Qualitative Health Research

Published by SAGE Publications
Online ISSN: 1049-7323
Publications
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Means and Standard Deviations for Organizational Climate Measures 
Floor layout of a typical medical-surgical unit Patient rooms are around the perimeter and medicine and equipment rooms are inside the "core." Note. The figure is from unpublished hospital archives; permission for use was granted by hospital administrators participating in the study. 
Article
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.
 
Article
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.
 
Participant Social and Clinical Characteristics 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Article
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.
 
Integrating Being, Knowing, and Doing 
Article
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.
 
Article
In this article, we discuss findings from an ethnographic study in which we explored experiences of access to primary care services from the perspective of Aboriginal people seeking care at an emergency department (ED) located in a large Canadian city. Data were collected over 20 months of immersion in the ED, and included participant observation and in-depth interviews with 44 patients triaged as stable and nonurgent, most of whom were living in poverty and residing in the inner city. Three themes in the findings are discussed: (a) anticipating providers' assumptions; (b) seeking help for chronic pain; and (c) use of the ED as a reflection of social suffering. Implications of these findings are discussed in relation to the role of the ED as well as the broader primary care sector in responding to the needs of patients affected by poverty, racialization, and other forms of disadvantage.
 
Article
The increasingly high rates of mortality and morbidity among Canadian Aboriginal women who are living with HIV/ AIDS indicate that there is a need to address deficiencies in the delivery of supportive services and health care. The purpose of this qualitative study was to develop a greater understanding of the barriers, challenges, and successes experienced when accessing health and related support services from the perspective of Aboriginal women living with HIV/AIDS. The findings are organized around four themes reflected in the interview data: fear of rejection when seeking services, finding strength in adversity, struggles with symptoms, and HIV as just one of many competing problems. It is anticipated that the findings from the study will be used to inform decision making regarding the development and delivery of appropriate, responsive, and accessible policies and programs that will support Aboriginal women who are living with HIV/AIDS.
 
Article
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.
 
Article
A portion of a study designed to explore community health nurses' (CHNs) perceptions of the concept of empowerment in their work with Australian Aboriginal clients is discussed in this article. The 12 study participants were identified through purposive convenience sampling. During this exploration, contentions regarding the concept of empowerment emerged, revealing the sociopolitical context of CHN's work with Aboriginal people that shaped their practice in crucial ways. These issues emerged from the participants' discussions regarding the meaning of empowerment in their work with Aboriginal clients and the strategies for and challenges to working in empowering ways within the context of Aboriginal health. Selected components of Habermas's works provided a useful framework to facilitate an understanding of the forces that underpin community health nursing practice.
 
Article
This article describes a case study examining the effects of participating in a health promotion project, one aspect of which was a health assessment conducted using participatory action research. The study was carried out over 2.5 years in a project for older Aboriginal women (hereafter known as the grandmothers). Participation in the project and health assessment contributed to a number of changes in them, which were categorized as cleansing and healing, connecting with self, acquiring knowledge and skills, connecting within the group, and external exposure and engagement. This experience demonstrated an approach to health promotion programming and conducting a health assessment that was acceptable to this group of people and fostered changes congruent with empowerment.
 
Examples of Changes to Ages and Stages Questionnare, 3rd Edition (ASQ-3).
36 month ASQ–TRAK Questionnaire sample.  
Article
A key challenge to providing quality developmental care in remote Aboriginal primary health care (PHC) centers has been the absence of culturally appropriate developmental screening instruments. This study focused on the cross-cultural adaptation of the Ages and Stages Questionnaires, 3rd edition (ASQ-3), with careful attention to language and culture. We aimed to adapt the ASQ-3 for use with remote dwelling Australian Aboriginal children, and to investigate the cultural appropriateness and feasibility of the adapted ASQ-3 for use in this context. We undertook a qualitative study in two remote Australian Aboriginal communities, using a six-step collaborative adaptation process. Aboriginal Health Workers (AHWs) were trained to use the adapted ASQ-3, and follow-up interviews examined participants' views of the cultural acceptability and usefulness of the adapted instrument. The adapted ASQ-3 was found to have high face validity and to be culturally acceptable and relevant to parents, AHWs, and early childhood development experts. © The Author(s) 2014.
 
