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Julie Barroso

Publications and source records attributed to Julie Barroso.

At least 19 recordsLinked to original sources

Comparability work and the management of difference in research synthesis studies.

The new imperative to be more methodologically inclusive has generated a burgeoning interest in synthesizing the findings of qualitative and quantitative studies, or mixed research synthesis. Yet, the very diversity seen to define the mixed research synthesis enterprise is also considered to defy it as it intensifies the problem of comparing the seemingly incomparable to enable the combination of the seemingly uncombinable. We propose here that the research synthesis enterprise, in general, and the mixed research synthesis enterprise, in particular, entail comparability work whereby reviewers impose similarity and difference on the studies to be reviewed. The very study diversity requiring management does not exist a priori but rather is itself an outcome of comparability work already done whereby judgments have been made about what constitutes methodological and topical diversity and uniformity. Conceiving the research synthesis process as defined by comparability work moves the backstage interpretive work of systematic review to center stage and, thereby, sets a new stage for addressing the methodological issues involved. These issues are explored by reference to the synthesis of empirical studies of antiretroviral adherence in HIV-positive women in the US.

Evidence-Based Medicine↗

Research results have expiration dates: ensuring timely systematic reviews.

Time and timeliness are key issues in appraising and ensuring the clinical relevance of systematic reviews. Time considerations entering the systematic review process include the history of the clinical problem, disease, or treatment that is the target of the review, and the history of the research conducted to address it. These considerations guide: (i) formulation of the research problems and questions; (ii) setting of parameters for the search and retrieval of studies; (iii) determination of inclusion and exclusion criteria; (iv) appraisal of the clinical relevance of findings; (v) selection of the findings that will be synthesized; and (vi) interpretation of the results of that synthesis.

Humans↗

From synthesis to script: transforming qualitative research findings for use in practice.

Although qualitative research synthesis has secured a place in the evidence-based practice movement, little effort has as yet been directed toward translating the results into material form for practice. The authors transformed a qualitative research synthesis of findings pertaining to stigma in HIV-positive women into a script and DVD. The process of transformation entailed bringing together the norms and imperatives of scientific research, clinical practice, and artistic presentation.

Adaptation, Psychological↗

Changes in neuropsychological functioning with progression of HIV-1 infection: results of an 8-year longitudinal investigation.

Despite the advent of more effective treatments for HIV-1 infection, cognitive impairment is still frequent and questions remain regarding which areas of impairment are more common in the different disease stages. This study investigated cognitive performance over an 8-year period of time in 59 HIV-1 seropositive (HIV-1+) men who were clinically asymptomatic at study entry, in comparison to a cohort of 55 HIV-1 seronegative (HIV-1-) men. Every 6 months we examined cognitive functioning in 5 domains-fine motor speed, attention, verbal memory, executive functioning, and speed of information processing. We found that patients with AIDS scored significantly worse on fine motor speed and speed of information processing than HIV-1- individuals and the HIV-1+ non-AIDS patients. In addition, the HIV-1+ non-AIDS patients performed more poorly than the HIV-1- group on speed of information processing. Depressive symptoms were also associated with diminished performance on measures of attention, executive functioning, and speed of information processing. Further research is needed to examine the effects of disease stage and depression on cognitive impairment in the era of new HIV treatments.

AIDS Dementia Complex↗

Stigma in HIV-positive women.

PURPOSE: To present a metasynthesis of qualitative findings on stigma in HIV-positive women. METHOD: Metasummary and metasynthesis techniques were used to integrate findings on stigma in 93 reports of qualitative studies conducted between 1991 and 2002 with a total of 1,780 women, mostly from minority groups. FINDINGS: Both perceived and enacted stigma were pervasive in the lives of HIV-positive women. HIV-related stigma was intensified in women because they were women. Stigma management largely involved efforts to control information in the service of preserving social relations and maintaining moral identity. DISCUSSION: This metasynthesis reprises and clarifies the connections between recurring themes in primary quantitative studies and metastudies of HIV-positive people and of stigmatizing diseases and conditions. This work also shows how affected people's location on key axes of difference can both facilitate and complicate efforts to manage stigma. CONCLUSIONS: HIV-positive women experience stigmatization in relationships with others. HIV-related stigma is as much a reflection of these others as it is central to the experience of HIV-positive people themselves. Even those not infected with HIV are still affected by it and are thus appropriate targets for interventions to reduce its negative effects.

Adaptation, Psychological↗

Toward a metasynthesis of qualitative findings on motherhood in HIV-positive women.

