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PubMed2001

Recovery after stroke: a qualitative perspective.

The purpose of this study was to determine the impact of stroke on survivors of the condition and to identify their physical and psychosocial needs in rural and regional settings. Data were collected via focus group interviews with stroke survivors, carers and key informants. Data were managed using NUD*IST and analysed using a content analysis method identifying major themes related to the impact of living in the community after having a stroke. It was found that stroke survivors suffered severe physical and emotional effects. The findings also identified the vulnerability of this group and a lack of organised, on-going psychosocial and rehabilitative support. Recommendations are made to enhance the current management of stroke after the acute and subacute phases.

Adult↗

PubMed2001

Value of unstructured time (breaks) during formal continuing medical education events.

BACKGROUND: Unstructured time (breaks) at formal continuing medical education (CME) events is nonaccredited in some jurisdictions. Program participants, however, perceive this time as valuable to their learning. The purpose of this research was to determine what activities occur during unstructured time in formal CME events and how these activities impact learning for physicians. METHODS: A qualitative method based on grounded theory was used to determine themes of behavior. Both individual and focus group interviews were conducted. Data were analyzed and coded into themes, which were then further explored and validated by the use of a questionnaire survey. RESULTS: One hundred ninety-seven family physicians were involved in the study. Several activities related to the enhancement of learning were identified and grouped into themes. There were few differences in the ranking of importance between the themes identified, nor were differences determined based on gender or type of CME in which the break occurred. FINDINGS: The results suggest that unstructured time (breaks) should be included in formal CME events to help physician learners integrate new material, solve individual practice problems, and make new meaning out of their experience. The interaction between colleagues that occurs as a result of the provision of breaks is perceived as crucial in aiding the process of applying knowledge to practice.

Behavior↗

PubMed1999

Hearing our voices: assessing HIV prevention needs among Asian and Pacific Islander women.

The purpose of this study was to (a) assess the impact of HIV/AIDS on the Asian-Pacific Islander (API) community and changes in their behavior due to AIDS, (b) identify perception of risk, HIV risk behaviors, factors contributing to those behaviors, barriers to HIV prevention, and the types of prevention programs that would benefit their community, and (c) describe culturally appropriate considerations when designing HIV prevention strategies for API women. Thirty API adults participated in three different groups. Focus group interviewing methods were used, guided by the Health Belief Model. The women had numerous concerns about HIV that placed them at risk for infection, such as their inability to talk with their sexual partners about condom use due to the cultural and taboo nature of sexual topics. All groups concluded that for HIV prevention interventions to be successful, they must be tailored to the cultural and specific needs of API women.

Adolescent↗

PubMed1991

Long-term sick-listing, medical rehabilitation and life quality change: a patient evaluation.

This evaluation of the health service at one of the hospitals of the National Insurance Board in Sweden is primarily based on the perspective of the patient. One interview group of 32 patients (I-group) made life quality ratings before-after their hospital stay. In responding to a postal questionnaire one year after discharge from hospital, another group of 93 former patients (Q-group) made parallel self-ratings. Due to prolonged sick-listing, the patients had been admitted to the hospital for rehabilitation/examination according to paragraph 2:11 in the general insurance law. The basis for their sick-listing was hereby critically reviewed. Within the framework of additional examinations (interview and structured general questions), more than 40% of the respondents stated that the hospital stay was mainly satisfying and a great majority appreciated the nursing care. However, the self-ratings showed that the patients did not ascribe any particularly great significance to the hospital stay. In the short term, it even seemed to have a certain negative impact on the life quality of the patients. No obvious positive bias seems to be built into the ratings. Thus, the assessment package applied may also work well in similar evaluative settings.

Adult↗

PubMed2003

Perceptions of equipoise are crucial to trial participation: a qualitative study of men in the ProtecT study.

