Qualitative Health Research

The provision of culturally competent health care is a priority for providers across the United States. However, for biomedicine, what does the provision of culturally sensitive, culturally competent care actually mean? To address this question, I use a case study of 30 years of practice at an urban free clinic founded to provide culturally sensitive health care. The model of culturally sensitive health care presented is compared to the U.S. Department of Health and Human Services standards for providing culturally and linguistically appropriate care (CLAS). I conclude that, for the most part, the urban free clinic founders and community participants through its history generated similar responses to CLAS in their effort to effectively serve Latino/Latina and Native American populations. However, the order in which the urban free clinic implemented cultural sensitivity measures seems to follow the theoretical concept of cultural lag, where material/nonmaterial culture transference differs in situations of culture contact and social change.

Twenty-one respondents in Havana, Cuba, were interviewed for the purpose of understanding the challenges facing the Cuban health care system since the 1990s and the individual solutions that have been proposed to these challenges. Three major shortages were identified: a lack of medication, a lack of medical supplies, and a lack of medical professionals. Consequently, informal coping mechanisms, such as the black market and using personal connections, were a common way of overcoming the difficulties associated with these shortages. Beyond this, however, Cuban health care has experienced a unique fusion of medical traditions, such that now biomedicine and complementary and alternative medicine not only coexist in Cuban society but actively collude together to respond to the increasing demands for health services in light of waning supplies of medication and medical supplies. As a result, Cuba has managed to survive its most difficult health crisis since the beginning of the Revolution.

The author examines how, as part of a reform of Wisconsin's public mental health system, a workgroup of system stakeholders defined and operationalized the concept of recovery. Based on participant observation, document analysis, and interviews, with an analytic framework drawn from symbolic interactionism, the author finds that although individual members held a range of definitions of recovery, the workgroup was able to reach consensus in its policy recommendations through processual means and by tacitly agreeing on a set of overarching values that were flexible enough to accommodate many definitions.

The researchers collected a data set of consumer-directed print advertisements for antidepressant medications from three female-directed magazines, three male-directed magazines, and four common readership magazines published between 1997 and 2003. They evaluated these data for advertising techniques that enable drug advertisements to function as agents of medicalization. The investigators discuss the use of incomplete syllogisms in drug advertisements and identify strategies that might lead readers to frame personal physical and/or emotional conditions medically. Key features in advertisements function as the particular and general premises of a syllogism, and the concluding premise--that the reader has a mood disorder--is unarticulated but implied. The researchers examine the implications of incomplete syllogisms in advertisements and suggest that their use might lead readers to redefine their physical and/or emotional problems to fit medical models of mental distress.

The Web 2.0 digital environment is revolutionizing how users communicate and relate to each other, and how information is shared, created, and recreated within user communities. The social media technologies in the Web 2.0 digital ecosystem are fundamentally changing the opportunities and dangers in disseminating qualitative health research. The social changes influenced by digital innovations shift dissemination from passive consumption to user-centered, apomediated cooperative approaches, the features of which are underutilized by many qualitative researchers. We identify opportunities new digital media presents for knowledge dissemination activities including access to wider audiences with few gatekeeper constraints, new perspectives, and symbiotic relationships between researchers and users. We also address some of the challenges in embracing these technologies including lack of control, potential for unethical co-optation of work, and cyberbullying. Finally, we offer solutions to enhance research dissemination in sustainable, ethical, and effective strategies. © The Author(s) 2015.

To understand complex human phenomena, it is necessary to triangulate the results of multiple separate projects that use diverse methods. Using the example of suffering, a research program emerging from studies exploring comfort was initiated. A model of enduring and emotional suffering (or releasing) was developed, and, using this model as a scaffold, eight subsequent projects explored the interaction of enduring and emotional suffering in various contexts and with different populations. Although there remains much to learn, the researcher argues that using this programmatic approach to explore new areas is an efficient and effective way to gain understanding of complex human phenomena.

