Showing papers in "Qualitative Health Research in 1999"

Ten Tips for Reflexive Bracketing

Abstract: Despite the realization that total objectivity is neither achievable nor necessarily desirable in qualitative research, researchers often are required to put aside assumptions so that the true experiences of respondents are reflected in the analysis and reporting of research. In many qualitative publications and conference presentations, researchers report that they have attempted this process, but the means by which this attempt was made often are not explicated. In this article, the author provides guidance to help qualitative researchers use reflexivity to identify areas of potential bias and to “bracket” them so their influence on the research process is minimal.

Using Reflexivity to Optimize Teamwork in Qualitative Research

Abstract: Reflexivity is often described as an individual activity. The authors propose that reflexivity employed as a team activity, through the sharing of reflexive writing (accounts of personal agendas, hidden assumptions, and theoretical definitions) and group discussions about arising issues, can improve the productivity and functioning of qualitative teams and the rigor and quality of the research. The authors review the literature on teamwork, highlighting benefits and pitfalls, and define and discuss the role for reflexivity. They describe their own team and detail how they work together on a project investigating doctor-patient communication about prescribing. The authors present two reflexive tools they have used and show through examples how they have influenced the effectiveness of their team in terms of process, quality, and outcome.

Phenomenography: A Qualitative Research Approach for Exploring Understanding in Health Care

Abstract: Phenomenography is a little-known qualitative research approach that has potential for health care research, particularly when people’s understanding of their experience is the goal. Phenomenography is explained as a qualitative, nondualistic research approach that identifies and retains the discourse of research participants. This article seeks to present the major assumptions associated with phenomenographic research. An example of the way in which research outcomes are presented is included to emphasize its distinctiveness. It is noted that phenomenography has potential in the area of qualitative health research and will benefit from ongoing development and application.

The Future of Grounded Theory

Abstract: This keynote address does not detail a “wish list”; it is not an ideology. Rather, it is a grounded analysis of data from the author’s travels that indicates what the future of grounded theory is likely to be. The author discusses in whose hands the future of grounded theory appears to be as well as what accounts for its spread, its use, and its misuse.

Stories of Suffering: Subjective Tales and Research Narratives

Abstract: The following analysis addresses relationships between suffering and the self. It emphasizes subjects’ stories of experiencing chronic illness and their relationship to the construction of self. A symbolic interactionist perspective informs the analysis. Topics include forms of suffering, the moral hierarchy of suffering, relationships between gender and moral status in suffering, and meanings of subjects’ stories. The major argument is that suffering is a profoundly moral status. Placement in the moral hierarchy of suffering affects whether and how an ill person’s stories will be heard.

Struggling for Dignity: The Meaning of Women’s Experiences of Living with Fibromyalgia

Abstract: Fibromyalgia (FM) is a common chronic pain syndrome with an obscure etiology, which mostly afflicts middle-aged women. In this study, 14 women with FM were interviewed about the meaning of living with the illness. A phenomenological-hermeneutic method was used to analyze and interpret the interview texts. The findings show that being a woman with FM means living a life greatly influenced by the illness in various ways. The women's experiences of living with FM were presented in three major interlaced themes: loss of freedom, threat to integrity, and a struggle to achieve relief and understanding. This study highlights the importance of meeting people suffering in illness with respect for their human dignity. The care of women with FM must empower the women to bring to bear their own resources so that they can manage to live with the illness.

Living with Diabetes as a Transformational Experience

Abstract: The construct of transformation has been presented in many research studies as the epitome of living with a chronic illness Because it has been inadequately defined, however, many other concepts (eg, hope, meaning, control) are used in ways that suggest considerable overlap and correspondence with transformation This article represents an attempt to explicate the structures and processes of transformation as they were revealed in a qualitative inquiry into the experience of individuals with Type I diabetes In the accounts constructed with participants in this study, the process of personal transformation was significant in the attainment of healthy outcomes The authors describe this transformation and examine its relationship to control and to the valued outcomes of intensified sense of self, meaning, and mastery

Data Alive! The Thinking Behind NVivo

Abstract: Rich data from qualitative research have been treated poorly by computers Yet, plain text and static documents largely have been uncritically accepted as a price of coding The new qualitative software from Qualitative Solutions and Research (QSR), NUD•IST Vivo (NVivo), challenges that assumption This article explores the goals of rich data in qualitative research and the ways NVivo addresses these Like its sibling software, NUD•IST4, NVivo supports code-based inquiry, searching, and theorizing combined with ability to annotate and edit documents However, NVivo is designed for researchers who wish to display and develop rich data in dynamic documents Documents can be imported and edited in rich text with hyperlinks to sound, image, and other files, but they also can be coded as finely as needed and the results of coding displayed, explored, and modeled The final section offers a brief outline of these and other features of the new software

