Evaluating the audio-diary method in qualitative research

Purpose Audio-diary methods are under-utilised in contemporary qualitative research. In this paper we discuss participants and researchers’ experiences of using audio-diaries alongside semi-structured interviews to explore breastfeeding experiences in a short-term longitudinal study with 22 first-time mothers. Design/methodology/approach We provide a qualitative content analysis of the participants’ feedback about their experiences of the audio-diary method and supplement this with the perspectives of the research team based on fieldwork notes, memos and team discussions. We pay particular attention to the ways in which the data attained from diaries compared with those from the interviews. Findings The diaries produced were heterogeneous in terms of data length and quality. Participants’ experiences with the method were varied. Some found the process therapeutic and useful for reflecting upon the development of breastfeeding skills whilst negative aspects related to lack of mobility, self-consciousness and concerns about confidentiality. Researchers were positive about the audio-diary method but raised certain ethical, epistemological and methodological concerns. These include debates around the use of prompts, appropriate support for participants and the potential of the method to influence the behaviour under scrutiny. Interview and diary accounts contrasted and complemented in ways which typically enriched data analysis. Practical implications The authors conclude that audio-diaries are a flexible and useful tool for qualitative research especially within critical realist and phenomenological paradigms Originality/value This appears to be the first paper to evaluate both participants and researchers’ experiences of using audio-diaries in a detailed and systematic fashio

Young people’s images of cigarettes, alcohol and drugs.

To meet their aim of reducing the acceptability of psychoactive substances to young people, the designers of drug prevention programmes need to have a thorough understanding of the personal views already held by their audience with respect to the object of attitude and behavioural change. However, few studies involving younger adolescents have collated participant-generated impressions of a range of legal and illegal substances. The present study used a word association methodology to explore adolescents' impressions of cigarette smoking, drinking alcohol and taking a range of illegal drugs. In total, 3571 images were generated which were placed into 24 categories on the basis of content analysis. The predominance of negative imagery was of note, particularly for cigarette smoking and drug taking and there was little evidence of a simplistic generic attitude to substance use. Images of alcohol, especially alcopops, were markedly more positive and were much less likely to contain reference to specific health problems than the images of cigarette smoking. However, there was less differentiation between 'hard' and 'soft' illegal drugs than has been found with older adolescents in other studies and many of the images relating to illegal drugs were poorly defined, revealing vague notions of danger and risk. The present methodology is proposed as a useful tool for assessing attitudes both prior to and following prevention programmes and it is suggested, based on the wide variation in images elicited, that successful prevention dialogues with young people may need to vary their message according to the particular substance targeted

Using audio-diaries to capture lived experience in health psychology: technological, methodological and epistemological issues

Although diary methods have a long tradition of use within psychology and appear to have considerable potential in researching health-related processes and experiences, the use of unstructured diary methods to generate detailed phenomenological accounts within contemporary health psychology has thus far been limited. In this poster presentation, we describe a recently completed British study in which a sample of first-time mothers used voice-recording technology to make daily diary entries about their infant feeding experiences. We present a consideration of the benefits and challenges of this approach to data collection. In particular, we focus on ethical and epistemological issues, drawing on the accounts of both participants and members of the research team. We also explore the most suitable ways of analysing data derived from diaries and consider the practical advantages and limitations of using audio-diaries. Finally, some of the implications for developing the use of audio-diaries in health psychologists' research and practice are considered

Becoming a breastfeeding mother: An interactionist perspective

Understanding the establishment of breastfeeding by focussing on the mother-child dyad offers only a limited perspective. Instead, breastfeeding can be understood as becoming established or breaking down within broader networks of relationships (e.g. Dykes, 2006; Tiedje et al., 2002). Quantitative research has suggested that support from various others (lay and professional) can be an important factor in sustaining breastfeeding (Sikorski et al., 2003). However, those around the mother may orientate to breastfeeding in various ways. For example, fathers play a key role in decisions about infant feeding and in supporting breastfeeding, and yet need to define and adjust to their new parenting role and changed relationship with their partner in a way that accommodates breastfeeding (Bar-Yam & Darby, 1997). From the perspective of the mother, breastfeeding can be an important aspect of the transition to motherhood. However, becoming a mother is not an individual project but one that involves redefining roles and relationships with others (Mercer, 2004; Nelson, 2003), and negotiating mothering practices such as breastfeeding in the context of others’ expectations and cultural prescriptions for motherhood (McBride-Henry, 2010). The present research aims to extend understanding of how breastfeeding mothers experience their relations with others and how these are implicated in their experiences of breastfeeding and their developing relationship with their infant. The data discussed here have been taken from a longitudinal qualitative study of 22 new mothers in the UK who expressed an intention to breastfeed and were interviewed during the first week following birth and one month later. At each time point they were also asked to keep an audio-diary of their experiences of feeding their baby for one week. The analysis discussed here draws on symbolic interactionism and other theoretical perspectives which emphasise the relational nature of the self and assume that relations with others are part of, rather than external to, lived experience and mediate more distal cultural influences. The themes explored include the women’s sense of duty to balance what they saw as the needs of their baby, their own needs and the needs, demands and sensibilities of others, and the ways in which they negotiated these. We also discuss the way in which, as the participants were developing their new identities as breastfeeding mothers, others with expertise in breastfeeding or perceived to have knowledge regarding related norms and expectations took on a particular significance in the women’s lives. As such, these "experts" were experienced by the participants as in a powerful position to provide either validation or invalidation of them as breastfeeding mothers. We discuss (i) the implications of our analysis for facilitating supportive interactions between health professionals and breastfeeding mothers and their immediate networks and (ii) the implications for breastfeeding promotion of viewing ongoing engagement with the practices of infant feeding as mutually negotiated and enabled, rather than as the choice of individual women

