Guys and dolls: a qualitative study of teachers’ views of gendered play in kindergarten

Drawing on data collected for a larger study investigating kindergarten teachers’ online discussions of play, the present qualitative study examines teachers’ discussions of gender. Findings suggest that teachers’ project onto their kindergarten students many of their own gender prejudices about play. These teachers reinforced gendered attitudes by encouraging the children, especially the boys, to play only with toys and in activities traditionally associated with their gender. Email interviews were then conducted with seven kindergarten teachers to further explore the main theme from the netnographic research. Findings support the contention that further research is needed to examine gendered play in kindergartens, and that kindergarten teachers could benefit from becoming aware of their unintentional teachings and in learning how better to encourage gender equity in play-based class activities.     

Stakeholders’ positions in the breast screening debate,and media coverage of the debate: a qualitative study

Against the backdrop of new research evidence suggesting breast screening causes avoidable harms and that women are not being given enough information to make informed decisions, we sought to explore the positions on breast screening adopted by a range of stakeholders and the coverage of this debate in the media. We sampled material from national newspapers, charity bodies’ websites and official bodies’ websites over a two-year period, and analysed this using thematic content analysis. Charities’ and official bodies’ positions were similar in that they were supportive of the NHS breast screening programme, and tended to defend it against its critics. They acknowledged, and partially explained the imperfect nature of breast screening but often omitted important information such as simple frequency statistics. There was a tendency for newspapers to cover the screening debate in an oblique way – presenting case studies of ‘real’ women and celebrities. These were mostly positive accounts of women who believed they had benefited from screening and supported the programme. Engagement with the debate in terms of discussion of the criticisms of the programme was lacking. The debate about breast cancer screening, and the increasing focus on its potential harms, received less coverage in the popular media than might have been expected. Interested stakeholder groups do make publicly available information about their positions on the relative value of screening, but these tend to focus on emphasising the potential benefits and less on the possible harms.     

General practitioners’ views on the influence of long-term care reforms on integrated elderly care in the Netherlands: a qualitative interview study

This study explores the long-term care (LTC) reform in the Netherlands and its relation to the day-to-day integrated care for frail elderly people, from the perspective of general practitioners (GPs). We assessed GP perspectives regarding which elements of the LTC reform have promoted and hindered the provision of person-centred, integrated care for elderly people in the Netherlands. We performed case studies conducted by semi-structured interviews, using the Healthy Alliances (HALL) framework as a framework for thematic analysis. GPs reported that the ideals of the LTC reform (self-reliance) were largely achievable and listed a number of positive effects, including increased healthcare professional engagement and the improved integration of the medical and social domains through the close involvement of social support teams. The reported negative implications were a lack of co-ordination in the implementation of the reforms by the municipality, insufficient funding for multidisciplinary team meetings and the reinforced fragmentation of home care. In particular, the implementation of the system reforms took place with little regard for the local context. We suggest that the implementation of national care reforms should be aligned with factors operating at the micro level and make the following recommendations: use one central location for primary health and social services, integrate regional ICT structures to improve the exchange of patient information, and reduce fragmentation in home care.     

Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England

BackgroundThe availability of a COVID-19 vaccine has been heralded as key to controlling the COVID-19 pandemic. COVID-19 vaccination programme success will rely on public willingness to be vaccinated.MethodsWe used a multi-methods approach - involving an online cross-sectional survey and semi-structured interviews - to investigate parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine. 1252 parents and guardians (aged 16 + years) who reported living in England with a child aged 18 months or under completed the survey. Nineteen survey participants were interviewed.FindingsMost survey participants reported they would likely accept a COVID-19 vaccine for themselves (Definitely 55.8%; Unsure but leaning towards yes 34.3%) and their child/children (Definitely 48.2%; Unsure but leaning towards yes 40.9%). Less than 4% of survey participants reported that they would definitely not accept a COVID-19 vaccine. Survey participants were more likely to accept a COVID-19 vaccine for themselves than their child/children. Participants that self-reported as Black, Asian, Chinese, Mixed or Other ethnicity were almost 3 times more likely to reject a COVID-19 vaccine for themselves and their children than White British, White Irish and White Other participants. Survey participants from lower-income households were also more likely to reject a COVID-19 vaccine. In open-text survey responses and interviews, self-protection from COVID-19 was reported as the main reason for vaccine acceptance. Common concerns identified in open-text responses and interviews were around COVID-19 vaccine safety and effectiveness, mostly prompted by the newness and rapid development of the vaccine.ConclusionInformation on how COVID-19 vaccines are developed and tested, including their safety and efficacy, must be communicated clearly to the public. To prevent inequalities in uptake, it is crucial to understand and address factors that may affect COVID-19 vaccine acceptability in ethnic minority and lower-income groups who are disproportionately affected by COVID-19.     

