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Theoretical Sampling: Strategies for Qualitative Research
Many patients with terminal cancer wish to die at home and general practitioners in the United Kingdom have a critical role in providing this care. However, it has been suggested general practitioners lack confidence in end‐of‐life care. It is important to explore with general practitioners their experience and perspectives including feelings of confidence delivering end‐of‐life care to people with cancer. The aim of this study was to explore general practitioners experiences of providing end‐of‐life care for people with cancer in the home setting and their perceptions of confidence in this role as well as understanding implications this has on policy design. A qualitative study design was employed using semi‐structured interviews and analysed using thematic analysis. Nineteen general practitioners from London were purposively sampled from eight general practices and a primary care university department in 2018–2019, supplemented with snowballing methods. Five main themes were constructed: (a) the subjective nature of defining palliative and end‐of‐life care; (b) importance of communication and managing expectations; (c) complexity in prescribing; (d) challenging nature of delivering end‐of‐life care; (e) the unclear role of primary care in palliative care. General practitioners viewed end‐of‐life care as challenging; specific difficulties surrounded communication and prescribing. These challenges coupled with a poorly defined role created a spread in perceived confidence. Experience and exposure were seen as enabling confidence. Specialist palliative care service expansion had important implications on deskilling of essential competencies and reducing confidence levels in general practitioners. This feeds into a complex cycle of causation, leading to further delegation of care.
The study conveys the experience of two social entrepreneurs from Latin America at the early stages of their projects. Both entrepreneurships solve the problem of building a pool of recurrent blood donors. The research applies the Extended Case Method to reconstruct the theory of critical mass. The practical contribution is the identification of the general process followed by both cases. The narrative of the general process provides actionable advice for entrepreneurs willing to create and sustain a critical mass for social purposes, whereas the theoretical contribution is the identification of the roles played by two types of heterogeneity of endorsements.
Unlike many Western countries, the Chinese state has a much more active role in innovation that includes direct involvement with actors in innovation processes and the use of state capacity, money and power to assert certain goals. With the rise of China, innovation processes that critically depend on state action, often labeled state‐led innovation, have thus received growing scholarly attention. However, only few contributions study the specific sector of New Energy Vehicles (NEV) and policy measures applied at the city level. This paper hence examines policy and planning tools used in Shenzhen, China, to assert innovation in the NEV industry, using an evaluation of documents and interviews. The paper finds that a city can play a decisive role in the implementation of innovation policy, and Chinese cities in particular make use of a broad set of innovation support measures ranging from binding quotas, public procurement and incentives to bans and orders. The findings underline the importance of strong regulatory instruments that do not conform to the Western notion of market‐compliant policy, but nevertheless work effectively in the Chinese context. Moreover, the results highlight how successful policy support for innovation in the NEV can be implemented.
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Introduction
Several models of differentiated care for stable HIV patients on antiretroviral therapy (ART) in Malawi have been introduced to ensure that care is efficient and patient-centered. Three models have been prioritized by the government for a deeper and broader understanding: adjusted appointment spacing through multi-month scripting (MMS); fast-track drug refills (FTRs) on alternating visits; and community ART groups (CAGs) where rotating group members collect medications at the facility for all members. This qualitative study aimed to understand the challenges and successes of implementing these models of care and of the process of patient differentiation.
Methods
A qualitative study was conducted as a part of a broader process evaluation in 30 purposefully selected ART facilities between February and May 2016. Semi-structured, in-depth interviews with 32 health workers that managed and coordinated ART clinics and 30 focus groups were held with 216 ART patients. Interviews and focus groups were audio recorded, transcribed, and coded thematically.
Results
Participants reported that the models of differentiated care have yielded key benefits, including: reduced patients’ travel and visit time, decongestion of facilities, and enhanced social support. Participants suggested that these benefits could lead to improved HIV treatment outcomes for patients. At the same time, some challenges were reported, such as inconsistent stocks of drugs, which can inhibit implementation of MMS. For CAGs, the group-based nature of the model presented some unique problems, such as conflicts within groups or concerns about privacy. Health workers also described some of the reasons why eligible patients may not receive the models or conversely why ineligible patients sometimes get the models.
Conclusions
Documenting patient and health worker perspectives on models of differentiated care is critical to understanding and improving these models. While these models can offer important benefits, the models may not be appropriate for all sites or patients, and patient status and needs may change over time. Key challenges should be recognized and addressed for optimal utilization of the models.
