Using qualitative research

Amplifying Their Voice: Inclusive Healthcare Provider Perspectives to Improve Advancement, Resilience, and Retention

BACKGROUND AND OBJECTIVES

 Addressing the issues of workplace advancement, resilience, and retention within medicine is crucial for creating a culture of equity, respect, and inclusivity especially towards women and nonbinary (WNB) providers including advanced practice providers (APPs), most notably those from marginalized groups. This also directly impacts healthcare quality, patient outcomes, and overall patient and employee satisfaction. The purpose of this study was to amplify the voices on challenges faced by WNB providers within a pediatric academic healthcare organization, to rank workplace interventions addressing advancement, resilience, and retention highlighting urgency towards addressing these issues, and, lastly, to provide suggestions on how to improve inclusivity.

METHODS

 Participants were self-identified WNB providers employed by a pediatric healthcare organization and its affiliated medical university. An eligibility screener was completed by 150 qualified respondents, and 40 WNBs actually participated in study interviews. Interviews were conducted using a semi-structured interview guide to rank interventions targeted at improving equity, with time allotted for interviewees to discuss their personal lives and how individual circumstances impacted their professional experiences.

RESULTS

 WNB providers called for efficient workflows and reducing uncompensated job demands. Support for family responsibilities, flexible financial/compensation models, and improved job resources all were endorsed similarly. Participants ranked direct supervisor and leader support substantially lower than other interventions.  Conclusions: Career mentorship and academic support for WNB individuals are recognized interventions for advancement and retention but were not ranked as top priorities. Respondents focused on personal supports as they relate to family, job resources, and flexible compensation models. Future studies should focus on implementing realistic expectations and structures that support whole lives including professional ambitions, time with family, personal pursuits, and self-care.

Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis

OBJECTIVE

Reductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children's health. The reasons for these changes are not well described. This review aims to explore the factors reported by parents that influenced their decision-making around accessing paediatric unscheduled healthcare during the COVID-19 pandemic.

DESIGN

Mixed methods rapid review and thematic synthesis based on the Enhancing Transparency of Reporting the Synthesis of Qualitative research framework.

DATA SOURCES

MEDLINE, Embase, Web of Science, PsycEXTRA, PsycINFO, Global Health, Global Index Medicus, Dissertations and Theses Global, Google Scholar and OAISter. Studies published from January 2020 to July 2023 were included.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Qualitative, quantitative and mixed methods studies that assessed the perspectives of parents on decisions to access or delay or avoid accessing paediatric unscheduled healthcare during the COVID-19 pandemic.

DATA EXTRACTION AND SYNTHESIS

Nvivo 14.23.0 was used to code results the of the primary studies and develop themes, following a thematic synthesis approach.

RESULTS

Twelve studies were included, all from high-income settings, mainly in Europe. The studies were conducted across varying times and levels of COVID-19-related restrictions. The principal descriptive themes identified were (i) concerns about COVID-19 infection, (ii) balancing and navigating risks, (iii) perception of healthcare service status and conditions and (iv) perception of information and advice. These were developed into analytic themes to further describe the decision-making process.

CONCLUSIONS

Parents balanced a range of risks, concerns, advice and responsibilities when considering accessing paediatric unscheduled healthcare during the COVID-19 pandemic. External sources of advice and information were important; misconceptions around public health advice may reflect the multitude of information sources and the rapidly changing circumstances of the pandemic. Public health policy and planning should consider parent perspectives when developing measures to ensure equitable access to appropriate paediatric healthcare services.

Developing a core competency and capability framework for advanced practice physiotherapy: A qualitative study

INTRODUCTION

There is an urgent need to develop an international competency and capability framework to support standardization of education and roles in advanced practice physiotherapy (APP). This need arose due to the rapid growth of the APP model of care, implemented out of necessity in the absence of agreement as to the competencies and capabilities or formal education required for the roles. This study explores the views and perceptions of practitioners and key stakeholders on a draft competency and capability framework for advanced practice physiotherapists.

OBJECTIVES

The purpose of this study was to: 1) gather feedback from key stakeholders (advanced practice physiotherapists, researchers, and leaders) on a draft competency and capability framework and 2) use that feedback to revise and improve the draft framework.

DESIGN

Qualitative study using a series of four multi-national online focus groups. Thematic analysis was conducted according to Braun and Clarke.

RESULTS

Sixteen participants from the United Kingdom, Ireland, Canada, Australia, and New Zealand participated in the study. Five themes were generated after data analysis: clinical expert, experienced communicator, strong leader, collaborator, and knowledge creator). A modified competency and capability framework was developed based on feedback from the focus groups and input from subject matter experts (SMEs).

CONCLUSION

This study provides a modified core competency and capability framework comprising 24 competencies grouped under six domains. This study is a step toward international standardization of advanced practice physiotherapy based on a commonly agreed framework for the education and training of advanced practice physiotherapists.

The optics of weight: expert perspectives from the panopticon and synopticon

Objective: That we all weigh something is a fact of life, yet the material reality of weight is refracted through multiple layers of surveillance revealing contradictions in experience and understanding, depending on one's vantage point. We explored the complexities of weight with the specific aim of furthering understanding of this multifaceted surveillance.

Methods and Measures: We used hermeneutics, the philosophy and practice of interpretation, as the method of inquiry. Ten experts by experience and seven professional experts participated in interviews, which were audio- recorded, transcribed, and analyzed. Interpretations were developed through group discussions among the eight authors and reiterative writing.

Results: Using the metaphor of optics, we demonstrate how the interplay of the panopticon (the few watching the many) and synopticon (the many watching the few) help us gain a deeper understanding of weight through "fitting in," being "captured by numbers," "dieting: the tyrannic tower," and "the male gaze."

Conclusion: Monitoring and judging body weight have become so normative in Western society that "weight watching" practices are synonymous with good citizenship and moral character. This study offers insight about how weight is conceptualized in personal and professional contexts, with implications for body image, dieting, eating disorders, public health, and weight bias.

Use of tele-nursing in primary care: A qualitative study on its negative and positive aspects

OBJECTIVE

To analyze the opinions of nursing professionals on the current limitations and future potential of digital tools in healthcare.

DESIGN

Qualitative and descriptive study.

LOCATION

The study took place during an asynchronous MOODLE course on the use of ICT in healthcare, specifically aimed at nursing professionals.

PARTICIPANTS

The number of nurses enrolled in the course was 150.

METHODS

A qualitative study was conducted focusing on the positive and negative aspects that telenursing can offer in the context of a Moodle training in new technologies for nurses. A thematic analysis was carried out following the method proposed by Braun and Clarke.

RESULTS

In the end 68 nurses participated in the forum. Their statements, opinions and perceptions were analyzed and 28 descriptive codes were obtained and subsequently categorized into positive and negative aspects.

CONCLUSIONS

Nurses positively value the usefulness of digital tools and identify a wide range of benefits of telenursing in daily practice. At the same time, they point out crucial limitations that may slow down the adoption of telenursing, pointing to areas for improvement such as training and digital literacy of both patients and professionals. They consider that telenursing can humanise care, but insist on the need to prevent its use from increasing health inequalities.

The mental health prognosis of offspring born of genocidal rape is influenced by family members, the community and their perceptions toward them

BACKGROUND

There is little known about the family and community maltreatment of the offspring born of the genocidal rape and the offspring's self-perceptions and how they influence their recovery from mental health problems. This study aimed to examine how the mental health prognosis of these offspring could be influenced by the family or community perceptions and attitudes toward them and their self-perception and coping strategies.

METHODS

Thirty-two semi-structured qualitative interviews were conducted on 16 dyads of mothers and their offspring who were selected from countrywide. The interviews were audio-recorded and transcribed verbatims that were analysed inductively using thematic analysis within the NVivo 12 software.

RESULTS

Participants reported long-term psychological and psychosomatic consequences stemming from being born of genocidal rape. Notably, family and community maltreatment of the offspring and their self-perception exacerbated psychological distress and affected their capacity to recover. The majority of the offspring were using coping strategies such as sole collaboration with peers with the same history, efforts to hide their birth history, social Isolation (silence, untrusting, involvement in media etc), hardworking, reversed roles in the parental relationship, extreme involvement in praying, and harmful alcohol use.

