Triangulating Approaches - Applying Qualitative Inquiry as a Global Endeavor

Understanding qualitative inquiry as a global endeavor and using it in a globalizing context leads to several challenges. Differences in concepts of what qualitative research is may become visible. Methods like interviews may have a different connotation in other cultures, where our interviewees come from. We may have to conduct and analyze interviews differently. These challenges are discussed here on the background of an ongoing project focused on migrants from former Soviet Union states living in Germany with drugs and alcohol addiction problems. For understanding how the help-seeking processes in this context work and what makes them more complicated, episodic interviews with the clients were conducted in German or Russian and triangulated with expert interviews with service providers

"Denen geht's ja dann noch dreckiger, als sie sowieso schon aussehen": Körperwahrnehmung im Kontext "Jugendobdachlosigkeit"

"Auf der Straße lebende Jugendliche gelten als besonders gefährdete Gruppe - durch die aktuellen Lebensbedingungen und das eigene 'riskante' Verhalten. Sehr intensiver Alkohol- und Drogen-Konsum ist gepaart mit aus finanziellen Gründen qualitativ und quantitativ oft ungenügender Ernährung. Gesundheitliche Beeinträchtigungen werden oft ignoriert, so dass die Jugendlichen erst im Notfall zum Arzt gehen. In diesem lebensweltlichen Kontext bündelt sich eine Vielzahl sozialer Probleme: Ausbreitung und Verstetigung der Obdachlosigkeit, Verbreitung sexueller Erkrankungen und verstärktes Auftreten von Gewalt, Prostitution und delinquentem Verhalten. Wenn auch das Risikoverhalten in seiner Phänomenologie sehr unterschiedlich sein kann, besteht eine Gemeinsamkeit darin, dass vielfältige soziale und lebensweltliche Probleme sich in einer unangemessenen Wahrnehmung des (eigenen bzw. fremden) Körpers und einem unangepassten Umgang mit dem Körper manifestieren. Der Zusammenhang zwischen der Körperwahrnehmung und der Lebensweise obdachloser Jugendlicher wird hier behandelt auf der Basis von Interviews aus einem DFG-Projekt zum Gesundheitsverhalten von Straßenjugendlichen in Bereichen wie Alkohol- und Drogenkonsum, Sexualverhalten, Ernährung, Umgang mit Beeinträchtigungen und Inanspruchnahme formeller Hilfen. Dabei zeigt sich u.a., dass sich die Repräsentation sozialer Probleme und gesundheitlicher Beeinträchtigungen auch entlang der Dimension ‚mein Körper und die Körper der Anderen' beschreiben lässt. Die Jugendlichen unterscheiden sich darin, ob sie 1. nur anderen Jugendlichen extremes körperliches Leiden unterstellen, wogegen der eigene körperliche Zustand und die eigene Lebensweise positiv erscheinen; 2. ausschließlich den Körper anderer Szenemitglieder als potentielle Infektionsquelle wahrnehmen, wogegen der eigene ('reine' und 'unbefleckte') zu schützen ist oder 3. den Körper der Anderen als 'weich', den eigenen jedoch als hart und unberührbar wahrnehmen. Beispiele solcher Körperwahrnehmungen werden für den Umgang mit sozialen Problemen diskutiert, um Konsequenzen für eine zielgruppenspezifische Prävention abzuleiten." (Autorenreferat

“Talking on the Phone Is Very Cold” - Primary Health Care Nurses’ Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic

Strengthening patient participation is considered a crucial element of primary health care (PHC) nurses’ practice when working with chronically ill patients. The COVID-19 pandemic had extraordinary effects on PHC nursing routines and how chronically ill patients’ could be involved in their own care. This study investigates the adaptation of Spanish PHC nurses’ approaches to supporting the participation of patients living with chronic illness during the COVID-19 pandemic. To reach this goal, we interviewed 13 PHC nurses who practiced in PHC centers in Spain. The interviews were analyzed using thematic coding. Three themes emerged from the descriptions of the nurses: (1) High COVID-19-related workload, decreasing health promotion, and chronic care, (2) Emphasis on patients’ and families’ self-responsibility, (3) Expanded digital and telephone communication with fewer in-person consultations. Nurses felt especially challenged to uphold the support for vulnerable groups, such as older people or patients without family support. Future research should focus on how the participation of the most vulnerable chronic patients can be supported in the context of the growing relevance of remote care