Breast Cancer Survivors’ Perceptions of Complementary/Alternative Medicine (CAM): Making the Decision to Use or Not to Use

Abstract: The study described in this article explored breast cancer survivors' perceptions and experiences as they decided whether to use a variety of complementary/alternative therapies. Six focus groups were conducted composed of women who had been diagnosed with breast cancer. Each 2-hour session was audiotaped and transcribed verbatim. In this article, the process by which the participants made the decision to use or not to use complementary/alternative therapies, including their discovery and investigation of complementary/alternative medicine (CAM) and their experiences using or not using CAM, are described. Barriers to using CAM included cost, access, and time. Family and friends generally supported the decision to use CAM; however, the participants described health care practitioners' reactions as mixed.

Accounting for Presence of Self: Reflections on Doing Qualitative Research

Abstract: In a qualitative study, the researcher’s curiosity, relationships with participants, and conceptual lenses through which data are gathered and interpreted have significant bearing on the research. This reflective account of the author’s experiences conducting a study of prenatal care use among low-income women reveals the necessarily personal nature of her work. She address some of her motives for carrying out the study, feelings that arose during interactions with participants and responses to those feelings, challenges in managing her role as researcher, and strategies to make meaning of gathered data. The author makes explicit how her self was a significant influence on the process of inquiry. Locating oneself in the research endeavor in this manner is essential for establishing a context within which others can appreciate the evolving search for new understanding and the creation of a final research product.

How Does Grounded Theory Explain

Abstract: This article argues that the concept of grounded theory, widely used in research in the human sciences, has not been adequately analyzed as to its structure as a theory. Analyzing grounded theory from predictionist and accommodationist views, as well as focusing on the issue of inference to the best explanation, it is concluded that this form of theorizing is basically accommodationist. Moreover, grounded theory, in terms of providing explanations, is simply a different version of a standard inductive argument. However, grounded theory’s strength lies in its potential to articulate a unique context and logic of discovery.

What We Didn’t Learn Because of Who Would Not Talk to Us

Abstract: Qualitative researchers relish the knowledge derived from multiple perspectives. They pride themselves on capturing the complexity of their informants’ experiences, they savor their ways of describing them, and they build models grounded in their narratives. Seldom do qualitative researchers ponder how their models might be different if those who refused to participate had talked to them. This article discusses sampling problems the authors encountered in a study of African American elders’ long-term care choices and preferences. They conducted 60 qualitative interviews with elders and caregivers of elders receiving one of three types of care: kin care, formal services, or nursing home care. Gatekeeper bias, refusals to participate, sampling frame, pragmatic constraints, and institutional barriers were major sources of sampling bias.

The Labor of Caregiving: A Theoretical Model of Caregiving During Potentially Fatal Illness

Abstract: The purpose of this study was to explore the influence that chronic and potentially fatal illness has on the caregiving process over time. Data were collected through in-depth interviews with 26 family caregivers of people experiencing AIDS or advanced cancer over a 4-month period. Constant comparative analysis was used to analyze the data. A substantive theory of family caregiving for people with life-threatening illnesses was developed around a core organizing theme: the labor of caregiving. Four phases emerged: becoming a caregiver, taking care, midwifing the death, and taking the next step. This study validates the taking-care or "tasks" aspect of caregiving, revealing that issues and tasks vary in each phase of caregiving. The key role of the caregiver in contributing to the quality of life of the ill person was apparent in the initial phase of an illness as well as at the time of death.

A Protocol for Researcher Safety

Abstract: Although there is an abundance of literature about how to conduct qualitative research and some consideration of possible threats to researchers' psychological well-being, there is little mention of the personal safety issues that researchers face while in the field. Few researchers have attempted to address the issue of researcher safety as a methodological concern. Consequently, there are minimal guidelines available to researchers to prevent and avoid dangerous incidents in the course of their research. The following is a discussion of the general guidelines for developing a protocol to address the issue of researcher safety in the field. These guidelines have been extrapolated from safety guidelines and policies written for students and clinicians who enter a client's home in their role as health care practitioners, relevant literature in the area of safety for researchers in violent settings, resources such as safety guidelines for employees, and the personal experiences of several researchers.

Courage as a Process of Pushing Beyond the Struggle

Abstract: Six qualitative studies have been carried out to better understand courage among individuals who range in age from 14 to 94 years and are experiencing a variety of lingering threats to their well-being. The purpose of this meta-interpretation was to synthesize those works and further delineate an emergent formal theory of courage. Based on the findings, courage is a dynamic phenomenon that is precipitated by a perceived threat. The ability to be courageous develops over time and includes efforts to fully accept reality, problem solve based on discernment, and push beyond ongoing struggles. Courageous behavior is characterized by efforts to be productive, make contributions, and help others and results in a sense of personal integrity and thriving. Courage is promoted and sustained by several interrelated intrapersonal and interpersonal forces as well as the reflective awareness that one has developed a courageous persona.