CONCLUSION

Given the documented detrimental effects of individual, family and community attitudes and perceptions on psychological, and psychosomatic symptoms as well as the offspring coping strategies, culturally relevant mental health interventions are required to support the well-being and social reintegration of individuals born of genocidal rape while minimizing stigma and their maladaptive coping strategies.

Technology, data, people, and partnerships in addressing unmet social needs within Medicaid Managed Care

BACKGROUND

Individuals with unmet social needs experience adverse health outcomes and are subject to greater inequities in health and social outcomes. Given the high prevalence of unmet needs among Medicaid enrollees, many Medicaid managed care organizations (MCOs) are now screening enrollees for unmet social needs and connecting them to community-based organizations (CBOs) with knowledge and resources to address identified needs. The use of screening and referral technology and data sharing are often considered key components in programs integrating health and social services. Despite this emphasis on technology and data collection, research suggests substantial barriers exist in operationalizing effective systems.

METHODS

We used qualitative methods to examine cross-sector perspectives on the use of data and technology to facilitate MCO and CBO partnerships in Kentucky, a state with high Medicaid enrollment, to address enrollee social needs. We recruited participants through targeted sampling, and conducted 46 in-depth interviews with 26 representatives from all six Kentucky MCOs and 20 CBO leaders. Qualitative descriptive analysis, an inductive approach, was used to identify salient themes.

RESULTS

We found that MCOs and CBOs have differing levels of need for data, varying incentives for collecting and sharing data, and differing valuations of what data can or should do. Four themes emerged from interviewees' descriptions of how they use data, including 1) to screen for patient needs, 2) to case manage, 3) to evaluate the effectiveness of programs, and 4) to partner with each other. Underlying these data use themes were areas of alignment between MCOs/CBOs, areas of incongruence, and areas of tension (both practical and ideological). The inability to interface with community partners for data privacy and ownership concerns contributes to division. Our findings suggest a disconnect between MCOs and CBOs regarding terms of their technology interfacing despite their shared mission of meeting the unmet social needs of enrollees.

CONCLUSIONS

While data and technology can be used to identify enrollee needs and determine the most critical need, it is not sufficient in resolving challenges. People and relationships across sectors are vital in connecting enrollees with the community resources to resolve unmet needs.

Parents' User Experience Accessing and Using a Web-Based Map of COVID-19 Recommendations for Health Decision-Making: Qualitative Descriptive Study

BACKGROUND

The eCOVID19 Recommendations Map & Gateway to Contextualization (RecMap) website was developed to identify all COVID-19 guidelines, assess the credibility and trustworthiness of the guidelines, and make recommendations understandable to various stakeholder groups. To date, little has been done to understand and explore parents' experiences when accessing and using the RecMap website for COVID-19 health decision-making.

OBJECTIVE

To explore (1) where parents look for COVID-19 health information and why, (2) parents' user experience when accessing and using the RecMap website to make health decisions, and (3) what knowledge mobilization activities are needed to increase parents' awareness, use, and engagement with the RecMap website.

METHODS

We conducted a qualitative descriptive study using semistructured interviews and a think-aloud activity with parents of children aged 18 years or younger living in Canada. Participants were asked to provide feedback on the RecMap website and to "think aloud" as they navigated the website to find relevant COVID-19 health recommendations. Demographic information was collected using a web-based questionnaire. A hybrid deductive and inductive thematic approach guided analysis and data synthesis.

RESULTS

A total of 21 participants (13/21, 62% mothers) were interviewed and participated in a think-aloud activity. The data were categorized into four sections, representative of key elements that deductively and inductively emerged from the data: (1) parent information seeking behaviors and preferences for COVID-19, (2) RecMap website usability, (3) perceived usefulness of the RecMap website, and (4) knowledge mobilization strategies to increase awareness, use, and engagement of the RecMap website. Parents primarily used the internet to find COVID-19 information and focused on sources that they determined to be credible, trustworthy, simple, and engaging. As the pandemic evolved, participants' information-seeking behaviors changed, specifically their topics of interest and search frequency. Most parents were not aware of the RecMap website before this study but found satisfaction with its concept and layout and expressed intentions to use and share it with others. Parents experienced some barriers to using the RecMap website and suggested key areas for improvement to facilitate its usability and perceived usefulness. Recommendations included a more user-friendly home page for lay audiences (separate public-facing user interface), improving the search and filter options, quicker navigation, clearer titles, more family-friendly graphics, and improving mobile-friendly access. Several strategies to disseminate the RecMap website were also expressed, including a mix of traditional and nontraditional methods (handouts and social media) in credible and high-traffic locations that parents frequent often.

CONCLUSIONS

Overall, parents liked the concept of the RecMap website but had some suggestions to improve its usability (language, navigation, and website interface). These findings can be used to improve the RecMap website for parents and offer insight for the development and dissemination of effective web-based health information tools and resources for the general public.

'I've never been so stressed in my life': a qualitative analysis of young adults' lived experience amidst pandemic restrictions in Prince Edward Island, Canada

OBJECTIVES

This qualitative study aimed to explore how young adults experienced the COVID-19 pandemic in relation to extensive lockdowns, social isolation and psychosocial distress. Specifically, this research focused on how the pandemic impacted those who did not contract COVID-19 and lived in a low-risk geographical location. The focus was young adults given they have large social circles (high risk for disease transmission) and have an increased propensity to mental health conditions. These insights can inform planning for future pandemics.

DESIGN

This paper draws on 30 in-depth semistructured interviews. Data were analysed inductively following the principles of a constructivist grounded theory approach.

SETTING AND PARTICIPANTS

30 young adults living in Prince Edward Island during the COVID-19 pandemic, a Canadian province with a low number of COVID-19 cases at the time of data collection.

RESULTS

We developed four themes that describe the experience of young adults during the COVID-19 pandemic: (1) life course disruption, (2) fear and anxiety about the COVID-19 virus, (3) isolation and loss of hope and (4) strategies for managing adversity. Our findings highlight the areas of young adults' lives that were affected by extensive social changes related to the COVID-19 pandemic. We demonstrate that even individuals who had not contracted the virus were considerably impacted.

CONCLUSION

We provide a detailed description of the comprehensive impact of COVID-19 on low-risk young adults not previously infected with the COVID-19 virus. By reflecting on the biographical disruption experienced by young adults, we highlight the need and opportunity to direct healthcare resources towards identifying and addressing the secondary impacts of pandemics. Consequently, these findings can guide decisions relating to future pandemic restrictions to better account for the experiences of individuals living through them.

Perceptions of physical activity among individuals with limb loss: A qualitative study

OBJECTIVES

Individuals with lower-limb amputations (LLA) often have deficits in balance and community walking ability. As a result, people with LLA are often sedentary. The aim of this study was to explore perceptions of physical activity from the perspective of people with LLA.

METHODS

A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semistructured interviews were held by telephone or in person with adults living with major LLAs recruited from rehabilitation hospitals and advertisements on social media. Individuals were included if they were age 18 years and older with a major LLA. Purposive sampling was used to ensure variation by sex, cause, and level of amputation.

RESULTS

Thirty-three people with LLA participated (22 men/11 women; median age 63 years). The majority of individuals had a unilateral, transtibial amputation (∼50% dysvascular LLA). Three main themes were developed to characterize participants' perceptions of physical activity: (1) physical activity is perceived as important but can be challenging after amputation; (2) physical activity has physical and mental health benefits; and (3) physical activity is a means to maintain independence and engagement in community and social life.

CONCLUSIONS

Obtaining the perspectives of individuals with LLA about physical activity helps us understand how they think about it, what motivates them, and how we can optimize physical activity levels. Future research is needed to evaluate the effectiveness of interventions to enhance physical activity in this population.

Understanding primary care perspectives on supporting women's health needs: a qualitative study

BACKGROUND

A consultation for the Women's Health Strategy for England in 2022 highlighted a need to understand and develop how general practice can support women's health needs.

AIM

To understand the perspectives and experiences of primary care practitioners (PCPs) about supporting women's healthcare needs.

DESIGN AND SETTING

Interpretive qualitative research set in general practice in England.

METHOD

PCPs working in general practice settings were recruited through research and professional networks. Semi-structured interviews were conducted via telephone or Microsoft Teams, audiorecorded, transcribed verbatim, and analysed through reflexive thematic analysis.

