Showing papers in "Qualitative Health Research in 2007"

Choose Your Method: A Comparison of Phenomenology, Discourse Analysis, and Grounded Theory

Abstract: The purpose of this article is to compare three qualitative approaches that can be used in health research: phenomenology, discourse analysis, and grounded theory. The authors include a model that summarizes similarities and differences among the approaches, with attention to their historical development, goals, methods, audience, and products. They then illustrate how these approaches differ by applying them to the same data set. The goal in phenomenology is to study how people make meaning of their lived experience; discourse analysis examines how language is used to accomplish personal, social, and political projects; and grounded theory develops explanatory theories of basic social processes studied in context. The authors argue that by familiarizing themselves with the origins and details of these approaches, researchers can make better matches between their research question(s) and the goals and products of the study.

Justifying Knowledge, Justifying Method, Taking Action: Epistemologies, Methodologies, and Methods in Qualitative Research

Abstract: In this article, the authors clarify a framework for qualitative research, in particular for evaluating its quality, founded on epistemology, methodology, and method. They define these elements and discuss their respective contributions and interrelationships. Epistemology determines and is made visible through method, particularly in the participant- researcher relationship, measures of research quality, and form, voice, and representation in analysis and writing. Epistemology guides methodological choices and is axiological. Methodology shapes and is shaped by research objectives, questions, and study design. Methodologies can prescribe choices of method, resonate with particular academic disciplines, and encourage or discourage the use and/or development of theory. Method is constrained by and makes visible methodological and epistemic choices. If we define good quality qualitative research as research that attends to all three elements and demonstrates internal consistency between them, standardized checklists can be transcended and innovation and diversity in qualitative research practice facilitated.

Health Information—Seeking Behavior

Abstract: Seeking information about one's health is increasingly documented as a key coping strategy in health-promotive activities and psychosocial adjustment to illness. In this article, the authors critically examine the scientific literature from 1982 to 2006 on the concept of health information-seeking behavior (HISB) to determine its level of maturity and clarify the concept's essential characteristics. A principle-based method of concept analysis provides the framework for exploring the nature of HISB. The authors reviewed approximately 100 published articles and five books reporting on HISB. Although HISB is a popular concept used in various contexts, most HISB definitions provide little insight into the concept's specific meanings. The authors describe the concept's characteristics, contributing to a clearer understanding of HISB, and discuss operationalizations, antecedents, and outcomes of HISB. Such an analysis of HISB might guide further theorizing on this highly relevant concept and assist health care providers in designing optimal informational interventions.

Theoretical Sampling and Category Development in Grounded Theory

Abstract: Theoretical sampling is a hallmark of grounded theory methodology, and yet there is little guidance available for researchers on how to implement this process. A review of recently published grounded theory studies in Qualitative Health Research revealed that researchers often indicate that they use theoretical sampling to choose new participants, to modify interview guides, or to add data sources as a study progresses, but few describe how theoretical sampling is implemented in response to emergent findings. In this article, two issues that arose relative to theoretical sampling in an ongoing grounded theory study are discussed. A theoretical sampling guide that was developed by the authors' research team to facilitate systematic decision making and to enhance the audit trail relative to theoretical sampling is described, and an example of how the guide was used to develop a category is presented.

“Focus Groups Can Be Fun”: The Use of Activity-Oriented Questions in Focus Group Discussions

Abstract: Interest in focus group discussions has grown recently, and so has the recognition of them as a valuable method for qualitative data collection. Despite increasing popularity, they are not an easy option, and moderators must find appropriate ways to approach participants to achieve good-quality data. A path to reach this aim is the inclusion in the focus group agenda of some "exercises" (or activity-oriented questions) that are enjoyable and productive supplements to questions. Exercises provide a different way of gathering information and are beneficial, for instance, for more reflective participants. They can help focus the group's attention on the core study topic and also make subsequent comparative analysis more straightforward. They can also be helpful with young people and to discuss sensitive topics. The author describes and provides suggestions for use and examples of several exercises, illustrating their application in a research project investigating the cultural meaning of youth suicide in university students in Italy, India, and Australia.

