and a qualitative longitudinal approach was chosen. A purposive sampling method was employed to select the participants, with 11 parents taking part. The study data comprised 29 interviews using a topic guide conducted over a span of 2 years. Thematic analysis and a matrix-based approach were utilized for data analysis. To enhance the scientific rigor of this research, four criteria, including Guba and Lincoln's principles, were implemented to ensure methodological accuracy. RESULTS The research findings highlight four primary forms through which structural violence impacts children on the autism spectrum and their families: access to healthcare, geographic disparities, awareness and stigma, and poverty and financial burden. Additionally, the study identified 11 subthemes related to structural violence in the context of autism and families. CONCLUSIONS We illustrated how structural forces create barriers to accessing adequate healthcare services, exacerbate discrimination based on ethnicity and geography, perpetuate stigma, and contribute to poverty and the inability to meet basic needs. These factors not only worsen health issues but also deepen existing disparities in healthcare access and outcomes for children on the autism spectrum and families. We emphasize the urgent need for systemic changes to address these issues. It is essential to promote public awareness, provide better access to health and support services, and address economic and political factors that contribute to these inequalities.
Collapse
Affiliation(s)
- Ansar Khougar
- Primary Health Care Center, Iran University of Medical Science, Shahryar, Iran
| | - Paria Baba Ahmadi
- Student Research Committee, School of Medicine, Shirza University of Medical Sciences, Shiraz, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Iran University of Medical Science, Tehran, Iran
| | - Mahsa Ahadi
- Student Research Committee, School of Medicine, Shirza University of Medical Sciences, Shiraz, Iran
| | - Parisa Ahadi
- Department of Pharmacy, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran.
| |
Collapse
|
6
|
Audulv Å, Westergren T, Ludvigsen MS, Pedersen MK, Fegran L, Hall EOC, Aagaard H, Robstad N, Kneck Å. Time and change: a typology for presenting research findings in qualitative longitudinal research. BMC Med Res Methodol 2023; 23:284. [PMID: 38057741 PMCID: PMC10698947 DOI: 10.1186/s12874-023-02105-1] [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: 01/06/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Qualitative longitudinal research (QLR) is an emerging methodology used in health research. The method literature states that the change in a phenomenon through time should be the focus of any QLR study, but in empirical studies, the analysis of changes through time is often poorly described, and the emphasis on time/change in the findings varies greatly. This inconsistency might depend on limitations in the existing method literature in terms of describing how QLR studies can present findings. The aim of this study was to develop and describe a typology of alternative approaches for integrating time and/or change in QLR findings. METHODS In this method study, we used an adapted scoping review design. Articles were identified using EBSCOhost. In total, methods and results sections from 299 QLR articles in the field of health research were analyzed with inspiration from content analysis. RESULTS We constructed a typology of three types and seven subtypes. The types were based on the underlying structural principles of how time/change was presented: Type A) Findings have a low utilization of longitudinal data, Type B) Findings are structured according to chronological time, and Type C) Findings focus on changes through time. These types differed in 1) the way the main focus was on time, change or neither; 2) the level of interpretation in the findings; and 3) how theoretical understandings of time/change were articulated in the articles. Each type encompassed two or three subtypes that represented distinct approaches to the aim and results presentation of QLR findings. CONCLUSIONS This method study is the first to describe a coherent and comprehensive typology of alternative approaches for integrating time/change into QLR findings in health research. By providing examples of various subtypes that can be used for results presentations, it can help researchers make informed decisions suitable to their research intent.
Collapse
Affiliation(s)
- Åsa Audulv
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Thomas Westergren
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Mette Spliid Ludvigsen
- Department of Clinical Medicine, Randers Regional Hospital, Aarhus University, Aarhus, Denmark
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Mona Kyndi Pedersen
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Liv Fegran
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Elisabeth O C Hall
- Faculty of Health, Aarhus University, Aarhus, Denmark
- Faculty of Health Sciences and Nursing, University of Faroe Islands, Torshavn, Faroe Islands
| | - Hanne Aagaard
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Nastasja Robstad
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Åsa Kneck
- Department of Health Care Sciences, Marie Cederschöld University, Stockholm, Sweden
| |
Collapse
|
7
|
Hysong SJ, Giardina TD, Freytag J, SoRelle R, Murphy DR, Cully JA, Sada YH, Amspoker AB. Study protocol: maintaining preventive care during public health emergencies through effective coordination. Implement Sci Commun 2023; 4:150. [PMID: 38012710 PMCID: PMC10680205 DOI: 10.1186/s43058-023-00507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/01/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Screening lies at the heart of preventive care. However, COVID-19 dramatically disrupted routine screening efforts, resulting in excess mortality not directly attributable to COVID-19. Screening rates during COVID varied markedly by facility and clinical condition, suggesting susceptibilities in screening and referral process workflow. To better understand these susceptibilities and identify new practices to mitigate interrupted care, we propose a qualitative study comparing facilities that exhibited high, low, and highly variable performance (respectively) in screening rates before and during the pandemic. We will be guided by Weaver et al.'s multi-team systems (MTS) model of coordination, using cancer and mental health screening rates as exemplars. METHOD Qualitative analysis of interviews and focus groups with primary care personnel, leadership, and patients at 10 VA medical centers. We will select sites based on rurality, COVID-19 caseload at the beginning of the pandemic, and performance on five outpatient clinical performance indicators of cancer and mental health screening. Sites will be categorized into one of five screening performance groups: high performers, low performers, improvers, plummeters, and highly variable. We will create process maps for each performance measure to create a workflow baseline and then interview primary care leadership to update the map at each site. We will clinician conduct focus groups to elicit themes regarding clinician coordination patterns (e.g., handoffs), strategies, and barriers/facilitators to screening during COVID. We will also conduct patient interviews to examine their screening experience during this period, for context. All interviews and focus groups will be audio-recorded, transcribed, and enhanced by field notes. We will analyze clinician transcripts and field notes using iterative, rapid analysis. Patient interviews will be analyzed using inductive/deductive content analysis. DISCUSSION Our study represents a unique opportunity to inform the multi-team systems literature by identifying specific forms of information exchange, collective problem solving, and decision-making associated with higher and improved clinical performance. Specifically, our study aims to detect the specific points in the screening and referral process most susceptible to disruption and coordination processes that, if changed, will yield the highest value. Findings apply to future pandemics or any event with the potential to disrupt care.