Empowerment or regulation? Exploring the implications of women's perspectives on pumping and expressing breast milk

The feminist literature on pumping and expressing breast milk has highlighted contradictory theorisation of these practices. On the one hand they have been argued to represent a form of ‘control’ placed upon breastfeeding in that they offer a way of managing future expectations about returning to ‘normal’ activities. Additionally, the use of breast pumps has been theorised as contributing to the commercialisation, medicalisation and mechanisation of breastfeeding. On the other hand, it has been noted that these practices have the potential to be empowering, in that they allow for greater paternal involvement in infant feeding and increased freedom for women. In this paper we report on an analysis of first-time mothers’ reasons for pumping and expressing breast milk drawn from a recent British qualitative study. Our analysis suggests that these practices were employed for a myriad of complex, multi-layered reasons which can be seen as potentially both empowering and disempowering. For instance, they were used as a way of managing breastfeeding difficulties and the perceived inefficiencies of the maternal body thus ensuring the continued provision of adequate breast milk. They were also constructed as practices which could be used to manage the realities of modern motherhood including facilitating shared parenting, feeding in public and managing returning to work. We illustrate this complexity by drawing on detailed case studies of women who used these practices extensively. Implications for public health theory and practice which have the potential to support women in their infant feeding choices are discussed

Applying clinical decision aids for the assessment and management of febrile infants presenting to emergency care in the UK and Ireland: Febrile Infant Diagnostic Assessment and Outcome (FIDO) Study protocol.

INTRODUCTION: Febrile infants 90 days and younger are at risk of invasive bacterial infections (bacteraemia and meningitis) and urinary tract infections. Together this is previously termed serious bacterial infection with an incidence of approximately 10-20%. The National Institute for Health and Care Excellence guidance advocates a cautious approach with most infants requiring septic screening, parenteral broad-spectrum antibiotics and hospital admission. Internationally, variations exist in the approach to febrile infants, with European and North American guidance advocating a tailored approach based on clinical features and biomarker testing. None of the available international clinical decision aids (CDAs) has been validated in the UK and Irish cohorts. The aim of the Febrile Infant Diagnostic Assessment and Outcome (FIDO) Study is to prospectively validate a range of CDAs in a UK and Irish population including CDAs that use procalcitonin testing. METHODS AND ANALYSIS: The FIDO Study is a prospective multicentre mixed-methods cohort study conducted in UK and Irish hospitals. All infants aged 90 days and younger presenting with fever or history of fever (≥38°C) are eligible for inclusion. Infants will receive standard emergency clinical care without delay. Clinical data and blood samples will be collected, and consent will be obtained at the earliest appropriate opportunity using research without prior consent methodology. The performance and cost-effectiveness of CDAs will be assessed. An embedded qualitative study will explore clinician and caregiver views on different approaches to care and perceptions of risk. ETHICS AND DISSEMINATION: This study was reviewed and approved by the Office for Research Ethics Committees Northern Ireland-Health and Social Care Research Ethics Committee B, Public Benefit and Privacy Panel for Health and Social Care Scotland, and Children's Health Ireland Research and Ethics Committee Ireland. The results of this study will be presented at academic conferences and in peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT05259683

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p

Implementation of corticosteroids in treating COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK:prospective observational cohort study

BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70–0·89], p=0·0001, for 70–79 years; 0·52 [0·46–0·58], p80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75–80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council

Point-of-care testing in paediatric settings in the UK and Ireland: A cross-sectional study

Background: Point-of-care testing (POCT) is diagnostic testing performed at or near to the site of the patient. Understanding the current capacity, and scope, of POCT in this setting is essential in order to respond to new research evidence which may lead to wide implementation. Methods: A cross-sectional online survey study of POCT use was conducted between 6th January and 2nd February 2020 on behalf of two United Kingdom (UK) and Ireland-based paediatric research networks (Paediatric Emergency Research UK and Ireland, and General and Adolescent Paediatric Research UK and Ireland). Results: In total 91/109 (83.5%) sites responded, with some respondents providing details for multiple units on their site based on network membership (139 units in total). The most commonly performed POCT were blood sugar (137/139; 98.6%), urinalysis (134/139; 96.4%) and blood gas analysis (132/139; 95%). The use of POCT for Influenza/Respiratory Syncytial Virus (RSV) (45/139; 32.4%, 41/139; 29.5%), C-Reactive Protein (CRP) (13/139; 9.4%), Procalcitonin (PCT) (2/139; 1.4%) and Group A Streptococcus (5/139; 3.6%) and was relatively low. Obstacles to the introduction of new POCT included resources and infrastructure to support test performance and quality assurance. Conclusion: This survey demonstrates significant consensus in POCT practice in the UK and Ireland but highlights specific inequity in newer biomarkers, some which do not have support from national guidance. A clear strategy to overcome the key obstacles of funding, evidence base, and standardising variation will be essential if there is a drive toward increasing implementation of POCT