Ethical Components of Researcher—Researched Relationships in Qualitative Interviewing

Abstract: Qualitative interviews are widely and often uncritically adopted for health care research, with little justification of therapeutic value. Although they might provide valuable insights into the perspectives of participants, they represent only a version of reality, rather than "truth" per se. Qualitative research is vulnerable to bias through the attitudes and qualities of the researcher, social desirability factors, and conditions of worth. Exploitation, through role confusion, therapeutic misconception, and misrepresentation are particular risks for health care-related research. Ethical codes, biomedical principles and care philosophies provide little contextual guidance on the moral dilemmas encountered in the practice of research. If nurse researchers are to navigate the moral complexities of research relationships, then sensitivity to risk to participants must be of continual concern, from conception of the study to the reporting of outcomes. Examination of the self through critical reflection and supervision are therefore necessary components of ethical research.

Further Than the Eye Can See? Photo Elicitation and Research With Men

Abstract: Photo elicitation studies have attracted modest attention in qualitative health research. However, few researchers have focused exclusively on men's health and/or illness experiences. In this article, the authors discuss the benefits of using photo elicitation among a subcohort of 19 prostate cancer survivors from a larger ethnographic study. Specifically, participants were asked to imagine that they were being paid to mount a photographic exhibition entitled Living With My Prostate Cancer, an exhibition that would show prostate cancer from their unique perspective. The authors subsequently discussed the photographs with the participants during individual interviews using photo elicitation techniques. The methods provided some unique and unanticipated benefits, the details of which the authors share to guide researchers considering similar approaches. In addition, the authors make specific recommendations for future photo elicitation applications to men's health research.

Challenges in Approaching Metasynthesis Research

Abstract: The overall aim of this study was to contribute to the development of metasynthesis through an analysis of the challenges involved. The study grew out of the critique of qualitative metaresearch raised by current developers of metamethodologies. Different views on the application of methodologies have emerged in the literature, contributing to confusion and ambiguity concerning the challenging questions of what, why, how, and who in metasynthesis research, which might increase the risk of misunderstanding. The roots of metasynthesis research are seen as multifaceted and influencing the development of the methods in different directions. The primary worth of metasynthesis is theoretical and/or methodological development (synthesis) combined with the potential for reflection: going beyond and behind the studies (meta). Metasynthesis research has also the potential to raise questions of research collaboration, culture, and language.

Multilingual Translation Issues in Qualitative Research Reflections on a Metaphorical Process

Abstract: Focus on the translation and validation of measurement instruments has left a gap in the discussion on how to construct multilingual qualitative tools, such as interviews. Traditional methods of forward and backward translation have been criticized for weak conceptual equivalence, a crucial issue when multiple language interview methods are used.Through a creative arts metaphor of weaving, the authors describe an alternative process of multicentric translation used in the development of an interview guide designed to explore the impact of transition on palliative care patients in six European countries. Four identified core constructs illuminate this multicentric process: Cohesion, Congruence, Clarity, and Courtesy. Mutual reciprocity between researcher and translator offers greater possibility for construction of nuance and meaning, particularly where cultural parameters influence the collection and meaning of sensitive data from vulnerable populations. The translator therefore becomes a collaborator in ...

Doing Synchronous Online Focus Groups With Young People Methodological Reflections

Abstract: Although online focus groups are emerging as a worthwhile methodological approach for qualitative researchers, reporting has been constrained in several ways. The majority of studies report asynchronous groups, whereas others employ synchronous exchanges, the efficacy of which with young people has seldom been explored. Considering the popularity of the Internet as a communication tool for young people, this missed opportunity is surprising. Based on a series of synchronous online focus groups with young people, the authors explore why this approach might be an effective way of engaging young people with appearance-related concerns in research. In this article, they discuss the process of hosting and moderating synchronous online focus groups, highlighting some of the ethical, pragmatic, and personal challenges that might face researchers using this method. Through a reflexive approach, they intend to inform and encourage qualitative researchers to consider alternative ways of engaging young people in research.