Collapse
Affiliation(s)
- Sylvia J Hysong
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
- Department of Medicine - Health Services Research, Baylor College of Medicine, Houston, TX, USA.
| | - Traber Davis Giardina
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine - Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Freytag
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine - Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Richard SoRelle
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine - Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Daniel R Murphy
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine - Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey A Cully
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Yvonne H Sada
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine - Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Amber B Amspoker
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine - Health Services Research, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
8
|
Chen L, Zhou Y. The symptom experience of newly diagnosed Chinese patients with Crohn's disease: A longitudinal qualitative study. J Adv Nurs 2023; 79:3824-3836. [PMID: 37243391 DOI: 10.1111/jan.15721] [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: 08/26/2022] [Revised: 04/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
AIMS To longitudinally explore the symptom experience of Chinese patients with Crohn's disease within the first year following their diagnosis. DESIGN A longitudinal qualitative study. METHOD Eighteen newly diagnosed Chinese patients with Crohn's disease were recruited through purposive sampling. Semi-structured interviews were conducted at four time points: soon after diagnosis, 3, 6 and 12 months post-diagnosis. Data were collected between January 2021 and February 2022. Conventional content analysis was used for data analysis of each time point. Afterwards, the data of each time point were compared longitudinally. COREQ checklist was followed. RESULTS Three themes and eight sub-themes were formed through analysis: feelings towards symptoms (symptoms make me feel uneasy, symptoms make me feel inferior and symptoms make me feel helpless); acceptability of symptoms (difficult to accept, have to accept, be able to accept); functions of symptoms (assessing disease conditions and treatment effects, warning of disease management). CONCLUSIONS Overall, the negative emotions related to symptoms gradually decreased over time, and the patient's acceptance of symptoms increased within the first year following diagnosis. In addition, when the disease was in remission after treatment, the warning function of symptoms gradually weakened. IMPACT The process of how patients accept their symptoms found in this study provides a basis for nurses to improve patients' acceptance of symptoms and reduce their symptom-related negative emotions. This study also emphasizes the phenomenon that patients gradually ignore some symptoms with their increased acceptance level, which warrants additional health education to strengthen their awareness of self-management. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was required to design or undertake this study. Patients contributed only to the data collection and member checking.
Collapse
Affiliation(s)
- Lingxi Chen
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
9
|
Relster M, Nielsen SH, Thrysøe L, Dieperink KB, Nielsen DS, Tolstrup LK. Transition from masters of nursing to clinical practice. NURSE EDUCATION TODAY 2023; 128:105882. [PMID: 37356185 DOI: 10.1016/j.nedt.2023.105882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Research indicates that nurses with a Master's degree can contribute to an increasing quality of care, thereby improving care pathways in hospitals. In 2014, the Master's programme in Nursing at the University of Southern Denmark was established to create a relationship between the university and clinical practice to improve nurses' ability to function at a higher clinical level. Therefore, this study aimed to explore the significance of the Master's degree on nurses' self-perceived competencies and their return to clinical practice. DESIGN AND METHODS A longitudinal qualitative design was used with six focus groups including graduates from the Master's programme in Nursing. The study was conducted in two phases: The first phase in 2017 (n = 16) investigated how the Master's degree affected the graduates' self-perceived competences and their working life. The second phase in 2021-2022 (n = 10) was a follow-up and included a subset of the participants from the first phase. Data were analysed with an inductive approach inspired by Malterud's systematic text condensation. RESULTS The analysis revealed two main categories: Transition to Practice and The Impact of the Master's Degree, along with five underlying sub-categories. CONCLUSION Graduates perceived themselves as better nurses because of the Master's degree. The Master's programme in Nursing enhanced their competencies enabling them to provide more qualified and evidence-based nursing for the benefit of clinical practice. The transition and the conditions under which the graduates were employed, such as the ward culture and the ward management, had a significant impact on how they experienced their return to clinical practice.
Collapse
Affiliation(s)
- Michelle Relster
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Surgery, Odense University Hospital, Denmark.
| | - Sofie Hald Nielsen
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Surgery, Odense University Hospital, Denmark.
| | - Lars Thrysøe
- Department of Cardiology, Odense University Hospital, Denmark
| | - Karin Brochstedt Dieperink
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Dorthe Susanne Nielsen
- Department of Clinical Research, University of Southern Denmark, Denmark; Research unit of Geriatric medicine, Odense University Hospital, Denmark
| | - Lærke Kjær Tolstrup
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Oncology, Odense University Hospital, Denmark
| |
Collapse
|
10
|
Cross R, Greaves C, Withall J, Kritz M, Stathi A. A qualitative longitudinal study of motivation in the REtirement in ACTion (REACT) physical activity intervention for older adults with mobility limitations. Int J Behav Nutr Phys Act 2023; 20:50. [PMID: 37101268 PMCID: PMC10131311 DOI: 10.1186/s12966-023-01434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/10/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Physical activity (PA) is beneficial for older adults' health, however they remain the least active age group in the UK. This qualitative longitudinal study aims to understand motivations in older adults receiving the REACT physical activity intervention, through the lens of self-determination theory. METHODS Participants were older adults randomised to the intervention arm of the Retirement in ACTion (REACT) Study, a group-based physical activity and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years). Stratified purposive sampling by physical functioning (Short Physical Performance Battery scores) and 3-month attendance was employed. Fifty-one semi-structured interviews were conducted at 6, 12 and 24-months with twenty-nine older adults (Mean age (baseline) = 77.9 years, SD 6.86, 69% female) and at 24-months with twelve session leaders and two service managers. Interviews were audio recorded, transcribed verbatim and analysed using Framework Analysis. RESULTS Perceptions of autonomy, competence and relatedness were associated with adherence to the REACT programme and maintenance of an active lifestyle. Motivational processes and participants' support needs, changed during the 12-month REACT intervention and across the 12-months post-intervention. Group interactions were an important source of motivation during the first six months but increased competence and mobility drove motivation at the later stages (12 months) and post-intervention (24 months). CONCLUSIONS Motivational support needs vary in different stages of a 12-month group-based programme (adoption and adherence) and post-intervention (long-term maintenance). Strategies to accommodate those needs include, (a) making exercise social and enjoyable, (b) understanding participants' capabilities and tailoring the programme accordingly, (c) capitalising on group support to motivate participants to try other activities and prepare sustainable active living plans. TRIAL REGISTRATION The REACT study was a pragmatic multi-centre, two-arm, single-blind, parallel-group, RCT (ISRCTN registration number 45627165).
Collapse
Affiliation(s)
- Rosina Cross
- Department for Health, University of Bath, Claverton Down, BA2 7AY, Bath, UK.
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, EX1 2LU, Exeter, UK.
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
| | - Janet Withall
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
| | - Marlene Kritz
- Curtin School of Population Health, Curtin University, Kent St, WA, 6102, Bentley, Australia
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
| |
Collapse
|
11
|
Eblie Trudel L, Sokal L. Dynamic perspectives on education during the COVID-19 pandemic and implications for teacher well-being. INTERNATIONAL JOURNAL OF EDUCATIONAL RESEARCH OPEN 2023; 4:100241. [PMID: 37056789 PMCID: PMC10079411 DOI: 10.1016/j.ijedro.2023.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/13/2023] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
Twenty teachers took part in bi-weekly interviews over the course of the 2020-2021 school year and again one year later during the COVID-19 pandemic. Comparative findings on teachers' experiences indicated varied circumstances and a wide array of perspectives on coping during this protracted and stressful time. While some teachers demonstrated flourishing and resilience, the majority experienced a tipping point toward burnout. A small group languished, relating indicators of burnout and post-traumatic stress. Given the dynamic findings, a continuum of awareness is suggested that might assist teachers and administrators in critically assessing the range and dimensions of coping exhibited during the pandemic or subsequent stressful periods of time. With information of this nature available, we propose that school organizations could be better informed to provide supports and resources and improve worklife balance and well-being of teachers.
