Showing papers in "Qualitative Health Research in 2005"

Three Approaches to Qualitative Content Analysis

Abstract: Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.

Virtually He@lthy: The Impact of Internet Use on Disease Experience and the Doctor-Patient Relationship

Abstract: In the current study, the author explores the complex effects and contradictory roles of the Internet as a source of empowerment and control, and as a site of “risk management.” Drawing on a study of the Internet usage of Australian men with prostate cancer, the author investigates how access to information and online support affects men’s experiences of disease and, in particular, the possible implications of Internet-informed patients for the doctor-patient relationship. The data reveal that accessing information and/or support online can have a profound effect on men’s experiences of prostate cancer, providing a method of taking some control over their disease and limiting inhibitions experienced in face-to-face encounters. However, it is also clear that some medical specialists view Internet-informed patients as a challenge to their power within medical encounters and, as a result, employ disciplinary strategies that reinforce traditional patient roles and alienate patients who use the Internet.

The Problems With Interviews

Abstract: Despite the popularity of the interview in qualitative research, methodological and theoretical problems remain. In this article, the author critically examines some of these problems for the researcher. He deals with the problems of power and resistance, distinguishing truth from authenticity, the (im)possibility of consent if knowing is a problem for both the interviewer and the interviewee, and the nature and significance of stories and the self. Although it is not always possible to address these problems directly, the author seeks in this article to create a dialogue with all of us for whom the interview is judged to be the appropriate answer to the research question “How can I know...?”

What About Focus Group Interaction Data

Abstract: The purpose of this article is to discuss issues related to group interaction data in focus groups. How should it be analyzed and reported? The author addresses these questions using qualitative research approaches with examples from her research to foster further discussion regarding focus group research.

What Is Dialogical Research, and Why Should We Do It?

Abstract: Social scientists have explored the writing of Russian literary philosopher Bakhtin from a variety of perspectives, but little attempt has been made to apply Bakhtin's conception of dialogue to the conduct of research and the production of research reports. The author's questions relate to what dialogical research would look like and the ethical imperative of dialogical research.

An Introduction to Concept Mapping as a Participatory Public Health Research Method

Abstract: In this article, the authors introduce concept mapping as a useful participatory research method for public health researchers interested in generating hypotheses and developing theory. The authors first provide an overview of concept mapping, which combines qualitative approaches with quantitative analytical tools to produce visual displays of the relationship between ideas. Then, they present an illustrative research application of the method to the exploration of women’s perceptions of the relationship between residential neighborhood factors and intimate partner violence experiences. They give attention to the data collection and analysis procedures and to demonstrating the intricacies of using concept mapping for public health research purposes. Finally, the article concludes with a discussion of the unique contributions and challenges associated with concept mapping.

Interviewing Young Children: Explicating Our Practices and Dilemmas

Abstract: Qualitative research studies have demonstrated that very young children can provide important insights into their daily lives and health experiences. Despite the shift to include children's perspectives in research and document principles related to good data collection with children, there has not been a parallel move within the scholarly community to lay bare the practical challenges inherent in conducting interviews with children. In this article, the authors consider the degree to which well-known standards for qualitative research apply to research interviews with young children. They make practical recommendations that build on existing theoretical work about the conduct of qualitative interviews with young children.

Case Study Research: The View From Complexity Science

Abstract: Many wonder why there has been so little change in care quality despite substantial quality improvement efforts. Questioning why current approaches are not making true changes draws attention to the organization as a source of answers. The authors bring together the case study method and complexity science to suggest new ways to study health care organizations. The case study provides a method for studying systems. Complexity theory suggests that keys to understanding the system are contained in patterns of relationships and interactions among the system’s agents. They propose some of the “objects” of study that are implicated by complexity theory and discuss how studying these using case methods might provide useful maps of the system. They offer complexity theory, partnered with case study method, as a place to begin the daunting task of studying a system as an integrated whole.

