Using qualitative methods to elicit young people's perspectives on their environments: some ideas for community health initiatives

This paper describes qualitative methods used in a research project for the former Health Education Authority, exploring Putnam's concept of 'social capital' in relation to children and young people's well-being and health. Putnam's conceptualization of social capital consists of the following features: trust, reciprocal support, civic engagement, community identity and social networks, and the premise is that levels of social capital in a community have an important effect on people's well-being. Research was carried out with 102 children aged between 12 and 15 in two relatively deprived parts of a town in southeast England. The paper describes the research setting, methods, consent process and ethical issues that arose. It explores how the methods generated different forms of interconnected data, giving rise to a number of health/well-being-related themes. The paper concludes that using a range of methods, including visual methods, has helped to explore quality of life issues for children that are usually neglected in studies of young people's health-related behaviours.     

Integrated use of qualitative and quantitative methods to elicit women's differential knowledge of breastfeeding and lactational amenorrhea in periurban Bolivia

Exclusive and extended breast feeding is responsible for much of the fertility limitation and child spacing throughout the world. In many developing countries, where breast feeding is almost universal and of long duration, postpartum amenorrhea protects women from closely spaced subsequent pregnancies. However, at the same time, increased pressures toward modernization, rapid rural-to-urban migration, frequent advertisements of powdered milk substitutes, and the increased employment of women outside of the home are adversely affecting traditional breast feeding practices. In Bolivia, almost all women breast feed their newborn infants, for periods up to 2 years. This paper reports findings which describe and compare patterns of women's differential knowledge of breast feeding and lactational amenorrhea resulting from data collection using a survey instrument and a focus group guide. The findings are part of a larger study on infant feeding and child spacing conducted in periurban communities in Bolivia. Current and historical trends with regard to paradigm and methodology in social science research are reviewed and the survey/focus group research method is described.     

Using qualitative methods for a conceptual analysis of measures of health status and presenteeism prior to a mapping study

Quality of Life Research - The inclusion of productivity in economic evaluations is a contentious issue. Methods are currently being developed to assess how it may feasibly be included for specific...     

Experiences of recall after mammography screening--a qualitative study

Women participating in biannual mammography screening for 20 years have a cumulative risk of 20% of being recalled. We conducted a prospective qualitative interview study with eight nonsymptomatic women recalled after mammography screening. These women expressed mixed emotions over being recalled. Information about recall rates and breast cancer risk was seen as alarming, and cancer risk estimates were seen by some as high. The short time between recall and examination was reassuring, but it was also perceived as an indication of malignancy. Despite distress from examinations, most of the women continued to want medical examinations to detect cancer early.     

Using qualitative methods to understand the determinants of patients' willingness to pay for cataract surgery: a study in Tanzania

Cataract is the leading cause of avoidable blindness in Africa. There are various documented barriers to the uptake of cataract surgery, cost being one of them. There is, however, little evidence regarding patients' willingness to pay (WTP) for cataract surgery in Africa and the best way to measure it. We conducted a grounded theory study in order to understand better cataract patients' WTP for surgery in Tanzania. A total of 47 cataract patients from three regions of Tanzania were interviewed. The interviews were tape-recorded and transcribed verbatim. The coding process involved identifying emerging themes and categories and their interconnection. Our study reveals that the main factors behind patients' WTP for cataract surgery are (1) the level of perceived need for sight and cataract surgery; (2) the decision-making processes at the family level and (3) the characteristics of local eye care programs. Our study shows that WTP concerns not only the patients but also their relatives. For most patients and families, the amount of $20-$30 is deemed reasonable for a sight-restoring procedure. It does not appear realistic for eye care program managers to charge the real cost of cataract surgery at present (about US $70-in Kilimanjaro). However, eye care programs can influence WTP for cataract surgery by providing quality services and by offering adequate counseling about the procedure. The qualitative findings enriched the interpretation of a previously reported quantitative survey and yield implications for both researchers and decision-makers using or relying on WTP methodologies in developing countries.     

Accuracy of men's recall of their partner's time to pregnancy

BACKGROUND: Occupational studies of fertility often rely on men's report of time to pregnancy (TTP). We assessed accuracy of men's report of TTP compared with TTP derived from data from their female partners. METHODS: Men from the Dieckmann diethylstilbestrol cohort were interviewed to assess fertility. Men were asked TTP for their most recent pregnancies. Their female partner was subsequently interviewed separately; TTP derived from her data was used as the gold standard. Our analysis was based on 202 couples. RESULTS: Men's report was identical to the women's-derived TTP in 32% of couples; 74% differed by no more than 2 cycles. Men tended to underestimate TTP (mean difference = -1.2 cycles). Weighted kappa was 0.5 overall and varied by the man's education, the number of pregnancies he had fathered, his stated confidence in reporting, his exposure to diethylstilbestrol, pregnancy planning, and whether he was still married to the index partner. CONCLUSIONS: Overall accuracy of men's report of TTP was reasonably good, particularly for men who had fathered only one pregnancy.     