Collapse
Affiliation(s)
| | - Laura Sokal
- University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, Canada
| |
Collapse
|
12
|
Keskinen K, Nikander P. Researching Time and Ageism: Applications of Qualitative Longitudinal Research to the Field. J Appl Gerontol 2023; 42:1335-1344. [PMID: 36866770 DOI: 10.1177/07334648231160982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Interest in ageism research has grown immensely since the term was coined. Despite methodological innovations to study ageism in different settings and the application of different methods and methodologies to the topic, qualitative longitudinal studies investigating ageism are still underrepresented in the field. Through qualitative longitudinal interview data with four individuals of the same age, this study explored the applications of qualitative longitudinal research on ageism, highlighting its potential benefits and challenges to the multidisciplinary study of ageism and to gerontological research. The paper presents four distinctively different narratives through which individuals "do," "undo," and "challenge" ageism in their interview dialogues over time. Doing this underlines the importance of understanding the heterogeneity and intersectionality among encounters, expressions, and dynamics of ageism. The paper concludes with a discussion of the potential contributions that qualitative longitudinal research makes to ageism research and policy.
Collapse
Affiliation(s)
- Katri Keskinen
- Faculty of Social Sciences, 7840Tampere University, Finland
| | | |
Collapse
|
13
|
Stathi A, Withall J, Greaves CJ, Thompson JL, Taylor G, Medina-Lara A, Green C, Snowsill T, Johansen-Berg H, Bilzon J, Gray S, Cross R, Western MJ, Koning JLD, Ladlow P, Bollen JC, Moorlock SJ, Guralnik JM, Rejeski WJ, Hillsdon M, Fox KR. A group-based exercise and behavioural maintenance intervention for adults over 65 years with mobility limitations: the REACT RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/mqbw6832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background
Mobility limitation in older age reduces quality of life, generates substantial health- and social-care costs, and increases mortality.
Objective
The REtirement in ACTion (REACT) trial aimed to establish whether or not a community-based active ageing intervention could prevent decline in physical functioning in older adults already at increased risk of mobility limitation.
Design
A multicentre, pragmatic, two-arm, parallel-group randomised controlled trial with parallel process and health economic evaluations.
Setting
Urban and semi-rural locations across three sites in England.
Participants
Physically frail or pre-frail older adults (aged ≥ 65 years; Short Physical Performance Battery score of 4–9). Recruitment was primarily via 35 primary care practices.
Interventions
Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal exercise and behavioural maintenance programme delivered in fitness and community centres. Randomisation was stratified by site and used a minimisation algorithm to balance age, sex and Short Physical Performance Battery score. Data collection and analyses were blinded.
Main outcome measures
The primary outcome was change in lower limb physical function (Short Physical Performance Battery score) at 24 months, analysed using an intention-to-treat analysis. The economic evaluation adopted the NHS and Personal Social Services perspective.
Results
Between June 2016 and October 2017, 777 participants (mean age 77.6 years, standard deviation 6.8 years; 66% female; mean Short Physical Performance Battery score 7.37, standard deviation 1.56) were randomised to the intervention arm (n = 410) or the control arm (n = 367). Data collection was completed in October 2019. Primary outcome data at 24 months were provided by 628 (80.8%) participants. At the 24-month follow-up, the Short Physical Performance Battery score was significantly greater in the intervention arm (mean 8.08, standard deviation 2.87) than in the control arm (mean 7.59, standard deviation 2.61), with an adjusted mean difference of 0.49 (95% confidence interval 0.06 to 0.92). The difference in lower limb function between intervention and control participants was clinically meaningful at both 12 and 24 months. Self-reported physical activity significantly increased in the intervention arm compared with the control arm, but this change was not observed in device-based physical activity data collected during the trial. One adverse event was related to the intervention. Attrition rates were low (19% at 24 months) and adherence was high. Engagement with the REACT intervention was associated with positive changes in exercise competence, relatedness and enjoyment and perceived physical, social and mental well-being benefits. The intervention plus usual care was cost-effective compared with care alone over the 2 years of REACT; the price year was 2019. In the base-case scenario, the intervention saved £103 per participant, with a quality-adjusted life-year gain of 0.04 (95% confidence interval 0.006 to 0.074) within the 2-year trial window. Lifetime horizon modelling estimated that further cost savings and quality-adjusted life-year gains were accrued up to 15 years post randomisation.
Conclusion
A relatively low-resource, 1-year multimodal exercise and behavioural maintenance intervention can help older adults to retain physical functioning over a 24-month period. The results indicate that the well-established trajectory of declining physical functioning in older age is modifiable.
Limitations
Participants were not blinded to study arm allocation. However, the primary outcome was independently assessed by blinded data collectors. The secondary outcome analyses were exploratory, with no adjustment for multiple testing, and should be interpreted accordingly.
Future work
Following refinements guided by the process evaluation findings, the REACT intervention is suitable for large-scale implementation. Further research will optimise implementation of REACT at scale.
Trial registration
This trial is registered as ISRCTN45627165.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Gordon Taylor
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | | | - Colin Green
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Tristan Snowsill
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
| | - Selena Gray
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Rosina Cross
- Department for Health, University of Bath, Bath, UK
| | | | | | - Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - Jessica C Bollen
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Sarah J Moorlock
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Worrell Professional Centre, Winston-Salem, NC, USA
| | - Melvyn Hillsdon
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| |
Collapse
|
14
|
Li H, Zhang L, Wang W, Xiang D, Zhang Z, Mei Y. Benefit finding in first-ever young and middle-aged patients who had a stroke and their spousal caregivers in China: a longitudinal mixed-methods study protocol. BMJ Open 2022; 12:e062859. [PMID: 36375986 PMCID: PMC9664300 DOI: 10.1136/bmjopen-2022-062859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The global burden caused by stroke is shifting to young and middle-aged people. Researchers have emphasised the significance of benefit finding (BF) in psychological health. However, current research has paid little attention to stroke and has discussed BF from only a single perspective, that is, that of either patients or caregivers. Our study aims to understand the changing trajectory, predictors and dyadic interaction of BF in dyads of patient who had a stroke and caregiver. METHODS AND ANALYSIS This study is a longitudinal mixed-methods, multicentre study. A total of 142 patients who had a stroke and 142 spousal caregivers will be investigated. Participants will be recruited from four large public hospitals in northern China. Quantitative and qualitative data will be collected at five time points (near discharge and 1, 3, 6 and 12 months following discharge). Validated and reliable questionnaires will be used in quantitative studies. Information on sociodemographic data, BF, functional status, perceived stress, coping styles and mutuality will be collected from the dyads. Qualitative data will be collected via semistructured interviews and observations. The growth mixture model will be used to analyse quantitative data, and Colaizzi's seven-step analysis method will be used to analyse qualitative data. We plan to conduct parallel but separate quantitative and qualitative data analyses and ultimately integrate the data sets to determine confirmation, expansion or discordance. ETHICS AND DISSEMINATION All participants will be provided with an informed consent form. This study will encode all identifiable data and store all recorded data on a secure research server. This study has been approved by the Ethics Review Committee of the College of Nursing and Health, Zhengzhou University (ZZUIRB2020-53). The results of the longitudinal study will be published in peer-reviewed journals and presented at national conferences. TRIAL REGISTRATION NUMBER ChiCTR2000039509.
