1
|
Waltz M, Walker RL, Flatt MA, MacKay D, Conley JM, Juengst ET, Cadigan RJ. Challenging the Boundaries Between Treatment, Prevention, and Enhancement in Human Genome Editing. CRISPR J 2024; 7:180-187. [PMID: 38976494 DOI: 10.1089/crispr.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Traditional distinctions between treatment and enhancement goals for human genome editing (HGE) have animated oversight considerations, yet these categories have been complicated by the addition of prevention as a possible target for HGE applications. To assess the role these three categories might play in continued HGE governance efforts, we report on interviews with genome editing scientists and governance group members. While some accepted traditional distinctions between treatment and enhancement and rejected the latter as unacceptable, others argued that the concept of enhancement is largely irrelevant or not as morally problematic as suggested. Others described how preventive goals for HGE create gray zones where prevention and enhancement may be difficult to distinguish, which may stymie uses of HGE. We conclude by discussing the governance implications of these various understandings of treatment, prevention, and enhancement as HGE research moves beyond the treatment of serious disease to embrace longer range preventive goals.
Collapse
Affiliation(s)
- Margaret Waltz
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca L Walker
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Philosophy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael A Flatt
- Department of Sociology, Cuyahoga Community College, Cleveland, Ohio, USA
| | - Douglas MacKay
- Department of Public Policy and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John M Conley
- School of Law, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric T Juengst
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - R Jean Cadigan
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
2
|
Waltz M, Flatt MA, Juengst ET, Conley JM, Cadigan RJ. Public participation in human genome editing research governance: what do scientists think? J Community Genet 2024; 15:249-257. [PMID: 38353891 PMCID: PMC11217205 DOI: 10.1007/s12687-024-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024] Open
Abstract
Within the numerous policy and governance recommendations for human genome editing research, anticipatory public engagement seems universally agreed upon as a vital endeavor. Yet it is unclear whether and how scientists whose research involves genome editing see value in engaging the public in discussions of genome editing research governance. To address this question, we interviewed 81 international scientists who use genome editing in their research. The views of our scientist interviewees about public engagement occupied a broad spectrum from enthusiastic support to strong skepticism. But most scientists' views landed somewhere in the middle, seeing public engagement as merely informing the public about the science of genome editing. We argue that such a stance reflects the traditional "knowledge-deficit model." Beyond addressing the operational difficulties of public engagement, many scientists' adherence to the deficit model is a deeper barrier that needs to be addressed if public engagement is to occur and be successful.
Collapse
Affiliation(s)
- Margaret Waltz
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC, 27599, USA.
| | - Michael A Flatt
- Department of Sociology, Cuyahoga Community College, Cleveland, OH, USA
| | - Eric T Juengst
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC, 27599, USA
| | - John M Conley
- University of North Carolina School of Law, Chapel Hill, NC, USA
| | - R Jean Cadigan
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC, 27599, USA
| |
Collapse
|
3
|
Ekkel MR, Depla MFIA, Sakhizadah Z, Verschuur EML, Veenhuizen RB, Onwuteaka-Philipsen BD, Hertogh CMPM. Advance Care Planning in Huntington Disease: The Elderly Care Physician's Perspective. J Am Med Dir Assoc 2023; 24:1843-1848.e1. [PMID: 37586417 DOI: 10.1016/j.jamda.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Huntington disease (HD) has a poor prognosis. Decision-making capacity and communication ability may become impaired as the disease progresses. Therefore, HD patients are encouraged to engage in advance care planning (ACP). Elderly care physicians (ECPs) can play an important role in ACP in HD patients. However, little is known about their experiences in this role. The aim of this study is to gain insight into how ECPs practice ACP with HD patients. DESIGN A qualitative interview study. SETTING AND PARTICIPANTS Nine ECPs working in HD-specialized nursing homes in the Netherlands. METHODS We conducted semistructured interviews with ECPs between June 2018 and July 2020. RESULTS Two phases could be identified in the process of ACP. In the first phase, when the feared future seems to be far away, the ECP asks about the patient's wishes for the future in an accommodating manner. In the second phase, when the feared future is closer, future medical treatment and care becomes less hypothetical. Agreement has to be reached on upcoming treatment decisions. In this phase, the ECP takes a more guiding role, and consequently encounters more difficulties, such as maintaining a positive patient/family-physician relationship while dealing with disagreements with patient or family. Most participants shared their experiences with euthanasia when asked about ACP. When making a comparison of ACP between HD patients and patients with other neurodegenerative disorders in nursing homes, the ECPs emphasized the similarities. CONCLUSIONS AND IMPLICATIONS ACP in HD can be classified into 2 phases, which differ in ECPs' approach and the complexity experienced by the ECP. Awareness of this finding may help to further develop training and education in ACP, including dealing with euthanasia, to make ECPs feel better equipped in practicing ACP in HD.
