Showing papers in "Qualitative Health Research in 2004"
TL;DR: The authors compare the philosophical components of descriptive and interpretive approaches to doing phenomenology and illustrate types of knowledge produced by each through reviewing specific studies and focus on the various uses of phenomenology in generating useful knowledge for health care practice.
Abstract: A number of articles in the nursing literature discuss the differences between descriptive and interpretive approaches to doing phenomenology. A review of studies demonstrates, however, that many researchers do not articulate which approach guides the study, nor do they identify the philosophical assumptions on which the study is based. Such lack of clarity makes it difficult for the reader to obtain a sense of how the knowledge produced by the study is to be evaluated and used. In this article, the authors compare the philosophical components of descriptive and interpretive approaches to doing phenomenology and illustrate types of knowledge produced by each through reviewing specific studies. They focus on the various uses of phenomenology in generating useful knowledge for health care practice.
1,414 citations
TL;DR: This article represents the reflections of five scholars, each of whom has authored a distinct qualitative metasynthesis strategy, which offer a finely nuanced examination of the tensions between comparison and integration, deconstruction and synthesis, and reporting and integration within the metasyNThesis endeavor.
Abstract: In an era of pressure toward evidence-based health care, we are witnessing a new enthusiasm for qualitative metasynthesis as an enterprise distinct from conventional literature reviews, secondary analyses, and the many other scholarly endeavors with which it is sometimes confused. This article represents the reflections of five scholars, each ofwhom has authored a distinct qualitative metasynthesis strategy. By providing the reader a glimpse into the tradition of their various qualitative metasynthesis projects, these authors offer a finely nuanced examination of the tensions between comparison and integration, deconstruction and synthesis, and reporting and integration within the metasynthesis endeavor. In so doing, they account for many of the current confusions about representation and generalization within the products of these inquiries. Through understanding the bases of their unique angles of vision, the reader is invited to engage in their commitment to scholarly integrity and intellectual credibility in this emerging methodological challenge.
646 citations
TL;DR: The author outlines a typology of six distinct forms of bracketed that encompasses the methodological rigor and evolution of bracketing within the richness of qualitative research.
Abstract: The term bracketing has increasingly been employed in qualitative research. Although this term proliferates in scientific studies and professional journals, its application and operationalization remains vague and, often, superficial. The growing disconnection of the practice of bracketing in research from its origins in phenomenology has resulted in its frequent reduction to a formless technique, value stance, or black-box term. Mapping the subtle theoretical and philosophical underpinnings of bracketing will facilitate identification and delineation of core elements that compose bracketing, and distinguish how different research approaches prioritize different bracketing elements. The author outlines a typology of six distinct forms of bracketing that encompasses the methodological rigor and evolution of bracketing within the richness of qualitative research.
570 citations
TL;DR: Issues affecting the utilization of qualitative research findings include the varied ways in which they are conceived, presented, synthesized, signified, and translated, and the complex repertoire of skills required to activate the knowledge transformation cycle in qualitative health research fully.
Abstract: A renewed urgency has emerged in the qualitative health research community concerning the utility of qualitative research. This urgency is the result of several converging trends in health care research, including the elevation of practical over basic knowledge, proliferation of qualitative health research studies, and the rise of evidence-based practice as a paradigm and methodology for health care. Diverse conceptualizations of use and users exist, and these have different implications for understanding, demonstrating, and enhancing the utility of qualitative research findings. Issues affecting the utilization of these findings include the varied ways in which they are conceived, presented, synthesized, signified, and translated, and the complex repertoire of skills required to activate the knowledge transformation cycle in qualitative health research fully.
525 citations
TL;DR: The author examines the use of drawings as a research tool used as an adjunct to other social research methods and argues that drawings offer a rich and insightful research method to explore how people make sense of their world.