Implementations of patient centeredness can vary tremendously across settings, yet we know little about how clinicians experience local interpretations of patient centeredness. In this article, we investigate nurses' experiences in a hospital designed to be patient centered in its emphasis on patient amenities and customer service. This environment altered nurses' articulation work by shifting the visibility of a number of nursing tasks; customer service tasks became more visible whereas many medical and caring tasks were obscured. We found that these changes in nursing work challenged nurses' professional roles, and the informants reported that the changes disrupted their relationships with patients and with one another. This implementation of patient centeredness resulted in a view of nursing that conflicted with many nurses' implicit and explicit understanding of their work. Our findings suggest that the adoption of some versions of patient centeredness might obscure substantial and substantive nursing work and might undermine nurses' concepts of caregiving.

Psoriasis is one of the most common chronic skin diseases. The author presented results from a qualitative study focusing on patients with severe psoriasis in an acute phase and their experience of living with the disease. Twenty-two hospitalized patients with psoriasis were interviewed in depth. The interviews were consecutively analyzed according to grounded theory methodology. Bodily suffering emerged as a core variable in the data. Bodily suffering includes the following categories: the visible body, staying on an even keel, coping with an all-consuming disease, and social vulnerability. The results of this study indicate that the criterion for the management of soriasis should be the patients' own perception of the consequences of the disease.

Of 50 women seeking an abortion in Rochester, New York, between November 1999 and January 2001, 35 went on to complete an in-depth interview from 1 to 6 weeks after their follow-up clinical visit. A higher proportion of women who defined their pregnancy as a baby indicated emotional distress during their in-depth interview compared to those who saw their pregnancy as only having the potential to become a baby. The authors conclude that abortion might be made less difficult through public education about the different views of pregnancy and abortion throughout U.S. history. It might be important for abortion counselors to first ask a woman how she defines her pregnancy. A larger study is warranted.

In a recent editorial, Morse warned against qualitative health researchers turning their backs on fundamental concepts such as validity and called on them to think, reconsider, and undo. With a view to stimulating further dialogue, in this article the author explores where this thinking, reconsidering, and undoing might take us in relation to the concept of validity. Four perspectives on this issue are presented for discussion: the replication, parallel, diversification, and letting-go perspectives. Each is seen as worthy of consideration in its own right, and it is suggested that coexistence of the perspectives is possible despite their differences. The implications of various forms of coexistence are discussed in relation to the problem of criteria. It is recommended that qualitative health researchers learn to judge a variety of approaches in different but appropriate ways.

Management of early tuberculosis (TB) symptoms and adherence to medical treatment are main challenges in controlling TB. The aim of this study is to explore how symptoms of TB are perceived and managed, from the onset of symptoms and during the course of treatment, in Addis Ababa, Ethiopia. We conducted a qualitative interview study, including 50 in-depth interviews and 2 focus groups, with TB patients, their relatives, and health personnel. We found that a patient's perceptions and self-treatment of early symptoms could cause diagnostic delay. Stigma associated with TB and public health services made many patients approach private clinics, causing further delay. Both private and public clinics often labeled and managed symptoms according to lay explanatory models. Lack of adequate knowledge about TB's etiology and cure caused patients to continue relating to symptoms by reference to their own understanding. This affected patients' ability to manage TB and its treatment.

The aim of this study was to explore the pre- and postsurgical journey to correct severe abdominal lipodystrophy of a woman living as AIDS defined for over 23 years. It utilized interpretative phenomenological analysis (IPA) and a single-case-study approach to capture the subjective understanding and sense-making of this surgical process. Verbatim transcripts of seven semi-structured interviews, three participant-created word boards of words or phrases clipped from magazines, field notes, and a reflexive journal were collected as data. Analysis revealed two superordinate themes: the unknown and the unanticipated. These themes simultaneously manifest with shared and nuanced meanings, including the unknown and unanticipated of surviving AIDS and discovering lipodystrophy, the unknown and the unanticipated of the surgical intervention itself, and finally the unknown and the unanticipated of postsurgical complications and experiences within outpatient and inpatient medical settings. © The Author(s) 2015.