RESULTS

In total, 46 PCPs were interviewed. Participants had a range of roles and worked in a variety of primary care settings. Results are presented within six themes: 1) being alongside a person from cradle to grave; 2) maintaining the balance between general and specialist skills; 3) generalists and specialists combined make more than the sum of their parts; 4) striving for equity in a collapsing system; 5) firefighting with limited resources; and 6) the GP is being cast as the villain.

CONCLUSION

The findings show that relationships and advocacy are valued as fundamental for women's health in general practice, and highlight the adverse impact of threats to these on staff and services. Developing specialist roles and bespoke services can foster staff wellbeing and could support retention. However, care is needed to ensure that service configuration changes do not result in clinician deskilling or rendering services inaccessible. Care is needed when services evolve to ensure that core aspects of general practice are not diminished or devalued. GP teams are well placed to advocate for their patients, including commitment to seeking equitable care, and these skills and specialist knowledge should be actively recognised, valued, and nurtured.

Perspectives of healthcare professionals and older patients on shared decision-making for treatment escalation planning in the acute hospital setting: a systematic review and qualitative thematic synthesis

Background

Shared Decision-Making (SDM) between patients and clinicians is increasingly considered important. Treament Escalation Plans (TEP) are individualised documents outlining life-saving interventions to be considered in the event of clinical deterioration. SDM can inform subjective goals of care in TEP but it remains unclear how much it is considered beneficial by patients and clinicians. We aimed to synthesise the existing knowledge of clinician and older patient (generally aged ≥65 years) perspectives on patient involvement in TEP in the acute setting.

Methods

Systematic database search was performed in MEDLINE, EMBASE, PsycInfo and CINAHL databases as well as grey literature from database inception to June 8, 2023, using the Sample (older patients, clinicians, acute setting; studies relating to patients whose main diagnosis was cancer or single organ failure were excluded as these conditions may have specific TEP considerations), Phenomenon of Interest (Treatment Escalation Planning), Design (any including interview, observational, survey), Evaluation (Shared Decision-Making), Research type (qualitative, quantitative, mixed methods) tool. Primary data (published participant quotations, field notes, survey results) and descriptive author comments were extracted and qualitative thematic synthesis was performed to generate analytic themes. Quality assessment was made using the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tools. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research) approach was used to assess overall confidence in each thematic finding according to methodology, coherence, adequacy and relevance of the contributing studies. The study protocol was registered on PROSPERO, CRD42022361593.

Findings

Following duplicate exclusion there were 1916 studies screened and ultimately 13 studies were included, all from European and North American settings. Clinician-orientated themes were: treatment escalation is a medical decision (high confidence); clinicians want the best for their patients amidst uncertainty (high confidence); involving patients and families in decisions is not always meaningful and can involve conflict (high confidence); treatment escalation planning exists within the clinical environment, organisation and society (moderate confidence). Patient-orientated themes were: patients' relationships with Treatment Escalation Planning are complex (low confidence); interactions with doctors are important but communication is not always easy (moderate confidence); patients are highly aware of their families when considering TEP (moderate confidence).

Interpretation

Based on current evidence, TEP decisions appear dominated by clinicians' perspectives, motivated by achieving the best for patients and challenged by complex decisions, communication and environmental factors; older patients' perspectives have seldom been explored, but their input on decisions may be modest. Presenting the context and challenge of SDM during professional education may allow reflection and a more nuanced approach. Future research should seek to understand what approach to TEP decision-making patients and clinicians consider to be optimum in the acute setting so that a mutually acceptable standard can be defined in policy.

Funding

HCA International and the NIHR Imperial Biomedical Research Centre.

Factors influencing decisions people with motor neuron disease make about gastrostomy placement and ventilation: A qualitative evidence synthesis

BACKGROUND

People with motor neuron disease (pwMND) are routinely offered gastrostomy feeding tube placement and (non-invasive and invasive) ventilation to manage the functional decline associated with the disease. This study aimed to synthesise the findings from the qualitative literature to understand how individual, clinical team and organisational factors influence pwMND decisions about these interventions.

METHODS

The study design was guided by the enhancing transparency in reporting the synthesis of qualitative research (ENTREC) statement. The search of five bibliography databases and an extensive supplementary search strategy identified 27 papers that included qualitative accounts of pwMND, caregivers and healthcare professionals' (HCPs) experiences of making decisions about gastrostomy and ventilation. The findings from each study were included in a thematic synthesis.

FINDINGS

Making decisions about interventions is an emotional rather than simply a functional issue for pwMND. The interventions can signal an end to normality, and increasing dependence, where pwMND consider the balance between quality of life and extending survival. Interactions with multiple HCPs and caregivers can influence the process of decision-making and the decisions made. These interactions contribute to the autonomy pwMND are able to exert during decision-making. HCPs can both promote and threaten pwMND perceived agency over decisions through how they approach discussions about these interventions. Though there is uncertainty over the timing of interventions, pwMND who agree to interventions report reaching a tipping point where they accept the need for change.

CONCLUSION

Discussion of gastrostomy and ventilation options generate an emotional response in pwMND. Decisions are the consequence of interactions with multiple external agents, including HCPs treading a complex ethical path when trying to improve health outcomes while respecting pwMND right to autonomy. Future decision support interventions that address the emotional response and seek to support autonomy have the potential to enable pwMND to make informed and timely decisions about gastrostomy placement and ventilation.

PATIENT OR PUBLIC CONTRIBUTION

The lead author collaborated with several patient and participant involvement (PPI) groups with regards to the conceptualisation and design of this project. Decisions that have been influenced by discussions with multiple PPI panels include widening the scope of decisions about ventilation in addition to gastrostomy placement and the perceptions of all stakeholders involved (i.e., pwMND, caregivers and HCPs).

Patients' perspectives of recovery after COVID-19 critical illness: An interview study

BACKGROUND

Critical illness is a traumatic experience, often resulting in post-intensive care syndrome, affecting people's physical, psychological, emotional, and social well-being. The early recovery period is associated with increased risk, negatively impacting longer-term outcomes.

AIMS

The aims of this study were to understand the recovery and rehabilitation needs of people who survive a COVID-19 critical illness.

STUDY DESIGN

An exploratory descriptive qualitative interview study with 20 survivors of COVID-19 critical illness from two community-based healthcare settings in London, England. Data collection took place September 2020-April 2021, at least 1 month after hospital discharge by telephone or virtual platform. Data were subjected to inductive thematic analysis and mapped deductively to the three core concepts of self-determination theory: autonomy, competence and relatedness.

RESULTS

Three key themes emerged: traumatic experience, human connection and navigating a complex system. Participants described how societal restrictions, fear and communication problems caused by the pandemic added to their trauma and the challenge of recovery. The importance of positive human connections, timely information and support to navigate the system was emphasized.

CONCLUSIONS

Whilst findings to some extent mirror those of other qualitative pre-pandemic studies, our findings highlight how the uncertainty and instability caused by the pandemic add to the challenge of recovery affecting all core concepts of self-determination (autonomy, competence, relatedness).

RELEVANCE TO CLINICAL PRACTICE

Understanding survivors' perspectives of rehabilitation needs following COVID-19 critical illness is vital to delivery of safe, high-quality care. To optimize chances of effective recovery, survivors desire a specialist, co-ordinated and personalized recovery pathway, which reflects humanized care. This should be considered when planning future service provisions.

The impact of learning styles on attitudes to interprofessional learning among nursing students: a longitudinal mixed methods study

BACKGROUND

A functional interprofessional teamwork improves collaborative patient-centred care. Participation in interprofessional education promotes cooperation after graduation. Individuals tend to use different approaches to learning depending on their individual preferences. The purpose of this study was to explore nursing students' experiences of professional development with a focus on the relationship between attitudes to interprofessional learning and learning styles.

METHODS

A longitudinal parallel mixed-methods design. The study was carried out at a Swedish three-year nursing program from August 2015 to January 2020. On enrolment, thirty-four students self-assessed their attitudes to interprofessional learning according to the Readiness for Interprofessional Learning Scale, and their learning style according to Kolbs' Learning Style Inventory. In the final semester the students participated in an interview focusing on their experiences and perceptions of teamwork and they self-assessed their attitudes to interprofessional learning again.