Abstract: Visual methodologies are becoming more evident in social research These methodologies encompass media such as film, video, still photography, electronic visual media, and material artifacts In this article, the author examines the use of drawings as a research tool used as an adjunct to other social research methods Using examples from two studies, she illustrates how drawings can be used to explore the ways in which people understand illness conditions She argues that the act of drawing necessitates knowledge production, with a visual product as its outcome Although the examples presented in this article are limited to illness conditions, she argues that drawings offer a rich and insightful research method to explore how people make sense of their world
462 citations
TL;DR: The author explores one approach to discourse analysis and examines how it offers possibilities for different ways of viewing health and health care practices, and raises questions as to whether discourse analysis is at the margins of qualitative research, whether that matters, and where discourse analysis might take those margins.
Abstract: Discourse analysis is a qualitative research approach that offers the potential to challenge our thinking about aspects of the reality of health and health care practice. In this article, the author explores one approach to discourse analysis and examines how it offers possibilities for different ways of viewing health and health care practices. She concludes by raising questions as to whether discourse analysis is at the margins of qualitative research, whether that matters, and where discourse analysis might take those margins.
418 citations
TL;DR: It is argued that researchers can build on Goffman’s ideas to strengthen their methodological practices and research products and suggest unacknowledged benefits of this work.
Abstract: In this keynote address, the author focuses on what we bring to qualitative inquiry and how we conduct our research. What we do, why we do it, and how we do it remain contested issues. She proposes that we look at our methodological premises anew, revisit our principles, and revise our practices. Throughout this address, she draws on Goffman's methodological insights to provide a foundation for reassessing qualitative inquiry. She argues that researchers can build on Goffman's ideas to strengthen their methodological practices and research products. Last, she counters current institutional scrutiny of qualitative inquiry and suggests unacknowledged benefits of this work.
347 citations
TL;DR: The authors examine some transcription circumstances that seem to bring about their own consistent set of problems and offers suggestions for working with transcriptionists as part of the qualitative research team.
Abstract: Everyone who has worked with qualitative interview data has run into problems with transcription error, even if they do the transcribing themselves. A thoughtful, accurate, reliable, multilingual transcriptionist with a quick turnaround time is worth her or his weight in gold. In this article, the authors examine some transcription circumstances that seem to bring about their own consistent set of problems. Based on their experiences, the authors examine the following issues: use of voice recognition systems; notation choices; processing and active listening versus touch typing; transcriptionist effect; emotionally loaded audiotaped material; class and/or cultural differences among interviewee, interviewer, and transcriptionist; and some errors that arise when working in a second language. The authors offer suggestions for working with transcriptionists as part of the qualitative research team.
322 citations
TL;DR: It is argued that a contextualized approach to the definition of social support is necessary to improve clarity in research, and results in interventions or practices that are useful, and qualitative methods to explore the meaning of socialSupport with groups of people for whom intervention research is ultimately intended.
Abstract: A substantial body of work on the concept of social support has resulted in many definitions, but none have been accepted as definitive. The lack of consensus about the definition of social support has resulted in a lack of consistency and comparability among studies. More important, the validity of any study attempting to measure or influence social support is undermined by the use of generic definitions, which lack contextual sensitivity. In this article concept analysis is used to evaluate definitions of social support to ascertain their utility for research. The authors argue that a contextualized approach to the definition of social support is necessary to improve clarity in research, and results in interventions or practices that are useful. They also assert that the development of a contextualized definition of social support requires qualitative methods to explore the meaning of social support with groups of people for whom intervention research is ultimately intended.
294 citations
TL;DR: The author used a case-centered, comparative, narrative approach to analyze the narratives of 14 male unaccompanied refugee youths from Sudan recently resettled in the United States and identified four themes that reflect coping strategies used by the participants.
Abstract: The purpose of this study was to explore how unaccompanied refugee youths from Sudan, who grew up amid violence and loss, coped with trauma and hardship in their lives. The author used a case-centered, comparative, narrative approach to analyze the narratives of 14 male unaccompanied refugee youths from Sudan recently resettled in the United States. She analyzed narratives for both content and form and identified four themes that reflect coping strategies used by the participants: (a) collectivity and the communal self, (b) suppression and distraction, (c) making meaning, and (d) emerging from hopelessness to hope. The findings underscore the importance of understanding the cultural variations in responses to trauma and are discussed in relation to the concept of resilience.
