Christine Holmberg

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (31)49 Total impact

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    ABSTRACT: Spiritual healers in contemporary Germany comprise a heterogeneous and growing group, yet little data exists about them. Therefore, one aim of this study was to learn about which biographical aspects and events were important to the process of becoming a healer and which biographical aspects drove clients to consult a healer. The study was based on semi-structured interviews combined with participant observations. All data were recorded digitally, transcribed, entered into the software program MAXQDA and analysed subjected to Content Analysis. In total, 15 healers (nine male, six female) and 16 clients (13 female, three male) were included. According to the healers, a talent for healing can be inborn, inherited or developed through life experiences. Most of the healers experienced a crisis, which prompted their transformation to healers (the wounded healer type). A smaller group became healers mainly out of interest without going through crisis and by focusing on the spiritual attitude itself (the healer by interest type). The basis of healing is seen as a connection to a transcendent reality, which enables an open, loving and empathetic attitude. The experience of crises and illnesses and the importance of spirituality are major biographical similarities between healers and clients. Near-death experiences as an extreme form of crisis were reported from a few healers and clients. The connections between healing talents and crises, including a deepened exploration of near-death experiences and questions regarding inclining towards spirituality could be of interest in further studies.
    Anthropology & Medicine 06/2015; DOI:10.1080/13648470.2015.1050578
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    ABSTRACT: Background. The aim of this study was to investigate the nature of the relationships between healers and their clients in Germany. Methods. An interdisciplinary research team performed semistructured interviews with healers and clients and participatory observation of healing sessions. All interviews were digitally recorded, transcribed, and analyzed using content analysis. Results. Fifteen healers and sixteen clients were included. The healer-client relationship was described as a profound and unique experience, which brought forth interpersonal and spiritual connections. The healers were seen as role models for healing to occur and support for being connected spiritually. The clients had to be open-minded and responsible. The importance of the healers' empathy was emphasized. Discussion. The relationship between healer and client can be seen as a triangular connection between client, healer, and a transcendent source which is not the case in typical patient-doctor relationships. The spiritual connection is also said to enhance the empathetic understanding of the healer. The personality and a partner-like attitude of the healer supported the client in giving a more positive meaning to his life, in reconnecting to his spirituality, and in taking responsibility. Future studies should address the role of spirituality in health care and the development of enduring healer-client relationships.
    Evidence-based Complementary and Alternative Medicine 06/2015; Article ID 145154:8 pages. DOI:10.1155/2015/145154 · 1.88 Impact Factor
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    ABSTRACT: On 28–29 April 2014, the Qualitative Research Group on Cancer, based at the Berlin School of Public Health, Charité – Universitätsmedizin, in Berlin, Germany, hosted a two-day conference to review current perspectives in qualitative cancer research.[note 1] Such research has become a major focus of qualitative health research in recent decades, both challenging and supplementing studies grounded in the epistemology of biomedical sciences. Qualitative cancer research is committed to investigating various actors’ perspectives on and the implications of contexts, (power) relations, and processes related to a cancer diagnosis, and cancer prevention, treatment, and the experience thereof. The conference provided a rare opportunity to bring together a diverse group of researchers and clinicians engaging in qualitative cancer research from twelve countries, various career stages, and multiple disciplines, including biomedicine, social sciences, and public health. The conference included fifteen individual presentations grouped into five thematic sessions (see the list of presentations at the end of this report). http://www.medanthrotheory.org/read/4798/qualitative-cancer
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    ABSTRACT: An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of merger. In a merger, two or more organizations - usually companies - are combined into one in order to strengthen the companies financially and strategically. The corporate culture of both merger partners has an important influence on the integration. The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems. A two-step approach (literature analyses and expert consensus procedure) was used to develop practical guidance for the development of a cultural basis for integrative medicine, based on the framework of corporate culture in "mergers," which could be used to build an integrative medicine department or integrative medicine service. Results include recommendations for general strategic dimensions (definition of the medical model, motivation for integration, clarification of the available resources, development of the integration team, and development of a communication strategy), and recommendations to overcome cultural differences (the clinic environment, the professional language, the professional image, and the implementation of evidence-based medicine). The framework of mergers in corporate culture provides an understanding of the difficulties involved in integrative medicine projects. The specific recommendations provide a good basis for more efficient implementation.
