Basics of qualitative research: Grounded theory procedures and techniques

Basic concepts for qualitative research

Abstract Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

There has been a growing interest over the past decade into the health benefits of music, in particular examining its psychological and neurological effects. Yet this is the first attempt to systematically review publications on the psychoneuroimmunology of music. Of the selected sixty-three studies published over the past 22 years, a range of effects of music on neurotransmitters, hormones, cytokines, lymphocytes, vital signs and immunoglobulins as well as psychological assessments are cataloged. Research so far points to the pivotal role of stress pathways in linking music to an immune response. However, several challenges to this research are noted: (1) there is very little discussion on the possible mechanisms by which music is achieving its neurological and immunological impact; (2) the studies tend to examine biomarkers in isolation, without taking into consideration the interaction of the biomarkers in question with other physiological or metabolic activities of the body, leading to an unclear understanding of the impact that music may be having; (3) terms are not being defined clearly enough, such as distinctions not being made between different kinds of stress and 'music' being used to encompass a broad spectrum of activities without determining which aspects of musical engagement are responsible for alterations in biomarkers. In light of this, a new model is presented which provides a framework for developing a taxonomy of musical and stress-related variables in research design, and tracing the broad pathways that are involved in its influence on the body.

The psychoneuroimmunological effects of music: A systematic review and a new model

Understanding voice problems: A physiological perspective for diagnosis and treatment

Music performance anxiety and occupational stress amongst opera chorus artists and their relationship with state and trait anxiety and perfectionism

Objectives: To assess the outcome of type II thyroplasty in the treatment of adductor spasmodic dysphonia (ASD).

Study Design: Prospective case series.

Methods: Thirteen patients with the diagnosis of ASD who were previously treated successfully with botulinum toxin therapy were recruited. Type II thyroplasty as described by Nobuhiko Isshiki was performed on all the patients. A self-rating assessment of the degree of severity and vocal effort were recorded and compared preoperatively and during postoperative follow-up.

Results: There were four early failures in our series, with two caused by friable thyroid cartilage. In the early postoperative period, after excluding the early failures, six (66.7%) and seven (77.8%) patients had moderate-good improvement in symptom severity and vocal effort, respectively. During the follow-up period, a further five patients had deterioration of voice quality and were classified as failures. Of these five patients, two patients had reversal of their procedure. At the end of the follow-up period (mean follow-up period of 12 months), six (66.7%) and five (55.5%) patients sustained improvement in symptom severity and vocal effort, respectively. However, only two (22.2%) and three (33.3%) patients had moderate-good improvements in symptom severity and vocal effort, respectively, after 12 months.

Conclusions: Botulinum toxin injection remains the gold-standard treatment for ASD in our center. Potential patients for type II thyroplasty need to be carefully selected and counseled by a multidisciplinary team of otolaryngologists, neurologists, and speech pathologists.

Long-term results of type II thyroplasty for adductor spasmodic dysphonia.

The aim of this qualitative study was to gain an understanding of the way male-to-female transsexuals perceived their communication and their satisfaction with it in different aspects of their lives. Three focus groups were conducted for the purposes of this study, each consisting of four participants. The transcribed dialogues of the groups were analysed using a grounded theory approach to find the common underlying themes. These then formed the basis of the five major categories that identified key themes relating to transsexuals' communicative satisfaction: communicative situations, emotions, groups of people, other contributing factors, and features of communication. The results revealed that although participants commented on the situations and contexts in which they experienced decreased communicative satisfaction, it was not always important to them to maintain their female communicative patterns in situations in which they felt comfortable. These five categories guided the development of a two-part pilot Functional Communicative Satisfaction Questionnaire (FCSQ). The FCSQ explores a variety of situations that the participants identified as impacting on their communicative satisfaction. Further development of the FCSQ is likely to enable speech pathologists to have a more informed approach to the management of this population.

Communicative satisfaction of male-to-female transsexuals

Which acoustic features (time- and spectral/cepstral-based) predict the perceived severity of dysphonia? 1 Abstracted from: Awan, S. N., & Roy, N. (2006). Toward the development of an objective ind...

Jenni Oates

Papers

Music performance anxiety and occupational stress amongst opera chorus artists and their relationship with state and trait anxiety and perfectionism

Long-term results of type II thyroplasty for adductor spasmodic dysphonia.

Communicative satisfaction of male-to-female transsexuals

A four-factor acoustic model provides an objective index for assessing dysphonia severity1