Recruitment to trials is known to be difficult. Previous research suggests that a crucial factor may be participants' difficulty with the concept of randomization. This study explored patients' perceptions of randomization and reasons for consent or refusal to participate in the ProtecT study (a randomized trial of surgery, radiotherapy, and monitoring for localized prostate cancer). In-depth interviews were conducted with 21 men diagnosed with localized prostate cancer who were invited to participate in the ProtecT treatment trial. Interviewees were selected purposefully from three U.K. clinical centers to ensure the inclusion of similar proportions of those agreeing or refusing random treatment allocation in each of the treatment groups. Interviews explored men's recall and understanding of chance, comparison, and equipoise, and reasons for consent/refusal of randomization and acceptance/rejection of treatment allocation. Data were analyzed methodically using the techniques of constant comparison. Checking of coding and interpretation was assured by four experienced qualitative researchers. Recall and understanding of the major principles of the randomized design were good and were similar for "chance" and "comparison" between those who consented to and refused randomization. Clinical equipoise, however, caused difficulty. Almost all recalled and understood it, but those who found it acceptable tended to consent to randomization and those who could not accept it tended to refuse to participate. Belief in clinical equipoise was key to participants' consent to randomization. Ensuring patients understand and accept equipoise may thus increase their readiness to consent to participate in trials. A priority for future research is to focus on the provision and presentation of suitable and effective trial information, concentrating in particular on the neglected concept of clinical equipoise.

Aged↗

PubMed1997

Issues of sexuality in older women.

The aim of this exploratory research study was to investigate the attitudes of women over 60 toward sexuality and intimacy, to elicit which issues concerning sexuality and intimacy are important to them, and to gather their perceptions of how issues of sexuality and intimacy are addressed by the medical profession. Fourteen women aged 60-85 participated in three focus group interviews organized in Kingston, Ontario, Canada. We qualitatively measured recurring themes in attitudes about sexuality. Although they grew up in a generation when sex and sexuality were rarely discussed, these older women did not have any problem talking about sex, sexuality, and their attitudes towards these topics within the focus group setting. The participants felt on the whole, that sexuality is, and will continue to be, an important part of their lives. There was consensus that they would feel comfortable talking to their family doctor about their own or their partner's problems if asked but might not volunteer the information. Sex and sexuality are important issues to these older women. Male impotence is the most common problem that affects these older women's sex lives. They need more information about normal changes with aging that affect sexuality of older women and men. These women have rarely been afforded the opportunity to discuss sexuality with their physician. The small sample size of this pilot study provided useful information but is not definitive in its conclusions. Further research is needed to determine physician attitudes and practices concerning sex and sexuality in this age group.

Aged↗

PubMed2005

Hindrance for patient participation in nursing care.

UNLABELLED: THE STUDY'S RATIONALE: Patients' influence in health care through participation, freedom of choice and information, is laid down in laws, national and local directives. In nursing care situations, the degree to which a patient participates depends on the nursing staff. Accordingly, hindrances for patient's participation during nursing care is an important question for the nursing profession. AIMS AND OBJECTIVES: The aim was to focus on Swedish Registered Nurses opinion of hindrances for patient participation in nursing care and to uncover the informants' perspectives in depth. METHODOLOGICAL DESIGN AND JUSTIFICATION: The study was limited to inpatient somatic care and has a qualitative approach. Data were collected through seven focus group interviews with 31 Registered Nurses from five hospitals. An analysis of the tape-recorded interview material was made, combining elements of content analysis with aspects of the Grounded Theory approach. ETHICAL ISSUES AND APPROVAL: The ethics of scientific work was followed. The participants gave informed consent. Verbal and written information was given as a guarantee that all information would be treated confidentially outside the focus group. Formal approval by ethical committee was not required according to national and local directives. RESULTS: Hindrance for patient participation in nursing care comprised three themes: Competence, Influence of significant others and Organization and work environment, and their seven underlying subthemes. CONCLUSIONS: The study clarified factors, which individually or combined may be hindrance for patient participation in nursing practice. Professional nurses must be able to find a balance for their patients' participation in nursing care activities through identification and coping with the hindrances. The three themes and seven subthemes here identified, can be used in patient care and its' evaluation, like also quality assurance of care and work organization and in nursing education. For further development replication studies are needed, like additional studies of patients and significant others.

Adaptation, Psychological↗

PubMed2006

Perceptions of elder abuse: voices of professionals and volunteers in Sweden--an exploratory study.