"Talking on the Phone Is Very Cold"-Primary Health Care Nurses' Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic

COVID-19; Chronic care; Patient participation; Primary health careCOVID-19; Atenció crònica; Participació del pacient; Atenció primària de salutCOVID-19; Atención crónica; Participación del paciente; Atención primariaStrengthening patient participation is considered a crucial element of primary health care (PHC) nurses' practice when working with chronically ill patients. The COVID-19 pandemic had extraordinary effects on PHC nursing routines and how chronically ill patients' could be involved in their own care. This study investigates the adaptation of Spanish PHC nurses' approaches to supporting the participation of patients living with chronic illness during the COVID-19 pandemic. To reach this goal, we interviewed 13 PHC nurses who practiced in PHC centers in Spain. The interviews were analyzed using thematic coding. Three themes emerged from the descriptions of the nurses: (1) High COVID-19-related workload, decreasing health promotion, and chronic care, (2) Emphasis on patients' and families' self-responsibility, (3) Expanded digital and telephone communication with fewer in-person consultations. Nurses felt especially challenged to uphold the support for vulnerable groups, such as older people or patients without family support. Future research should focus on how the participation of the most vulnerable chronic patients can be supported in the context of the growing relevance of remote care.This research was funded by the Stiftung Wohlfahrtspflege NRW (Public Welfare Foundation NRW) in the frame of funds for cross-sectional analyses regarding the subject of “Gesundheitskompetenz und Selbstmanagementförderung im Lebenslauf—Bedeutung im Kontext nutzerorientierter Versorgungsmodele (förges Q)” (Promotion of health literacy and self-management in the lifecourse—meanings in the context of user-oriented care models) (Ref.: SW-620 6852–6856) within the research network “Nutzerorientierte Versorgung: Förderung der Gesundheitskompetenz und des Selbstmanagements bei chronischer Krankheit und Pflegebedürftigkeit (förges)” (User-oriented care: Promotion of health literacy and self-management for chronic conditions and need of care)

"Pflege stationär - Weiterdenken!" Abschlussbericht der Wissenschaftlichen Evaluation des Modellverbunds

Röhnsch G, Hämel K, Vorderwülbecke J, Heumann M. "Pflege stationär - Weiterdenken!" Abschlussbericht der Wissenschaftlichen Evaluation des Modellverbunds. Durchges., leicht überarbeitete Fass. d. Erstberichts 2019. Bielefeld: Universität Bielefeld; 2019

Barriers to and enablers of the promotion of patient and family participation in primary healthcare nursing in Brazil, Germany and Spain: A qualitative study

Cuidador familiar; Educació del pacient; Participació del pacientCuidador familiar; Educación del paciente; Participación del pacienteFamily Caregiver; Patient education; Patient participationBackground: Most health systems are insufficiently prepared to promote the participation of chronically ill patients in their care. Strong primary health care (PHC) strengthens patients' resources and thus promotes their participation. The tasks of providing continuous care to people with chronic diseases and promoting self‐ management are the responsibility of PHC nurses. Recent research assessing enablers of or barriers to nurses' efforts to support patients' participation has mostly not considered the special situation of patients with chronic diseases or focused on the PHC setting. Objective: To investigate enablers of and barriers to PHC nurses' efforts to promote the participation of chronically ill patients in their care. Methods: We interviewed 34 practicing PHC nurses and 23 key informants with advanced knowledge of PHC nursing practice in Brazil, Germany and Spain. The data was analyzed using thematic coding. Results: We identified four categories of barriers and enablers. (1) Establishing bonds with patients: Interviewees emphasized that understanding patients' views and behaviours is important for PHC nurses. (2) Cooperation with relatives and families: Good relationships with families are fundamental, however conflicts within families could challenge PHC nurses efforts to strengthen participation. (3) Communication and cooperation within PHC teams: PHC nurses see Cooperative team structures as a potential enabler, while the dominance of a ‘biomedical’ approach to patient care is seen as a barrier. (4) Work environment: Interviewees agreed that increased workload is a barrier to patient participation. Discussion and Conclusions: Supporting patient participation should be acknowledged as an important responsibility for nurses by general practitioners and PHC planners. PHC nurses should be trained in communicative competence when discussing participation with chronically ill patients. Interprofessional education could strengthen other professionals' understanding of patient participation as a nursing task. Patient or Public Contribution: This study is part of a research project associated with the research network ‘forges: User‐oriented care: Promotion of health in the context of chronic diseases and care dependency’. The study's focus and provisional results were discussed continuously with partners in health and social care practice and presented to and discussed with the public at two conferences in which patient representatives, professionals and researchers participated