Collapse
Affiliation(s)
- Marina R Ekkel
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands; Huntington Expert Centre Atlant, Apeldoorn, the Netherlands.
| | - Marja F I A Depla
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| | - Zahra Sakhizadah
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| | | | - Ruth B Veenhuizen
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands; Huntington Expert Centre Atlant, Apeldoorn, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands; Department of Public and Occupational Health, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Kamat S, Kondapalli S, Syed S, Price G, Danias G, Gorbenko K, Cantor J, Valera P, Shah AK, Akiyama MJ. Access to Hepatitis C Treatment during and after Incarceration in New Jersey, United States: A Qualitative Study. Life (Basel) 2023; 13:life13041033. [PMID: 37109562 PMCID: PMC10146294 DOI: 10.3390/life13041033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Despite effective antiviral therapy for hepatitis C virus (HCV), people who are incarcerated and those returning to the community face challenges in obtaining HCV treatment. We aimed to explore facilitators and barriers to HCV treatment during and after incarceration. From July-November 2020 and June-July 2021, we conducted 27 semi-structured interviews with residents who were formerly incarcerated in jail or prison. The interviews were audio-recorded and professionally transcribed. We used descriptive statistics to characterize the study sample and analyzed qualitative data thematically using an iterative process. Participants included five women and 22 men who self-identified as White (n = 14), Latinx (n = 8), and Black (n = 5). During incarceration, a key facilitator was having sufficient time to complete HCV treatment, and the corresponding barrier was delaying treatment initiation. After incarceration, a key facilitator was connecting with reentry programs (e.g., halfway house or rehabilitation program) that coordinated the treatment logistics and provided support with culturally sensitive staff. Barriers included a lack of insurance coverage and higher-ranking priorities (e.g., managing more immediate reentry challenges such as other comorbidities, employment, housing, and legal issues), low perceived risk of harm related to HCV, and active substance use. Incarceration and reentry pose distinct facilitators and challenges to accessing HCV treatment. These findings signal the need for interventions to improve engagement in HCV care both during and after incarceration to assist in closing the gap of untreated people living with HCV.
Collapse
Affiliation(s)
- Samir Kamat
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Shumayl Syed
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gabrielle Price
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - George Danias
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ksenia Gorbenko
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Institute for Healthcare Delivery Science, Mount Sinai Health System, New York, NY 10016, USA
| | - Joel Cantor
- Center for State Health Policy, Rutgers University, New Brunswick, NJ 08901, USA
| | - Pamela Valera
- Department of Urban-Global Public Health, Rutgers University School of Public Health, Newark, NJ 07102, USA
- Community Health Justice Lab, Newark, NJ 07107, USA
| | - Aakash K Shah
- Department of Emergency Medicine, Department of Psychiatry and Behavioral Health, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Matthew J Akiyama
- Department of Medicine, Divisions of General Internal Medicine and Infectious Disease, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| |
Collapse
|
5
|
Waltz M, Canter C, Bensen JT, Berg JS, Foreman AKM, Grant TL, Lich KH, Navas A, O’Daniel JM, Powell BC, Rini CM, Staley BS, Cadigan RJ. The Burden of COVID-19 on Caregivers of Children with Suspected Genetic Conditions: A Therapeutic Odyssey. Phys Occup Ther Pediatr 2022; 43:257-271. [PMID: 36310386 PMCID: PMC10079636 DOI: 10.1080/01942638.2022.2138734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
AIMS Children with disabilities and rare or undiagnosed conditions and their families have faced numerous hardships of living during the COVID-19 pandemic. For those with undiagnosed conditions, the diagnostic odyssey can be long, expensive, and marked by uncertainty. We, therefore, sought to understand whether and how COVID-19 impacted the trajectory of children's care. METHODS We conducted semi-structured qualitative interviews with 25 caregivers who, prior to the pandemic, were on a diagnostic odyssey for their children. RESULTS Most caregivers did not report any interruptions to their child's diagnostic odyssey. The greatest impact was access to therapy services, including the suspension or loss of their child's in-person therapeutic care and difficulties with virtual therapies. This therapy gap caused caregivers to fear that their children were not making progress. CONCLUSION Although much has been written about the challenges of diagnostic odysseys for children and their families, this study illustrates the importance of expanding the focus of these studies to include therapeutic odysseys. Because therapeutic odysseys continue regardless of whether diagnoses are made, future research should investigate how to support caregivers through children's therapies within and outside of the COVID-19 context.