Two random repeat recall methods to assess alcohol use.

Two random repeat recall methods were compared with a summary measure to assess alcohol use. Subjects (n = 142) were randomly assigned to one of two groups; they were called either on 14 random days during three 30-day waves and asked about drinking yesterday, or on 2 random days during each wave and asked about drinking in the past week. Follow-up telephone interviews obtained summary measures for each wave. Random repeat methods generally obtained higher estimates. However, the high dropout rate makes questionable the feasibility of using this approach with general population samples.     

Using a modified nominal group technique to elicit director of nursing input for an osteoporosis intervention

BACKGROUND: Barriers prevent osteoporosis care in nursing homes. Successful interventions designed to circumvent these barriers benefit from target recipient input during development. OBJECTIVE: To elicit suggestions for an osteoporosis quality improvement intervention designed for use by nursing home health care professionals. DESIGN: Modified nominal group technique. SETTING: Convenience sample of Alabama nursing home directors. PARTICIPANTS: Fifteen Alabama nursing home directors of nursing were recruited by mailing. Sixty percent of respondents participated (n = 9). MEASUREMENTS: In the first phase conducted via teleconference, an experienced moderator used a preformulated question and elicited 41 suggestions to improve osteoporosis care in nursing homes. Substantively similar suggestions were combined and idiosyncratic suggestions were discarded resulting in the retention of 20 suggestions. In the second phase conducted by mail, the same participants rated the 20 suggestions based on perceived practicality and helpfulness. Elements were grouped into tertiles based on the ranking of the mean ratings of the 2 attributes and then cross-tabulated. RESULTS: All director of nursing (n = 9) participants completed both phases. The most practical, most helpful suggestions were information on fall prevention program implementation, osteoporosis treatment protocols, and osteoporosis medication information. CONCLUSIONS: A modified nominal group technique provided useful information from nursing home directors of nursing for an osteoporosis intervention. The technique proved efficient and facile to perform.     

Using meta ethnography to synthesise qualitative research: a worked example

OBJECTIVES: To demonstrate the benefits of applying meta ethnography to the synthesis of qualitative research, by means of a worked example. METHODS: Four papers about lay meanings of medicines were arbitrarily chosen. Noblit and Hare's seven-step process for conducting a meta ethnography was employed: getting started; deciding what is relevant to the initial interest; reading the studies; determining how the studies are related; translating the studies into one another; synthesising translations; and expressing the synthesis. RESULTS: Six key concepts were identified: adherence/compliance; self-regulation; aversion; alternative coping strategies; sanctions; and selective disclosure. Four second-order interpretations (derived from the chosen papers) were identified, on the basis of which four third-order interpretations (based on the key concepts and second-order interpretations) were constructed. These were all linked together in a line of argument that accounts for patients' medicine-taking behaviour and communication with health professionals in different settings. Third-order interpretations were developed which were not only consistent with the original results but also extended beyond them. CONCLUSIONS: It is possible to use meta ethnography to synthesise the results of qualitative research. The worked example has produced middle-range theories in the form of hypotheses that could be tested by other researchers.     

How to measure comorbidity. a critical review of available methods

The object of this article was to systematically review available methods to measure comorbidity and to assess their validity and reliability. A search was made in Medline and Embase, with the keywords comorbidity and multi-morbidity, to identify articles in which a method to measure comorbidity was described. The references of these articles were also checked, and using a standardized checklist the relevant data were extracted from these articles. An assessment was made of the content, concurrent, predictive and construct validity, and the reliability. Thirteen different methods to measure comorbidity were identified: one disease count and 12 indexes. Data on content and predictive validity were available for all measures, while data on construct validity were available for nine methods, data on concurrent validity, and interrater reliability for eight methods, and data on intrarater reliability for three methods. The Charlson Index is the most extensively studied comorbidity index for predicting mortality. The Cumulative Illness Rating Scale (CIRS) addresses all relevant body systems without using specific diagnoses. The Index of Coexisting Disease (ICED) has a two-dimensional structure, measuring disease severity and disability, which can be useful when mortality and disability are the outcomes of interest. The Kaplan Index was specifically developed for use in diabetes research. The Charlson Index, the CIRS, the ICED and the Kaplan Index are valid and reliable methods to measure comorbidity that can be used in clinical research. For the other indexes, insufficient data on the clinimetric properties are available.     

