PubMed Health⌕ Search

Biomedical subjects

M Dixon-Woods

Publications and source records attributed to M Dixon-Woods.

At least 19 recordsLinked to original sources
PubMed2006

Why is compliance with occlusion therapy for amblyopia so hard? A qualitative study.

OBJECTIVE: To explore parents' perceptions and experiences of occlusion (patching) therapy for treatment of amblyopia in children. METHODS: Qualitative study involving semistructured interviews with 25 families of a child with amblyopia being treated at a specialist clinic. Interviews were tape recorded and transcribed verbatim. Data analysis was based on the constant comparative method, assisted by qualitative analysis software. RESULTS: Parents of children prescribed patching treatment found themselves obliged to manage the treatment. This involved dilemmas and tensions, with many parents describing children's distress, particularly in the early stages of patching treatment. Parents were highly sensitive to the credibility of the treatment, but were sometimes confused by information given in the clinic or did not see clinic staff as authoritative. There was evidence that parents were likely to abandon or modify treatment if no improvement could be detected or if the child continued to suffer socially or educationally. Parents described a range of strategies for facilitating patching, including explanation; normalisation; rewards; customising the patch; establishing a routine; and enlisting the help of others. Whatever their practices in relation to patching, parents were keen to defend their behaviour as that of a "good parent". CONCLUSIONS: Interventions that aim to improve compliance should take account of the difficulties and tensions experienced by parents, rather than simply treating non-compliance as resulting from information deficits. Practical support that builds on strategies described by parents is likely to be of benefit.

Adaptation, Psychological↗
PubMed2006

Practices and views on fetal heart monitoring: a structured observation and interview study.

OBJECTIVE: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. DESIGN: Qualitative study. SETTING: Large teaching hospital in the UK. SAMPLE: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. METHODS: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. MAIN OUTCOME MEASURES: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. RESULTS: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. CONCLUSION: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution.

Attitude of Health Personnel↗
PubMed2006

Referral and attendance at a specialist antenatal clinic: qualitative study of women's views.

OBJECTIVE: To explore women's views on being referred to and attending a specialist antenatal hypertension clinic. DESIGN: Qualitative interview study. SETTING: A pregnancy hypertension clinic in a large teaching hospital in the East Midlands. POPULATION: Twenty-one women (aged 18 years and above) attending the pregnancy hypertension clinic for the first time during their current pregnancy. METHODS: Women who had been referred to and attended a specialist antenatal clinic participated in semi-structured interviews. Data analysis was based on the constant comparative method. MAIN OUTCOME MEASURES: Women's experiences and perceptions of being referred to and attending a specialist antenatal clinic. RESULTS: Being referred to the clinic conferred an 'at risk' status on women. Some women welcomed the referral but others experienced it as unsettling. Many were unclear about why they had been identified as being at risk or had difficulties in accepting the legitimacy of the reason for referral. Women were often inadequately informed about why they were referred to the clinic, what they could expect and the benefits of attending the clinic over management in the community. Although attendance at the clinic was cited as a source of reassurance, the reassurance was often made necessary by concern raised by the initial referral. CONCLUSIONS: Women's accounts suggest that the interface between community and secondary antenatal services needs improvement to minimise possible adverse effects from identifying women as being 'at risk' during pregnancy.

Adolescent↗
PubMed2006

Consistency in decision making by research ethics committees: a controlled comparison.

There has been longstanding interest in the consistency of decisions made by research ethics committees (RECs) in the UK, but most of the evidence has come from single studies submitted to multiple committees. A systematic comparison was carried out of the decisions made on 18 purposively selected applications, each of which was reviewed independently by three different RECs in a single strategic health authority. Decisions on 11 applications were consistent, but disparities were found among RECs on decisions on seven applications. An analysis of the agreement between decisions of RECs yielded an overall measure of agreement of kappa = 0.286 (95% confidence interval -0.06 to 0.73), indicating a level of agreement that, although probably better than chance, may be described as "slight". The small sample size limits the robustness of these findings. Further research on reasons for inconsistencies in decision making between RECs, and on the importance of such inconsistencies for a range of arguments, is needed.

Decision Making↗
PubMed2006

Participating in a trial in a critical situation: a qualitative study in pregnancy.

BACKGROUND: Randomised controlled trials of interventions in critical situations are necessary to establish safety and evaluate outcomes. Pregnant women have been identified as a potentially vulnerable population. OBJECTIVE: To explore women's experiences of being recruited to ORACLE, a randomised controlled trial of antibiotics in pre-term labour. METHODS: Twenty qualitative interviews were conducted with women who had participated in ORACLE. Analysis was based on the constant comparative method. RESULTS: Women gave prominence to the socioemotional aspects of their interactions with healthcare professionals in making decisions on trial participation. Comments on the quality of written and spoken information were generally favourable, but women's accounts suggest that the stressful nature of the situation affected their ability to absorb the information. Women generally had poor understanding of trial design and practices. The main motivation for trial participation was the possibility of an improved outcome for the baby. The second and less prominent motivation was the opportunity to help others, but this was conditional on there being no risks associated with trial participation. In judging the risks of participation, women seemed to draw on "common sense" understandings including a perception that antibiotics were risk free. DISCUSSION: Recruitment to trials in critical situations raises important questions. Future studies should explore how rigorous governance arrangements for trials, particularly in critical situations, can protect participants rather than relying on ideals of informed consent that may be impossible to achieve. Future research should include a focus on interactions between research candidates and professionals involved in recruitment.