    Patient Preference and Adherence 01/2015; 9:113-20. DOI:10.2147/PPA.S66778 · 1.49 Impact Factor
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    ABSTRACT: Purpose: Patients who need to make a major medical decision are often expected to understand and use probabilistic information well enough to be capable of evaluating a complex set of tradeoffs between the treatment’s risks and benefits. Much effort has been invested in creating materials to improve decision making in such situations, but patients vary in the extent to which they use probabilistic information even when it is provided to them in a way that is comprehensible. This study explored decision making, including the use of probabilities, from the perspective of women who were invited to participate in the Study of Tamoxifen and Raloxifene (STAR). Methods: We conducted in-depth one-on-one narrative interviews with 20 women who agreed to participate in STAR and 20 women who declined. The interviewer began with a single open-ended question (“You have done a statistical risk assessment. Can you tell me about that?”) and allowed interviewees to direct the conversation with minimal interviewer interference. Data were analyzed using an iterative process that included developing summaries of each interview, coding the transcripts, identifying themes, and ensuring validity by presenting and discussing the study in a qualitative research group. Results: Interviewees explained their decisions using a framework of lived experiences. They did not indicate that they used probabilistic information to weigh the risks and benefits of treatment. Rather, their decisions were embedded within experiences encountered throughout their lives. Such lived experiences included, but were not limited to, their family history of breast cancer, their personal history of breast biopsies, and their experiences and assumptions about the potential consequences of taking tamoxifen. Interviewees also discussed their decisions in the context of the challenges of using population-derived data, such as that used to calculate risk estimates, for making decisions and predicting health outcomes for individuals. Conclusions: Women’s explanations of their decisions about participating in a breast cancer chemoprevention trial were more complex than decision strategies that rely solely on a quantitative risk-benefit analysis of probabilities derived from populations. Recognizing that lay decision-making strategies may be reasonable may facilitate patient-provider communication about this challenging topic.
    The 36th Annual Meeting of the Society for Medical Decision Making; 10/2014
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    ABSTRACT: In Germany, many prostate cancer patients use complementary medicine (CM) or have an interest in these treatment approaches; however, the information and consultation situation of cancer patients is insufficient and therefore the Competence Network Complementary Medicine in Oncology (COCON) was launched by the German Cancer Aid Society. One of the projects of the COCON examines the use of CM and the information and counseling needs regarding these topics in various groups of cancer patients. The focus of this article is on the qualitative study reporting selected results for the subgroup of prostate cancer patients.
    Der Urologe 10/2014; 53(11). DOI:10.1007/s00120-014-3613-2 · 0.44 Impact Factor
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    ABSTRACT: Background Utilisation of multidisciplinary teams is considered the best approach to care and treatment for cancer patients. However, the multidisciplinary approach has mainly focused on inpatient care rather than routine outpatient care. The situation in private practice care and outpatient care is gradually changing. We aimed to 1), investigate interdisciplinary cooperations in the care of tumor patients among urologists and oncologists in the community setting, 2), establish an estimate of the prevalence of cooperation among oncologists and organ-specific providers in community settings in Germany and 3), characterise existing cooperations among oncologists and urologists. Methods We conducted simultaneously a cross-sectional survey with private practice urologists (n = 1,925) and a qualitative study consisting of semi-structured interviews with urologists and oncologists (n = 42), primarily with private practices, who had indicated cooperation the care of urological tumor patients. Results Most of the participants (66%) treated their own tumor patients. When physicians referred patients, they did so for co- and subsequent treatments (43%). Most cooperating urologists were satisfied with the partnership and appreciated the competency of their partners. Qualitative interviews revealed two types of collaboration in the community setting: formal and informal. Collaborations were usually ongoing with many physicians and depended equally on both patient preference and diagnosis. Conclusion Joint patient treatment requires clear delineation of roles and responsibilities and simple means of communication. Formal frameworks should allow for incorporation of patients’ critical role in collaboration decisions in treatment and care.