Article
In this study we examined the meaning of abortion in the religious Jewish sector on both the individual and the couple levels. In a qualitative, descriptive, interpretive-narrative study, semistructured interviews were conducted with five religious couples. Both members of each couple were interviewed separately. The findings show that although both members of the couple experienced spontaneous abortion as a loss, each expressed it in different ways and thus perceived it differently in the couple relationship. Men who demonstrated the ability to bypass their own pain and made an effort to respond to their partners' distress motivated the women's exit from the isolation cycle, and contributed to a sense of dyadic cohesion and to creating a meaning for their "togetherness." These findings are discussed in the context of research and theoretical literature that deal with bereavement and mourning processes, and with constructing meaning for a pregnancy-related loss.
 
Article
In this article we explore how nurse practitioners, physician assistants, and nurse midwives in California (collectively referred to as clinicians) developed confidence while learning to provide vacuum aspiration abortion. We interviewed clinicians (n = 30) who worked in reproductive health care settings and had participated in a large abortion-training study. Although the training had moral and political significance for the trainees, in this article we focus on their experience of skill development and how they gained confidence and competence in aspiration abortion, a procedure typically performed by physicians. We argue that confidence is not one dimensional. Understanding the diverse ways in which clinicians arrive at confidence might inform health care training and education generally. By examining attained competency from the clinicians' perspectives, we continue the discussion within the social science of health care and medicine about how clinicians know what they know and what expertise feels like to them.
 
Article
In this qualitative research, the author explored (in general) whether domestic violence and induced abortion feature in men's and women's sexual and reproductive health experiences. In particular, he explored whether and how gender roles influence reproductive decision-making behavior regarding contraception, unwanted pregnancy, and induced abortion. The study area was Wakiso district in central Uganda, which surrounds the capital city, Kampala. The author collected data using in-depth interviews and focus group discussions and analyzed them using grounded theory. Effects of unplanned pregnancy were perceived to be gender specific. Unintended pregnancy and induced abortion as a health issue did not concern men. Rather, what concerned them was spouses' contraception, which they often strongly opposed. Consequently, covert contraceptive use was common. The author describes a relation between domestic violence, nonuse of contraception, unintended pregnancy, and induced abortion.
 
Characteristics of Women Interviewed (N = 34) 
Article
This study focuses on lowest income Mexican women attended for abortion-related complications in a public hospital. The objective was to investigate the women's experience of having a so-called "spontaneous" abortion and their related strategies to avoid stigmatization. Four strategies emerge from women's testimonies: presenting themselves as women who "play by the rules," pleading ignorance of the pregnancy, stating that they had already accepted their pregnancy, or presenting the abortion as the result of an accident. Women use these strategies to deflect any blame to which they might be subjected and as a means of dealing with the stigma attached to a behavior that transgresses social norms regarding reproduction. Far from being passive receptors of the social imperative, which makes motherhood compulsory, women oscillate strategically within the margins of a seemingly uniform normative discourse and thereby ensure their moral survival. The authors discuss results within the framework of praxis theory.
 
Article
When older people develop delirium, their demeanor changes; they often behave in ways that are out of character and seem to inhabit another world. Despite this, little is known about the experiences of family members who are with their older loved one at this time. This article reports a phenomenological study that involved in-depth interviews with 14 women whose older loved one had delirium. Analysis and interpretation of the data depict the women's experiences as "Changing family portraits: Sudden existential absence during delirium," capturing the way family members lose the taken-for-granted presence of their familiar older loved one and confront a stranger during delirium. © The Author(s) 2015.
 
Article
Historically, we have assumed that workplaces, where employed individuals spend approximately one third of their days, provide safe and supportive environments and opportunities to enhance women's capacities. Unfortunately, workplace bullying and consequent sickness absence are prevalent and costly realities that significantly influence women's health. In this study, sickness absence among 18 Canadian women who were targets of workplace bullying was explored using a grounded theory secondary analysis. Findings show that although sickness absence is critical in attenuating the health consequences of being bullied, it is a partial solution because rehabilitation and successful return to work is challenged when working conditions remain unchanged. This problem is addressed using is a three-stage process of discerning a path that involves gaining space, making sense, and moving forward. Organizational support is critical to all stages of the process; it can reduce the risk of declines in health and sickness absence, and is essential for successful return to work.
 
Article
In the late 1990s, there was a marked increase in Sweden in long-term sickness absence with mental diagnoses. In the extensive research on burnout, little attention has been paid to the link with sickness absence. Our aim in this study was to discover what caused burnout, or such severe stress that it led to long-term sickness absence (> 28 days). We interviewed 32 individuals on long-term sickness absence with a diagnosis of burnout and used grounded theory to analyze the data. We believe that events prior to the sickness absence can be understood as a process of emotional deprivation, and we described the process in terms of a flight of stairs with eight steps: "The Burnout Stairs." We argue that the emotion conveying the process of emotional deprivation is unacknowledged shame, which has its basis in poor social relations at work. We discuss the study's limitations and the need for further research in this field.
 