Using Photographs to Capture Women's Experiences of Chemotherapy: Reflecting on the Method

Abstract: This article examines the value of using the photo-elicitation method for generating health-related narratives. Drawing on research in which women kept a photographic record of their experiences of chemotherapy treatment for breast cancer, this research explored how this method (a) produced elaborate accounts of illness experiences through an exploration of the process of representing experiences and through an interrogation of the images themselves; (b) allowed an opportunity to capture experiences over time and a way of capturing the past, which can then be reexplored from the present; (c) enabled patients to retain control over their images of themselves and how they choose to represent their experiences; and (d) provided a window into the private, everyday experiences of patients away from a health care setting.

Exploring the Use of Vignettes: From Validity to Trustworthiness

Abstract: In this article one of the authors presents her experience of using vignettes in an action research case study, with particular emphasis on their trustworthiness. The research was carried out with a group of health care professionals who were working together to improve preoperative education for patients awaiting a hip replacement in one National Health Service Trust in the United Kingdom. The authors describe the exploration of three types of vignette--napshots, portraits, and composites--as a means of collecting, analyzing, and representing data. They provide an example of each and briefly present their evaluative use by the health care professionals. The vignettes were constructed to provide one account of the truth that was representative of events. Within this representation was the writer, researcher, and reader feature. The vignettes stimulated reflection and analysis within the action research cycle and thus contributed to the improvement of practice.

Participatory Design in Health Sciences: Using Cooperative Experimental Methods in Developing Health Services and Computer Technology

Abstract: Participatory design (PD) is a research approach to the development of technological solutions to real-world problems, an approach that shares many concerns and some of its roots with action research. In this article, the authors discuss their experience in conducting a PD research project intended to develop a technological and a related organizational intervention to support the treatment of foot ulcers for people with diabetes at home. They provide a historical overview of the PD approach and a description of how they used it in their research study. They describe their experience in conducting the research, including the participants' responses, the outcomes of the research, and the challenges confronted in bridging the practical and disciplinary issues that arose. In the conclusion, they propose that PD holds potential as a research approach that might effectively merge computer technology and health-related interventional research.

“Researcher Saturation”: The Impact of Data Triangulation and Intensive-Research Practices on the Researcher and Qualitative Research Process

Abstract: Theoretically and methodologically sound qualitative research demands an extended period of fieldwork and the use of multiple methods to achieve data saturation and develop the grounded theory. Little is known about the experiences of researchers who conduct such studies. The authors explore these matters by drawing on their experiences of conducting a 3-year qualitative study with women about their gynecological cancer journey. Their fieldwork consisted of participant observation and in-depth interviews with women and health professionals. They demonstrate that researchers who are involved in all phases of emotionally demanding research; that is, data collection (recruiting, observing, expanding field notes, and interviewing), transcription, and data analysis repeatedly relive difficult events, which might potentially compromise the researchers' well-being and, in turn, the research process and data validity. The authors discuss how researchers can deal effectively with these matters during fieldwork and propose a more formal approach to debriefing.

The Relationship Between Culture, Gender, Structural Factors, Abuse, Trauma, and HIV/AIDS for Latinas

Abstract: The study, in which the author aim to understand the contextual risks of HIV-positive serostatus and intimate partner violence (IPV) of 32 Latina women, involved focus groups, in-depth face-to-face narratives, and community meetings. The data emerged into four themes: histories of trauma, living with HIV, vulnerability, and la suerte (luck). In addition to the themes, women in this study talked about how structural and cultural factors such as machismo, marianismo, and fatalism are implicated in the risk for HIV and IPV. Women in the study reconceptualized the notion of IPV to denote a form of situational abuse, such as threats of deportation, that is exacerbated by their HIV status.