    BMC Cancer 10/2014; 14(1):746. DOI:10.1186/1471-2407-14-746 · 3.32 Impact Factor
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    ABSTRACT: Ovarian cancer is a malignant entity typically diagnosed in advanced stages, with concomitant poor prognosis. Delayed healthcare seeking is commonly explained by the ‘vague’ character of the disease's symptoms combined with a lack of awareness among patients. However, research on the social contexts of ovarian cancer patients' pre-diagnostic illness experiences and healthcare seeking is scarce. To explore these topics, we initiated a qualitative interview study guided by the principles of grounded theory and based on interviews with 42 ovarian cancer patients. The study was conducted in Germany from September 2011 to February 2013. Our analysis illustrates how, in the narratives, the interviewees struggled to balance specific bodily sensations with aspects of their life-worlds prior to consulting a biomedical professional. We propose a three-phase model to capture these experiences and demonstrate how the developments of pre-diagnostic sensations were catalysed by the dynamic and complex interplay of the sensations with a variety of individual and socio-cultural factors. To conceptualize these interplays, we introduce the analytical notion of a triggering process, and we elaborate on the different ways in which such a process conditioned the transformation of a sensation into a symptom and decisions to seek healthcare. We finally discuss our findings both in relation to current research on sensations, symptoms and healthcare seeking and in their relevance for understanding diagnostic delays in ovarian cancer.
    Social Science & Medicine 10/2014; 119:123–130. DOI:10.1016/j.socscimed.2014.08.022 · 2.56 Impact Factor
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    ABSTRACT: This paper aims to understand the influence of welfare institutions on illness experiences, particularly health insurance and income compensation policies, by comparing narrative interviews with breast- and prostate cancer patients in Germany (n=90 for both cancers) and Japan (n=97 for both cancers). Both countries have a comprehensive social security system. Using the data collected for the project Database of Individual Patient Experiences (DIPEx), two levels of comparison will be sought: 1) country, and 2) disease type, resulting in four analytic groups. Due to language constraints, cross-national comparisons will be based on the analysis within each country is complete with regards to the study question: How do health insurance systems and income compensation policies such as sick leave and disability benefits affect the experience of having cancer? Preliminary findings show that in both countries breast cancer patients who are generally younger and thus still in the workforce tend to express financial concerns more than prostate cancer patients. However, the impact of financial pressure is more apparent in Japan where out-of-pocket copayments are higher and the terms for sick leave are less favorable to employees, affecting patients’ treatment decisions and the timing of return to work. For German patients who are eligible for early retirement and disability benefits, the diagnosis in many cases does not present financial disaster. However, receiving disability benefits led to stigmatization through the bureaucratic mechanism in place. Subsequently women discussed feelings of shame and worthlessness induced by bureaucratic mechanisms. The present study will be one of the first studies in which international comparisons on qualitative interview materials that have been collected in different languages and by different interviewers are analyzed within the same research framework. Thus the paper presents important findings on production of inequality in high-income countries, and provides a new methodology for cross-cultural secondary analysis.
    XVIII ISA World Congress of Sociology; 07/2014
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    ABSTRACT: Limited research has been conducted on contemporary spiritual healing in European countries. The aim of this article is to report how German healers and their clients experienced and perceived the outcomes of spiritual healing and which explanations they use to describe the perceived effects.
    BMC Complementary and Alternative Medicine 07/2014; 14(1):240. DOI:10.1186/1472-6882-14-240 · 1.88 Impact Factor
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    ABSTRACT: Background Policy efforts focus on a reorientation of health care systems towards primary prevention. To guide such efforts, we analyzed the role of primary prevention in general practice and general practitioners’ (GPs) attitudes toward primary prevention. Methods Mixed-method study including a cross-sectional survey of all community-based GPs and focus groups in a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs 474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention. Results Most respondents considered primary prevention within their realm of responsibility (70%). Primary prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs’ health care recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18% claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant to take on the role of “health policing”. GPs saw primary prevention as the responsibility of multiple actors in a network of societal and municipal institutions. Conclusions The mixed-method study showed that primary prevention approaches such as lifestyle counseling is not well established in primary care. GPs used a selective approach to offer preventive advice based upon indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral approach to population health. This type of restructuring of the health care sector may benefit patients who are unable to afford specific prevention programmes and who have competing demands that hinder their ability to focus on behavior change.
