Special Issue "Qualitative Research and Mixed Methods, Application in Health Care Science"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: 31 July 2021.

Special Issue Editor

Prof. Dr. Domingo Palacios-Ceña
E-Mail Website
Guest Editor
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Madrid, Spain.
Interests: qualitative research; mixed methods; pain; geriatrics; caring science; vulnerable groups; disability and rehabilitation
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Special Issue Information

Dear Colleagues,

As a result of health science changes, the number of designs and methodology types of health science studies has increased. At the same time, epidemiological designs (quantitative studies) co-exist with different methodological forms to study and describe a complex event related to health science and contexts such as qualitative research and mixed methods.

The actual use of qualitative research and mixed methods in the context of health care, which are often part of complex health conditions, is increased. For qualitative and mixed studies to be implemented in health care science and services and to be part of the common health designs used, many health professionals, managers, stakeholders, patients, and families have to be considered.

This Special Issue welcomes original studies that consider and use qualitative research and mixed methods to study topics in health care science. The studies can show the perspective of health professionals, managers, patients, and family through qualitative research (e.g., phenomenological study, grounded theory) and mixed studies (e.g., qualitative case-study, convergent, exploratory sequential).

For this Special Issue, it is recommended to use the Consolidated Criteria for Reporting Qualitative Research (COREQ), or Standards for Reporting Qualitative Research (SRQR) guides for the qualitative studies, and the Best Practices for Mixed Methods Research in the Health Sciences recommendations, Second Edition by NIH Office of Behavioral and Social Sciences, for mixed methods research.

This Special Issue will provide readers with the theory state-of-the-art and practical information on health research perspectives that determine the uptake of qualitative research and mixed methods in the health care science and services.

Prof. Dr. Domingo Palacios-Ceña
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • qualitative research
  • mixed methods
  • health care
  • health services
  • caring science
  • health science education

Published Papers (22 papers)

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Article
Multiple Gestations and Assisted Reproductive Technologies: Qualitative Study of the Discourse of Health Professionals in Spain
Int. J. Environ. Res. Public Health 2021, 18(11), 6031; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18116031 - 03 Jun 2021
Viewed by 645
Abstract
Multiple gestations have become an increasing phenomenon that has impacted public health globally, largely due to the application of assisted reproductive technologies. The objective of this work was to find out the discourse that the health professionals involved in its follow-up have in [...] Read more.
Multiple gestations have become an increasing phenomenon that has impacted public health globally, largely due to the application of assisted reproductive technologies. The objective of this work was to find out the discourse that the health professionals involved in its follow-up have in our context. For this, a qualitative methodology was chosen, with semi-structured interviews recorded in audio, prior authorisation, and transcribed verbatim. It was based on a script designed for this purpose, with the following analysis categories: the current trend of multiple gestations, impact, and follow-up. The content analysis was based on the experiences, knowledge, and perceptions of the professionals interviewed. Professionals stated that the current socioeconomic and legal context hinders a single embryo transfer policy that decreases multiple gestation rates. They emphasised the importance of the psychic impact of such gestations on the couple, on the mother in particular, as well as the economic effect on families, health, and society in general. They expressed the need to create specific protocols to assist these gestations. Midwives, in particular, demanded that the health administration recognise and support the differentiated care they perform with this type of gestation. Work on specific models is needed to adequately size the impact of multiple gestations, as well as to generate social health policies that lead to co-responsible reconciliation measures that favour women having one pregnancy at a time. Full article
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Article
Upgrading Nursing Students’ Foreign Language and Communication Skills: A Qualitative Inquiry of the Afterschool Enhancement Programmes
Int. J. Environ. Res. Public Health 2021, 18(10), 5112; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105112 - 12 May 2021
Viewed by 466
Abstract
Learning a foreign language is not easy for many students, particularly for nursing students who need to complete their internships in the hospital. However, motivation always drives them to the foreign language classrooms. The purpose of this study was to understand the motivations [...] Read more.