Community-Academic Research on Hard-to-Reach Populations: Benefits and Challenges

Abstract: In this article, the authors examine some of the benefits and challenges associated with conducting research on hard-to-reach/hidden populations: in this instance, sex workers. The population studied was female and male sex workers working in different sectors of the sex industry in a medium-size Canadian metropolitan area. The authors describe the need for close community-academic cooperation, given the hidden and highly stigmatized nature of the target population that was investigated and the local context in which the research project was embedded. The authors discuss the main benefits and challenges of the research collaboration for the various parties involved, including the community partner organization, indigenous research assistants, and academic research team. They conclude with a discussion of strategies to help overcome the main challenges faced during the research endeavor.

Sources of Practice Knowledge Among Nurses

Abstract: Several studies have been published listing sources of practice knowledge used by nurses. However, the authors located no studies that asked clinicians to describe comprehensively and categorize the kinds of knowledge needed to practice or in which the researchers attempted to understand how clinicians privilege various knowledge sources. In this article, the authors report findings from two large ethnographic case studies in which sources of practice knowledge was a subsidiary theme. They draw on data from individual and card sort interviews, as well as participant observations, to identify nurses' sources of practice knowledge. Their findings demonstrate that nurses categorize their sources of practice knowledge into four broad groupings: social interactions, experiential knowledge, documents, and a priori knowledge. The insights gained add new understanding about sources of knowledge used by nurses and challenge the disproportionate weight that proponents of the evidence-based movement ascribe to research knowledge.

Quality-of-Life Concerns of African American Breast Cancer Survivors Within Rural North Carolina: Blending the Techniques of Photovoice and Grounded Theory

Abstract: Social norms imposing a prevailing silence around breast cancer in rural African American communities have made it difficult for survivors to express their quality-of-life (QOL) concerns. In this article, the authors describe how they blended the photovoice method (providing participants with cameras so they can record, discuss, and relate the realities of their lives) with grounded theory techniques to assist 13 African American breast cancer survivors from rural eastern North Carolina in (a) exploring how they perceive and address their QOL within their own social context and (b) developing a conceptual framework of survivorship QOL. The framework that emerged reveals that three social forces (racism, stigmas regarding cancer, and cultural expectations of African American women) drive four QOL concerns (seeking safe sources of support, adjusting to the role of cancer survivor, feeling comfortable about the future, and serving as role models) and that survivors address these concerns by relying on spirit...

Participant Diaries as a Source of Data in Research With Older Adults

Abstract: Solicited participant diaries are an excellent source of data that has not been given sufficient attention as a data collection strategy for qualitative research. In a recent grounded theory study designed to explore strategies used by older adults to manage their chronic health problems, solicited diaries, when combined with an initial and follow-up interview, provided a rich source of data about day-to-day activities of participants. There were three options for maintaining the diary: written, audiotaped, or telephone conversation. The solicited diaries were guided by a set of open-ended questions designed to encourage participants to focus on daily activities and reflect on their values. The authors provide examples of data from participant diaries and suggestions for incorporating solicited participant diaries into data collection strategies for qualitative research.

AIDS-Related Stigma and Social Interaction: Puerto Ricans Living With HIV/AIDS

Abstract: People living with HIV/AIDS are stigmatized. Although personal and social consequences of this stigmatization have been documented, research regarding its impact on social interactions is scarce. Latinos, and Puerto Ricans in particular, have voiced concern regarding AIDS stigma. The authors investigated the key role of social interaction in the process of stigmatization through in-depth, semistructured interviews in a sample of 30 Puerto Ricans living with HIV/AIDS. Participants reported instances in which AIDS stigma negatively influenced social interactions with family, friends, sexual partners, coworkers, and health professionals. Some of the consequences they described were loss of social support, persecution, isolation, job loss, and problems accessing health services. Findings support the need for interventions to address AIDS stigma and its consequences.