RESULTS

Our findings indicated that 64.7% had a predominantly concrete learning style and 35.3% had a predominantly reflective learning style. No significant relationship with internal consistency reliability was identified among the participants between attitudes to interprofessional learning and learning styles. The content analysis resulted in four main categories: Amazing when it's functional; Deepened insight of care; Increased quality of care; Understanding own profession which were summarized in the theme: Well-functioning teams improve patients' outcome and working environment.

CONCLUSION

The students' attitudes to interprofessional learning were positive and it was considered as an opportunity to participate in interprofessional cooperation during internship. Transformative learning is a useful strategy in fostering interprofessional relationships due to the interdependence of various professions in interprofessional teams. When students are guided to use reflection to develop new perspectives and meaning structures, they acquire emotional and rational skills beneficial for interprofessional cooperation.

Qualitative Story Completion: Opportunities and Considerations for Health Research

Qualitative story completion (QSC) is an innovative research method that offers researchers a range of unique opportunities for generating and analysing data. Participants are asked to write a 'story' in response to a hypothetical 'story stem', often in the third-person and involving fictional characters, rather than reporting on their direct experiences. QSC is being developed and increasingly taken up by researchers working across a range of fields; but it has been little used in health research, especially in the fields of nursing, health services research, medicine, and allied health. This means that health researchers have few examples to draw on when considering what QSC can offer them and how to rigorously design, conduct, and report a QSC study within health-related fields. We aim to address this gap and contribute to existing QSC literature by promoting increased use of QSC by health researchers and supporting them to produce rigorous QSC research. We outline three case examples illustrating how we have used QSC to conduct multidisciplinary health research relevant to nursing, medicine and nutrition. Drawing on these case examples, we reflect on challenges that we encountered, describe decision-making processes, and offer recommendations for conducting rigorous health research using QSC.

Designing a program to support weight loss for patients attending the sleep medicine clinic: a qualitative study

STUDY OBJECTIVES

Excess body weight is the most important risk factor in sleep-disordered breathing. Weight loss is a treatment alternative to positive airway pressure therapy, but there is a knowledge gap of what is feasible, acceptable, and sustainable in this population. We seek to add the voices of sleep medicine patients and providers to the medical literature to understand what makes this population unique when considering weight loss, and what we can do differently to create more sustainable weight loss interventions.

METHODS

We conducted one-on-one semistructured interviews with 12 patients with obstructive sleep apnea/obesity hypoventilation syndrome and obesity and with 9 sleep medicine providers regarding previous weight loss efforts, perceptions of barriers to and facilitators of weight loss, and potential components of a program to support those with sleep apnea and excess weight.

RESULTS

Patients indicated they appreciated direct conversation with their sleep physician regarding weight loss and providers felt the patient population was generally very receptive to weight loss conversations. Patients emphasized the most important aspects of a future weight loss program would be personalized diet, exercise, accountability, integration of technology, and an individualized approach to addressing the psychological aspects of eating.

CONCLUSIONS

This is a unique population of patients who are very receptive to conversations about weight loss. We plan to use this data to inform a future weight loss program based in health coaching to address the specific needs of this population.

CITATION

Dupuy-McCauley K, Benzo R, Barwise A. Designing a program to support weight loss for patients attending the sleep medicine clinic: a qualitative study. J Clin Sleep Med. 2023;19(3):459-471.

Impact of COVID-19 on the Health Response to Family Violence in Aotearoa New Zealand: A Qualitative Study

COVID-19 pandemic planning and response has resulted in unprecedented upheaval within health systems internationally. With a concern for increasing frequency and escalation of family violence, the so called "shadow pandemic," we wondered how health system violence intervention programs were operating during this time. In Aotearoa New Zealand, the Ministry of Health Violence Intervention Program (VIP), using a systems approach, seeks to reduce and prevent the health impacts of family violence and abuse through early identification, assessment, and referral of victims presenting to designated health services. In this qualitative descriptive study, we explored how the VIP program was impacted during the first year of the COVID-19 pandemic. Forty-one VIP coordinators and managers representing 15 of the 20 New Zealand District Health Boards and the National VIP Team participated. Across 12 focus groups (8 face to face and 4 via Zoom) and 7 individual interviews (all via Zoom) participants shared their experience navigating systems to support frontline health providers' responsiveness to people impacted by family violence during the pandemic. In our reflexive thematic analysis, we generated 3 themes: Responding to the moment, valuing relationships, and reflecting on the status quo. Our findings demonstrate the dynamic environment in which participants found creative ways to adapt to the uncertainty and engage with communities to re-shape interventions and ensure continued implementation of the program. At the same time, challenges within the system prior to the pandemic were brought into view and highlighted the need for action. These included, for example, the need for improved engagement with Māori (Indigenous people of Aotearoa New Zealand) to address long-standing health inequities. Having quality essential services for those impacted by family violence that engages with local knowledge and networks and routinely copes with uncertainty will strengthen our systems to minimize risk of harm during emergencies.

Barriers and Enablers to COVID-19 Vaccination in San Francisco's Spanish-Speaking Population

Populations at high risk for COVID-19- including Spanish speakers-may face additional barriers to obtaining COVID-19 vaccinations; by understanding their challenges, we can create more equitable vaccine interventions. In this study, we used interviews to identify barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Data analysis employed Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework as guides to target barriers with interventions and supporting policies. This paper presents data from interviews focused on COVID-19 vaccine uptake that was part of a project to improve COVID-19 preventive behaviors in San Francisco. We completed seventeen interviews between February and May 2021; six (35%) were completed in English and 11 (65%) in Spanish. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Behavioral factors influencing vaccine uptake were mainly related to physical opportunity, automatic motivation, and psychological capability. Interventions that could address the most significant number of barriers included education, enablement, and environmental restructuring. Finally, communication and marketing policies that use diverse multi-lingual social media and environmental planning that includes accessible vaccine sites for people with disabilities, literacy barriers, and limited English proficiency could significantly increase vaccination. Public health departments should tailor interventions to high-risk populations by understanding the specific barriers they face. This exploratory study suggests how implementation science can provide frameworks to achieve this.

Intensive Care Nurses' Experience of Caring in Greece; A Qualitative Study

BACKGROUND

Whilst nurses and critical care services have been at the forefront of the COVID-19 pandemic, it has become more apparent that intensive care nurses are presented with challenging ethical and clinical decisions and are required to care for individuals with critical illnesses under high-pressure conditions. This is not a new phenomenon. The aim of this study, which was conducted before the outbreak of COVID-19, was to explore the experience of caring through the narratives of intensive care nurses in Greece.

METHODS

A qualitative study was conducted through in-depth, semi-structured interviews with nineteen ICU nurses in Athens. Transcripts were subjected to Braun and Clarke's thematic analysis and organised with Atlas.ti v8 QDA software.

RESULTS

The intensive care nurses' experience of caring in Greece encompassed four themes: (A) being "proximal", "co-present" and caring with empathy, (B) being "responsible" for your patient and negotiating with the doctors, (C) technology and "fighting with all you've got", and (D) "not being kept informed" and disappointment.

CONCLUSIONS

The narratives of this study highlight that ICU nurses in Greece provide patient-centred and compassionate care. Nurse leaders should develop appropriate healthcare policies so as to ensure the adequate provision of staff, specialist education, and support to nurses working in critical care. Failure to address these issues may lead to poor quality of care and negative patient outcomes.

The Experience of Dancing Among Individuals with Cerebral Palsy at an Inclusive Dance Group: A Qualitative Study

BACKGROUND

Art practices such as dance have the potential to support people with disabilities. It is possible that through dancing, bodies that may be regarded as "deficient" can be strengthened while enhancing their personal and cultural identities. It is also possible that inclusive group dance classes can enable the integration of people with disabilities in their social context. However, there is limited research on how these potential benefits are experienced by participants.

AIM

The purpose of this research is to describe the experience of people with cerebral palsy participating in regular dance classes.

METHODS

Semi-structured interviews were conducted with six participants with cerebral palsy who participated in an inclusive dance group that was informed by the creative approach of Laban. The interviews were transcribed, coded, and analyzed according to the thematic analysis of Braun and Clarke. The qualitative analysis software program ATLAS.TI version 8 was used for organizing and data analysis.