Clinical essentialising: a qualitative study of doctors’ medical and moral practice

While certain substantial moral dilemmas in health care have been given much attention, like abortion, euthanasia or gene testing, doctors rarely reflect on the moral implications of their daily clinical work. Yet, with its aim to help patients and relieve suffering, medicine is replete with moral decisions. In this qualitative study we analyse how doctors handle the moral aspects of everyday clinical practice. About one hundred consultations were observed, and interviews conducted with fifteen clinical doctors from different practices. It turned out that the doctors’ approach to clinical cases followed a rather strict pattern across specialities, which implied transforming patients’ diverse concerns into specific medical questions through a process of ‘essentialising’: Doctors broke the patient’s story down, concretised the patient’s complaints and categorised the symptoms into a medical sense. Patients’ existential meanings were removed, and the focus placed on the patients’ functioning. By essentialising, doctors were able to handle a complex and ambiguous reality, and establish a medically relevant problem. However, the process involved a moral as well as a practical simplification. Overlooking existential meanings and focusing on purely functional aspects of patients was an integral part of clinical practice and not an individual flaw. The study thus questions the value of addressing doctors’ conscious moral evaluations. Yet doctors should be aware that their daily clinical work systematically emphasises beneficence at the expense of others—that might be more important to the patient.     

Adolescents,parents and teachers’ perceptions of risk and protective factors of substance use in Moroccan adolescents: a qualitative study

Background

Substance use in adolescents is a global public health concern that continues to draw attention from academics, policy experts, and government officials. In Morocco, few studies have investigated the influencing factors of substance use in adolescents. Here, we aimed to fill this gap and to better understand factors that protect or influence substance use in adolescents.

Methods

We conducted a qualitative study using focus group discussions. The semi-structured interview guides were based on the socio-ecological model as a theoretical framework to explore perceptions of students, parents, and teachers regarding substance use risks and protective factors in adolescents. Data from each group were audio-recorded, transcribed, and analyzed using thematic analysis.

Results

From May to July 2016, 17 focus group discussions were conducted at two middle schools in Taza city, Morocco, which included 8 groups of 7 adolescents (28 boys and 28 girls) aged 14 to 16 years, 5 groups of parents (5 females and 21 males), and 4 groups of teachers (13 males and 5 females). Thematic analysis resulted in six common themes that represented the most salient perceived risk and protective factors regarding substance use among adolescents: perceived benefits of substance use, awareness and beliefs, family influence, peer influence, easy accessibility of substances, and social norms.

Conclusions

Our results demonstrate that multilevel prevention programs in adolescents should address influencing factors from the individual to the societal level, including social norms and the government’s policy toward substance use. Health education programs included as part of the school curriculum can contribute to promoting awareness and reducing risky behaviors of Moroccan adolescents.

     

Obesity treatment—more than food and exercise: a qualitative study exploring obese adolescents' and their parents' views on the former's obesity

The aim of this study was to explore obese adolescents’ and their parents’ views on the former''s obesity; especially to gain knowledge about barriers and motivational factors that influence obese adolescents’ ability to lose weight. This is a qualitative study involving field observation and semi-structured interviews with obese adolescents and their parents. The analysis takes a phenomenological–hermeneutic approach. Fifteen obese adolescents aged 13–16 years and their parents/grandparents participated in this study (one father, seven mothers, five sets of parents and two sets of grandparents). The results showed that obese adolescents’ are aware that they have unhealthy eating habits and they wish they were able to attain to a healthier diet. Although in poor physical shape, obese adolescents perceive their daily level of exercise as moderate. Obese adolescents blame themselves for being obese and blame their parents for an unhealthy diet, and for being unsupportive regarding exercise. Parents blame their obese child of lacking will power to change eating and exercise habits. As a consequence, the homely atmosphere is often characterised by quarrels and negative feelings. The conclusion is that despite obese adolescents’ intention of reducing weight, underlying issues interfere with this goal. This is particularly related to quarrels with parents, self-blame and misguided understanding of eating and exercising habits. These matters need to be addressed when treating obesity among adolescents.     

