Basics of qualitative research: Grounded theory procedures and techniques

Qualitative research is increasingly common in health services research (Shortell 1999; Sofaer 1999). Qualitative studies have been used, for example, to study culture change (Marshall et al. 2003; Craigie and Hobbs 2004), physician–patient relationships and primary care (Flocke, Miller, and Crabtree 2002; Gallagher et al. 2003; Sobo, Seid, and Reyes Gelhard 2006), diffusion of innovations and quality improvement strategies (Bradley et al. 2005; Crosson et al. 2005), novel interventions to improve care (Koops and Lindley 2002; Stapleton, Kirkham, and Thomas 2002; Dy et al. 2005), and managed care market trends (Scanlon et al. 2001; Devers et al. 2003). Despite substantial methodological papers and seminal texts (Glaser and Strauss 1967; Miles and Huberman 1994; Mays and Pope 1995; Strauss and Corbin 1998; Crabtree and Miller 1999; Devers 1999; Patton 1999; Devers and Frankel 2000; Giacomini and Cook 2000; Morse and Richards 2002) about designing qualitative projects and collecting qualitative data, less attention has been paid to the data analysis aspects of qualitative research. The purpose of this paper is to offer practical strategies for the analysis of qualitative data that may be generated from in-depth interviewing, focus groups, field observations, primary or secondary qualitative data (e.g., diaries, meeting minutes, annual reports), or a combination of these data collection approaches.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1475-6773.2006.00684.x

Qualitative data analysis for health services research: developing taxonomy, themes, and theory.

www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

How does communication heal? Pathways linking clinician-patient communication to health outcomes.

Patient-centered communication in cancer care: Promoting healing and reducing suffering

BACKGROUND
Logistic, cultural, educational, and other barriers can impede the delivery of high-quality cancer care to underserved patients. Patient navigation services represent one innovation for addressing perceived barriers to care encountered by disadvantaged patients. In this report, the authors have 1) defined patient navigation, distinguishing it from other cancer support services; 2) described how programs are organized; and 3) discussed the need for research on program effectiveness.

METHODS
Information was examined on navigation programs published in the scientific literature and on line. Qualitative research also was conducted, consisting of direct observation of patient care in cancer clinics with and without navigators in northern California, in-person interviews with personnel and patients in the clinics observed, and telephone interviews with navigators at four sites across the United States.

RESULTS
The authors found that navigation services have been implemented at all stages of cancer care: prevention, screening, treatment, and survival. Navigators differ from other cancer support personnel in their orientation toward flexible problem solving to overcome perceived barriers to care rather than the provision of a predefined set of services. There are no rigorous demonstrations of the effects and effectiveness of navigation, although such studies are underway.

CONCLUSIONS
Currently, patient navigation is understudied, and literature documenting its effects and effectiveness is scant. Rigorous studies are needed of the navigator role and program costs and benefits. Such studies will facilitate an assessment of program effectiveness, feasibility across a range of health care settings, and performance relative to alternative approaches for addressing barriers to care among the underserved. Cancer 2005. © 2005 American Cancer Society.

/pdf/using-navigators-to-improve-care-of-underserved-patients-qjn71fxkoi.pdf

Using navigators to improve care of underserved patients: current practices and approaches.

BACKGROUND
Although numerous studies have addressed external factors associated with difficulty in surrogate decision making, intrapersonal sources of tension are an important element of decision making that have received little attention

/pdf/i-don-t-want-to-be-the-one-saying-we-should-just-let-him-die-298zy5h0su.pdf

I Don’t Want to Be the One Saying ‘We Should Just Let Him Die’: Intrapersonal Tensions Experienced by Surrogate Decision Makers in the ICU

Improving provision of palliative care in oncology may require efforts beyond increasing service availability. Developing ways for oncologists and palliative care physicians to collaborate and integrate their respective skills may help.

/pdf/oncologist-factors-that-influence-referrals-to-subspecialty-2051xmuyvd.pdf

Oncologist Factors That Influence Referrals to Subspecialty Palliative Care Clinics

PART I--INTRODUCTION Preface Chapter 1 Institutions of Poverty Chapter 2 Income Generation in the Barrios PART II--WORK Chapter 3 The Job Market Chapter 4 The Experience of Low-Wage Work Chapter 5 Networks and Work PART III--CRIME Chapter 6 Illegal Routines Chapter 7 The Consequences of Illegal Work PART IV--WELFARE Chapter 8 Making Ends Meet Chapter 9 Making Welfare Stigma PART V--CONCLUSION: WORK, CRIME, AND WELFARE Chapter 10 The Price of Poverty Appendix Methods of this Study

The Price of Poverty: Money, Work, and Culture in the Mexican American Barrio

We sought to determine what women recall about reproductive health risks (RHR) from cancer therapy at the time of cancer diagnosis in order to identify barriers to reproductive health counseling (RHC) and fertility preservation (FP). Data were obtained by surveying 1,041 female cancer survivors from the California Cancer Registry. Inclusion criteria included women age 18–40 with a diagnosis of leukemia, Hodgkin’s disease, non-Hodgkin’s lymphoma, breast or GI cancer diagnosed between 1993 and 2007. Women were asked to respond to an open-ended question: “what did your doctor tell you about how cancer treatment could affect your ability to get pregnant?” Framework analysis was used to identify themes surrounding patient perceptions of RHC. Of the patients, 51.8 % (361 out of 697) recalled receiving reproductive health counseling and 12.2 % (85 out of 697) recalled receiving FP counseling. Of the patients, 45.3 % (277 out of 612) reported that uncertain prognosis, risk of recurrence or vertical transmission, age, parity, or uncertain desire may have prevented them from receiving timely and essential information on RHRs. Communication barriers included omission of information, failure to disclose RHRs, and presentation of incorrect information on FP. In a sample of women diagnosed with cancer of reproductive age, almost half did not recall counseling on RHRs and few recalled FP counseling. Communication barriers between physicians and patients regarding fertility may lead to uninformed (reproductive health) RH decisions. Many women may not receive adequate information about RHRs or FP at the time of cancer diagnosis. Advancements in reproductive technology and emerging organizations that cover financial costs of FP have dramatically changed what options women have to preserve their fertility. Routine and thoughtful RHR and FP counseling, as well as collaborative cancer care will help ensure that women diagnosed with cancer are provided with the services and information they need to make an informed choice about their reproductive future.

Daniel Dohan

Papers

Using navigators to improve care of underserved patients: current practices and approaches.

I Don’t Want to Be the One Saying ‘We Should Just Let Him Die’: Intrapersonal Tensions Experienced by Surrogate Decision Makers in the ICU

Oncologist Factors That Influence Referrals to Subspecialty Palliative Care Clinics

The Price of Poverty: Money, Work, and Culture in the Mexican American Barrio

Patient perceptions of reproductive health counseling at the time of cancer diagnosis: a qualitative study of female California cancer survivors.