Qualitative research in medicine & healthcare最新文献

{"title":"\"But when I come home…\": How patients with chronic musculoskeletal pain account for their absent pain during naturally occurring clinical consultations.","authors":"Trine C B Andersen, Olaug S Lian","doi":"10.4081/qrmh.2024.12612","DOIUrl":"10.4081/qrmh.2024.12612","url":null,"abstract":"<p><p>When patients' embodied experiences cannot be conveyed to clinicians in real-time, the challenges of reaching a shared understanding between patient and clinician are enhanced. In this study, we explore how patients with chronic musculoskeletal pain manage the situation of knowing that they regularly experience pain, yet exhibit minimal signs of it during clinical consultations. Utilizing a multimethod, conversation analysis approach and an interactional perspective, this paper analyzes 10 naturally occurring consultations at a specialized rehabilitation clinic in Norway. The analysis shows that patients account for the absence of pain by referring to i) specific events, ii) pain tolerance, and iii) pain periods. Such accounts were typically triggered by null findings (i.e., the absence of findings in technological and physical tests) in the physical examination and clinicians' positive summaries of patients' bodily conditions. Patients resist clinicians' positive stance by accounting for absent pain, cautiously challenging the clinicians' epistemic stance. If clinicians do not pursue patients' accounts, this might lead to a misalignment between patient and clinician which can obstruct efforts to reach a shared understanding of the pain. These findings may have general relevance for clinical consultations where patients' symptoms are difficult to measure and validate biomedically. Understanding how patients account for absent pain can enhance clinician-patient communication and improve clinicians' understanding of patients' everyday circumstances and thereby improve the outcome of consultations.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 3","pages":"12612"},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychogeriatric experts' experiences with risk factors of non-suicidal and suicidal self-injury in older adults: A qualitative study.","authors":"Lisa Van Hove, Imke Baetens, Steven Vanderstichelen","doi":"10.4081/qrmh.2024.12457","DOIUrl":"10.4081/qrmh.2024.12457","url":null,"abstract":"<p><p>While research has highlighted potential age-related differences in risk factors for non-suicidal and suicidal self-injury ((N)SSI), studies on such distinct risk factors among older adults are scarce. The present study addresses this gap by gaining insights into the experiences of psychogeriatric experts who work with older adults who engage in (N)SSI. In total, nine experts were interviewed about factors associated with (N)SSI in older adults. The responses were thematically analyzed using the biopsychosocial framework. We located a range of biological, psychological, and social factors contributing to (N)SSI, which largely align with previous findings regardless of age. Nonetheless, according to the experts cognitive and physical decline, advancing age, various experiences of loss, and social isolation were observed as particularly significant risk factors for older adults. These results emphasize the need for tailored preventive measures, interventions, and screening tools to address the unique challenges faced by older adults at risk of (N)SSI. Additionally, future research should investigate (N)SSI experiences in older age with a more diverse sample, including mapping the perspective of older adults themselves, healthcare providers, and other informants, to enhance our comprehension of this phenomenon among older adults.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 Suppl 1","pages":"12457"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Constantly justifying my existence\": Lower-income, higher-weight Canadian adults' stigma coping mechanisms.","authors":"Lee Turner, Andrea E Bombak","doi":"10.4081/qrmh.2024.12480","DOIUrl":"10.4081/qrmh.2024.12480","url":null,"abstract":"<p><p>Individuals who are higher-weight and low-income may disproportionately experience weight and income stigmas in healthcare experiences compared to lower-weight, higher-income individuals. The ways that weight and income stigmas interact in healthcare should be better understood in order to provide better, less stigmatizing care to higher-weight, low-income patients. This study assesses how patients manage stigmatizing experiences in both healthcare and everyday experiences and how that impacts health seeking and stigma management behaviors through semi-structured interviews with 11 higher-weight (Body Mass Index ≥30), low-income adults (≥18 years of age) in an Atlantic Canadian province. Participants took part in two interviews that focused on healthcare experiences and both positive and negative places/spaces. The two face-to-face interviews for each participant (total 21 interviews) were audio-recorded and professionally transcribed verbatim. The transcripts were analyzed using thematic analysis to identify recurring concepts and patterns within the data. Two major themes emerged from the data, <i>uptake of stigmatizing, neoliberal health messaging</i> and <i>coping with stigma</i>. <i>Coping with stigma</i> included subthemes <i>control over stigmatizing experiences</i> and <i>stoicism in the face of stigma</i>. The findings suggest that individuals understand their health and wellness through a neoliberal lens and that they deploy strategies of control and stoicism to cope with the stigmas they face.