Collapse
Affiliation(s)
- Hui Li
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Leyun Zhang
- Department of Pediatrics, Women and Children's Hospital, Xiamen University School of Medicine, Xiamen, Fujian, China
| | - Wenna Wang
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Dandan Xiang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
15
|
Derrer-Merk E, Ferson S, Mannis A, Bentall RP, Bennett KM. Belongingness challenged: Exploring the impact on older adults during the COVID-19 pandemic. PLoS One 2022; 17:e0276561. [PMID: 36264965 PMCID: PMC9584528 DOI: 10.1371/journal.pone.0276561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/09/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The sense of belonging is a fundamental human need. Enacting it through face-to-face social activities was no longer possible during the COVID-19 pandemic. In this study, we investigate how the sense of belonging, and how it is enacted, changed longitudinally amongst older adults in the UK. In addition, we examine the interplay of the sense of belonging and resilience over time. METHODS We employed a longitudinal qualitative research design to explore the experiences of older adults during one year of the COVID-19 pandemic (April 2020-April 2021). The analysis was undertaken with constructivist grounded theory. FINDINGS Before the pandemic older adults were free to engage in social relationships with family and friends, often enacted within social activity groups where they felt valued and gained positive experiences. During the pandemic face to face enactment of belongingness was reduced; adjustments needed to be made to maintain the sense of belonging. The experience of older adults was heterogeneous. We examine three themes. First, how belongingness was enacted prior to the pandemic. Examples include: family holidays, visiting each other, sports activities, eating with friends and family, and visiting cultural events. Second, how participants adapted and maintained their social involvement. Examples include: distanced face-to-face activities; and learning new technology. Third, for some, a belongingness gap emerged and persisted. There was an irretrievable loss of family members or friends, the closure of social groups, or withdrawal from groups as priorities changed. As a consequence, of challenged belongingness, participants expressed increased loneliness, anxiety, social isolation, frustration and, feelings of depression. For many, the disrupted sense of belonging no longer fostered resilience, and some previously resilient participants were no longer resilient.
Collapse
Affiliation(s)
- Elfriede Derrer-Merk
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
- Institute for Risk and Uncertainty, School of Engineering, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Scott Ferson
- Institute for Risk and Uncertainty, School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - Adam Mannis
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - Richard P. Bentall
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Kate M. Bennett
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
16
|
Mutumba M, Ssewamala F, Namirembe R, Sensoy Bahar O, Nabunya P, Neilands T, Tozan Y, Namuwonge F, Nattabi J, Acayo Laker P, Mukasa B, Mwebembezi A. A Multilevel Integrated Intervention to Reduce the Impact of HIV Stigma on HIV Treatment Outcomes Among Adolescents Living With HIV in Uganda: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40101. [PMID: 36197706 PMCID: PMC9582915 DOI: 10.2196/40101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND HIV stigma remains a formidable barrier to HIV treatment adherence among school-attending adolescents living with HIV, owing to high levels of HIV stigma within schools, rigid school structures and routines, lack of adherence support, and food insecurity. Thus, this protocol paper presents an evidence-informed multilevel intervention that will simultaneously address family- and school-related barriers to HIV treatment adherence and care engagement among adolescents living with HIV attending boarding schools in Uganda. OBJECTIVE The proposed intervention-Multilevel Suubi (MSuubi)-has the following objectives: examine the impact of M-Suubi on HIV viral suppression (primary outcome) and adherence to HIV treatment, including keeping appointments, pharmacy refills, pill counts, and retention in care; examine the effect of M-Suubi on HIV stigma (internalized, anticipated, and enacted), with secondary analyses to explore hypothesized mechanisms of change (eg, depression) and intervention mediation; assess the cost and cost-effectiveness of each intervention condition; and qualitatively examine participants' experiences with HIV stigma, HIV treatment adherence, and intervention and educators' attitudes toward adolescents living with HIV and experiences with group-based HIV stigma reduction for educators, and program or policy implementation after training. METHODS MSuubi is a 5-year multilevel mixed methods randomized controlled trial targeting adolescents living with HIV aged 10 to 17 years enrolled in a primary or secondary school with a boarding section. This longitudinal study will use a 3-arm cluster randomized design across 42 HIV clinics in southwestern Uganda. Participants will be randomized at the clinic level to 1 of the 3 study conditions (n=14 schools; n=280 students per study arm). These include the bolstered usual care (consisting of the literature on antiretroviral therapy adherence promotion and stigma reduction), multiple family groups for HIV stigma reduction plus family economic empowerment (MFG-HIVSR plus FEE), and Group-based HIV stigma reduction for educators (GED-HIVSR). Adolescents randomized to the GED-HIVSR treatment arm will also receive the MFG-HIVSR plus FEE treatment. MSuubi will be provided for 20 months, with assessments at baseline and 12, 24, and 36 months. RESULTS This study was funded in September 2021. Participant screening and recruitment began in April 2022, with 158 dyads enrolled as of May 2022. Dissemination of the main study findings is anticipated in 2025. CONCLUSIONS MSuubi will assess the effects of a combined intervention (family-based economic empowerment, financial literacy education, and school-based HIV stigma) on HIV stigma among adolescents living with HIV in Uganda. The results will expand our understanding of effective intervention strategies for reducing stigma among HIV-infected and noninfected populations in Uganda and improving HIV treatment outcomes among adolescents living with HIV in sub-Saharan Africa. TRIAL REGISTRATION ClinicalTrials.gov NCT05307250; https://clinicaltrials.gov/ct2/show/NCT05307250. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40101.
Collapse
Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Fred Ssewamala
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Rashida Namirembe
- International Center for Child Health and Development, Masaka, Uganda
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Proscovia Nabunya
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Torsten Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Yesim Tozan
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Jennifer Nattabi
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Penina Acayo Laker
- Sam Fox School of Design and Visual Arts, Washington University in St Louis, St Louis, MO, United States
| | | | | |
Collapse
|
17
|
Audulv Å, Hall EOC, Kneck Å, Westergren T, Fegran L, Pedersen MK, Aagaard H, Dam KL, Ludvigsen MS. Qualitative longitudinal research in health research: a method study. BMC Med Res Methodol 2022; 22:255. [PMID: 36182899 PMCID: PMC9526289 DOI: 10.1186/s12874-022-01732-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 09/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background Qualitative longitudinal research (QLR) comprises qualitative studies, with repeated data collection, that focus on the temporality (e.g., time and change) of a phenomenon. The use of QLR is increasing in health research since many topics within health involve change (e.g., progressive illness, rehabilitation). A method study can provide an insightful understanding of the use, trends and variations within this approach. The aim of this study was to map how QLR articles within the existing health research literature are designed to capture aspects of time and/or change. Methods This method study used an adapted scoping review design. Articles were eligible if they were written in English, published between 2017 and 2019, and reported results from qualitative data collected at different time points/time waves with the same sample or in the same setting. Articles were identified using EBSCOhost. Two independent reviewers performed the screening, selection and charting. Results A total of 299 articles were included. There was great variation among the articles in the use of methodological traditions, type of data, length of data collection, and components of longitudinal data collection. However, the majority of articles represented large studies and were based on individual interview data. Approximately half of the articles self-identified as QLR studies or as following a QLR design, although slightly less than 20% of them included QLR method literature in their method sections. Conclusions QLR is often used in large complex studies. Some articles were thoroughly designed to capture time/change throughout the methodology, aim and data collection, while other articles included few elements of QLR. Longitudinal data collection includes several components, such as what entities are followed across time, the tempo of data collection, and to what extent the data collection is preplanned or adapted across time. Therefore, there are several practices and possibilities researchers should consider before starting a QLR project. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01732-4.
