1
|
Inglis-Jenson M, Robler SK, Gallo JJ, Ivanoff P, Ryan S, Hofstetter P, Emmett SD. Community Perspectives on Hearing Loss in Rural Alaska. Ear Hear 2023; 44:1078-1087. [PMID: 36939709 PMCID: PMC10426783 DOI: 10.1097/aud.0000000000001348] [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: 09/26/2022] [Accepted: 01/11/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES The aim of this study is to present an explanatory model of hearing loss in the Bering Strait region of Alaska in order to contextualize the results of a cluster randomized trial and propose implications for regional hearing-related health care. DESIGN To promote ecological validity, or the generalizability of trial findings to real world experiences, qualitative methods (focus groups and interviews) were used within a mixed methods cluster randomized trial evaluating school hearing screening and follow-up processes in 15 communities in the Bering Strait region of Alaska. Focus groups were held between April and August 2017, and semistructured interviews were conducted between December 2018 and August 2019. Convenience sampling was used for six of the 11 focus groups to capture broad community feedback. Purposive sampling was used for the remaining five focus groups and for all interviews to capture a variety of experiences with hearing loss. Audio recordings of focus groups and interviews were transcribed, and both notes and transcripts were deidentified. All notes and transcripts were included in the analysis. The constant comparative method was used to develop a codebook by iteratively moving between transcripts and preliminary themes. Researchers then used this codebook to code data from all focus groups and interviews using qualitative analysis software (NVIVO 12, QSR International) and conducted thematic analyses to distill the findings presented in this article. RESULTS Participants in focus groups (n = 116) and interviews (n = 101) shared perspectives in three domains: etiology, impact, and treatment of hearing loss. Regarding etiology, participants emphasized noise-induced hearing loss but also discussed infection-related hearing loss and various causes of ear infections. Participants described the impact of hearing loss on subsistence activities, while also detailing social, academic, and economic consequences. Participants described burdensome treatment pathways that are repetitive and often travel and time intensive. Communication breakdowns within these pathways were also described. Some participants spoke positively of increased access via onsite hearing health care services in "field clinics" as well as via telemedicine services. Others described weaknesses in these processes (infrequent field clinics and communication delays in telemedicine care pathways). Participants also described home remedies and stigma surrounding the treatment for hearing loss. CONCLUSIONS Patient-centered health care requires an understanding of context. Explanatory models of illness are context-specific ways in which patients and their networks perceive and describe the experience of an illness or disability. In this study, we documented explanatory models of hearing loss to foster ecological validity and better understand the relevance of research findings to real-life hearing-related experiences. These findings suggest several areas that should be addressed in future implementation of hearing health care interventions elsewhere in rural Alaska, including management of repetitious treatments, awareness of infection-mediated hearing loss, mistrust, and communication breakdowns. For hearing-related health care in this region, these findings suggest localized recommendations for approaches for prevention and treatment. For community-based hearing research, this study offers an example of how qualitative methods can be used to generate ecologically valid (i.e., contextually grounded) findings.
Collapse
Affiliation(s)
- Meade Inglis-Jenson
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Norton Sound Health Corporation, Nome, Alaska, USA
- These authors contributed equally to this work
| | - Samantha Kleindienst Robler
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Norton Sound Health Corporation, Nome, Alaska, USA
- These authors contributed equally to this work
| | - Joseph J. Gallo
- Mixed Methods Research Training Program, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Paul Ivanoff
- Lead Parent Stakeholder, Hearing Norton Sound, Unalakleet, Alaska, USA
| | - Stephanie Ryan
- Lead Patient Partner, Hearing Norton Sound, Anchorage, Alaska, USA
| | | | - Susan D. Emmett
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Duke Global Health Institute, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arkansas for Medical Sciences, Arkansas, USA
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Arkansas, USA
| |
Collapse
|
2
|
Gunnarsson M, Törrönen J. Performing normality in working life among heavy substance users. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:473-486. [PMID: 36284744 PMCID: PMC9549223 DOI: 10.1177/14550725221108796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 06/07/2022] [Indexed: 12/02/2022] Open
Abstract
Aim: Work is an important part of most people's everyday lives and
well-being. Substance use by employees is associated with several negative consequences,
such as absence from work and poor work performance. The study examines the strategies
through which people who have problems with substance use produce a “normal” self and
avoid becoming stigmatised in the workplace. Methods: The study uses data
from in-depth unstructured life story interviews, which were conducted over phone with 13
people. The participants had developed various problematic heavy substance use habits. The
interviews were analysed by applying interactional analysis and by using Goffman's
concepts of “normality”, “embarrassment”, “face-work”, “stigma” and “performance”.
