Social and economically influenced factors associated with breast cancer treatment among blacks and whites. A qualitative study

Background: Despite the fact breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. A part of these disparities may be due to either inadequately following guideline recommended treatment or treatment delays. Although racial/ethnic disparities in breast cancer treatment and mortality have been extensively documented, the mechanisms by which these disparities occur remain largely unknown. Social and economically influenced factors such as choice of providers, distance of treatment facility, transportation, health insurance, and job related factors may also contribute to racial differences in breast cancer treatment; however, these have not been explored sufficiently in previous research. ^ Aim: The purpose of this study was to evaluate the role of social and economically influenced factors that may contribute to racial disparities in the receipt of guideline recommended treatment using the Health Disparities Model. ^ Methods: In this qualitative comparative case study, data from medical records, structured telephone interviews, and in-depth patient interviews explored the relationship between social and economically influenced factors and breast cancer treatment. Transcripts were analyzed using standard iterative process followed by immersion/crystallization approach. Participants were identified through rapid ascertainment from the New Jersey Cancer Registry and this study included 8 African-American and 8 white women aged 20-85 years old diagnosed with early stage breast cancer between 2003-2007, matched on age, race, and physician recommended treatment. ^ Results: We did not identify differences by race in factors that influenced the receipt of breast cancer treatment among the individual matched pairs. Four prominent themes emerged among women from both groups who experienced similar difficulties influenced by socioeconomic factors. Choice of providers, distance of facility, health insurance, and job related factors all contributed to breast cancer treatment experience among these women. Conclusions: We identified common issues influenced by socioeconomic factors and its relation with the receipt of breast cancer treatment, regardless of race. However, more research is needed to study the additional factors conveying racial differences affecting breast cancer treatment. ^

A Qualitative Study of Potential Suicide Risk Factors Among Soldiers Transitioning From Operation Iraqi Freedom/Operation Enduring Freedom

Using qualitative methods, this study explored potential risk factors for suicide, as defined by Joiner's Interpersonal-Psychological Theory of Suicide (IPTS), in a population of Soldiers returning from deployment in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Sixty-eight Soldiers participated in semi-structured interviews during the period of transition from deployment to the garrison environment. These Soldiers were asked about changes in perception of pain, experiences of perceived burdensomeness, and lack of belonging. Interviews were transcribed and analyzed. A phenomenological methodology was employed (Creswell, 2006). In response to questions about perception of pain, Soldiers discussed both positive and negative changes in their experience of physical and emotional pain. When asked about experiences of perceived burdensomeness, Soldiers described changes related to deployment, such as injuries and combat related guilt, as well as changes related to transition from combat, including care seeking, reintegration into family and society, and emotional distancing. Regarding the experience of lack of belonging, Soldiers described difficulties related to the deployment, such as combat injuries, leadership roles, and individual differences, as well as difficulties related to reintegration such as symptoms of emotional numbing and distancing. Findings highlight the potential utility of IPTS in exploring both acute and chronic suicide risk factors associated with deployment and transition, as well as potential treatment strategies that may reduce suicide risk in the population of Soldiers during reintegration.

A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

Background: Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods: A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results: We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions: Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Effective Behaviors of Expert Rowing Coaches: A Qualitative Investigation of Canadian Athletes and Coaches

Ten Canadian expert rowing coaches and 10 Canadian elite rowers were interviewed regarding their perceptions of effective coaching behaviors. The questions of the interview guide focused on coaches' behaviors in training, competition, and organization settings. Qualitative data analyses revealed seven behaviors elicited by coaches and athletes. Effective coaching behaviors perceived as important by both athletes and coaches were; 1) plan proactively, 2)create a positive training environment, 3)facilitate goal setting, 4)build athletes' confidence, 5) teach skills effectively, 6)recognize individual differences, and 7)establish a positive rapport with each athlete.