Mothering Through Addiction: A Survival Strategy among Puerto Rican Addicts

Abstract: In this article, the importance of motherhood in the lives of Puerto Rican addicts is examined. Using a life history method, the authors interviewed 20 Latina females in various stages of recovery from addiction to crack-cocaine or heroin. Their lives as mothers took place in a context of poverty, marginalization, and abuse. Motherhood provided an identity and a line of work that grounded them amidst this dislocation. As their life options became more restricted over time, motherhood provided a lifeline through addiction and into recovery. While using drugs, they relied on a number of strategies to maintain mothering. In recovery, children became the markers of success in a treatment program. These findings challenge public images of female addicts as parents.

The Physical Environment of Special Care Units: Needs of Residents with Dementia from the Perspective of Staff and Family Caregivers

Abstract: To manage the care of increasing numbers of residents with dementia, many long-term care facilities have created special care units (SCUs) designed to meet the unique needs of this group. This article describes results of the qualitative component of a larger research project examining environment-behavior relationships in dementia care settings. Eighteen in-depth interviews were conducted with 9 staff and 9 family members of SCU residents. Thematic analysis was conducted using grounded theory techniques. Participants described residents’ needs in relation to both the physical and social environments. This article focuses on the five areas of need identified by participants in relation to the physical environment: safety, homelike setting, optimal stimulation, cues, and options for privacy and social interaction.

Making the Best of It: Adapting to the Ambivalence of a Nursing Home Environment

Abstract: This article is based on a 9-month ethnographic study of a nursing home for older Jewish people. In this article, the process that 21 key informants went through in adapting to the dual nature of the nursing home as institution and as home is examined. A widely used phrase, "making the best of it," was used by informants and other residents of the nursing home to describe this process. Interpretive analysis of this emic phrase revealed four dimensions: (a) recognizing the ambivalence of their living environment and situation, (b) downplaying negative aspects of it, (c) having no other options, and (d) using their will to transcend and create a home.

Dissonance in the Dining Room: A Study of Social Interaction in a Special Care Unit

Abstract: This study is a multi-method, intrinsic case study of social interaction in a special care unit (SCU) for cognitively impaired older persons. It is found that residents are capable of developing a range of social bonds even though the SCU in question is found to have several organizational and physical factors that unwittingly thwart its therapeutic potential. These limitations are illuminated by consideration of the congruence between the conceptualization of the dining areas held by staff and that held by residents as revealed throught the process of negotiation occurring in social interaction. The study adopts an enviornment-behavior perspective following the theoretical development of Lawton (1986) and merges it with the qualitative approach to place pursued by Goffman (1961) and Gubrium (1978). It is suggested that a focus on place as a unit of analysis offers potential for bridging Quality of Life with the cognitively impaired.

Women’s Midlife Experience of their Changing Bodies

Abstract: The purpose of the ethnographic report described in this article is to discuss midlife women’s perceptions of their changing bodies within the Western cultural context and to provide a basis for health care with women. The narratives of 11 midlife women (ages 40-53) were obtained. Data were analyzed using Spradley’s (1979) Developmental Research Sequence Method. Results of the study indicate that women’s midlife experience of their changing bodies encompasses a broad spectrum, full of contradiction and change. Issues of loss, cultural influences that perpetuate ageism and sexism, lack of consistent information about menopause, questioning, redefining self, and self-care, all played a central role in the women’s lives during this time of transition.

Defensive Mothering in HIV-Positive Mothers

Abstract: The grounded theory study discussed in this article provides an explanatory schema that illuminates the mothering experiences of women living with HIV infection. Eighteen HIV-positive mothers provided 24 in-depth interviews. The grounded theory method was used for data analysis. Defensive mothering was the basic social psychological process that these HIV-positive mothers used in response to their diagnosis and the inherent stigma. Their defensive posture afforded these mothers and their children some degree of psychological protection. Defensive mothering involved much mental work and included three subprocesses: preventing the spread of HIV, preparing the children for a motherless future, and protecting themselves through thought control.

Complicating Mourning: The Social Economy of Perinatal Death

Abstract: In this article, the social economic practices related to perinatal death, based on Rando’s model of complicated mourning and on an analysis of interactions with social institutions identified in the literature as relevant to perinatal death, are examined. Data are reported from semistructured interviews with 22 individuals who lost children to perinatal death. Parents’ stories indicate that they were not provided with material social supports that normally would be provided to individuals in the case of a “real” birth or death. Family and community gestures, workplace measures, and medical and legal supports were either discouraged or actively withheld. This lack of financial and material support creates an informal social economy of perinatal death that conveys clear messages to parents regarding their rights and claims to support. It is evident that these practices contribute to feelings of non-legitimacy and to complicated mourning.