Learning a foreign language is not easy for many students, particularly for nursing students who need to complete their internships in the hospital. However, motivation always drives them to the foreign language classrooms. The purpose of this study was to understand the motivations and reasons behind why these nursing students decided to study Mandarin Chinese as part of their personal development and enhancement beyond the curriculum. One main question and one sub-research question were written, why would nursing students decide to take Chinese as the tool for foreign language and culture development? What and why are the reasons and motivations for nursing students to take Chinese beyond their curriculum? The qualitative case study method was employed in order to investigate 36 nursing university students in the United Kingdom. The results of this study concluded that nursing students tend to study Chinese due to personal development and career goals. School leaders, department heads, government leaders, policymakers, human resources professionals, vocational trainers, and researchers may take this study as the opportunity to reform their current human resource and education plans to offer foreign language courses to university students, members of the public, learners, and interested parties for both personal development and career enhancements. Full article
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Article
Concepts, Beliefs, and Traditional Treatment for Childhood Seizures in a Quilombola Community in Northeastern Brazil: Analysis by the Discourse of the Collective Speech
Int. J. Environ. Res. Public Health 2021, 18(4), 1875; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041875 - 15 Feb 2021
Viewed by 719
Abstract
Background: Non-pharmacological therapy related to traditional, magical, and/or religious treatments for managing recurrent and non-recurrent seizures in children persists in several traditional communities. The research aims to investigate the concepts, beliefs, and types of traditional treatments used for cases of seizures in children [...] Read more.
Background: Non-pharmacological therapy related to traditional, magical, and/or religious treatments for managing recurrent and non-recurrent seizures in children persists in several traditional communities. The research aims to investigate the concepts, beliefs, and types of traditional treatments used for cases of seizures in children reported by residents of a quilombola community. Methods: The research took place in the quilombo community Sítio Arruda, Ceará, northeastern Brazil. The study population consisted of 19 participants, including healers, prayers, and midwives. Applied a socioeconomic form and a semi-structured interview script. For data analysis, the Discourse of the Collective Speech (DCS) technique was used. Results: For the questions asked, a total of 14 central ideas were found. The most prevalent was seizure is the most common type of disease in children (50.0%); The seizure occurs because of the fever (42.0%); In the community, we treat and prevent seizures with the use of plants (63.2%). Conclusions: The present study’s results addressed relevant issues that include valuing and understanding the traditional knowledge of the community, access to health services, and the need for clarification actions about seizures. Full article
Article
Participatory Action Research Applied to an Ear, Nose, and Throat Specialty Service Redesign in Remote Australia: A Mixed-Methods Study of Key Stakeholder Perspectives
Int. J. Environ. Res. Public Health 2021, 18(1), 167; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010167 - 29 Dec 2020
Viewed by 763
Abstract
This mixed-methods study reports on the key stakeholders’ perspectives on the ear, nose, and throat (ENT) service redesign in remote Australia, using a participatory action research (PAR) approach. A primary health care (PHC) clinician survey was conducted to assess local needs and possible [...] Read more.
This mixed-methods study reports on the key stakeholders’ perspectives on the ear, nose, and throat (ENT) service redesign in remote Australia, using a participatory action research (PAR) approach. A primary health care (PHC) clinician survey was conducted to assess local needs and possible educational gaps in clinical knowledge. This was followed by an internal stakeholder forum and a follow-up survey with Torres and Cape Hospital and Health Service staff to gain their perspectives on current service delivery and table ideas for a new ENT health service model. Qualitative data were analyzed inductively and grouped in emerging themes. Quantitative data were imported into tables and analyzed descriptively. PAR allowed for input from 19 PHC clinicians, 10 face-to-face stakeholders perspectives, and 18 stakeholder follow-up survey respondents. Four themes emerged: 1. Training for health workers in ENT management; 2. Improved local service access; 3. New referral pathways to improve continuity of care; and 4. Introduction of telehealth. PAR engaged key stakeholders, identifying gaps in ENT service delivery, and guided the development of the new service model. The inclusion of stakeholders throughout the service redesign process is likely to create a more sustainable model of care which already has local “buy-in”. Full article
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Article
Emotional Experience and Feelings during First COVID-19 Outbreak Perceived by Physical Therapists: A Qualitative Study in Madrid, Spain
Int. J. Environ. Res. Public Health 2021, 18(1), 127; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010127 - 27 Dec 2020
Cited by 1 | Viewed by 1446
Abstract
Knowing the experiences and feelings of health professionals who have actively worked on the first-line during the first COVID-19 outbreak could help for identifying specific professional duties focused on health assistance objectives. No qualitative study has been published describing the emotion/feelings of physical [...] Read more.