Collapse
Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Courtney Canter
- Department of Anthropology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jeannette T. Bensen
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Tracey L. Grant
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Angelo Navas
- Department of Pediatrics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Julianne M. O’Daniel
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Bradford C. Powell
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Christine M. Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brooke S. Staley
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - R. Jean Cadigan
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
6
|
Ridgeway JL, Njeru JW, Breitkopf CR, Mohamed AA, Quirindongo-Cedeño O, Sia IG, Wieland ML. Closing the Gap: Participatory Formative Evaluation to Reduce Cancer Screening Disparities among Patients with Limited English Proficiency. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:795-803. [PMID: 32052262 DOI: 10.1007/s13187-020-01706-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients with limited English proficiency (LEP) have disproportionately lower rates of cancer screening than English-proficient patients. Given the multifactorial nature of screening disparities, strategies to improve screening rates must address barriers within and outside of the clinic setting. The objectives of this study were to understand local barriers from multiple stakeholder perspectives, to identify potential multilevel intervention approaches, and to mobilize community-engaged intervention decision making and planning. This participatory formative evaluation approach employed needs assessment and user engagement in order to enhance intervention usefulness and relevance. The study took place in several stages and involved clinic and community partners in a small metropolitan area of the Midwest USA. Interviews were conducted with LEP patients (n = 9) who had not completed three recommended screenings (breast, cervical, and colorectal), primary care providers (n = 5), medical interpreter (n = 5), and community members (n = 3). These highlighted multilevel barriers including limited patient understanding of preventive health, time and cost constraints, and variable roles of language interpreters. The literature was also reviewed to identify interventions used with similar populations. Findings from this review suggest that interventions are largely focused on single population groups or address single screening barriers. Finally, a community-academic summit (n = 48 participants) was held to review results and develop recommendations for community and clinic interventions. Findings from this study indicate that it is possible to engage a diverse group of stakeholders in strategies that are responsive to health care providers and patients, including LEP patients from heterogeneous backgrounds.
Collapse
Affiliation(s)
- Jennifer L Ridgeway
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Ahmed A Mohamed
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Mark L Wieland
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
| |
Collapse
|
7
|
Ellis T, Li Q, Bertram JM, Meadows JT, Ozturk B, Nelson-Gardell D. Poetry authored by vulnerable populations as secondary data: methodological approach and considerations. JOURNAL OF POETRY THERAPY 2020. [DOI: 10.1080/08893675.2020.1803614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Taylor Ellis
- Department of Social Work, Jacksonville State University, Jacksonville, AL, USA
| | - Qingyi Li
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | | | - James T. Meadows
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Burcu Ozturk
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | | |
Collapse
|
8
|
Carter B, Fisher-Smith D, Porter D, Lane S, Peak M, Taylor-Robinson D, Bracken L, Carrol E. Being 'at-home' on outpatient parenteral antimicrobial therapy (OPAT): a qualitative study of parents' experiences of paediatric OPAT. Arch Dis Child 2020; 105:276-281. [PMID: 31558443 PMCID: PMC7041500 DOI: 10.1136/archdischild-2019-317629] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/08/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To better understand the factors that facilitate and hinder a positive experience of paediatric outpatient parenteral antimicrobial therapy (OPAT). DESIGN Qualitative study using semistructured interviews. SETTING A dedicated paediatric consultant-led hospital-based, outreach OPAT service in England. PARTICIPANTS Participants were primarily parents of children who had received OPAT; one child participated. METHODS Children and parents of children who received OPAT and who had participated in the survey phase of the larger study were invited to be interviewed. RESULTS 12 parents (10 mothers and 2 fathers) of 10 children participated; one child (aged 15 years). Data analysis resulted in one meta-theme, 'At-homeness' with OPAT, this reflected the overall sense of home being a place in which the children and their parents could be where they wanted to be. Four key themes were identified that reflect the ways in which parents and children experienced being at-home on OPAT: 'Comfort, security, freedom, and control'; 'Faith, trust and confidence'; 'Explanations and communication' and 'Concerns, restrictions and inconveniences'. CONCLUSIONS Despite feeling anxious at times, parents reported that they and their children generally had a positive experience of OPAT; being at-home brought many benefits compared with in-patient care. Recommendations arising from the study include a 'whole-system' approach to discharge home that includes support related to return to school/nursery, reduction in disruptions to home-based routines, more clarity on choice and preparation for managing potential anxiety, better consideration of dose timing and enhanced preparation and information.