Collapse
Affiliation(s)
- Åsa Audulv
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Elisabeth O C Hall
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Faculty of Health Sciences, University of Faroe Islands, Thorshavn, Faroe Islands, Denmark
| | - Åsa Kneck
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Thomas Westergren
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway.,Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Liv Fegran
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Mona Kyndi Pedersen
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Hanne Aagaard
- Lovisenberg Diaconale Univeristy of College, Oslo, Norway
| | - Kristianna Lund Dam
- Faculty of Health Sciences, University of Faroe Islands, Thorshavn, Faroe Islands, Denmark
| | - Mette Spliid Ludvigsen
- Department of Clinical Medicine-Randers Regional Hospital, Aarhus University, Aarhus, Denmark.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| |
Collapse
|
18
|
Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 6: Longitudinal qualitative and mixed-methods approaches for longitudinal and complex health themes in primary care research. Eur J Gen Pract 2022; 28:118-124. [PMID: 35593106 PMCID: PMC9132407 DOI: 10.1080/13814788.2022.2053106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article, the sixth in a series aiming to provide practical guidance for qualitative research in primary care, introduces two approaches for addressing longitudinal and complex health themes in primary care research. The first approach – longitudinal qualitative research – supports the study of change during the life course. The second approach – mixed-methods research – integrates quantitative and qualitative research to gain new insights to address the complex and multifaceted themes in primary care. We discuss the context, what, why, when and how of these approaches and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.
Collapse
Affiliation(s)
- Irene Korstjens
- Faculty of Health Care, Research Centre for Midwifery Science, Zuyd University of Applied Sciences, Maastricht, The Netherlands
| | - Albine Moser
- Faculty of Health Care, Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
19
|
Cahill M, Galvin R, Pettigrew J. Being an academic retiree: a qualitative, follow-up study of women academics in the Republic of Ireland. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2022. [DOI: 10.1108/ijot-02-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Retirement is a complex process that can impact daily lives and relationships. While some gender differences in academic retirement experiences have been noted, few studies have focused exclusively on women academics’ retirement experiences. This follow-up study aims to explore the meaning of retirement and its impact on retired women academics' daily lives and relationships over time from an occupational perspective.
Design/methodology/approach
Using a qualitative, longitudinal descriptive design, semi-structured interviews (n = 11) were completed with women retirees from one university and an academically linked university-level, college of education and liberal arts, in the Republic of Ireland (n = 11). This paper presents the findings of follow-up interviews conducted one year later (n = 10). Data were analysed using Braun and Clarke’s six-phase thematic analysis. A longitudinal analysis was then undertaken using a recurrent cross-sectional approach (Grossoehme and Lipstein, 2016) to enable discussion of changes and continuity that had occurred over time in their daily lives.
Findings
The analysis yielded four themes: (i) continuing to navigate occupational identity challenges, (ii) structuring free time, (iii) appreciating health and well-being and (iv) continuing meaningful professional relationships and activities. Participants described on-going occupational identity challenges linked with contextual factors and experiences of occupational injustices of lack of recognition, lack of inclusion and a lack of choice to continue working in their paid academic employment.
Originality/value
These findings suggest that occupational therapists advocate for older adults, so that meaningful choices in retirement timing can be offered to all equally and so that older people are acknowledged for their contributions to society.
Collapse
|
20
|
Balmer DF, Richards BF. Conducting qualitative research through time: how might theory be useful in longitudinal qualitative research? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:277-288. [PMID: 34460054 DOI: 10.1007/s10459-021-10068-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
This paper explores the use of theory in longitudinal qualitative research, an approach to research which explores lived experiences as they unfold. The authors illustrate how the complexity of conducting qualitative research through time drives an understanding and use of theory that differs from other research approaches. Longitudinal qualitative research considers time as fluid, subjective, and unbounded-in contrast to the more common taken-for-granted understanding of time as fixed, objective, and linear. Furthermore, longitudinal qualitative research is predicated on a premise of trust in the context of enduring research relationships. Therefore, while subject-matter theories used to investigate topics of interest to health professions educators may be useful frameworks for other types of research, longitudinal qualitative research needs theories that accommodate the myriad of changes in lived experiences through time. The authors share their decade-long, longitudinal qualitative research story, highlighting their decision points and insights. In doing so, they foreground issues such as time as fluid as an important contribution to health professions education literature.
Collapse
Affiliation(s)
- Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 9NW 72, Philadelphia, PA, 19104, USA.
| | - Boyd F Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
21
|
Freytag J, Chu J, Hysong SJ, Street RL, Markham CM, Giordano TP, Westbrook RA, Njue-Marendes S, Johnson SR, Dang BN. Acceptability and feasibility of video-based coaching to enhance clinicians' communication skills with patients. BMC MEDICAL EDUCATION 2022; 22:85. [PMID: 35135521 PMCID: PMC8822679 DOI: 10.1186/s12909-021-02976-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 09/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Despite a growing call to train clinicians in interpersonal communication skills, communication training is either not offered or is minimally effective, if at all. A critical need exists to develop new ways of teaching communication skills that are effective and mindful of clinician time pressures. We propose a program that includes real-time observation and video-based coaching to teach clinician communication skills. In this study, we assess acceptability and feasibility of the program using clinician interviews and surveys. METHODS The video-based coaching intervention targets five patient-centered communication behaviors. It uses trained communication coaches and live feed technology to provide coaching that is brief (less than 15 min), timely (same day) and theory-informed. Two coaches were trained to set up webcams and observe live video feeds of clinician visits in rooms nearby. As coaches watched and recorded the visit, they time stamped illustrative clips in real time. Video clips were a critical element of the program. During feedback sessions, coaches used video clips to promote discussion and self-reflection. They also used role play and guided practice techniques to enforce new tips. Clinicians included residents (n = 15), fellows (n = 4), attending physicians (n = 3), and a nurse practitioner (n = 1) at two primary care clinics in Houston, Texas. We administered surveys to clinicians participating in the program. The survey included questions on quality and delivery of feedback, and credibility of the coaches. We also interviewed clinicians following the intervention. We used rapid analysis to identify themes within the interviews. RESULTS Survey measures showed high feasibility and acceptability ratings from clinicians, with mean item scores ranging from 6.4 to 6.8 out of 7 points. Qualitative analysis revealed that clinicians found that 1) coaches were credible and supportive, 2) feedback was useful, 3) video-clips allowed for self-reflection, 4) getting feedback on the same day was useful, and 5) use of real patients preferred over standardized patients. CONCLUSIONS Video-based coaching can help clinicians learn new communication skills in a way that is clinician-centered, brief and timely. Our study demonstrates that real-time coaching using live feed and video technology is an acceptable and feasible way of teaching communication skills.