Results: The analysis identified multiple strategies the participants used
to produce normality and to avoid embarrassment and stigmatisation at work. These include
skilful use of drugs in order not to show withdrawal symptoms, various ways of hiding
their heavy substance use, frequent change of jobs, the maintenance of a clean and
professional look, and attributing the absence from work to mental or physical illness.
Moreover, the participants strategically avoided social contacts in which embarrassing
situations could arise. When this was not possible, they manipulated their corporeal looks
by hiding such kinds of bodily marks that would connote abnormality.
Conclusion: The analysis points out that maintaining normality at work does
not only refer to the efforts of trying to hide the effects of the drugs on behaviours and
the body. It also reveals that the participants used substances to be able to perform
energetically their work tasks, and in this way present themselves as normal workers. This
ambivalence in performing normality makes the work life of people who use substances
challenging.
Collapse
Affiliation(s)
- Malin Gunnarsson
- Department of Public Health Science, Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden
| | - Jukka Törrönen
- Department of Public Health Science, Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden
| |
Collapse
|
3
|
Törrönen J. Analyzing agency and identity navigation in addiction stories by drawing on actor-network theory and narrative positioning analysis. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2035684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jukka Törrönen
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| |
Collapse
|
4
|
Caçador TGV, Gomes R. [Narrative as a strategy for understanding the experience of chronic illness: a literature review]. CIENCIA & SAUDE COLETIVA 2020; 25:3261-3272. [PMID: 32785559 DOI: 10.1590/1413-81232020258.24902018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/05/2018] [Indexed: 11/22/2022] Open
Abstract
This article aims to explore, in available literature, the use of narrative in studies of chronic illness. It is hoped that this study in addition to knowing how to have been the use of narrative in studies, contribute to the care of people with chronic illness. Methodologically, the study consists of a literature review of qualitative nature, focusing on articles with the Virtual Health Library descriptors (VHL). In terms of results, three stand out meanings attributed to the use of narrative by the authors: technique to get testimonies, research method and specific type of testimony; and in terms of the main results attributed by the authors with the use of narrative, are evident two themes: the experience of chronic illness in the subject ill perspective, highlighting the search for meaning, reframing the chronicity and coping strategies; and the possibility of understanding chronic illness, by professionals from the experience of the subject ill. It is verified, in the analyzed studies, that the use of the narrative itself or the narration process can make possible the resignification of the process of illness by the subjects and point out strategies for care management in chronic illness.
Collapse
Affiliation(s)
| | - Romeu Gomes
- Instituto Sírio-Libanês de Ensino e Pesquisa. R. Prof. Daher Cutait 69, Bela Vista. 01308-060 São Paulo SP Brasil.
| |
Collapse
|
5
|
Kılınç S, Campbell C, Guy A, van Wersch A. Negotiating the boundaries of the medical model: Experiences of people with epilepsy. Epilepsy Behav 2020; 102:106674. [PMID: 31783319 DOI: 10.1016/j.yebeh.2019.106674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/09/2023]
Abstract
People with epilepsy (PWE) continually report dissatisfaction with the support they receive, particularly in regard to their psychological wellbeing. With its focus on optimal seizure control, epilepsy treatment is entrenched in the medical model of illness, despite growing evidence of the broader psychosocial impact of the condition. This study aimed to explore how PWE experience healthcare in the context of their lives. Semistructured interviews were conducted with thirty-nine adults with epilepsy from across the UK. An adapted version of interpretative phenomenological analysis (IPA) was conducted, and three superordinate themes were identified. Firstly, "negotiating the space between health and illness" identified how participants rejected the illness identity and struggled with a treatment regime, which reminded them of the longevity of their condition. Secondly, "tensions in adopting a biomedical perspective" considered how medical professionals overlooked the negative side effects medication had on participants' lives, in favor of optimal seizure control. Thirdly, "the need for broader support" highlighted the additional psychosocial support PWE require. The findings indicate the need to incorporate person-centered, psychological services within the care pathway for PWE, as well as training for health professionals to recognize the broader impact of epilepsy beyond seizure management.
