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PubMed2004

Does harm reduction programming make a difference in the lives of highly marginalized, at-risk drug users?

Harm reduction is a controversial model for treating drug users, with little formal research available on its operation and effectiveness. In order to advance the field, we first conducted participatory research of harm reduction with 120 clients using nominal-group technique to develop culturally relevant outcomes to measure progress. Second, we conducted focus group interviews with a different group of clients to help validate the outcomes. Third, we used the outcomes in an evaluation of the largest harm reduction program in New York City, which involved a representative sample of 261 and entailed baseline, post, and six follow-up assessments. The participatory research resulted in outcomes of 10 life areas important to drug users. Evaluation results showed that program participants made positive improvements across most outcomes, with the most substantial progress made in how clients dealt with drug-use problems. Along with their participation in the program, progress in some outcomes was also associated with clients' type of drug use (i.e., stable vs. chaotic), where more stable drug use was associated with better ways of making an income and types of housing. Surprisingly, progress was not associated with the kinds or numbers of services received or the length of time in the program. This was attributed to the service delivery model of harm reduction, in which clients are less inclined to associate their success with a single staff person or with a single service or intervention received than with the program as a whole.

Journal Article↗
PubMed2006

[Mothers' experience of caregiving for their children with schizophrenia].

PURPOSE: The purpose of this study was to explore Korean mothers' experiences of caregiving for their adult children with schizophrenia. METHOD: A iterative descriptive qualitative research design was used to understand and explain the caregiving experience from the perspective of mothers. The data were collected by individual in-depth interviews and one focus group interview from 11 mothers. The ages of the participants ranged from 50 to 60 years old and the ages of their sick children ranged from late 20s to early 40s. RESULTS: Three major themes were identified from qualitative thematic analysis: (a) "emotional debris from the disease," (b) "the disease that makes mothers dumb" (c) "space of rational reason." CONCLUSIONS: This study would provide health care professionals insights in establishing intervention for mothers by deeply understanding the process of recognition and acceptance of their children with schizophrenia.

Adult↗
PubMed1997

Professional nurses knowledge and understanding of AIDS/HIV infection.

This study examined professional nurses' knowledge and understanding of AIDS/HIV infection. The sample was formed by 53 professional nurses; 27 being those that have done the AIDS counselling course (trained counsellors) and 26 who have not done the course. This sample was randomly chosen from a population of 192 professional nurses representing all departments. Questionnaires were sent to the participants and focus group interviews formed by a group of 21 participants, were done to elicit any information that may not have been obtained through the use of a questionnaire. The results showed good knowledge of general information which included the mode of spread of infection. Lack of knowledge in identification of high risk groups, symptoms, diagnostic tests and use of universal precautions in specific areas was identified.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Strategies to improve the performance of learners in a nursing college. Part I: Issues pertaining to nursing education.

The aim of this contextual, exploratory, descriptive and qualitative study was to describe strategies to improve the performance of learners in a nursing college. The article seeks to deal with factors relating to nursing education that contribute to the poor performance of learners and to outline related strategies to improve the situation. Three focus group interviews were conducted. One group was formed by seven tutors, and the other two groups were formed by fourth-year learners following a four-year comprehensive diploma course. All participants voluntarily took part in the study. Data was analyzed using the descriptive method of open coding by Tesch (in Creswell, 1994:154-156). Trustworthiness was ensured in accordance with Lincoln and Guba's (1985:290-326) principles of credibility, conformability, transferability and dependability. The findings were categorized into issues pertaining to nursing education as follows: curriculum overload; lack of theory and practice integration; teaching and assessment methods that do not promote critical thinking; tutors' lack of skills and experience; inadequate preparation of tutors for lectures; insufficient knowledge of tutors regarding outcomes-based education approach to teaching and learning; inadequate process of remedial teaching; discrepancies between tutors' marking; lack of clinical role-models and high expectations from the affiliated university as regards standards of nursing development programme by the staff development committee of the nursing college under study for implementation. Future research should focus on the effectiveness of the described strategies to improve the learners' performance. It is also recommended that similar studies be conducted or replicated in other nursing colleges to address the problem of poor performance of learners engaged in a four-year comprehensive diploma course.

Curriculum↗
PubMed1999

Perceived barriers and recommendations concerning hormone replacement therapy counseling among primary care providers.