Collapse
Affiliation(s)
- Jennifer Freytag
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Jinna Chu
- Baylor College of Medicine, Houston, USA
| | - Sylvia J Hysong
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Richard L Street
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Baylor College of Medicine, Houston, USA
- Texas A&M University, College Station, USA
| | | | - Thomas P Giordano
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Robert A Westbrook
- Jesse H. Jones Graduate School of Business, Rice University, Houston, USA.
| | - Sarah Njue-Marendes
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Syundai R Johnson
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Bich N Dang
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| |
Collapse
|
22
|
Byun M, Feller H, Ferrie M, Best S. Living with a genetic, undiagnosed or rare disease: A longitudinal journalling study through the COVID-19 pandemic. Health Expect 2022; 25:2223-2234. [PMID: 35122367 PMCID: PMC9111564 DOI: 10.1111/hex.13405] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/04/2021] [Accepted: 11/21/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction COVID‐19 changed the way we lived with uncertainty from the outset as the pandemic impacted every aspect of our lives from well‐being, socializing to accessing healthcare. For people in vulnerable populations, such as those with genetic, undiagnosed and rare disorders, the experience was heightened. Aim The aim of this study was to identify how the rapidly changing COVID‐19 environment impacted the lives of the Genetic, Undiagnosed and Rare Disease community. Methods From June 2020 to May 2021, we collected monthly open‐ended journals from people living in Australia with genetic, undiagnosed and rare disorders. Data analysis was deductive, using the Resilience Scale for Adults, and inductive using thematic analysis. Results We recruited 29 people (average of n = 9.7 submissions each month). Responses changed over the year, with initial journals focusing on the importance of developing new structures for day‐to‐day lives, while later journals started to focus on mental well‐being. Throughout the project, participants reported challenges in accessing health and social care that was compounded by fear and concern over being exposed to the virus. Later journals highlight inconsistent messaging for vaccinations for this vulnerable community. Discussion/Conclusion In parallel with the waves of the COVID‐19 pandemic, there need to be waves of targeted support for vulnerable communities. The first support wave needs to focus on facilitating the identification of new frameworks to structure day‐to‐day lives. A later second wave needs to focus on mental well‐being and coping with isolation, while consistent communication relating to health and social care throughout was essential. Patient/Public Contribution This study was co‐designed, co‐led and analysed with a patient support network.
Collapse
Affiliation(s)
- Malia Byun
- California Lutheran University, California, USA
| | - Hollie Feller
- Genetic Support Network Victoria, Melbourne, Victoria, Australia
| | - Monica Ferrie
- Genetic Support Network Victoria, Melbourne, Victoria, Australia
| | - Stephanie Best
- Australian Genomics Health Alliance, Murdoch Childrens Research Institute, Melbourne, Australia.,Australian Institute of Health Innovation, Sydney, Australia
| |
Collapse
|
23
|
WANG C, LIN S, WANG Q, Xie S, Tu Q, ZHANG H, PENG M, ZHOU J, REDFERN J. The experience of stroke survivors and caregivers during hospital-to-home transitional care: A qualitative longitudinal study. Int J Nurs Stud 2022; 130:104213. [DOI: 10.1016/j.ijnurstu.2022.104213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
|
24
|
Terzis LD, Saltzman LY, Logan DA, Blakey JM, Hansel TC. Utilizing a Matrix Approach to Analyze Qualitative Longitudinal Research: A Case Example During the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2022; 21:16094069221123723. [PMID: 36091640 PMCID: PMC9442150 DOI: 10.1177/16094069221123723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Qualitative Longitudinal Research (QLR) is an evolving methodology used in understanding the rich and in-depth experiences of individuals over time. QLR is particularly conducive to pandemic or disaster-related studies, where unique and rapidly changing environments warrant fuller descriptions of the human condition. Despite QLR's usefulness, there are a limited number of articles that detail the methodology and analysis, especially in the social sciences, and specifically social work literature. As researchers adjust their focus to incorporate the impact of the COVID-19 global pandemic, there is a growing need in understanding the progression and adaptation of the pandemic on individuals' lives. This article provides a process and strategy for implementing QLR and analyzing data in online diary entries. In the provided case example, we explore a phenomenological QLR conducted with graduate level students during the COVID-19 pandemic (Saltzman et al., 2021), and outline a matrix framework for QLR analysis. This paper provides an innovative way in which to engage in qualitative data collection and analysis for social science research.
Collapse
Affiliation(s)
| | | | - Dana A. Logan
- School of Social Work, Tulane University, New Orleans, LA, USA
| | - Joan M. Blakey
- School of Social Work, University of Minnesota, Minneapolis, MN, USA
| | - Tonya C. Hansel
- School of Social Work, Tulane University, New Orleans, LA, USA
| |
Collapse
|
25
|
Bloom I, Zhang J, Hammond J, Bevilacqua G, Lawrence W, Ward KA, Cooper C, Dennison EM. Impact of the COVID-19 pandemic on community-dwelling older adults: A longitudinal qualitative study of participants from the Hertfordshire Cohort Study. PLoS One 2022; 17:e0275486. [PMID: 36240147 PMCID: PMC9565385 DOI: 10.1371/journal.pone.0275486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Older adults have been especially vulnerable to adverse effects from the COVID-19 pandemic including higher mortality and more severe disease complications. At the same time, social isolation, malnutrition and physical inactivity are serious concerns among older adults. The pandemic and associated restrictions may serve to exacerbate these issues, presenting increased risks to physical and mental health. The aims of this qualitative study were: i) to explore how community-living older people in the UK experienced the first wave of the COVID-19 pandemic, specifically how it impacted their well-being and associated health behaviours; ii) to explore how older people's experiences and behaviours changed over time throughout the first wave. METHODS Qualitative data were collected by conducting serial telephone interviews, with an interval of approximately three months. Participants were from the Hertfordshire Cohort Study, all aged over 80 years. Discussions were audio-recorded, information related to the COVID-19 pandemic was transcribed verbatim and transcripts analysed thematically. Interviews were conducted from March to October 2020. RESULTS Data for twelve participants (7 men and 5 women) from a total of 35 interviews were used, comprising two or three timepoints per participant. Analysis identified five overarching themes: 1) shopping strategies and food accessibility, 2) limitations on activities and going out, 3) disruption to healthcare, 4) social and psychological repercussions, and 5) coping strategies. Findings highlight challenges associated with accessing shops, healthcare, and usual activities due to pandemic-related restrictions. Longitudinal findings showed that for some, the ongoing pandemic and related restrictions appeared to aggravate mental health issues (low mood, anxiety) over time, as well as greater feelings of isolation or loneliness, reduced activity and functional limitations; this was despite some relaxation of restrictions later on. Coping strategies used by participants included finding ways to keep busy and to do physical activity safely, maintaining social contact remotely, and having an optimistic or positive outlook, a 'do what you can' attitude. CONCLUSIONS Interventions are likely to be needed in the wake of the COVID-19 pandemic to support health behaviours, such as increasing physical activity, social engagement and improving mental health among community-living older adults.
Collapse
Affiliation(s)
- Ilse Bloom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- * E-mail:
| | - Jean Zhang
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Julia Hammond
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Gregorio Bevilacqua
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Kate A. Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, United Kingdom
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- Victoria University of Wellington, Wellington, New Zealand
| |
Collapse
|
26
|
Balmer DF, Varpio L, Bennett D, Teunissen PW. Longitudinal qualitative research in medical education: Time to conceptualise time. MEDICAL EDUCATION 2021; 55:1253-1260. [PMID: 33847408 PMCID: PMC8596518 DOI: 10.1111/medu.14542] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 05/14/2023]
Abstract
CONTEXT Longitudinal qualitative research is an approach to research that entails generating qualitative data with the same participants over extended periods of time to understand their lived experiences as those experiences unfold. Knowing about dynamic lived experiences in medical education, that is, learning journeys with stops and starts, detours, transitions and reversals, enriches understanding of events and accomplishments along the way. The purpose of this paper is to create access points to longitudinal qualitative research in support of increasing its use in medical education. METHODS The authors explore and argue for different conceptualisations of time: analysing lived experiences through time versus analysing lived experiences cross-sectional or via 2-point follow-up studies and considering time as subjective and fluid as well as objective and fixed. They introduce applications of longitudinal qualitative research from several academic domains: investigating development and formal education; building longitudinal research relationship; and exploring interconnections between individual journeys and social structures. They provide an illustrative overview of longitudinal qualitative research in medical education, and end with practical advice, or pearls, for medical education investigators interested in using this research approach: collecting data recursively; analysing longitudinal data in three strands; addressing mutual reflexivity; using theory to illuminate time; and making a long-term commitment to longitudinal qualitative research. CONCLUSIONS Longitudinal qualitative research stretches investigators to think differently about time and undertake more complex analyses to understand dynamic lived experiences. Research in medical education will likely be impoverished if the focus remains on time as fixed. Seeing things qualitatively through time, where time is fluid and the past, present and future interpenetrate, produces a rich understanding that can move the field forward.