FINDINGS

The six interviews were analyzed and codified in four main categories: (1) the experience of cerebral palsy (the body does not help); (2) dance as a form of relationship with myself and the other; (3) the value of dancing and; (4) the dancer. These categories led to the creation of two subthemes: (a) the "unlocking" concerning the therapeutic effect of dance and (b) the "acquisition of a dancer's identity" by engaging with dance as an artform. An overall theme also emerged, "the passage from darkness to light."

CONCLUSIONS

Individuals with cerebral palsy, while taking the risk of being physically "exposed" in dance classes and dance group performances, managed to unlock their bodies, develop connections with others, acquire the identity of a dancer, and move from "darkness" to "light."

Understanding Openness to Involvement in Sexual Health Care Research: Narratives from a Sample of Black College Women in the United States

Little is known about Black college women's openness to participating in sexual health care research. Guided by literature on Black feminism, the current study involved qualitative interviews with 39 Black Women (aged 19-25, mean age 20.7) from one historically Black university and one predominantly white university who answered questions about participating in research on the sexual health of Black women. Results from our thematic analysis found that participants were willing to participate in research when they were recruited by trusted community members, particularly Black female researchers. The women were willing to participate because they saw the value in having Black women's perspectives on sexual health research and improving Black women's lives. We found that participants believed that non-Black women researchers should receive training to increase understanding of the issues facing Black women and create safe and judgment-free spaces to engage Black Women in sexual health research. Participants wanted non-Black female and all male researchers to demonstrate a genuine interest in their lives as Black women. The findings highlight the importance of listening to the perspectives of participants and their experiences with sexual health care providers.

Adherence of those at low risk of disease to public health measures during the COVID-19 pandemic: A qualitative study

Public health measures (PHMs) proactively and reactively reduce the spread of disease. While these measures target individual behaviour, they require broad adherence to be effective. Consequently, the World Health Organization issued a special appeal to young adults, a known non-adherent population, for increased adherence with COVID-19 guidelines. However, little is known about why these low-risk individuals do or do not adhere to PHMs. This study investigates why young adults in a low-risk setting adhered to PHMs implemented during the COVID-19 pandemic. A qualitative research approach was chosen to gain an in-depth understanding of participants’ thoughts and experiences related to PHM adherence. Semi-structured interviews were conducted in April-May 2021 with 30 young adults living in Prince Edward Island (PEI), the province with the lowest COVID-19 case rate in Canada at that time. Thematic analysis was used to create a codebook based on the Theoretical Domains Framework, which was then inductively modified. The analysis identified eight themes that explained the adherence of young adults: (1) clear, purpose-driven adherence rationale, (2) developing trust in the local leadership, (3) adapting to novel measures, (4) manageable disruption, (5) adhering to reduce anxiety, (6) collective duty towards one’s community, (7) moral culpability and (8) using caution rather than compliance. Together, these themes demonstrate that young adults adhered to PHMs because of their sense of connection to their community, public health leadership, and concerns over stigma. We further argue that clear guidelines and communication from public health officials during both periods of high and low COVID-19 cases facilitate adherence. These findings are important for mitigating future public health emergencies as they explain why young adults, an important segment of the population whose adherence is critical to the success of PHMs, follow PHMs. Further, these findings can inform public health officials and other stakeholders aiming to develop successful adherence strategies.

Undergraduate nursing students' experiences of becoming a professional nurse: a longitudinal study

Background

During education it is essential for nursing students to develop professionalism in nursing. Nurses are placed in situations based on trust, and it is crucial that their patients have confidence in them to provide professional and safe care. A key period in nursing students’ development of a professionalism occurs during training when students gain knowledge and skills that separate nurses as professional healthcare workers from laypeople. The purpose of this study was to investigate nursing students’ experiences of professional competence development during education.

Methods

A longitudinal study was carried out using qualitative content analysis with a manifest inductive approach. Thirty-four students enrolled in a Swedish three-year nursing program, from August 2015 to January 2017 were interviewed on four occasions.

Results

The results revealed that students’ professional role developed gradually. The students’ started their education with dreams and a naive understanding of the profession, but their understanding of the complexity of the nursing profession gradually evolved. Students became theoretically equipped at the university and developed clinical skills through practice. Students’ focus went from mastering medical technology to a more holistic approach. Before graduating, students felt ready but not fully trained.

Conclusions

Our findings indicate a discrepancy between the content of the theoretical education and the clinical settings since students identified a lack of evidence-based practice. A solid theoretical education before entering clinical training offered students possibilities for reflecting on evidence-based practice and the clinical settings. The realization that there is always potential for professional improvement can be interpreted as an emerging awareness, and development of professionalism. It is clear that students could benefit from increased collaborative work between clinical supervisors and faculty staff at the university.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01002-0.

Exploring Blood Donation Challenges and Mobilization Mechanisms in North China During the COVID-19 Pandemic: A Qualitative Study

Purpose

The coronavirus disease 2019 (COVID-19) pandemic disrupted the supply of blood globally, resulting in numerous studies focusing on the challenges in maintaining blood supply, and the responses to it, in countries with a mixed blood donation model. This study explored blood donation challenges and mobilization mechanisms in North China, which employs a non-remunerative donation model, during the COVID-19 pandemic’s first wave.

Materials and Methods

A qualitative approach was adopted to investigate blood donation practices in Chengde from April to June 2020. Data were collected from eight blood donors, six potential donors, three blood donation station leaders, and two government officials, through semi-structured interviews.

Results

The major challenge for blood supply was decreased blood donations, owing to lockdown restrictions, and individual and familial apprehensions. Mobilization mechanisms included bureaucratic and ideological mobilization. However, although group blood donation alleviates the pressure on supply chains during emergencies, it is detrimental to the cultivation of civic engagement in the long run.

Conclusion

This study contributes to the understanding of how countries with uncompensated blood donation models respond to public health emergencies. It suggests that striking a balance between the society’s and the state’s perception of blood donation would allow the state to incorporate the different “voices” of society, and devise an inclusive blood donation policy.

Parental experience of parent-mediated intervention for children with ASD: A systematic review and qualitative evidence synthesis

LAY ABSTRACT

The effectiveness of parent-mediated interventions in the field of autism spectrum disorder is well documented but information on the experience of parents involved in parent-mediated interventions is limited.This study is the first synthesis of evidence concerning the experience of parents involved in parent-mediated interventions. It synthesizes the voice of 345 parents across the world into four general themes: barriers to implementation and logistical issues, feeling overwhelmed and stressed (a need for support), facilitators of implementation, and empowerment in the parent and improvement in the child.The findings of our study provide evidence that parent-mediated interventions should be adapted to the needs of each family. Specific care and support should be offered to parents in addition to parent-mediated interventions. Our study, however, highlights which outcomes are important to parents and should be considered in future studies.

Pragmatism as a philosophical foundation to integrate education, practice, research and policy across the nursing profession

AIM

A discussion of the philosophy of pragmatism and how it can underpin and integrate nursing education, practice, research and policy across the nursing profession.

BACKGROUND

Although the concepts of plurality, truth, fallibilism, subjectivity and meliorism have been discussed across foundational philosophical literature, the relation of these concepts across various facets of the nursing profession have not been thoroughly articulated in the nursing literature.

DESIGN

Critical theoretical reflection.

DATA SOURCES

In this article, we draw from literature written on the philosophy of pragmatism from 1907 through to 2021.

IMPLICATIONS FOR NURSING

We propose an integrative approach for the nursing profession where education, practice, research and policy speak and contribute to each other through a lens of pragmatism. In this approach, education has a relationship with practice and practice has a direct line to research where nurses on the front lines can engage with pragmatic inquiry. Researchers in return can inform frontline nurses and policymakers of evidence emerging in areas pertinent to practice. These relationships are made possible through integrated knowledge translation by including all stakeholders at every point of knowledge generation. Each facet of the nursing profession is filled with stakeholders of nursing knowledge, who are invested in its utility. Although it requires focused effort to integrate knowledge across the profession, pragmatism calls for action in the face of challenges in hope for a stronger body of nursing knowledge and ultimately profession.

CONCLUSION

Pragmatism is an apt philosophy to underpin and integrate nursing education, practice, research and policy across the nursing profession.

