Qualitative Health Research current issue

Mixing Qualitative Methods

Morse, J. M. — Tue, 20 Oct 2009 16:47:03 PDT

Being There for Another With a Serious Mental Illness

Champlin, B. E. — Tue, 20 Oct 2009 16:47:03 PDT

In this article I describe the unique caring and caretaking relationship between a mentally ill person and the nonprofessional caretaker in his or her life. Stressing the perspective of the caretaker, I call this relationship "being there" for the mentally ill person. I collected the data through in-depth interviews and used a descriptive phenomenological approach to unveil the general structure of the experience. Eight constituents emerged as central to the general structure of this experience: (a) accepting the changed other and grieving the loss of who the other once was; (b) taking action in challenging circumstances; (c) recognizing the ongoing, never-ending, and sometimes unpredictable nature of the experience; (d) feeling isolated; (e) having ambiguity of the heart; (f) experiencing the tension of waiting; (g) knowing the other well; and (h) caring for the other. Knowledge gained from the study findings will help health care professionals understand and support people who are in this experience from a more caring paradigm.

Dignity Violation in Health Care

Jacobson, N. — Tue, 20 Oct 2009 16:47:03 PDT

In this grounded theory analysis I sought to understand dignity violation in health care and to explore the context in which such violations take place. I found that dignity violation in health care occurs through processes of rudeness, indifference, condescension, dismissal, disregard, dependence, intrusion, objectification, restriction, labeling, contempt, discrimination, revulsion, deprivation, assault, and abjection. The conditions that promote these processes reside in the positions of the actors involved; in the asymmetrical relationships between the actors; in the health care setting itself, which is characterized by multiple tensions—including those between needs and resources, crisis and routine, experience and expertise, and rhetoric and reality; and in the embeddedness of health care in a broader social order of inequality. These findings suggest several interventions that might mitigate dignity violation in health care.

Incomprehensibility in the Narratives of Individuals With a Diagnosis of Schizophrenia

Saavedra, J., Cubero, M., Crawford, P. — Tue, 20 Oct 2009 16:47:03 PDT

The fact that individuals with a diagnosis of schizophrenia have difficulties in terms of ordering and communicating their life stories is well known, and undoubtedly these dysfunctions are linked to the experience of alienation and isolation. In this article we contribute to the debate by studying life narratives of ten patients with a diagnosis of paranoid schizophrenia living in care homes in Andalusia, Spain. Patients were selected through meetings held with the directors of the care homes and data obtained from narrative, semistructured interviews. Thematic self-positioning and structure analysis identified four types of clearly distinctive narratives: delusive episodes with invasive voices, delusive episodes with no invasive voices, absence of delusive episodes or invasive voices and domination of self-position as patient, and complexity and articulation of self-positions.

Perspectives of Colorectal Cancer Risk and Screening Among Dominicans and Puerto Ricans: Stigma and Misperceptions

Goldman, R. E., Diaz, J. A., Kim, I. — Tue, 20 Oct 2009 16:47:03 PDT

Colorectal cancer is the second most common cancer among Latinos, but a lower percentage of Latinos are screened than Whites and Blacks. Along with recognized economic barriers, differences in knowledge and perceptions might impede colorectal screening among Latinos. We conducted 147 individual, qualitative interviews with Dominicans and Puerto Ricans in the northeastern United States to explore their explanatory models for colorectal cancer and screening barriers. Many participants had not previously heard of colorectal cancer. The most commonly mentioned cause of colorectal cancer was anal sex. Also considered risks were "bad food," digestion leading to constipation, and strained bowel movements. Screening barriers included stigma, misperceptions, embarrassment, and machismo. Progress toward increasing colorectal cancer screening requires normalization of this screening among Latinos. Higher patient familiarity, along with improved physician counseling and referral, might contribute to reducing stigma and other barriers, and to enhancing knowledge and Latino community support of colorectal cancer screening.

Women's Accounts of Their Decision to Quit Taking Antidepressants

McMullen, L. M., Herman, J. — Tue, 20 Oct 2009 16:47:03 PDT

Over the past 15 years, the rates at which antidepressants are prescribed have increased dramatically. Adherence, however, is often low and considered to be problematic. Using a discursive approach to analyzing interviews with six Canadian women who chose unilaterally to discontinue their use of antidepressants, we focus on three rhetorical strategies used to justify their actions: (a) referencing the actual or potential effects of antidepressants, (b) positioning lay knowledge as superior to expert medical knowledge, and (c) denigrating medical authorities. We argue that these women drew on the responsible-use-of-drugs framework as a way of positioning themselves against potential charges of having engaged in an irrational act.

Experiencing "The Other Side": A Study of Empathy and Empowerment in General Practitioners Who Have Been Patients

Tue, 20 Oct 2009 16:47:03 PDT

Work-related pressures and susceptibility to health problems mean that many general practitioners (GPs) will, at some stage, experience the role of patient. However qualitative evidence about their experiences of illness and patienthood is sparse. Our study offers an interpretative perspective on GPs’ experiences of illness and the influence that this has had on their practice. Seventeen GPs who had experienced significant illness took part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis (IPA). The findings highlight the relationship between empathy and empowerment and explore the role of self-disclosure of GP status by GPs in consultations. We make suggestions as to how empathy in doctor—patient relationships can be developed through consideration of power and status as well as through interaction with patients from similar backgrounds. Future research should focus on more specific ways to integrate these ideas into medical training.