Knowing the experiences and feelings of health professionals who have actively worked on the first-line during the first COVID-19 outbreak could help for identifying specific professional duties focused on health assistance objectives. No qualitative study has been published describing the emotion/feelings of physical therapists during the first COVID-19 outbreak. This study describes and explores the emotional experiences and feelings of thirty physical therapists working at the first-line at eleven public health hospitals in Madrid (Spain) during the first COVID-19 outbreak (March–May 2020). A qualitative exploratory study was conducted based on an interpretive framework. Participants were recruited by purposeful sampling and snow-ball techniques between May and June 2020. In-depth interviews and researchers’ field notes were used to collect the data. An inductive thematic analysis was conducted to identify significant emerging themes from verbatim transcription. After identifying 2135 codes and 9 categories, three themes emerged to describe their emotional experiences and feelings. First, “Critical events”, with negative and positive critical events. Second theme, “Emotional Roller Coaster”, with emotions, feelings, and coping strategies. Third theme: “Last words: Conclusions of the COVID-19 outbreak experience”, with the meaning of the COVID-19 outbreak from a personal and professional perspective. Comprehensive support for all first-line healthcare professionals is needed. Full article
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Article
Why Do Some Spanish Nursing Students with Menstrual Pain Fail to Consult Healthcare Professionals?
Int. J. Environ. Res. Public Health 2020, 17(21), 8173; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17218173 - 05 Nov 2020
Cited by 1 | Viewed by 851
Abstract
Dysmenorrhea is a problem that affects a large percentage of young women worldwide. Alarmingly, the majority of these women choose to self-medicate rather than consult a healthcare professional, despite the risks involved. The present study aimed to explore the reasons why undergraduate nursing [...] Read more.
Dysmenorrhea is a problem that affects a large percentage of young women worldwide. Alarmingly, the majority of these women choose to self-medicate rather than consult a healthcare professional, despite the risks involved. The present study aimed to explore the reasons why undergraduate nursing students do not consult health care professionals regarding their menstrual pain. A qualitative study was conducted using an open question: “Why didn’t you consult a healthcare professional?” within the context of a research project on primary dysmenorrhea among nursing students at the University of Huelva, Spain. The responses of 202 women were analyzed using content analysis. Three categories were identified: assessment of the pain experienced, expectations, and experiences of professional care and selfcare. We found a striking normalization of the problem; notably, students downplayed the importance of the problem, considering that it was not worth consulting a physician. Furthermore, there was a notable degree of self-medication using non-steroidal anti-inflammatories (NSAIDs). These results may be useful for orienting policies to raise social awareness of this problem and for designing health education strategies aimed at women with primary dysmenorrhea. Full article
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Article
A Case-Centered Approach to Nursing Ethics Education: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(21), 7748; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17217748 - 23 Oct 2020
Cited by 1 | Viewed by 937
Abstract
Nurses deal with ethical decisions as they protect patients’ rights, but a consensus on effective approaches to nursing ethics education is lacking. The “four topics” method can facilitate decision-making when nurses experience ethical dilemmas in practice. This study aimed to describe nursing students’ [...] Read more.
Nurses deal with ethical decisions as they protect patients’ rights, but a consensus on effective approaches to nursing ethics education is lacking. The “four topics” method can facilitate decision-making when nurses experience ethical dilemmas in practice. This study aimed to describe nursing students’ perspectives on and experiences of a case-centered approach to nursing ethics education using the four topics method. This qualitative study consisted of two phases. First, we delivered case-centered nursing ethics education sessions to nursing students using the four topics method. Then, we conducted two focus group discussions that explored students’ perspectives on and experiences of nursing ethics education. Data were analyzed using conventional content analysis. Four themes were identified: the importance of ethics education as perceived by nursing students, problems in current nursing ethics education, the experience of case-centered nursing ethics education using the four topics approach, and suggestions for improving nursing ethics education. The case-centered approach using the four topics method is effective in enhancing nursing students’ nursing ethics ability. It is crucial to understand that nursing students would like to set up their own ethical standards and philosophy. Continuous efforts to encourage students’ participation and to provide ethical reflection opportunities during clinical practice are needed to better connect theory with clinical practice. Full article
Article
Occupational Physicians’ Perspectives on Determinants of Employee Participation in a Randomized Controlled Musculoskeletal Health Promotion Measure: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(20), 7445; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17207445 - 13 Oct 2020
Viewed by 668
Abstract
Occupational physicians (OPs) are key figures for advising employees and employers about prevention and health at the workplace. However, knowledge of their views on participation in health promotion measures is sparse. This qualitative study aims to explore occupational physicians’ experiences with employee participation [...] Read more.
