SSM. Qualitative research in health最新文献

{"title":"New stories, same Stigma: Framing analysis of news articles about people with alcohol-related conditions needing liver transplants","authors":"Whitney Langlee ,&nbsp;Divya Kalluri ,&nbsp;Rivka Abedon ,&nbsp;Aura T. Teles ,&nbsp;Janetta Brundage ,&nbsp;Po-Hung Chen ,&nbsp;Andrew M. Cameron ,&nbsp;Hannah C. Sung ,&nbsp;Olivia S. Kates","doi":"10.1016/j.ssmqr.2025.100567","DOIUrl":"10.1016/j.ssmqr.2025.100567","url":null,"abstract":"<div><h3>Background</h3><div>Public stigma surrounding alcohol use disorder (AUD) negatively impacts people with alcohol-related liver disease (ALD) in need of liver transplants (LT). Representations of LT for ALD are socially constructed in part through media, but media on this topic has been underexplored in current research.</div></div><div><h3>Methods</h3><div>Research team members conducted systematic searches during 7/2022-5/2024 for online, publicly available articles about LT for ALD within leading English-language news sites in the US by monthly visits (n = 24). Using inductive framing analysis, we coded and identified patterns in news articles (n = 42) from 1990 to 2021 to generate frames.</div></div><div><h3>Findings</h3><div>Our inductive analysis generated 4 main frames: (a) making individual exceptions: good people in a bad group, (b) appealing to societal costs: individual actions putting a strain on society, (c) questioning professionals' judgements: doctors’ discretionary power, and (d) portraying healthcare as a competition: unfair play in a zero-sum game. Media characterized people with ALD as less deserving of liver transplant, but with individual exceptions. Articles described people with “self-induced” illnesses as irresponsible towards themselves, other LT candidates, and society; doctors as “gatekeepers” with discretionary power over how to apply criteria or rules; and the liver transplant waitlist as a competitive zero-sum game in which people with ALD are or should be deprioritized.</div></div><div><h3>Discussion</h3><div>News articles reflect our society's stigmatization of alcohol-related conditions as well as misconceptions about transplant listing and allocation. Such mischaracterizations can further marginalize stigmatized patients with alcohol-related conditions in need of LTs. We offer recommendations for public communications, including avoiding representations of patients with ALD as exceptions to the norm and contextualizing LT for ALD within the context of public health and social and systemic factors.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100567"},"PeriodicalIF":1.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of context on interphysician collaboration and learning: A focused ethnography around hip fracture patients in the emergency department","authors":"M. van der Ven ,&nbsp;N. Looman ,&nbsp;N. Ergun- Al Kafadji ,&nbsp;S. Dalloyaux ,&nbsp;O. Sir ,&nbsp;J. Braspenning ,&nbsp;C. Fluit ,&nbsp;W. Kuijer-Siebelink ,&nbsp;D. van Asselt","doi":"10.1016/j.ssmqr.2025.100566","DOIUrl":"10.1016/j.ssmqr.2025.100566","url":null,"abstract":"<div><h3>Introduction</h3><div>Older patients with complex care needs are increasingly seen in the emergency department (ED), requiring patient-centered care that involves collaboration among multiple specialists. Inadequate interphysician collaboration (IPhC) can increase the risk of adverse outcomes. Although the ED presents opportunities for learning IPhC, it is unknown how this potential could be exploited. This study examines ED interactions between residents and supervisors caring for hip fracture patients to explore influencing contextual factors and how IPhC (learning) can be improved.</div></div><div><h3>Methods</h3><div>Interactions between residents and supervisors from anesthesiology, emergency medicine, geriatric medicine, trauma, and orthopedic surgery concerning eight hip fractures patients were observed. Thirteen residents and twelve supervisors participated in field interviews to discuss observed behavior. Thematic analysis was conducted on observation notes and interviews. Themes were discussed with participants in four focus groups to reflect on interactions and explore opportunities for improving (learning) IPhC.</div></div><div><h3>Results</h3><div>Residents primarily performed their own tasks with remote supervision. Repeated tasks and contradictory treatment plans were common. Five contextual factors influenced IPhC interactions: swarm of unacquainted professionals, bustling ED environment, lack of coordination, silo mentality, and limited, hierarchical feedback culture. Residents viewed their IPhC interactions as sufficient, despite observed contradictions. In focus groups, participants recognized these issues but were unaware of the associated risks.</div></div><div><h3>Conclusion</h3><div>Interactions in acute care lack coordination and integration. The complex acute care context impedes connectivity between specialties and IPhC learning, which may lead to increased risk of adverse outcomes. To improve IPhC and learning, addressing both contextual aspects and improved role modelling and feedback are needed.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100566"},"PeriodicalIF":1.