Qualitative Health Research

Broomfield, Katherine; Sage, Karen; Jones, Georgina L.; Judge, Simon; James, Deborah

doi: 10.1177/10497323221139803pmid: 36382907

As speech and language therapists, we explored theories of communication and voice that are familiar to our profession and found them an inadequate basis on which to generate deep and rich analysis of the qualitative data from people who have communication difficulties and who use augmentative and alternative communication. Expanding our conceptual toolkit to include the work of John Shotter allowed us to reconceptualise voice and where it is emergent in dialogue. Reimaging voice will inform clinical and research praxis with people who have communication difficulties as it allows practitioners to attend more closely to the complexity and nuance inherent in interactions with this population. Our proposition is exemplified with excerpts from a single participant who has communication difficulties to illustrate the value of dialogic theory in praxis. This article presents a provocation for the wider academy of qualitative health research; do we have the concepts and tools to develop meaning with people whose lived experiences may also be hard to voice in monologues?

Finster Úlfarsson, Maria; Svavarsdóttir, Margrét Hrönn; Thórarinsdóttir, Kristín

doi: 10.1177/10497323221137211pmid: 36384362

The relationship between mother and daughter is exceptional when it comes to closeness and its impact on their whole life. Thus, a mother’s move to a nursing home is pivotal for both of them. The aim of this interpretative phenomenological study, using the Vancouver School of Doing Phenomenology, was to explore daughters’ experience of having a mother in a nursing home, its impact on the maternal relationship, and the daughters' need for education and support. Data were collected by 21 semi-structured interviews with 12 women who had mothers living in a nursing home. Keeping the connection alive with tender care and common sense encapsulates the interrelation between the daughters’ urge to hold on to the mother–daughter relationship and the rare consideration of education and support from health professionals. Responsibility and sense of duty paired with relief because the mother is in a safe place were accompanied by the daughters’ need for confirmation that the mother is well taken care of.

Karnieli-Miller, Orit; Divon-Ophir, Orna; Sagi, Doron; Pessach-Gelblum, Liat; Ziv, Amitai; Rozental, Lior

doi: 10.1177/10497323221139781pmid: 36384326

Medical clowns (MCs) are trained professionals who aim to change the hospital environment through humor. Previous studies focused on their positive impact and began identifying their various skills in specific situations. When placed in pediatrics, MCs face various challenges, including approaching frustrated adolescents who are unwilling to cooperate with their care, dealing with their anxious parents, and communicating in a team in the presence of other health professionals. Research that systematically describes MCs’ skills and therapeutic goals in meeting these challenges is limited. This article describes a qualitative, immersion/crystallization study, triangulating between 26 video-recorded simulations and 12 in-depth-semi-structured interviews with MCs. Through an iterative consensus-building process we identified 40 different skills, not limited to humor and entertainment. Four main therapeutic goals emerged: building a relationship, dealing with emotions, enhancing a sense of control, caring, and encouragement, and motivating treatment adherence. Mapping MCs’ skills and goals enhances the understanding of MCs’ role and actions to illustrate their unique caring practices. This clarification may help other healthcare professionals to recognize their practices and the benefits in involving them in care. Furthermore, other health professionals may apply some of the identified skills when faced with these challenges themselves.

Offomiyor, Feyisayo Adeola; Rehal, Satwinder

doi: 10.1177/10497323221139105pmid: 36409078

Gestational Diabetes Mellitus (GDM) is a major public health issue and a threat to the well-being of a mother and her offspring. As a growing concern in sub-Saharan Africa, this paper explores the knowledge, attitude, and practices of healthy expectant mothers towards GDM, and the content of GDM information delivered by prenatal nurses during Antenatal Clinic (ANC) in Warri, Delta State, Nigeria. Semi-structured telephone interviews were employed with 22 participants comprising 20 pregnant women and 2 antenatal nurses. The results reveal that majority of the pregnant women were unaware of GDM as a particular health condition during pregnancy that poses a risk to both maternal and infant health and could lead to a long-term risk of developing the chronic condition of Type 2 Diabetes Mellitus (T2DM). This low level of awareness was attributed to a lack of adequate information during prenatal clinic sessions. The findings from this study emphasize the need to enhance the quality of public health education offered to pregnant women during pre and antenatal clinical services emphasizing GDM as part of the overall global agenda on promoting maternal and infant health.

Chiang, HL Michelle; Wong, Audrey Yoke Poh; Tan, Serene Leong Hwee; Mohapatra, Litali; Chan, Olivia Harmony; Ho, Andy Hau Yan

doi: 10.1177/10497323221139392pmid: 36420949

Physicians, nurses, social workers, and allied health professionals including physiotherapists and occupational therapists play important roles as they work closely with stroke survivors to improve functional independence in daily activities and quality of life. Yet, in Singapore little is known about their perspectives on what constitute quality stroke care based on their clinical experiences. In this project, our qualitative interviews with 15 healthcare workers at a major stroke center in the country yielded a Continuity of Care Advocate Model (CCAM) to help us better understand our participants’ experience-based perspectives on quality stroke care. We found that CCAM, constructed based on the perspectives of HCWs across a stroke care continuum, is a holistic model of quality stroke care which prioritizes support for patients and their families throughout the patient’s health trajectory. We conclude by discussing how this model is aligned with and differs from current research on definitions of care continuity.