Occupational physicians (OPs) are key figures for advising employees and employers about prevention and health at the workplace. However, knowledge of their views on participation in health promotion measures is sparse. This qualitative study aims to explore occupational physicians’ experiences with employee participation in a randomized controlled workplace measure for musculoskeletal disorders (MSDs) in Germany. We conducted eight semi-structured telephone interviews with occupational physicians. Interviews were transcribed verbatim and analyzed using a combination of conventional and directed content analysis. Findings were mapped based on Andersen’s behavioral model of health services use, resulting in four categories and 10 subcategories. (a) Contextual factors of the measure comprised impacts of the healthcare system and company environment, (b) individual factors of measure participation comprised demographic, social, belief, and MSD need characteristics, (c) health behavior during the measure included OPs’ communication, employees’ personal practices and measure participation, and (d) outcomes of participation included health status, satisfaction, and dissatisfaction with the measure. Findings imply occupational physicians’ and employees’ views should be investigated on a broader scale. Researchers should use present statements for the development of intervention studies, while political and managerial authorities can improve organizational conditions of prevention based on these findings. Full article
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Article
“My Friends are at the Bottom of My Schedule”: A Qualitative Study on Social Health among Nursing Students during Clinical Placement
Int. J. Environ. Res. Public Health 2020, 17(18), 6921; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17186921 - 22 Sep 2020
Cited by 1 | Viewed by 862
Abstract
Clinical placement is an essential component for nursing students, allowing them to transfer professional knowledge into practice. The quality of life among nursing students and nurses was reviewed to examine its impact on the quality of provided care. However, it is unclear how [...] Read more.
Clinical placement is an essential component for nursing students, allowing them to transfer professional knowledge into practice. The quality of life among nursing students and nurses was reviewed to examine its impact on the quality of provided care. However, it is unclear how social health among nursing students is affected during clinical placement. Final-year students who had finished clinical placement were invited to participate in this qualitative study. Twenty-one in-depth interviews were conducted and transcribed verbatim for thematic analysis. Two main themes, i.e., contributors to lack of social health, and manifestations of lack of social health, emerged from seven sub-themes. Students experienced different challenges during the clinical placement, but some of these did contribute to effects on their social health. Lack of social health might further influence career development after graduation. Supportive strategies from colleagues, nursing colleges and hospitals might potentially improve students’ social health during the clinical placement. Full article
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Article
Exploring Health Literacy in Individuals with Alcohol Addiction: A Mixed Methods Clinical Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6728; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17186728 - 15 Sep 2020
Viewed by 876
Abstract
This mixed methods research paper explores health literacy (HL) in individuals with alcohol addiction by using the 47-item version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) and semi-structured interviews concerning health-related competencies (access, understand, appraise, and apply health information), and determines the [...] Read more.
This mixed methods research paper explores health literacy (HL) in individuals with alcohol addiction by using the 47-item version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) and semi-structured interviews concerning health-related competencies (access, understand, appraise, and apply health information), and determines the limitations of the HLS-EU-Q47 when used under specific conditions of clinical practice. The questionnaire survey and the interviews were conducted with individuals of different health literacy levels who were undergoing inpatient alcohol addiction treatment. The findings indicate that individuals with alcohol addiction might require different types of health information according to their health literacy level in terms of quantity and quality of information to recover from alcohol addiction and improve their overall health. The implications for the clinical practice of addiction treatment as well as recommendations for national and regional policy are also discussed. Full article
Article
Psychosocial Influence of Ehlers–Danlos Syndrome in Daily Life of Patients: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(17), 6425; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176425 - 03 Sep 2020
Cited by 1 | Viewed by 1333
Abstract
(1) Background: Ehlers–Danlos syndrome is a heterogeneous group of connective tissue disorders causing pain, fatigue, and disabilities; it has several implications for patients who suffer from this disease. The major clinical manifestations of EDS include joint hypermobility, skin hyperextensibility, and generalized conjunctive tissue [...] Read more.