Collapse
Affiliation(s)
- Stephanie Kılınç
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK.
| | | | - Alison Guy
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK
| | - Anna van Wersch
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK
| |
Collapse
|
6
|
Tarr J, Cornish F, Gonzalez-Polledo E. Beyond the binaries: reshaping pain communication through arts workshops. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:577-592. [PMID: 29441591 DOI: 10.1111/1467-9566.12669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pain is difficult to communicate and translate into language, yet most social research on pain experience uses questionnaires and semi-structured interviews that rely on words. In addition to the mind/body dualism prevalent in pain medicine in these studies pain communication is characterised by further value-laden binaries such as real/unreal, visible/invisible, and psychological/physical. Starting from the position that research methods play a role in constituting their object, this article examines the potential of participatory arts workshops for developing different versions of pain communication. Twenty-two participants were involved in workshops using drawing, digital photography, sound and physical theatre to explore pain communication. The use of arts materials made pain tangible. By manipulating pain-related objects, participants could consider alternative relationships to their pain. Pain's sociality was also explored, with relations with clinicians and others emerging as potentially cooperative rather than adversarial. Discussions considered whether pain felt internal or external, and whether it was possible to conceive of a self without pain. We argue that the socio-material context of participatory arts workshops enabled these alternative versions of pain. Such methods are a useful addition to medical sociology's heavy reliance on qualitative interviewing.
Collapse
Affiliation(s)
- Jen Tarr
- Department of Methodology, London School of Economics, UK
| | - Flora Cornish
- Department of Methodology, London School of Economics, UK
| | | |
Collapse
|
7
|
Orr DMR, Preston-Shoot M, Braye S. Meaning in hoarding: perspectives of people who hoard on clutter, culture and agency. Anthropol Med 2017; 26:263-279. [PMID: 29232962 DOI: 10.1080/13648470.2017.1391171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hoarding has become increasingly prominent in clinical practice and popular culture in recent years, giving rise to extensive research and commentary. Critical responses in the social sciences have criticised the cultural assumptions built in to the construct of 'hoarding disorder' and expressed fears that it may generate stigma outweighing its benefits; however, few of these studies have engaged directly with 'hoarders' themselves. This paper reports on in-depth, semi-structured interviews with 10 individuals living in England, who received assessment and intervention for hoarding from Social Services. Their narratives drew on the cultural repertoire of values and discourses around waste and worth, the mediation of sociality and relationships through material objects, physical constraints on keeping order and the role played by mental health. Analysing these perspectives anthropologically shows how dominant models of hoarding, such as the DSM-5 paradigm, potentially lend themselves to reductionist understandings that efface the meaning 'hoarding' may have and thereby deny agency to the person labelled as 'hoarder'. More culturally informed analysis, by contrast, affords insights into the complex landscape of value, waste, social critique, emotion, interpersonal relationships and practical difficulties that may underlie hoarding cases, and points the way to more person-centred practice and analysis.
Collapse
Affiliation(s)
- David M R Orr
- Social Work and Social Care, University of Sussex, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Michael Preston-Shoot
- School of Applied Social Studies, Faculty of Health and Social Sciences, University of Bedfordshire, Luton, United Kingdom of Great Britain and Northern Ireland
| | - Suzy Braye
- Social Work and Social Care, University of Sussex, Brighton, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
8
|
Charmaz K. Teaching Theory Construction With Initial Grounded Theory Tools: A Reflection on Lessons and Learning. QUALITATIVE HEALTH RESEARCH 2015; 25:1610-22. [PMID: 26646825 DOI: 10.1177/1049732315613982] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article addresses criticisms of qualitative research for spawning studies that lack analytic development and theoretical import. It focuses on teaching initial grounded theory tools while interviewing, coding, and writing memos for the purpose of scaling up the analytic level of students' research and advancing theory construction. Adopting these tools can improve teaching qualitative methods at all levels although doctoral education is emphasized here. What teachers cover in qualitative methods courses matters. The pedagogy presented here requires a supportive environment and relies on demonstration, collective participation, measured tasks, progressive analytic complexity, and accountability. Lessons learned from using initial grounded theory tools are exemplified in a doctoral student's coding and memo-writing excerpts that demonstrate progressive analytic development. The conclusion calls for increasing the number and depth of qualitative methods courses and for creating a cadre of expert qualitative methodologists.
