The use of creative case studies to explore non-verbal and non-ambulant children and young people's well-being

BACKGROUND AND PURPOSE

The aim of this paper is to describe and critically analyse creative research methods, exploring how these can offer ways to enable non-verbal and non-ambulant children and young people with cerebral palsy, to express their views about their well-being. The context of this research explored their choices for recreational activities, seeking to understand how their level of participation impacted upon their well-being.

METHODS

A qualitative comparative case study design was chosen comprising of two interviews, using photographs and diaries to elicit discussion, supported by observations. These observations provided evidence of well-being indicators that were interpreted by the researcher, alongside their parents. Seven participants volunteered, aged nine to sixteen years. Data were analysed utilising Braun and Clark's six stages. Firstly, each case's data sources were coded, themes identified, then across cases comparisons, arriving at three final themes. Triangulation of data sources which made up each case, enhanced the trustworthiness in this study.

RESULTS

Observations were key to providing insight into their well-being. Interpretation of this rich data, supported by their parents, revealed that the participants could self-advocate, as shown by their intentional behaviours, to choose their level of participation.

DISCUSSION

The researcher's ability to be creative in the data collection methods is original in physiotherapy. It was important to work in partnership with parents, to ensure the correct interpretation of their intentional behaviours from the observations. The diaries and photographs added a unique contribution to knowledge, which enabled the non-verbal participants inclusion, empowering them to express their well-being.

STUDY REGISTRATION

This study is registered with the International Study + Clinical Trials Network Register (ISRCTN) Number:42717948. CONTRIBUTION OF PAPER.

"Live Gerontology": Understanding and Representing Aging, Loneliness, and Long-Term Care Through Science and Art

This article proposes an expansive conceptualization of gerontological research by engaging with a "live gerontology" that combines sciences and arts to better understand and represent aging and its diverse meanings and contexts. Borrowing the sociological concept of "live methods," we argue that gerontology can benefit from a "live" approach-not only methodologically, but also conceptually. To guide pathways between artistic and gerontological fields and frame its practices and outcomes, we suggest four propositions for a live gerontology: (1) using multiple genres to artfully connect the whole-interweaving micro-, meso-, and macrolevels to contextualize aging within various sociocultural milieus; (2) fostering the use of the senses to capture more than just what people say-what they do, display, and feel; (3) enabling a critical inventiveness by relying on arts' playfulness to design/refine instruments; and (4) ensuring a constant reflection on ethics of representation and public responsibility. To apply and experiment with a live gerontological approach, we describe collaborations with an award-winning writer and an illustrator. The collaborations drew on qualitative data from a study on lived experiences of loneliness in long-term care through ethnography and interviews with residents of 2 Australian facilities. The writer explored participants' accounts as creative stories, which were then illustrated. Motivated by an ethics of representation, we aimed to represent findings without othering or further marginalizing participants. The creative materials offered more than appealing representations, shining new light on the intricate nature of aging, loneliness, institutionalization, and gerontology research and practice.

The INSCHOOL project: showcasing participatory qualitative methods derived from patient and public involvement and engagement (PPIE) work with young people with long-term health conditions

BACKGROUND

Evidence suggests resources and services benefit from being developed in collaboration with the young people they aim to support. Despite this, patient and public involvement and engagement (PPIE) with young people is often tokenistic, limited in engagement and not developmentally tailored to young people. Our paper aims to build knowledge and practice for meaningfully engaging with young people in research design, analysis and as research participants.

METHODS

We report the participatory processes from the INSCHOOL project, examining long-term health conditions and schooling among 11-18 year olds. Young people were consulted at the inception of the project through a hospital-based youth forum. This began a partnership where young people co-designed study documents, informed the recruitment process, developed creative approaches to data collection, participated in pilot interviews, co-analysed the qualitative data and co-presented results.

