"I Get It, I'm Sick Too": An Autoethnographic Study of One Researcher/Practitioner/Patient With Chronic Illness

This autoethnographic research utilizes reflexivity as a method to explore my self-experience of Lyme disease while holding co-occurring identities as a researcher, health professional, and mother. Awareness of self is central in psychotherapy so that therapists do not adversely impact their clients. This is similar for researchers who are ethically required to acknowledge and reduce any potential risk(s) of harm to their participants. In this study, I describe and systematically analyze my experiences as a patient with symptom-persistent Lyme disease, contextualized through co-occurring identities as a mother, a regulated (mental) health professional, and a scholar investigating the embodied experience of being a Lyme disease patient in the Canadian context. The central research question guiding this study is: "What are my experiences with symptom-persistent Lyme disease?" The results of this study suggest reflexivity is an important practice in both health research and healthcare. Relationships with health professionals have a significant impact on patients' healthcare experiences, and engaging in reflexive practice may improve the responsivity of healthcare professionals toward patients' needs and embodied experiences and serve as a check on pre-existing power relations in healthcare. Further, this research contributes to the current academic knowledge on symptom-persistent Lyme disease by offering a reflexive representation of my experiences as a researcher who is also a health professional and a patient within the Canadian healthcare system. Representations of patients' experiences are critical in advancing health research and ensuring equitable care for patients. Autoethnography offers important insights into patients' disease experiences.

A mixed-methods study of race-based stress and trauma affecting Asian Americans during COVID

COVID-19 propelled anti-Asian racism around the world; empirical research has yet to examine the phenomenology of racial trauma affecting Asian communities. Our mixed methods study of 215 Asian participants of 15 ethnicities examined experiences of racism during COVID and resulting psychological sequelae. Through qualitative content analysis, themes emerged of emotional, cognitive, and behavioral changes resulting from these racialized perpetrations, including: internalizing emotions of fear, sadness, and shame; negative alterations in cognitions such as reduced trust and self worth; and behavioral isolation, avoidance, and hypervigilance, in addition to positive coping actions of commitment to racial equity initiatives. We engaged in data triangulation with quantitative Mann-Whitney U tests, finding that those who experienced COVID discrimination had significantly higher racial trauma and PTSD scores compared to those who did not. Our convergent findings provide clinicians with novel ways to assess the ongoing impact of racial trauma and implement appropriate interventions for clients.

Nurses' reflections on caring for sexual and gender minorities pre-post stigma reduction training in Uganda

BACKGROUND

Men who have sex with men (MSM) and transgender women (TGW) have a significant HIV burden worldwide. Data from eight countries across sub-Saharan Africa found a pooled HIV prevalence of 14% among MSM and 25% among TGW. Stigma and discrimination among healthcare providers are barriers to healthcare access by these populations. We sought to explore nurses' attitudes before and after sensitivity training to reduce stigma in HIV prevention and care provision to MSM and transgender persons in Uganda.

METHODS

An explorative qualitative study comprising in-depth interviews. Nineteen nurses who underwent sensitivity training in caring for the vulnerable, priority and key populations in Uganda participated. We interviewed each participant before and after the stigma reduction training and analyzed the data with NVivo.

RESULTS

Eight (8) themes emerged from the reflections before the training, namely, 'the definition of MSM and transgender persons', 'legal concerns', 'mental illness', 'attitude in health care provision', 'personal perceptions', 'self-efficacy', 'insufficient training preparation', and 'reasons for gender or sexual orientation preference'. The post-training reflections suggested a change in knowledge and attitude. Five themes emerged for MSM: 'stigma reduction', 'sexual practices and sexuality', 'the need for tailored health approaches', 'MSM and the law' and 'corrected misconceptions'. For transmen, 'reproductive health needs', 'social needs', 'safety needs', 'Gender identity recognition' and 'reduced stigma, discrimination, and barriers to care'. Finally, the reflections on their attitudes towards transwomen were on five topics; Gender affirming care', 'Healthcare provision for transwomen', 'Need for further training', 'New knowledge acquired', and 'Sexual violence'.

