An Introduction to Qualitative Health Research - Un'introduzione alla ricerca sanitaria qualitativa

Within the context of evidence-informed decision making, health care professionals are critical consumers of research evidence. Clinician scientists, including nurse researchers, play a central role in producing this research evidence to inform and improve health practice, education, and policy. Health research is commonly conducted within one of three different paradigms: quantitative, qualitative or mixed methods. Each research approach is underpinned with unique philosophic assumptions, methods, and rhetoric. The evidence produced within each paradigm is necessary to provide health care decision-makers with information about the complex, and intrinsically diverse, human experiences of health and illness. Qualitative health research has been defined as a discipline, which has its roots in qualitative research and yet is unique in its focus, methods, and rules. The focus of qualitative health research is to describe, explore, and explain the health-illness continuum and issues specific to health services or policy contexts. Research designs unique to conducting qualitative health research include qualitative description, interpretive description, focused ethnography, and case study. Each qualitative health research design helps to logically and pragmatically determine the appropriate methods to use to: 1) define a purposeful sample; 2) identify appropriate strategies for data collection; 3) rigorously apply analytic techniques to the gathered data; and 4) present valid findings. In health, qualitative studies are often an integral component of program evaluations to identify and describe contextual factors related to individuals, teams, organizations or social structures that inhibit or facilitate the successful adoption, implementation and delivery of an intervention or program. Findings from qualitative studies can also inform the development of theoretically and contextually relevant assessment tools that can be used in practice.Keywords: Research Methodology, Qualitative Research, Qualitative Health Research, Research DesignUn'introduzione alla ricerca sanitaria qualitativaNel contesto dell'evidence informed decision making, i professionisti della salute sono utilizzatori critici di evidence. I ricercatori clinici, inclusi i ricercatori infermieristici, hanno un ruolo centrale nel produrre queste evidence per informare e migliorare la pratica clinica, la formazione e le politiche sanitarie. La ricerca sanitaria è generalmente condotta con uno dei tre diversi paradigmi: quantitativo, qualitativo o misto. Ogni approccio di ricerca è sostenuto da dei propri presupposti filosofici, dai propri metodi e dalla propria retorica. Le evidence prodotte attraverso ciascun paradigma sono necessarie per fornire a chi prende decisioni evidence informed nell'ambito della salute, informazioni circa la complessa, ed intrinsecamente diversa, esperienza umana di salute e malattia. La ricerca sanitaria qualitativa è stata definita come una disciplina, che ha le sue radici nella ricerca qualitativa eppure è unica nel suo focus, nei metodi e nelle regole. Il focus specifico della ricerca sanitaria qualitativa è quello di descrivere, esplorare e spiegare il continuum salute-malattia e argomenti specifici al contesto dei servizi alla salute e delle politiche sanitarie. I disegni di ricerca specifici per la conduzione di ricerca sanitaria qualitativa includono: qualitative description, interpretive description, focused ethnography e case study. Ogni disegno di ricerca sanitaria aiuta a determinare logicamente e pragmaticamente i metodi appropriati da utilizzare per: 1) definire un campionamento propositivo; 2) identificare strategie appropriate per la raccolta dati; 3) applicare ai dati raccolti rigorose tecniche analitiche; 4) presentare risultati valide. In sanití , gli studi qualitativi sono spesso una parte integrale della valutazione delle politiche, per identificare e descrivere fattori contestuali legati a individui, team, organizzazioni o strutture sociali che agiscono come barriere o facilitatori per un'adozione, implementazione o erogazione di un intervento o programma. I risultati derivanti da studi qualitativi possono inoltre informare lo sviluppo di strumenti di valutazione rilevanti teoreticamente e contestualmente che possono essere utilizzati nella pratica.Parole Chiave: Metodologia della ricerca, Ricerca Qualitativa, Ricerca Sanitaria Qualitativa, Disegni di Ricerca"

Enhancing graduate student learning experiences: A qualitative research peer group