How sharp can a screening tool be? A qualitative study of patients’ experience of completing a bowel cancer screening questionnaire

Introduction There is evidence to suggest that the Patient Consultation Questionnaire (PCQ) is a reliable tool to predict symptomatic left‐sided colorectal cancer. While previous research has examined the sensitivity and specificity of the PCQ as a tool, it has not addressed patients’ perspectives. Objective To examine qualitatively patients’ perspectives on ease of use of the PCQ, and their attitude to completing it. Method The target population were patients in North Wales between 55 and 85 years with colorectal symptoms who had completed the PCQ. A sample of six was randomly selected. The approach was qualitative, using semi‐structured, in‐depth cognitive interviews, which were recorded and transcribed before content and thematic analysis. Results The study found some areas of concern in relation to the PCQ’s design and presentation, concerning such issues as the use of medical jargon or ambiguous wording, and the use of questions to which patients may not have an answer. It also found that patients responded to the form as something more than a screening tool, treating it variously as way of speeding up diagnosis and treatment, an opportunity to ‘play the system’, and a way of bypassing embarrassing encounters. Discussion and conclusions Although major problems were not identified, the minor issues observed in the PCQ’s design and presentation may reduce accuracy and patient satisfaction. A greater understanding of patients’ perception of the role and function of the PCQ may help clinicians to interpret responses to the form more accurately.     

Strategies for diagnosing leg oedema in primary care: A qualitative study of GPs’ approaches

Background: The symptom leg oedema represents a broad range of possible underlying aetiologies. The background of leg oedema is multifactorial and usually the GP is the first contact point for patients presenting with this symptom. GPs rely on patient history and physical examination as their main diagnostic tools.

Objective: To identify GPs’ diagnostic approaches and heuristics in patients presenting with leg oedema.

Methods: Interviews with 15 GPs (20–30 min) using a semi-structured interview-guideline were conducted. GPs described their individual diagnostic strategies concerning all patients presenting with leg oedema they had prospectively identified during the previous four weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters.

Results: GPs applied a variety of diagnostic approaches, which can be grouped in active and passive strategies. Active strategies comprised the use of decision rules and guidelines, Bayesian arguing, problem dichotomisation and discrepancy heuristics. Passive approaches included test of time, therapy as diagnosis, and taking patient assumptions into account.

Conclusion: When dealing with leg oedema, GPs use prior information of individual patients in a specific way. There is a broad variety of diagnostic approaches that can be grouped in ‘active’ and ‘passive’ behaviour. Approaches mostly match with established diagnostic strategies in primary care.     

Black families’ perceptions of barriers to the practice of a healthy lifestyle: a qualitative study in the UK

While studies have focused on tangible indicators of the practice of healthy lifestyles, there remains a dearth of research exploring the inter-relationships between the practice of healthy lifestyles and the prevailing living circumstances of Black and other visible minority ethnic communities in Western societies. This article presents an account of African Caribbean men and women's beliefs and perceptions about the barriers of practising a healthy lifestyle, focusing specifically on the effects of social exclusion, racism and ethnic identity. A total of 18 participants from the north of England participated in the study, with in-depth interviews conducted in their homes. The participants believed that principles of healthy lifestyles were largely not relevant to their lived experiences because they failed to take into account their experiences of racism, social exclusion, ethnic identity, values and beliefs. Indeed, participants argued that, with their emphasis on illness prevention and perceived Eurocentric approaches, the principles of healthy lifestyle were part of the social exclusion paradigm experienced by their community. The study concludes by suggesting that it is essential to place notions of socio-economic disadvantage, discrimination, marginalisation and racism at the centre rather than the periphery when considering strategies to make healthier choices an easier option for Black and other visible minority ethnic communities.     

Transgender women in Malaysia,in the context of HIV and Islam: a qualitative study of stakeholders’ perceptions

Background

Globally, one of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group. In the Malaysian context there has been a scarcity of published research relating to transgender women, a sensitive issue in a Muslim majority country, where Islam plays an influential role in society. Furthermore, there has been a paucity of research relating to how such issues relate to HIV prevention in transgender women in Malaysia.Thus, the aim of this study is to explore the attitudes of stakeholders involved in HIV prevention policy in Malaysia towards transgender women, given the Islamic context.

Methods

In-depth interviews were undertaken with stakeholders involved in HIV prevention, Ministry of Health, Religious Leaders and People Living with HIV, including transgender women. Thirty five participants were recruited using purposive sampling from June to December 2013 within Kuala Lumpur and surrounding vicinities. Interviews were in person, audiotaped, transcribed verbatim and used a framework analysis.