Termination of pregnancy for fetal anomaly: a systematic review of the healthcare experiences and needs of parents

BACKGROUND

Improved technology and advances in clinical testing have resulted in increased detection rates of congenital anomalies during pregnancy, resulting in more parents being confronted with the possibility of terminating a pregnancy for this reason. There is a large body of research on the psychological experience and impact of terminating a pregnancy for fetal anomaly. However, there remains a lack of evidence on the holistic healthcare experience of parents in this situation. To develop a comprehensive understanding of the healthcare experiences and needs of parents, this systematic review sought to summarise and appraise the literature on parents' experiences following a termination of pregnancy for fetal anomaly.

REVIEW QUESTION

What are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly?

METHODS

A systematic review was undertaken with searches completed across six multi-disciplinary electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane). Eligible articles were qualitative, quantitative or mixed methods studies, published between January 2010 and August 2021, reporting the results of primary data on the healthcare experiences or healthcare needs in relation to termination of pregnancy for fetal anomaly for either, or both parents. Findings were synthesised using Thematic Analysis.

RESULTS

A total of 30 articles were selected for inclusion in this review of which 24 were qualitative, five quantitative and one mixed-methods. Five overarching themes emerged from the synthesis of findings: (1) Contextual impact on access to and perception of care, (2) Organisation of care, (3) Information to inform decision making, (4) Compassionate care, and (5) Partner experience.

CONCLUSION

Compassionate healthcare professionals who provide non-judgemental and sensitive care can impact positively on parents' satisfaction with the care they receive. A well organised and co-ordinated healthcare system is needed to provide an effective and high-quality service.

TRIAL REGISTRATION

PROSPERO registration number: CRD42020175970 .

'Direct' and 'instant': the role of digital technology and social media in young Filipinos' intimate relationships

Young people today grow up in a social landscape in which digital technology and social media are ubiquitous in daily life and interpersonal relations, including intimate (romantic and sexual) relationships. This study sought to study Filipino young people's relationship motivations and contexts in the digital age. We found that digital technology and social media are transforming the way Filipino young people approach and behave in intimate relationships. Digital technology and social media are making it easier for young people to engage in social comparison with their peers and role models, expanding possibilities for social interaction, facilitating rapid relationship progression, and enabling digital togetherness and self-expression in a context where conservative religious and sociocultural norms and sexual double standards remain dominant. This social environment brings opportunities to engage in relationships in new ways but also exposure to risks that may lead to poor sexual and reproductive health outcomes. Our findings underscore the importance of comprehensive sexuality education in schools and at home, and highlight the need for critical dialogue about the social norms and stereotypes that perpetuate gender-based violence and inequality in online and offline spaces.

Factors influencing physical activity among individuals with lower limb amputations: a qualitative study

PURPOSE

The purpose of this study was to explore the barriers and facilitators to physical activity from multiple stakeholder perspectives including individuals with LLA and health professionals.

MATERIALS AND METHODS

A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semi-structured interviews were held with individuals with LLA recruited from rehabilitation hospitals in a metropolitan city in Canada. Health professionals with experience in amputation care were recruited from across Canada. Data were analysed using codebook thematic analysis.

RESULTS

Thirty-three individuals with LLA and eighteen health professionals participated. Six themes were generated which represent the perceived barriers and facilitators to physical activity. Themes including Informal and Formal Supports, Availability of and Access to Community Resources, and Fit and Function of the Prosthesis were perceived by many individuals as facilitators, while acting as a barrier for others depending on an individual's circumstances.

CONCLUSIONS

These findings provide us with a basis of understanding from which we can begin addressing barriers to physical activity for individuals with LLA, in support of developing patient-centred interventions and physical activity programs for this population. IMPLICATIONS FOR REHABILITATIONIrrespective of amputation etiology, individuals who have lower limb amputation experience several barriers to engaging in physical activity.Many system-level barriers to physical activity exist for people with lower limb amputation, which include lack of availability and access to community resources and specialised prostheses conducive to physical activity participation.A participatory approach engaging both patients and rehabilitation professionals can address the patient-provider discordance with respect to a patient's motivation and attitude towards physical activity participation by creating a supportive environment conducive to behaviour change.The development of future, patient-centered interventions, and physical activity programs for individuals with lower limb amputation must consider fear of falling as a prominent barrier to physical activity and devise potential strategies to address this barrier, by setting realistic and actionable goals.

Intensive outpatient treatment for post-traumatic stress disorder: a thematic analysis of patient experience

BACKGROUND

Intensive treatments have shown encouraging results in the treatment of several psychological disorders, including post-traumatic stress disorder (PTSD). However, qualitative studies on patient experiences with intensive treatment for PTSD remain scarce.

OBJECTIVE

The aim of this study was to explore patient experiences with an intensive, outpatient treatment for PTSD and to discover important factors behind treatment feasibility.

METHOD

Eight participants were recruited from two groups of patients having completed the intensive treatment programme. Semi-structured qualitative interviews were conducted, and data sets were analysed using thematic analysis.

RESULTS

The main result indicated that patients experienced the treatment as very demanding, but still worth the effort in terms of reducing symptoms. The intensity was valued as useful. Participants emphasized the sense of unity with other participants as well as physical activity as important factors for completion of the treatment programme. The rotation of therapists was also highlighted as important for treatment efficacy.

CONCLUSIONS

This study provides insights into what the patients experienced and emphasized as important aspects of treatment and essential factors for completing treatment. The main conclusions were that all of the patients evaluated the treatment as demanding, but the reward of reduced symptoms made it worthwhile. The high frequency of therapy sessions and the therapist rotation were reported to counteract avoidance and increase the patients' commitment to therapy. Physical activity and unity in the group were highlighted as essential for treatment feasibility.

HIGHLIGHTS

• High treatment intensity enabled increased focus and adherence, and reduced avoidance.  Therapist rotation led to heightened intensity and new learning experiences.• Physical activity and sense of unity through group elements were reported as important factors for treatment feasibility.

Points of Consideration on Climate Adaptation of Solar Power Plants in Thailand: How Climate Change Affects Site Selection, Construction and Operation

Solar energy is planned to undergo large-scale deployment along with Thailand’s transformation to a carbon neutral society in 2050. In the course of energy transformation planning, the issue of energy infrastructure adaptation to climate change has often been left out. This study aims to identify climate-related risks and countermeasures taken in solar power plants in Thailand using thematic analysis with self-administered observations and structured interviews in order to propose points of consideration during long-term energy planning to ensure climate adaptation capacity. The analysis pointed out that floods and storms were perceived as major climate events affecting solar power plants in Thailand, followed by lightning and fires. Several countermeasures were taken, including hard countermeasures that require extensive investment. Following policy recommendations were derived from the climate-proofing investment scenario study. Policy support in terms of enabling regulations or financial incentives is needed for implementation of climate-proofing countermeasures. Public and private sectors need to secure sufficient budget for fast recovery after severe climate incidents. Measures must be taken to facilitate selection of climate-resilient sites by improving conditions of power purchase agreement or assisting winning bidders in enhancing climate adaptability of their sites. These issues should be considered during Thailand’s long-term energy planning.

"They Wait until the Disease Has Taking over You and the Doctors Cannot Do Anything about It": Qualitative Insights from Harambee! 2.0

African immigrants make up a large subgroup of Black/African-Americans in the US. However, because African immigrant groups are typically categorized as "Black," little is known about their preventative healthcare needs. Differences in culture, life and healthcare experiences between African immigrant populations and US-born people may influence preventive health care uptake. Thus, policymakers and healthcare providers lack information needed to make informed decisions around preventive care for African immigrants. This formative study was conducted among the largest East African immigrant communities in King County, WA. We recruited religious leaders, community leaders, health professionals, and lay community members to participate in thirty key informant interviews and five focus group discussions (n = 72 total), to better understand preventative healthcare attitudes in these communities. Through inductive coding and thematic analysis, we identified factors that impact preventative healthcare attitudes of the Somali, Ethiopian and Eritrean immigrant communities and deter them from accessing and utilizing healthcare. Cultural beliefs and attitudes around preventative healthcare, mistrust of westernized healthcare, religious beliefs/views, intersecting identities and shared immigrant experiences all influence how participants view preventative healthcare. Our results suggest that interventions that address these factors are needed to most effectively increase uptake of preventative healthcare in African immigrant communities.

