"I am there just to get on with it": a qualitative study on the labour of the patient and public involvement workforce

BACKGROUND

Workers tasked with specific responsibilities around patient and public involvement (PPI) are now routinely part of the organizational landscape for applied health research in the United Kingdom. Even as the National Institute for Health and Care Research (NIHR) has had a pioneering role in developing a robust PPI infrastructure for publicly funded health research in the United Kingdom, considerable barriers remain to embedding substantive and sustainable public input in the design and delivery of research. Notably, researchers and clinicians report a tension between funders' orientation towards deliverables and the resources and labour required to embed public involvement in research. These and other tensions require further investigation.

METHODS

This was a qualitative study with participatory elements. Using purposive and snowball sampling and attending to regional and institutional diversity, we conducted 21 semi-structured interviews with individuals holding NIHR-funded formal PPI roles across England. Interviews were analysed through reflexive thematic analysis with coding and framing presented and adjusted through two workshops with study participants.

RESULTS

We generated five overarching themes which signal a growing tension between expectations put on staff in PPI roles and the structural limitations of these roles: (i) the instability of support; (ii) the production of invisible labour; (iii) PPI work as more than a job; (iv) accountability without control; and (v) delivering change without changing.

CONCLUSIONS

The NIHR PPI workforce has enabled considerable progress in embedding patient and public input in research activities. However, the role has led not to a resolution of the tension between performance management priorities and the labour of PPI, but rather to its displacement and - potentially - its intensification. We suggest that the expectation to "deliver" PPI hinges on a paradoxical demand to deliver a transformational intervention that is fundamentally divorced from any labour of transformation. We conclude that ongoing efforts to transform health research ecologies so as to better respond to the needs of patients will need to grapple with the force and consequences of this paradoxical demand.

Student physiotherapists' perspectives of peer learning during multi-model placements

INTRODUCTION

Placements are a key component of physiotherapy courses; however, placement providers struggle to meet rising demands. To enhance placement capacity, multi-models are increasingly employed, where Universities place more than one student with one educator. Student support on placement is important, and studies exploring multi-placement models reveal educators welcome the peer support possible with this placement pattern. This research explored UK physiotherapy students' perspectives of peer relationships during placements, for which there is yet little research.

METHODS

Eight single, semi-structured interviews were conducted, exploring students' experiences of peer working on placement October to December 2020. Participants and researchers were undergraduate students at the same UK university. Interviews were virtual, recorded via Microsoft Teams and transcribed verbatim. Transcripts were analysed first individually, then collaboratively, sharing ideas and interpretations using a phenomenologically informed analytical lens.

RESULTS

Two main themes were identified: collaboration vs conflict and supportive vs hindering relationships. Students appreciated the emotional and academic support from peers, but there could be difficulties in generating constructive peer relationships, and sometimes a sense of competition from divided tutor attention.

CONCLUSION

Multi-model placements provide social and emotional support to students, increasing their confidence. Peer relationships present opportunities for collaborative working and academic support if they are adequately framed as such by the practice educator and wider team. Students may benefit from university-based support to prepare them to maximise the peer relationship. Practice educators may benefit from information about supporting students in multi-model placements. Student-led research can offer rich qualitative data and helpful educational solutions.

CONTRIBUTION OF THE PAPER

This small project from one UK University produced similar findings as research from other professions: placement peer relationships had the capacity to provide helpful social and emotional support to students, resulting in greater levels of confidence, collaborative working, and learning. However, there were indications that educational institutions could a) further support students to develop their capabilities in cooperative peer working, and b) assist educators to manage the challenges of multi-model placements.

Doubly Marginalized: Addressing the Minority Stressors Experienced by LGBTQ+ Researchers Who Do LGBTQ+ Research

Lesbian, gay, bisexual, transgender, and nonbinary, and queer people (LGBTQ+) experience significantly higher levels of stressors due to discrimination, stigma, and marginalization than do cisgender heterosexual people. These high levels of stressors have impacts on health and well-being as well as career impacts. Limited research suggests that within higher education LGBTQ+ faculty experience bullying, discrimination, and harassment within the workplace. There is also data to suggest that research on marginalized populations is perceived to be less objective and valuable than research on majority populations. Research on the challenges of being a member of a marginalized population who conducts research on the same population suggests potentially negative career and personal impacts. To my knowledge, there has been little to no research on the double marginalization related to being an LGBTQ+ researcher doing research within the LGBTQ+ community. To describe the potential impacts of being an LGBTQ+ researcher who does LGBTQ+ research, I apply the extant literature on marginalized researchers who do research among marginalized populations to LGBTQ+ researchers. I also describe the potential minority stressors that LGBTQ+ researchers may face and how that may impact careers. Finally, I offer multiple recommendations for improvements for our research community and argue that senior faculty, leadership, and mentors can take specific actions to lessen stressors for LGBTQ+ researchers studying LGBTQ-related topics.