    BMC Family Practice 05/2014; 15(1):103. DOI:10.1186/1471-2296-15-103 · 1.74 Impact Factor
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    ABSTRACT: Chronic pain is prevalent in elderly populations. The goals of this study were 1) to understand the results of a randomized clinical trial - Qigong and Exercise Therapy for Elderly Patients with Chronic Neck Pain (QIBANE) - that showed no difference between qigong, exercise therapy, and no-treatment on quality of life, and 2) to understand how elderly individuals with chronic pain experience interventions of qigong and exercise therapy. A qualitative interview study was conducted with 20 QIBANE participants. Interviews asked about motivation for and expectations of trial participation, experiences with the exercise classes (qigong or exercise therapy), and changes in pain experience. Interviews were transcribed, entered into the software program ATLAS.ti, and coded thematically by two coders. Content analysis was performed. All interviewees reflected positively on their QIBANE experience and described their participation in QIBANE as helpful. However, what was discussed in both groups when they talked about "positive experiences" in the study differed between the two groups. For example, themes that emerged in the exercise-therapy group related to difficulties associated with aging and staying physically active. In the interviews with qigong group members, emergent themes related to qigong as a method that improved bodily experiences and influenced daily activities. The effects that exercise therapy and qigong have on an elderly population cannot be captured by health-related quality-of-life measurements, such as the Short Form (36) Health Survey. Broader concepts of quality of life that include the concepts of self-efficacy and positive affect may be more appropriate. The results presented in this study suggest that for this population group, the approach of patient-centered outcomes is especially pertinent in order to design meaningful intervention studies in the elderly. This means that research questions, interventions, and outcome measurements need to take into account the special situation of elderly people.
    Clinical Interventions in Aging 03/2014; 9:403-10. DOI:10.2147/CIA.S54249 · 1.82 Impact Factor
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    ABSTRACT: To improve clinical study developments for elderly populations, we aim to understand how they transfer their experiences into validated, standardised self-completed study measurement instruments. We analysed how women (mean 78±8 years of age) participating in a randomised controlled trial (RCT) cognised study instruments used to evaluate outcomes of the intervention. The interview study was nested in an RCT on chronic neck pain using common measurement instruments situated in an elderly community in Berlin, Germany, which comprised of units for independent and assisted-living options. The sample (n=20 women) was selected from the RCT sample (n=117, 95% women, mean age 76 (SD±8) years). Interview participants were selected using a purposive sampling list based on the RCT outcomes. We asked participants about their experiences completing the RCT questionnaires. Interviews were analysed thematically, then compared with the questionnaires. Interviewees had difficulties in translating complex experiences into a single value on a scale and understanding the relationship of the questionnaires to study aims. Interviewees considered important for the trial that their actual experiences were understood by trial organisers. This information was not transferrable by means of the questionnaires. To rectify these difficulties, interviewees used strategies such as adding notes, adding response categories or skipping an item. Elderly interview participants understood the importance of completing questionnaires for trial success. This led to strategies of completing the questionnaires that resulted in 'missing' or ambiguous data. To improve data collection in elderly populations, educational materials addressing the differential logics should be developed and tested. Pilot testing validated instruments using cognitive interviews may be particularly important in such populations. Finally, when the target of an intervention is a subjective experience, it seems important to create a method by which participants can convey their personal experiences. These could be nested qualitative studies. ISRCTN77108101807.