CONCLUSION

Nurses' attitudes and empathy for vulnerable and key populations improved following the training. Nursing training programs should consider incorporating sexual and gender minority (SGM) specific health training into their curricula to decrease negative attitudes. There is a need to identify best practices and conduct implementation research to provide culturally sensitive and affirming healthcare delivery in sub-Saharan Africa. Future studies should evaluate the effect of provider sensitivity training on sexual health and HIV outcomes for SGM. Furthermore, interventions targeting higher-level stigma, such as structural and policy levels, are critical because they influence interpersonal stigma reduction efforts and initiatives.

Relational coding: Enhancing the transparency and trustworthiness of grounded theory research

Grounded theory practitioners are undoubtedly familiar with critiques of their research which problematise its lack of transparency and, subsequently, trustworthiness. While the literature on grounded theory already benefits from numerous varying guides on ‘how to do grounded theory’, comparatively less instruction exists around how to do it clearly and convincingly. One of the elements of the grounded theory methodology (GT) which appears to be impacted most by confusion around transparent writeup is coding, naturally leading to the theoretical outputs thereof suffering from questionable trustworthiness. Through the course of my own postgraduate research, I developed a tool which not only makes coding more transparent to the reader, but to the researcher themselves. This tool, Relational Coding, highlights the relationships between codes which form the foundation of theory, and reveals them more obviously to the reader and researcher alike. Rather than ‘a how to guide to GT’, this is a ‘how to show you have actually done GT’ tool. This allows for stronger arguments to be built from the theory which this methodology builds due to the trustworthiness inspired by enhanced transparency. Here I demonstrate its usefulness and applicability, as well as key shortcomings which may be addressed by fellow grounded theory enthusiasts as the tool is inherently organic and modifiable.

Connecting ethics and epistemology of AI

The need for fair and just AI is often related to the possibility of understanding AI itself, in other words, of turning an opaque box into a glass box, as inspectable as possible. Transparency and explainability, however, pertain to the technical domain and to philosophy of science, thus leaving the ethics and epistemology of AI largely disconnected. To remedy this, we propose an integrated approach premised on the idea that a glass-box epistemology should explicitly consider how to incorporate values and other normative considerations, such as intersectoral vulnerabilities, at critical stages of the whole process from design and implementation to use and assessment. To connect ethics and epistemology of AI, we perform a double shift of focus. First, we move from trusting the output of an AI system to trusting the process that leads to the outcome. Second, we move from expert assessment to more inclusive assessment strategies, aiming to facilitate expert and non-expert assessment. Together, these two moves yield a framework usable for experts and non-experts when they inquire into relevant epistemological and ethical aspects of AI systems. We dub our framework ‘epistemology-cum-ethics’ to signal the equal importance of both aspects. We develop it from the vantage point of the designers: how to create the conditions to internalize values into the whole process of design, implementation, use, and assessment of an AI system, in which values (epistemic and non-epistemic) are explicitly considered at each stage and inspectable by every salient actor involved at any moment.

Calling situated: a survey among medical students supplemented by a qualitative study and a comparison with a surveyed sample of physicians

BACKGROUND

Calling within the medical context receives growing academic attention and empirical research has started to demonstrate its beneficial effects. The purpose of this study is to investigate what motivates students to enter medical school and what role calling may play (i), to evaluate if calling influences the way in which they experience their studies (ii), and to compare medical students' experience of calling with those of physicians.

METHODS

A questionnaire survey was distributed among medical students (N = 1048; response rate above 60%) of the University of Lausanne in Switzerland. It was supplemented by a group discussion between bachelor medical students (N = 8) and senior physicians (N = 4), focusing on different facets of calling. An existing data set of a survey among physicians, addressing calling with the same questionnaire, was used to compare students' and physicians' attitudes towards calling. Survey data were analyzed with the habitual statistical procedures for categorical and continuous variables. The group discussion was analyzed with thematic analysis.

