Therapeutic landscapes: an evolving theme.
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Diffusion of Innovation↗
Biomedical subjects
W Gesler
Publications and source records attributed to W Gesler.
Approaches to sampling and case selection in qualitative research: examples in the geography of health.
This paper focuses on the question of sampling (or selection of cases) in qualitative research. Although the literature includes some very useful discussions of qualitative sampling strategies, the question of sampling often seems to receive less attention in methodological discussion than questions of how data is collected or is analysed. Decisions about sampling are likely to be important in many qualitative studies (although it may not be an issue in some research). There are varying accounts of the principles applicable to sampling or case selection. Those who espouse 'theoretical sampling', based on a 'grounded theory' approach, are in some ways opposed to those who promote forms of 'purposive sampling' suitable for research informed by an existing body of social theory. Diversity also results from the many different methods for drawing purposive samples which are applicable to qualitative research. We explore the value of a framework suggested by Miles and Huberman [Miles, M., Huberman,, A., 1994. Qualitative Data Analysis, Sage, London.], to evaluate the sampling strategies employed in three examples of research by the authors. Our examples comprise three studies which respectively involve selection of: 'healing places'; rural places which incorporated national anti-malarial policies; young male interviewees, identified as either chronically ill or disabled. The examples are used to show how in these three studies the (sometimes conflicting) requirements of the different criteria were resolved, as well as the potential and constraints placed on the research by the selection decisions which were made. We also consider how far the criteria Miles and Huberman suggest seem helpful for planning 'sample' selection in qualitative research.
Chronic Disease↗
Physical access to primary health care in Andean Bolivia.
Limited physical access to primary health care is a major factor contributing to the poor health of populations in developing countries, particularly in mountain areas with rugged topography, harsh climates and extensive socioeconomic barriers. Assessing physical access to primary health care is an important exercise for health care planners and policy makers. The development of geographic information system (GIS) technology has greatly improved this assessment process in industrialized countries where digital cartographic data are widely available. In developing countries particularly in mountain areas, however, detailed cartographic data, even in hardcopy form, are nonexistent, inaccurate or severely lacking. This paper uses GIS technology to assess physical access to primary health care in a remote and impoverished region of Andean Bolivia. In addition, it proposes an alternative model of health personnel distribution to maximize physical accessibility. Methods involved extensive fieldwork in the region, utilizing GPS (global positioning system) technology in the development of the GIS and gathering other pertinent health data for the study. Satellite imagery also contributed to the development of the GIS and in the modeling process. The results indicate significant variation in physical access to primary health care across the three study sites. More importantly, this paper highlights the use of GIS technology as a powerful tool in improving physical accessibility in mountain areas of developing countries.
Bolivia↗
Hans Castorp's journey-to-knowledge of disease and health in Thomas Mann's The Magic Mountain.
The paper examines Thomas Mann's novel, The Magic Mountain, to show how imaginative literature can enhance our understanding of health in place. The story centers on the experiences of Hans Castorp, a young bourgeois German, at a tuberculosis sanatorium in the Swiss Alps. Three themes are examined: (1) how knowledge about illness and health, death and life, is gained; (2) how knowledge is arrived at through a dialectical process which reconciles seeming opposites; and(3) how new knowledge is gained through making transitions. Lessons for health geography are drawn from analysis of the three themes.
Adaptation, Psychological↗
An introduction to three studies of rural elderly people: effects of religion and culture on health.
The paper introduces three empirical studies which relate the religious beliefs and practices or rural older adults from different ethnic groups to their health behaviors. It briefly describes the rationale for the studies and their main components, including their aims, study sites, study populations, methods used, and their principal findings. Then it discusses two primary themes which run through all the papers, namely rurality and cross-cultural comparisons. Finally, several secondary themes are discussed, including the importance of place, types of analysis, variable definition, causal relationships among variables, types of healing, locus of control, discourses about religion and health, and the religion and health connection.
Journal Article↗
The uses of spatial analysis in medical geography: a review.
This paper is a review of how geographers and others have used spatial analysis to study disease and health care delivery patterns. Point, line, area and surface patterns, as well as map comparisons and relative spaces are discussed. Problems encountered in applying spatial analytic techniques in medical geography are pointed out. The paper is intended to stimulate discussion about where medical geography can and should go in this area of study. Point pattern techniques include standard distance, standard deviational ellipses, gradient analysis and space and space-time clustering. Line methods include random walks, vectors and graph theory or network analysis. Under areas, location quotients, standardized mortality ratios, Poisson probabilities, space and space-time clustering, autocorrelation measures and hierarchical clustering are discussed. Surface techniques mentioned are isolines and trend surfaces. For map comparisons, Lorenz curves, coefficients of areal correspondence and correlation coefficients have been used. Case-control matching, acquaintance networks, multidimensional scaling and cluster analysis are examples of methods that are based on relative or non-metric spaces. The review gives rise to the discussion of several general points: problems encountered in spatial analysis, theory building and verification, the appropriate role of technique and computer use. Some suggestions are made for further use of spatial analytic techniques in medical geography: Monte Carlo simulation of point patterns, network analysis to study referral systems and health care for pastoralists, geographic information systems to assess environmental risk, difference mapping for disease and risk factor map comparisons and multidimensional scaling to measure social distance.
Cross-Sectional Studies↗
Updated feasibility trial experience with the Viaderm percutaneous access device.
The percutaneous access device (PAD) is used to connect an external drive unit to the Kantrowitz CardioVad (KCV), a cardiac assist device for the treatment of chronic heart failure. The PAD conveys pneumatic power from a drive unit to the implanted blood pump and an electrocardiogram signal from the myocardium to the drive unit. The device-tissue interface of the PAD is precoated with autologous fibroblasts cultured from a skin sample of the intended recipient. This preparation demonstrated long-term stability in animals and was adopted for use in patients receiving the KCV. The KCV is activated intermittently, and the drive unit may be connected and disconnected by the patient, which subjects the PAD to frequent manipulation. To date, the PAD has been implanted in nine patients ranging in age from 41 to 74 years. Implant times ranged from 2 to 458 days, for a total of 1082 days, of which 557 days were in an outpatient setting. Two patients experienced episodes of infection that did not originate from the PAD-tissue interface. This feasibility study demonstrated that (1) the PAD is stable and infection resistant in long-term ambulatory patients, (2) the PAD withstood the challenge of daily manipulation (the KCV is turned on and off electively), and (3) PADs can be replaced, if necessary.
Adult↗