Plackowski, Emily F.; Bogart, Kathleen R.

doi: 10.1177/10497323221135974pmid: 36444970

In a two-study project, researchers used qualitative methods and inductive thematic analyses to investigate the lived awareness- and advocacy-related experiences of 27 adults with over 35 different rare diseases, disorders, or disabilities (RDs). In Study 1, participants in two focus groups described how a lack of RD awareness led to experiences with several types of stigma, complicated their expressions and disclosures of disability, and spurred them to work towards awareness. Participant priorities identified in Study 1 motivated researchers to design and conduct Study 2. In Study 2, researchers interviewed 18 RD self-advocates about their lived experiences with and ideas regarding advocacy. Their recommendations included increasing social and systemic support, education, and media and professional representation. Advocates in Study 2 also warned of potential roadblocks to self-advocacy and change, including systemic invalidation and bias, lack of access to activist spaces, and limited time and energy for advocacy. Overall, analyses exposed the complex and interwoven influences of RD awareness and advocacy.

Fixsen, Alison; Kossewska, Magdalena; Bardey, Aurore

doi: 10.1177/10497323221141629pmid: 36475406

The fashion industry has been critiqued for promoting ultra-thin bodies, yet the relationship between models’ aesthetic labor and eating disorder (ED) development is unclear. Using interpretive phenomenological analysis, we explored the lived experiences of nine female fashion models including metaphors they used to describe body perceptions and eating behaviors. Four superordinate themes emerged: Shaped for the industry; The body as a market product; Food restriction (“it’s almost glamorized”); Toward a healthier modelhood. Models’ career trajectories were those of lost childhoods, punitive body rules, inadequate dietary advice, and self-regulated food restriction. Models were “shaped” by agents from an early age to conform to the industry’s body rules irrespective of the physiological and psychological consequences. A “toxic” side to this aesthetic industry was depicted; agents were judged callous and money-focused, while idioms like, “feeling like a piece of meat” and “being a hanger of clothes” conveyed a deep sense of degradation and objectification. Ideas instilled at a formative age continued to influence self-image and eating patterns into maturity, pointing to an industrial element to the construction of eating disorders. Our study highlights how infantilization, sexism, and other unethical elements become normalized in poorly regulated industries such as fashion, with dire consequences for the health and wellbeing of employees. Model agencies should recognize the impact of occupational edicts and poor communication on young recruits in a sensitive phase of personality development. Finally, we advocate for more acknowledgment and further investigation into eating disorder construction commercial/industrial side.

Iregbu, Sandra; Spiers, Jude; Duggleby, Wendy; Salami, Bukola; Schick-Makaroff, Kara

doi: 10.1177/10497323221143889pmid: 36519805

Nigeria struggles to reframe its traditional acute-care disease approach to health care to accommodate rising needs for chronic disease care. This interpretive descriptive study explored Nigerian healthcare providers’ (HCPs) perspectives, experiences, and practices related to self-management support (SMS). Observational and experiential data were gathered from 19 HCPs at two urban hospitals in Southeastern Nigeria (seven physicians, four nurses, five dietitians/nutritionists, and three health educators). There were four themes: (a) compliance-oriented medical model, (b) SMS as advice, informal counseling, and education, (c) navigating the sociocultural terrain, and (d) workarounds. Nigerian HCPs perspectives and SMS practices were characterized by attempts to foster compliance with healthcare instructions within a traditional biomedical model. Participants enhanced patient support using specific strategies to bypass structural system obstacles. These findings demonstrate the need to reevaluate the current understanding of SMS in Nigeria and its practice.

Tutone, Senitila; Fuimaono-Asafo, Atua; Wilson, Ailsa; Harwood, Matire; Love, Rachelle; Rahiri, Jamie-Lee

doi: 10.1177/10497323221144929pmid: 36538013

The establishment of a culturally diverse surgical workforce, largely on the basis of gender, has been highly promoted in Australasia in the last decade. Despite this, discussions of gender diversity in surgery have largely excluded Indigenous women. This study presents the experiences of wāhine Māori and Pasifika doctors in Aotearoa, who formed a surgical sisterhood to support them towards applying for advanced surgical training. Utilising mana wāhine and Masi methodologies, semi-structured interpersonal interviews were undertaken with five wāhine who formed the surgical sisterhood. Following transcription and analysis of all interviews, four key themes were identified. These were mana wāhine, unity, our why and change on the horizon. These themes illustrate the complex and varied experiences of wāhine Māori and Pasifika and how they have navigated their surgical pathways amidst multiple layers of discrimination towards being in a position to apply for advanced surgical training.

Treloar, Carla; Idle, Jan; valentine, kylie

doi: 10.1177/10497323221144923pmid: 36476020

Adverse childhood experiences, including childhood sexual abuse, have significant immediate and lifelong effects including higher risks of alcohol and other drug use and contact with the criminal justice system. The concept of trauma to describe adverse experiences and later behaviours provides potential to reshape prevention and responses for victims. We draw on survivor accounts to a national enquiry, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, to examine the ways in which trauma is narrated in adverse childhood experiences, alcohol and other drug use and contact with the criminal justice system, and how trauma is interpreted by others in the context of policy and legal findings. These accounts showed damaging and unjust experiences of childhood, which were compounded by subsequent contact with the criminal justice system. Trauma seems to be important to both the experienced narrated by survivors and the synthesising of these experiences into narratives. National enquiries play important roles in listening to survivors and advocating for reform. There is a risk, however, that they will fail to result in substantive change, and function primarily as a forum for bearing witness to trauma, but not preventing it.