Collapse
Affiliation(s)
- Dorene F. Balmer
- Department of PediatricsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Lara Varpio
- Department of MedicineCenter for Health Professions EducationUniformed Services University of the Health SciencesBethesdaMDUSA
| | - Deirdre Bennett
- Medical Education UnitSchool of MedicineUniversity College CorkCorkIreland
| | - Pim W. Teunissen
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
- Department of Obstetrics and GynecologyMaastricht University Medical CenterMaastrichtThe Netherlands
| |
Collapse
|
27
|
Ayalon L, Shinan-Altman S. Tension between reality and visions: Lessons from an evaluation of a training program of paid elder care workers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1915-1924. [PMID: 33560571 DOI: 10.1111/hsc.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 12/09/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
The present study is based on a 3-year evaluation of an Israeli training program for local paid elder care workers, called, 'community care'. Interviews were conducted with all stakeholders involved in the program, including program developers, facilitators, funders, trainees, dropouts, graduates, employers and older care recipients. Qualitative thematic analysis was used. Analysis was supplemented by quantitative data concerning the program's inputs, outputs and outcomes. The program had multiple strengths, including a substantial funding stream and a highly skilled and committed team. Yet, out of 130 participants, 94 completed the program and 31 worked as care workers afterwards. Three main challenges to the efficacy of the training program were identified. A first challenge stems from the gap between the program's vision and real-life requirements and constraints. The second challenge concerns a disagreement between stakeholders concerning the definition of the new community care profession as an opportunity to empower trainees and encourage personal growth versus the community care worker as being no different from the traditional direct paid carer. A third challenge concerns the program's lack of integration between personal/physical care on the one hand and emotional and psychological care, on the other hand. The findings stress the importance of adequately conducting a needs assessment prior to embarking on a new social program and the tension between an ideal prototype and real-life constraints. The findings also stress the necessity of top-down processes, supported by the government to the development of a new profession of community elder care.
Collapse
Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Shiri Shinan-Altman
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| |
Collapse
|
28
|
Verhage M, Thielman L, de Kock L, Lindenberg J. Coping of Older Adults in Times of COVID-19: Considerations of Temporality Among Dutch Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 76:e290-e299. [PMID: 33423054 PMCID: PMC7928596 DOI: 10.1093/geronb/gbab008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Globally, mitigation measures during the coronavirus disease 2019 (COVID-19) pandemic have focused on protecting older adults. Earlier disaster studies have shown the importance of including older peoples' voices to prevent secondary stressors, yet these voices have received little attention during this pandemic. Here, we explore how Dutch older adults view this crisis and cope with measures to contribute to our understanding of coping of older adults in general and during disaster situations more specifically. METHOD Qualitative study using semistructured telephone interviews with 59 diverse older adults aged 54-95 throughout the Netherlands. RESULTS Older adults typify this crisis as ungraspable, disrupting their daily and social lives. Despite filling their lives with activities, they experience loss or lack of purpose. They try to follow measures to decrease infection risk and gain control, and use problem- and emotion-focused coping strategies. Emotion-focused strategies used were interpreting their personal vulnerability, self-enhancing comparisons, acceptance, and distraction. In the latter 2 strategies, the temporary nature of measures was emphasized. DISCUSSION Older adults describe this crisis consistently with earlier findings from disaster studies. They use known coping strategies, but emphasize the duration in relation to their expectation of temporality. This underscores a dynamic, processual approach toward coping that incorporates temporal dimensions such as duration and order. Our findings stress the importance of acknowledging heterogeneity among older adults and adjusting communication about mitigation measures to decrease insecurity and increase resonance. This may make COVID-19 mitigation measures more manageable and age-responsible and allow older adults to start living again.
Collapse
Affiliation(s)
- Miriam Verhage
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands
| | - Lucia Thielman
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Faculty of Behavioural and Movement Sciences, Educational Studies, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lieke de Kock
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
| | - Jolanda Lindenberg
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands
| |
Collapse
|
29
|
Nevedal AL, Reardon CM, Opra Widerquist MA, Jackson GL, Cutrona SL, White BS, Damschroder LJ. Rapid versus traditional qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). Implement Sci 2021; 16:67. [PMID: 34215286 PMCID: PMC8252308 DOI: 10.1186/s13012-021-01111-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background Qualitative approaches, alone or in mixed methods, are prominent within implementation science. However, traditional qualitative approaches are resource intensive, which has led to the development of rapid qualitative approaches. Published rapid approaches are often inductive in nature and rely on transcripts of interviews. We describe a deductive rapid analysis approach using the Consolidated Framework for Implementation Research (CFIR) that uses notes and audio recordings. This paper compares our rapid versus traditional deductive CFIR approach. Methods Semi-structured interviews were conducted for two cohorts of the Veterans Health Administration (VHA) Diffusion of Excellence (DoE). The CFIR guided data collection and analysis. In cohort A, we used our traditional CFIR-based deductive analysis approach (directed content analysis), where two analysts completed independent in-depth manual coding of interview transcripts using qualitative software. In cohort B, we used our new rapid CFIR-based deductive analysis approach (directed content analysis), where the primary analyst wrote detailed notes during interviews and immediately “coded” notes into a MS Excel CFIR construct by facility matrix; a secondary analyst then listened to audio recordings and edited the matrix. We tracked time for our traditional and rapid deductive CFIR approaches using a spreadsheet and captured transcription costs from invoices. We retrospectively compared our approaches in terms of effectiveness and rigor. Results Cohorts A and B were similar in terms of the amount of data collected. However, our rapid deductive CFIR approach required 409.5 analyst hours compared to 683 h during the traditional deductive CFIR approach. The rapid deductive approach eliminated $7250 in transcription costs. The facility-level analysis phase provided the greatest savings: 14 h/facility for the traditional analysis versus 3.92 h/facility for the rapid analysis. Data interpretation required the same number of hours for both approaches. Conclusion Our rapid deductive CFIR approach was less time intensive and eliminated transcription costs, yet effective in meeting evaluation objectives and establishing rigor. Researchers should consider the following when employing our approach: (1) team expertise in the CFIR and qualitative methods, (2) level of detail needed to meet project aims, (3) mode of data to analyze, and (4) advantages and disadvantages of using the CFIR. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01111-5.