Las instituciones, como el resto de los agentes de la esfera pública, precisan adaptarse para mantener el contacto con sus públicos.
La webserie titulada Joobing Hood, un graduado frente a Europa, ha sido producida en 2016, dentro de un programa de la Comisión Europea en Madrid y realizada en el Laboratorio de Audiovisuales de la Universidad Rey Juan Carlos de Madrid.
El proyecto ha empleado fórmulas comunicativas del campo del entretenimiento audiovisual al marketing institucional, con el objetivo de dar voz a la comisión europea en su comunicación con los jóvenes. La webserie ha construido una narrativa en torno al imaginario del personaje Robin Hood, origen de innumerables películas, novelas, y todo tipo de causas sociales, que son ampliamente reconocibles. Se utiliza esta universalidad del personaje para trasladar sus rasgos y construir un protagonista carismático para una serie dirigida a los jóvenes españoles en busca de empleo. Se describen las características del problema comunicacional, los rasgos del público objetivo y se caracteriza a la webserie como el formato que permite un contexto comunicativo de branded content para la comunicación institucional de la Comisión Europea con los jóvenes.
Data security incidents have led to a wave of security awareness campaigns by public institutions targeted towards the so-called home user. Despite this rise, studies have shown poor adoption rates of security measures by the target. In this paper, we conduct a qualitative investigation of 15 home users, analyse the data using Grounded Theory and present a model of factors of data security decisions made in the home. We further consolidate the literature on this topic and analyse our findings against it using meta-synthesis. From this we identify the critical issues that surround data security in the home environment. We finally present a consolidated theoretical model for investigating factors that influence security practices in the home, and suggest future work based on our findings.
La finalidad del trabajo es reseñar los pasos seguidos en la investigación que condujo a proponer un modelo teórico para orientar la formación de docentes en Geografía. El problema es que la escuela ha dejado de ser la instancia esencial en la transferencia del conocimiento; ella debería hacer énfasis en el sujeto como centro de todo proceso escolar y educativo. La Reforma Educativa de 1996 generó dos modelos opuestos, un desfase entre las dos primeras etapas de Educación Básica, concebidas con el constructivismo, y la Tercera Etapa de Educación Básica, junto con Educación Media, mantenidas en el conductismo. La formación del docente especialista en Geografía minimiza contenidos basados en cotidianidad, entorno y paisaje y hace énfasis en otros de poca utilidad. Se estableció un marco teórico referencial conceptual con aportes de Kant, Vico, Piaget, Vygotski, Brunner, Ausubel, Maturana, Platón, Aristóteles, Marina, Echeverría y Legendre. El método de investigación empleado fue el Comparativo Continuo de Análisis Cualitativo de Miles y Huberman el cual explica, por la vía gráfica y el análisis del discurso, las categorías estudiadas y las relaciones que existen entre ellas para determinar el modelo final.
Unlabelled:
Research has largely ignored the systematic examination of physicians' attitudes towards providing care for patients with chronic noncancer pain. The objective of this study was to identify barriers and facilitators to opioid treatment of chronic noncancer pain patients by office-based medical providers. We used a qualitative study design using individual and group interviews. Participants were 23 office-based physicians in New England. Interviews were audiotaped, transcribed, and systematically coded by a multidisciplinary team using the constant comparative method. Physician barriers included absence of objective or physiological measures of pain; lack of expertise in the treatment of chronic pain and coexisting disorders, including addiction; lack of interest in pain management; patients' aberrant behaviors; and physicians' attitudes toward prescribing opioid analgesics. Physician facilitators included promoting continuity of patient care and the use of opioid agreements. Physicians' perceptions of patient-related barriers included lack of physician responsiveness to patients' pain reports, negative attitudes toward opioid analgesics, concerns about cost, and patients' low motivation for pain treatment. Perceived logistical barriers included lack of appropriate pain management and addiction referral options, limited information regarding diagnostic workup, limited insurance coverage for pain management services, limited ancillary support for physicians, and insufficient time. Addressing these barriers to pain treatment will be crucial to improving pain management service delivery.
Perspective:
This article demonstrates that perceived barriers to treating patients with chronic noncancer pain are common among office-based physicians. Addressing these barriers in physician training and in existing office-based programs might benefit both noncancer chronic pain patients and their medical providers.
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