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 3","pages":"12480"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I have some people who actually really care:\" Young sexual minority women's lived experiences of non-suicidal self-injury disclosure.","authors":"Lindsay A Taliaferro, Jennifer J Muehlenkamp, Dahlia Wrubluski, Karli Reeves, Sarah A Job, Robert D Dvorak, Eric W Schrimshaw","doi":"10.4081/qrmh.2024.12632","DOIUrl":"10.4081/qrmh.2024.12632","url":null,"abstract":"<p><p>Sexual minority youth are more likely to engage in Non-Suicidal Self-Injury (NSSI) than their heterosexual peers, and sexual minority women demonstrate greater risk of NSSI than their sexual minority male counterparts. However, a lack of research exists on NSSI among young sexual minority women, particularly their NSSI disclosure experiences. We used a descriptive-interpretive, qualitative design with semi-structured interviews to examine young sexual minority women's lived experiences disclosing NSSI and of others' responses to these disclosures. The sample included 65 sexual minority women aged 14-30 recruited via paid social media advertising from across the U.S. We performed an inductive thematic analysis of transcripts from 58 participants (89%) who reported a history of NSSI. Participants shared reasons for disclosure (wanting help, communicating distress) or nondisclosure (cultural stigmas), types of disclosure (accidental/involuntary, and direct/voluntary), and recipients of a disclosure (friends, partners, mental health providers, and parents). They also described responses to, and feelings after, NSSI disclosure, revealing two themes: i) Unhelpful/stigmatizing responses (based on fear, anger, and apathy) and ii) Helpful/destigmatizing responses (expressions of concern, emotional support, and alternative coping strategies). Overall, young sexual minority women's disclosure experiences were consistent with those of other populations, highlighting the need to further reduce stigma about NSSI, as well as sexual minority identities, and provide universal education promoting helpful responses to NSSI disclosure.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 Suppl 1","pages":"12632"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking the cycle: Memorable messages of \"grin n' bear it\" and silence in menarche narrative recall.","authors":"Sarah S LeBlanc","doi":"10.4081/qrmh.2024.12239","DOIUrl":"10.4081/qrmh.2024.12239","url":null,"abstract":"<p><p>To better understand adolescent experiences of menstruation, the CODE Red project was initiated to examine period poverty and menstruation stigma. As part of the project, a survey was posted online through Qualtrics, and the link was posted to social media sites. One hundred and eighty-seven individuals completed the open-ended questionnaire between January and August 2022. The individuals are based in the United States, with most coming from northeastern Indiana. Using an iterative analysis, the data were analyzed using the theory of memorable messages. Three themes emerged supporting memorable messages: <i>the negative cycle of self</i>, <i>talk silence breeds silence</i>, and <i>my mom wasn't there</i>. The study concludes that <i>grin n' bear it</i> and <i>silence</i> are the predominant types of memorable messages first-time menstruators' experience Moreover, first-time menstruators experience self-silencing and other-silencing. Implications include that silence negatively impacts the mother-daughter relationship and that attention should be paid to the importance of communication before menarche.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 2","pages":"12239"},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"It's not avoiding anything\": Exploring avoidance in the context of non-suicidal self-injury.","authors":"Sophie Haywood, Penelope Hasking, Mark Boyes","doi":"10.4081/qrmh.2024.12301","DOIUrl":"10.4081/qrmh.2024.12301","url":null,"abstract":"<p><p>Non-suicidal self-injury is a concerning and prevalent behavior, particularly among adolescents and university students. Most theoretical models focus on the role avoidance plays in self-injury but, there is no consensus on what is being avoided. The aim of this study was to gain insight from individuals with lived experience of self-injury to better understand the role of avoidance in NSSI. Thirty-five interviews were conducted with individuals with lived experience of NSSI (18 - 44 years) and analyzed using reflexive thematic analysis. Three themes were developed to address our aim: active not passive; a short term distraction; externalizing inner turmoil. Our analysis suggests that avoidance is not a term that resonates with individuals with lived experience of NSSI. The theoretical and methodological implications of these findings are that we need to use language that resonates with individuals with lived experience and improve the way avoidance is conceptualized.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 Suppl 1","pages":"12301"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MeSsy identities: an ethnographic exploration of a multiple sclerosis support group.","authors":"Alyse Keller Johnson","doi":"10.4081/qrmh.2024.12175","DOIUrl":"https://doi.org/10.4081/qrmh.2024.12175","url":null,"abstract":"<p><p>The following is an ethnographic study of a multiple sclerosis (MS) support group. This study underscores the importance of access to counternarratives for individuals with chronic illness and disabilities through organizational structures such as support groups. This work can help those with disabilities/chronic diseases, such as MS, because it provides a space for discussing the communicative forces that shape individual experiences of living with disability and chronic illness. Thus, this study seeks to understand how pharmaceutical representatives' and doctors' grand medical narratives influence the communication of MS support group attendees and their construction/performance of self. This study shows that participation in support groups provides a space to renegotiate identity in which new forms of self can develop external to the dominant discourse. The support group becomes a space where counternarratives of empowerment develop in the face of master narratives.