The Process of Conducting Qualitative Grounded Theory Research for a Doctoral Thesis: Experiences and Reflections

In this article, the author offers her experiences as an example of the application of a grounded theory approach in qualitative research. She describes, in detail, her experiences of the process of collecting, analyzing, and storing data for her doctoral thesis. She focuses on the special challenges of employing a qualitative methodology to developing a conceptual framework. The substantive area in which the study took place was at a hospital-based occupational health clinic for professional artists. Various stakeholders involved in the clinic participated in in-depth individual interviews and focus groups to explore how the concept of integrative health care (IHC) is understood both in theory and in practice at the clinic

Relationship-centred care in health: A 20-year scoping review

Relationship-centred care (RCC) is a framework for conceptualizing health care which recognizes that the nature and quality of relationships in health care influence the process and outcomes of health care. Our goal was to undertake a scoping review of the peer-reviewed and grey literature on RCC in health. Using Arksey and O’Malley’s scoping review methodology we identified literature about RCC in teaching, learning and clinical practice. Electronic databases were searched, and targeted searches were also conducted for grey literature to capture unpublished material. Subsequently, data abstraction tools were used with eligible studies for analysis. Sixty-nine publications originated mainly from the United States and the United Kingdom by authors from various academic disciplines, of which medicine and nursing were dominant. Thematic analysis revealed that the most commonly cited definition of RCC emerged from the Pew-Fetzer report and focused on the central role of relationships between practitioners and their patients, the community and other practitioners in providing quality care and improving outcomes. The concept of RCC was found to be influenced by theories of sociology, social psychology and psychiatry. The practice of RCC was demonstrated through organizational environments that model RCC, practice settings that focus on the patient or family in care planning, and health professional education that is based on RCC principles. RCC is important to: humanize health care and improve patient care. Our review identified three sub-categories that could add to the relational dimension of the practitioner-organization: practitioner–education, practitioner–profession, and practitioner–practice. Recommendations for future research include: outcome and process studies of health professions education and health care that focuses on RCC. The RCC approach provides a paradigm to move beyond the patient-centred care model by focusing on the central role of all relationships in the delivery and outcomes of care

Embedding lived experience into mental health academic research organizations: Critical reflections

Background: As part of a growing emphasis on engaging people with lived experience of mental health conditios in mental health research, there are increasing calls to consider and embed lived experience throughout academic research institutes. This extends beyond the engagement of lay patients andalso considers the potential roles of academic researchers with lived experience. When the lived experience of academic researchers is applied to academic work, there is the potential to improve the relevance of the research, while destigmatizing mental illness within academia. However, there are different and often contrasting perspectives on the way a lived experience academic researcher initiative should be implemented. Objectives: This article describes some of the key issues to be considered when planning an initiative that leverages and values the lived experience of academic researchers, including the advantages and disadvantages of each potential approach. Discussion & Recommendations: Institutions are encouraged to reflect on the ways that they might support and value lived experience among academic researchers. In developing any such initiative, institutions are encouraged to be transparent about their objectives and values, undertake a careful planning process, involve researchers with lived experience from the outsetand consistently challenge the stigma experienced by academic researchers with lived experience. Patient or Public Contribution: Multiple authors are academic researchers with lived experience of mental health conditions

The Job Accommodation Scale (JAS): Psychometric Evaluation of a New Measure of Employer Support for Temporary Job Modifications

