Use of Ecomaps in Qualitative Health Research

Qualitative health research plays a central role in exploring individuals’ experiences and perceptions of wellness, illness, and healthcare services. Visual tools are increasingly used for data elicitation. An ecomap is a visual tool that applies ecosystems theory to human communities and relationships to provide an illustration of the quality of relationships. We describe the use of ecomaps in qualitative health research. Searches across eight databases identified 407 citations. We screened them in duplicate to identify 129 publications that underwent full text review and included 73 in the final synthesis. We classified and summarized data based on iterative comparisons across sources. Benefits of using ecomaps include improving rapport and engagement with study participants, facilitating iterative question development, and highlighting the social contexts of relationships. When used in conjunction with interviews, they promote data credibility through triangulation. Investigators have used ecomaps as a tool to facilitate primary and secondary analysis of data. Researchers have adapted the ecomap to meet their health research needs. Challenges to their use include additional time and training needed to complete, and potential privacy and confidentiality concerns. Ecomaps can be useful in qualitative health research to enhance data elicitation, analysis, presentation, and to augment study rigor

Factors influencing decision making in neonatology: inhaled nitric oxide in preterm infants.

ObjectiveWe studied decision making regarding inhaled nitric oxide (iNO) in preterm infants with Pulmonary Hypertension (PH).Study designWe asked members of the AAP-Society of Neonatal-Perinatal Medicine and Division-Chiefs to select from three management options- initiate iNO, engage parents in shared decision making or not consider iNO in an extremely preterm with PH followed by rating of factors influencing their decision.ResultsThree hundred and four respondents (9%) completed the survey; 36.5% chose to initiate iNO, 42% to engage parents, and 21.5% did not consider iNO. Provider's prior experience, safety, and patient-centered care were rated higher by those who initiated or offered iNO; lack of effectiveness and cost considerations by participants who did not chose iNO.ConclusionsMost neonatologists offer or initiate iNO therapy based on their individual experience. The minority who chose not to consider iNO placed higher value on lack of effectiveness and cost. These results demonstrate a tension between evidence and pathophysiology-based-therapy/personal experience

How to Design a Qualitative Health Research Study. Part 2: Data Generation and Analysis Considerations

In the first part of this article, we introduced methodological issues associated with study design, research questions, contexts, sampling, and recruiting for qualitative health research studies. Here, in this second part of the article, we continue providing health researchers with information on how to design a qualitative health research study and we aim to prepare novice researchers for entering the field. Specifically, by providing considerations for selecting data gathering strategies, differentiation of types of qualitative data and practical tips on how to go into the field. Then, we will briefly discuss data management, analysis and dissemination.Keywords: Research Methodology, Qualitative Research, Qualitative Health Research, Research Design, Data gathering, Data analysis. Come disegnare uno studio di ricerca sanitaria qualitativa. Parte 2: Considerazioni su generazione e analisi dei datiNella prima parte di questo articolo, abbiamo introdotto questioni metodologiche associate alla progettazione dello studio, domande di ricerca, contesto, campionamento e reclutamento per studi di ricerca qualitativa sanitaria. In questa seconda parte dell'articolo, continuiamo a fornire ai ricercatori della salute informazioni su come progettare uno studio di ricerca qualitativa sanitaria e ci proponiamo di preparare i ricercatori alle prime armi per andare sul campo. In particolare, fornendo considerazioni per la selezione della strategia di raccolta dati, differenziazione dei tipi di dati qualitativi e consigli pratici su come andare sul campo. Dopodiché, discuteremo brevemente la gestione, l'analisi e la diffusione dei dati.Parole Chiave: Metodologia della ricerca, Ricerca Qualitativa, Ricerca Sanitaria Qualitativa, Disegni di Ricerca, Raccolta Dati, Analisi dei dat

Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach

Q2Q1Artículo de investigación1-10Background: There are diverse opinions and confusion about defining and including patient values and preferences (i.e. the importance people place on the health outcomes) in the guideline development processes. This article aims to provide an overview of a process for systematically incorporating values and preferences in guideline development. Methods: In 2013 and 2014, we followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to adopt, adapt and develop 226 recommendations in 22 guidelines for the Ministry of Health of the Kingdom of Saudi Arabia. To collect context-specific values and preferences for each recommendation, we performed systematic reviews, asked clinical experts to provide feedback according to their clinical experience, and consulted patient representatives. Results: We found several types of studies addressing the importance of outcomes, including those reporting utilities, non-utility measures of health states based on structured questionnaires or scales, and qualitative studies. Guideline panels used the relative importance of outcomes based on values and preferences to weigh the balance of desirable and undesirable consequences of alternative intervention options. However, we found few studies addressing local values and preferences. Conclusions: Currently there are different but no firmly established processes for integrating patient values and preferences in healthcare decision-making of practice guideline development. With GRADE Evidence-to-Decision (EtD) frameworks, we provide an empirical strategy to find and incorporate values and preferences in guidelines by performing systematic reviews and eliciting information from guideline panel members and patient representatives. However, more research and practical guidance are needed on how to search for relevant studies and grey literature, assess the certainty of this evidence, and best summarize and present the findings