Thematic Evidence of Psychosocial Thriving in Childhood Cancer Survivors

Abstract: Advances in medical treatment for childhood cancer have resulted in dramatically increased survival rates and a growing population of long-term survivors. Until recently, researchers reported primarily negative psychosocial sequelae of childhood cancer. Emergent conceptual frameworks propose that the assumption of pathology or long-term deficits in functioning might obscure an understanding of the full range of outcomes. Using qualitative interview data (N = 50), the authors explore how cancer can lead to positive psychosocial outcomes, including thriving. The findings suggest that processes of coping, meaning making, and psychospiritual growth are intimately related to long-term psychosocial well-being. The results suggest that in the aftermath of a trauma such as childhood cancer, many outcomes are possible, including thriving.

Uncovering the Limits of Patient-Centeredness: Implementing a Self-Management Trial for Chronic Illness:

Abstract: Research evaluating self-management of chronic conditions points to the effectiveness of interventions' changing the health behavior of individuals. However, we know little about how self-management is negotiated within health services. The authors designed a qualitative investigation to illuminate the quantitative findings of a randomized controlled trial (RCT) of a self-management program for people with inflammatory bowel disease. They conducted in-depth interviews with physicians and patients, and qualitative analysis illuminated the nature of doctor-patient encounters and possible reasons for lack of change in patient satisfaction with the consultation. The findings suggest that factors inhibiting effective patient-centered consultations include failure of physicians to incorporate expressed need relevant to people's self-management activities fully, interpretation of self-management as compliance with medical instructions, and the organization of outpatients' clinics. Giving attention to these barriers might maximize the opportunities for patient self-management of chronic illness based on a therapeutic alliance with health care professionals.

Using Critical Ethnography to Explore Issues in Health Promotion

Abstract: In this article, the author outlines the need for a critical research method in the field of health promotion to explore the determinants of health. These determinants, including healthy child development, employment and working conditions, and education, for example, underlie many of the health issues that individuals experience. They are, in turn, influenced by nebulous factors such as patterns of inequality, and cultural norms, which are difficult to research using conventional methodologies. The author provides an overview of critical ethnography as a method for health promotion research. She describes specific data collection and analysis techniques, with the addition of critical discourse analysis to add scope to ethnographic findings. She concludes with an overview of the congruence between critical ethnography and health promotion research, including a discussion of the differences between critical ethnography and participatory action research.

Normalization in Families Raising a Child Who Is Medically Fragile/Technology Dependent and Developmentally Delayed

Abstract: The authors combined and analyzed parent data from two field studies examining family experiences in raising children who were both medically fragile and developmentally delayed or disabled to compare these families' experiences to published attributes of normalization. Normalization is usually considered a useful conceptual and coping strategy for families of children with chronic conditions, but it has not been examined in families whose children have both complex physical and developmental disabilities. Developmental delays compounded the effects of the children's physical chronic conditions, severely affecting how families organized and managed their daily lives, with the result that families did not fit currently established attributes of normalization. Instead, parents recognized normal and positive aspects of their lives while acknowledging the profound challenges that their families faced. Parents concluded that it was possible to have a good life that was not necessarily normal by usual standards.

Compassion Stress and the Qualitative Researcher

Abstract: Human subjects are carefully protected in the research process. However, the same consideration is not currently being given to the qualitative researcher, even those investigating topics that are likely to elicit powerful emotions. The role of researcher's emotional responses and the self-care strategies that, in some circumstances, are appropriate for the researcher and other research support personnel have not received the attention they deserve in qualitative research literature. Based on experience in conducting research on the topic of self-directed learning and breast cancer, and on the limited literature available, the author makes the case for the use of strategies such as counseling, peer debriefing, and journal writing as means of dealing with the potential for "compassion stress" as experienced by the researcher and other research support personnel. She also suggests that the preparation of social science researchers should include information on appropriate self-care strategies.

Benefits of Participating in Internet Interviews: Women Helping Women

Abstract: Advantages of face-to-face qualitative interviews for participants have been addressed in the literature. The benefits of participating in qualitative interviews over the Internet, however, have yet to be discussed. Based on the experiences of 40 women who made up the sample for an Internet study on birth trauma, the author describes in this article the benefits reaped by these mothers through their participation in qualitative e-mail interviews. She used content analysis to identify these benefits. Seven themes emerged: experiencing caring by being listened to and acknowledged, sense of belonging, making sense of it all, letting go, being empowered, women helping women, and providing a voice.