Collapse
Affiliation(s)
- Kathy Charmaz
- Sonoma State University, Rohnert Park, California, USA
| |
Collapse
|
9
|
Markle GL, Attell BK, Treiber LA. Dual, Yet Dueling Illnesses: Multiple Chronic Illness Experience at Midlife. QUALITATIVE HEALTH RESEARCH 2015; 25:1271-1282. [PMID: 25420479 DOI: 10.1177/1049732314559948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The prevalence of multiple chronic illnesses is increasing dramatically, especially among those in middle adulthood, yet much prior research has focused on the experience of multiple morbidity among older adults. We examined the online illness narratives (blogs) of 10 men and women aged 36 to 59 to better understand the experience of living with multiple chronic illnesses at midlife. Multiple morbidity presents distinct challenges to those at midlife: (a) diagnosis and management of multiple illnesses, (b) need for information, (c) identity dilemmas and threats to self-image, and (d) stigma and social rejection. Relinquishing the work identity was especially difficult for participants because it threatened to foreshorten middle adulthood and push them prematurely into late adulthood. Participants used their blogs to revise their identities, alleviate isolation, and inform and guide others.
Collapse
|
10
|
Eaves ER, Nichter M, Ritenbaugh C, Sutherland E, Dworkin SF. Works of Illness and the Challenges of Social Risk and the Specter of Pain in the Lived Experience of TMD. Med Anthropol Q 2014; 29:157-77. [PMID: 25331799 DOI: 10.1111/maq.12146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Temporomandibular Disorders (TMD) represent a particular form of chronic pain that, while not outwardly debilitating, profoundly impacts interactions as fundamental to human existence as smiling, laughing, speaking, eating, and intimacy. Our analysis, informed by an expanded "works of illness" assessment, draws attention to work surrounding social and physical risk. We refer to these as the work of stoicism and the work of vigilance and identify double binds created in contexts that call for both. Conflicting authorial stances in informants' narratives are shown to be essential in maintaining a positive identity in the face of illness. While earlier ethnographic studies report TMD sufferers' experience of stigma and search for diagnosis and legitimacy, we present a group of individuals who have accepted diagnosis at face value and soldier through pain as a fundamental aspect of their identity.
Collapse
Affiliation(s)
- Emery R Eaves
- School of Anthropology and Department of Family and Community Medicine, University of Arizona.
| | - Mark Nichter
- School of Anthropology and Department of Family and Community Medicine and College of Public Health, University of Arizona
| | - Cheryl Ritenbaugh
- Department of Family and Community Medicine and School of Anthropology, University of Arizona
| | | | - Samuel F Dworkin
- Department of Oral Medicine, School of Dentistry and Department of Psychiatry and Behavioral Science, University of Washington
| |
Collapse
|
11
|
Bernays S, Rhodes T, Jankovic Terzic K. Embodied accounts of HIV and hope: using audio diaries with interviews. QUALITATIVE HEALTH RESEARCH 2014; 24:629-640. [PMID: 24667100 DOI: 10.1177/1049732314528812] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Capturing the complexity of the experience of chronic illness over time presents significant methodological and ethical challenges. In this article, we present methodological and substantive insights from a longitudinal qualitative study with 20 people living with HIV in Serbia. We used both repeated in-depth interviews and audio diaries to explore the role of hope in coping with and managing HIV. Using thematic longitudinal analysis, we found that the audio diaries produced distinctive, embodied accounts that straddled the public/private divide and engaged with alternative social scripts of illness experience. We suggest that this enabled less socially anticipated accounts of coping, hoping, and distress to be spoken and shared. We argue that examining the influence of different methods on accounting not only illustrates the value of qualitative mixed-method study designs but also provides crucial insights to better understand the lived experience of chronic illness.