The Incorporation of the HIV/AIDS Identity Into the Self Over Time

Abstract: In the mid-1990s HIV/AIDS transitioned from a terminal illness to a chronic disease because of medical advances In this qualitative study the author examines how people incorporate the HIV/AIDS identity into their selves at three points in time Findings demonstrate a five-component process, including diagnosis, postdiagnosis turning point, immersion, post-immersion turning point, and integration In addition, the disclosure process corresponds to a particular component of incorporation The author makes comparisons with the incorporation process of other chronic illness Findings augment the literature on HIV/AIDS, chronic illness, and identity and have practical implications for HIV/AIDS educators

The Perspective of Patients on Their Experience of Powerlessness

Abstract: Although self-determination is a key issue in empowerment, the perspective of patients on their experience of empowerment has been poorly investigated. The authors have attempted to understand better what the process of empowerment means to patients by investigating the situations and feelings of powerlessness from which a process of empowerment might evolve. They conducted 40 interviews of patients with various chronic conditions and looked for the commonalities in their experiences of powerlessness. Their findings show that powerlessness extends well beyond strictly medical and treatment-related issues, as the study participants all expressed or demonstrated to have at some point or another experienced a distressing feeling of insecurity and a threat to their social and personal identities. The authors therefore suggest that an empowering provider-patient interaction should address these issues by providing for reassurance and opportunities for self-exploration as a prerequisite to participation and self-determination in treatment-related decisions.

Using Focus Groups in Disability Research

Abstract: Qualitative health service research has increasingly drawn on focus groups to inform health policy and intervention design. Focus groups provide opportunities to engage in the development and evaluation of health services for those service users who are often excluded from other forms of data collection. Increasingly, people with disabilities have been recognized as a marginalized group in health research. To provide appropriate accommodation and to maximize the utility of focus groups with people who have disabilities, careful preparation and planning are necessary. In this article, the authors highlight critical issues in conducting focus groups with people who have various impairments and provide advice on what to consider in terms of preparation and analysis.

Explanatory Models and Help-Seeking Behavior: Pathways to Psychiatric Care Among Patients Admitted for Depression in Mulago Hospital, Kampala, Uganda

Abstract: In this article, the authors present findings from a qualitative study exploring how people diagnosed with depression conceptualize their condition and how their conceptualization shaped their efforts to seek help. They used an interview guide based on an explanatory model framework for data collection. Four major themes emerged from the analysis: (a) somatization, social meaning of illness, and help seeking; (b) meaning and perceived consequences of illness; (c) How did I get here? Making sense of psychiatric admission; and (d) variations in the causal attribution and the role of significant others in help seeking. Somatization of emotional problems, variations in causal attribution between patients and their significant others, the nature of the available health care system, and burden of infectious disease complicate access to care. These findings suggest the need to raise the awareness of primary care providers on how to recognize and help people with depression appropriately in this setting.

Confidentiality and Autonomy: The Challenge(s) of Offering Research Participants a Choice of Disclosing Their Identity

Abstract: In this article, the authors present one of the key ethical features of research: confidentiality as maintained by nondis-closure of participants' identities. In light of (a) the contingency that certain participants might vest interest in research studies through their identity and (b) the concept of respect for participants' autonomy, the authors consider the possibilities of offering research participants the choice of nonconfidentiality, afforded as an autonomous (negative) right of refusal of nondisclosure of identity. They address the issue that this possibility generates within the context(s) of current codes of ethics related to health research and the manifest responsibilities of the institutional review process. In this way, they attempt to elucidate potential benefits and consequences that arise from confidentiality and nonconfidentiality.