Theoretical and Practical Reflections on Sharing Transcripts With Participants

Abstract: This article is a critical reflection on the process of creating transcripts and sharing them with interviewees. It relates to two elements of the research process: first, sharing transcripts with research participants and, second, participants' seeing extracts from transcripts in academic writing. The authors explore participants' experiences of revisiting the interview in written form by reflecting on the interconnections between social research methods and epistemology. They also consider the ethical implications of this process. They consider the relationship between the transcript and the representation (re-presentation) of what participants believe to have occurred within the interview. This leads to a discussion of the importance of developing reflexivity with respect to the practice and processes of sharing transcripts.

Life Versus Disease in Difficult Diabetes Care: Conflicting Perspectives Disempower Patients and Professionals in Problem Solving:

Abstract: Conflicts in problem solving are known from diabetes research on patients with good glycemic control but have rarely been studied in the care of patients with poor glycemic control. Equally, the different perspectives of health care providers and patients have not been a focus in previous studies. The authors studied the interactions between health care providers and 11 diabetes patients with poor glycemic control in a grounded theory study at a Danish university hospital. Keeping Life and Disease Apart was identified as a core category. It involved a pattern of conflicts both between and within patients and health professionals, which disempowered them in problem solving. Three approaches to problem solving were identified: A compliance-expecting approach kept the pattern unchanged, a failure-expecting approach deadlocked the pattern, and a mutuality-expecting approach appeared to neutralize the conflict.

Developing Resilience: How Women Maintain Their Health in Northern Geographically Isolated Settings

Abstract: The purpose of this study was to explore how women maintain their health in northern geographically isolated settings, using a feminist grounded theory method. Twenty-five women of diverse backgrounds in northern British Columbia, Canada, engaged in qualitative interviews over a 2-year period to express perspectives about how the north affects their health and how they maintain their health in northern settings. Findings reveal that the women experienced vulnerability to physical health and safety risks, psychosocial health risks, and risks of inadequate health care. The women responded to these vulnerabilities by developing resilience through the strategies of becoming hardy, making the best of the north, and supplementing the north. These strategies, which reflect both individual and collective actions, were determined by the needs and interests of the women and their social and personal resources. The findings have implications for women's health research and health practices and policies in geographically isolated settings.

Victims Twice Over: Perceptions and Experiences of Injured Workers

Abstract: The authors discuss the qualitative component of a participatory research project conducted in Toronto, Ontario, between 1999 and 2001. Injured workers, who were trained as peer researchers, conducted one-time, semistructured interviews with other injured workers (N = 17) and helped with inductive coding and analyzing the interview transcripts. The qualitative research group consisted of seven peer researchers, four academic researchers, and a community legal worker. The group recruited interviewees by advertising on bulletin boards and in newsletters and newspapers, and selected a diverse group of interviewees who had encountered problems with the return-to-work process. Interviewees believed that the process victimizes them and renders them powerless and dependent on others. Furthermore, they considered that health professionals and bureaucrats impede their rehabilitation. The authors suggest that injured workers should be included in the decision-making process of rehabilitation and rebuilding their lives.

Nurse Assistant Mental Models, Sensemaking, Care Actions, and Consequences for Nursing Home Residents

Abstract: In a nursing home case study using observation and interview data, the authors described two mental models that guided certified nurse assistants (CNAs) in resident care. The Golden Rule guided CNAs to respond to residents as they would want someone to do for them. Mother wit guided CNAs to treat residents as they would treat their own children. These mental models engendered self-control and affection but also led to actions such as infantilization and misinterpretations about potentially undiagnosed conditions such as depression or pain. Furthermore, the authors found that CNAs were isolated from clinicians; little resident information was exchanged. They suggest ways to alter CNA mental models to give them a better basis for action and strategies for connecting CNAs and clinical professionals to improve information flow about residents. Study results highlight a critical need for registered nurses (RNs) to be involved in frontline care.