Collapse
Affiliation(s)
- Sarah Bernays
- 1London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | |
Collapse
|
12
|
Clark PG. Narrative in interprofessional education and practice: implications for professional identity, provider–patient communication and teamwork. J Interprof Care 2013; 28:34-9. [DOI: 10.3109/13561820.2013.853652] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Ryan S, Räisänen U. "The brain is such a delicate thing": an exploration of fear and seizures among young people with epilepsy. Chronic Illn 2012; 8:214-24. [PMID: 22615484 DOI: 10.1177/1742395312449666] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Epilepsy is a condition where pathology, diverse manifestations and attached social understandings contribute to an emotional experience unlike many other chronic conditions. The emotional dimension to epilepsy has been little considered in existing research. OBJECTIVES To explore the emotional experience of young people with epilepsy. METHODS A qualitative study involving in-depth interviews with 37 young people diagnosed with epilepsy. RESULTS Fear emerged as the key emotion and this largely related to the experience, or anticipated experience, of seizure activity. Three key features of fear and epilepsy emerged through the analysis; harm, temporality and action. The fear experienced was not only external, relating to immediate injury, but also internal in terms of potential damage to the brain. The embodied nature of epilepsy can, therefore, present a threat to conceptions of the self. Underlying this internal dimension of fear is an understanding of the brain as central to the sense of self. CONCLUSIONS The experience of epilepsy does not only involve fear of physical harm but also fear of a loss of self. We conclude that there are broader (alternative) readings of the experience of epilepsy that are often overlooked.
Collapse
Affiliation(s)
- Sara Ryan
- Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
| | | |
Collapse
|
14
|
Abstract
Chronic obstructive pulmonary disease (COPD) in advanced stages runs an unpredictable downward course with increasingly frequent, ultimately fatal exacerbations. Worldwide financial and human costs are huge. Responsibility for initiating advance care planning in COPD has usually fallen to the physicians. The tendency has been to avoid this aspect of care, which can result in inadequate, rushed, reactive, crisis decision-making in the form of a “code status” discussion. In this article, I review the relevant literature and report findings from a qualitative study designed within my doctoral program to explore the question, “What is required for meaningful and effective advance care planning in the context of advanced COPD?” I describe the “collaborative care” approach to advance care planning I used with eight patients and carers living with advanced COPD. Along with a skilled clinician facilitator, user-friendly education elements, and attention to readiness, unique aspects of the approach included a focus on caring, engaging hope, facilitator reflective praxis, and contextual sensitivity. This approach has significant potential for enhancing decision making and goal setting, efficiency of resource utilization, and satisfaction with outcomes. Done well, it may reclaim the care element in advance care planning as it addresses barriers cited by physicians and patients/families.
Collapse
Affiliation(s)
- Catherine Simpson
- Division of Respirology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| |
Collapse
|
15
|
Gillard A, Witt PA, Watts CE. Outcomes and processes at a camp for youth with HIV/AIDS. QUALITATIVE HEALTH RESEARCH 2011; 21:1508-1526. [PMID: 21709127 DOI: 10.1177/1049732311413907] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The impact of HIV/AIDS on the lives of youth with this chronic illness suggests the need for additional support as youth develop. Summer camp can serve as a therapeutic intervention for youth with HIV/AIDS. Using a case study employing observations, focus groups, and interviews, we examined outcomes associated with participation in a camp for youth with HIV/AIDS, and program processes that influenced outcomes. Findings showed that camp played a major developmental role for youth. Three outcomes of camp emerged: (a) forming caring connections (awareness of commonalities, lack of isolation); (b) feeling reprieve and recreation (fun activities, anticipation of and reflection on camp, sense of freedom); and (c) increasing knowledge, attitudes, and skills (conflict management, disclosure, skill learning and education, medication adherence). Processes included formal and informal education, staff-camper interactions, long-term relationships, outside-of-camp support, activities, planning for camper needs, accessibility, and freedom from worry. We discuss implications for youth programs.
Collapse
Affiliation(s)
- Ann Gillard
- Springfield College, Springfield, MA 01109-3797, USA.
| | | | | |
Collapse
|
16
|
Woodby LL, Williams BR, Wittich AR, Burgio KL. Expanding the notion of researcher distress: the cumulative effects of coding. QUALITATIVE HEALTH RESEARCH 2011; 21:830-838. [PMID: 21393618 DOI: 10.1177/1049732311402095] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Qualitative researchers who explore the individual's experience of health, illness, death, and dying often experience emotional stress in their work. In this article, we describe the emotional stress we experienced while coding semistructured, after-death interviews conducted with 38 next of kin of deceased veterans. Coding sensitive topic data required an unexpected level of emotional labor, the impact of which has not been addressed in the literature. In writing this discussion article, we stepped back from our roles as interviewers/coders and reflected on how our work affected us individually and as a team, and how a sequence of exposures could exert a cumulative effect for researchers in such a dual role. Through this article, we hope to generate an expanded discourse on how qualitative inquiry impacts the emotional well-being of researchers.