Providing English and native language quotes in qualitative research: A call to action

Background

When publishing qualitative research in international journals, researchers studying non‐English‐speaking participants provide quotes in English language. This is an issue of increasing concern given the need to be rigorous to represent a diversity of participants within their context, beyond how language (alone) situates them.

Aim

To argue for providing English and native language quotes in qualitative research reports.

Design

Discussion.

Methods

This paper is based on the literature on use of quotes and translation in qualitative research and authors’ experiences of publishing qualitative research.

Results

Provision of native and English language quotes may allow for greater transparency of findings, thereby reflecting that the researchers adequately captured the socially and culturally dependent experiences of participants.

Conclusions

Presentation of findings with eloquent quotes serves as the gateway into the sociocultural experiences of individuals. We argued against the norm of providing translated quotes in qualitative reports and build a case for the provision of native as well as English language quotes to promote cross‐cultural understanding.

Qualitative Research in Veterinary Medical Education: Part 2-Carrying Out Research Projects

This is the second of two articles that together comprise an orientation and introduction to qualitative research for veterinary medical educators who may be new to research, or for those whose research experience is based on the quantitative traditions of biomedicine. In the first article (Part 1-Principles of Qualitative Design), we explored the types of research interests and goals suited to qualitative inquiry and introduced the concepts of research paradigms and methodologies. In this second article, we move to the strategies and actions involved in conducting a qualitative study, including selection and sampling of research sites and participants, data collection and analysis. We introduce some guidelines for reporting qualitative research and explore the ways in which qualitative research is evaluated and the findings applied. Throughout, we provide illustrative examples from veterinary and human medical education and suggest useful resources for further reading. Taken together, the two articles build an understanding of qualitative research, outline how it may be conducted, and equip readers with an improved capacity to appraise its value.

Services for people with intellectual disabilities and mental health problems in Singapore: perspectives from mainstream mental health professionals

Background: Generic mental health staff often have contact with people with intellectual disabilities when they access mainstream mental health services. To date, there has not been any research conducted in non-western countries to explore their views. This paper investigates the views and experiences of mainstream mental health professionals regarding the mental health services for people with intellectual disabilities in Singapore. Methods: Eight staff members from generic mental health services were interviewed. Thematic analysis was used to identify main themes. Findings: The main themes are related to their work experiences, perceptions of people with intellectual disabilities, ideal staff characteristics and service recommendations. Conclusions: Participants identified a lack of experience and knowledge when working with this population. They highlighted the challenges they face promoting choice and autonomy for people with intellectual disabilities. The discussion includes recommendations for improving staff knowledge through training opportunities, consideration of non-pharmacological approaches and early collaboration with caregivers during the treatment process.

Strict and Comprehensive Tobacco Control Policy is Needed: A Qualitative Study Exploring How People Responding a New Policy of Pictorial Health Warning on Cigarette Package in Indonesia

BACKGROUND: Little is known about the process on how smoker and nonsmoker responses to a Pictorial Health Warning (PHW) which is important for policy improvement. AIM: We aim to explore the nature of the reaction and the extent of impact of the PHW implementation on smoking habit in Indonesia. METHODS: We collected the data among adult aged 18+ years in Sleman District, Yogyakarta, Indonesia, involving 45 informants in in-depth interviews and 22 informants in four Focus Group Discussions, selected using the maximum variation sampling according to smoking status and area of residence. We discussed with respondents about the meaning of the PHWs, how they felt when seeing the PHWs, how those feelings emerged when seeing the PHWs, and the impact of seeing the PHWs. We analyzed the data using the content analysis. RESULTS: PHWs raised the intended negative emotional response, that wearing out over time. However, for smokers, the disease threat in the message was less obvious than to defeat smoking addiction. Smokers tried to manage their risk of illness themselves. Among non-smokers, they were more confident in being non-smokers. Both smokers and non-smokers thought that Government is half-hearted in controlling the smoking problem. Smokers were grateful, but non-smokers were sorry for this. CONCLUSIONS: The application of PHW threatens smokers but does not make them quit smoking because of the fear of defeating cigarette dependence. For non-smokers, they feel more confident to be a smoker-free. Respondents claim the government is not serious about controlling smoking.

Asking "Meaning Questions" in Evidence-Based Reviews and the Utility of Qualitative Findings in Practice

Evidence-based practice (EBP) systematic reviews are mostly conducted using etiology, diagnosis, therapy, prevention, and prognosis question format. "Meaning" or qualitative questions are very rarely used. The purpose of this article is to discuss qualitative findings' contribution to EBP through asking "meaning questions" in conducting systematic reviews and the utilization of the results to practice. Two EBP systematic review exemplars using meaning questions including the relevance and utilization of qualitative findings in health care decision-making, practice, and policy are presented. There is a need to instill an evidence-based mindset into systematic reviews that balance scientific knowledge gained through empirical research and evidence from qualitative studies. This is turn will increase awareness among clinicians and decision makers on the different ways in which qualitative evidence can be used and applied in practice.

Exploring adult critical illness survivors' experiences of fatigue: A qualitative study

AIMS

To explore adult experiences of fatigue after discharge from an intensive care unit and identify potential management strategies.

DESIGN

An exploratory qualitative study.

METHODS

One to one audio-recorded semi-structured interviews with 17 adult survivors of critical illness in the United Kingdom, lasting up to 1 h, between September 2019 and January 2020. Anonymised and verbatim-transcribed interview data underwent a standard process of inductive thematic analysis as described by Braun and Clarke.

FINDINGS

Three themes were identified: fatigue is different for everyone; complex interrelating interactions; and personalised fatigue strategies. Fatigue was described as a distressing symptom, unique to the individual that causes an array of complex, often long-term interrelating impacts on the survivor and their wider family, made worse by a lack of understanding, empathy and support resources. Support from others, alongside interventions such as exercise, good nutrition, information and alternative therapies are used by survivors with variable degrees of success.

CONCLUSIONS

This qualitative study reports peoples' experiences of fatigue after critical illness. Findings highlight the significant impact it has on people's lives and those of their family and friends.

Educational needs of fertility healthcare professionals using ART: a multi-country mixed-methods study

RESEARCH QUESTION

What are the most pressing educational needs of fertility healthcare professionals using assisted reproductive technologies (ART)?

DESIGN

This mixed-methods study combined qualitative interviews with quantitative surveys. Participants included physicians and nurses specialized in reproductive endocrinology or in obstetrics/gynaecology, and laboratory specialists, with a minimum of 3 years of experience, practising in Australia, Brazil, Canada, China, France, Germany, India, Italy, Japan, Mexico, Spain or the UK. Maximum variation purposive sampling was used to ensure a mix of experience and settings. Interviews were transcribed and coded through thematic analysis. Quantitative data were analysed using frequency tables, cross-tabulations and chi-squared tests to compare results by reimbursement context.

RESULTS

A total of 535 participants were included (273 physicians, 145 nurses and 117 laboratory specialists). Knowledge gaps, skills gaps and attitude issues were identified in relation to: (i) ovarian stimulation (e.g. knowledge of treatments and instruction protocols for ovarian stimulation), (ii) embryo culture and cryopreservation/vitrification (e.g. diverging opinions on embryo freezing, (iii) embryo assessment (e.g. performing genetic testing), (iv) support of luteal phase and optimizing pregnancy outcomes (e.g. knowledge of assessment methods for endometrial receptivity), and (v) communication with patients (e.g. reluctance to address emotional distress).

CONCLUSIONS

This descriptive, exploratory study corroborates previously reported gaps in fertility care and identifies potential causes of these gaps. Findings provide evidence to inform educational programmes for healthcare professionals who use ART in their practice and calls for the development of case-based education and interprofessional training programmes to improve care for patients with fertility issues.

Are Cost-of-Care Conversations Best Practice? A Qualitative Study of Oncologists' Attitudes and Practice

PURPOSE

Patients' desire for cost conversations exceeds the incidence of such conversations, and many oncologists report avoiding cost conversations despite reporting willingness to have them. Our objective was to examine oncologists' attitudes toward cost conversations and how those attitudes affect practice.

METHODS

An experienced investigator conducted individual interviews with oncologists practicing in Kentucky. Participants were asked about their attitude toward and experience with cost conversations and their advice for discussing cost with patients. Interview transcripts were analyzed by a four-member team using qualitative descriptive analysis to identify themes.