Women as Agents of Change: Exploring Women Leaders' Resistance and Shaping of Gender Ideologies in Pakistan

Despite a growing focus on processes to promote gender equity, women remain significantly underrepresented in leadership positions in the Global South. In the present study we focus on the role of familial experiences in shaping and contesting gender ideologies of Pakistani women in the workplace. We specifically examine the reciprocal ways in which women leaders and their family members shape each other’s gender ideologies regarding the workplace. Data collected and analyzed for this study were semi-structured interviews with eight women in positions of leadership in Lahore, Pakistan, and interviews with one family members of each of the women leaders (thus 16 interviews total). Using thematic narrative analysis, we identified three thematic phases: learning gender expectations, resistance, and familial transformation. These phases reflect the progression of developing, resisting, and influencing individual and familial gender ideologies. We document the manifestation of these phases in three specific domains: education, marriage and motherhood, and the workplace. We then discuss how these findings contribute to understanding the experiences of women leaders and perceptions of their family members regarding women’s role in the workplace. Findings from our research provide novel insights into the ways globalization and capitalism continue to shape the socio-cultural context for women leaders in the Global South.

Virtually Trans: an Australian Facebook group supporting gender diverse adults' health and wellbeing

Social networking sites are the primary means by which trans and gender diverse people meet, enabling both community contact and information exchange. This study considers the meaning of participation in a secret Facebook group for trans and gender diverse adults in Melbourne (Australia). A peer ethnographic methodology was used to study the Melbourne-based group listed under the pseudonym 'Virtually Trans'. Qualitative semi-structured interviews were conducted with 12 Virtually Trans group members. Interviews were transcribed and thematically analysed. Interview data were supplemented with field notes written throughout online participation over an 8-month period to add richness and provide context to the data. Three major themes were developed from this analysis. First, experiences outside of Virtually Trans, most notably within health care settings, were perceived to be unsafe. Second, practices of care in Virtually Trans conferred a sense of kinship and identity affirmation. Finally, Virtually Trans enabled localized information exchange between peers. Virtually Trans is not a neutral platform of self-performance but a safe(r) environment for expanding the gendered possibilities of who and how people may become. This study highlights the importance of a secret Facebook group in filling care, information and resource gaps experienced by trans and gender diverse people within a major metropolitan setting. The findings have implications for practitioners working with trans and gender diverse adults and peer health navigation.

The narrative self in rural dementia: a case study from eastern Nova Scotia

This analysis examines how the narrative self of a person with dementia is maintained by family members in a small rural Nova Scotian community. In the literature, the expectation is often that rurality is a condition of isolation, distance from family and limited health resources. However, drawing on three years of ethnographic and interviewing research with a large extended family whose patriarch, Alexander, is a person with dementia, we demonstrate how a community's rurality influences interpretations of dementia. In Alexander's rurality, of particular import are local definitions of belonging, which privilege intimate knowledge of local history, working as a farmer to shape the land, and being of Scottish descent and male. As family members find Alexander's belonging to come into question in their community, we show them to employ narratives in which he is valorised for continuing to uphold local values – of ‘usefulness’ and of ‘being the land’. We show how the family members must also revisit and revise these narratives when Alexander's belonging is further called into question outside the family setting and, specifically, at the local farmer's market, where Alexander is often no longer greeted by other marketgoers. The men and women of the family arrive at different interpretations of this development, with the women considering marketgoers to demean and dehumanise Alexander, while the men feel that the marketgoers are avoiding interactions that would embarrass him. Such disagreements reveal the ongoing emotional labour of creating narratives that lack closure, certainty and consensus, as well as ways in which gender and rurality operate intersectionally in the process of meaning-making.