Collapse
Affiliation(s)
- Lesa L Woodby
- Department of Veterans Affairs, Birmingham VA Medical Center, Birmingham, Alabama 35233, USA.
| | | | | | | |
Collapse
|
17
|
Maciver D, Jones D, Nicol M. Parents' experiences of caring for a child with chronic pain. QUALITATIVE HEALTH RESEARCH 2010; 20:1272-1282. [PMID: 20406993 DOI: 10.1177/1049732310367499] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Involvement of parents in their children's pain management is universally accepted as best practice, yet there is little understanding of their needs. Twelve parents of children with chronic pain were recruited to this study in which the impact of caring for a child with chronic pain was explored. All parents started in distress, and most moved into a stance that enabled them to balance the child's needs with their own. These parents discussed "stepping back" from their child's distress and gaining mastery over fearful emotional reactions. A minority remained in distress, finding an adaptive response to the child's pain challenging. Catastrophic thinking, fear of pain, and the desire to fulfill a nurturing parental role led parents to place themselves continually "on call." Findings indicate that parents might require support to care effectively for their children, and that many of the actions necessitated by children's pain require complex and counterintuitive decisions.
Collapse
Affiliation(s)
- Donald Maciver
- School of Health Sciences, Occupational Therapy and Arts Therapies Subject Area, Queen Margaret University, Edinburgh, Scotland, United Kingdom, EH21 6UU.
| | | | | |
Collapse
|
18
|
Abstract
Self-care management is essential for effective chronic disease management. Yet prevailing approaches of healthcare practitioners often undermine the efforts of those who require on-going medical attention for chronic conditions, emphasizing their status as patients, failing to consider their larger life experience as people, and most importantly, failing to consider them as people with the potential to be partners in their care. This article explores two approaches for professional-patient interaction in chronic disease management, namely, patient-centred care and empowering partnering, illuminating how professionals might better interact with chronically ill individuals who seek their care. The opportunities, challenges, theory and research evidence associated with each approach are explored. The advantages of moving beyond patient-centred care to the empowering partnering approach are elaborated. For people with chronic disease, having the opportunity to engage in the social construction of their own health as a resource for everyday living, the opportunity to experience interdependence rather than dependence/independence throughout on-going healthcare, and the opportunity to optimize their potential for self-care management of chronic disease are important justifications for being involved in an empowering partnering approach to their chronic disease management.
Collapse
Affiliation(s)
- Carol L McWilliam
- Faculty of Health Sciences, The University of Western Ontario, London, Ontario N6A 5C1, Canada.
| |
Collapse
|
19
|
Lefebvre H, Cloutier G, Josée Levert M. Perspectives of survivors of traumatic brain injury and their caregivers on long-term social integration. Brain Inj 2008; 22:535-43. [PMID: 18568706 DOI: 10.1080/02699050802158243] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) has damaging impacts on victims and family members' lives and their long-term social integration constitutes a major challenge. PURPOSE The objective of the study was to document the repercussions of TBI on victims' long-term social integration (10 years post-trauma) and the contribution made by the services received from the point of view of TBI victims and family caregivers. This article examines the determinants of long-term social integration as well as the impact of TBI on family caregivers. METHODS A qualitative design was used (semi-directed interviews). The sample consisted of 22 individuals who had sustained a moderate or severe TBI and 21 family caregivers. RESULTS The results show that TBI is an experience that continues to present difficulties, even 10 years after the accident, and that different barriers contribute to this difficulty: not going back to work, depressive episodes, problems in relationships and sequellae. Family caregivers must help TBI victims confront the barriers in their path. IMPLICATIONS This study adopts a longitudinal perspective to help professionals determine how to intervene with TBI victims and their families. It validates the importance of having clients and family caregivers describe their reality.