African American Women's Beliefs, Coping Behaviors, and Barriers to Seeking Mental Health Services

Ward, E. C., Clark, L. O., Heidrich, S. — Tue, 20 Oct 2009 16:47:03 PDT

Little is known about African American women’s beliefs about mental illness. In this qualitative study we employed the Common Sense Model (CSM) to examine African American women’s beliefs about mental illness, coping behaviors, barriers to treatment seeking, and variations in beliefs, coping, and barriers associated with aging. Fifteen community-dwelling African American women participated in individual interviews. Dimensional analysis, guided by the CSM, showed that participants believed general, culturally specific, and age-related factors can cause mental illness. They believed mental illness is chronic, with negative health outcomes. Participants endorsed the use of prayer and counseling as coping strategies, but were ambivalent about the use of medications. Treatment-seeking barriers included poor access to care, stigma, and lack of awareness of mental illness. Few age differences were found in beliefs, coping behaviors, and barriers. Practice and research implications are discussed.

Ethical Dilemmas: The Experiences of Israeli Nurses

Shapira-Lishchinsky, O. — Tue, 20 Oct 2009 16:47:03 PDT

In this study I explored ethical dilemmas in nursing to gain a better understanding of nurses’ work and their professional status. Qualitative data on ethical dilemmas were collected by interviewing 52 nurses in 18 hospitals and health maintenance organizations. The transcribed interviews were analyzed using a stepwise method. Results indicate a large number of dilemmas that can be divided into five main categories: caring vs. following formal codes; fair process vs. fair outcome; organizational standards vs. family agenda; autonomy vs. deference to higher authority, and guarding secrecy vs. duty to report. The study findings might enhance nurses’ ability to cope with ethical dilemmas and bring about change in their professional status. In addition, the results might guide nurses and their supervisors toward developing practitioner programs for nurses that deal with ethical aspects. All these might reduce the expected shortage of nurses and improve the ability of the system to provide quality health care.

Recovery From Total Hip Replacement Surgery: "It's Not Just Physical"

Grant, S., St John, W., Patterson, E. — Tue, 20 Oct 2009 16:47:03 PDT

In this grounded theory study we explored the process of recovery following total hip replacement (THR) surgery from the perspective of the older adult. In-depth interviews were conducted with 10 patients aged more than 65 years who had been discharged from hospital for a period of 4 to 6 months following THR surgery. Findings showed that three distinct but interrelated processes constitute the physical, psychological, and social recovery process: reclaiming physical ability, reestablishing roles and relationships, and refocusing self. Intervening conditions affecting the recovery process include comorbid conditions, the personal outlook of the patient, patients’ relationships, and social support. The recovery process can lead to changes in personal and social functioning that patients might not anticipate. Awareness of potential changes will inform patient education and enable clinicians to develop strategies that facilitate THR patients’ return to health.

Positions in Doctors' Questions During Psychiatric Interviews

Ziolkowska, J. — Tue, 20 Oct 2009 16:47:03 PDT

In this article I apply the concept of positioning to the analysis of 15 initial psychiatric interviews. I argue that through their questions the psychiatrists-in-training impose positions requiring the patients to gaze at themselves and their actual problems from particular perspectives. I point to three such positions: (a) the position of the observing assessor, from which it is expected that the patients will make a detached assessment of themselves or their problems, (b) the position of the informing witness, which requires the patients only to verify the information about themselves, and (c) the marginal one, the position of the experiencing narrator, from which talk about experiences and problems is expected. I explore the roots and consequences of the positions, with particular attention toward objectivization of the patients’ experiences in the dominant witness and assessor positions. I conclude with a discussion about the medical model in psychiatry.

Protecting Respondent Confidentiality in Qualitative Research

Kaiser, K. — Tue, 20 Oct 2009 16:47:03 PDT

For qualitative researchers, maintaining respondent confidentiality while presenting rich, detailed accounts of social life presents unique challenges. These challenges are not adequately addressed in the literature on research ethics and research methods. Using an example from a study of breast cancer survivors, I argue that by carefully considering the audience for one’s research and by reenvisioning the informed consent process, qualitative researchers can avoid confidentiality dilemmas that might otherwise lead them not to report rich, detailed data.

Practicing the Awareness of Embodiment in Qualitative Health Research: Methodological Reflections

Sharma, S., Reimer-Kirkham, S., Cochrane, M. — Tue, 20 Oct 2009 16:47:03 PDT

Although the importance of the researcher’s embodiment has been noted in health and social sciences research, in many instances, more attention has been paid to the embodiment of the researched. Thus, more in-depth analysis of the embodied researcher can illuminate qualitative inquiry. The influence of the embodied researcher became visible in a recent critical ethnographic study examining the negotiation of religious, spiritual, and cultural plurality in health care. In this article, we do not present research findings per se, but rather methodological reflections. As researchers, we highlight emotional and bodily ways of knowing and experiences of difference such as culture, race, and religion as embodied and a part of researcher—participant encounters. We aim to elucidate the awareness of being embodied researchers, and with this elucidation, we consider implications for knowledge generation for health and social sciences.