The aim of this study was to examine perceptions of elder abuse in groups representing organizations considered potential sources of help and support for abused elders in Sweden. Focus group interviews were conducted with representatives from: the police; primary care; municipal eldercare; a church; a caregiver support organization; and a crime victim support organization. Data were analysed through qualitative content analysis. Although participants discussed elder abuse from the position of their respective organization/group, analysis revealed a preponderance of shared perceptions between groups. A descriptive framework of elder abuse was developed and four themes emerged including: good intentions in abusive situations; older generation's responsibility for elder abuse; failing to report abuse; and prevention of abuse. Findings included perceptions of victim blaming and a tolerance for elder abuse. Participants perceived that anyone could be provoked to abuse, and that abusers can also be considered victims in abusive situations. Further research on elder abuse perceptions is recommended among involved family members, in order to address elder abuse in ways that will allow recognition among both those providing and those receiving assistance.

Adult↗

PubMed2005

Exploring the benefits of an exercise program for people with schizophrenia: a qualitative study.

The relationship between regular exercise and physical health and well-being is extensively documented in the literature. However, considerably less attention is devoted to the impact of exercise on health outcomes for people experiencing a mental illness. In response to the recognized paucity, a structured exercise program was developed and implemented for residents of a Community Care Unit in metropolitan Melbourne, Australia. Six residents participated in the program over a period of three months. This paper reports the findings of a qualitative study. A focus group interview was conducted with the resident participants (n=6), the exercise physiologists who developed and implemented the program (n=2), and nursing staff involved in implementing and supporting the program (n=4). Analysis of the data collected revealed that four main themes had emerged: the individual nature of the program, physical improvement, group dynamics, and future plans. The findings of this study suggest that involvement in the program produced very positive outcomes, most notably in the physical fitness of residents. The individual nature of the program which enabled gradual participation, and the cohesive approach of the group as a whole were considered very important factors contributing to the overall success. Furthermore, the participants planned to continue with some form of physical activity in the future. The potential value of regular exercise for patients experiencing a mental illness has significant implications for nursing and requires further research exploration.

Adult↗

PubMed2002

"I am allowed to be myself": women with chronic muscular pain being recognized.

AIMS: Since 1992, the authors have completed 11 treatment groups for women with chronic muscular pain. The programme includes movement training and group discussions. Qualitative data indicate that the participants valued the experience of being recognized in the groups as a crucial and beneficial effect of the treatment. In the present article, this finding is examined in more detail by studying the types of action and interaction that the women considered to have benefited from by participating in group treatment. METHODS: Data are drawn from an action research project and the material originates from three treatment groups where 24 participants completed the programme. Qualitative data originating from five focus group interviews are analysed using Giorgi's principles of phenomenological analysis. RESULTS: The women described different concrete aspects of interaction and awareness illustrating psychologist Løvlie Schibbye's theoretical perspectives of a recognizing attitude: listening, understanding, acceptance, tolerance, and confirmation. The women tell how they themselves have experienced these expressions of recognition from other group members and from the group leaders. CONCLUSIONS: The women confirmed that recognition had an important effect on how much they benefited from the treatment programme. The need for mutual recognition draws attention to the power and possible abuse of power inherent in human relationships, as exemplified by the relationship between the patient and healthcare providers. An explicit presentation of the human and moral value behind the treatment programme represents a challenge.

Adult↗

PubMed2000

[Perceptions of nursing service managers in the South African Military Health Service on their level of motivation].

The process of transformation in the South African Military Health Services, has influenced the nursing service managers' level of motivation and the following research question is applicable: what are the perceptions of the nursing service managers within the South African Military Health Services on their level of motivation? The purpose with this study was to explore and describe the perceptions of nursing service managers on their level of motivation within these health services. A qualitative research design was utilized and four focus group interviews were conducted with 33 nursing service managers country wide. The transcribed interviews were exposed to a content analysis. The results confirm that the level of motivation amongst these nursing service managers is low. The demotivators relate mainly to the following: inadequate acknowledgement, job insecurity in relation to the future, problems with the process of integration, transformation and rationalization, problems with management, many labour related issues, poor/inadequate communication, inadequate support, increased work load, poor physical environment, negative publicity and poor self motivation. Although there were a few motivators identified, they were of less importance. These results were interpreted within Herzberg's motivation theory to identify the hygiene/maintenance factors and to assess whether the important motivators were in place. During any process of change, and/or when the level of motivation amongst employees is low, it is important to adequately manage the environment (hygiene/maintenance factors within the Herzberg theory). But it is even more important to ensure that the motivators are in place or to intensify them. It is therefore recommended that a motivation strategy, based on the Herzberg theory as well as the Hackman-Oldham job enrichment model, be developed, implemented and evaluated.