278 citations
TL;DR: This narrative research was to explore the affective component of dyspnea/anxiety as described by patients living with COPD characterized by acute illness events, and suggested that patient-reported anxiety might provide an important marker during acute exacerbation events.
Abstract: Dyspnea, the major symptom associated with acute exacerbation events of chronic obstructive pulmonary disease (COPD), is a subjective experience. Extensive research has been done on the pathophysiology and affective components of dyspnea; however, the precise physical mechanism of breathlessness remains elusive. One purpose of this narrative research was to explore the affective component of dyspnea/anxiety as described by patients living with COPD characterized by acute illness events. Ten patient-family units participated in interviews during an acute episode of the patient's lung disease. They described their understanding of acute dyspnea as an experience inextricably related to anxiety and emotional functioning. Their stories suggest that given the absence of clear objective measures of illness severity, patient-reported anxiety might provide an important marker during acute exacerbation events. Health care providers need to recognize anxiety as an important and potentially measurable sign of invisible dyspnea for end-stage patients with COPD in acute respiratory distress.
TL;DR: The author presents a synthesis of literature that informed the decision to adopt a mixed methods, mixed methodology, dominantly naturalistic study approach to health services research in which she explored the process and organizational consequences of new artifact adoption in surgery.
Abstract: Mixed methods, mixed methodology research is a little documented but increasingly accepted approach employed to investigate organizational phenomena. The author presents a synthesis of literature that informed the decision to adopt a mixed methods, mixed methodology, dominantly naturalistic study approach to health services research in which she explored the process and organizational consequences of new artifact adoption in surgery. She describes the way whereby a collective case study involving five Australian hospitals yielded quantitative and qualitative data that were analyzed using inductive and/or deductive reasoning. She goes beyond the theoretical rationale for employing a mixed methods, mixed methodology approach to present a summative conceptual model of the research process and describe the structural aspects of the dissertation in which the research was reported that should benefit researchers contemplating the value of such an approach.
TL;DR: Analysis of transcripts from 20 meetings reveals physician identity is developed through ideological discourse that produces and reproduces systems of domination that privilege scientific medicine and marginalize humanistic approaches.
Abstract: In this study, the authors investigate how medical ideology and physician professional identity are socially constructed during morning report, a formal teaching conference considered to be a cornerstone of medical education. Analysis of transcripts from 20 meetings reveals physician identity is developed through ideological discourse that produces and reproduces systems of domination that privilege scientific medicine and marginalize humanistic approaches. Findings indicate how, in a socialization context uniquely focused on discourse, communication functions to construct a professional identity grounded in the principles of the biomedical model. Although medical residents deviate from traditional ideology by articulating the voice of the lifeworld, faculty physicians counter these moves by asserting the voice of medicine. The authors draw conclusions regarding identity formation and the socialization practices of medical education.
TL;DR: An intricate interplay between common features within the disease trajectory and the communications that are perceived as helpful or unhelpful to living well with this chronic illness is illustrated.
Abstract: Communication between persons with chronic illness and their professional health care providers is a critical element of appropriate health care. As the field of health care communication evolves, it becomes apparent that aspects of the illness experience shared by those affected by specific diseases might be a source of particular insight into what constitutes effective or appropriate communications. This interpretive description of health care communication issues in multiple sclerosis was based on qualitative secondary analysis of a set of in-depth interviews and focus groups conducted with 12 persons with longstanding MS experience. Analysis of their accounts illustrates an intricate interplay between common features within the disease trajectory and the communications that are perceived as helpful or unhelpful to living well with this chronic illness. From the analysis of these findings, the authors draw interpretations regarding what might be considered communication competencies for those who care for patients with this disease.
TL;DR: The authors examine how a youth-focused research program negotiated ethical practices in the creation of its comprehensive health site and online message board, and present practical guidelines for resolving ethical dilemmas in research on Internet communities.
Abstract: There has been a rapid growth in the number of articles using Internet data sources to illuminate health behavior. However, little has been written about the ethical considerations of online research, especially studies involving data from Internet discussion boards. Guidelines are needed to ensure ethical conduct. In this article, the authors examine how a youth-focused research program negotiated ethical practices in the creation of its comprehensive health site and online message board. They address three situations in which ethical predicaments arose: (a) enrolling research participants, (b) protecting participants from risk or harm, and (c) linking public and private data. Drawing on the ethical principles of autonomy, nonmaleficence, justice, and beneficence, the authors present practical guidelines for resolving ethical dilemmas in research on Internet communities.
