General practitioners' wellbeing during the COVID-19 pandemic: Novel methods with social media data

BACKGROUND

It is difficult to engage busy healthcare professionals in research. Yet during the COVID-19 pandemic, gaining their perspectives has never been more important.

OBJECTIVE

To explore social media data for insights into the wellbeing of UK General Practitioners (GPs) during the Covid-19 pandemic.

METHODS

We used a combination of search approaches to identify 381 practising UK NHS GPs on Twitter. Using a two stage social media analysis, we firstly searched for key themes from 91,034 retrieved tweets (before and during the pandemic). Following this we used qualitative content analysis to provide in-depth insights from 7145 tweets related to wellbeing.

RESULTS

Social media proved a useful tool to identify a cohort of UK GPs; following their tweets longitudinally to explore key themes and trends in issues related to GP wellbeing during the pandemic. These predominately related to support, resources and public perceptions and fluctuations were identified at key timepoints during the pandemic, all achieved without burdening busy GPs.

CONCLUSION

Social media data can be searched to identify a cohort of GPs to explore their wellbeing and changes over time.

A 10-year follow-up survey of US academic libraries highlights the COVID-19 experience and greater interest in health information outreach

BACKGROUND

As follow-up to their previous survey on health information outreach (HIO) in 2010, the authors became interested in the evolving nature of HIO activities at academic libraries within the past decade.

OBJECTIVES

The aim of this study was to understand how HIO activities at academic libraries have evolved since 2010, especially considering the current COVID-19 pandemic.

METHODS

An online survey, designed to collect quantitative data on general HIO activities and qualitative data specifically on COVID-19 information outreach, was distributed to over 1700 librarians at US general academic and academic health science libraries.

RESULTS

Two hundred and fifty-five respondents completed the survey. Quantitative findings generally paralleled the 2010 results, except in a few areas. Most notably, a greater percentage of librarians in 2020 were participating in HIO (44%) than in 2010 (37%). Qualitative findings revealed that librarians are leveraging traditional information services and implementing innovative partnerships to promote reputable health information resources on COVID-19.

DISCUSSION

Evidence suggests that further engagement and campus partnerships can enhance libraries' supportive roles as trustworthy purveyors of quality health information.

CONCLUSION

US academic librarians are increasingly engaging in HIO to support the health information needs of campus communities and should consider aligning outreach activities with national health goals.

Parents of children with cancer require health literacy support to meet their information needs

BACKGROUND

Timely and relevant information helps parents to cope when a child is diagnosed with cancer. However, obtaining and understanding information is not a straightforward process for parents.

OBJECTIVES

This article aims to explain paediatric cancer parents' information behaviour related to the care of their child.

METHODS

Qualitative in-depth interviews were conducted with fourteen Malaysian paediatric cancer parents and eight healthcare professionals who worked with paediatric cancer patients. Reflexivity and inductive approaches were used to interpret the data to identify meaningful themes and subthemes.

RESULTS

Three themes about how paediatric cancer parents interact with information emerged: Acquiring information, internalising information, and using information. Information may be actively sought or passively acquired. Cognitive and affective aspects influence how information is internalised into meaningful knowledge. Knowledge then leads to further action including further information gathering.

CONCLUSION

Paediatric cancer parents need health literacy support to meet their information needs. They require guidance in identifying and appraising suitable information resources. Development of suitable supporting materials is needed to facilitate parents' ability to comprehend information related to their child's cancer. Understanding parents' information behaviour could assist healthcare professionals in providing information support in the context of paediatric cancer.

Expert searchers identified time, team, technology and tension as challenges when carrying out supplementary searches for systematic reviews: A thematic network analysis

BACKGROUND

Systematic reviews require detailed planning of complex processes which can present logistical challenges. Understanding these logistical challenges can help with planning and execution of tasks OBJECTIVES: To describe the perspectives of expert searchers on the main logistical challenges when carrying out supplementary searches for systematic reviews, in particular, forward citation searching and web searching.

METHODS

Qualitative interviews were undertaken with 15 experts on searching for studies for systematic reviews (e.g. information specialists) working in health and social care research settings. Interviews were undertaken by video-call between September 2020 and June 2021. Data analysis used thematic network analysis.

RESULTS

We identified three logistical challenges of using forward citation searching and web searching which were organised under the global theme of 'tension': time, team and technology. Several subthemes were identified which supported the organising themes, including allocating time, justifying time and keeping to time; reviewer expectations and contact with review teams; and access to resources and reference management.

CONCLUSION

Forward citation searching and web searching are logistically challenging search methods for a systematic review. An understanding of these challenges should encourage expert searchers and review teams to maintain open channels of communication, which should also facilitate improved working relationships.

Characterizing the research data management practices of NIH biomedical researchers indicates the need for better support at laboratory level

BACKGROUND

The study investigated the research data management (RDM) practices of biomedical researchers at the National Institutes of Health (NIH) representing various biomedical disciplines.

OBJECTIVES

This study aimed to analyse the state of biomedical researchers' RDM practices based on RDM practice levels (individual, laboratory, institution and external). The findings of the study are expected to provide directions to information professionals for effective RDM services.