The final publication is available at Springer via http://dx.doi.org/10.1007/s10926-014-9508-7An employer offer of temporary job modification is a key strategy for facilitating return-to-work for musculoskeletal conditions, but there are no validated scales to assess the level of support for temporary job modifications across a range of job types and organizations. Objective To pilot test a new 21-item self-report measure [the Job Accommodation Scale (JAS)] to assess its applicability, internal consistency, factor structure, and relation to physical job demands. Methods Supervisors (N = 804, 72.8 % male, mean age = 46) were recruited from 19 employment settings in the USA and Canada and completed a 30-min online survey regarding job modification practices. As part of the survey, supervisors nominated and described a job position they supervised and completed the JAS for a hypothetical worker (in that position) with an episode of low back pain. Job characteristics were derived from the occupational informational network job classification database. Results The full response range (1–4) was utilized on all 21 items, with no ceiling or floor effects. Avoiding awkward postures was the most feasible accommodation and moving the employee to a different site or location was the least feasible. An exploratory factor analysis suggested five underlying factors (Modify physical workload; Modify work environment; Modify work schedule; Find alternate work; and Arrange for assistance), and there was an acceptable goodness-of-fit for the five parceled sub-factor scores as a single latent construct in a measurement model (structural equation model). Job accommodations were less feasible for more physical jobs and for heavier industries. Conclusions The pilot administration of the JAS with respect to a hypothetical worker with low back pain showed initial support for its applicability, reliability, and validity when administered to supervisors. Future studies should assess its validity for use in actual disability cases, for a range of health conditions, and to assess different stakeholder opinions about the feasibility of job accommodation strategies.This research was supported by CIHR Grant MOP-102571, Supervisors’ perspectives on accommodating back injured workers: a mixed-methods study (PI: V Kristman) and by intramural research funding (Project LMRIS 09-01) of the Liberty Mutual Research Institute for Safety (PI: W Shaw).http://dx.doi.org/10.1007/s10926-014-9508-

Early Psychosis Intervention-Spreading Evidence-based Treatment (EPI-SET) : Protocol for an effectiveness-implementation study of a structured model of care for psychosis in youth and emerging adults

Introduction While early psychosis intervention (EPI) has proliferated in recent years amid evidence of its effectiveness, programmes often struggle to deliver consistent, recovery-based care. NAVIGATE is a manualised model of EPI with demonstrated effectiveness consisting of four components: individualised medication management, individual resiliency training, supported employment and education and family education. We aim to implement NAVIGATE in geographically diverse EPI programmes in Ontario, Canada, evaluating implementation and its effect on fidelity to the EPI model, as well as individual-level outcomes (patient/family member-reported and interviewer-rated), system-level outcomes (captured in provincial administrative databases) and engagement of participants with lived experience. Methods and analysis This is a multisite, non-randomised pragmatic hybrid effectiveness-implementation type III mixed methods study coordinated at the Centre for Addiction and Mental Health (CAMH) in Toronto. Implementation is supported by the Provincial System Support Program, a CAMH-based programme with provincial offices across Ontario, and Extension of Community Healthcare Outcomes Ontario Mental Health at CAMH and the University of Toronto. The primary outcome is fidelity to the EPI model as measured using the First Episode Psychosis Services-Fidelity Scale. Four hundred participants in the EPI programmes will be recruited and followed using both individual-level assessments and health administrative data for 2 years following NAVIGATE initiation. People with lived experience will be engaged in all aspects of the project, including through youth and family advisory committees. Ethics and dissemination Research ethics board approval has been obtained from CAMH and institutions overseeing the local EPI programmes. Study findings will be reported in scientific journal articles and shared with key stakeholders including youth, family members, programme staff and policymakers. Trial registration number NCT03919760; Pre-results

Designing a workplace return-to-work program for occupational low back pain: an intervention mapping approach

<p>Abstract</p> <p>Background</p> <p>Despite over 2 decades of research, the ability to prevent work-related low back pain (LBP) and disability remains elusive. Recent research suggests that interventions that are focused at the workplace and incorporate the principals of <it>participatory ergonomics </it>and return-to-work (RTW) coordination can improve RTW and reduce disability following a work-related back injury. Workplace interventions or programs to improve RTW are difficult to design and implement given the various individuals and environments involved, each with their own unique circumstances. Intervention mapping provides a framework for designing and implementing complex interventions or programs. The objective of this study is to design a best evidence RTW program for occupational LBP tailored to the Ontario setting using an intervention mapping approach.</p> <p>Methods</p> <p>We used a qualitative synthesis based on the intervention mapping methodology. Best evidence from systematic reviews, practice guidelines and key articles on the prognosis and management of LBP and improving RTW was combined with theoretical models for managing LBP and changing behaviour. This was then systematically operationalized into a RTW program using consensus among experts and stakeholders. The RTW Program was further refined following feedback from nine focus groups with various stakeholders.</p> <p>Results</p> <p>A detailed five step RTW program was developed. The key features of the program include; having trained personnel coordinate the RTW process, identifying and ranking barriers and solutions to RTW from the perspective of all important stakeholders, mediating practical solutions at the workplace and, empowering the injured worker in RTW decision-making.</p> <p>Conclusion</p> <p>Intervention mapping provided a useful framework to develop a comprehensive RTW program tailored to the Ontario setting.</p