Views of general practitioners and benzodiazepine users on benzodiazepines: A qualitative analysis

Effectively assisting benzodiazepine users to cease use requires a greater understanding of general practitioners' (GPs) and benzodiazepine users' views on using and ceasing benzodiazepines. This paper reports the findings from a qualitative study that examined the views of 28 GPs and 23 benzodiazepine users (BUs) in Cairns, Australia. A semi-structured interview was conducted with all participants and the information gained was analysed using the Consensual Qualitative Research Approach, which allowed comparisons to be made between the views of the two groups of interviewees. There was commonality between GPs and BUs on reasons for commencing benzodiazepines, the role of dependence in continued use, and the importance of lifestyle change in its cessation. However, several differences emerged regarding commencement of use and processes of cessation. In particular, users felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before commencing benzodiazepines. Cessation could be discussed with all patients who use benzodiazepines for longer than 3 months, strategies offered to assist in management of withdrawal and anxiety, and referral to other health service providers for additional support. Lifestyle change could receive greater focus at all stages of treatment. (c) 2005 Elsevier Ltd. All rights reserved.

Within-country ethnic differences and product positioning:a comparison of the perceptions of two British sub-cultures

While cross-cultural consumer behaviour and its impact on marketing strategies has received considerable interest within the marketing literature, differences between ethnic groups within countries have received significantly less attention. This study examines the effect of within-country ethnic differences on brand positioning, using the UK automobile industry as a context. Both qualitative and quantitative research is used to identify the perceptions of two sub-cultural groups: British of Indian extraction, and Caucasian British. It was found that these two groups display appreciably different values, and also place different levels of importance on different product attributes when evaluating brands. Furthermore, the two groups exhibited different perceptions of the same set of brands. The results suggest that, to position brands effectively, marketers should take account of cultural diversity within countries as well as between them.

Applying qualitative reasoning to finance

Qualitative reasoning has traditionally been applied in the domain of physical systems, where there are well established and understood laws governing the behaviour of each `component' in the system. Such application has shown that it is possible to produce models which can be used for explaining and predicting the behaviour of physical phenomena and also trouble-shooting. The principles underlying the theory ensure that the models are robust and exhibit consistent behaviour under all conditions. This research examines the validity of applying the theory in the financial domain where such laws may not exist or if they do, may not be universally applicable. In particular, it investigates how far these principles and techniques may be applied in the construction of financial analysis models. Because of the inherent differences in the nature of these two domains, it is argued that a different qualitative value system ought to be employed. The dissertation enlarges on the constraints this places on model descriptions and the effect it may have on the power and usefulness of the resulting models. It also describes the implementation of a system that investigates the implications of applying this theory by way of testing it on situations drawn from both text-books and published financial information.