Collapse
Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Debra Fisher-Smith
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - David Porter
- Department of Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Steven Lane
- Biostatistics, University of Liverpool, Liverpool, UK
| | - Matthew Peak
- Research and Development, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK,Cheshire and Merseyside Medicines for Children Research Network, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Enitan Carrol
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| |
Collapse
|
9
|
Sheard L, Marsh C. How to analyse longitudinal data from multiple sources in qualitative health research: the pen portrait analytic technique. BMC Med Res Methodol 2019; 19:169. [PMID: 31375082 PMCID: PMC6679485 DOI: 10.1186/s12874-019-0810-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 07/23/2019] [Indexed: 11/25/2022] Open
Abstract
Background Longitudinal qualitative research is starting to be used in applied health research, having been popular in social research for several decades. There is potential for a large volume of complex data to be captured, over a span of months or years across several different methods. How to analyse this volume of data – with its inherent complexity - represents a problem for health researchers. There is a previous dearth of methodological literature which describes an appropriate analytic process which can be readily employed. Methods We document a worked example of the Pen Portrait analytic process, using the qualitative dataset for which the process was originally developed. Results Pen Portraits are recommended as a way in which longitudinal health research data can be concentrated into a focused account. The four stages of undertaking a pen portrait are: 1) understand and define what to focus on 2) design a basic structure 3) populate the content 4) interpretation. Instructive commentary and guidance is given throughout with consistent reference to the original study for which Pen Portraits were devised. The Pen Portrait analytic process was developed by the authors, borne out of a need to effectively integrate multiple qualitative methods collected over time. Pen Portraits are intended to be adaptable and flexible, in order to meet the differing analytic needs of qualitative longitudinal health studies. Conclusions The Pen Portrait analytic process provides a useful framework to enable researchers to conduct a robust analysis of multiple sources of qualitative data collected over time.
Collapse
Affiliation(s)
- Laura Sheard
- Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, BD9 6RJ, UK.
| | - Claire Marsh
- Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, BD9 6RJ, UK
| |
Collapse
|
10
|
Kneck Å, Audulv Å. Analyzing variations in changes over time: development of the Pattern-Oriented Longitudinal Analysis approach. Nurs Inq 2019; 26:e12288. [PMID: 30834658 DOI: 10.1111/nin.12288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/30/2022]
Abstract
Longitudinal qualitative research in nursing is rare but becoming more common. Data collection and analysis over time provide some intriguing possibilities to better understand processes, development, and change in illness experience, healthcare organizations, and self-management. This paper aims to present a process for analyzing qualitative longitudinal data material, namely the Pattern-Oriented Longitudinal Analysis approach (POLA). We developed this approach after synthesizing experiences from two longitudinal qualitative projects and comparing our procedures and reflections with the relevant literature. Using the POLA approach, researchers can describe complexity and variation in changes over time. During the analysis process, emphasis is put on visualizing and identifying change at both an individual and a group level. Ontological and epistemological assumptions for the approach are also described. The benefit of this approach is the possibility to describe complexity and diversity in processes over time, which is important for the development of nursing knowledge. The analysis approach can be further used and developed by researchers seeking to understand variance or contextual features in processes and changes over time.
Collapse
Affiliation(s)
- Åsa Kneck
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Åsa Audulv
- Department of Nursing Sciences, Mid Sweden University, Sundsvall/Östersund, Sweden
| |
Collapse
|
11
|
Kotovicz F, Getzin A, Vo T. Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists. J Patient Cent Res Rev 2018; 5:28-35. [PMID: 31413994 DOI: 10.17294/2330-0698.1577] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin. Methods Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. Results Four overarching themes regarding health care for refugee patients were identified: 1) difficulty balancing the dynamic of autonomy versus support for refugees; 2) educational needs of refugee families outpacing available resources; 3) challenges for refugees developing trust; and 4) diversity of cultures, education levels, and experiences among refugee families. Language barriers in accessing health care services and insufficient time to meet educational needs of refugees were major challenges outside of the clinic visit setting. Poor health literacy and difficulties communicating health needs and building trust within the interactive triad of refugee, physician, and interpreter impacted clinic visits. Conclusions Refugee patients and other participants in refugee care work to navigate a complicated path to equitable health care for a vulnerable population. Continued pursuit of strategies that increase time allocation, education, and support for all parties are needed as we seek to improve health outcomes for newly arrived refugee families.
Collapse
Affiliation(s)
- Fabiana Kotovicz
- Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Anne Getzin
- Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Thy Vo
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI.,Department of Psychiatry Residency Training, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|