Antibiotic Prophylaxis↗
PubMed2006

Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh.

OBJECTIVE: To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms. DESIGN: Mixed methods qualitative study. SETTING: Large government medical college hospital in Bangladesh. SAMPLE: Providers and users of EmOC. METHODS: Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers. RESULTS: Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal "poor fund" system to help the poorest women. There was no formal assessment of poverty; rather, doctors made "adjudications" of women's need for support based on severity of condition and presence of friends and relatives. Limited resources led to a "wait and see" policy that meant women's condition could deteriorate before help was provided. CONCLUSIONS: Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment. Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity.

Academic Medical Centers↗
PubMed2004

The problem of appraising qualitative research.

Qualitative research can make a valuable contribution to the study of quality and safety in health care. Sound ways of appraising qualitative research are needed, but currently there are many different proposals with few signs of an emerging consensus. One problem has been the tendency to treat qualitative research as a unified field. We distinguish universal features of quality from those specific to methodology and offer a set of minimally prescriptive prompts to assist with the assessment of generic features of qualitative research. In using these, account will need to be taken of the particular method of data collection and methodological approach being used. There may be a need for appraisal criteria suited to the different methods of qualitative data collection and to different methodological approaches. These more specific criteria would help to distinguish fatal flaws from more minor errors in the design, conduct, and reporting of qualitative research. There will be difficulties in doing this because some aspects of qualitative research, particularly those relating to quality of insight and interpretation, will remain difficult to appraise and will rely largely on subjective judgement.

Consensus↗
PubMed2004

Women's accounts of consenting to surgery: is consent a quality problem?

BACKGROUND: Consent has been placed at the centre of doctor-patient relationships. Attempts to improve the consent process in medicine have drawn on bioethical and legal traditions. Current approaches to consent emphasise the provision of information and have, in the UK, resulted in a single standardised format and process for both elective and emergency situations. Investigation of patients' perceptions and priorities are important in understanding the quality of the consent process. METHODS: In this qualitative study, semi-structured interviews were conducted with 25 women. Eleven had elective and 14 had emergency operations in obstetrics and gynaecology. All interviews were recorded and transcribed verbatim. Data analysis was based on the constant comparative method. RESULTS: Participants' perceptions of surgery strongly influenced the meanings they gave to consent. Some, particularly those undergoing elective operations, wanted surgery. Others were uncertain of their desire for surgery or felt that it was imposed on them. Consenting was interpreted as a ritualistic legal procedure. There was an overwhelming tendency to view consent as not primarily serving patients' needs, although some advantages of the consent process were identified. Accounts made no reference to ethics. CONCLUSION: Countering paternalism will remain difficult to achieve if issues surrounding consent continue to be debated between professionals without due effort to reflect patients' own views and values and to appreciate the circumstances under which consent is sought.

Adult↗
PubMed2002

Childhood cancer and users' views: a critical perspective.

The understanding of users' views of childhood cancer services has been hampered by several important problems. First, this area has been dominated by the tradition of psycho-oncology, with its overly narrow focus on the psychopathological sequelae of chronic childhood illness. Second, a set of inappropriate and undertheorized assumptions has prevailed about the nature of childhood and children's experiences of illness and children's ability to articulate and report on these. Third, the roles, responsibilities and experiences of parents of children with cancer have been unhelpfully conceptualized and underinvestigated. Finally, there has been a lack of suitable methods for making progress with empirical research in this area. In this paper, we argue that interpretive perspectives and associated methods can offer much to those seeking more insightful and better-informed approaches to the views of users of childhood cancer services. We offer some specific examples of where such approaches have already demonstrated considerable promise, showing, for example, that the parenting role is distinctive and should not be assumed to be interchangeable, theoretically or practically, with that of a carer. We conclude by identifying areas where both empirical research and theoretical development are needed.

Adaptation, Psychological↗
PubMed2002

Parents' accounts of wheeze and asthma related symptoms: a qualitative study.

AIMS: To examine parents' accounts of how they recognise and judge respiratory symptoms in children, and to investigate their interpretations of respiratory survey questions about wheeze, shortness of breath, and cough. METHODS: Qualitative study using semistructured interviews. Data were analysed using the constant comparative method. Nineteen parents of children aged under 6 years were recruited from a cohort of parents who had responded to an earlier respiratory symptom survey and from one general practice. RESULTS: Parents judged respiratory symptoms using a range of cues, including changes in the sound of breathing and changes in appearance and behaviour. Experiential resources and contextual factors played an important role in parents' judgements. Interpretations of questions about respiratory symptoms were varied, particularly in relation to the terms "attacks of wheeze" and "shortness of breath". Parents' descriptions of wheeze differed from descriptions of the sound of wheeze used in some survey questionnaires. Parents drew fine distinctions between different "types" of cough and identified a distinct "asthma" cough. CONCLUSIONS: Attention needs to be given to the complexity of reporting respiratory symptoms in children and to the importance of contextual factors in parents' judgements. We suggest that questions which require parents to report on children's internal feelings or states be avoided. Consideration should be given to providing parents with explicit direction on what cues to attend to or ignore in reporting symptoms, and to clarifying some questions that are currently used in clinical practice and in surveys.