Influence of the recall period on self-reported alcohol intake

OBJECTIVE: To estimate the accuracy of recall on self-reported alcohol intake. DESIGN: Population-based random sample. SETTING: The Danish Health and Morbidity Survey 1994. SUBJECTS: The study is based on 6,354 persons chosen at random among the adult Danish citizens. The response rate was 77%. MAIN OUTCOME MEASURE: Number of alcoholic drinks consumed on each day during the last week. RESULTS: For self-reported alcohol intake on the last Saturday, respondents with a recall period of one day have the shortest recall period (reference group) and respondents with a recall period of seven days the longest. Respondents with a recall period of seven days reported significant lower alcohol intake (Odds Ratio: 0.56). The reported alcohol intake declines when the recall period increases. The decline in recall of alcohol intake is very clear already after 2-3 days. CONCLUSION: The systematic decrease in reported alcohol use with increased recall period indicates problems in correctly reporting alcohol intake for a full week. Many surveys use recall periods that are longer than a week and, therefore, underreported alcohol intake is expected to be even higher.     

Weight history over a forty-year time period

BACKGROUND: Mortality and disease risk assessments consider body mass index (BMI), among other parameters. Nowadays optimal BMI is discussed controversially as risk assessments are usually performed using BMI of arbitrarily chosen age points. A more comprehensive approach could be based on BMI history. However, longitudinal studies investigating BMI are rare. OBJECTIVES: To determine pragmatically different weight history patterns over forty years. DESIGN: Longitudinal study with four follow-ups over forty years, elucidating risk factors for peripheral vessel diseases as the original goal. SUBJECTS: There were 343 male subjects whose weight was measured both at baseline and at follow-ups. RESULTS: Based on pragmatic methods the following eight patterns were found: "stable" (24.8%), "stable and increasing" (28.6%), "stable and decreasing" (9.0%), "hill" (10.0%), "valley" (7.0%), "yo-yo" (14.0%), continually "increasing" (6.4%%), and continually "decreasing" (0.3%). In subjects over 45 years at baseline, stable patterns were most frequent (42%), and descending patterns became more prominent. CONCLUSIONS: The determination of different weight history patterns in a longitudinal study is possible with the use of a pragmatic procedure. Applying such weight history patterns to the mortality risk assessment of overweight could add new aspects to that risk assessment.     

Physical activity promotion in the preschool years: a critical period to intervene

The primary aim of this paper is to provide a rationale for the necessity of intervening with a physical activity intervention in the preschool years and why the daycare environment is amenable to such intervention. We also review the prevalence of physical activity, sedentary behaviour and obesity in the preschool population and the impact that these lifestyle behaviours and conditions have on the health of preschool aged children, as secondary objectives. Moreover we discuss implications for intervention and research using a "lessons learned" model based on our research team's experience of conducting a randomized controlled trial aimed at increasing physical activity, reducing sedentary behaviour and improving motor skill development and body composition in preschoolers. Lastly, we make conclusions based on the literature and highlight issues and directions that need to be addressed in future research in order to maximize health promotion and chronic disease prevention in the pediatric population.     

定性变量的数量化方法新探

目的 传统意义上的品质变量的数量化方法是引入虚拟变量.但是,当遇到一些无法观察或有多种结果表述的定性变量时,这一方法就无法解决品质变量的数量化问题了.本文试图运用比较量化方法来解决这一难题,运用比较量化方法将需要量化的定性变量数量化.方法 首先选取与要量化的定性变量相近或者是等价的定量变量进行替换或转化,再通过求该定量变量的样本平均值,用定量变量样本值与其样本平均值进行比较,将需要量化的定性变量以＂比较方法＂为媒介过渡到虚拟变量,将定量变量样本比较结果用虚拟变量的赋值进行对应表示,实现需要量化的定性变量的数量化需要.结果 实证结果表明：经过比较量化方法处理后的妇女健康意识在健康教育层面上可以从定量角度有效地得到反映.同时也为进一步的定量分析研究做好铺垫.结论 比较量化方法可以高效地在各种统计分析过程中满足需要赋值的定性变量的量化分析需要.尤其是可以方便地将定性变量在经过比较量化处理后以虚拟变量的形式融入到逻辑回归模型的构建过程中.     

Using theory-informed data science methods to trace the quality of dental student reflections over time

Advances in Health Sciences Education - This study describes a theory-informed application of data science methods to analyze the quality of reflections made in a health professions education...     

Using reflexivity to optimize teamwork in qualitative research

Reflexivity is often described as an individual activity. The authors propose that reflexivity employed as a team activity, through the sharing of reflexive writing (accounts of personal agendas, hidden assumptions, and theoretical definitions) and group discussions about arising issues, can improve the productivity and functioning of qualitative teams and the rigor and quality of the research. The authors review the literature on teamwork, highlighting benefits and pitfalls, and define and discuss the role for reflexivity. They describe their own team and detail how they work together on a project investigating doctor-patient communication about prescribing. The authors present two reflexive tools they have used and show through examples how they have influenced the effectiveness of their team in terms of process, quality, and outcome.