Attitude of Health Personnel↗

PubMed1999

Left in limbo: patients' views on care across the primary/secondary interface.

OBJECTIVES: To discover the views of patients about their experiences across the interface between primary and secondary health care, including referral from general practitioners, outpatient and inpatient care, discharge, and aftercare. DESIGN: A qualitative study involving individual and focus group interviews of patients and interviews of carers. SUBJECTS: 33 patients who had attended at least one outpatient appointment or had been an inpatient between two and four months previously, and eight carers of patients with chronic conditions. SETTING: Three acute hospitals and one community health service in Leicestershire. MAIN OUTCOME MEASURES: Common themes in the views of patients and carers towards their experiences of care. RESULTS: Five themes emerged. The first four were: "getting in" (access to appropriate care), "fitting in" (orientation of care to the patient's requirements), "knowing what's going on" (provision of information), and "continuity" (continuity of staff and coordination and communication among professionals). The fifth theme was "limbo" (difficulty in making progress through the system), which was influenced by failures in care in relation to the other four themes. CONCLUSIONS: The concept of progress is central to patients' views of care. It involves both progress through the healthcare system and progress towards recovery or adjustment to an altered health state. Patients' views on how well they progress through the healthcare system may be an appropriate indicator for monitoring health service performance.

Continuity of Patient Care↗

PubMed2000

Assisting women to establish breastfeeding: exploring midwives' practices.

Breastfeeding is recognised by many mothers, families and health professionals to be important for the health and wellbeing of mothers and babies. Successful breastfeeding depends on the acquisition of basic skills, accurate information and practice, and is strongly influenced by the support provided following childbirth. Midwives' practices may therefore have the potential to influence breastfeeding outcomes. Correct positioning and attachment of the newborn at the breast is a crucial component of the successful establishment of breastfeeding. A literature review revealed that minimal research exists on the practices that midwives use when assisting women to initiate breastfeeding. A series of focus group interviews were therefore conducted to stimulate in-depth exploration of midwives' understanding and practices in the positioning and attachment of a newborn infant at the breast. Eighteen midwives, each of whom had worked at least 12 months in the postnatal environment of a large metropolitan hospital in Adelaide, participated in the focus group discussions. Using thematic analysis, the following broad themes emerged from discussions--education, problem-solving, support, midwives' views about breastfeeding and influences on midwives' practice. These themes identify the roles and practices that midwives take on when assisting women to establish breastfeeding following childbirth, and also raise awareness of influences on their practice.

Breast Feeding↗

PubMedDate not supplied

Overweight consumers' salient beliefs on omega-3-enriched functional foods in Australia's Illawarra region.

OBJECTIVE: To determine consumer salient beliefs toward functional foods enriched with omega-3 fatty acids. DESIGN: Focus group interviews with adult consumers using the Theory of Planned Behavior (TPB) as a theoretical framework. SETTING: Community-based residents living in the Illawarra region of New South Wales, Australia. PARTICIPANTS: Forty-two overweight participants (29 female, 13 male) aged 30 to 80 years recruited by advertisement and attending 1 of 6 focus groups, which were recorded and transcribed verbatim. ANALYSIS: Content analysis was carried out, and subcategories were developed to capture the emerging themes according to the TPB model. RESULTS: Most participants were aware of a range of potential benefits of omega-3 fatty acids, but they had reservations about the ability of omega-3-enriched foods to deliver a health benefit. They were concerned about whether these foods were labeled clearly and about the possibility of overdosing. Family and friends were viewed as important in introducing participants to novel foods on the market. Participants regarded dietitians as a credible source and were least trusting of food companies and scientists. Overall, participants reported that cost was a major barrier, and that they would not necessarily trade taste for health benefits. Adding omega-3 fatty acids to foods regarded as less healthful was viewed more as a gimmick rather than a real health benefit. CONCLUSIONS AND IMPLICATIONS: The consumer attitudes and purchase intentions identified in this study will be helpful to educators as they plan messages and strategies to guide dietary choices related to products enriched with omega-3 fatty acids.

Adult↗

PubMed2006

[General practitioner and mental diseases among children and adolescents].