Barriers to and enablers of the promotion of patient and family participation in primary healthcare nursing in Brazil, Germany and Spain: A qualitative study

Background Most health systems are insufficiently prepared to promote the participation of chronically ill patients in their care. Strong primary health care (PHC) strengthens patients' resources and thus promotes their participation. The tasks of providing continuous care to people with chronic diseases and promoting self-management are the responsibility of PHC nurses. Recent research assessing enablers of or barriers to nurses' efforts to support patients' participation has mostly not considered the special situation of patients with chronic diseases or focused on the PHC setting. Objective To investigate enablers of and barriers to PHC nurses' efforts to promote the participation of chronically ill patients in their care. Methods We interviewed 34 practicing PHC nurses and 23 key informants with advanced knowledge of PHC nursing practice in Brazil, Germany and Spain. The data was analyzed using thematic coding. Results We identified four categories of barriers and enablers. (1) Establishing bonds with patients: Interviewees emphasized that understanding patients' views and behaviours is important for PHC nurses. (2) Cooperation with relatives and families: Good relationships with families are fundamental, however conflicts within families could challenge PHC nurses efforts to strengthen participation. (3) Communication and cooperation within PHC teams: PHC nurses see Cooperative team structures as a potential enabler, while the dominance of a ‘biomedical’ approach to patient care is seen as a barrier. (4) Work environment: Interviewees agreed that increased workload is a barrier to patient participation. Discussion and Conclusions Supporting patient participation should be acknowledged as an important responsibility for nurses by general practitioners and PHC planners. PHC nurses should be trained in communicative competence when discussing participation with chronically ill patients. Interprofessional education could strengthen other professionals' understanding of patient participation as a nursing task. Patient or Public Contribution This study is part of a research project associated with the research network ‘forges: User-oriented care: Promotion of health in the context of chronic diseases and care dependency’. The study's focus and provisional results were discussed continuously with partners in health and social care practice and presented to and discussed with the public at two conferences in which patient representatives, professionals and researchers participated

"Ich vertrau der anderen Person eigentlich...". Armut und Obdachlosigkeit als Kontexte sexuellen Risiko- und Schutzverhaltens von Jugendlichen

Was heißt es für Jugendliche in Deutschland, \u27auf der Straße\u27 zu leben? Welche Auswirkungen hat diese Lebenssituation, die von Armut und sozialer Benachteiligung gekennzeichnet ist, auf Gesundheitsvorstellungen und -verhaltensweisen der Betroffenen? Solchen Fragen wird hier auf der Grundlage der Ergebnisse einer von der DFG geförderten Studie exemplarisch anhand des Sexualverhaltens der Jugendlichen nachgegangen. Da eine wesentliche Gesundheitsgefahr, der Straßenjugendliche ausgesetzt sind, sexuell übertragbare Erkrankungen darstellen, ist es von besonderem Interesse, wie dieses mögliche \u27objektive\u27 Risiko wahrgenommen und verarbeitet wird. In diesem Kontext lassen sich drei Typen unterschiedlicher Deutungs- und Handlungsmuster identifizieren. Sie differieren vor allem im Hinblick auf das Risikobewusstsein der Jugendlichen sowie die Absicht, sich schützen zu wollen. Im Einzelnen zeigen sich Unterschiede in Bezug darauf, welche Einstellung die Jugendlichen gegenüber Kondomen vertreten, ob sie andere Schutzmaßnahmen \u27jenseits\u27 des Präservativs anwenden und inwiefern sie diese als \u27sicher\u27 erleben. Abschließend werden Konsequenzen aus den Studienergebnissen für eine zielgruppenspezifische Sexualprävention diskutiert. (DIPF/Orig.)What does it mean for adolescents in Germany, to live \u27in the street\u27? Which are the consequences of these living conditions characterised by poverty and social discrimination for adolescents\u27 health related representations and practices? Such questions are pursued based on a study funded by the German Research Council. In this paper, interview data are analysed in an exemplary way focusing on adolescents\u27 sexual behaviour. Sexually transmitted diseases are a major threat for the health of homeless adolescents. Therefore it is of special interest, how these adolescents perceive this risk and how they cope with it. Three types of interpretive patterns and practices could be identified. These types differ mainly in the extent to which adolescents are aware of risks and in their intentions to protect themselves. In particular, these three types vary by attitudes towards condoms; adolescents\u27 use of other forms of protection beyond the condom, and by how far these are seen as \u27safe\u27. Implications of these findings are discussed regarding how to design a sexual prevention that is specific for this target group. (DIPF/Orig.