Collapse
Affiliation(s)
- Andrea L Nevedal
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), 795 Willow Road, Building 324, Menlo Park, CA, 94025, USA.
| | - Caitlin M Reardon
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
| | - Marilla A Opra Widerquist
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA.,Department of Population Health Science, Duke University, Durham, USA.,Division of General Internal Medicine, Duke University, Durham, USA.,Department of Family Medicine and Community Health, Duke University, Durham, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Boston, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, USA.,Division of General Internal Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Brandolyn S White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA
| | - Laura J Damschroder
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
| |
Collapse
|
30
|
Searby A, Burr D. The impact of COVID-19 on alcohol and other drug nurses' provision of care: A qualitative descriptive study. J Clin Nurs 2021; 30:1730-1741. [PMID: 33656227 PMCID: PMC8014781 DOI: 10.1111/jocn.15732] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022]
Abstract
Aims and objectives To explore the impact of the COVID‐19 pandemic on alcohol and other drug nurses providing treatment for individuals presenting with problematic alcohol and other drug use. Background COVID‐19 has caused disruption to contemporary health service delivery, including alcohol and other drug treatment. Provisional research on drug and alcohol consumption patterns shows changes attributable to the pandemic, with implications for service delivery. Research also indicates the impact of the pandemic on healthcare staff is significant, leading to workforce challenges that threaten care provision. Design Qualitative descriptive study design. Methods Data were collected using semi‐structured, individual telephone interviews with practising alcohol and other drug nurses from Australia and New Zealand (n = 19). COREQ reporting guidelines were used. Results After thematic analysis, three key themes emerged: ‘No room at the inn: Changes to service delivery due to COVID‐19’, ‘We are providing care to a very vulnerable group of people: Consumer factors during COVID‐19’ and ‘Personally, we were very, very stressed: Workforce factors due to COVID‐19’. Conclusions The findings from this study indicate that the impact of the pandemic was felt by alcohol and other drug nurses, services and healthcare consumers alike. The experiences of alcohol and other drug nurses through the COVID‐19 pandemic need further exploration both to ensure workforce sustainability and that disruptions to alcohol and other drug services do not occur in future outbreaks of communicable disease. Relevance to clinical practice COVID‐19 has had a profound effect on nurses in all settings, and these effects are likely to be felt for some time after the pandemic: nursing specialties require support to ensure ongoing workforce sustainability and well‐being of nursing staff. All nurses need to be aware of changes to alcohol and other drug use during the pandemic and screen healthcare consumers accordingly.
Collapse
Affiliation(s)
- Adam Searby
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Dianna Burr
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
31
|
Affiliation(s)
- Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
| |
Collapse
|
32
|
Narratives of long-term resilience: two cases of women aging with spinal cord injury. Spinal Cord Ser Cases 2020; 6:23. [PMID: 32303683 DOI: 10.1038/s41394-020-0267-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is a life-changing event that drastically affects a person's sense of identity, ability to participate, and quality of life (QOL). Researchers studying the coping process have often focused on identifying maladaptive behaviors and barriers, and less on positive psychology approaches emphasizing individual strengths. More recently, positive psychology constructs, such as resilience, have received greater attention from SCI researchers. Early and ongoing recognition of resilience in patients with SCI may provide important information to clinicians about adjustment and long-term management. Our purpose is to document patterns and indicators of resilience, using a narrative approach, during various stages of adjustment following SCI. CASE PRESENTATIONS Narrative case presentations are deriving from in-depth qualitative interviews with two women aged 63 and 52, living with SCI. Both had complete motor neurological injuries that incurred at 27 and 35 years, respectively. Each woman was interviewed twice, approximately 10 years apart (age 63 and 52, and age 54 and 42). Each demonstrated high levels of resilience through evolving roles of family and caregivers, inner personal strength, and participation in their respective communities. We highlight differences, similarities, and evolution of resilience factors in and between each case. DISCUSSION These cases illustrate examples of long-term resilience, adding richness to the resilience construct. Results provide knowledge that can be used to target rehabilitation interventions toward successful coping styles. In sharing these cases, we hope to assist clinicians and researchers to better recognize patterns of resilience in their own patients and study participants.
Collapse
|
33
|
Tuthill EL, Maltby AE, DiClemente K, Pellowski JA. Longitudinal Qualitative Methods in Health Behavior and Nursing Research: Assumptions, Design, Analysis and Lessons Learned. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2020; 19:10.1177/1609406920965799. [PMID: 34566547 PMCID: PMC8459825 DOI: 10.1177/1609406920965799] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Longitudinal qualitative research (LQR) is an emerging methodology in health behavior and nursing research. Researchers are turning to LQR to understand experiences across time as well as identify facilitators and inhibitors of health/illness behaviors and transitions. Currently, a lack of information exists to guide researchers on LQR techniques and considerations. Our objective was to provide a methodological resource for health behavior and nursing researchers conducting LQR. LQR may be applied to understand any human experience, as well as the sequalae of the experience and is well suited for studying transitions and developmental or behavioral changes. Conducting LQR is resource intensive and requires flexibility and complex analyses. We discuss multiple components of LQR such as design considerations, analysis options, and our lessons learned. Despite complexities, LQR provides the opportunity to understand experiences across time within an individual and among a group resulting in holistic, in-depth understandings beyond a cross-sectional time point.
Collapse
Affiliation(s)
- Emily L. Tuthill
- Department of Community Health Systems, School of Nursing, University of California San Francisco, CA, USA
| | - Ann E. Maltby
- Department of Community Health Systems, School of Nursing, University of California San Francisco, CA, USA
| | - Kira DiClemente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer A. Pellowski
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- International Health Institute, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology and Biostatistics, University of Cape Town, South Africa
| |
Collapse
|
34
|
Understanding changes and stability in the long-term use of technologies by seniors who are aging in place: a dynamical framework. BMC Geriatr 2019; 19:236. [PMID: 31462214 PMCID: PMC6712781 DOI: 10.1186/s12877-019-1241-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background If technologies are to support aging in place, then it is important to develop fundamental knowledge on what causes stability and changes in the use of technologies by seniors. However, longitudinal studies on the long-term use of technologies that have been accepted into the home (i.e., post-implementation use) are very scarce. Many factors potentially could influence post-implementation use, including life events, age-related decline, changes in personal goal orientation, and various types of social influences. The aforementioned factors are likely to be interrelated, adding to the complexity. The goal of this study is to better understand changes and stability in the use of technologies by independent-living seniors, by using a dynamical systems theory approach. Methods A longitudinal qualitative field study was conducted involving home visits to 33 community-dwelling seniors in the Netherlands, on three occasions (2012–2014). Interviews were held on technology usage patterns, including reasons for stable, increased, declined and stopped use. Technologies were included if they required electric power in order to function, were intended to be used in or around the home, and could support activities of daily living, personal health or safety, mobility, communication, and physical activity. Thematic analysis was employed, using constant case comparison to better understand dynamics and interplay between factors. In total, 148 technology use patterns by 33 participants were analyzed. Results A core of six interrelated factors was closely linked to the frequency of technology use: emotional attachment, need compatibility, cues to use, proficiency to use, input of resources, and support. Additionally, disruptive forces (e.g., social influences, competition with alternative means, changes of personal needs) could induce change by affecting these six factors. Furthermore, long-term technology use was in some cases more resilient to disruption than in other cases. Findings were accumulated in a new framework: Dynamics In Technology Use by Seniors (DITUS). Conclusions Similar to aging, the use of technologies by older people is complex, dynamic and personal. Periods of stability and change both occur naturally. The DITUS framework can aid in understanding stability and instability of technology use, and in developing and implementing sustainable technological solutions for aging in place. Electronic supplementary material The online version of this article (10.1186/s12877-019-1241-9) contains supplementary material, which is available to authorized users.
Collapse
|