(1) Background: Ehlers–Danlos syndrome is a heterogeneous group of connective tissue disorders causing pain, fatigue, and disabilities; it has several implications for patients who suffer from this disease. The major clinical manifestations of EDS include joint hypermobility, skin hyperextensibility, and generalized conjunctive tissue fragility. This research aims to explore their perceptions and experiences about the phycological and social spheres. (2) Methods: Semistructured interviews were carried out. Participants were encouraged to talk about issues related to their disease by asking open-ended questions in one to one interview. The interview guide included questions to identify the syndrome’s influence on the social and psychological life of patients All interviews were audio recorded, fully transcribed, and analyzed using the phenomenological theoretical framework. The method of analysis was the thematic interpreting of perspectives and approaches. (3) Results: 31 individuals were proposed to participate in this study. Five patients refused to participate, so a total of 26 interviews were performed. Six themes ((1) Pain and its consequences on a daily basis; (2) The need to name the problem: the diagnosis; (3) Restructuring leisure and social relationships; (4) Limitations due to economic conditions; (5) Psychological impact of the disease situation; (6) Professional limitations) and four subthemes ((1) The value of partner support; (2) The weather influence on social plans; (3) Physical exercise and illness; (4) Support groups) emerged from the data. (4) Conclusions: This study revealed the impact of the syndrome on the social and daily life of patients, and not only in a physical level, but also in a psychological and social approach. These findings allow healthcare providers to know more about this disease in order to support and give advice to patients about the changes they will have to make. Full article
Article
Capturing the Spatial Relatedness of Long-Distance Caregiving: A Mixed-Methods Approach
Int. J. Environ. Res. Public Health 2020, 17(17), 6406; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176406 - 02 Sep 2020
Cited by 2 | Viewed by 1181
Abstract
Long-distance caregiving (LDC) is an issue of growing importance in the context of assessing the future of elder care and the maintenance of health and well-being of both the cared-for persons and the long-distance caregivers. Uncertainty in the international discussion relates to the [...] Read more.
Long-distance caregiving (LDC) is an issue of growing importance in the context of assessing the future of elder care and the maintenance of health and well-being of both the cared-for persons and the long-distance caregivers. Uncertainty in the international discussion relates to the relevance of spatially related aspects referring to the burdens of the long-distance caregiver and their (longer-term) willingness and ability to provide care for their elderly relatives. This paper is the result of a first attempt to operationalize and comprehensively analyze the spatial relatedness of long-distance caregiving against the background of the international literature by combining a longitudinal single case study of long-distance caregiving person and semantic hierarchies. In the cooperation of spatial sciences and geoinformatics an analysis grid based on a graph-theoretical model was developed. The elaborated conceptual framework should stimulate a more detailed and precise interdisciplinary discussion on the spatial relatedness of long-distance caregiving and, thus, is open for further refinement in order to become a decision-support tool for policy-makers responsible for social and elder care and health promotion. Moreover, it may serve as a starting point for the development of a method for the numerical determination of the long-distance caregivers on different spatial reference scales. Full article
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Article
The 4 U’s Rule of Fibromyalgia: A Proposed Model for Fatigue in a Sample of Women with Fibromyalgia: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(17), 6224; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176224 - 27 Aug 2020
Cited by 3 | Viewed by 841
Abstract
Although fatigue usually goes unnoticed, it is a symptom that poses great challenges to patients with fibromyalgia and is a strong limitation. The aim of this study is to identify and describe the variables involved in fatigue in nine different situations of the [...] Read more.
Although fatigue usually goes unnoticed, it is a symptom that poses great challenges to patients with fibromyalgia and is a strong limitation. The aim of this study is to identify and describe the variables involved in fatigue in nine different situations of the Goal Pursuit Questionnaire (GPQ) that may occur in the daily lives of women with fibromyalgia, according to an ABC (Antecedents–Behaviors–Consequences) model. This study followed a qualitative descriptive research method and a deductive–inductive hybrid approach based on a phenomenological paradigm. Twenty-six women with fibromyalgia participated in focus group discussions between February and March of 2018. Thematic content analysis was carried out from transcribed verbatim interviews. We identified nine major themes that emerged from the participants’ conversations: self-imposed duties, muscle fatigue, overwhelming feeling of tiredness, difficulty thinking, difficulty concentrating, negative emotions, lifestyle changes, affected everyday activities, and lack of motivation for daily activities and social interactions. We conclude that the ABC model allowed certain elements to emerge regarding the fatigue experience, highlighting its importance as a symptom in fibromyalgia. This additional analysis of the ABC model showed that fatigue can be described through the 4 U’s Rule, which is integrated by these four adjectives: (1) Unpredictable, (2) Uncontrollable, (3) Unseen, and (4) Unintelligible. Identifying these characteristics can contribute to a better understanding of fibromyalgia in addition to better treatment for these patients. Full article
Article
Quality of Life and Health in Patients with Chronic Periodontitis: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(13), 4895; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17134895 - 07 Jul 2020
Cited by 2 | Viewed by 913
Abstract
Purpose: Periodontal disease causes tooth loss if not treated early, and advanced periodontitis can cause a decline in various oral functions. These results diminish the health-related quality of life (QOL) for various populations. Thus, early detection and management of the disease, as well [...] Read more.