METHODS

Semi-structured interviews with 11 researchers were conducted. The interviews were analysed by levels of RDM practices.

RESULTS

The findings revealed that biomedical researchers focus on storing and sharing data and that RDM is performed mainly at the individual level. There seems to be a lack of laboratory level RDM system that allows consistent RDM practices among researchers. External RDM practice is often challenged by not having one responsible for RDM.

DISCUSSION

Findings suggested a need for an agreed RDM system and customized support, particularly at the laboratory level. Also, institutional support can help researchers prepare for long term data preservation.

CONCLUSION

Our suggestions emphasize the importance of RDM training and support for long term data preservation, especially at the laboratory level.

A qualitative study of the health information seeking behaviour of adolescent girls in Iran indicates that public libraries could help supply information required about puberty

INTRODUCTION

The present study aimed to identify the puberty related information seeking behaviour of adolescent female members of Zarrinshahr public libraries.

METHODOLOGY

Using a phenomenology approach, this study sought to identify the puberty related information seeking behaviours for a population of female adolescent public library patrons located in the Middle East. The data were collected via event based interviews and the samples were selected by purposeful sampling method. After converting the audio to text, the transcripts were imported into MAXQDA 10, they were coded and then, the relevant categories were extracted.

RESULTS

The information needs of girls experiencing puberty were identified and divided into four thematic categories: health issues, psychological issues, religious issues (religious precepts), and issues related to physical activity. Girls get this information from a variety of resources such as people, the Internet, social networks, documents, and libraries. The process of information seeking is so problematic for them because they are faced with content, family, social, and financial barriers and mainly lack Internet literacy and search skills.

CONCLUSION

Health information seeking constitutes the main part of adolescent girls' daily lives. Identification of adolescent girls' health information needs, the main channels of information seeking, and the barriers the girls face while information seeking can help public libraries adopt the right policies regarding the provision of health information services.

Library research support services in China's universities of traditional medicine: Understanding user requirements

In this article, Ms Yihang Chen with her supervisor, Prof Lihong Zhou, reports on her MA in Library Science study aimed to identify user requirements of library research support services (RSS) at the universities of Traditional Chinese Medicine (TCM) in China. This study adopted an inductive qualitative approach, employed as a case study and 14 TCM researchers and academic librarians using semi-structured interviews. The research findings point to 28 RSS requirements in five main themes: mastering, planning, project, publication and electronic preservation stages. Although this research is situated in China, it has implications for libraries worldwide in supporting research into holistic and indigenous medicine. LZ.

Outreach marketing may be a successful strategy for NHS libraries

This dissertation study investigates the ways that NHS libraries are currently marketing their services within their organisation and was submitted as part of the MA Library and Information Management at the University of Sheffield in 2019. This paper presents the findings from twelve semi-structured interviews carried out with NHS library managers in the East of England to identify the most and least successful methods, and in comparison with that which is currently in the general marketing literature. The study found that outreach marketing was the most effective and that librarians are currently conducting marketing to the best of their ability, but they lack time and funding to be able to make the most of their promotional campaigns. F.J.

The Experience of Living to an Extreme Age: A Meta-Ethnography

Advances in health care mean that we can now treat diseases that once cut lives short. However, the increase in life expectancy has not been matched by improvements in quality of life. The World Health Organization warns us that all countries should prepare to meet the challenges of an aging population and this is integral to the United Nations 2030 Agenda for Sustainable Development. This may require a shift in attitude toward aging. We aimed to use meta-ethnography to explore the experience of adults living beyond the age of 80. Our conceptual model illuminates the phenomenon of connection in older age and reflects on the paradox of time: ephemeral, yet interminable. Our findings encourage us to reflect on the influence of enlightenment philosophies that underpin the desire for autonomy at all costs. Our study challenges the stereotypes of old age and has the potential to influence people's perspectives toward aging.

Discussing teamwork in health care: from interprofessional collaboration to coordination and cooperation

This doctoral research investigates teamwork, specifically collaboration, at two different hospitals both of which were highly involved in the promotion of interprofessional collaboration. The analysis of the field observations and data collected revealed that this concept did not accurately reflect daily interactions between health care professionals, but that other forms of interaction such as coordination and cooperation were more frequent. Furthermore, the use of these more specific concepts to discuss teamwork in health care enabled important differences to be observed between the clinical settings. The impact of this research in practice suggests that adopting more specific concepts would make it easier to identify relevant literature and to design policies and educational programmes that address teamwork in health care. FJ.

Health information behaviour of rare disease patients: seeking, finding and sharing health information

BACKGROUND

Rare disease patients find independent health information seeking necessary due to the general lack of knowledge on rare diseases and inadequate information provision by health care professionals.

OBJECTIVE

The aim of this study is to describe distinctive aspects of health information behaviour of rare disease patients and specific challenges they face when seeking health information.

METHODS

A qualitative research approach was employed including semi-structured interviews that were analysed using thematic analysis. Fifteen respondents suffering from three different rare diseases participated in the study.