Collapse
Affiliation(s)
- Hélène Lefebvre
- Faculty of Nursing, Universite de Montreal, Montreal, Quebec, Canada.
| | | | | |
Collapse
|
20
|
Reynolds F, Lim KH, Prior S. Images of Resistance: A Qualitative Enquiry Into the Meanings of Personal Artwork for Women Living With Cancer. CREATIVITY RESEARCH JOURNAL 2008. [DOI: 10.1080/10400410802060059] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
21
|
|
22
|
|
23
|
Leonard L, Ellen JM. "The Story of My Life": AIDS and 'Autobiographical Occasions'. QUALITATIVE SOCIOLOGY 2008; 31:37-56. [PMID: 20216918 PMCID: PMC2834208 DOI: 10.1007/s11133-007-9086-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Talk and 'telling' have assumed prominent roles in preventing HIV and promoting life with the disease at the start of the twenty-first century. Our concern in this paper is to show how social structures and circumstances shape the narrative productions of HIV positive patients whose lives are institutionally managed. We consider what 'telling' means when young women with few economic resources are encouraged or mandated to talk about themselves by case managers, researchers, therapists, welfare workers, and clinic staff. We organize our analysis around three such 'autobiographical occasions': disclosures to intimate partners prompted by agents of the state; employment opportunities in which women are hired to tell others about living with HIV as peer educators or outreach health workers; and research interviews. We argue that storylines about living with HIV have been laid down by powerful social actors whose illness experiences do not reflect those of many poor patients. These formulations constitute an 'archive' which organizes institutional practices and discourses. These matter not only because they provide patients with a language through which to render their actions meaningful, but because they shape the everyday experience of HIV outside the clinic, the welfare office, and the therapy session.
Collapse
Affiliation(s)
- Lori Leonard
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, 624 N. Broadway, Room 257, Baltimore, MD 21205, USA
| | - Jonathan M. Ellen
- Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord, Center Tower, 5200 Eastern Ave., Suite 4200, Baltimore, MD 21224, USA
| |
Collapse
|
24
|
Warren-Findlow J. Weathering: stress and heart disease in African American women living in Chicago. QUALITATIVE HEALTH RESEARCH 2006; 16:221-37. [PMID: 16394211 DOI: 10.1177/1049732305278651] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Researchers have suggested that lifelong chronic and cumulative exposure to social and economic stressors is associated with early onset of chronic illness in African American women. Recent literature has demonstrated that socioeconomic aspects of neighborhoods contribute to health disparities in heart disease morbidity and mortality. In this article, the author analyzes the stories of older African American women concerning stress and other events related to heart disease, triangulated with individual- and neighborhood-level socioeconomic and environmental data, from the perspective of the weathering conceptual framework. She conducted in-depth qualitative interviews with urban, older Black women with early-stage heart disease. Women described lifelong and recent incidents of stress that they perceived as contributing to their "bad heart." The episodes described were a mixture of chronic social, environmental, and family-related challenges. Findings reveal substantial evidence supporting the weathering conceptual framework and the Sojourner syndrome in this sample of older, chronically ill Black women.
Collapse
Affiliation(s)
- Jan Warren-Findlow
- Department of Health Behavior and Administration, College of Health and Human Services, University of North Carolina at Charlotte, NC 28233-0001, USA.
| |
Collapse
|
25
|
Mosack KE, Abbott M, Singer M, Weeks MR, Lucy R. If I didn't have HIV, I'd be dead now: illness narratives of drug users living with HIV/AIDS. QUALITATIVE HEALTH RESEARCH 2005; 15:586-605. [PMID: 15802537 PMCID: PMC2910614 DOI: 10.1177/1049732304271749] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The purpose of this study is to illuminate the experiences of lower income, urban, HIV-positive drug users. The authors asked 60 participants about HIV risk behaviors, the impact of HIV on their lives, religious beliefs, life plans, relationships, and work-related issues both prior to and since diagnosis. They developed a theoretical framework based on illness narratives and ambiguous loss theories. Themes pertaining to both physical and emotional or spiritual dimensions were located within Benefit, Loss, or Status Quo orientations. The findings contribute to researchers' understanding of the HIV/AIDS illness experiences among the very marginalized and have important implications for physical and mental health care professionals working with HIV-positive drug users.