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 2","pages":"12175"},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The four Cs of physician leadership: A key to academic physician success.","authors":"R Thomas Collins Ii, Neha J Purkey, Meenu Singh, Alan D DeSantis, Rania A Sanford","doi":"10.4081/qrmh.2024.11519","DOIUrl":"https://doi.org/10.4081/qrmh.2024.11519","url":null,"abstract":"<p><p>Leadership is increasingly recognized as important in medicine. Physician leadership impacts healthcare delivery and quality. Little work has been done to determine how physician leadership in practice aligns with established models in leadership theory. We conducted 40 semi-structured, 50-minute interviews of physicians who had achieved the rank of professor in our school of medicine and were serving, or had served, in leadership positions. We used an inductive content analysis approach to identify content categories, with leadership emerging as one such category. Subsequently, for the present study, we performed a secondary analysis of the data. To do this, we reviewed all transcripts, seeking to identify if and how participants discussed leadership in relation to success in academic medicine. Following identification of sub-categories related to leadership, we performed qualitative content analysis. We then used a deductive content analysis approach to determine how participants' discussions of leadership aligned with major leadership theories. Then, the principal investigator conducted a secondary inductive content analysis revealing leadership themes that were synthesized into a new model of physician leadership. Twenty-nine participants spontaneously discussed leadership and leadership-related topics as important to their own academic success and comprised the present study cohort. Participants identified contributors to leadership success that aligned with multiple major leadership theories, including leadership traits, skills, behaviors styles, and situational leadership. None of the leadership theories aligned completely with our physician leaders' discussions, suggesting an alternate leadership framework was operating. Further analysis revealed a new model of leadership comprised of the \"Four Cs of Physician Leadership\": <i>character</i>, <i>competence</i>, <i>caring</i>, and <i>communication.</i> Our participant group of academic physicians identified leadership capabilities as being important in their academic success. While they discussed leadership in ways that fit to varying degrees with the major leadership theories, their discussions revealed a novel, more holistic leadership framework. Further work will be beneficial to determine if this model of leadership is specific to physicians or is more generalizable.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 2","pages":"11519"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the phenomenological experiences of schema therapy for those with an eating disorder.","authors":"Alice Cunningham, Marie Reid, Stephanie Sayan, Richard Hammersley","doi":"10.4081/qrmh.2024.11376","DOIUrl":"10.4081/qrmh.2024.11376","url":null,"abstract":"<p><p>Schema therapy expands traditional cognitive-behavioral models, weakening early maladaptive schemas and schema modes while strengthening adaptive modes. This study investigated participant experiences of schema therapy for eating disorders, focusing on schema modes and the eating disorder voice, how these maintained disordered eating, and how therapy helped. Semistructured online video interviews with clients receiving schema therapy for eating disorders (N=10) were analyzed using interpretative phenomenological analysis. Four group experiential themes were developed: (1) <i>adverse experiences</i>, typically in childhood and adolescence, (2) <i>interpersonal relationships</i>, especially with primary caregivers and the benefits of a good therapeutic relationship, (3) <i>self-awareness</i> of schema modes and the eating disorder voice and their impact on participants' eating disorders, and (4) <i>recovery</i> using schema concepts, including finding one's inner child, better self-management, and ambivalence about recovering. Overall, schema therapy was perceived as beneficial, specifically regarding participants' awareness of their inner child, development of their eating disorder, and awareness of their eating disorder voice. Participants expressed a growing positive sense of agency, connecting with their inner child's needs and developing a connection to their healthy adult mode. They also felt that schema therapy had equipped them with the tools to strengthen their healthy adult mode, while simultaneously weakening their maladaptive modes.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 2","pages":"11376"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11445698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the decision to disclose non-suicidal self-injury align with decision-making frameworks of personal information disclosure? A directed content analysis.","authors":"Sylvanna Mirichlis, Penelope Hasking, Mark Boyes, Stephen P Lewis, Kassandra Hon","doi":"10.4081/qrmh.2024.12318","DOIUrl":"https://doi.org/10.4081/qrmh.2024.12318","url":null,"abstract":"<p><p>Non-suicidal self-injury (NSSI) is the deliberate damage caused to one's own body tissue, without the intent to die. Voluntary disclosure of one's NSSI can catalyze help-seeking and provision of support, although what informs the decision to disclose NSSI is not yet well understood. There is currently no existing framework specific to the process of NSSI disclosure, and the aim of this study was to assess the fit between factors involved in the decision to disclose NSSI and two broader frameworks of disclosure: the Disclosure Decision-Making and Disclosure Processes models. A directed content analysis was used to code interview transcripts from 15 participants, all of whom were university students aged between 18 and 25 (<i>M</i> = 20.33, <i>SD</i> = 1.88), with 11 identifying as female. All participants had lived experience of NSSI which they had previously disclosed to at least one other person. All codes within the coding matrix, which were informed by the disclosure models, were identified as being present in the data. Of the 229 units of data, 95.63% were captured in the existing frameworks with only 10 instances being unique to NSSI disclosure. Though factors that inform the decision to disclose NSSI largely align with the aforementioned models of disclosure, there are aspects of disclosure decision-making that may be specific to NSSI.</p>","PeriodicalId":74623,"journal":{"name":"Qualitative research in medicine & healthcare","volume":"8 Suppl 1","pages":"12318"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}