Results

Five central themes emerged from the qualitative data; Perceptions of Transgender women and their place in Society; Reaching out to Transgender Women; Islamic doctrine; ‘Cure’, ‘Correction’ and finally, Stigma and Discrimination.Discussion: Islamic rulings about transgenderism were often the justification given by participants chastising transgender women, whilst there were also more progressive attitudes and room for debate. Pervasive negative attitudes and stigma and discrimination created a climate where transgender women often felt more comfortable with non-governmental organisations.

Conclusion

The situation of transgender women in Malaysia and HIV prevention is a highly sensitive and challenging environment for all stakeholders, given the Muslim context and current legal system. Despite this apparent impasse, there are practically achievable areas that can be improved upon to optimise HIV prevention services and the environment for transgender women in Malaysia.

     

The influence of students’ gender on equity in Peer Physical Examination: a qualitative study

Peer Physical Examination (PPE) is an educational tool used globally for learning early clinical skills and anatomy. In quantitative research, there are differences in students’ preferences and actual participation in PPE by gender. This novel study qualitatively explores the effect that gender has on medical students’ experiences of learning physical examination through PPE. We employ an interpretative approach to uncover the PPE experiences of students from a European, graduate-entry medical school. Volunteers participated in either individual or group interviews. The data were transcribed, de-identified and analysed using thematic analysis. There was evidence of gender inequity in PPE, with students describing significant imbalances in participation. Male students adopted roles that generated significant personal discomfort and led to fewer experiences as examiners. Assumptions were made by tutors and students about gender roles: male students’ ready acceptance of exposure to be examined and female students’ need to be protected from particular examinations. In contrast with the first assumption, male students did feel coerced or obliged to be examined. Students described their experiences of taking action to break down the gender barrier. Importantly, students reported that tutors played a role in perpetuating inequities. These findings, whilst relating to one university, have implications for all settings where PPE is used. Educators should be vigilant about gender issues and the effect that they may have on students’ participation in PPE to ensure that students are not disadvantaged in their learning.     

Technology versus humanism: how patients perceive the use of electronic health records in physicians’ offices—a qualitative study

Electronic Health Records (EHRs) have the potential to improve the quality of care. In view of the accelerated adoption of EHRs, there is a need to understand conditions necessary for their effective use. Patients are the focus of healthcare and their perceptions and expectations need to be included in developing and implementing EHRs. The purpose of this study was to gather exploratory qualitative information from patients about their experiences and perceptions regarding the effects of EHRs on healthcare quality in physicians’ offices. We conducted five focus groups with patients representing a random mix of diverse socio-demographic backgrounds in Oklahoma. Related to EHRs, patients reported improvements on the technical side of care but no change on the human side. They expressed concerns about the potential for breach of confidentiality and security of medical records. They were also concerned about the possibility of governmental agencies or insurance companies having unauthorized access to patient records. Patients differentiated between the human and technical sides of care and reported no change or improvement in the doctor-patient interaction. Patients have an important perspective on the use of EHRs and their perceptions and experiences should be considered in the development, adoption and implementation of EHRs. Otherwise, the use of EHRs may not be fully effective. There is also a need to educate patients about the potential benefits and risks of EHRs and the steps being taken to mitigate such risks.     

Is advice incompatible with autonomous informed choice? Women’s perceptions of advice in the context of antenatal screening: a qualitative study

Background Patient autonomy in antenatal screening is a high priority for policy developers in many countries. Objective This paper presents women’s understandings of how health professionals should facilitate informed screening choices with an emphasis on their understandings of autonomy and advice. Design, setting and participants The study was carried out in 2009 in the UK, using a qualitative approach. Ninety‐eight participants of African, British White, Caribbean, Chinese and Pakistani origin had semi‐structured interviews, which were analysed using framework analysis. Results Four themes were identified during the analysis: ‘Meanings of advice in antenatal screening: the advice continuum’, ‘Recognition of the role of health professionals in decision making’, ‘Understandings of advice in the context of autonomous decision making’ and ‘Reasons given for wanting advice’. Women said they valued advice from health professionals to make decisions about antenatal screening, but their understandings of ‘advice’ ranged from information giving only to direction about screening choices. Conclusion Many women wanted health professionals to support the process of making informed choices by engaging in discussion and did not see advice as incompatible with making autonomous choices. However, some women wanted direction about whether to have a screening test or not, something which policy and guidelines explicitly prohibit. This may cause an ethical dilemma for health professionals who are required to both support women’s preference for care and adhere to a policy of non‐directiveness. Further clarification is needed on how health professionals should support the process of making informed choices when women ask for clear direction on screening choices.