The purpose of this article is to explore the effects of radiofrequency ablation (RFA), an investigational treatment for breast cancer, on the quality of life of elderly women. For this descriptive phenomenological study, the authors interviewed 12 White women (aged 60-81 years) 4 months to 1 year after treatment and analyzed these interviews for common themes. They asked questions regarding the lived experience of RFA treatment and its effects on quality of life. Analyses focused on the effects of deciding to have the RFA treatment and the treatment itself. They found quality of life improved because the women felt empowered by (a) their decision to have the procedure, (b) knowing that the procedure might kill the tumor, (c) and feeling that they were contributing to cancer research. The level of support received from the medical team, family and friends, and other cancer survivors also improved participant quality of life.

Using grounded theory, a multidisciplinary study team compared the narratives of 30 women who had recently experienced a breast cancer scare. Even though 10 women received a benign diagnosis, all women reported a difficult time prediagnosis, characterized by an array of emotions and contemplation of the meaning of life. Diagnosis separated the two groups with emotional relief dominant for the benign group and intensification of emotions for the cancer group. For those diagnosed with cancer, three factors contributed to arriving at a point of acceptance about the diagnosis and treatment: (a) sustained coping mechanisms; (b) a belief system that shifted the meaning of the cancer experience; and (c) the ability to manage non-cancer-related stressful events. Implications include the need for tailored biopsychosocial treatments that focus on reducing stress, enhancing support systems, reframing beliefs about the illness, and providing the opportunity for the women to talk about their experiences.

Pregnancy termination for fetal abnormality (TFA) can have significant psychological consequences. Most previous research has been focused on measuring the psychological outcomes of TFA, and little is known about the coping strategies involved. In this article, we report on women's coping strategies used during and after the procedure. Our account is based on experiences of 27 women who completed an online survey. We analyzed the data using interpretative phenomenological analysis. Coping comprised four structures, consistent across time points: support, acceptance, avoidance, and meaning attribution. Women mostly used adaptive coping strategies but reported inadequacies in aftercare, which challenged their resources. The study's findings indicate the need to provide sensitive, nondirective care rooted in the acknowledgment of the unique nature of TFA. Enabling women to reciprocate for emotional support, promoting adaptive coping strategies, highlighting the potential value of spending time with the baby, and providing long-term support (including during subsequent pregnancies) might promote psychological adjustment to TFA.

We explored with Aboriginal adults living in a remote Australian community the social context of food choice and factors perceived to shape food choice. An ethnographic approach of prolonged community engagement over 3 years was augmented by interviews. Our findings revealed that knowledge, health, and resources supporting food choice were considered "out of balance," and this imbalance was seen to manifest in a Western-imposed diet lacking variety and overrelying on familiar staples. Participants felt ill-equipped to emulate the traditional pattern of knowledge transfer through passing food-related wisdom to younger generations. The traditional food system was considered key to providing the framework for learning about the contemporary food environment. Practitioners seeking to improve diet and health outcomes for this population should attend to past and present contexts of food in nutrition education, support the educative role of caregivers, address the high cost of food, and support access to traditional foods.

In this study, we attempted to explore the experiences and beliefs of Aboriginal families as they cared for their children in the first year of life. We collected family stories concerning child rearing, development, behavior, health, and well-being between each infant's birth and first birthday. We found significant differences in parenting behaviors and child-rearing practices between Aboriginal groups and mainstream Australians. Aboriginal parents perceived their children to be autonomous individuals with responsibilities toward a large family group. The children were active agents in determining their own needs, highly prized, and included in all aspects of community life. Concurrent with poverty, neocolonialism, and medical hegemony, child-led parenting styles hamper the effectiveness of health services. Hence, until the planners of Australia's health systems better understand Aboriginal knowledge systems and incorporate them into their planning, we can continue to expect the failure of government and health services among Aboriginal communities.