“I Try to Take Care of It Myself.” How Rural Women Search for Health Information:

Abstract: Rural living poses special challenges (and opportunities) for the significant health information intermediary role that women enact. The authors describe interviews with 40 women living in a rural, medically underserved county in south-western Ontario, Canada, who discussed their information-seeking experiences and the strategies used to find information about a chronic health concern or an acute medical problem. The women's stories reveal that they define health very broadly and that their information seeking is influenced by contextual factors, such as rural living and gender roles, that interplay with their self-reliance, health literacy, and the availability and willingness of others in professional and non-professional roles to give support within relationships of care. The authors discuss themes emerging from the interviews in connection with the apparent mismatch between women's lived realities and the policy assumptions supporting the development of e-health strategies for providing health information to people living in rural and remote communities.

Using Focus Groups With Minority Ethnic Communities: Researching Infertility in British South Asian Communities

Abstract: Little attention has been given to the specific methodological issues that can accompany the use of focus groups with minority ethnic communities in the United Kingdom. In this article, the authors discuss the use of this method in a study of the provision of infertility services to South Asian communities in three English cities. Focus groups are an invaluable research method for working in a diverse linguistic and cultural environment, providing interesting, rich, and complex data. However, their use can raise significant methodological and ethical challenges for researchers working with minority ethnic communities. The authors discuss key issues that arose in their exploration of ethnicity and infertility around language and cultural diversity, the role of community facilitators, access and recruitment, infertility as a "sensitive" topic, and reciprocity in research relations.

Reflexive Journaling on Emotional Research Topics: Ethical Issues for Team Researchers

Abstract: Traditional epistemological concerns in qualitative research focus on the effects of researchers' values and emotions on choices of research topics, power relations with research participants, and the influence of researcher standpoints on data collection and analysis. However, the research process also affects the researchers' values, emotions, and standpoints. Drawing on reflexive journal entries of assistant researchers involved in emotionally demanding team research, this article explores issues of emotional fallout for research team members, the implications of hierarchical power imbalances on research teams, and the importance of providing ethical opportunities for reflexive writing about the challenges of doing emotional research. Such reflexive approaches ensure the emotional safety of research team members and foster opportunities for emancipatory consciousness among research team members.

Learning From the Grandmothers: Incorporating Indigenous Principles Into Qualitative Research

Abstract: In this article, the author describes the process she undertook to incorporate Indigenous principles into her doctoral research about the midlife health experiences of elder Aboriginal women in Nova Scotia, Canada. By employing qualitative methods within the context of an Indigenous worldview, she gained knowledge of and developed competence in Aboriginal health research. The emergent partnership among Aboriginal community research facilitators, participating Mi'kmaq women, and the researcher provided many opportunities for the researcher to incorporate the paradigmatic and methodological traditions of Western science and Indigenous cultures. The application of these principles to this study might provide a useful example for other health researchers who are attempting to incorporate diverse methodological principles.

Factors Leading to Self-Disclosure of a Positive HIV Diagnosis in Nairobi, Kenya: People Living With HIV/AIDS in the Sub-Sahara

Abstract: Understanding why, how, and to whom people living with HIV/AIDS disclose their diagnosis to others is a critical issue for HIV prevention and care efforts, but previous investigations of those issues in sub-Saharan Africa have been limited to one or two questions included in quantitative studies of social support or stigma. Instruments and findings on serostatus disclosure based on U.S. populations are likely to be at best only partially relevant because of Africa's primarily heterosexual transmission vectors and highly communalistic social structures. This qualitative analysis of two male and two female focus groups comprised of persons living with HIV/AIDS (PLWHAs) in Nairobi, Kenya, revealed several HIVstatus disclosure patterns that appear distinctive to Africa. These include (a) intermediaries as vehicles for disclosure to family, (b) indirectness as a communication strategy, and (c) church pastors as common targets for disclosure.