    BMJ Open 03/2014; 4(3):e004363. DOI:10.1136/bmjopen-2013-004363 · 2.06 Impact Factor
  • Christine Holmberg
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    ABSTRACT: BACKGROUND:: Breast cancer patients experience profound life changes that include feelings of fear years after concluding treatment. OBJECTIVE:: The aim of this article was to understand the nature and origin of the persistent worry women experience after breast cancer treatment. METHODS:: Materials from participant observation of an oncology ward and from interviews with 17 first-time breast cancer patients, 4 oncologists, and 10 nurses were analyzed. Interpretation of materials was guided by theoretical concepts such as embodiment and liminality to understand the phenomenological aspects and cultural shaping of the illness experience. RESULTS:: Interviewees felt healthy at the time of diagnosis. It was the physician's word that initiated the illness process through the experience of shock. Nurses' work and therapeutic emplotment were instrumental in guiding the women to overcome the shock and engage in treatment. Study participants' lives were restructured under biomedical conditions. This included mistrust toward their bodies. Because of the mode of diagnosis and the initial shock, long-term fear can be seen as an integral part of the experience of having had breast cancer. CONCLUSIONS:: The study participants' sense of being in the world had changed in that their bodies had become objects unto themselves, dangerous objects. Fear became part of women's lives. To control the fear, women relied on biomedical practices to interpret bodily sensations. IMPLICATIONS FOR PRACTICE:: Therapeutic interventions and practices of care that facilitate a reconnection of trust with the (physical) body should be included in the care of posttreatment patients.
    Cancer nursing 02/2013; 37(3). DOI:10.1097/NCC.0b013e318281395e · 1.93 Impact Factor
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    Christine Holmberg, Benno Brinkhaus, Claudia Witt
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    ABSTRACT: Background Integrative medicine (IM) is currently the most commonly used term to describe the integration of complementary and alternative medicine (CAM) into conventional medicine. In the definitions of IM the most important feature is the focus on evidence as crucial factor for therapeutic decision-making. However, there are discussions on the term “integrative medicine” with the most notable critique from within CAM that it describes the integration of complementary methods into conventional institutions and into a “conventional framework of thinking”. The aim of this qualitative study was to understand the thoughts of leading experts on IM and on the scientific debate in the field as well as their personal opinions about terminology in general. Methods We have conducted semi-standardized interviews with ten leading experts in the field of CAM and integrative medicine in the USA, England, and Germany, who have had leading positions at medical schools or the NIH in 2010 and 2011. Interviews were recorded, transcribed and analyzed using content analysis with the qualitative analysis software maxqda. Results Overall the current terminology was seen as a problem, although most experts agreed that the term “integrative medicine” (IM) described well what they do or they think is useful for medical care. The terminology debate was discussed from four perspectives: 1) from the perspective of medical practice, 2) from the perspective of research, 3) from the perspective of public relations, and 4) from the perspective of health care delivery. These perspectives may be used to evaluate the appropriateness of different terms in use in the field. When interviewees discussed the terminology question, they also discussed the type of health care system they envisioned. Such reflections led the interviewees to caution about too narrow a focus on the terminology question. The question of naming was one about influencing and changing medicine. Conclusion The discussion of the experts demonstrated that the discussion about terminology is an important debate about the shaping of medicine. The experts discussed terminology in the light of "how health care systems" should look like in the future.
    BMC Complementary and Alternative Medicine 11/2012; 12(1):218. DOI:10.1186/1472-6882-12-218 · 1.88 Impact Factor
  • 12. Deutscher Kongress für Versorgungsforschung, Berlin; 10/2012
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    Claudia M Witt, Christine Holmberg
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    ABSTRACT: In Western countries, complementary and alternative medicine (CAM) is more and more provided by practitioners and family doctors. To base this reality of health care provision on an evidence-base, academic medicine needs to be included in the development. In the study we aimed to gain information on a structured approach to include CAM in academic health centers. We conducted a semistructured interview study with leading experts of integrative medicine to analyze strategies of existing academic institutions of integrative medicine. The study sample consisted of a purposive sample of ten leaders that have successfully integrated CAM into medical schools in the USA, Great Britain, and Germany and the Director of the National Center for Alternative and Complementary Medicine. Analysis was based on content analysis. The prerequisite to foster change in academic medicine was a strong educational and professional background in academic medicine and research methodologies. With such a skill set, the interviewees identified a series of strategies to align themselves with colleagues from conventional medicine, such as creating common goals, networking, and establishing well-functioning research teams. In addition, there must be a vision of what should be needed to be at the center of all efforts in order to implement successful change.