RESULTS

PPIE advisors, participants and researchers all benefitted from consistent involvement of young people throughout the project. Long-term engagement allowed advisors and researchers to build rapport and facilitated openness in sharing perspectives. PPIE advisors valued being able to shape the initial aims and language of the research questions, and contribute to every subsequent stage of the project. Advisors co-designed flexible data collection methods for the qualitative project that provided participants with choices in how they took part (interviews, focus groups, written tasks). Further choice was offered through co-designed preparation activities where participants completed one of four creative activities prior to the interview. Participants were therefore able to have control over how they participated and how they described their school experiences. Through participatory analysis meetings advisors used their first-hand experiences to inform the creation of themes and the language used to describe these themes. PPIE in every stage of the process helped researchers to keep the results grounded in young people's experience and challenge their assumptions as adults.

CONCLUSIONS

Young people have much to offer and the INSCHOOL project has shown that researchers can meaningfully involve young people in all aspects of research. Consistent PPIE resulted in a project where the voices of young people were prioritised throughout and power imbalances were reduced, leading to meaningful participant-centred data.

Pandemic Diaries: Lived Experiences of Loneliness, Loss, and Hope Among Older Adults During COVID-19

BACKGROUND AND OBJECTIVES

While research on loneliness in later life has increased during the coronavirus disease 2019 (COVID-19) pandemic, we still lack diverse qualitative approaches capturing lived experiences of lonely older adults. Approaches to research with older adults instead of on them are also scant in gerontological literature on loneliness. Through solicited diaries, this study aimed to explore how older Australians who were already lonely before the pandemic managed lockdowns (stay-at-home orders) in Victoria, Australia, which lived through one of the longest lockdowns in the world.

RESEARCH DESIGN AND METHODS

This article is based on qualitative diaries completed by 32 older adults (aged 65 and older). Diaries provide a 'live' document where participants become active research partners, recording and sharing their perceptions and experiences. This method is useful to capture sensitive issues, but to the best of our knowledge has not been employed in loneliness studies. Data were thematically analyzed through the identification of themes within and across diaries.

RESULTS

Loneliness was defined by participants as a detrimental absence of companionship and meaningful social interactions. For most, lockdowns exacerbated loneliness, presented new triggers, and upended coping strategies. The disruption of the 'emotion work' involved with managing loneliness led to a reconfiguration of response strategies, including through digital technology, which brought both challenges (e.g., digital ageism) and opportunities (e.g., novel communication forms).

DISCUSSION AND IMPLICATIONS

Understanding how older people living alone define and respond to loneliness in diverse contexts-for example, before and during a pandemic that restricts social interaction-provides critical insights to inform interventions to tackle loneliness.

Transforming urban planning processes and outcomes through creative methods

Inclusively delivering the sustainable development goals (SDGs) remains challenging, particularly in urban areas, where some of the most pressing concerns exist. To achieve the transformative SDG agenda, new methods are required to overcome current deficits in engagement around inclusion and equitable outcomes. Evaluating against theories of governance and inclusion, we test a mixture of digital and physical creative methods abilities to deliver co-designed solutions that influence mobility and road safety planning outcomes in East African cities. Greater inclusion led to improved interactions of citizens with decision makers, and the identification of novel, practical solutions, delivering some elements of transformation. Risks include creative methods being used to co-opt communities to official agendas, and institutional planning norms needing to adapt to respond to a wider range of stakeholders. Overall, where risks are mitigated, we recommend that using Creative Methods could localise SDG delivery, ensuring more equitable and effective outcomes from infrastructure development investments.