RESULTS

Health information behaviour of rare disease patients is characterised by independent and continuous health information seeking and sharing. Connecting with other patients and getting realistic insight into the condition after diagnosis, advice for everyday life, comfort and hope and confirmation that their symptoms are 'normal' are of particular importance. Lack of specific advice for daily life, inaccessible new knowledge, lack of information about drugs and encountering severe health information are common challenges patients face due to insufficient support from health care professionals.

CONCLUSION

Health information seeking and sharing are important aspects of rare disease patients' everyday life. Challenges they face could be overcome in cooperation with patient support groups, health care professionals and health information professionals.

Mothers and Mentors: Exploring Perinatal Addiction and Recovery Through Digital Storytelling

Substance use disorders (SUDs) are a growing problem for pregnant and parenting women. Woman-to-woman peer support may positively influence perinatal outcomes but little is known about the impact of such support on the women who are providing support. The purpose of this study was to describe experiences of addiction in pregnancy, recovery, and subsequently serving as a peer mentor to other pregnant women with active SUD among women in recovery in a rural setting. We conducted one digital storytelling workshop with five women serving as peer mentors with lived experience of perinatal SUD. The mentors faced significant stigma in pregnancy. They had each done the "inside work" to achieve recovery, and maintained recovery by staying balanced. Peer mentoring supported their own recovery, and story sharing was integral to this process. Peer-led support models may be an effective, self-sustaining method of providing pregnancy-specific peer support for SUD.

Adolescent Victims Emerging From Cyberbullying

Cyberbullying is a pervasive public health issue, affecting 10% to 50% of adolescents and resulting in significant negative health outcomes. Due to the relative newness of cyberbullying, there are many elements of the phenomenon that are not understood. Fifteen adolescents and young adults who had experienced cyberbullying as adolescents, participated in one-on-one, semi-structured interviews. A grounded theory and model, Emerging From Cyberbullying, was constructed to describe the process of being a victim of cyberbullying. The process began by Being Targeted and a cycle of Being Cyberbullied, Losing Oneself, and Attempting to Cope followed. Once out of the cycle, victims could begin the process of Resolving and Finding Oneself. This theory can be used to inform cyberbullying prevention efforts and adolescent providers can utilize this theory to understand the process of being a victim of cyberbullying, promote open discussions with adolescents about cyberbullying, and offer suggestions for effective methods to cope.

Resilience Among Nepali Widows After the Death of a Spouse: "That Was My Past and Now I Have to See My Present"

Responses to the death of a spouse vary; although some are at increased risk of poorer physical and mental health outcomes, others have more resilient responses. In light of the limited scope of research on widows' experiences in Nepal, a setting where widows are often marginalized, we explore themes of resilience in Nepali widows' lives. Drawing from a larger qualitative study of grief and widowhood, a thematic narrative analysis was performed on narratives from four widows that reflected resilient outcomes. Individual assets and social resources contributed to these widows' resilient outcomes. Forgetting, acceptance, and moving forward were complemented by confidence and strength. Social support and social participation were key to widows' resilient outcomes. These four narratives reflect the sociocultural context that shape widows' resilient outcomes in Nepal. Future studies on the emergent themes from this exploratory study will help identify how best to encourage resilient outcomes among widows.

Poststroke Trajectories: The Process of Recovery Over the Longer Term Following Stroke

We adopted a grounded theory approach to explore the process of recovery experienced by stroke survivors over the longer term who were living in the community in the United Kingdom, and the interacting factors that are understood to have shaped their recovery trajectories. We used a combination of qualitative methods. From the accounts of 22 purposively sampled stroke survivors, four different recovery trajectories were evident: (a) meaningful recovery, (b) cycles of recovery and decline, (c) ongoing disruption, (d) gradual, ongoing decline. Building on the concept of the illness trajectory, our findings demonstrate how multiple, interacting factors shape the process and meaning of recovery over time. Such factors included conception of recovery and meanings given to the changing self, the meanings and consequences of health and illness experiences across the life course, loss, sense of agency, and enacting relationships. Awareness of the process of recovery will help professionals better support stroke survivors.

Experiences and Constructions of Menarche and Menstruation Among Migrant and Refugee Women

Experiences and constructions of menarche and menstruation are shaped by the sociocultural environment in which women are embedded. We explored experiences and constructions of menarche and menstruation among migrant and refugee women resettled in Sydney, Australia, and Vancouver, Canada. Seventy-eight semistructured individual interviews and 15 focus groups comprised of 82 participants were undertaken with women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and varying South American countries. We analyzed the data using thematic decomposition, identifying the overall theme "cycles of shame" and two core themes. In "becoming a woman," participants constructed menarche as a marker of womanhood, closely linked to marriage and childbearing. In "the unspeakable," women conveyed negative constructions of menstruation, positioning it as shameful, something to be concealed, and polluting. Identifying migrant and refugee women's experiences and constructions of menarche and menstruation is essential for culturally safe medical practice, health promotion, and health education.