    Evidence-based Complementary and Alternative Medicine 10/2012; 2012:652546. DOI:10.1155/2012/652546 · 1.88 Impact Factor
  • DMW - Deutsche Medizinische Wochenschrift 09/2012; 137(S 03). DOI:10.1055/s-0032-1323183 · 0.55 Impact Factor
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    ABSTRACT: In this first part of a 3-part discussion paper the working group "Qualitative Methods" in the German Network of Health Services Research (DNVF) identifies the potentials and opportunities qualitative research methods provide for health services research. Many research questions relevant for health services research require the use of qualitative methods. However, the potential of and need for qualitative research in health services research has not yet received sufficient attention from funding bodies. We discuss the applicability and importance of qualitative research for the field of health services research. We then move on to describe the key characteristics of qualitative research that need to be taken into account in health services research. We discuss characteristics such as open-ended (qualitative) data, interpretation of meanings, the search for contradictions, closeness to everyday life, openness towards change or modification of the research question and processes in the context of health services research. To ensure a high-quality approach in qualitative methods for the health services research, sufficient competency in methods and appropriate settings that account for the peculiarities of qualitative methods need to be developed. These include an appropriate time frame and sufficient and qualified personnel to conduct qualitative research. Qualitative research is not a research paradigm in itself rather it comprises of many different and diverging approaches. The goal of this paper is to show the diversity of qualitative research methods, its importance for health services research, and to open up the discussion on strategies for integrating qualitative methods into health services research.
    Das Gesundheitswesen 08/2012; 74(8-9):510-5. DOI:10.1055/s-0032-1323693 · 0.62 Impact Factor
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    ABSTRACT: This is the second part of a 3-part discussion paper by the working group on "Qual-it-ative Methods" in the German network of health services research (DNVF) that shall contribute to the development of a memorandum concerning qualitative health services research. It aims to -depict the different types of qualitative research that are conducted in health services research in Germany. In addition, the authors pres-ent a speci-fic set of qualitative data collection and analysis tools to demonstrate the potential of qualitative research for health services research.To give an overview of the types of qualitative research conducted in German health services research, the abstracts of the 8th German Conference on Health Services Research were filtered to identify qualitative or mixed-methods studies. These were then analysed by looking at the context which was -studied, who was studied, the aims of the stud-ies, and what type of methods were used. Those methods that were mentioned most often for data collection and analysis are described in -detail.Approximately a fifth of all abstracts (n=74) had a qualitative (n=47) or a mixed-methods approach combining quantitative and qualitative methods (n=27). Research aims included needs assessment (41%), survey development (36%), evaluation (22%), and theorizing (1%). Data collection mostly consisted of one-on-one interviews (n=45) and group discussions (n=29). Qualitative content analysis was named in 35 abstracts, 30 abstracts did not reference their method of analysis. In -addition to a quantitative summary of the ab-stract findings, the diversity of fields addressed by quali-tative methods is highlighted.Although drawing conclusions on the use of qualitative methods in German health services research from the analysis of conference abstracts is not possible, the overview we present demonstrates the diversity of methods used for data collection and analysis and showed that a few select methods are extensively used. One of the tasks a memorandum of qualitative health services research should accomplish is to highlight underutilized research methods, which may help to develop the potential of qualitative methodology in German health services research.
    Das Gesundheitswesen 08/2012; 74(8-9):516-25. DOI:10.1055/s-0032-1323694 · 0.62 Impact Factor

Publication Stats

55 Citations
49.00 Total Impact Points

Institutions

  • 2011–2015
    • Charité Universitätsmedizin Berlin
      • Institute for Social Medicine, Epidemiology and Health Economics
      Berlín, Berlin, Germany