Qualitative Health Research

Ramsay, Natalie; Hossain, Rahat; Moore, Mo; Milo, Michael; Brown, Allison

doi: 10.1177/1049732319829434pmid: 30810072

Persons struggling with housing remain significantly disadvantaged when considering access to health care. Effective advocacy for their needs will require understanding the factors which impact their health care, and which of those most concern patients themselves. A qualitative descriptive study through the lens of a transformative framework was used to identify barriers and facilitators to accessing health care as perceived by people experiencing homelessness in the regional municipality of Niagara, Canada. In-person, semi-structured interviews with 16 participants were completed, and inductive thematic analysis identified nine barriers and eight facilitators. Barriers included affordability, challenges finding primary care, inadequacy of the psychiatric model, inappropriate management, lack of trust in health care providers, poor therapeutic relationships, systemic issues, and transportation and accessibility. Facilitators included accessibility of services, community health care outreach, positive relationships, and shelters coordinating health care. Knowledge of the direct experiences of marginalized individuals can help create new health policies and enhance the provision of clinical care.

Shankar, Sneha; Gogosis, Evie; Palepu, Anita; Gadermann, Anne M.; Hwang, Stephen W.

doi: 10.1177/1049732318798353pmid: 30253692

Resilience is a factor related to positive health outcomes. Exploring this concept among adults experiencing homelessness can inform interventions while subsequently considering individuals’ strengths. A phenomenographic approach was applied to examine this concept among a sample of 22 individuals involved in qualitative interviews. The phenomenographic inquiry identified eight conceptions and found resilience is captured in both positive and negative ways. Conceptions are summarized by two categories, situated in an outcome space which describes the overall resilience experience and the different ways these conceptions are understood and experienced. Categories summarize conceptions as Staying Strong and Sustaining Positive Beliefs, which highlight the construct as being captured by a persistent positive aspect; however, the findings also uniquely describe the influence of negative conceptions toward the overall phenomenon. The findings suggest resilience is recognizable during adversity, and it is a phenomenon that has the potential to be strengthened.

Badenhorst, Marelise; Verhagen, Evert; Lambert, Mike; van Mechelen, Willem; Brown, James

doi: 10.1177/1049732319834930pmid: 30864491

Most contact sports, including rugby union, carry a risk of injury. Although acute spinal cord injuries (ASCIs) in rugby are rare, the consequences of such injuries are far-reaching. Optimal management of these injuries is challenging, and a detailed understanding of the different barriers and facilitators to optimal care is needed. In this study, we aimed to describe the perception of players, regarding factors related to the optimal immediate management of a catastrophic injury in a developing country with socioeconomic and health care inequities. The most frequently reported barriers were transportation delays after injury and admission to appropriate medical facilities. Other barriers included inadequate equipment, the quality of first aid care, and barriers within the acute hospital setting. Barriers were more prevalent in rural and lower socioeconomic areas. These findings are relevant for all rugby stakeholders and may help shape education, awareness, and future policy around the immediate management of ASCIs.

Monaghan, Lee F.; Gabe, Jonathan

doi: 10.1177/1049732318808521pmid: 30461359

In this article, we explore the relationship between asthma and stigma, drawing on 31 interviews with young people (aged 5–17) in Ireland. Participants with mild to moderate asthma were recruited from Traveller and middle-class settled communities. Themes derived from an abductive approach to data analysis and a critical appreciation of Goffmanesque sociology include asthma as a discreditable stigma, negative social reactions (real, imagined, and anticipated), and stigma management. Going beyond a personal tragedy model, we reflect upon macro-social structures (e.g., ethnicity, class, gender) which underlie stigma and the management of a potentially spoiled identity. This raises issues about the politics of chronic illness, embodying health identities and efforts to tackle stigma in neoliberal times.

Setchell, Jenny; Abrams, Thomas; McAdam, Laura C.; Gibson, Barbara E.

doi: 10.1177/1049732319838235pmid: 30957656

Clinicians’ positive demeanor and “strengths based” focus can include working to create a cheerful atmosphere in health care environments, cheering for improvements in assessment outcomes, and cheering up clients in situations of decline. Drawing from philosopher Karen Barad’s theories of inclusions and exclusions, we investigated what comes to matter (and what is excluded from mattering) when there is cheerfulness, cheering, and so forth (cheer*) in the day-to-day practices of a neuromuscular clinic. We worked collaboratively with clinicians, young people with Duchenne muscular dystrophy, and their families to co-examine the clinic in three iterative exploratory method spaces: (a) group “dialogues” with clinicians; (b) consultative interviews with children, families, and clinicians; and (c) transdisciplinary research team analysis sessions. Cheer* made some things matter in the clinic (“normal” physical function, “positive” emotions, test scores, compliance); and excluded others (grief and loss, “non-normative” bodies and lives, alternative practices, embodied knowledge). We discuss implications across health care settings.