Urban Congolese Refugees in Kenya: The Contingencies of Coping and Resilience in a Context Marked by Structural Vulnerability

The global increase in refugee migration to urban areas creates challenges pertaining to the promotion of refugee health, broadly conceived. Despite considerable attention to trauma and forced migration, there is relatively little focus on how refugees cope with stressful situations, and on the determinants that facilitate and undermine resilience. This article examines how urban Congolese refugees in Kenya promote psychosocial well-being in the context of structural vulnerability. This article is based on interviews ( N = 55) and ethnographic participant observation with Congolese refugees over a period of 8 months in Nairobi in 2014. Primary stressors related to scarcity of material resources, political and personal insecurity, and emotional stress. Congolese refugees mitigated stressors by (a) relying on faith in God's plan and trust in religious community, (b) establishing borrowing networks, and (c) compartmentalizing the past and present. This research has broader implications for the promotion of urban refugees' psychosocial health and resilience in countries of first asylum.

Urban Congolese Refugees in Kenya: The Contingencies of Coping and Resilience in a Context Marked by Structural Vulnerability

The global increase in refugee migration to urban areas creates challenges pertaining to the promotion of refugee health, broadly conceived. Despite considerable attention to trauma and forced migration, there is relatively little focus on how refugees cope with stressful situations, and on the determinants that facilitate and undermine resilience. This article examines how urban Congolese refugees in Kenya promote psychosocial well-being in the context of structural vulnerability. This article is based on interviews ( N = 55) and ethnographic participant observation with Congolese refugees over a period of 8 months in Nairobi in 2014. Primary stressors related to scarcity of material resources, political and personal insecurity, and emotional stress. Congolese refugees mitigated stressors by (a) relying on faith in God's plan and trust in religious community, (b) establishing borrowing networks, and (c) compartmentalizing the past and present. This research has broader implications for the promotion of urban refugees' psychosocial health and resilience in countries of first asylum.

Understanding How Bereaved Parents Cope With Their Grief to Inform the Services Provided to Them

Our objective was to develop a rich description of how parents experience their grief in the first year after the death of their child, and how various bereavement follow-up and support services helped them during this time, with the aim of informing follow-up and support services offered to bereaved parents. Our findings situated parents' individual experiences of coping within the social and institutional contexts in which they grieved. In the first year after the death of their child, parents regulated their intense feelings of grief through loss-oriented, restoration-oriented, and/or meaning reconstruction strategies. Often, parents' relationships with others and many of the bereavement follow-up and support services helped them in this regard. This article also explores how the results may aid service providers in accompanying parents in a way that optimizes outcomes for these parents.

Holistic Experiences and Strategies for Conducting Research With Couples

In this article, we outline methodological considerations for conducting research interviews with couples. We draw from two qualitative men's health studies, both developed to explore social interactions between men and their partners of either sex in relation to their health practices. We utilized a combination of separate interviews and joint couple interviews. From these studies, we offer insight into our experiences of using both types of interview styles, addressing four key areas which span elements across the research project journey: (a) choosing a mode of interview, (b) ethical concerns in couple research,

The One or the Many: Quantified Subjectivity and Aggregated Uniqueness in Qualitative Rehabilitation Research

This article aims to identify and critically assess qualitative intervention studies of rehabilitation processes that target young adults. By applying a meta-epistemological approach inspired by the works of Michel Foucault and Julia Kristeva, we examine how the included studies present qualitative knowledge and whether they adhere to their own stated principles of qualitative knowledge. Through their stated aims and theoretical framing, the articles draw attention to individual processes of meaning making. Nonetheless, we find that the articles to a great extent emphasize frequencies of the qualitative data they present. Individual processes and experiences are subject to subdivisions and categorization and transformed into manageable objects of knowledge. In conclusion, these studies, with one important exception, contribute to self-marginalization of the knowledge they themselves promote: They undermine the uniqueness of the qualitative knowledge they proclaim by focusing on frequency and the general patterns and categories encompassing the unique.

Lessons Learned Designing and Using an Online Discussion Forum for Care Coordinators in Primary Care

While an increasing number of researchers are using online discussion forums for qualitative research, few authors have documented their experiences and lessons learned to demonstrate this method's viability and validity in health services research. We comprehensively describe our experiences, from start to finish, of designing and using an asynchronous online discussion forum for collecting and analyzing information elicited from care coordinators in Patient-Centered Medical Homes across the United States. Our lessons learned from each phase, including planning, designing, implementing, using, and ending this private online discussion forum, provide some recommendations for other health services researchers considering this method. An asynchronous online discussion forum is a feasible, efficient, and effective method to conduct a qualitative study, particularly when subjects are health professionals.

Responding to Scars After Breast Surgery

This article represents a phenomenological study on how women endow meaning to their scarred bodies after breast cancer treatment. Data collection consisted of multiple interviews with 10 women who had mastectomy, and 9 women who had breast-saving surgery. Against the background of the phenomenological premise that one's body can appear to oneself in various ways, we identified meaningful differences between experiences that go together with one's body "at a distance" and experiences that go together with one's body's "closeness." The diversity in body experiences we have revealed in our study calls for reconsidering the prejudiced critique of the "body as object" in mainstream phenomenology of health care, and invites medical professionals to develop the ability to recognize different perspectives on embodiment.