Looking upstream to understand low back pain and return to work: Psychosocial factors as the product of system issues

Low back pain (LBP) is the most common and expensive musculoskeletal (MSK) disorder in industrialized countries. There is evidence that personal and occupational psychosocial variables play a more important role than spinal pathology or the physical demands of the job. However, it is unclear which psychosocial variables are most important. The objective of this study is to understand which psychosocial variables are deemed most important to various workplace stakeholders involved in the process of returning a worker with LBP to work. Nine focus groups were convened with injured workers, small and large employers, unions, health and safety associations, physicians and non-physician clinicians, return to work coordinators and compensation board representatives in Ontario, Canada. A qualitative grounded theory approach was applied to explore, from their perspectives, important psychosocial factors that prevent the promotion of early and safe return to work (RTW) for individuals with LBP. While the study began by asking questions related to the various psychosocial factors and their association to LBP and RTW, it took an interesting turn. The majority of study participants described how psychosocial factors were the product of larger systemic/organizational issues. Rather than focusing solely on individual psychosocial factors, respondents described how the context of a much larger system, and the complex interplay between the many different components of that system, contributes directly or indirectly to the treatment of LBP and RTW. It is the interrelationships between these systems that determine the process of returning an injured worker with LBP back to work. Although it is important to understand how psychosocial factors affect RTW, organizational structures within our social context seem to play a role in shaping how all stakeholders see and emotionally respond to LBP and RTW, as well as the degree to which they can envision taking action on them. We need to consider moving beyond a psychosocial conceptualization of LBP and RTW into a sociopolitical and economic conceptualization. This reconceptualization provides insight into the "upstream factors" associated with LBP and RTW.Low back pain Return to work Psychosocial Organizational factors Canada Workplace

Defining competencies for the practice of telepsychiatry through an assessment of resident learning needs

Abstract Background A foundational assessment of learning needs is missing from previous reports of telepsychiatry curricula. We used an in-depth needs assessment to identify specific skills required for the practice of effective telepsychiatry, and provide an evidence base to guide the development of telepsychiatry curricula in postgraduate psychiatry training. Many of these skills set telepsychiatry apart from practice in traditional face-to-face clinical settings, or result from adaptations to clinical practice to meet the needs of a telepsychiatry interface in patient care. Methods We used a qualitative, modified grounded theory approach to gain insight into areas of importance for telepsychiatry training in postgraduate psychiatry residency. 16 interviews of faculty and residents (9 and 7 interviews, respectively), allowed participants to reflect on their experiences in telepsychiatry. Data were then thematically analyzed. Results Interview respondents identified important aspects of the context for telepsychiatry training; the skills required to competently practice telepsychiatry; and the desired teaching and learning methods for acquiring these skills. Specific domains of competency were identified: technical skills; assessment skills; relational skills and communication; collaborative and interprofessional skills; administrative skills; medico-legal skills; community psychiatry and community-specific knowledge; cultural psychiatry skills, including knowledge of Indigenous cultures; and, knowledge of health systems. The skills identified in this study map well to competency- based medical education frameworks. Conclusions Telepsychiatry is increasingly being adopted as a solution to health systems problems such as regional disparities in access to care, and it requires explicit competency development. Ensuring adequate and quality exposure to telepsychiatry during residency training could positively impact our health systems and health equity