A qualitative metasynthesis of qualitative findings ought to be more than a mere summary of those findings. Yet the processes by which the interpretive innovation expected of qualitative metasynthesis projects can be achieved remain opaque. Several analytic devices for the metasynthesis of findings were clarified in the course of an ongoing methodological project involving 45 reports of qualitative studies of HIV-positive women. These devices include the creation of a taxonomy of findings, the explicit use of sustained comparisons, the translation of in vivo concepts, and the use of imported concepts. Any qualitative metasynthesis of findings constitutes an interpretation at least three times removed from the lives represented in them. Clarifying the analytic devices used to create such metasyntheses is essential to demonstrating that despite being far away from participants' lives, these interpretations remain close to them.

Female↗

Motherhood in the context of maternal HIV infection.

Metasummary and metasynthesis techniques were used to integrate findings pertaining to motherhood in 56 reports of qualitative studies conducted with HIV-positive women. Motherhood in the context of maternal HIV infection entailed work directed toward the illness itself and the social consequences of having HIV infection in the service of two primary goals: the protection of children from HIV infection and HIV-related stigma and the preservation of a positive maternal identity. Motherhood both intensified and mitigated the negative physical and social effects of HIV infection. HIV-positive mothers engaged in a distinctive kind of maternal practice-virtual motherhood-to resist forces that disrupted their relationships with and ability to care for their children, as well as their identities as mothers.

Chronic Disease↗

The challenges of searching for and retrieving qualitative studies.

The authors' purpose in this article is to report the results of their search and retrieval efforts to date in an ongoing study to develop the procedural, analytic, and interpretive techniques to conduct qualitative meta-synthesis projects, using studies on women with HIV infection as the method case. For researchers conducting qualitative meta-synthesis projects, the ideal goal is to retrieve all of the relevant studies in a field--not simply a sample of them. Bates's model of berrypicking is used as the framework to describe the techniques used to conduct these searches. The authors discuss, in particular, the challenges of working with bibliographic databases, including choosing which databases to search, learning about the idiosyncrasies of working with each database, developing a list of search terms, and refining inclusion criteria regarding which studies to include in the meta-synthesis. Recommendations are given for searchers and writers of qualitative research.

Databases, Factual↗

Writing the proposal for a qualitative research methodology project.

Writing the proposal for a qualitative research methodology study is a double challenge because of the emergent nature of qualitative research design and because a methodology study entails describing a process to produce a process. How the authors addressed this challenge is shown in the annotated text of the grant proposal--"Analytic Techniques for Qualitative Metasynthesis"--funded by the National Institute of Nursing Research. Appealing qualitative research proposals adhere to principles that engage writers and readers in an informative and mutually respectful interaction.

Clinical Protocols↗

Classifying the findings in qualitative studies.

A key task in conducting research integration studies is determining what features to account for in the research reports eligible for inclusion. In the course of a methodological project, the authors found a remarkable uniformity in the way findings were produced and presented, no matter what the stated or implied frame of reference or method. They describe a typology of findings, which they developed to bypass the discrepancy between method claims and the actual use of methods, and efforts to ascertain its utility and reliability. The authors propose that the findings in journal reports of qualitative studies in the health domain can be classified on a continuum of data transformation as no finding, topical survey, thematic survey, conceptual/thematic description, or interpretive explanation.

Data Interpretation, Statistical↗

Physiological and psychological markers associated with HIV-related fatigue.

Fatigue is among the most common and debilitating complaints of HIV-positive individuals. These data are part of a larger exploratory study investigating the relationships of selected psychological and physiological factors among 40 participants with HIV-related fatigue. Fatigue severity was measured using the HIV-Related Fatigue Scale. Fatigue was correlated with depression (r = .40, p < .01), state anxiety (r = .40, p <.01), and trait anxiety (r = .46, p <.01). Of the physiological factors, there were three statistically significant correlations: thyroid-stimulating hormone was negatively correlated with fatigue severity (r = -.36, p = .02), and platelets (r = .35, p = .03) and alkaline phosphatase (r = .27, p = .09) were positively correlated with fatigue severity. There were no correlations between fatigue severity and CD4 count (r = -.16, p = .31) or fatigue severity and HIV viral load levels (r = .031, p = .84). Even among the group with excellent viral suppression, fatigue scores were still very high for many participants.

Adult↗

HIV-related fatigue.

Explore the source record for details and available documents.

Activities of Daily Living↗

Finding the findings in qualitative studies.