Doctor-Patient Relationship Between Individuals With Fibromyalgia and Rheumatologists in Public and Private Health Care in Mexico

The aim of this article was to describe and analyze the doctor-patient relationship between fibromyalgia patients and rheumatologists in public and private health care contexts within the Mexican health care system. This medical anthropological study drew on hospital ethnography and patients' illness narratives, as well as the experiences of rheumatologists from both types of health care services. The findings show how each type of medical care subsystem shape different relationships between patients and doctors. Patient stigmatization, overt rejection, and denial of the disease's existence were identified. In this doctor-patient-with-fibromyalgia relationship, there are difficult encounters, rather than difficult patients. These encounters are more fluid in private consultations compared with public hospitals. The doctor-centered health care model is prevalent in public institutions. In the private sector, we find the characteristics of the patient-centered model coexisting with the traditional physician-centered approach.

Exploring Professional Help-Seeking for Mental Disorders

Only a third of people with mental disorders seek professional help. In this study, we aimed to investigate attitudes toward help-seeking among non-help-seekers drawn from a community survey in South London. We conducted qualitative interviews with 24 participants with symptoms of mental disorders. We analyzed data using thematic analysis. Participants' reasons for not seeking professional help included perceiving their problems as normal or unsuitable for professional help, negative expectations of professional help, believing informal strategies were sufficient, fearing being stigmatized for having a mental disorder and help-seeking, and self-perceptions of being strong and/or self-reliant. A small number (n = 4) had resolved their problems. Participants with unresolved mental disorders (n = 20) had more chronic stressors, particularly about finances and family relationships, and greater concerns about professional help and stigma than other participants. Potential targets for interventions to encourage help-seeking could be focused around stigma about help-seeking as well as the self-perception of being strong.

The Framing and Fashioning of Therapeutic Citizenship Among People Living With HIV Taking Antiretroviral Therapy in Uganda

In this article, we examine how people living with HIV (PLWH) were able to reconceptualize or "reframe" their understanding of HIV and enhance their capacity to self-manage the condition. Two in-depth interviews were held with 38 PLWH (20 women, 18 men) selected from three government and nongovernment antiretroviral therapy (ART) delivery sites in Wakiso District, and the narratives analyzed. ART providers played an important role in shaping participants' HIV self-management processes. Health workers helped PLWH realize that they could control their condition, provided useful concepts and language for emotional coping, and gave advice about practical self-management tasks, although this could not always be put into practice. ART providers in this setting were spaces for the development of a collective identity and a particular form of therapeutic citizenship that encouraged self-management, including adherence to ART. Positive framing institutions are important for many PLWH in resource-limited settings and the success of ART programs.

Perceptions of Depression and Access to Mental Health Care Among Latino Immigrants: Looking Beyond One Size Fits All

Compared with non-Latino Whites, Latino immigrants have a lower prevalence of depression. However, they are also less likely to seek professional mental health services. Our objective was to compare and contrast perceptions of depression and access to mental health care among four of the largest Latino immigrant subgroups in Florida (Puerto Rican, Cuban, Mexican, and Colombian). We conducted a total of 120 interviews (30 men and women from each subgroup). Thematic analysis of qualitative data revealed that participants across the four groups were aware of the signs and symptoms of depression and had similar perceptions of depression. However, notable differences by subgroup emerged with regard to perceptions of access to mental health care. We suggest that the variation stems from differences in life experiences and the immigration context. Understanding the variances and nuances of Latino immigrants' cultural construction of depression and immigration experience will enable practitioners to better serve this community.

"Protect Your Loved Ones From Fataki": Discouraging Cross-Generational Sex in Tanzania

The Fataki campaign aired in Tanzania via radio from 2008 to 2011 to address cross-generational sex, a major driver of HIV in the region. The campaign sought to incite social disapproval of men who engage in such relationships, generate dialogue around the issue, and encourage community interventions in these relationships through social learning. Using qualitative methods, we explored campaign reactions, use of the term Fataki to describe men in relationships with much younger women, and the nature of discussions spurred by the campaign. We conducted focus group discussions and individual interviews in Iringa and Pwani regions with young women, older men, and community leaders. Results showed that the Fataki term was widely used and had negative connotations reflecting social disapproval of men who participate in such relationships. Dialogue spurred by the campaign, primarily directed toward young women, focused on reasons for avoiding these relationships. We conclude with suggestions for relevant future interventions.

In-Person Versus Online Focus Group Discussions: A Comparative Analysis of Data Quality

Online focus group discussions (FGDs) are becoming popular as a qualitative research method. Methodological examinations regarding the data quality of online versus more traditional in-person FGDs are limited. We compared two online FGDs with two in-person FGDs conducted with gay and bisexual men using a sensitive topic (the experience of intimate partner violence) to examine differences in data quality between the two methods. The online FGDs resulted in larger word count but were shorter in time than the in-person FGDs. There was high overlap in the themes generated across groups; however, the online discussions yielded one additional theme regarding a sensitive topic. In-person FGDs involved less sharing of in-depth stories, whereas sensitive topics were discussed more candidly in the online FGDs. The results illustrate that although theformatof the data generated from each type of FGD may differ, thecontentof the data generated is remarkably similar.

Nursing Home Stakeholder Views of Resident Involvement in Medical Care Decisions

Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged.