BACKGROUND: Child and adolescent psychiatry in primary health care is scarcely investigated. The purpose of this article is to describe some aspects of the role of the general practitioner in the care of young patients with psychiatric problems. MATERIAL AND METHODS: Data were collected from four focus group interviews with 19 general practitioners. The material was analysed in a phenomenological perspective. The aim was to develop new and documented descriptions seen from the participants' point of view, interpreted within the framework of available knowledge about care for children and adolescents with psychiatric problems. RESULTS AND INTERPRETATION: The general practitioner is in a good position to provide psychiatric care for these patients because of his or her unique knowledge about the families and the local communities. They have their patients' confidence and acquired skills from their unselected practice to recognise serious and abnormal conditions. The majority of the informants did not feel sufficiently skilled in order to treat more specific child and adolescent psychiatric disorders. Some informants were actively involved in multidisciplinary networks concerning their young patients, while others were neither involved nor informed about it. In addition, local health and welfare services to a lesser extent involved these doctors. Because of this, children and adolescents who might have been assessed and treated in primary health care could be referred directly to specialists. A need for guidance and updating on relevant knowledge from the specialist health care was expressed. From the results we might assume that specialists might give some general practitioners the professional security needed in order to take on the role of medical co-coordinator of the multidisciplinary services to young patients with mental health problems.

Adolescent↗

PubMed1984

Subjective tinnitus in children with otological disorders.

Children attending ENT and audiology clinics and a further group interviewed in the partially hearing units of their schools have been questioned about tinnitus. A total of 79 children reported tinnitus during the course of the study. A wide variety of descriptions were given. Only 10 of the subjects found the symptom annoying. Only 17 of them could say when their tinnitus began. Of a group of 66 children with secretory otitis media, 43.9% reported tinnitus, while amongst 44 children with sensorineural hearing loss the incidence was 29.5%. Tinnitus is a common phenomenon in children with ear disease, but it is seldom reported spontaneously.

Adolescent↗

PubMed2003

How Japanese nurses provide care: a practice based on continuously knowing the patient.

AIM: Criticisms of the nursing process as a problem-solving approach have emerged recently. This study aimed to identify and describe a way of nursing based on the clinical practice of selected nurses in Japan. METHODS: Data were collected using semi-structured interviews and observations at one 300-bed Japanese hospital in 1999. The purposive sample consisted of 24 female nurses. Data analysis occurred simultaneously with data collection, and questioning and constant comparison were used for data analysis. Codes were clustered into categories and relationships among these were identified. In the final stage of the analysis, two group interviews with participants were carried out to enhance credibility. FINDINGS: This study identified a Japanese way of nursing intended to help patients explore and realize meanings and values of their experiences with illness. When nurses first contacted a patient, they quickly formed a patient image, but altered it each time they obtained new patient information. A patient image consisted of the patient's subjective world (the patient's perspective) and the holistic patient (nurses' perspectives of the patient). The nurses sometimes pursued strategies to know the patient's subjective world. The target, direction, conditions and ways of nursing care were decided based on continuously knowing the patient. The nurses related their knowledge and thoughts to the patient, and by talking with the patient promoted the patient's consideration and participation, and empowered the patient. Nurses continued attending to patients even when they could not provide specific nursing interventions. CONCLUSIONS: Knowing the patient was found to be especially important in determining nursing care. The model described in this study does not contradict the nursing process as a systematic approach to problem-solving. Rather, it has some alternatives that might be useful in providing individual care in Japan.

Adult↗

PubMed1995

Focus group methodology in the development of a survey to measure physician use of cancer staging systems.

Accurate classification and staging of cancers enables physicians to select appropriate treatments, to evaluate outcomes of health management more reliably, to compare and interpret statistics reported from various institutions on a local, regional, national and international basis more consistently and to assist exchanges of information between different centers of treatment. This paper examines group interview methodology to develop the first-ever survey of Canadian cancer care specialists pertaining to staging systems. It is shown how the responses provided by participants contributed to the formulation of testable hypotheses and shaped the development of survey questions. As well, experiences are shared regarding the technical issues that arose using the focus group technique with physicians. In conclusion, there is a brief discussion of how the use of staging classification systems might be understood from the perspective of diffusion theory and social marketing (i.e., how information about cancer staging has been communicated and disseminated.

Canada↗