Purpose: Periodontal disease causes tooth loss if not treated early, and advanced periodontitis can cause a decline in various oral functions. These results diminish the health-related quality of life (QOL) for various populations. Thus, early detection and management of the disease, as well as a systematic strategy for the prevention of periodontal disease, are necessary. Methods: Adults, 19 years of age or older and diagnosed with chronic gingivitis or chronic periodontitis under the ICD-10 codes, were selected to participate in the study. A total of 20 participants were informed of the purpose of the study and gave consent to participate in in-depth interviews. Results: The treatment of periodontal disease improved health-related QOL and enabled the participants to have positive dental care health behaviors. Furthermore, the participants recognized the severity of periodontal disease and the importance of dental examinations. It enabled them to be aware of the societal need for dental care awareness. Conclusions: This study was an in-depth examination of the health-related QOL of periodontal patients through a qualitative research methodology. We expect that this study will expand research on health-related QOL due to periodontal disease and revitalize the dental health system and practices. Full article
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Article
Caregivers of Patients with Hematological Malignancies within Home Care: A Phenomenological Study
Int. J. Environ. Res. Public Health 2020, 17(11), 4036; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17114036 - 05 Jun 2020
Cited by 2 | Viewed by 1004
Abstract
The role of caregivers in homecare settings is relevant to the patient’s wellbeing and quality of life. This phenomenon is well described in the literature for the oncological setting but not specifically for that of hematological malignancies. The aim of this study was [...] Read more.
The role of caregivers in homecare settings is relevant to the patient’s wellbeing and quality of life. This phenomenon is well described in the literature for the oncological setting but not specifically for that of hematological malignancies. The aim of this study was to explore the experience of primary caregivers of patients with hematological malignancies within home care. We conducted a phenomenological study based on interviews with 17 primary caregivers of hematological patients. Analysis of the contents led to the identification of five main themes. Perhaps, the innovative aspects of this study can be summarized in three points: This service was demonstrated to fulfil the ethical aspects of providing the patient with a dignified accompaniment to the end of life. Secondly, the efficiency of the service and the benefit are directly dependent on the caregivers’ wellbeing, so knowledge of the dynamics and emotions involved can lead to the development and implementation of programs for hematological malignancies. Lastly, a collaborative caregivers–professionals relationship can improve a sense of accomplishment for all parties involved, lessening the family’s frustration related to not having done their best. Home care brings significant benefits for both the patient and the caregivers and fulfils the ethical obligation of providing the patient dignified end-of-life care. Full article
Article
Influence of Aquatic Therapy in Children and Youth with Cerebral Palsy: A Qualitative Case Study in a Special Education School
Int. J. Environ. Res. Public Health 2020, 17(10), 3690; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17103690 - 23 May 2020
Cited by 2 | Viewed by 3844
Abstract
Cerebral palsy results in the progressive loss of motor functions, with a negative impact on daily activities and participation. Despite the well described benefits of aquatic therapy in children, little is known about the effects of the same in school settings. This study [...] Read more.