Turner, Nalita Nungarrayi; Taylor, Judy; Larkins, Sarah; Carlisle, Karen; Thompson, Sandra; Carter, Maureen; Redman-MacLaren, Michelle; Bailie, Ross

doi: 10.1177/1049732319843107pmid: 31014184

Drawing from Australian Aboriginal and Torres Strait Islander perspectives, we conceptualize the association between community participation and continuous quality improvement (CQI) processes in Indigenous primary health care (PHC) services. Indigenous experiences of community participation were drawn from our study identifying contextual factors affecting CQI processes in high-improving PHC services. Using case study design, we collected quantitative and qualitative data at the micro-, meso-, and macro-health system level in 2014 and 2015 in six services in northern Australia. Analyzing qualitative data, we found community participation was an important contextual factor in five of the six services. Embedded in cultural foundations, cultural rules, and expectations, community participation involved interacting elements of trusting relationships in metaphorically safe spaces, and reciprocated learning about each other’s perspectives. Foregrounding Indigenous perspectives on community participation might assist more effective participatory processes in Indigenous PHC including in CQI processes.

Folker, Anna P.; Kristensen, Mette M.; Kusier, Amalie O.; Nielsen, Maj Britt D.; Lauridsen, Sigurd M.; Sølvhøj, Ida N.

doi: 10.1177/1049732319840286pmid: 30966911

Continuity of mental health care is central to improve the treatment and rehabilitation of people with mental disorders. While most studies on continuity of care fail to take the perspectives of service users into account, the aim of this study was to explore the perceived meanings of continuity of care among people with long-term mental disorders. Fifteen service users participated in semi-structured in-depth interviews. We used template analysis to guide the analysis. The main transversal themes of continuity were “Navigating the system” and “Connecting to people and everyday life.” While the first theme related to the participants’ experiences of their interaction with the mental health care system, the latter related to their hopes and perceived opportunities for a good life as desired outcomes of mental health care. We conclude that efforts to improve continuity of mental health care should be tailored to the priorities of service users.

Baumann, Eva; Scherer, Helmut; Link, Elena; Wiltfang, Jörg; Wenz, Hans-Jürgen; Koller, Michael; Hertrampf, Katrin

doi: 10.1177/1049732318802263pmid: 30296926

Oral cancer is a considerable public health problem, and a low level of awareness and knowledge about this tumor and its risk factors is prevalent. To gain a profound understanding of risks groups and to identify suitable communication strategies for a prevention campaign in Northern Germany, an exploratory research was realized. In semistructured face-to-face interviews, the participants of the study (n = 28) described their individual oral cancer-related perceptions and information-seeking behaviors. A computer-assisted qualitative data analysis showed a vague but also deterring picture of cancer combined with restricted attitudes toward the topic and an inactive or even avoiding information behavior. Four underlying cognitive patterns of self-distancing were identified: (a) optimistic bias, (b) fatalism, (c) hedonism, and (d) pragmatism. The main challenge of oral cancer prevention is to deal with the target groups’ informational and cognitive barriers.

De Vries, Raymond G.; Ryan, Kerry A.; Gordon, Linda; Krenz, Chris D.; Tomlinson, Tom; Jewell, Scott; Kim, Scott Y. H.

doi: 10.1177/1049732318791826pmid: 30095038

Do members of the public believe that biobanks should accommodate the moral concerns of donors about the types of research done with their biospecimens? The answer to this question is critical to the future of genomic and precision medicine, endeavors that rely on a public willing to share their biospecimens and medical data. To explore public attitudes regarding the requirements of consent for biobank donations, we organized three democratic deliberations involving 180 participants. The deliberative sessions involved small group discussions informed by presentations given by experts in both biobank research and ethics. We found that participants had a sophisticated understanding of the ethical problems of biobank consent and the complexity of balancing donor concerns while promoting research important to the future of health care. Our research shows how deliberative methods can offer policy makers creative ideas for accommodating the moral concerns of donors in the biobank consent process.

Gabay, Gillie

doi: 10.1177/1049732319844999pmid: 31043144

Patient trust is positively related to health outcomes, but there remain barriers to patient trust in physicians. This narrative study analyzed patient experiences and highlights barriers to patient trust underlying communication with physicians in acute care. Snowball sampling was used. Informants were 12 participants, in poor physical health, upon discharge from a 3-week hospitalization in an acute-care setting at an Israeli public general hospital. Two narrative interviews were conducted with each participant upon and after discharge. Findings suggest presurgery barriers to trust (lack of acknowledgment of patient’s crisis, underrating patient’s autonomy, and use of unique empathy) and postsurgery barriers to trust (lack of attentive listening, lack of medical professionalism, and delegitimization to patients’ self-alienation). Two common narrative identities emerged linking trust with self-worth. To build trust, physicians are called upon to extend their dedication from dedication to improve clinical outcomes to dedication to improve clinical outcomes and preserve patients’ self-worth.