RESULTS

The survey showed that experiencing calling is a motivational factor for study choice and influences positively choice consistency. Students experiencing calling differed from those who did not: they attributed different definitions to calling, indicated more often prosocial motivational factors for entering medical school and perceived the learning context as less burdensome. The analysis of the group discussion revealed that the concept of calling has a fluid definition. It was conceived as having the characteristics of a double-edged sword and as originating from within or outside or from a dialectic interplay between the inner and outer world. Finally, calling is experienced less often by physicians than by medical students, with a decreasing prevalence as the immersion in the clinical years of the study of medicine progresses.

CONCLUSIONS

Calling plays an important role in study choice and consistency of medical students. Given its relevance for medical students and its ramifications with the learning context, calling should become a topic of the reflexive parts of the medical curriculum. We critically discuss the role played by calling for medical students and provide some perspectives on how calling could be integrated in the reflection and teaching on physicianhood.

'Staying alive' with antiretroviral therapy: a grounded theory study of people living with HIV in Peru

BACKGROUND

To achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America.

METHODS

A constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas.ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality.

RESULTS

The core category 'staying alive' emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers.

CONCLUSION

Adherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.

The Social Construction of Incompetency: Moving Beyond Embedded Paternalism Toward the Practice of Respect

This article illustrates the less-acknowledged social construction of the concept of 'incompetency' and draws attention to the moral concerns it raises in health care encounters in the south Indian city of Chennai. Based on data drawn from qualitative research, this study suggests that surgeons subjectively construct the idea of incompetency through their understanding of the perceived circumstantial characteristics of the patients and family members they serve. The findings indicate that surgeons often underestimate patients and family members' capacity based on constructed assessments, which leads to paternalistic practice. In this article, I illustrate how these assessments influence the surgeons' practices and provide the moral and practical justifications for their actions. The constructed knowledge becomes a source for drawing normative justification for surgeons' actions and, in conjunction with socially enforced power relationships, results in patients and family members to be on the receiving end of disrespectful attitudes. Based on the data analysis and by drawing on philosophical analysis, I emphasize the need to focus on 'respect for persons,' to rethink the framework of 'capacity,' and to practice respect in hospital settings.

Destabilizing the privilege of the knower to establish forms of solidarity: Reflections on conducting fieldwork with vulnerable communities in India and Romania

In this article, I interrogate the researcher’s role in conducting ethnographic and qualitative fieldwork with vulnerable communities and argue that increased epistemological reflexiveness is needed to support solidarity ties between researchers and participants. In line with critical feminist literature and methodology, I present the inconsistencies of the power relations I entered as a researcher, as well as the systemic inequalities I found operating in the background. Using several vignettes based on my fieldwork with communities labeled as “Gypsy” in Romania and India, I make the argument that power dynamics encountered in the field reveal the researchers’ simultaneous privilege and their subaltern status, creating an epistemological position grounded in the intersection of gender, race/ ethnicity, and class, which in turn could deter from bonds of solidarity. In line with feminist methodologies and intersectionality literature, I argue that the researcher’s gender, race, ethnicity, and class (co)generate epistemological outcomes, and that without critical reflection researchers may reinforce hierarchies of power. Thus, I both adopt and innovate this approach, by showing how as researchers we inhabit concomitantly different and fluctuating positionalities. I end by advocating for reflexiveness on the researchers’ power to create epistemological categories and processes, which may (re)enforce solidarity relations between researchers and communities.

‘If you didn’t laugh, you’d cry’: Emotional labour, reflexivity and ethics-as-practice in a qualitative fieldwork context

This article takes Guillemin and Gillam’s distinction between ‘procedural ethics’ and ‘ethics in practice’ as a point of departure and return for reflecting critically on a recently completed doctoral research project about political violence and terrorism. It provides an overview of the study before offering some instructive vignettes to show how ethical decision-making processes engaged with ‘in the field’ were an extension of more everyday and mundane reasoning than we may typically associate with such quintessentially ‘sensitive research’. As the final section of this article argues, it is this everyday and mundane quality to ethical reasoning which is sometimes obscured in formal accounts of ‘reflexivity’. It is hoped that this article is useful for scholars interested in the ethics and emotional practices of qualitative inquiry, as well as those researching serious violence and bereavement.