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multi-site study of clinician perspectives in the lifecycle of an algorithmic risk prediction tool","authors":"Rita Dexter,&nbsp;Kristin Kostick-Quenet,&nbsp;Jennifer Blumenthal-Barby","doi":"10.1016/j.ssmqr.2025.100562","DOIUrl":"10.1016/j.ssmqr.2025.100562","url":null,"abstract":"<div><div>Recent advancements in the performative capacities of artificial intelligence (AI), machine learning (ML), and algorithmic-based tools open up numerous applications in modern medicine. There are, however, few studies that track the whole lifecycle of a digital healthcare tool as it evolves from conception, to design, and deployment in real world settings—especially with a focus on the social dynamics amongst the end-users of the tool: clinicians. In this paper, we present data from a multi-site, 5-year study focused on the development and deployment of an algorithmic risk calculator (HeartMate 3 Risk Score) into a validated and efficacy tested clinical decision support system (CDSS) for patients and clinicians engaging in shared decision making about left ventricular assist device (LVAD) therapy for advanced heart failure. We conducted a total of 76 interviews with 20 advanced heart failure cardiologists and 14 nurse coordinators with LVAD expertise (n=34) across different timepoints during the lifecycle of this digital healthcare tool. Results from Thematic Analysis revealed an array of social factors at play at each stage of the tool’s development and implementation, from finding social consensus around risk messaging in the conception and design phases, to various social contingencies that served as facilitators and barriers to the successful integration of the tool in its later stages. Our findings confirm many previously raised issues with introducing new medical and digital healthcare tools into clinical care, and highlight new issues specific to the rapidly advancing technology in CDSS.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100562"},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143879298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘You can sleep hungry just to buy the medicine’: Applying a patient-centred model of cumulative complexity to explore how patients manage the lifelong workload of hypertension care in Kenya","authors":"Ruth Willis ,&nbsp;Daniel Mbuthia ,&nbsp;Mary Gichagua ,&nbsp;Jacinta Nzinga ,&nbsp;Carl May ,&nbsp;Peter Mugo ,&nbsp;Adrianna Murphy","doi":"10.1016/j.ssmqr.2025.100563","DOIUrl":"10.1016/j.ssmqr.2025.100563","url":null,"abstract":"<div><div>This research applies the Cumulative Complexity model to examine patient experiences of hypertension management following prescription of anti-hypertensive medication in the public health system in Kenya. Set in Kiambu County, central Kenya, it draws on abductive analysis of interviews with patients (n = 24), caregivers (n = 7) and non-participant observation in four purposively selected public facilities conducted between November 2022 and April 2023. Patients undertook three kinds of ‘work’ to reduce their blood pressure: processing work to accept hypertension diagnosis and its chronic dimension; practical work managing care and medications, and work of managing emotions. Four inter-related domains of patient capacity influenced patients' ability to do this work: individual financial resources; physical functioning; social support and religious faith. Variations in treatment cost and medicine availability increased patient workload. When workload overwhelmed capacity treatment adherence was interrupted. Interruptions in treatment resulted in negative feedback loops further reducing patient capacity. Recognising temporal variability in workload and capacity is key to understand treatment adherence in resource constrained settings. Consideration of adaptive counter-agency can strengthen treatment burden models. We encourage policy makers to prioritise addressing treatment burdens to support treatment adherence and sustained hypertension control.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100563"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Not all bathrooms are created Equal”: Moral experiences of maneuvering in inaccessible infrastructure with physical disability","authors":"Abby Arthur Smith","doi":"10.1016/j.ssmqr.2025.100561","DOIUrl":"10.1016/j.ssmqr.2025.100561","url":null,"abstract":"<div><div>How do people with physical disabilities characterize their encounters with inaccessible infrastructure? I draw on interviews and focus groups with older adults with spinal cord injuries from the Midwestern United States to argue that participants experienced inaccessible space as morally harmful, damaging their sense of worth and dignity. They developed strategic bodily “<em>maneuvers</em>” to squeeze through narrow corridors, scale ledges, navigate the back of rooms and buildings, and avoid filth and garbage–resulting in situations of exclusion and marginalized inclusion. Maneuvering established inaccessible spaces and disabled bodies as “<em>denied”</em> and “<em>undignifying,”</em> two stigmatizing classifications which participants experienced as hurtful and unfair. Denied space was exclusionary and associated