Clinic consultations with children and parents on the dietary management of cystic fibrosis

The aim of this paper is to examine clinic consultations on the dietary management of cystic fibrosis with particular consideration to the role of children.  The role of parents is also examined to determine how their involvement impacts on the role of children during consultations. The data are drawn from interviews with 32 Irish school aged children with cystic fibrosis and their parents, and participant observations during clinic consultations with a sub-group of 21 children. Data were analysed concurrently with data collection using a method of constant comparison, which involved comparing and contrasting incidents in the data to develop themes. Theoretical sampling was used to further explore and develop emergent themes. Discourse analysis was applied to clinic conversations. Children were seen to have little active involvement during consultations leaving them marginalised as conversations were directed at parents primarily and their accounts were privileged over those of children. A surveillance approach to consultations  involving interrogative style questioning and generally closed conversations  was seen to contribute to the marginalised position of children. In addition, dietary advice limited children s involvement because it was of little relevance to children s understandings of being healthy and to the dietary implications of these. The findings highlight a need to acknowledge children as active participants in their dietary care. Implications for developing a child-centred approach to dietary consultations are discussed including implications for working with children towards improved health outcomes of managing CF diet.  

Online vs. face-to-face discussions in a web-based research methods course for postgraduate nursing students : A quasi-experimental study

Background: Web-based technologies are increasingly being used to create modes of online learning for nurses but their effect has not been assessed in nurse education. Objectives: Assess whether participation in face-to-face discussion seminars or online asynchronous discussion groups had different effects on educational attainment in a webbased course. Design: Non-randomised or quasi-experimental design with two groups – students choosing to have face-to-face discussion seminars and students choosing to have online discussions. Setting: The Core Methods module of a postgraduate research methods course. Participants: All 114 students participating in the first 2 years during which the course teaching material was delivered online. Outcome: Assignment mark for Core Methods course module. Methods: Background details of the students, their choices of modules and assignment marks were collected as part of the routine course administration. Students’ online activities were identified using the student tracking facility within WebCT. Regression models were fitted to explore the association between available explanatory variables and assignment mark. Results: Students choosing online discussions had a higher Core Methods assignment mark (mean 60.8/100) than students choosing face-to-face discussions (54.4); the difference was statistically significant (t = 3.13, df = 102, p = 0.002), although this ignores confounding variables. Among online discussion students, assignment mark was significantly correlated with the numbers of discussion messages read (Kendall’s taub = 0.22, p = 0.050) and posted (Kendall’s taub = 0.27, p = 0.017); among face-to-face discussion students, it was significantly associated with the number of non-discussion hits in WebCT (Kendall’s taub = 0.19, p = 0.036). In regression analysis, choice of discussion method, whether an MPhil/PhD student, number of non-discussion hits in WebCT, number of online discussion messages read and number posted were associated with assignment mark at the 5% level of significance when taken singly; in combination, only whether an MPhil/PhD student (p = 0.024) and number of non-discussion hits (p = 0.045) retained significance. Conclusions: This study demonstrates that a research methods course can be delivered to postgraduate healthcare students at least as successfully by an entirely online method in which students participate in online discussion as by a blended method in which students accessing web-based teaching material attend face-to-face seminar discussions. Increased online activity was associated with higher assignment marks. The study highlights new opportunities for educational research that arise from the use of virtual learning environments that routinely record the activities of learners and tutors

The Digital Revolution in Qualitative Research: Working with Digital Audio Data Through Atlas.Ti

Modern versions of Computer Assisted Qualitative Data Analysis Software (CAQDAS) are enabling the analysis of audio sound files instead of relying solely on text-based analysis. Along with other developments in computer technologies such as the proliferation of digital recording devices and the potential for using streamed media in online academic publication, this innovation is increasing the possibilities of systematically using media-rich, naturalistic data in place of transcribed 'de-naturalised' forms. This paper reports on a project assessing online learning materials that used Atlas.ti software to analyse sound files, and it describes the problems faced in gathering, analysing and using this data for report writing. It concludes that there are still serious barriers to the full and effective integration of audio data into qualitative research: the absence of 'industry standard' recording technology, the underdevelopment of audio interfaces in Atlas.ti (as a key CAQDAS package), and the conventional approach to data use in many online publication formats all place serious restrictions on the integrated use of this data. Nonetheless, it is argued here that there are clear benefits in pushing for resolutions to these problems as the use of this naturalistic data through digital formats may help qualitative researchers to overcome some long-standing methodological issues: in particular, the ability to overcome the reliance on data transcription rather than 'natural' data, and the possibility of implementing research reports that facilitate a more transparent use of 'reusable' data, are both real possibilities when using these digital technologies, which could substantially change the shape of qualitative research practice.CAQDAS, Recording Technology, Online Publication