Search Strategies for Identifying Qualitative Studies in CINAHL

Abstract: Nurses, allied health professionals, clinicians, and researchers increasingly use online access to evidence in the course of patient care or when conducting reviews on a particular topic. Qualitative research has an important role in evidence-based health care. Online searching for qualitative studies can be difficult, however, resulting in the need to develop search filters. The objective of this study was to develop optimal search strategies to retrieve qualitative studies in CINAHL for the 2000 publishing year. The authors conducted an analytic survey comparing hand searches of journals with retrievals from CINAHL for candidate search terms and combinations. Combinations of search terms reached peak sensitivities of 98.9% and peak specificities of 99.5%. Combining search terms optimized both sensitivity and specificity at 94.2%. Empirically derived search strategies combining indexing terms and textwords can achieve high sensitivity and high specificity for retrieving qualitative studies from CINAHL.

A Practical Guide to the E-Mail Interview

Abstract: The e-mail interview is a novel technique that has a number of advantages over traditional interviewing, but there are also some disadvantages. In this methodological article, the authors review the issues surrounding the use of the e-mail interview, providing a concrete example of its use, that of interviewing people with alopecia areata regarding psychological issues associated with the disorder. The authors show in the article that the e-mail interview is an effective interview technique but that users must take account of a number of sensitive issues, and there are a number of serious disadvantages that limit its use to specific areas. The e-mail interview cannot be used simply as a cheap alternative to face-to-face interviews in all circumstances.

Promoting Public Health Messages: Should We Move Beyond Fear-Evoking Appeals in Road Safety?

Abstract: Road traffic injury is one of the most significant global public health issues of the 21st century. The extent to which negative, fear-evoking messages represent effective persuasive strategies remains a contentious public and empirical issue. Nevertheless, negative, fear-based appeals represent a frequently used approach in Australasian road safety advertising. The authors conducted a series of focus groups with 16 licensed drivers to explore the potential utility of appeals to emotions other than fear. More specifically, they sought to explore the utility of positive emotional appeals, such as those incorporating humor. The themes emerging from the qualitative analysis suggested that both emotion and the provision of strategies are key components contributing to the overall persuasiveness of a road safety advertisement. Overall, it appears there is support for researchers and health advertising practitioners to provide further attention to the role that positive emotional appeals might play in future campaigns.

Men, Masculinities, and Prostate Cancer: Australian and Canadian Patient Perspectives of Communication With Male Physicians

Abstract: Patient-physician communication is vital in cancer care, and aspects of the patients' experiences provide insight into what constitutes effective cancer communication. Complexities inherent in prostate cancer regarding screening, treatment(s) efficacy, and side effects commonly form the basis of patient-physician discussions. However, the specificities of patient-physician communications, particularly in the male dyad, and the connections to masculinity are poorly understood. The authors used secondary analysis of data from two interview studies of 19 Canadian and 33 Australian prostate cancer survivors who were treated by male general practitioners and prostate cancer specialists. Participants acknowledged that physician expertise and compassion underpinned the development of trust, and both reassurance and humor were effective communication strategies. Participants were often self-directed in researching prostate cancer, consistently using biomedical language and numerical markers when discussing their disease. Analysis of findings enabled interpretations regarding what might be considered prostate cancer communication competencies in the male patient-physician dyad.

Spirituality in African Americans With Diabetes: Self-Management Through a Relationship With God:

Abstract: The purpose of this study was to develop a theoretical model about how the spirituality of African Americans affects their self-management of diabetes. The sample consisted of 29 African American men and women, ages 40 to 75, with type 2 diabetes. The authors used a grounded theory design and collected data using minimally structured interviews. The method of analysis was constant comparison. The core concept identified was Self-Management Through a Relationship With God. Participants fell into one of three typologies: (a) Relationship and Responsibility: God Is in Background; (b) Relationship and Responsibility: God Is in Forefront: (c) Relationship and Relinquishing of Self-Management: God Is Healer. These typologies varied according to how participants viewed their relationship with God and the impact of this relationship on their self-management. The spirituality of these African Americans was an important factor that influenced the self-management of their diabetes.