Coming In: Queer Narratives of Sexual Self-Discovery

Many models of queer sexuality continue to depict a linear narrative of sexual development, beginning in repression/concealment and eventuating in coming out. The present study sought to challenge this by engaging in a hermeneutically informed thematic analysis of interviews with eight queer people living in Western Australia. Four themes were identified: "searching for identity," "society, stigma, and self," "sexual self-discovery," and "coming in." Interviewees discussed internalized homophobia and its impact on their life; experiences and implications of finding a community and achieving a sense of belonging; the concept of sexual self-discovery being a lifelong process; and sexuality as fluid, dynamic, and situational rather than static. The article concludes by suggesting that the idea of "coming in"-arriving at a place of acceptance of one's sexuality, regardless of its fluidity or how it is viewed by society-offers considerable analytic leverage for understanding the journeys of sexual self-discovery of queer-identified people.

Gender-related aspects of transmasculine people's vocal situations: insights from a qualitative content analysis of interview transcripts

BACKGROUND

Transmasculine people assigned female gender at birth but who do not identify with this classification have traditionally received little consideration in the voice literature. Existing analyses tend to be focused on evaluating speaker voice characteristics, whereas other factors that contribute to the production of vocal gender have remained underexplored. Most studies rely on researcher-centred perspectives, whereas very little is known about how transmasculine people themselves experience and make sense of their vocal situations.

AIMS

To explore how participants described their subjective gender positionings; which gender attributions they wished to receive from others; which gender they self-attributed to their voices; which gender attributions they had received from others; and how far participants were satisfied with the gender-related aspects of their vocal situations.

METHODS & PROCEDURES

Transcripts of semi-structured interviews with 14 German-speaking transmasculine people served as the original data corpus. Sections in which participants described the gender-related aspects of their vocal situations and that were relevant to the current research objectives were selected and explored using qualitative content analysis.

OUTCOMES & RESULTS

The analysis revealed diverse accounts pertaining to the factors that contribute to the production of vocal gender for individual participants and variable levels of satisfaction with vocal gender presentation and attribution.

CONCLUSIONS & IMPLICATIONS

Transmasculine people need to be regarded as a heterogeneous population and clinical practice needs to follow a client-centred, individualized approach.

De novo Families: Lesbian Motherhood

The aim of this recent Australian study was to explore the experiences of lesbian women choosing motherhood. Participants included 30 self-identifying lesbian mothers. Data were collected via interviews, data collection sheets, and online journaling. The interview and journaling data were analyzed using constant comparative analysis and subsequently illuminated three main themes: becoming mothers, constructing motherhood, and legitimizing our family. These papers described the journey to motherhood and specifically explored the various methods of conception and other decisions that participants made when planning their family, the challenge of heteronormativity in health care, and legitimizing the role of the non-birth mother in de novo families. This article aims to present the participants' experiences of motherhood that was a constant topic found woven throughout all three of the identified themes. Participants identified that they had a unique opportunity to create their own mothering roles in the absence of significant "lesbian mother" role models and that they were able to adjust and to adapt their roles depending on fluctuating circumstances.

Inside/out: Challenges of conducting research in lesbian communities

Conducting research within one's own community can present challenges that are rarely addressed by graduate education, articles, or books on research design. Binary notions of insider and outsider are too simplistic; rather insider/outsider positions exist on a continuum. This article explores how the researcher's shifting position affects every aspect of a study of lesbian, bisexual, and/or queer women. Helpful theoretical frameworks include feminist research principles and intersectionality, and the article ends with lessons learned about tackling taboo topics, sensitivity to language, embracing diversity, researcher reputation, and looking upstream for solutions.

Psychosocial Influences on Bisexual Women’s Body Image

Research on body image has focused almost exclusively on heterosexual women and lesbians, leaving bisexual women’s experiences largely ignored. The present study sought to gain an understanding of psychosocial factors (including sexual prejudice, romantic relationship history, lesbian, gay, bisexual, and transgender [LGBT] communities, and feminist identity) that may contribute to bisexual women’s experiences of body image. The authors conducted semistructured interviews with six bisexual women and used interpretative phenomenological analysis to analyze the results. This analysis resulted in four themes: bisexual women’s desire to accept their bodies in a context of societal objectification; the influence of dominant sexuality and gender binaries that leave bisexual women feeling invisible; the protective role of LGBT communities and feminist identification in helping them resist the thin ideal; and the positive and the negative influences of romantic relationships with men and women. Results highlight the importance of validating sexual identity and promoting feminist identification and inclusion within an LGBT community for bisexual women. Future research might further explore the role of feminist communities and romantic relationships in bisexual women’s body satisfaction and should include the experiences of bisexual women from diverse backgrounds. Editor's Note: Findings for the present study must be considered along with the discussion across the accompanying set of three reflection papers: Yost and Chmielewski (2013); Wilkinson and Kitzinger (2013); and Crawford (2013).