Parental migration, intergenerational obligations and the paradox for left-behind boys in rural China

Drawing on in-depth interviews with caregivers of left-behind children (LBC) in rural China, this article seeks to explore their understanding of migration motives and the social process of taking on care-giving roles for LBC. The authors argue that there are underlying socio-cultural explanations pertaining to economic motives for migration; such as, making contributions to social events (weddings and funerals) in village life, and fulfilling social obligations for left-behind sons’ futures. Parents migrate to save for sons’, but not daughters’, adult lives. Grandparents, particularly on the paternal side, are expected to fulfil social obligations to care for left-behind grandchildren, even without immediate financial returns. These suggest that left-behind boys, and in particular boys cared for by paternal grandparents, may be at greater risk than other LBC, as they may receive even fewer resources in the form of remittances from migrant parents in their early childhood

Influence of religion on healthcare professionals’ beliefs toward teenage sexual practices in Malaysia

Background: Teenagers are influenced by their surroundings, and this may also include their sexual behavior or societal responses to this type of behavior. It is important to understand the complexity of religious mandates and sociocultural disapproval of premarital sex from the perspectives of healthcare professionals. Methods: This qualitative study aimed to explore the influence of religion on healthcare professional’s beliefs toward providing sexual and reproductive health information and treatment. An interview topic guide was used in the in-depth interview of 32 healthcare professionals in several health clinics in Malaysia. The data were transcribed and entered into the NVivo 11 software. Thematic analysis was used to evaluate the data. Results: The findings show that some healthcare professionals positively incorporated Islamic beliefs into sexual health education session but excluded the contraception information. This study also highlights the strategies used by healthcare professionals (discourse on risk, being selective, maintaining their own honor) when providing sexual health services to teenagers. Conclusion: These findings revealed how religion perpetuates a “moral” approach in the provision of sexual health services that potentially affects teenagers’ access to healthcare

Intergenerational differences in beliefs about healthy eating among carers of left-behind children in rural China: a qualitative study

China's internal migration has left 61 million rural children living apart from parents and usually being cared for by grandparents. This study aims to explore caregivers' beliefs about healthy eating for left-behind children (LBC) in rural China. Twenty-six children aged 6–12 (21 LBC and 5 non-LBC) and 32 caregivers (21 grandparents, 9 mothers, and 2 uncles/aunts) were recruited in one township in rural China. Children were encouraged to keep food diaries followed by in-depth interviews with caregivers. Distinct intergenerational differences in beliefs about healthy eating emerged: the grandparent generation was concerned about not having enough food and tended to emphasise the importance of starchy foods for children's growth, due to their past experiences during the Great Famine. On the other hand, the parent generation was concerned about food safety and paid more attention to protein-source foods including meat, eggs and milk. Parents appeared to offer children high-energy food, which was viewed as a sign of economic status, rather than as part of a balanced diet. Lack of remittances from migrant parents may compromise LBC's food choices. These findings suggest the potential for LBC left in the care of grandparents, especially with experience of the Great Famine, may be at greater risk of malnutrition than children cared for by parents. By gaining an in-depth understanding of intergenerational differences in healthy eating beliefs for children, our findings could inform for the development of nutrition-related policies and interventions for LBC in rural China

A mixed methods study of the management of hearing loss associated with otitis media with effusion in children with Down syndrome

Objectives: To scope current service provision across England for management of otitis media with effusion and hearing loss in children with Down syndrome; to explore professional decision-making about managing otitis media with effusion and hearing loss; and to explore patient and public views on the direction of future research. Design: Mixed methods including a service evaluation of NHS clinical practice through a structured telephone survey; a qualitative study of professional decision-making with in-depth interviews collected and analysed using grounded theory methods; patient/public involvement consultations. Participants: Twenty-one audiology services in England took part in the evaluation; 10 professionals participated in the qualitative study; 21 family members, 10 adults with Down syndrome and representatives from two charities contributed to the consultations. Results: There was variation across services in the frequency of routine hearing surveillance, approaches to managing conductive hearing loss in infancy and provision of hearing aids and grommets. There was variation in how professionals describe their decision-making, reflecting individual treatment preferences, differing approaches to professional remit and institutional factors. The consultations identified that research should focus on improving practical support for managing the condition and supporting decision-making about interventions. Conclusions: There is system-level variation in the provision of services and individual-level variation in how professionals make clinical decisions. As a consequence, there is inequity of access to hearing health care for children with Down syndrome. Future research should focus on developing core outcomes for research and care, and on improving decision support for families