OBJECTIVE: To increase our understanding of the factors that impede or promote counseling about hormone replacement therapy, we asked clinicians to provide information concerning barriers and strategies to promote counseling. DESIGN: We asked clinicians to consider two different scenarios: (1) what they do in they current practice and (2) what they would do if their health care systems implemented the United States Preventive Services Task Force recommendation regarding hormone replacement therapy counseling. A total of 49 of 50 invited clinicians participated in one of six focus group interviews (three women's groups and three men's groups). Our analysis consisted of four steps: (1) identifying segments and classifying them into themes, (2) categorizing themes into topic areas, (3) establishing a final consensus of themes and topics, and (4) ascertaining similarities and contrasts among groups. Transcripts of sessions were analyzed across groups for themes using a text-based analysis system. Conceptualization of themes was derived using a system model of preventive care. Interrater agreement before consensus was good: Kappa (kappa) ranged from 0.70 to 1.00. RESULTS: For current practice, identified barriers included lack of information about risks and benefits, unique challenges of counseling, and lack of resources to conduct counseling. The major strategies suggested were to develop and distribute patient education materials. Discussions about barriers to implementing the United States Task Force recommendation focused on lack of information and resources. CONCLUSIONS: Suggested strategies were multiple, involving individual-, relationship-, and system-level interventions. We expect the strategies identified to be supportive of future efforts to promote counseling for hormone replacement therapy.

Counseling↗
PubMed1999

Lessons from the Oslo Study Diet and Anti-smoking Trial: a qualitative study of long-term behaviour change.

The aim of this study was to identify factors associated with sustainable behaviour change among persons at increased risk for future cardiovascular disease. A qualitative approach based on focus group interviews was used. Twenty-five men aged 62-71 years who participated in the Oslo Study Diet and Anti-smoking Trial were interviewed in four focus groups. The study identified five categories of factors linked to the process of lifestyle changes: the doctor-patient relationship, significant others, motivators, barriers, and empowerment. A strong personal attachment to the principal investigator of the Oslo Study was revealed. The relationship was described as friendly and supportive. The family based approach and the impact of spouses, in particular, was emphasized by the participants. Somatic symptoms and fear often acted as motivators to behavioural change. Individual feedback was also identified as an important motivator. Psychological resistance to external pressure, concerns regarding behaviour change, and benefits from current (unhealthy) behaviour were identified as barriers. Participants reported a process of empowerment and personal control as an important element of sustainable change. The importance of the unique relationship with a certain provider has implications for future healthcare planning. This factor may also limit the external validity of studies of human behaviour.

Aged↗
PubMedDate not supplied

Trials and tribulations of country doctors: a qualitative study of doctor-patient relationships in rural Israel.

Rural areas of Israel are organized into small villages that attract physicians by offering inexpensive accommodation and the promise of a high quality of life. However, conflicts often arise in the relationship between the village residents and the doctor, leading to dissatisfaction and physician turnover. In order to examine the issues, we conducted a qualitative study of rural physicians using a group interviewing technique, called focus groups. The sample consisted of 46 physicians, aged between 35 and 45, of whom 60% were male. In the focus groups, the physicians mainly discussed issues of unclear boundaries between private life and physician roles, exaggerated expectations on the part of community members, difficulties with teamwork, the impact of the physician's family, work satisfaction, and burnout. Recommendations for physicians considering rural practice include making a careful and studied choice of a village before making a final decision, setting both clear professional limits and an overall time limit for service, allowing for mistakes, and organizing Balint-type physician support groups.

Adaptation, Psychological↗
PubMedDate not supplied

Establishing baseline information on cigarette smoking behavior from ethnic-specific groups of Asian American and Pacific Islander youth in Seattle, Washington, 1996-1998.

OBJECTIVES: To gather baseline impressionistic data from Asian American and Pacific Islander (AAPI) teens about their tobacco cigarette smoking behaviors. METHODS: Twenty six separate focus group interview sessions consisting of youth age 12-19 years, 49% female, and of mixed self-reported smoking status (N=190) were conducted over a three-year period from 1996-1999. Gender stratified groups of Samoans, Mien, Vietnamese, Filipino, Laotian, Chinese, and Cambodians were interviewed employing focus groups. FINDINGS: Content analysis of more than 900 pages of transcripts revealed themes suggesting that, overall, parental authority loomed central in the control of youths' smoking; keen awareness and cynicism of media's role in the proliferation of tobacco products existed; and generally, tobacco regulation was thought needed to protect the health of the more vulnerable members of society. CONCLUSIONS: The diversity within the broad AAPI category must be respected. This qualitative group interview approach uncovered general hypotheses for further cultural-specific research.

Adolescent↗
PubMed2003

Needs assessment of persons with multiple sclerosis and significant others: using the literature review and focus groups for preliminary survey questionnaire development.

The purpose of this study was to conduct focus group interviews to obtain information for development of a needs assessment questionnaire. Four focus groups were conducted with 10 people with multiple sclerosis (MS) and five significant others. A facilitator from the learning services department at the hospital conducted the interviews guided by questions developed by the researcher. The focus group interviews were audiotaped and transcribed. The researcher analyzed the transcribed interviews. Content analysis was used to analyze the transcribed data creating categories from key words and phrases as they appeared. The findings were grouped by themes. The results highlighted the participants' experiences and needs regarding physical changes; sources of assistance; unmet needs; psychological, employment, leisure, and informational needs. A comparison of themes developed from the focus groups and in the literature captured categories for questionnaire development. One new theme, leisure, was not found in the literature and was incorporated based on the findings of this study. The final categories for questionnaire development were: physical, health, psychological, financial, employment/meaningful daytime activity and leisure, accessibility and information. A survey questionnaire was developed from the focus group data using the phraseology of the participants.

