Article

Kuper A, Reeves S, Levinson WAn introduction to reading and appraising qualitative research. BMJ 337: a288

Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5.
BMJ (online) (Impact Factor: 17.45). 02/2008; 337(7666):a288. DOI: 10.1136/bmj.a288
Source: PubMed

ABSTRACT

This article explores the difference between qualitative and quantitative research and the need for doctors to be able to interpret and appraise qualitative research.

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    • "We used a descriptive exploratory qualitative design to generate rich data and explore CTC services from different perspectives within the context of policy revision in Kenya (Kuper et al. 2008). Two counties were selected, Nairobi and Kitui, to provide representation for both urban and rural contexts. "
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    ABSTRACT: Background: Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change. Methods: We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before framework analysis. Results: There is widespread community appreciation for the existing strategy. High attrition, lack of accountability for voluntary CHWs and lack of funds to pay CHW salaries, combined with high CHEW workload were seen as main drivers for strategy change. Areas for change identified include: lack of clear supervisory structure including provision of adequate travel resources, current uneven coverage and equity of community health services, limited community knowledge about the strategy revision and demand for home-based HIV testing and counselling. Conclusion: This in-depth analysis which captures multiple perspectives results in robust recommendations for strategy revision informed by the Five Wonders of Change Framework. These recommendations point towards a more people-centred health system for improved equity and effectiveness and indicate priority areas for action if success of policy change through the roll-out of the revised strategy is to be realized.
    Preview · Article · Mar 2015 · Health Policy and Planning
    • "S.). The research was conducted from the constructivist position that ''the reality we perceive is constructed by our social, historical, and individual contexts'' (Kuper et al. 2008b). Our perspective was that learning is essentially situated within practice (Lave & Wenger 1991; Wenger 1998; Billett 2002), so doctors construct their learning and professional identity by performing clinical work (Dornan et al. 2007; Teunissen et al. 2007b; Yardley et al. 2012). "
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    ABSTRACT: Abstract Purpose: Changing the current geographical maldistribution of the medical workforce is important for global health. Research regarding programs that train doctors for work with disadvantaged, rural populations is needed. This paper explores one approach of remote supervision of registrars in isolated rural practice. Researching how learning occurs without on-site supervision may also reveal other key elements of postgraduate education. Methods: Thematic analysis of in-depth interviews exploring 11 respondents' experiences of learning via remote supervision. Results: Remote supervision created distinctive learning environments. Respondents' attributes interacted with external supports to influence whether and how their learning was promoted or impeded. Registrars with clinical and/or life experience, who were insightful and motivated to direct their learning, turned the challenges of isolated practice into opportunities that accelerated their professional development. Discussion: Remote supervision was not necessarily problematic but instead provided rich learning for doctors training in and for the context where they were needed. Registrars learnt through clinical responsibility for defined populations and longitudinal, supportive supervisory relationships. Responsibility and continuity may be as important as supervisory proximity for experienced registrars.
    No preview · Article · Aug 2014 · Medical Teacher
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    • "A qualitative methodology was employed as it provides participants with scope to discuss personal experiences in depth. It can also achieve a specific and deep knowledge of an issue and has the potential to capture concepts that may not have previously been identified [29-33]. Interpretive Phenomenological Analysis (IPA) was used as it enables the researcher to explore, flexibly and in detail, an area of concern [31]. "
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    ABSTRACT: Background Guidelines surrounding maternal contact with the stillborn infant have been contradictory over the past thirty years. Most studies have reported that seeing and holding the stillborn baby is associated with fewer anxiety and depressive symptoms among mothers of stillborn babies than not doing so. In contrast, others studies suggest that contact with the stillborn infant can lead to poorer maternal mental health outcomes. There is a lack of research focusing on the maternal experience of this contact. The present study aimed to investigate how mothers describe their experience of spending time with their stillborn baby and how they felt retrospectively about the decision they made to see and hold their baby or not. Method In depth interviews were conducted with twenty-one mothers three months after stillbirth. All mothers had decided to see and the majority to hold their baby. Qualitative analysis of the interview data was performed using Interpretive Phenomenological Analysis. Results Six superordinate themes were identified: Characteristics of Contact, Physicality; Emotional Experience; Surreal Experience; Finality; and Decision. Having contact with their stillborn infant provided mothers with time to process what had happened, to build memories, and to ‘say goodbye’, often sharing the experience with partners and other family members. The majority of mothers felt satisfied with their decision to spend time with their stillborn baby. Several mothers talked about their fear of seeing a damaged or dead body. Some mothers experienced strong disbelief and dissociation during the contact. Conclusions Results indicate that preparation before contact with the baby, professional support during the contact, and professional follow-up are crucial in order to prevent the development of maternal mental health problems. Fears of seeing a damaged or dead body should be sensitively explored and ways of coping discussed. Even in cases where mothers experienced intense distress during the contact with their stillborn baby, they still described that having had this contact was important and that they had taken the right decision. This indicates a need for giving parents an informed choice by engaging in discussions about the possible benefits and risks of seeing their stillborn baby.
    Full-text · Article · Jun 2014 · BMC Pregnancy and Childbirth
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