Qualitative Health Research

Morse, Janice M.

doi: 10.1177/1049732308321410pmid: 18689529

Sword, Wendy; Busser, Dianne; Ganann, Rebecca; McMillan, Theresa; Swinton, Marilyn

doi: 10.1177/1049732308321736pmid: 18689530

This qualitative descriptive study explored women's care-seeking experiences after referral for postpartum depression. Interviews with 18 participants revealed individual-, social network—, and health system—related factors that hindered and facilitated care seeking. Women's normalizing of symptoms, limited understanding of postpartum depression, waiting for symptom improvement, discomfort discussing mental health concerns, and fears deterred care seeking; symptom awareness and not feeling like oneself were facilitating influences. Family and friends sometimes hindered care seeking because they, too, normalized symptoms or had limited understanding of postpartum depression. Care seeking was facilitated when women encouraged a health professional visit or expressed worry and concern. Health system barriers included normalizing of symptoms, offering of unacceptable interventions, and disconnected care pathways. Care seeking was facilitated by having established and supportive relationships, outreach and follow-up, legitimization of postpartum depression, and timeliness of care. These findings can be used to guide clinical practice and service provision.

Wittink, Marsha N.; Dahlberg, Britt; Biruk, Crystal; Barg, Frances K.

doi: 10.1177/1049732308321737pmid: 18689531

Past research has suggested that patients might not accept depression treatment in part because of differences between patient and doctor understandings of depression. In this article, we use a cultural models approach to explore how older adults incorporate clinical and experiential knowledge into their model of depression. We conducted semistructured interviews about depression with 19 patients aged 65 years and older who were identified by their physicians as depressed. We found that whereas older adults viewed as helpful the doctor's ability to identify symptoms and “put it all together” into a diagnosis, they felt that this viewpoint omitted important information about the etiology and feeling of depression grounded in embodied experience and social context. Our findings suggest that more emphasis on issues related to the etiology of depression, the effect of depression on social relationships, and emotions emanating from depression might lead to more acceptable depression treatments for older adults.

Nichter, Mimi; Nichter, Mark; Adrian, Shelly; Goldade, Kate; Tesler, Laura; Muramoto, Myra

doi: 10.1177/1049732308321738pmid: 18689532

The authors present findings from a qualitative study on postpartum smoking among low-income women ( N = 44) who had been smokers at the onset of pregnancy. Interview data collected after delivery at Months 1, 3, and 6 postpartum are discussed to explore contextual factors contributing to smoking abstinence, relapse, and harm-reduction practices. By 6 months postpartum, 10 women (23%) had completely quit, 21 women (48%) had reduced their smoking by 50% of their prepregnancy levels, and 7 women (16%) had reduced their smoking by one third of their prepregnancy levels. Thus, the majority of the women were engaging in significant harm-reduction efforts despite being entrenched in high-risk smoking environments where they were provided with few messages to quit. Many mothers were concerned about their moral identity as a smoker and expressed concerns that their child might initiate smoking at an early age. Future programs targeting this population should acknowledge women's harm-reduction efforts in environments where smoking is normative.

Leppänen, Vesa

doi: 10.1177/1049732308321739pmid: 18689533

I describe methods used by home carers to cope with troublesome clients and analyze how the organizational context affects their use. Empirical data consist of participant observation and field interviews with 14 home carers in three municipalities in southern Sweden. Home carers might try to avoid working with troublesome clients, prepare themselves mentally before visiting them, try to withhold them psychologically, try to understand them and explain their behavior, try to change their behavior, and vent experiences with colleagues. Although some of these methods are practiced frontstage, in interactions with clients, others take place backstage, only involving staff. Their use is influenced both by properties of frontstage work, for instance, the intimate nature of many tasks and the experienced need to keep up a “good” relationship with clients, and by the organization of backstage work, for instance, the organization of staff meetings and supervisors' understanding of coping processes.

Holt, Nicholas L.; Moylan, Beverly A.; Spence, John C.; Lenk, Julie M.; Sehn, Zoë L.; Ball, Geoff D. C.

doi: 10.1177/1049732308321740pmid: 18689534

The purpose of this study was to examine the family environment and assess treatment preferences among overweight youth and their parents. Data were collected via 41 interviews with parents and children from the wait-list of a weight management clinic and analyzed using grounded theory methodology. Framed around an ecological framework, findings ranged from proximal family issues to more distal policy issues. At the family level, parents attempted to influence their children's lifestyle behaviors by using contradictory and inconsistent strategies that reflected extremes of leniency and control. There was resistance to reducing screen time because participants thought that it was important for the children's social lives. Participants desired better help from health care professionals, requested family-centered treatment, expressed a desire for increased social support, and needed policy/ program-level changes to assist their weight management efforts. These findings offer insight into the complexity of individual, familial, and environmental factors that impact both behavior change and health services delivery in pediatric weight management.

Marcellus, Lenora

doi: 10.1177/1049732308321741pmid: 18689535

A significant percentage of children in foster care in North America are younger than 1 year of age and are in foster care because of parental substance use and other social challenges. Infants might present with specific health and behavioral issues that are challenging to manage within the foster family home environment; foster families require specialized skills and knowledge to manage these issues. In this article, the author describes a constructivist grounded theory of the process of becoming and providing family foster caregiving in the context of caring for infants with prenatal alcohol and/or drug exposure. The basic social process of (ad)ministering love was identified. The author further describes the three phases of this process and the core concepts within each phase.

Willging, Cathleen E.; Waitzkin, Howard; Nicdao, Ethel

doi: 10.1177/1049732308321742pmid: 18689536

Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future reform. After 160 interviews and participant observation at SNIs, we analyzed data through iterative coding procedures. SNIs responded to MMC by nonparticipation, partnering, downsizing, and tapping into alternative funding sources. Numerous barriers impaired access under MMC: service fragmentation, transportation, lack of cultural and linguistic competency, Medicaid enrollment, stigma, and immigration status. By privatizing Medicaid and contracting with for-profit managed care organizations, the state placed additional responsibilities on “disciplined” providers and clients. Managed care models might compromise the rural mental health safety net unless the serious gaps and limitations are addressed in existing services and funding.

Rhodes, Penny; Small, Neil; Rowley, Emma; Langdon, Mark; Ariss, Steven; Wright, John

doi: 10.1177/1049732308321743pmid: 18689537

Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

Carter, Stacy M.; Jordens, Christopher F. C.; McGrath, Catherine; Little, Miles

doi: 10.1177/1049732308321753pmid: 18689538

In this article, we examine participants' talk about qualitative research. We provide empirical support for post-structural theorizations of the interview and propose three distinct but related dimensions of qualitative research: emotional, purposive/relational, and epistemic/ontological. In this study, participants often became upset but constructed participation as enjoyable and cathartic. The purpose of participation was to assist the communities to which one belonged. Participation was an active, reflexive practice that reconstructed the self and changed knowledge about one's self. This latter epistemic/ontological dimension of participation appeared to be the most compelling for participants, but it is also the hardest to observe, with implications for how we consider the costs and benefits of participation. We suggest two practical measures for researchers and institutional review boards to consider in light of our findings: routinely asking questions about the research experience in qualitative studies and reformulating patient information statements to particularize them to qualitative research.