Situated Motives of Lay Participants in Community Collaboratives for Children's Mental Health

Publicly funded programs in many industrialized countries increasingly require the participation of citizens. In this article, I explore the "situated motives" of family members who participated alongside professionals in implementing children's mental health programs in two communities in the United States. I conducted in-depth interviews with family members and observed monthly meetings of Community Collaboratives to assess how family members understood their participation. The inductive data analysis demonstrates that family members participated (a) as a therapeutic outlet, (b) to pay it forward, (c) to gain new skills, (d) to have a voice, and/or (e) to empower the community. I then use Giddens' concepts of "life politics" and "emancipatory politics" to explore how these accounts variously reflected lay members' orientations as consumers, empowered individuals, and/or citizen advocates. In the absence of articulated and specific objectives for family participation, these "situated motives" were salient and had implications for how policy was implemented.

Health/Service Providers' Perspectives on Barriers to Healthy Weight Gain and Physical Activity in Pregnant, Urban First Nations Women

The purpose of this article is to examine health/service providers' perspectives of barriers to healthy weight gain and physical activity for urban, pregnant First Nations women in Ottawa, Canada. Through the use of semi-structured interviews, we explored 15 health/service providers' perspectives on the complex barriers their clients face. By using a postcolonial feminist lens and a social determinants of health framework, we identified three social determinants of health that the health/service providers believed to have the greatest influence on their clients' weight gain and physical activity during pregnancy: poverty, education, and colonialism. Our findings are then contextualized within existing Statistics Canada and the Ottawa Neighbourhood Study data. We found that health/service providers are in a position to challenge colonial relations of power. We conclude by urging health/service providers, researchers, and policymakers alike to take into consideration the ways in which these social determinants of health and their often synergistic effects affect urban First Nations women during pregnancy.

Drawing on Accounts of Long-Term Urinary Catheter Use: Design for the "Seemingly Mundane"

The design of the Foley catheter has not changed since 1937. Scientists interested in medical technology tend to focus on state-of-the-art designs for newsworthy specialties rather than the more mundane technologies of daily life. We interviewed 36 people living with a long-term urinary catheter in the United Kingdom, who described limitations of the current catheter design, including infections and complications and consequences for social life and relationships, and their perceptions of whose responsibility it was to improve the design. All took steps to hide the urine bag, but the need to use a catheter and urine bag had, for some, a very detrimental effect on social life and relationships. People living with long-term catheters are relatively isolated at home and dealing with many different underlying health problems, undermining opportunities to speak with a collective patient voice. Qualitative health researchers could act as a conduit to help stimulate new designs.

Photovoice: Assessing the Long-Term Impact of a Disaster on a Community's Quality of Life

Photovoice is a qualitative method of inquiry whereby individuals can document their lived experiences, particularly individuals whose voices are not typically heard in regard to promoting social change and policy development. We used photovoice to elicit major themes regarding community members' perceptions of the long-term impact on their quality of life as a deadly technological disaster hit a small, rural town in South Carolina. Overall, participants photographed more negative images than positive. Overarching themes included residential and business vacancies, economic decline, the need for clean-up and modernization, attention to wellness or rehabilitation, and concerns for safety. Emergency response agencies should consider the themes elicited from these community residents to help identify where to focus disaster response efforts both in the immediate aftermath and during the long-term recovery period of technological disasters, particularly in underserved, rural communities.

Inside the "Black Box" of a Knowledge Translation Program in Applied Health Research

In this article, we present the findings of a participatory realistic evaluation of a 5-year program of health care research intended to promote the translation of knowledge into routine clinical practice. The program was one of the nine pilot Collaborations for Leadership in Applied Health Research and Care funded by the English National Institute for Health Research between 2008 and 2013. Our aim was to delineate the mechanisms by which, and circumstances in which, some projects carried out under the program achieved success in knowledge translation while others were frustrated. Using qualitative methods, we examined how closer collaboration between academics and clinicians worked in four purposefully chosen case studies. In a synthesis of the findings, we produced a "black box" model of how knowledge translation was enabled by the activation of nine mechanisms. These are summarized in the form of five simple rules for promoting knowledge translation through collaborations based on principles of coproduction.

Creating an Ethnodrama to Catalyze Dialogue in Home-Based Dementia Care

This article describes the development of a theater script derived from a critical ethnographic study that followed people living with dementia--and their family and professional caregivers--over an 18-month period. Analysis of the ethnographic data yielded four themes that characterized home-based dementia care relationships: managing care resources, making care decisions, evaluating care practices, and reifying care norms. The research team expanded to include a colleague with playwright experience, who used these themes to write a script. A theater director was included to cast and direct the play, and finally, a videography company filmed the actors on a realistic set. To contribute to the qualitative health research and the research-based theater knowledge translation literatures, this article describes and explains the creative decisions taken as part of our effort to disseminate research focused on home-based dementia care in a way that catalyzes and fosters critical (actionable) dialogue.