Collapse
Affiliation(s)
- Katie E. Mosack
- Center for AIDS Intervention Research (CAIR), 2071 N. Summit Avenue, Milwaukee, Wisconsin 53202; phone (414) 456-7740; fax (414) 287-4209
| | - Maryann Abbott
- Institute for Community Research, 2 Hartford Square West, Suite 100, Hartford, Connecticut 06106; phone (860) 278-2044; fax (860) 278-2141
| | - Merrill Singer
- Hispanic Health Council, 175 Main Street, Hartford, Connecticut 06106; phone (860) 527-0856; fax (860) 724-0437
| | - Margaret R. Weeks
- Institute for Community Research, 2 Hartford Square West, Suite 100, Hartford, Connecticut 06106; phone (860) 278-2044; fax (860) 278-2141
| | - Rohena Lucy
- Hispanic Health Council, 175 Main Street, Hartford, Connecticut 06106; phone (860) 527-0856; fax (860) 724-0437
| |
Collapse
|
26
|
Harden J. Parenting a young person with mental health problems: temporal disruption and reconstruction. SOCIOLOGY OF HEALTH & ILLNESS 2005; 27:351-71. [PMID: 15953212 DOI: 10.1111/j.1467-9566.2005.00446.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The article explores the experiences of parents living with a young person with mental health problems. Qualitative interviews were conducted with 25 parents (18 mothers and 7 fathers) whose child had a diagnosed psychiatric condition. It is argued that the parents engaged in a form of narrative reconstruction of their dual roles as parents and carers as they tried to make sense of the illness in their lives by reconstructing their past, present and future experiences. The concept 'responsibility' was threaded through the parents' narratives and is discussed in relation to three key dimensions - moral responsibility; causal responsibility; and responsibility for self. It is argued that the moral imperative to care for their child was the dominant theme in the parents' narratives but that this was challenged by their lack of knowledge of psychiatric conditions; their interactions with healthcare professionals; their relationships with their child; and their difficulties in coping with the extended parental responsibility that arose from their caring role.
Collapse
Affiliation(s)
- Jeni Harden
- School of Psychology and Sociology, Napier University, Edinburgh, Edinburgh, UK.
| |
Collapse
|
27
|
Harden J. "Uncharted waters": the experience of parents of young people with mental health problems. QUALITATIVE HEALTH RESEARCH 2005; 15:207-223. [PMID: 15611204 DOI: 10.1177/1049732304269677] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In this article, the author discusses the experiences of parents of young people with mental health problems and their relations with health care professionals. She conducted qualitative interviews with 25 parents whose teenage child had a diagnosed psychiatric condition. She argues that the experiences of parent-carers can best be understood in the context of the particular relationships involved. The author contextualizes the meanings parents give to care received in wider understandings of parenting and the parental caregiving role. She argues that the parents were deskilled by the condition and by the medical profession. At the same time, parents engaged in a range of actions through which they were reskilled and their parental caregiving role was reestablished.
Collapse
Affiliation(s)
- Jeni Harden
- School of Psychology and Sociology, Napier University, Edinburgh, Scotland
| |
Collapse
|
28
|
Werner A, Isaksen LW, Malterud K. 'I am not the kind of woman who complains of everything': illness stories on self and shame in women with chronic pain. Soc Sci Med 2004; 59:1035-45. [PMID: 15186903 DOI: 10.1016/j.socscimed.2003.12.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this study, we explore issues of self and shame in illness accounts from women with chronic pain. We focused on how these issues within their stories were shaped according to cultural discourses of gender and disease. A qualitative study was conducted with in-depth interviews including a purposeful sampling of 10 women of varying ages and backgrounds with chronic muscular pain. The women described themselves in various ways as 'strong', and expressed their disgust regarding talk of illness of other women with similar pain. The material was interpreted within a feminist frame of reference, inspired by narrative theory and discourse analysis. We read the women's descriptions of their own (positive) strength and the (negative) illness talk of others as a moral plot and argumentation, appealing to a public audience of health personnel, the general public, and the interviewer: As a plot, their stories attempt to cope with psychological and alternative explanations of the causes of their pain. As performance, their stories attempt to cope with the scepticism and distrust they report having been met with. Finally, as arguments, their stories attempt to convince us about the credibility of their pain as real and somatic rather than imagined or psychological. In several ways, the women negotiated a picture of themselves that fits with normative, biomedical expectations of what illness is and how it should be performed or lived out in 'storied form' according to a gendered work of credibility as woman and as ill. Thus, their descriptions appear not merely in terms of individual behaviour, but also as organized by medical discourses of gender and diseases. Behind their stories, we hear whispered accounts relating to the medical narrative about hysteria; rejections of the stereotype medical discourse of the crazy, lazy, illness-fixed or weak woman.
Collapse
Affiliation(s)
- Anne Werner
- Centre for Women's Studies and Gender Research, University of Oslo, P.O. Box 1040 Blindern, N-0315 Oslo, Norway.
| | | | | |
Collapse
|