Article
In this article, the authors describe a recruitment strategy used to enroll female Bangladeshi immigrants into a study of spousal abuse, crucial in the process of identifying abuse in this community. The researchers used a qualitative method involving a three-staged process designed for sampling and recruiting for focus groups and in-depth interviews. The Bangladeshi women declined participation in either of these qualitative genres, but the modified and adapted strategies proved effective in recruiting participants from the tightly knit immigrant community. Key to the success of the effort was the involvement of a Bangladeshi investigator, unspecified time to establish rapport with key informants and representatives of the larger community, and maintaining contact with the target population after completion of the project.
 
Article
Using a metasynthesis approach, our aim was to articulate new insights relating to the most efficient and effective means of helping homeless women with substance abuse problems to enhance their well-being and become more stably housed. Distorted perceptions of competency, which are shaped by dysfunctional relationships and mental health problems, make it challenging for women with substance abuse problems to resolve homelessness. Women with particularly low or high levels of perceived competency tend to grapple with challenges related to structure and control, trust, and hopelessness. Therapeutic strategies for approaching these women include careful assessment, caring, personalized structure and control, development of interpersonal trust, instillation of hope, and the targeted use of psychotherapeutic agents and counseling. Framing care for homeless women within the context of perceived competency offers a new way of understanding their plight and shaping interventions to more expeditiously move them toward healthy and stable lives.
 
Article
The study, in which the author aim to understand the contextual risks of HIV-positive serostatus and intimate partner violence (IPV) of 32 Latina women, involved focus groups, in-depth face-to-face narratives, and community meetings. The data emerged into four themes: histories of trauma, living with HIV, vulnerability, and la suerte (luck). In addition to the themes, women in this study talked about how structural and cultural factors such as machismo, marianismo, and fatalism are implicated in the risk for HIV and IPV. Women in the study reconceptualized the notion of IPV to denote a form of situational abuse, such as threats of deportation, that is exacerbated by their HIV status.
 
Article
In spite of a history of collaboration between epidemiology and qualitative research, the mix of these two perspectives is not well developed in the substance use field. Part of the reason for the difficult match is that qualitative research often adds issues of context and meaning that complicate the epidemiological data of interest. In the substance use field, epidemiological indicators tend to focus on a single drug, but the context typically involves persons who use multiple illicit and licit substances in a variety of ways that change over time. In this article, the author describes four adolescents in an outpatient substance abuse treatment center to provide context and insight into the lives behind the epidemiological indicators. Studying a site of epidemiological data collection ethnographically is yet another way to build collaboration between epidemiology and qualitative research.
 
Article
Most researchers have studied physical and/or sexual abuse, substance use, and mental health problems separately or as a dual diagnosis, and from a theory-driven, empirical perspective. In this study, the authors examined these three phenomena together and from a phenomenological perspective. Thirty women each participated in an individual interview about living with a history of physical and/or sexual abuse, substance use, and mental health problems. Using a hermeneutic approach, a team of researchers analyzed the transcribed interview texts. They identified three themes: (a) being thrown: the cycle of abuse; (b) living life fearfully: a restricted world; and (c) helping: hearing my story. The results are significant, in that they challenge current assumptions underlying health care for women with histories of physical and/or sexual abuse, substance use, and mental health problems.
 
Key Demographic Features of the Communities 
Article
Mandates for culturally competent substance abuse and mental health services call for behavioral health providers to recognize and engage cultural issues. These efforts to incorporate culture typically focus on client culture, but provider views of culture can also influence the provision of services. Analysis of 42 semistructured interviews with behavioral health providers suggests that culture is considered by many to be an obstacle to help seeking and treatment of substance-abusing youth. Although some providers do not highlight cultural issues, others conceptualize culture in terms of (a) generalized Hispanic cultural attributes, (b) male-dominant gender roles, and (c) the culture of poverty. Recommendations for provider training on cultural issues focus on ways they might critically consider their ideas about culture.
 