Analyzing Data Generated Through Deliberative Dialogue: Bringing Knowledge Translation Into Qualitative Analysis

Deliberative dialogue (DD) is a knowledge translation strategy that can serve to generate rich data and bridge health research with action. An intriguing alternative to other modes of generating data, the purposeful and evidence-informed conversations characteristic of DD generate data inclusive of collective interpretations. These data are thus dialogic, presenting complex challenges for qualitative analysis. In this article, we discuss the nature of data generated through DD, orienting ourselves toward a theoretically grounded approach to analysis. We offer an integrated framework for analysis, balancing analytical strategies of categorizing and connecting with the use of empathetic and suspicious interpretive lenses. In this framework, data generation and analysis occur in concert, alongside engaging participants and synthesizing evidence. An example of application is provided, demonstrating nuances of the framework. We conclude with reflections on the strengths and limitations of the framework, suggesting how it may be relevant in other qualitative health approaches.

Introducing Evidence Through Research "Push": Using Theory and Qualitative Methods

A multitude of factors can influence the uptake and implementation of complex interventions in health care. A plethora of theories and frameworks recognize the need to establish relationships, understand organizational dynamics, address context and contingency, and engage key decision makers. Less attention is paid to how theories that emphasize relational contexts can actually be deployed to guide the implementation of an intervention. The purpose of the article is to demonstrate the potential role of qualitative research aligned with theory to inform complex interventions. We detail a study underpinned by theory and qualitative research that (a) ensured key actors made sense of the complex intervention at the earliest stage of adoption and (b) aided initial engagement with the intervention. We conclude that using theoretical approaches aligned with qualitative research can provide insights into the context and dynamics of health care settings that in turn can be used to aid intervention implementation.

Using a Qualitative Vignette to Explore a Complex Public Health Issue

This article discusses how qualitative vignettes were combined with interviews to explore a complex public health issue; that is, promoting unhealthy foods and beverages to children and adolescents. It outlines how the technique was applied in practice and the combination of vignette-based interviews with a broader approach involving Gadamerian hermeneutics. Twenty-one participants from the public health community and the marketing and food and beverage industries took part in vignette-based interviews between March and September 2012. Overall, the qualitative vignette method afforded an efficient, generally well-received technique that effectively explored the issue of promoting unhealthy foods and beverages to children and adolescents. The vignette provided structure to interviews but allowed certain responses to be investigated in greater depth. Through this research, we argue that qualitative vignettes allow researchers to explore complex public health issues. This article also provides a valuable resource for researchers seeking to explore this technique.

On the Creative Edge: Exploring Motivations for Creating Non-Suicidal Self-Injury Content Online

The last decade has witnessed an exponential growth in user-generated online content featuring Non-Suicidal Self-Injury (NSSI), including photography, digital video, poems, blogging, and drawings. Although the increasing visibility of NSSI content has evoked public concern over potential health risks, little research has investigated why people are drawn to create and publish such content. This article reports the findings from a qualitative analysis of online interviews with 17 individuals who produce NSSI content. A thematic analysis of participants' narratives identified two prominent motives: self-oriented motivation (to express self and creativity, to reflect on NSSI experience, to mitigate self-destructive urges) and social motivation (to support similar others, to seek out peers, to raise social awareness). Participants also reported a double-edged impact of NSSI content both as a trigger and a deterrent to NSSI.

Therapeutic Jurisprudence in Health Research: Enlisting Legal Theory as a Methodological Guide in an Interdisciplinary Case Study of Mental Health and Criminal Law

Studies that seek to understand and improve health care systems benefit from qualitative methods that employ theory to add depth, complexity, and context to analysis. Theories used in health research typically emerge from social science, but these can be inadequate for studying complex health systems. Mental health rehabilitation programs for criminal courts are complicated by their integration within the criminal justice system and by their dual health-and-justice objectives. In a qualitative multiple case study exploring the potential for these mental health court programs in Arctic communities, we assess whether a legal theory, known as therapeutic jurisprudence, functions as a useful methodological theory. Therapeutic jurisprudence, recruited across discipline boundaries, succeeds in guiding our qualitative inquiry at the complex intersection of mental health care and criminal law by providing a framework foundation for directing the study's research questions and the related propositions that focus our analysis.

Clinical Positioning Space: Residents' Clinical Experiences in the Outpatient Oncology Clinic

In this article, we present a case study of residents' clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights and duties. Drawing from seven qualitative interviews and six days of observation, we investigate the residents' social positioning and their conversations with patients or supervisors. Our focus is on how (a) relational shifts in authority depend on each situation and its participants; (b) storylines establish acts and positions and narratively frame what participants can expect from a medical consultation viewed as a social episode; and (c) the positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that residents and patients locate themselves in outpatient conversations as participants who jointly produce and are produced by patients' and nurses' storylines about who should take responsibility for treatment.

Revisiting Symbolic Interactionism as a Theoretical Framework Beyond the Grounded Theory Tradition

The tight bond between grounded theory (GT) and symbolic interactionism (SI) is well known within the qualitative health research field. We aimed to disentangle this connection through critical reflection on the conditions under which it might add value as an underpinning to studies outside the GT tradition. Drawing on an examination of the central tenets of SI, we illustrate with a field study using interpretive description as methodology how SI can be applied as a theoretical lens through which layers of socially constructed meaning can help surface the subjective world of patients. We demonstrate how SI can function as a powerful framework for human health behavior research through its capacity to orient questions, inform design options, and refine analytic directions. We conclude that using SI as a lens can serve as a translation mechanism in our quest to interpret the subjective world underlying patients' health and illness behavior.