Innovation in teams : a qualitative and quantitative study of team behaviours

This thesis explores the processes of team innovation. It utilises two studies, an organisationally based pilot and an experimental study, to examine and identify aspects of teams' behaviours that are important for successful innovative outcome. The pilot study, based in two automotive manufacturers, involved the collection of team members' experiences through semi-structured interviews, and identified a number of factors that affected teams' innovative performance. These included: the application of ideative & dissemination processes; the importance of good team relationships, especially those of a more informal nature, in facilitating information and ideative processes; the role of external linkages in enhancing quality and radicality of innovations; and the potential attenuation of innovative ideas by time deadlines. This study revealed a number key team behaviours that may be important in successful innovation outcomes. These included; goal setting, idea generation and development, external contact, task and personal information exchange, leadership, positive feedback and resource deployment. These behaviours formed the basis of a coding system used in the second part of the research. Building on the results from the field based research, an experimental study was undertaken to examine the behavioural differences between three groups of sixteen teams undertaking innovative an task to produce an anti-drugs poster. They were randomly assigned to one of three innovation category conditions suggested by King and Anderson (1990), emergent, imported and imposed. These conditions determined the teams level of access to additional information on previously successful campaigns and the degree of freedom they had with regarding to the design of the poster. In addition, a further experimental condition was imposed on half of the teams per category which involved a formal time deadline for task completion. The teams were video taped for the duration of their innovation and their behaviours analysed and coded in five main aspects including; ideation, external focus, goal setting, interpersonal, directive and resource related activities. A panel of experts, utilising five scales developed from West and Anderson's (1996) innovation outcome measures, assessed the teams' outputs. ANOVAs and repeated measure ANOVAs were deployed to identify whether there were significant differences between the different conditions. The results indicated that there were some behavioural differences between the categories and that over the duration of the task behavioural changes were identified. The results, however, revealed a complex picture and suggested limited support for three distinctive innovation categories. There were many differences in behaviours, but rarely between more than two of the categories. A main finding was the impact that different levels of constraint had in changing teams' focus of attention. For example, emergent teams were found to use both their own team and external resources, whilst those who could import information about other successful campaigns were likely to concentrate outside the team and pay limited attention to the internal resources available within the team. In contrast, those operating under task constraints with aspects of the task imposed onto them were more likely to attend to internal team resources and pay limited attention to the external world. As indicated by the earlier field study, time deadlines did significantly change teams' behaviour, reducing ideative and information exchange behaviours. The model shows an important behavioural progression related to innovate teams. This progression involved the teams' openness initially to external sources, and then to the intra-team environment. Premature closure on the final idea before their mid-point was found to have a detrimental impact on team's innovation. Ideative behaviour per se was not significant for innovation outcome, instead the development of intra-team support and trust emerged as crucial. Analysis of variance revealed some limited differentiation between the behaviours of teams operating under the aforementioned three innovation categories. There were also distinct detrimental differences in the behaviour of those operating under a time deadline. Overall, the study identified the complex interrelationships of team behaviours and outcomes, and between teams and their context.

Education and self-management for people newly diagnosed with type 2 diabetes: a qualitative study of patients' views.

OObjectives: We explored the perceptions, views and experiences of diabetes education in people with type 2 diabetes who were participating in a UK randomized controlled trial of methods of education. The intervention arm of the trial was based on DESMOND, a structured programme of group education sessions aimed at enabling self-management of diabetes, while the standard arm was usual care from general practices. Methods: Individual semi-structured interviews were conducted with 36 adult patients, of whom 19 had attended DESMOND education sessions and 17 had been randomized to receive usual care. Data analysis was based on the constant comparative method. Results: Four principal orientations towards diabetes and its management were identified: `resisters', `identity resisters, consequence accepters', `identity accepters, consequence resisters' and `accepters'. Participants offered varying accounts of the degree of personal responsibility that needed to be assumed in response to the diagnosis. Preferences for different styles of education were also expressed, with many reporting that they enjoyed and benefited from group education, although some reported ambivalence or disappointment with their experiences of education. It was difficult to identify striking thematic differences between accounts of people on different arms of the trial, although there was some very tentative evidence that those who attended DESMOND were more accepting of a changed identity and its implications for their management of diabetes. Discussion: No one single approach to education is likely to suit all people newly diagnosed with diabetes, although structured group education may suit many. This paper identifies varying orientations and preferences of people with diabetes towards forms of both education and self-management, which should be taken into account when planning approaches to education.

Self-monitoring of blood glucose in Black Caribbean and South Asian Canadians with non-insulin treated Type 2 diabetes mellitus:a qualitative study of patients' perspectives

Background: To examine the views and current practice of SMBG among Black Caribbean and South Asian individuals with non-insulin treated Type 2 diabetes mellitus. Methods: Twelve participants completed semi-structured interviews that were guided by the Health Belief Model and analyzed using thematic network analysis. Results: The frequency of monitoring among participants varied from several times a day to once per week. Most participants expressed similar experiences regarding their views and practices of SMBG. Minor differences across gender and culture were observed. All participants understood the benefits, but not all viewed SMBG as beneficial to their personal diabetes management. SMBG can facilitate a better understanding and maintenance of self-care behaviours. However, it can trigger both positive and negative emotional responses, such as a sense of disappointment when high readings are not anticipated, resulting in emotional distress. Health care professionals play a key role in the way SMBG is perceived and used by patients. Conclusion: While the majority of participants value SMBG as a self-management tool, barriers exist that impede its practice, particularly its cost. How individuals cope with these barriers is integral to understanding why some patients adopt SMBG more than others. © 2013 Gucciardi et al.; licensee BioMed Central Ltd.