Cerebral palsy results in the progressive loss of motor functions, with a negative impact on daily activities and participation. Despite the well described benefits of aquatic therapy in children, little is known about the effects of the same in school settings. This study aimed to describe the experience of children and youth with cerebral palsy participating in an aquatic therapy program within a special education school considering their educational and therapeutic perspectives. A qualitative descriptive case study with embedded units was developed, comprising 27 participants. This study employed purposeful sampling to include children and youth with cerebral palsy from the Asociación Ayuda a la Paralisis Cerebral (APACE) special education school, together with their parents, the special education teachers, and health care professionals. Data were collected via non-participant observation, semi-structured and informal interviews, focus groups, and researcher field notes. A thematic analysis was conducted, revealing the following themes: (a) the connection with the environment; (b) postural improvements and mobility; (c) the opportunity to perform tasks; (d) learning and transfer. A motivating environment leads to physical, cognitive and social benefits, both at school and in the home. Aquatic therapy was viewed as a means for learning and participation. These findings may enhance understanding regarding the potential benefits of implementing multidisciplinary aquatic therapy programs in specialist school settings. Full article
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Article
Perceptions of Medical Students Regarding Career Counseling in Korea: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(10), 3486; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17103486 - 16 May 2020
Cited by 1 | Viewed by 985
Abstract
Current medical school education focuses on acquiring appropriate knowledge with relatively little interest in developing the career selection skills of medical students. We investigated medical students’ perceptions of career problems and the required types of career counseling programs. Five focus group discussions were [...] Read more.
Current medical school education focuses on acquiring appropriate knowledge with relatively little interest in developing the career selection skills of medical students. We investigated medical students’ perceptions of career problems and the required types of career counseling programs. Five focus group discussions were held with 23 medical students. The consensual qualitative study method was used to analyze the recorded discussion process. The medical students were more influenced by parents and grades than by subjective choices when deciding on admission to medical school. In future career choices, medical students considered the stability and feasibility of the career and expected quality of life. However, there were several opinions that it is essential to understand oneself. Objective and specific career information was lacking, and meeting with the professor was not very helpful for career counseling. Most medical students expected the effectiveness of the career counseling program but hoped the program would proceed with voluntary participation. Medical students wanted a variety of concrete and objective information, such as specialty information for choosing residency training, trainee hospital information, and post-residency training information in the career counseling program. Most medical students are not ready for career-related problems, therefore making it necessary to develop a career counseling program suitable for them. Full article
Article
Impact of Perinatal Death on the Social and Family Context of the Parents
Int. J. Environ. Res. Public Health 2020, 17(10), 3421; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17103421 - 14 May 2020
Cited by 4 | Viewed by 1674
Abstract
Background: Perinatal death (PD) is a painful experience, with physical, psychological and social consequences in families. Each year, there are 2.7 million perinatal deaths in the world and about 2000 in Spain. The aim of this study was to explore, describe and understand [...] Read more.
Background: Perinatal death (PD) is a painful experience, with physical, psychological and social consequences in families. Each year, there are 2.7 million perinatal deaths in the world and about 2000 in Spain. The aim of this study was to explore, describe and understand the impact of perinatal death on parents’ social and family life. Methods: A qualitative study based on Gadamer’s hermeneutic phenomenology was used. In-depth interviews were conducted with 13 mothers and eight fathers who had suffered a perinatal death. Inductive analysis was used to find themes based on the data. Results: Seven sub-themes emerged, and they were grouped into two main themes: 1) perinatal death affects family dynamics, and 2) the social environment of the parents is severely affected after perinatal death. Conclusions: PD impacts the family dynamics of the parents and their family, social and work environments. Parents perceive that society trivializes their loss and disallows or delegitimizes their grief. Implications: Social care, health and education providers should pay attention to all family members who have suffered a PD. The recognition of the loss within the social and family environment would help the families to cope with their grief. Full article
Article
What Bothers Me Most Is the Disparity between the Choices that People Have or Don’t Have”: A Qualitative Study on the Health Systems Responsiveness to Implementing the Assisted Decision-Making (Capacity) Act in Ireland
Int. J. Environ. Res. Public Health 2020, 17(9), 3294; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17093294 - 09 May 2020
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Abstract
Objective: The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 in Ireland and will be commenced in 2021. This paper is focused on this pre-implementation stage within the acute setting and uses a health systems responsiveness framework. Methods: We conducted face-to-face interviews [...] Read more.