Article
Female survivors of childhood abuse have increased risk for substance misuse. Childhood abuse survivors describe current mental health and substance misuse services as not addressing central problems, the "heart of the matter." Negative core issues related to abuse events, contexts, substance use, and current problems were explored in open-ended interviews with 20 female abuse survivors. Most were marginalized because of cocaine use, poverty, and ethnic status. Narrative analysis involved within- and between-account comparisons through adequate paraphrasing of in vivo descriptions. Results include in-depth description of basic core beliefs, developmental core influences, and current core experiences. Implications for practice and policy include appreciation of the influence of negative core experiences on mental health, substance misuse recovery, and preparedness for adulthood demands.
 
Thriving Participants Categorized by Types of Redemption Narratives and Timing of Upward Turn in Trajectory (n = = 22)
The " Steady Upward Progression " Pattern: Ruth as Exemplar  
The " Roller-Coaster " Pattern: Carmen as Exemplar  
The " Struggler " Pattern: Lynn as Exemplar  
Article
A narrative study of thriving adult female survivors of childhood maltreatment was undertaken to discover how they had achieved success. Life trajectory patterns, turning points, and setbacks were identified. Data consisted of 81 interview transcripts derived from a series of three interviews, spaced over 6 to 12 months, with 27 survivors. The childhood abuse was intrafamilial, beginning as early as infancy and continuing, in most cases, until participants left home. The onset and pace of the healing trajectory were quite variable, including a roller-coaster pattern as well as patterns of slow, steady progress and continued struggle. Four types of redemption narratives were delineated. Survivors had not been spared depression but had made achievements in work and education and displayed remarkable generativity, parenting their own children well, and mentoring other young girls, especially victims of abuse.
 
Article
Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.
 
Article
This study explores the relationship between child sexual abuse and adolescent motherhood, using a life story interview method. The sample consists of 27 mothers participating in a home-visitation parenting program for mothers at risk of child maltreatment. The failure to articulate the violation of child sexual abuse and to appropriately construct blame resulted in a range of self-destructive behaviors, some of which placed mothers at greater risk of teen pregnancy. Repressed feelings associated with the trauma often resurfaced with motherhood as victims re-experienced their innocence and vulnerability as children.
 
Article
A theoretical framework that explains how survivors of childhood sexual abuse tell others about their abuse experiences is presented. Data are drawn from open-ended interviews conducted with 74 individuals who experienced ongoing childhood sexual abuse by a family member or close acquaintance. Grounded theory methods were used to develop the framework. The psychosocial problem shared by the participants is that childhood sexual abuse both demands and defies explanation. The core psychosocial process used in response to this problem is storying childhood sexual abuse. The framework includes five processes, and the stories associated with each process vary in their nature and function. The processes and associated stories are (a) starting the story: the story-not-yet-told, (b) coming out with the story: the story-first-told, (c) shielding the story: the story-as-secret, (d) revising the story: the story-as-account, and (e) sharing the story: the story-as-message. Clinical applications of the framework are discussed.
 
Article
In this article we explore the lives of young women living with HIV who experienced physical and/or sexual abuse in childhood. Using a modified version of the Life Story Interview, 40 women recruited from HIV clinics in three different states participated in a qualitative interview. Interviews covered abuse experiences, cognitive and emotional consequences of abuse, coping strategies, and sexual behavior and relationships. Overall, these young women had complex abuse histories, often experiencing more than one type of abuse in the context of other difficult life events. Avoidance and substance use were frequently utilized as coping strategies for abuse-related distress. Young women reported sexual and relationship concerns, including avoidance of sex, sexual dysfunction, sex as a trigger for abuse memories, and difficulty establishing intimacy and trust. Relationships between abuse-related reactions and sexual risk behavior, as well as recommendations for interventions, are discussed.
 
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Children's health is a key factor in women's decisions to leave abusive partners, yet how these families promote their health after leaving is poorly understood. In this feminist grounded theory study, the authors conducted repeat interviews with 40 single-parent families that had left abusive partners/fathers and analyzed the data using constant comparative methods. Findings reveal the central problem faced by families is intrusion, unwanted interference in everyday life that stems from abuse and its fallout. Over time, families promote their health through the basic social process of strengthening capacity to limit intrusion via four subprocesses: providing, regenerating family, renewing self, and rebuilding security. Depending on the degree of intrusion, the focus strengthening capacity shifts between practical goals of surviving and more proactive efforts directed toward positioning for the future. This theory adds to our knowledge of the long-term consequences of IPV for families and provides direction for practice and policy.
 
Top-cited authors
Sarah E Shannon
  • University of Washington Seattle
Hsiu-Fang Hsieh
  • National Quemoy University
Janice M Morse
  • University of Utah
Kirsti Malterud
  • University of Bergen
David L Morgan
  • Portland State University