TL;DR: Close relatives in this study seemed to be living lives characterized by a reduced sense of individual freedom and an increased sense of responsibility for the care of the ill person, which means struggling to obtain the strength to manage their duty and an inner sense of community and of solidarity.
Abstract: Living with serious chronic illness has a directly threatening effect on the life course of healthy relatives. The aim of this study was to elucidate the meaning of close relatives' experiences of living with a person with serious, chronic illness. Using a narrative approach, the authors interviewed 13 spouses and 1 daughter about the meaning of their experiences. They used a phenomenological hermeneutic method to interpret the interview text. The structural analysis revealed three major themes: A Shrinking Life, Forced to Take Responsibility, and Struggling to Keep Going. Close relatives in this study seemed to be living lives characterized by a reduced sense of individual freedom and an increased sense of responsibility for the care of the ill person. It means struggling to obtain the strength to manage their duty and an inner sense of community and of solidarity. The authors interpret the findings in the light of the works of philosophers who have described ethical demands and natural love between people.
TL;DR: The authors noted gender differences for health-seeking behaviors, with most male youth reporting embarrassment about needing to seek care, and female youth reporting fears over safety issues while ill and homeless.
Abstract: The purpose of this study was to document the illness experiences of homeless youth. The research was a focused ethnography with 45 clinic- and street-based homeless youth aged 15 to 23 years. The authors noted gender differences for health-seeking behaviors, with most male youth reporting embarrassment about needing to seek care, and female youth reporting fears over safety issues while ill and homeless. Most youth under age 18 stated that they were often denied health care at hospitals because of their underage status, and youth over age 18 stated that health care bills contributed to their inability to obtain stable housing. Street-based youth reported more illnesses related to substance use and greater reliance on emergency departments for health care than clinic-based youth did. Policies and programs focused on improving the health of homeless youth need to address the differences in illness experiences by age, gender, and sampling site.
TL;DR: The author argues that the representation of the researcher in qualitative inquiries is inevitable, and the exclusion, or not, of theearcher from the text is a mere conventional agreement founded on a paradigmatic consensus.
Abstract: Although qualitative inquiry has developed into a popularized and very useful way of conducting research within the health sciences, there has been a relatively disproportionate amount of literature devoted to “who“ is represented in such inquiries. It is most often assumed that the end text should present an objective, value-free, and accurate representation of the participants and therefore exclude by all means the researcher’s presence from the study. Although this might hold grounds for some inquiries, it is not necessarily the norm of a qualitative research. In this article, the author argues that the representation of the researcher in qualitative inquiries is inevitable, and the exclusion, or not, of the researcher from the text is a mere conventional agreement founded on a paradigmatic consensus. He concludes with the notion that there is a correlation between issues of representation and the researcher’s stated epistemological and ontological assumptions.
TL;DR: The author reflects on her involvement in qualitative health among disadvantaged and disenfranchised groups whose life experiences are, for the most part, very different from her own and is persuaded that it is possible to have an empathetic understanding of other people’s experiences through research.
Abstract: In this article, the author reflects on her involvement in qualitative health among disadvantaged and disenfranchised groups whose life experiences are, for the most part, very different from her own. Despite the differences, she is persuaded that it is possible to have an empathetic understanding of other people's experiences through research. Recalling experiences from her own research encounters, she shows the ways in which these encounters as embodied and situated interactions generate a powerful methodological potential for gaining insight into other people's lives. She suggests strategies for preserving the layers of context and meaning that can otherwise be lost when research encounters are transformed into research data. Furthermore, the methodological power of qualitative research can mean that research encounters are intense and emotional experiences for researchers. Therefore, she offers some strategies for managing the emotional potency of some of the more distressing life stories that social researchers might come to know.
TL;DR: An ethnographic study of breast cancer support groups for white women describes the cultural model of illness and recovery espoused by the groups and examines contested areas that might influence participation.