Investigating the “Self” in Deliberate Self-Harm

Abstract: In this study, the authors explored how a group of young people aged 16 to 26 years (who identified themselves as having engaged in deliberate self-harm) made sense of the self by conducting two online focus groups and four e-mail interviews. They analyzed data using interpretive phenomenological analysis. The concept of validation was the primary means of making sense of the self and concerned the desire to be considered legitimate and of worth. This desire was clearly evident across three realms of conflict: (a) the intrinsic or extrinsic self, which marked the distinction between objective fact and subjective opinion; (b) the accepted or denied self; and (c) the notion of normality. It is possible that having one's denied self validated online might lead to an exacerbation of an individual's self-harming behavior. Further work is needed to explore the effects of online discussion forums on such taboo forms of behavior.

The Case for Integrating Grounded Theory and Participatory Action Research: Empowering Clients to Inform Professional Practice

Abstract: Grounded theory and participatory action research methods are distinct approaches to qualitative inquiry. Although grounded theory has been conceptualized in constructivist terms, it has elements of positivist thinking with an image of neutral search for objective truth through rigorous data collection and analysis. Participatory action research is based on a critique of this image and calls for more inclusive research processes. It questions the possibility of objective social sciences and aspires to engage people actively in all stages of generating knowledge. The authors applied both approaches in a project designed to explore the experiences of female survivors of childhood sexual abuse with physical therapy and subsequently develop a handbook on sensitive practice for clinicians that takes into consideration the needs and perspectives of these clients. Building on this experience, they argue that the integration of grounded theory and participatory action research can empower clients to inform professional practice.

Gestational Diabetes: The Meaning of an At-Risk Pregnancy

Abstract: Being diagnosed with gestational diabetes (GDM) is coupled with the implication that the woman and her fetus are at risk. In this study, the authors use a hermeneutic phenomenological approach to gain an in-depth understanding of GDM as pregnant women meaningfully experience it. They conducted conversational interviews with 12 women who were diagnosed with and being treated for diabetes in pregnancy. Data analysis involved a reflective process consistent with the guidelines of thematic analysis. Four themes identified as characteristic of the women's pregnancy experience were Living a Controlled Pregnancy, Balancing, Being a Responsible Mother, and Being Transformed. The findings challenge health care professionals to discuss openly and reassess their present models of care for pregnant women and their families.

Understanding Women’s Journey of Recovering From Anorexia Nervosa

Abstract: Previous studies of recovery from anorexia nervosa (AN) have concentrated on discrete behavioral responses of individual women. Little is understood about the subjective process of women’s recovery in the context of family, community, or society. In this feminist grounded theory study, the authors explored the perceptions of 12 women who considered themselves recovered or recovering from AN. They discovered a substantive theory of selfdevelopment that explains, within the current social context, women’s journey from the perilous self-soothing of devastating weight loss to the informed self-care of healthy eating and problem-solving practices. The findings provide an urgently needed explanatory framework to inform women, clinicians, and health policy makers in their prevention and recovery efforts.

Patient Participation in Health Research: Research With and for People With Spinal Cord Injuries

Abstract: Traditionally, patients are rarely seen as partners in health research; their influence on priority setting, research design, the undertaking of research, and interpretation and dissemination of findings was marginal. Nowadays, health researchers, funding agencies, governments, and patient organizations are beginning to acknowledge that the passive role of patients in health research is no longer satisfactory. The emerging commitment and consensus concerning the aims and features of patient participation in research have created a need for an appropriate method to engage patients as partners in health research. In this article, the author argues that a responsive-constructivist approach to evaluation fits with the aims and features of patient participation. She illustrates its potential with a case example that concerns a dialogue among patients and (clinical) researchers in the field of spinal cord injuries. She reflects on learning experiences and the (un)expected difficulties and potentials in creating social conditions for patient participation in health research.