"Lieber besoffen. Oder bekifft. Dann kann man\u27s wenigstens noch aushalten". Zum Alkohol- und Drogenkonsum obdachloser Jugendlicher

Für obdachlose Jugendliche sind Alkohol und Drogen oft alltäglich und selbstverständlich, doch sind sie zugleich mit vielfältigen - sozialen und gesundheitlichen - Risiken verbunden. Wie nehmen die Betroffenen das Spannungsfeld zwischen subjektiver Angemessenheit ihres Alkohol- und Drogenkonsums und den möglichen Gefährdungen wahr? Wie gehen sie mit den substanzbedingten Risiken und bereits vorliegenden Beeinträchtigungen durch Missbrauch und/oder Sucht um? Solchen Fragen wird hier anhand der Ergebnisse unserer aktuellen (von der DFG geförderten) qualitativ-empirischen Studie zu Gesundheitsvorstellungen und -verhalten obdachloser Jugendlicher nachgegangen, die von uns zu ihrer Lebenssituation sowie ihren Gesundheitskonzepten und ihrem Gesundheitsverhalten befragt wurden. Ergänzend haben wir teilnehmende Beobachtungen in der einschlägigen \u27Szene\u27 durchgeführt. Vier verschiedene Typen von Deutungs- und Handlungsmustern des Alkohol- und Drogenkonsums haben sich ausfindig machen lassen. Abhängig vom Alter und Geschlecht, differieren diese vor allem darin, inwieweit der regelmäßige Substanzgebrauch als riskant bewertet und welche Konsequenzen daraus gezogen werden. Den subjektiven (Risiko-) Einschätzungen der Jugendlichen werden die berichteten Konsummuster von alkoholischen Getränken und Drogen sowie die in unseren Beobachtungen ermittelten Verhaltensweisen gegenübergestellt. Abschließend werden die Konsequenzen aus den Ergebnissen unserer DFG-Studie für eine ziel-gruppenorientierte - alters- und geschlechtsspezifische - Suchtprävention diskutiert. (DIPF/Orig.)For homeless adolescents, alcohol and drugs are often \u27functional\u27 i.e. integrated in their daily lives, but still linked to various social and health risks. How do they experience the tensions between a subjective appropriateness of using drugs and alcohol and the possible risks of it? How do they deal with the risks of substance use and their already existing health problems because of their dependency and/or addiction? These questions are pursued on the background of our empirical-qualitative research project funded by the German Research Council (DFG) with a focus on homeless adolescents\u27 health representations and practices. Our interviews addressed their life situations and their health concepts and practices and were complemented by participant observations in their urban settings. Four types of interpretive patterns and practices of alcohol and drug consumption could be identified from the analysis of our data. With regard to age and gender, they mainly differ in how far one\u27s own use of substances is seen as risky and in the consequences the adolescents draw from this. The adolescents\u27 subjective risk perceptions are confronted with their reported patterns of consumption of alcoholic beverages and drugs and their everyday practices, which could be observed. In the end, consequences from our study\u27s results are discussed for how to design some sort of drug prevention that is specific for our target group. (DIPF/Orig.

Förderung von Partizipation in Lebenswelten und Versorgungsbezügen. Wie können Pflegende in der Primär- und Langzeitversorgung beitragen?

Röhnsch G, Hämel K, Heumann M. Förderung von Partizipation in Lebenswelten und Versorgungsbezügen. Wie können Pflegende in der Primär- und Langzeitversorgung beitragen? In: Hämel K, Röhnsch G, eds. Förderung von Gesundheit und Partizipation bei chronischer Krankheit und Pflegebedürftigkeit im Lebensverlauf. Weinheim, Basel: BeltzJuventa; 2022: 24-41