Abstract: In an ethnographic study of breast cancer support groups for white women, the authors describe the cultural model of illness and recovery espoused by the groups and examine contested areas that might influence participation. Through analysis of interviews, observation at meetings, and program documents, they develop a model of group culture that includes five components: recovery narrative, group metaphors, perceived benefits, group processes, and contested domains. The recovery narrative focuses on optimism and personal growth, and members invoke metaphors of family and sisterhood to describe their relationship to the group. Linkages are made between perceived benefits and group processes. Contested domains challenge dominant features of the recovery narrative. The authors discuss the value of cultural studies of illness support groups for understanding member-group fit.
TL;DR: The author discusses the derivation and the kinds of concepts that qualitative inquiry generates and how the contribution of those concepts to completed theory varies according to the researchers’ agenda and the various roles assumed by different types of concepts.
Abstract: Although concepts differ in scope, specificity, and function within qualitatively derived theory (QDT), and the organization and integration of concepts is essential for the attainment of theoretical integrity, this topic has not been discussed previously in the literature. In this presentation, the author discusses the derivation and the kinds of concepts that qualitative inquiry generates. She examines the various positioning of certain types of concepts in emerging theoretical schemes and how the contribution of those concepts to completed theory varies according to the researchers' agenda and the various roles assumed by different types of concepts.
TL;DR: Poverty and the presence of structural barriers that cripple Santali existence emerge as the critical themes of Santali health meanings and the author draws policy-based implications from the findings of this research.
Abstract: Recent years have witnessed a surge in scholarship that problematizes the linear, Eurocentric approach to international health communication and suggests the pressing need for a culture-centered approach. This author takes a culture-centered approach to exploring the Santali meanings of health in rural Bengal. The open-ended interviews conducted with the Santals bring to surface key issues and meaningful theories of health. Central to the Santali experience of health is food; for the Santal, it is his or her hunger that is the greatest cause of disease and illness. Poverty and the presence of structural barriers that cripple Santali existence emerge as the critical themes of Santali health meanings. The study also illuminates the complex process of meaning making engaged in by participants of marginalized sectors. The author draws policy-based implications from the findings of this research.
TL;DR: Findings can guide health care professionals to evaluate and develop community services and help significant others understand what oldest-old rural adults need to remain at home.
Abstract: The author elicited the lived experience of 19 oldest-old adults (13 women, all White, mean age 90.7 years, range 85-98 years) who lived alone in the rural Midwest to describe their everyday activities, concerns and struggles, and adaptive strategies. In-depth interviews (59 total) were audiotaped, transcribed, and analyzed in an interpretive phenomenological tradition of thematic analysis, interpretation of paradigm cases, and interpretation of exemplars. Participants described how historical, cultural, and environmental contexts shaped their everyday thoughts, activities, and what was meaningful to them. Findings can guide health care professionals to evaluate and develop community services and help significant others (family, friends, neighbors) understand what oldest-old rural adults need to remain at home.
TL;DR: The author presents the perspectives of people with mental illness about the benefits and drawbacks of employment, what factors influence these, and how they affect consumers’ decisions and actions to suggest several areas for future exploration.
Abstract: In this article, the author presents the perspectives of people with mental illness about the benefits and drawbacks of employment, what factors influence these, and how they affect consumers' decisions and actions. Forty-one consumers of mental health services participated in 76 in-depth interviews and two focus groups. The author coded data inductively and analyzed them using grounded theory method. The results demonstrate that the benefits and drawbacks of employment are experienced in six domains. Individuals' perceptions of benefits and drawbacks are influenced by individual and contextual factors, are dynamic over time, and are instrumental in determining their employment-related actions. The findings suggest several areas for future exploration with a view to improving policy and practice in employment for people with mental illness.
TL;DR: Discussion of several contemporary ethnographies offers practical advice on writing by asking how the authors tell such good stories, which begins with how to catch readers’ attention and moves to issues of telling the truth in postmodern times.