participants’ disabilities with what they could not do. Undignifying space facilitated a sidelined, dirty, burdensome sense of inclusion. These were moral experiences: they made participants feel less whole and welcome. While denied space offered fewer mobility opportunities, participants felt most stigmatized by undignifying space, precisely because they had greater opportunity to encounter its degrading features by navigating through it. Participants articulated forceful moral judgments toward degrading and exclusionary infrastructure. In instances when opportunities for maneuvering <em>through</em> space were totally unavailable or too degrading to bear, most participants maneuvered <em>away</em> from it. Through such embodied micro-protests against marginalizing spaces, participants constructed themselves as moral agents worthy of inclusion and dignity. This process developed out of encounters between the body and the material forms of inaccessible space, speaking to literature that indicates the relevance of material things–like infrastructure and the body–to sociologists of morality and disability.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100561"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Context and Public Health Compliance: Mask wearing during the COVID-19 pandemic","authors":"James W. Shockey","doi":"10.1016/j.ssmqr.2025.100564","DOIUrl":"10.1016/j.ssmqr.2025.100564","url":null,"abstract":"<div><div>As medical science worked to understand how the coronavirus is transmitted and how it can be controlled, public health professionals have been faced with the challenge of translating medical science recommendations into actions that support community health. These actions must be effective, but also adopted by individuals within the community. During the coronavirus pandemic, most people appeared to comply with guidelines for wearing face masks. On the other hand, a significant fraction of the population has consistently avoided wearing masks.</div><div>This paper explores the factors involved in an individual's decision to wear a mask, looking also at the relationships among a wider range of actions recommended as part of the CDC's COVID- 19 public health strategy. Using national panel data collected beginning in March 2020, we analyze the interaction among self-reported measures of adherence to public health recommendations, individual perceptions of the effectiveness of mask wearing as a mitigation strategy, and indicators of individual attitudes toward political aspects of coronavirus mitigation. Results from a Qualitative Comparative Analysis (QCA) suggest that compliance with wearing a face mask is associated with other protective behaviors, such as avoiding public places (APUBLIC); believing that wearing a mask helps to keep oneself and others safe from coronavirus infection (MESAFE, OTHERSAFE); and not believing that mask wearing is a political statement and that individuals should not be forced to wear facemasks since the U.S. is a free country (POL, FREE).</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100564"},"PeriodicalIF":1.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living in the shadows: the persistence of secrecy in young people living with HIV on antiretroviral therapy, a qualitative study of the BREATHER Plus trial","authors":"Tamlyn Carmin Seunanden ,&nbsp;Nothando Ngwenya ,&nbsp;Stella Namukwaya ,&nbsp;Londiwe Shandu ,&nbsp;Moherndran Archary ,&nbsp;Cissy Kityo Mutuluuza ,&nbsp;Sarah Lilian Pett ,&nbsp;Adeodata Rukyalekere Kekitiinwa ,&nbsp;Sarah Bernays ,&nbsp;Janet Seeley","doi":"10.1016/j.ssmqr.2025.100560","DOIUrl":"10.1016/j.ssmqr.2025.100560","url":null,"abstract":"","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100560"},"PeriodicalIF":1.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When structure creates strain: Physician perspectives on work-home interference, professional relationships, and organizational resilience","authors":"Karen S. Schaepe ,&nbsp;Tait D. Shanafelt ,&nbsp;Liselotte N. Dyrbye ,&nbsp;Natasha Matt-Hensrud ,&nbsp;Colin P. West","doi":"10.1016/j.ssmqr.2025.100558","DOIUrl":"10.1016/j.ssmqr.2025.100558","url":null,"abstract":"<div><div>Despite widespread recognition of work-home interference (WHI) as a key driver of physician burnout, the day-to-day realities of how physicians navigate these challenges remain underexplored. This study examines how WHI shapes physicians’ professional and personal lives, with a particular focus on its impact on relationships and organizational resilience.</div><div>Through seven focus groups with 64 physicians across specialties and career stages at Mayo Clinic in Rochester, Minnesota, we identified key sources of WHI, including inflexible work schedules and the persistent mental burden of balancing multiple roles. Physicians described resorting to unsustainable coping strategies that, over time, became entrenched. They also expressed frustration with institutional efforts to mitigate WHI, which emphasized personal resilience and time management while overlooking deeper structural issues.