Exploring the experiences of people with hypo- and hyperthyroidism

Thyroid diseases evoke a complex range of psychological and physical symptoms. The psychosocial aspects of living with diseases causing hypo- or hyperthyroidism are poorly understood. In this article, we report the findings of a qualitative interview study in which we explored the lived experiences of 16 people with hypo- or hyperthyroidism. We purposefully selected participants from Danish outpatient clinics according to their diagnosis (Hashimoto's thyroiditis or Graves' disease with or without orbitopathy), age (18 to 65 years), and duration of treatment (more than 6 months). We used interpretative phenomenological analysis (IPA) as a theoretical frame and analytical approach and identified three superordinate themes: losing control over mental and physical states, ambiguous signs of disease, and negotiating sickness. We discuss the findings in the context of the recent literature on chronic illness and argue that these themes play an important role in the conceptualization and management of thyroid diseases.

Foucault, surveillance, and carbon monoxide testing within stop-smoking services

Health professionals have adopted proactive testing for early evidence of disease. Researchers have identified that this leads to enumerated understandings and shapes behavior in productive ways. Smoking-cessation advisors regularly test clients for carbon monoxide (CO), but client views of this had not previously been explored. We interviewed 23 clients of a United Kingdom-based stop-smoking service regarding their experiences of CO testing. The majority of participants were successful quitters. We used ATLAS.ti 7 as a data-management tool during structured qualitative analysis. Our findings reveal that clients believed the results of their CO tests. Many became enumerated in their understanding, and thus placed themselves in a hierarchy with other members of their group. Almost all clients found that knowing their CO test score was motivating. We conclude that additional research is needed to understand the experiences of CO testing among clients who do not quit.

Experiences of cancer caregiving in socioeconomically deprived areas of Attica, Greece

The shift of the majority of cancer care from inpatient to outpatient settings has given rise to a number of issues that have not yet been adequately addressed. This is especially true in countries undergoing rapid and profound socioeconomic changes that have substantially affected the health care sector. We conducted 12 in-depth interviews with family cancer caregivers residing in socioeconomically deprived areas of Attica, Greece. Using an inductive thematic approach, we identified three major themes: (a) the truth within boundaries, focusing on the flow of information in the triad doctor-caregiver-patient; (b) the evil called "cancer," reflecting caregivers' perceptions of the illness; and (c) being left "high and dry," reflecting participant experiences of home-based care. Against a background of financial crisis, this study underlines the need for safeguarding the rights of chronically ill patients and ensuring that informal cancer care, apart from a cost-effective solution, will also be an efficient one.

Barriers to qualitative dementia research: the elephant in the room

As our population is aging, the global prevalence of dementia is rising. Recent extensive reviews of the dementia literature highlight a clear need for additional qualitative research to address the experiences of people with dementia and their carers. To date, the vast majority of published dementia research is quantitative in nature and, perhaps not surprisingly, attracts the bulk of government funding. In contrast, qualitative dementia research is poorly resourced and less frequently published. Although a myriad of factors are responsible for this dichotomy, we propose that inadequate funding represents the "elephant in the room" of dementia research. In this article, we describe and emphasize the need for qualitative dementia research, highlight existing barriers, and outline potential solutions. Examples of barriers are provided and theoretical underpinnings are proposed.

Characteristics of lifelong physically active older adults

Most adults in developed countries fail to accrue enough regular physical activity to prevent or decrease the impact of chronic diseases associated with aging. I conducted semistructured interviews with 16 purposely selected older adults ranging in age from 53 to 70 years to explore the practices of successful lifelong adherents to physical activity. I used an interpretive descriptive approach to data analysis. My findings suggest that both social and competitive motivations were important during early adulthood, although for many participants the latter were more likely to endure over time. Based on these findings, I recommend that programmers be aware of the potential for older participants to be less fulfilled by social motivations as they become more experienced exercisers.

Perceptions of health professionals on pain in extremely low gestational age infants

Extremely low gestational age infants (<28 weeks at birth) experience significant pain from repeated therapeutic procedures while hospitalized in the neonatal intensive care unit. As part of a program of research examining pain in preterm infants, we conducted a qualitatively driven mixed-methods design, supplemented with a qualitative and quantitative component, to understand how health care professionals (HCPs) assess and manage procedural pain for tiny and underdeveloped preterm infants. Fifty-nine HCPs from different disciplines across four tertiary-level neonatal units in Canada participated in individual or focus group interviews and completed a brief questionnaire. Four themes from the content analysis were (a) subtlety and unpredictability of pain indicators, (b) infant and caregiver attributes and contextual factors that influence pain response and practices, (c) the complex nature of pain assessment, and (d) uncertainty in the management of pain. The information gleaned from this study can assist in identifying gaps in knowledge and informing unit-based and organizational knowledge translation strategies for this vulnerable population.

Acceptable care? Illness constructions, healthworlds, and accessible chronic treatment in South Africa

Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas-conversely-these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating "disease" to responding to "illness" by acknowledging and incorporating patients' healthworlds in patient-provider interactions.