RESULTS

Participants were 32 MDs (male = 68.8%) age 31-77 years who were board-certified in medical oncology (53.1%), surgical oncology (25.0%), or radiation oncology (21.9%). We categorized participants into two groups: (1) those who viewed cost conversations as best practice and reported pursuing such conversations (37.5%) and (2) those who viewed cost conversations as not best practice and reported avoiding them (62.5%). Our analysis revealed three parallel themes for each category: Cost conversation attitudes and practice were based on (1) making good treatment decisions, (2) being a good clinician, and (3) having a good relationship with patients.

CONCLUSION

Not all oncologists view cost conversations as best practice. To improve cost conversation attitudes and practice, cost conversations can be framed as a strategic tool that-when used well-fosters optimal decision making, professionalism, and the therapeutic relationship.

Supporting parents and healthy behaviours through parent-child meetings - a qualitative study in the Netherlands

Background

The first 2 years of a child’s life have been found to be crucial to healthy growth and development. Parent support groups can help parents to promote health-related behaviours during this crucial period. The aim of this study was to explore the experiences of parents who participated in a parent support group (Parent-Child Meetings) which promoted health-related behaviours of their children, and to determine whether and how these meetings supported them in promoting these behaviours.

Methods

We used a qualitative study design. The parent support group consisted of weekly Parent-Child Meetings organized in a multi-ethnic, relatively low-income neighbourhood in Amsterdam, the Netherlands. Data on the experiences of parents was collected through participatory observations, informal conversations (n = 30 sessions) and semi-structured interviews (n = 13) between April 2019 and March 2020. The data was analysed using thematic content analysis.

Results

Parents indicated that they experienced the parent-child meetings as enjoyable and as providing them with socio-emotional support. They reported that the meetings increased their parenting knowledge, skills and practices regarding healthy behaviours of their children and that they used this knowledge in their daily lives. They also appreciated the practical information and advice provided by experts in the meetings. Parents indicated that the positive attitude of the experts was crucial in accepting and adopting their advice. Additionally, parents valued the interactive and hands-on workshops, which integrated health-related behaviours and active play with children, as it enabled them to learn while they played with their children.

Conclusion

This study indicated that parent-child meetings contributed to enhancing parental knowledge, skills and practices regarding healthy behaviours of their children. This could potentially benefit the health of children during the first 2 years of their lives. In particular, the peer support of other parents, the hands-on workshops, and the concrete advice and information provided in an informal setting were highly valued by parents. Future parent support groups could use these findings to improve their meetings or to start meetings that better suit the needs of parents with young children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11248-z.

Parent and practitioner perspectives on Circle of Security Parenting (COS-P): A qualitative study

Circle of Security Parenting (COS-P) is an attachment-theory-informed program for parents of infants and young children. Designed for scalability, COS-P has been widely adopted internationally. Evidence for the program's effectiveness is limited, however, restricting capacity to make informed decisions about program allocation, and threatening ongoing program funding. To help address this evidence gap, this qualitative study explored the experiences and perceptions of 20 COS-P facilitators and 14 parent recipients in Australia, where COS-P uptake has been particularly widespread. Thematic analysis of combined interview and focus group data revealed a perception that COS-P primarily changes the lens through which parents view (a) their child, (b) themselves in the parenting role, and (c) the parent-child relationship, and that this was a pathway to increased empathy, compassion, and parenting confidence. Participants identified four components that underpinned program impact: key content, skills practice, group processes, and facilitator support. Although COS-P was considered suitable for broad application, limitations were noted. Findings can guide clinical application of COS-P and inform empirical research.

Stakeholder Recommendations to Increase the Accessibility of Online Health Information for Adults Experiencing Concussion Symptoms

Background: Concussion is a global public health problem. In Canada, concussion is among the top five reasons for workplace time-loss. Concussion results in physical, cognitive, and/or emotional symptoms that temporarily worsen with physical and mental exertion, such as viewing electronic screens. The Internet is the primary source of consumer health information. Studies on the end-user needs of adults with brain injuries in regards to digital health technologies largely focus on informational content. There is little to no research on the accessibility of screen-based informational websites and smartphone applications among this population.

Objective: The aim of this research was to involve stakeholders in the design of a comprehensive educational resource to guide concussion recognition, recovery, and return-to-work, called the Concussion Awareness Training Tool for Workers and Workplaces (CATT WW). In order to ensure both relevant content and appropriate delivery of the information to the target groups, participants were asked whether adaptations could increase the accessibility of online health information for the general adult population experiencing concussion symptoms.

Methods: Data have been generated through semi-structured in-depth interviews and focus groups with participants from across British Columbia (BC): workers from various industries who were in the concussion recovery process or had returned to work (n = 31); and healthcare or workplace professionals who support concussion diagnosis, recovery, and return-to-work (n = 16). Data were analyzed using NVivo 12. Before commencing data collection, ethical permission was granted by the University of British Columbia Research Ethics Board (H18-00604), and approval was received from WorkSafeBC Research Services.

Results: Participants (n = 47) recommended twenty adaptations or supplements to electronic screen-based digital health technologies.

Conclusion: Given the high prevalence of concussion among the working adult population, the symptom exacerbation commonly caused by prolonged use of electronic screens, and the demand for online educational resources, these findings can guide clinicians, researchers, technology developers, employers, and occupational health and safety committees to further support adults in concussion recovery and return-to-work.

An Exploration of Characteristics and Behavioral Traits of DAISY Honorees and Nominees: A Qualitative Study

BACKGROUND

In the literature, an abundance of stories exist describing patient situations and caregiver actions, but only 2 studies were identified that outline DAISY honorees' actions and behavioral characteristics.

OBJECTIVE

This study utilized patient nomination data and DAISY honoree insight to identify and gain better understanding of the characteristics and behavioral traits of DAISY nurses.

METHODS

A grounded theory approach and purposive sample were used in this study, which was conducted in 2 phases using 2 different data sets. In phase 1, the NarrativeDx AI platform generated insights from DAISY nomination comments. In phase 2, a survey was administered to DAISY honorees collecting descriptive data that were analyzed in SPSS, whereas insights on DAISY nurses were collected via open-ended responses and analyzed using NVivo software.

RESULTS

Three themes emerged in phase 1 from DAISY nomination data: caring, knowledge/skills, and reliability. A total of 37 DAISY honorees participated in phase 2. Most participants were bachelor's degree-prepared and worked day shift in the emergency department, critical care units, or medical-surgical units; some entered leadership roles post award, and 34% cited nursing as a 2nd career. Four themes emerged from their open-ended responses: engaging in care, environment of care, dedicated to care, and competence of care. Subthemes emerged in both analyses.

CONCLUSIONS

The essence of caring was noted continuously in both nomination and honoree data. Further research aimed at discovering the characteristics and behaviors of DAISY honorees is recommended as examination of these factors may provide a deeper understanding of this exemplary group of nurses. Insights could be incorporated into training and practice programs aimed at increasing patient and nursing satisfaction.

A hermeneutic phenomenological exploration of 'last resort' in the use of restraint

Restraining patients is a practice that dates back at least three centuries. In recent years, there has been a mandate and advocacy in various countries for organizations to shift towards the minimization of restraint, whereby its use is only as a 'last resort'. There is growing evidence internationally indicating the negative impact of the use of restraint. However, to date there is no research specifically focusing on trying to understand the concept of 'last resort'. Further insights to explore this concept among mental health nurses are therefore warranted. The empirical research comprised a hermeneutic phenomenological study. By recruiting and interviewing thirteen mental health nurses from across Canada who had experiences of restraint use, the research aimed to generate a deeper understanding of the meanings and lived experiences of the concept of 'last resort'. Data were collected through fifteen in-depth interviews. Data analysis was undertaken through a hermeneutic phenomenological framework based on van Manen's approach and Heideggerian philosophy. Five Heideggerian concepts were used to illuminate 'last resort' in restraint use by mental health nurses - temporality, inauthenticity, thrownness, leaping in and leaping ahead, and mood (fear). Key findings highlight the influence of nurses' past experiences, how nursing staff adopt a collective (rather than individual) approach, and the dependency on knowledge and skills of others in using restraint as a 'last resort'. Overall, the lived experience of 'last resort' is comprised of many elements. This study provides insights and an initial understanding, which is hoped to advance the field of restraint minimization.