Graduate students are often exposed to the philosophical assumptions, methodological orientations, and common tenets of qualitative research through an introductory academic course. However, a basic understanding may not be sufficient for students interested in designing and conducting a qualitative study. Learning the practical application of qualitative research methods is necessary to achieve the rigorous and substantive requirements of a quality thesis or dissertation. This presentation outlines the student experience of an informal, faculty-facilitated, qualitative research learning group. To support graduate learning, students and a faculty member meet monthly to discuss issues related to qualitative inquiry and apply practical techniques to writing, analyzing, and defending research. Both PhD and Masters-level students indicated that participation in the group enhanced understanding of qualitative methods and analysis, provided anticipatory learning, and aided connection to peers. Barriers to participation included time constraints, disinterest in the posted topic, and frustration with the academic process. Some students who could not participate in person attended via Skype or teleconference. Although the group is faculty-facilitated, it is student-driven and responsive to their needs and desires. In addition to meeting academic requirements, this experience has the potential to build confident and competent qualitative researchers

Family care conferences in long-term care : exploring content and processes in end-of-life communication

Objective: End-of-life (EoL) communication in long-term care (LTC) homes is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed, and dissatisfied with care. Family care conferences (FCCs) aim to increase structured systematic communication around goals and plans for the end of life. As part of the Strengthening a Palliative Approach to Care (SPA-LTC) project, FCCs were implemented in four LTC sites in Ontario, Canada. The purpose of this substudy was to examine FCC content and such guiding processes as documentation and multidisciplinary staff participation.Method: A total of 24 FCCs were held for residents with a Palliative Performance Scale score of 40% (nearing death). Data were collected from conference forms (i.e., Family Questionnaires, Care Plan Conference Summaries), site-specific electronic chart documents, and fieldnotes. Directed content analysis of data was informed by the Canadian Hospice Palliative Care Association's Square of Care Model, which describes eight domains of care: disease management, physical, psychological, social, practical, spiritual, EoL, and loss/bereavement.Results: The FCCs addressed an average of 71% of the content domains, with physical and EoL care addressed most frequently and loss/bereavement addressed the least. Two goals and five interventions were documented and planned on average per FCC. Examination of the processes supporting EoL communication found: (1) advantages to using FCC forms versus electronic charts; and (2) high levels of multidisciplinary participation overall but limited participation of personal support workers (PSWs) and physicians.Significance of Results: Communication around the end of life in LTC can be supported through the use of FCCs. Description of content and FCC processes provides guidance to persons implementing FCCs. Recommendations for tailoring conferences to optimize communication include use of specific conference forms, increased bereavement discussion, and further engagement of PSWs and physicians

Reflexive Thematic Analysis for Applied Qualitative Health Research

Thematic analysis is a widely cited method for analyzing qualitative data. As a team of graduate students, we sought to explore methods of data analysis that were grounded in qualitative philosophies and aligned with our orientation as applied health researchers. We identified reflexive thematic analysis, developed by Braun and Clarke, as an interpretive method firmly situated within a qualitative paradigm that would also have broad applicability within a range of qualitative health research designs. In this approach to analysis, the subjectivity of the researcher is recognized and viewed not as problematic but instead valued as integral to the analysis process. We therefore elected to explore reflexive thematic analysis, advance and apply our analytic skills in applied qualitative health research, and provide direction and technique for researchers interested in this method of analysis. In this paper, we describe how a multidisciplinary graduate student group of applied health researchers utilized Braun and Clarke’s approach to reflexive thematic analysis. Specifically, we explore and describe our team’s process of data analysis used to analyze focus group data from a study exploring postnatal care referral behavior by traditional birth attendants in Nigeria. This paper illustrates our experience in applying the six phases of reflexive thematic analysis as described by Braun and Clarke: (1) familiarizing oneself with the data, (2) generating codes, (3) constructing themes, (4) reviewing potential themes, (5) defining and naming themes, and (6) producing the report. We highlight our experiences through each phase, outline strategies to support analytic quality, and share practical activities to guide the use of reflexive thematic analysis within an applied health research context and when working within research teams