</div><div>A critical finding from the study was the often-underappreciated role of professional relationships in buffering against WHI and sustaining both individual and organizational resilience. Physicians described how efficiency-driven interventions—such as workflow changes and increased productivity demands—unintentionally eroded collegial connections, leaving them feeling increasingly isolated and unsupported. This loss of professional community exacerbated the emotional toll of WHI and arguably weakens the adaptive capacity of most healthcare organizations.</div><div>These findings suggest that WHI and burnout cannot be addressed solely through individual-level interventions or efficiency measures. Instead, healthcare institutions must acknowledge the social dimensions of physician well-being and foster work environments that prioritize connection alongside productivity. By reassessing the trade-offs between efficiency and relational cohesion, organizations can better support physicians and promote a more sustainable, resilient workforce.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100558"},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dèyè mòn, gen mòn: Qualitative examination of drivers and facilitators of stigma as a barrier to sexual and maternal healthcare in Haiti","authors":"Jasmine Abrams ,&nbsp;Jaleah D. Rutledge ,&nbsp;Elizabeth Raskin ,&nbsp;Alexis Kiyanda ,&nbsp;Joanne Gaillard ,&nbsp;Morgan Maxwell ,&nbsp;Trace Kershaw","doi":"10.1016/j.ssmqr.2025.100556","DOIUrl":"10.1016/j.ssmqr.2025.100556","url":null,"abstract":"<div><div>Haitian women face heightened risk of contracting HIV and encounter challenges in accessing quality care due to sociocultural and economic barriers. Stigma compounds these challenges, especially for pregnant women living with HIV. Globally, HIV-related stigma is a recognized barrier to testing, treatment, and prevention, contributing to low testing rates and substandard treatment and care. This study examines sources and origins of stigma that impact pregnant women's access to and experience with sexual and maternal healthcare. Qualitative data was collected from 85 participants via focus groups with HIV-positive pregnant women (n = 26) and HIV-negative pregnant women (n = 35). We also conducted 24 interviews with maternal health care providers, HIV prevention specialists, and traditional healers. We used thematic analysis to identify key themes related to drivers and facilitators of stigma and its impact on access to healthcare among pregnant women in rural Haiti. Drivers of stigma were: 1) Lack of Knowledge, 2) Stereotypes, Prejudice, &amp; Blaming People Living with HIV (PLHIV), 3) Lack of Hospital Resources and Protocols. Facilitators of stigma were: 1) Underdeveloped Healthcare Infrastructure, 2) Classism, 3) Healthcare as a Commodity, 4) Hospital Policies and Practices, and 5) Patriarchal Society. Each of these facilitators uniquely influence HIV stigma experiences and practices. Our study identified complex multilevel drivers and facilitators of HIV and class related stigma and its impact on sexual and maternal healthcare access in Haiti, emphasizing the need for more comprehensive interventions that address psycho-socio-cultural determinants of health.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100556"},"PeriodicalIF":1.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicalizing aesthetics or beautifying illness? Exploring the absence of diagnosis and the centrality of patient autonomy in dermatology","authors":"Dana Alsaialy,&nbsp;Dino Numerato","doi":"10.1016/j.ssmqr.2025.100551","DOIUrl":"10.1016/j.ssmqr.2025.100551","url":null,"abstract":"<div><div>The <em>moment</em> of diagnosis is often regarded as a cornerstone of clinical practice and patienthood. It has mainly been viewed as preceding, and hence profoundly shaping, patients’ constructions of health and illness. However, amidst a rise in patient autonomy, the significance of a diagnosis as the starting point for care and patient identity is diminishing. This shift is particularly evident in dermatology due to its visual nature, the prevalence of alternative experts (e.g., cosmetologists, skincare gurus), and the intersection between its biomedical and cosmetic features. Against this backdrop, our study aims to reconsider the position of diagnosis in the dermatological context by raising the following questions: how is a dermatological condition socially constructed and therapeutically approached by patients, and what role does a diagnosis play? To address these questions, we thematically analyzed in-depth interviews with a heterogeneous sample of culturally diverse subjects diagnosed with seven distinct skin and hair conditions. Our findings reveal that the diagnostic <em>moment</em> is often absent in dermatological settings; instead, multiple agencies contribute to a dermatological diagnosis, with patients, rather than physicians, as the central agency. We situate our results within the broader context of increasing patient autonomy and lay expertise, noting that while the pursuit of “optimal” well-being is justified in the name of health, some skin and hair diseases are minimized, beautified, or embraced in the form of skin positivity.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"7 ","pages":"Article 100551"},"PeriodicalIF":1.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}