"It's in the Cards": The Contribution of Illustrated Metaphor Cards to Exploring Values Within Narratives

Using projective exercises to identify patient perspectives of living with comorbid type 2 diabetes and asthma

OBJECTIVE

Patient self-management of a single chronic condition can be challenging, but few studies have examined the emotional impact of living with comorbid conditions and how that differs from a single chronic condition. This study examined patient perspectives of the emotional impact of living with asthma or asthma with comorbid type 2 diabetes (asthma+diabetes).

METHODS

Data were collected from 41 adults (asthma only n = 22, asthma+diabetes n = 19) using semi-structured interviews on two separate online bulletin boards. Respondents engaged in discussions that leveraged two projective exercises: describing their health condition(s) as an animal, and selecting one of eight images that best illustrated how they were living with and managing their health condition(s).

RESULTS

Respondents described physical and emotional challenges related to managing asthma or asthma+diabetes. Animal- and image- projective exercises were categorized by response and health condition. Thematic analysis across both projective exercises identified four themes: (1) frustrations with dual diagnosis, (2) juggling the dual diagnosis, (3) anticipating the future, and (4) unpredictability.

DISCUSSION

Projective exercises are one way to elicit feelings about living with chronic conditions. Healthcare providers can improve support for patients with more than one health condition by providing education on how to manage comorbid conditions.

Researching relationality: Reflections on the use of concept cards during in-depth interviews

This article reflects on the use of concept cards during in-depth interviews when researching reproductive decision-making in the context of neoliberalism and postfeminism. As existing literature has shown, card methods are valuable in centring participants’ individual experiences through increased control and inclusion during data collection, and attention has been drawn to their use as an ethically attentive method that can elicit richer, more complex narratives than interviews alone. While these strengths initially led me to consider the cards as an appropriate ‘fit’ with my feminist methodological approach, on reflection, the cards also illuminated the relationality of experiences that my research was concerned with. I view this as occurring in two ways. First, participants’ use of the cards helped to uncover the intertwining of their reproductive decisions with the social and political world, therefore complicating the neoliberal prioritization of the individual. Second, the cards brought the relation between myself and the participants, and between the participants, to the forefront. The reflections in this article therefore offer new insights into what concept cards can achieve, as not only validating individual accounts, but as enhancing the relationality of knowledge production.

A creative method for career supervision: Therapeutic associative cards

This article proposes the use of therapeutic associative cards in career supervision. Associative therapeutic cards, as a stimulus material, can be used to elicit thoughts and feelings and to encourage communication with trainees. The aim of the study is to suggest and evaluate new and creative ways of closing the gap between theory and practice by demonstrating a possible implementation of associative therapeutic cards in career supervision. A scenario-based example is provided to illustrate how these cards could be used in the process. In addition, future recommendations, caveats, and the limitations of using therapeutic associative cards in career supervision are highlighted in order to shape the agenda of future research in validating such instruments using evidence-based studies.

Evaluating Complex Health Interventions With Randomized Controlled Trials: How Do We Improve the Use of Qualitative Methods?

Qualitative methods are underutilized in health intervention evaluation, and overshadowed by the importance placed on randomized controlled trials (RCTs). This Commentary describes how innovative qualitative methods are being used as part of RCTs, drawing on articles included in a special issue of Qualitative Health Research on this topic. The articles' insights and a review of innovative qualitative methods described in trial protocols highlights a lack of attention to structural inequalities as a causal mechanism for understanding human behavior. We situate this gap within some well-known constraints of RCT methodologies, and a discussion of alternative RCT approaches that hold promise for bringing qualitative methods center stage in intervention evaluation, including adaptive designs, pragmatic trials, and realist RCTs. To address the power hierarchies of health evaluation research, however, we argue that a fundamental shift needs to take place away from a focus on RCTs and toward studies of health interventions.

Assessing an Intervention Focused on Enhancing Interpersonal Communication Skills and Humor: A Multi-Method Quasi-Experiential Study Among Medical Students

Teaching and applying interpersonal communication skills (ICS) and humor in medicine is challenging. The present study assessed an innovative course focused on enhancing ICS and humor based on the Four Habits Model and theater concepts. Medical students enrolled in the course (the study group) were assessed pre- and post-intervention, as well as compared with their peers (the control group) using quantitative methods to measure attitudes, self-efficacy, and behaviors. Qualitative methods were used to learn about students' change in perceptions related to ICS and humor following the course, as well as their experiences of developing these skills during the course. Post-intervention study group participants scored significantly higher on all ICS measurements and on humor behavior compared with pre-intervention, and significantly higher on all humor measurements compared with control group participants. Interviews indicated students' increased understanding and difficulties in learning these skills. Analyses showed how framing humor as one possible ICS and focusing on specific parts of the medical encounter can promote patient-centered care.

Who Cares for Those Who Take Care? Risks and Resources of Work in Care Homes

Over the years – due to the aging population, the process of corporatisation and a demand for a higher quality of services – professionals who work in Care Homes have been exposed to an increasing risk of physical and emotional malaise because of the number of challenges they’ve been asked to manage. Given these factors, there is a growing interest in the study and understanding of professions in geriatric care settings. In the literature there is a prevalence of quantitative studies offering an overview in terms of indicators – at the individual or group or organizational level – concerning the potential development of situations of professional malaise. Conversely, there is a lack of qualitative studies exploring the risk and protection factors. For this reason, in this study we decided to use a qualitative approach to explore “more up close” this kind of organizational context and to keep together the different levels in systemic terms in order to identify – according to professionals’ perceptions – resource factors (in order to leverage these aspects) and fatigue factors (to identify them and treat them). Three Italian Care Homes were involved and the interview’s sample was composed of 45 professionals – 15 nurses, 30 total Patient Care Assistants (PCAs) and Auxiliary Care Assistants (ACAs), of these, 17 males and 28 females, with an average age of 43 years (SD = 0.78) – selected using a sampling of maximum variability. From the analysis of the materials there seem to be four profiles of the professionals involved. Implications to ensure a functional human resource management are discussed for the purpose of promote the well-being of the various professionals, and, as a result, an increasing quality of service.