Concerns related to the body are associated with health-compromising behaviors, and although research has indicated that young Aboriginal women are dissatisfied with their bodies, their voices have typically been absent from the literature. The purpose of this case study was to provide insight into the body-related emotional experiences of young, Canadian, urban Aboriginal women. Four young women participated; 3 identified themselves as Aboriginal (one 14-year-old, two 18-year-olds) and 1 as non-Aboriginal (18 years old). Multiple methods (focus group, one-on-one interviews, and artwork) provided the authors the opportunity to listen to the young women's stories. Five themes emerged: (a) conflicting cultures, (b) need to belong, (c) the beauty of difference, (d) journey to acceptance of the body, and (e) the body affects everything. This research highlights the complexity of young Aboriginal women's body-related emotional experiences and indicates that their experiences might not be as negative as previous research has led us to believe.

In this article, we consider how the broad context of Aboriginal people's lives can shape their experience and understanding of their HIV diagnosis. We conducted interviews across Canada with 72 Aboriginal people living with HIV who also reported feelings of depression. Consistent with what has been found in previous studies, participants responded to their HIV diagnosis with shock, disbelief, and often anger. Prior depression, drug and alcohol use, multiple losses, stigma, and social isolation also shaped how participants experienced their diagnosis. We consider how the history of colonization of Aboriginal communities in Canada relates to the experience of HIV diagnosis, and end with a discussion of the service implications of our findings.

Researchers working with Aboriginal Australian partners are confronted with an array of historical, social, and political complexities which make it difficult to come to theoretical and methodological decisions. In this article, we describe a culturally safe and respectful framework that maintains the intellectual and theoretical rigor expected of academic research. As an Aboriginal woman and two non-Aboriginal women, we discuss the arguments and some of the challenges of using grounded theory methods in Aboriginal Australian contexts, giving examples from our studies of Aboriginal empowerment processes. We argue that the ethics of care and responsibility embedded in Aboriginal research methodologies fit well with grounded theory studies of Aboriginal social processes. We maintain that theory development grounded in data provides useful insights into the processes for raising the health, well-being, and prosperity of Aboriginal Australians.

Many Aboriginal communities call heart problems, and in particular cardiovascular disease, "White man's sickness." At the same time, Aboriginal women present with some of the highest rates of this disease. Against this backdrop, we explored how women with cardiac problems understand their heart health and used narrative-discursive methods to analyze interviews conducted with women from two First Nations in North America. The women told stories that were riddled with contradictions, unfolding a complicated personal and cultural reality of living with cardiovascular disease. In many stories, heart disease was described as resulting from a "community imbalance" in the wake of colonialism whereby the women had to take over the traditional roles of men. Their ideas of heart disease risk and healing flowed from this understanding. They derived a sense of strength, however, from their ability to undertake both gender roles. Based on our findings, we provide some recommendations for cardiac care.

Tuberculosis (TB) continues to be a serious health issue for some Aboriginal populations in Canada. In this article we build on two previous studies partnered with an Aboriginal community organization to examine TB in Montreal, Quebec. The current study draws on qualitative interviews with Aboriginal participants who had either themselves contracted TB or knew someone who had the disease. Thematic analysis revealed a high level of experiential knowledge among participants, although gaps in biomedical knowledge about the disease and available resources were apparent even among those who had been ill. Negative memories and experiences relating to the colonial history of TB treatment emerged as significant for many participants, helping to explain a silence around the topic of TB in the community. Barriers to TB testing were identified, including the fear of positive test results, the burden of long-term treatment for either latent or active disease, and systemic barriers within and mistrust of the health system. Community support for, as well as negative reactions toward, individuals ill with TB were identified. We conclude with a number of community health lessons to address the treatment and prevention of TB in urban populations.