Paramedics, poetry, and film: health policy and systems research at the intersection of theory, art, and practice

Violence is a public health issue. It is the consequence of a complex set of interacting political, social, and economic factors firmly rooted in past and current injustice. South Africa remains one of the most unequal countries in the world, and in some areas, the rates of violence are comparable to a country that is at war. Increasingly, paramedics working in high-risk areas of Cape Town are being caught in the crossfire, and in 2018, there was an attack on a paramedic crew nearly every week. These attacks are a symptom of much deeper, complex societal issues. Clearly, we require new approaches to better understand the complexity as we collectively find a way forward. It is in this context that we are collaborating with paramedics, poets, and filmmakers to tell human stories from the frontline thereby bringing the lived experiences of healthcare workers into policy making processes. In this commentary, we share a series of poems and a poetry-film that form part of a larger body of work focused on the safety of paramedics, to catalyze discussion about the possibilities that arts-based methods offer us as we seek to better understand and engage with complex social issues that have a direct impact on the health system.

Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (Capability, Opportunity, Motivation-Behaviour) model

BACKGROUND

Health behaviours during pregnancy and the early years of life have been proven to affect long term health, resulting in investment in interventions. However, interventions often have low levels of completion and limited effectiveness. Consequently, it is increasingly important for interventions to be based on both behaviour change theories and techniques, and the accounts of pregnant women. This study engaged with pregnant women from deprived communities, to understand their subjective experiences of health in pregnancy.

METHODS

The study adopted a women-centred ethos and recruited a purposive sample of ten pregnant women, who lived in deprived areas and were on low incomes. Participants engaged with three creative techniques of visual data production (timelines, collaging and dyad sandboxing), followed by elicitation interviews. One participant only engaged in the initial activity and interview, resulting in a total of 28 elicitation interviews. This in-depth qualitative approach was designed to enable a nuanced account of the participants' thoughts, everyday experiences and social relationships. Data were deductively coded for alcohol, smoking and infant feeding and then mapped to the COM-B model (Capability, Opportunity, Motivation - Behaviour).

RESULTS

Five participants had experience of smoking during pregnancy, four had consumed alcohol during pregnancy, and all participants, except one who had exclusively formula fed her child, disclosed a range of infant feeding experiences and intentions for their current pregnancies. Considerable variation was identified between the drivers of behaviour around infant feeding and that related to abstinence from tobacco and alcohol during pregnancy. Overall, knowledge and confidence (psychological capability), the role of partners (social opportunity) and support from services to overcome physical challenges (environmental opportunity) were reported to impact on (reflective) motivation, and thus women's behaviour. The role of the public in creating and reinforcing stigma (social opportunity) was also noted in relation to all three behaviours.

CONCLUSIONS

When designing new interventions to improve maternal health behaviours it is important to consider the accounts of pregnant women. Acknowledging pregnant women's subjective experiences and the challenges they face in negotiating acceptable forms of motherhood, can contribute to informed policy and practice, which can engage rather than isolate potential user groups.

Discursive constructions of youth cancer: findings from creative methods research with healthy young people

PURPOSE

As part of work to understand the experiences of young people who had cancer, we were keen to examine the perspectives of peers who share their social worlds. Our study aimed to examine how cancer in young people, young people with cancer and young cancer survivors are represented through language, metaphor and performance.

METHODS

We generated data using creative activities and focus group discussions with three high school drama classes and used Foucauldian discourse analysis to identify the discursive constructions of youth cancer.

RESULTS

Our analysis identified two prevailing discursive constructions: youth cancer as an inevitable decline towards death and as overwhelming personhood by reducing the young person with cancer to 'cancer victim'.

CONCLUSIONS

If we are to understand life after cancer treatment and how to support young people who have been treated for cancer, we need a sophisticated understanding of the social contexts they return to. Discourses shape the way young people talk and think about youth cancer; cancer as an inevitable decline towards death and as overwhelming personhood is a key discursive construction that young people draw on when a friend discloses cancer.

IMPLICATIONS FOR CANCER SURVIVORS

The way cancer is constructed shapes how friends react to and relate to a young person with cancer. These constructions are likely to shape challenging social dynamics, such as bullying, that many young cancer survivors experience. Awareness of these discursive constructions can better equip young cancer survivors, their family and health professionals negotiate life after cancer.