Objective: The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 in Ireland and will be commenced in 2021. This paper is focused on this pre-implementation stage within the acute setting and uses a health systems responsiveness framework. Methods: We conducted face-to-face interviews using a critical incident technique. We interviewed older people including those with a diagnosis of dementia (n = 8), family carers (n = 5) and health and social care professionals (HSCPs) working in the acute setting (n = 26). Results: The interviewees reflected upon a healthcare system that is currently under significant pressures. HSCPs are doing their best, but they are often halted from delivering on the will and preference of their patients. Many older people and family carers feel that they must be very assertive to have their preferences considered. All expressed concern about the strain on the healthcare system. There are significant environmental barriers that are hindering ADM practice. Conclusions: The commencement of ADM provides an opportunity to redefine the provision, practices, and priorities of healthcare in Ireland to enable improved patient-centred care. To facilitate implementation of ADM, it is therefore critical to identify and provide adequate resources and work towards solutions to ensure a seamless commencement of the legislation. Full article
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Article
Experience and Awareness of Health Managers, Administrators, and Workers on a Hearing Conservation Program in Korea: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(7), 2302; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072302 - 29 Mar 2020
Cited by 1 | Viewed by 863
Abstract
This study aims to evaluate the experience and awareness of a hearing conservation program to explore its activation plan. Three focus group discussions were conducted with five health managers, five labor supervisors, and five workers. A single in-depth interview was conducted with a [...] Read more.
This study aims to evaluate the experience and awareness of a hearing conservation program to explore its activation plan. Three focus group discussions were conducted with five health managers, five labor supervisors, and five workers. A single in-depth interview was conducted with a health manager. Since hearing loss has a significant influence on the quality of life of workers, all participants recognized the importance of management. Although the need for hearing conservation programs was acknowledged, the participants had negative views about their effectiveness. Most health managers have not been able to demonstrate tangible results from their efforts to solve hearing problems, and they have been unable to demand that their employers actively invest resources and personnel in solving or preventing hearing problems. The participants in this study did not entirely understand the hearing conservation program, negative comments suggested that it is impossible to eliminate noise sources from the workplace, and measures for noise reduction would reduce work efficiency. This study can be supplied not only as a basis for reidentifying the real problems of the hearing conservation program but also for the tailored implementation method of future hearing conservation programs at each worksite. Full article
Article
Bus Workers’ Experiences with and Perceptions of a Health Promotion Program: A Qualitative Study Using a Focus Group Discussion
Int. J. Environ. Res. Public Health 2020, 17(6), 1992; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17061992 - 18 Mar 2020
Viewed by 822
Abstract
We conducted a focus group discussion with bus workers to evaluate their experiences and perceptions, as well as their reasons for participating in a program for vulnerable workers. The study also sought to identify the strengths and weaknesses of the program. A total [...] Read more.
We conducted a focus group discussion with bus workers to evaluate their experiences and perceptions, as well as their reasons for participating in a program for vulnerable workers. The study also sought to identify the strengths and weaknesses of the program. A total of nine bus workers participated in the focus group discussion. The focus group discussion was conducted based on a semi-structured guide, which was developed from discussions among the researchers and a review of major preliminary studies. The verbatim transcriptions were analyzed using content analysis. The sole existence of a health promotion program for vulnerable workers in Ulsan was sufficient to attract participants who had not been involved in other health management programs. Participants reported that participation in the program mitigated some of their musculoskeletal symptoms, which are often faced by bus workers. The findings of this study may contribute to the expansion of the health promotion program targeting workers in vulnerable working environments in Ulsan and other places. In order to increase users’ satisfaction and the sustainability of the program, it is necessary to develop a strategy to increase the accessibility of the program and enhance the self-efficacy of participants. Full article

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Study Protocol
Contextualizing Evidence for Action on Diabetes in Low-Resource Settings—Project CEAD Part-II, Strengthening the Health System: A Mixed-Methods Study Protocol
Int. J. Environ. Res. Public Health 2021, 18(7), 3391; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073391 - 25 Mar 2021
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Abstract
Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate [...] Read more.
Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate context-led health systems innovations to improve diabetes care and reduce inequity. The mixed-methods approach includes a 24-month retrospective study to assess the current level of implementation of comprehensive diabetes care and participants will be followed up prospectively for two years to assess changes in healthcare and clinical outcomes from the outset of the research. We will include individuals diagnosed with type-2 diabetes aged over 18 years, who are accessing diabetes care in health facilities in the study districts. Varied stakeholders (patients and family members, community members, healthcare workers and decision-makers) will interpret the underlying causes of the observed weaknesses and propose solutions to strengthen diabetes-related healthcare in focus group discussions (FG). A second set of FG will analyze perceived improvements in healthcare based on prospective cohort findings and consider the success/failure of any context-led innovations occurring throughout the research. Our study will demonstrate how evidence can be contextualized to stimulate local innovations and overcome weaknesses of diabetes-related healthcare in low resource settings. Full article
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