Community Formation and Community Roles among Persons with Alzheimer’s Disease: A Comparative Study of Experiences in a Residential Alzheimer’s Facility and a Traditional Nursing Home

Abstract: Based on an ethnographic study in a residential Alzheimer's facility and a traditional nursing home, this article discusses the process of community formation and the maintenance of community roles among individuals suffering from dementia in institutional settings. These include: therapeutic programming that promotes resident independence and choice; flexible and person-centered staff roles; and a physical environment that facilitates social interaction, autonomy, and participation in the activities of daily living. In contrast, institutional programs that are regimented, that follow a medical rather than a social model of care, and that take place in physical environments that have limited options may discourage resident interaction and social bonding, thus inhibiting community formation. Although Alzheimer's disease and other forms of dementia may create difficulties for the realization of community and community roles among institutionalized people, more significant are the environmental conditions in which such individuals live and the programs designed for their care.

Describing Expert Practice in Physical Therapy

Abstract: In this article, the authors demonstrate how grounded theory may be used to develop models for understanding clinical practice. Through a series of research studies involving novice, experienced, and expert physical therapy practitioners, conceptual frameworks were continually revised based on data obtained from returning to the field and relevant literature available at the time. As concepts and relationships moved to larger themes, a theoretical framework for expertise in clinical practice was proposed. Current work on verifying the theoretical framework continues. Grounded theory is an excellent research approach to bound and help guide a multistage research program involving multiple researchers working in multiple settings.

Locating the Feminist Scholar: Relational Empowerment and Social Activism

Abstract: Over the past decade, the rhetoric of "empowerment" has permeated the health promotion, education, and social welfare literature. Many scholars and professionals, particularly those active in the field of social intervention and community development, have found themselves struggling for location in the emancipatory process. This struggle often is characterized by a profound self-consciousness of privilege and the fear of being perceived as imposing and manipulative. This article explores the tensions inherent in the role of the scholar/activist using illustrations from the author's experience as principal investigator of the Atlantic Regional Evaluation of the Community Action Program for Children. In so doing, it discusses the importance of a relational approach to empowerment, one characterized by mutuality. A commitment to mutuality is seen as a key factor in enhancing the emancipatory capacities of empowerment-based research projects.

Adaptation to HIV Infection: The Development of Coping Strategies Over Time

Abstract: The purpose of this study was to understand the use of coping strategies in adapting to an HIV-positive diagnosis. Also, the question of whether there was an underlying developmental process, in the sense of movement from less adaptive to more adaptive strategies, was addressed. In-depth interviews were conducted with 18 HIV-positive individuals younger than age 45. Analysis of the qualitative data using the constant comparative method revealed that specific coping strategies were used immediately after diagnosis and differed from those later employed. The developmental process uncovered in this study included a period of transition that served as the testing ground for the following adaptive strategies: humor, faith, altruism, seeking the support of others, and balance.

Qualitative Methods: The State of the Art

Abstract: Qualitative methods offer the researcher different approaches to a research problem. They offer alternatives in analytic approaches; cater to different disciplinary perspectives, assumptions, and agendas; provide a means to explore various levels of analysis, from micro-analytic to complex behaviors; and permit the development of the necessary level of conceptualization of results. Depending on the researcher’s question(s), any one or combinations of qualitative approaches offer the researcher the means to obtain optimal research results. In this article, the example of the experience of traumatic injury is used to explore research possibilities and to convey an appreciation for methodological diversity.

Qualitative Research into Nurse Decision Making: Factors for Consideration in Theoretical Sampling

Abstract: This article details some of the theoretical sampling choices available to researchers considering qualitative approaches to research into nurse decision making and the information that informs it. It draws on the theoretical and empirical literature on decision theory and, in so doing, provides a rationale for the theoretical sampling choices proposed. The final sampling frame is designed to be applied to decision research in nursing but could offer starting points for research into the decisions of other professional clinical groups.

The Bricoleur with a Computer: Piecing Together Qualitative and Quantitative Data

Abstract: The researcher as bricoleur will gather whatever data is at hand, experimenting and exploring to find answers to the questions he or she has set. With computer in hand and new tools available, the researcher can readily combine data types, moving beyond complementarity and simple triangulation. Data may be transferred in either or both directions between NUD•IST (a program to assist the analysis of qualitative data) and a spreadsheet or statistical package. Thus, analysis and interpretation are enriched, and new ways of thinking about data are laid open. Such techniques inevitably challenge traditional assumptions about particular methods. But perhaps in the final analysis, all methods, other than those employed in reductionist, hypothesis testing experiments, are essentially interpretive.