Activities of Daily Living↗
PubMed2005

Consumers' perceptions of community pharmacy in Portugal: a qualitative exploratory study.

OBJECTIVE: Pharmacists are health professionals who are ideally positioned to perform a primary health care role. However, the definition of professional value needs to be considered not just as professional education and skills, but also in terms of how consumers perceive it. The main aim of this work was to explore the public's perceptions and attitudes towards community pharmacy in Portugal. METHODS: A pure qualitative approach was undertaken. The data were collected through a semi-structured interview, conducted with a 'snowball' like sample. First, individuals (n = 15) were interviewed, allowing for adjustment and validation of the interview schedule, followed latter by group interviews with adults in rural and urban areas. Group participants (n = 25) were asked about their behaviour and beliefs, resulting from their perceptions of community pharmacies, pharmacists and medicines. Future expectations regarding the community pharmacy service were also explored. The interviews were tape recorded and transcribed verbatim. An iterative, reflexive coding process was applied, assisted by the qualitative software package QSR NUD*IST v4. The inductive analysis of the extracted codes assembled those codes into themes. RESULTS AND DISCUSSION: This article will mainly focus on community pharmacy service representations and cognitions (theme A) and community pharmacy evaluative perceptions and behaviours (theme B). Participants displayed general and contradictory ideas about the actual functions of the pharmacist, including weak conceptualizations and a positive demand for services in relation to product supply. This superficial understanding is in line with previous results from satisfaction studies, confirming a low expectation level. The public's poor knowledge and low expectations can justify a reduced desire for an extended role of the pharmacist in the community. This uncertain service conceptualization does not define the professional responsibility from a consumer's perspective. CONCLUSIONS: Although these results allow for the development of a framework to describe the perceptions of community pharmacy users, further research is needed to determine the prevalence of these and other possible results.

Adult↗
PubMed2003

Doing the analysis differently. Using narrative to inform understanding of patient participation in contact tracing for sexually transmissible infections.

The aims and objectives of this paper were to understand the key influences hindering patients, participation in the contact tracing process for sexually transmissible infection exposure; to study the anatomy of acomplex sexual network through the eyes of a committed contact tracer and a group of teenagers; and to identify lessons from the research. Unstructured and group interviews were undertaken with a group of sixth form students and an unstructured interview with a contact tracer. Cue (storyboards) cards and hypothetical sexual networks were used--the outcome demonstrated that generated narrative about sexual network experiences can be analysed using a schema of representation of experience and could be subjected to Labov's structural categories for assignment of spheres of action, to undertake interpretation. Themes identified include: confidentiality, secrecy, friendship, community, the law and social sanctions. We conclude that contact tracing is under the spotlight and that we need to understand the personal experiences of being subjected to a process where little consideration has been given to the social and psychological consequences. Narrative analytic strategies can be applied to gain this much-needed rich data.

Adolescent↗
PubMedDate not supplied

The qualities and skills of practice developers.

AIM: To explore and describe the activities and approaches that constitute practice development by providing an insight into the qualities and skills exhibited by staff in practice development roles. METHOD: This involved examining 177 articles, plus data collected during focus group interviews with 60 staff around the UK and telephone interviews with 25 clinical staff. The focus groups and telephone interviews formed part of an earlier published study Garbett and McCormack (2002). RESULTS: A range of skills and qualities were highlighted. These include being effective, having vision, being motivated, empathic, experiential, cognitive political, communicative, facilitative and possessing clinical skills. CONCLUSION: The work of practice developers is of central importance in the light of NHS policy developments, such as the NHS Plan or the response to the Bristol inquiry.

Focus Groups↗
PubMed2002

Listening to women: culturally tailoring the violence prevention guidelines from the put prevention into practice program.

PURPOSE: To develop five reliable and valid (culturally tailored) guidelines focused on the prevention of violence as presented in the violence prevention guideline of the Put Prevention into Practice Clinician's Handbook on Preventative Services (PPIP). DATA SOURCES: The data collection for this qualitative, descriptive design of naturalistic inquiry was focus group interviews with five different ethnic groups of women (Caucasian, Filipino, Hawaiian, Japanese and Hispanic) using a semi-structured interview guide. CONCLUSIONS: The women interviewed provided a variety of suggestions for adaptations to the guideline. Cultural similarities and differences are presented. Development of a nonjudgmental and trusting relationship is key to disclosure. IMPLICATIONS FOR PRACTICE: Violence against women is recognized as a major public health problem. Little is known about the effectiveness of standardized interventions such as those contained in the PPIP Handbook. Even less is known about the efficacy of such protocols within culturally diverse populations. Providers should consider adaptation of the guideline based on the individual relationship with the client. The next phase of this research is to implement the culturally tailored adaptations of these guidelines and test their effectiveness.

Female↗