Abstract: Writing is the integral part of research when a story is crafted. This story makes whatever claim the research will have on readers, and social scientists have increasingly recognized the need to take their storytelling seriously. Discussion of several contemporary ethnographies offers practical advice on writing by asking how the authors tell such good stories. Advice begins with how to catch readers' attention and moves to issues of telling the truth in postmodern times.
TL;DR: The link between bowel control and the constitution of adult identity must be acknowledged if health professionals and carers are to offer the most appropriate forms of information and support to people affected by colorectal cancer.
Abstract: The diagnosis and treatment of colorectal cancer entail detailed discussions of bodily functions, invasive procedures, and a reorientation of life around bowel habit. Furthermore, people with stomas undergo a second experience of toilet training in adulthood. For these reasons, colorectal cancer is sometimes considered an embarrassing disease. Narrative interviews with colorectal cancer patients indicate the inadequacy of the concept of embarrassment in describing the loss of dignity, privacy, independence, and sexual confidence as well as a compromised ability to work, travel, and socialize. The link between bowel control and the constitution of adult identity must be acknowledged if health professionals and carers are to offer the most appropriate forms of information and support to people affected by colorectal cancer.
TL;DR: Various strategies that women with chronic fatigue syndrome and fibromyalgia report applying to find a way of managing the illness and to influence caregivers are highlighted.
Abstract: The authors interviewed 12 women diagnosed with chronic fatigue syndrome and 13 with fibromyalgia with the aim of determining the strategies they perceive themselves as using to gain control over their situation during the health care process. The results highlight various strategies that the women report applying to find a way of managing the illness and to influence caregivers. They describe, for example, how they try to gain control over their situation by acquiring knowledge about the illness. The women also describe various power strategies they use in their interaction with the caregivers to take command of their situation, namely exiting, noncompliance, confrontation, persuasion/insistence, making demands, and demonstrative distancing.
TL;DR: Women’s reliance on and rejection of medicalized understandings of this condition are explored via participants’ descriptions of memories of treatment, demonstrating that further research into the experience of breast cancer is necessary.
Abstract: This article represents one facet of the author’s research on women’s experiences of embodiment after breast cancer. Herein, women’s reliance on and rejection of medicalized understandings of this condition are explored via participants’ descriptions of memories of treatment. Data collection consisted of 24 in-depth interviews with 12 women, using phenomenological and feminist approaches. Five themes emerged: (a) issues of control, (b) suffering, (c) encountering medicine, (d) visible loss, and (e) leaving active treatment. Participants found the medicalization of breast cancer to be problematic, but they were also reluctant to leave the realm of acute care. Although a large volume of breast cancer research now exists, the women’s accounts demonstrate that further research into the experience of breast cancer is necessary.
TL;DR: The authors reflect on the utility of the concept of involvement-detachment for researchers involved in a study of the lifeworlds of gay, lesbian, and bisexual young people where one of the researchers was lesbian and focus on the process of semistructured interviewing in qualitative research.
Abstract: In this article, the authors reflect on the utility of the concept of involvement-detachment for researchers involved in a study of the lifeworlds of gay, lesbian, and bisexual young people where one of the researchers was lesbian. They focus in particular on the process of semistructured interviewing in qualitative research and the analysis of material generated by the interviews, noting that complete detachment from the subject of study is neither achievable nor desirable. They discuss the benefit of teamwork in supporting researchers and enhancing the integrity of the research, particularly when the subject is sensitive, the importance of researchers' active management of their own ideological leanings, and the understanding of project management as a conceptual and cognitive process that is fundamental to enhancing research rigor.
TL;DR: Analysis of interview data suggests that older people’s understandings of quality of life are not readily measurable and should be viewed in terms of phenomenological experience.
Abstract: The concept of quality of life has received considerable attention as an inclusive notion of health and as a basis for health interventions. The authors’ argument in this article is that notwithstanding this attention, little consensus exists as to definition of the term. In addition, a focus on measurement has led to the neglect of wider aspects of quality of life. Such difficulties are particularly relevant to the study of quality of life of older people. Analysis of interview data suggests that older people’s understandings of quality of life are not readily measurable and should be viewed in terms of phenomenological experience. The authors discuss the implications for studying quality of life of this group and difficulties for the concept itself.