Qualitative Research in Medicine and Healthcare

“Constantly justifying my existence”: Lower-income, higher-weight Canadian adults’ stigma coping mechanisms

Lee Turner, Andrea E. Bombak — Wed, 20 Nov 2024 00:00:00 +0000

Individuals who are higher-weight and low-income may disproportionately experience weight and income stigmas in healthcare experiences compared to lower-weight, higher-income individuals. The ways that weight and income stigmas interact in healthcare should be better understood in order to provide better, less stigmatizing care to higher-weight, low-income patients. This study assesses how patients manage stigmatizing experiences in both healthcare and everyday experiences and how that impacts health seeking and stigma management behaviors through semistructured interviews with 11 higher-weight (Body Mass Index ≥30), low-income adults (≥18 years of age) in an Atlantic Canadian province. Participants took part in two interviews that focused on healthcare experiences and both positive and negative places/spaces. The two face-to-face interviews for each participant (total 21 interviews) were audio-recorded and professionally transcribed verbatim. The transcripts were analyzed using thematic analysis to identify recurring concepts and patterns within the data. Two major themes emerged from the data, uptake of stigmatizing, neoliberal health messaging and coping with stigma. Coping with stigma included subthemes control over stigmatizing experiences and stoicism in the face of stigma. The findings suggest that individuals understand their health and wellness through a neoliberal lens and that they deploy strategies of control and stoicism to cope with the stigmas they face.

“Suicide’s very abstract”: A qualitative analysis of risk assessment training recommendations from family physicians

Mark A. Dixon, Kathleen A. McNamara, David A. Moss — Wed, 22 Jan 2025 00:00:00 +0000

Suicide risk has consistently increased over the past 2.5 decades, despite growing awareness and tailored programs aimed at combating this epidemic. Suicide prevention initiatives include ensuring 24/7 access to crisis hotlines, encouraging individuals to seek mental health care, and reducing access to lethal means among high-risk populations. A recent area of focus is the physician’s office, as research shows that nearly half of those who die by suicide had seen a primary care physician within one month of their death. However, primary care physicians do not consistently inquire about suicide risk among their patients. This study presents findings from 15 interviews with family medicine residents at a U.S. military hospital. Participants identified gaps in three key areas of training: i) foundational knowledge (e.g., risk assessment flow, available tools and resources, and therapeutic skills), ii) training program structure (e.g., timing, exposure, and effectiveness), and iii) training culture (e.g., fostering courage and support). Residents recognized their central role in suicide prevention and were eager to address perceived gaps in their knowledge. They also shared their ideal training environment, which would support learning and skill development. This paper offers clear and actionable recommendations for family medicine residency programs to advance the suicide prevention agenda.

“But when I come home…”: How patients with chronic musculoskeletal pain account for their absent pain during naturally occurring clinical consultations

Trine C.B. Andersen, Olaug S. Lian — Mon, 20 Jan 2025 00:00:00 +0000

When patients’ embodied experiences cannot be conveyed to clinicians in real-time, the challenges of reaching a shared understanding between patient and clinician are enhanced. In this study, we explore how patients with chronic musculoskeletal pain manage the situation of knowing that they regularly experience pain, yet exhibit minimal signs of it during clinical consultations. Utilizing a multimethod, conversation analysis approach and an interactional perspective, this paper analyzes 10 naturally occurring consultations at a specialized rehabilitation clinic in Norway. The analysis shows that patients account for the absence of pain by referring to i) specific events, ii) pain tolerance, and iii) pain periods. Such accounts were typically triggered by null findings (i.e., the absence of findings in technological and physical tests) in the physical examination and clinicians’ positive summaries of patients’ bodily conditions. Patients resist clinicians’ positive stance by accounting for absent pain, cautiously challenging the clinicians’ epistemic stance. If clinicians do not pursue patients’ accounts, this might lead to a misalignment between patient and clinician which can obstruct efforts to reach a shared understanding of the pain. These findings may have general relevance for clinical consultations where patients’ symptoms are difficult to measure and validate biomedically. Understanding how patients account for absent pain can enhance clinician-patient communication and improve clinicians’ understanding of patients’ everyday circumstances and thereby improve the outcome of consultations.

What is veteran suicide prevention really about? Questions from the community to researchers

Brandy M. Fox — Wed, 22 Jan 2025 00:00:00 +0000

Military veterans are one of the most researched groups in healthcare in the United States. This population has extremely high rates of suicide attempts and completions. Despite increasing research focus, millions of dollars in funding, and being designated as a high clinical priority, rates of suicidal behavior continue to rise among veterans. Veterans are extremely concerned about this trend and critical of some suicide prevention projects. This study engaged 20 veterans who are connected to individuals within the military community who have attempted or completed suicide. Through semi-structured interviews, participants expressed a profound sense of disconnection from existing policies, treatments, and strategies aimed at preventing veteran suicide. During the course of the interviews, participants posed their own questions: Why is the public really concerned about veteran suicide? Why won’t the public recognize its part in the veteran suicide epidemic? Why won’t the medical industry listen and collaborate with us? This study underscores the critical need for all stakeholders involved in veteran suicide prevention to reflect on these concerns and to incorporate veterans’ insights into future prevention strategies, creating a more responsive and effective approach.

Obstetric care under the military health system: An analysis of active-duty women’s and female spouses’ online discussions

Amanda M. Rebhi — Wed, 22 Jan 2025 00:00:00 +0000

This research undertakes a thematic analysis of discussion threads on social media forums to determine women’s perceptions of quality of obstetric care under TRICARE Prime and TRICARE Select. Following an open coding process and thematic analysis, themes arose regarding obstetric care as experienced by active-duty women as well as female spouses of active-duty members. Themes surrounding active-duty perceptions of quality of obstetric care concerned proximity to care deferred deliveries, lack of care options, deficient on-base care, better civilian care experiences, and lamenting having less options than spouses. Spouses generated themes of positive connotation with TRICARE Select, including low costs, freedom of choice, and proximity to care and negative connotation with TRICARE Prime, such as difficulty getting care, process bureaucracy, and deficient care. Ample evidence pointed to a strong spouse preference for TRICARE Select over TRICARE Prime, but there was not enough evidence to indicate if active-duty women were pursuing out-of-pocket care to circumvent TRICARE Prime restrictions. Overall, women’s discussions point to a need to improve the Military Health System and concerningly suggest active-duty women are confined to care within a system plagued with issues that impact obstetric care.

Qualitative research is about listening and growing

Warren Bareiss — Thu, 23 Jan 2025 00:00:00 +0000

Change can be frightening. Or maybe it’s better to say that the thought of change can be frightening. Qualitative Research in Medicine & Healthcare is about to see a major change as it shifts publishers from PAGEPress to KeAi Publishing. This will be the last issue published by PagePress, where it began in 2017 under the leadership of founding editor, Mariaelena Bartesaghi. I became editor in 2021.

My time spent with QRMH has easily been the most fulfilling of my 25+ years in academia. I have had the support of an editorial board consisting of dedicated scholars who find the service of working on QRMH as rewarding as I do. And QRMH reviewers are unwaveringly generous, writing detailed, thoughtful reviews that balance fair critique with concrete, encouraging suggestions. [...]