Asthma↗
PubMed2001

Parents' accounts of obtaining a diagnosis of childhood cancer.

BACKGROUND: Quick diagnosis and treatment of cancers is a UK government priority. However, the process of arriving at a diagnosis of childhood cancer has been neglected in comparison with the attention given to cancers in adults. We investigated parents' narratives about the period before their child's diagnosis. METHODS: We undertook semistructured interviews with 20 parents whose children (aged 4-18 years) had a confirmed diagnosis of cancer or brain tumour. All interviews were recorded and fully transcribed. Dates of consultations and investigations were noted from children's medical records. Data were analysed by the constant comparison method. FINDINGS: The time before diagnosis is very significant for parents and might affect their adaptation and reaction to their child's diagnosis. Parents were first alerted to their child's illness by a range of signs and symptoms, and by behavioural and affective changes. These early symptoms were often vague, non-specific, and common, and some older children were reluctant to disclose symptoms. Ten families' accounts of this period before diagnosis included a dispute with doctors. Disagreements between parents and doctors about the seriousness of children's symptoms and the need for investigations occurred in both primary and secondary care. Some parents felt that doctors discounted their special knowledge of their child. INTERPRETATION: Parents' accounts offer valuable insights into their experiences of obtaining a diagnosis of childhood cancer and into possible sources of delays in this complex process. If delays are to be avoided or reduced, attention must be given to the different roles of parents, children, general practitioners, hospital specialists, and type of cancer. Our findings have important implications for policy, practice, and research, and for the management of childhood illnesses.

Adolescent↗
PubMed2001

Writing wrongs? An analysis of published discourses about the use of patient information leaflets.

Much has been written about how to communicate with patients, but there has been little critical scrutiny of this literature. This paper presents an analysis of publications about the use of patient information leaflets. It suggests that two discourses can be distinguished in this literature. The first of these is the larger of the two. It reflects traditional biomedical concerns and it invokes a mechanistic model of communication in which patients are characterised as passive and open to manipulation in the interests of a biomedical agenda. The persistence of the biomedical model in this discourse is contrasted with the second discourse, which is smaller and more recent in origin. This second discourse draws on a political agenda of patient empowerment, and reflects this in its choice of outcomes of interest, its concern with the use of leaflets as a means of democratisation, and its orientation towards patients. It is suggested that the two discourses, though distinct, are not entirely discrete, and may begin to draw closer as they begin to draw on a wider set of resources, including sociological research and theory, to develop a rigorous theoretically grounded approach to patient information leaflets.

Bibliometrics↗
PubMed2001

Including qualitative research in systematic reviews: opportunities and problems.

Qualitative research has been increasingly recognized in recent years as having a distinctive and important contribution to make to health care research. It is capable of being used as a methodologically sufficient approach in its own right, as a precursor to quantitative studies, during or after trials to explain processes and outcomes, and as a means of enhancing the link between evidence and practice. However, qualitative research has been little used as an evidence resource for systematic reviews. We argue that formal synthesis of both qualitative and quantitative forms of research is essential, and we discuss some of the problems that need to be overcome in carrying out such syntheses. These include methodological prejudice, problems in searching for qualitative evidence, and issues in synthesizing qualitative data. We call for progress to be made on the science and methods of including qualitative research in the evidence base of medicine.

Evidence-Based Medicine↗
PubMed2001

Choosing and using services for sexual health: a qualitative study of women's views.

OBJECTIVE: To explore women's accounts of choosing and using specialist services for sexual health. METHODS: A qualitative study involving semistructured interviews with 37 women screened for Chlamydia trachomatis attending genitourinary medicine and family planning clinics in an East Midlands health authority. RESULTS: In making the decision to seek help, women act on a range of specific prompts, including lay ideas about the significance of symptoms; their own behaviour; their partner's symptoms or behaviour; contact tracing; and health promotion. Some women do not seek help specifically in relation to sexual health but are identified as being at risk of sexually transmitted infections (STIs) during routine consultations. Important influences on women's choice of services include the lay referral system, "insider" knowledge of health services, referral by health professionals, and need to have alternatives to general practice care. Women's willingness to access services is mediated by psychosocial factors such as embarrassment. They may use smear tests as a legitimate opportunity to raise questions about sexual health. Women's priorities for services are that their feelings of stigma and embarrassment are managed appropriately; that staff communicate well and are sensitive to their emotions and comfort during tests and procedures; that they are "in control" when obtaining test results; and that confidentiality is preserved. CONCLUSIONS: A detailed understanding of both lay people's response to symptoms or behaviour that indicates risk of an STI and their needs when using services should inform interventions aimed at encouraging secondary prevention of STIs.

Adolescent↗