PURPOSE: To describe the challenges of finding the findings in qualitative studies. METHOD: Review of literature on representation in qualitative research and analysis of 99 reports of qualitative studies of women with HIV infection. FINDINGS: Factors complicating finding the findings in qualitative studies include varied reporting styles, misrepresentation of data and analytic procedures as findings, misuse of quotes and theory, and lack of clarity concerning pattern and theme. Theses and dissertations present special challenges because they often contain several of these problems. CONCLUSIONS: Given the varied beliefs about findings among qualitative researchers, the challenge is to find ways to present findings that will make them discernible to the diverse audiences for whom they are intended, including researchers and practitioners.

Data Interpretation, Statistical↗

Bioimpedance analysis and HIV-related fatigue.

Although various physiological and psychological causes of fatigue in HIV-positive persons have been proposed, it is still not well understood. Bioimpedance analysis has proved to be an easily used, non-invasive measurement of body composition and cellular integrity. This study, looking at whether body composition as measured by bioimpedance analysis is associated with fatigue, is part of a pilot study looking for physiological and psychological biomarkers that could be factors in the fatigue experienced by HIV-positive people. Twenty-nine men and eleven women were measured for height, weight, and bioimpedance analysis. Correlations were examined between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, extracellular mass, and phase angle. Because of the fat redistribution that has occurred with some people taking protease inhibitors, we also examined differences in weight, body mass index, body cell mass, fat-free mass, and fatigue intensity between those taking and those not taking protease inhibitors. There was no association between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, or phase angle, nor were there differences between those taking and those not taking protease inhibitors. However, it was noted that both the phase angle and the ratio of extracellular mass to body cell mass (extracellular mass:body cell mass) were below their respective normal ranges, indicating that the participants were somewhat compromised nutritionally and with regard to cell membrane integrity. Although fatigue was not shown to be related to body composition measurement in this study, further work is needed on the causes of fatigue, because its effects on the lives of HIV-positive people can be devastating.

Activities of Daily Living↗

Salivary cortisol values in HIV-positive people.

Fatigue is one of the most prevalent and troubling symptoms suffered by people with HIV infection. As part of a pilot study to examine physiological and psychosocial correlates of fatigue, the authors report results from a sample of 40 HIV-positive men and women who collected three saliva samples each over the course of a day. Few in the sample exhibited the normal salivary cortisol slope (a peak in the morning and falling throughout the day). There were four groups (N = 36) based on salivary cortisol plots: a normal downward trend (n = 7), an afternoon peak (n = 15), an afternoon drop (n = 9), and an upward trend (n = 5). The data in each of these groups were then analyzed on the key variables of sex, age, depression, state/trait anxiety, fatigue severity, CD4 count, and HIV viral load; the group that had an upward trend in cortisol values had a tendency toward more depression, more state and trait anxiety, higher fatigue severity, and higher HIV viral load. However, they also trended toward higher CD4 counts than the other three groups. The need to compare additional variables over a period of time is discussed.

Adult↗

Psychometric properties of the HIV-Related Fatigue Scale.

The HIV-Related Fatigue Scale (HRFS) was developed to address the specific aspects of fatigue experienced by people who are HIV-positive and are not measured in any commonly used fatigue scale. The necessity for a new scale was determined after analysis of a qualitative study to explore HIV-related fatigue in which it was found that HIV-related fatigue has components related to intensity, circumstances, and consequences that must be included in the measurement of fatigue for this population. The HRFS has 56 items, most of which are on a 1-to-10 scale, drawn from five existing fatigue scales and the data from this qualitative study. The items were deemed content valid, easy to understand, and not fatiguing to complete by people with HIV-related fatigue. Cronbach's alpha for the entire tool was .94; internal consistency for each of the three preliminary subscales is reported as well. Test-retest reliability was moderate at r = .43. Further testing needs to be done, but the HRFS has the potential to be a valuable addition to the measurement of fatigue in seropositive persons.

Activities of Daily Living↗

Delayed pursuit of health care among HIV-positive gay men enrolled in a longitudinal research study.

The aim of this qualitative article is to describe the reasons HIV-positive gay men who are enrolled in a longitudinal research project give for not initiating health care. Extreme sampling techniques were used to recruit four HIV-positive gay men who are enrolled in a research project that is examining factors related to disease progression in HIV infection but who do not otherwise receive any health care. Intensive, open-ended interviews were conducted, and the interviews were analyzed for recurring themes. Results indicate that the participants did not have an accurate perception of health care and therefore were hesitant in seeking health care. Part of this hesitation involved their strong reluctance to begin antiretroviral therapy. Enrollment in a longitudinal study allowed the participants to have some monitoring of their HIV infection. However, not having a primary care provider resulted in a lack of preparedness when they encountered changes in their health status. The end result of this process was progression in their HIV disease. Implications for clinicians and researchers are discussed.

Attitude of Health Personnel↗