Generational differences in consumption patterns in Hungary

Various authors have used the term consumer society with a number of different meanings, yet one common point has been the shift of focus to the consumer ethos, which alters the everyday life of society members and their relationship to each other and society as a whole. One’s relationship to consumption determines fundamental levels of consumption and for what purposes (e.g. hedonic values, family and savings), thus it is essential to explore this relationship to develop an understanding of consumer behaviour and to create effective marketing messages. This paper provides a brief summary of the various approaches and research lines of consumer culture and reviews the findings of the first, qualitative phase of our consumer culture study in Hungary. The purpose of this research programme is to analyse the changes in people’s relationships to consumption since the change of regime.

Fiscal and organizational determinants of transportation outcomes: A quantitative and qualitative analysis of sustainability factors

Federal transportation legislation in effect since 1991 was examined to determine outcomes in two areas: (1) The effect of organizational and fiscal structures on the implementation of multimodal transportation infrastructure, and (2) The effect of multimodal transportation infrastructure on sustainability. Triangulation of methods was employed through qualitative analysis (including key informant interviews, focus groups and case studies), as well as quantitative analysis (including one-sample t-tests, regression analysis and factor analysis). ^ Four hypotheses were directly tested: (1) Regions with consolidated government structures will build more multimodal transportation miles: The results of the qualitative analysis do not lend support while the results of the quantitative findings support this hypothesis, possibly due to differences in the definitions of agencies/jurisdictions between the two methods. (2) Regions in which more locally dedicated or flexed funding is applied to the transportation system will build a greater number of multimodal transportation miles: Both quantitative and qualitative research clearly support this hypothesis. (3) Cooperation and coordination, or, conversely, competition will determine the number of multimodal transportation miles: Participants tended to agree that cooperation, coordination and leadership are imperative to achieving transportation goals and objectives, including targeted multimodal miles, but also stressed the importance of political and financial elements in determining what ultimately will be funded and implemented. (4) The modal outcomes of transportation systems will affect the overall health of a region in terms of sustainability/quality of life indicators: Both the qualitative and the quantitative analyses provide evidence that they do. ^ This study finds that federal legislation has had an effect on the modal outcomes of transportation infrastructure and that there are links between these modal outcomes and the sustainability of a region. It is recommended that agencies further consider consolidation and strengthen cooperation efforts and that fiscal regulations are modified to reflect the problems cited in qualitative analysis. Limitations of this legislation especially include the inability to measure sustainability; several measures are recommended. ^

Quantitative and Qualitative Aspects of Dissolved Organic Carbon Leached from Senescent Plants in an Oligotrophic Wetland

We conducted a series of experiments whereby dissolved organic matter (DOM) was leached from various wetland and estuarine plants, namely sawgrass (Cladium jamaicense), spikerush (Eleocharis cellulosa), red mangrove (Rhizophora mangle), cattail (Typha domingensis), periphyton (dry and wet mat), and a seagrass (turtle grass; Thalassia testudinum). All are abundant in the Florida Coastal Everglades (FCE) except for cattail, but this species has a potential to proliferate in this environment. Senescent plant samples were immersed into ultrapure water with and without addition of 0.1% NaN3 (w/ and w/o NaN3, respectively) for 36 days. We replaced the water every 3 days. The amount of dissolved organic carbon (DOC), sugars, and phenols in the leachates were analyzed. The contribution of plant leachates to the ultrafiltered high molecular weight fraction of DOM (>1 kDa; UDOM) in natural waters in the FCE was also investigated. UDOM in plant leachates was obtained by tangential flow ultrafiltration and its carbon and phenolic compound compositions were analyzed using solid state 13C cross-polarization magic angle spinning nuclear magnetic resonance (13C CPMAS NMR) spectroscopy and thermochemolysis in the presence of tetramethylammonium hydroxide (TMAH thermochemolysis), respectively. The maximum yield of DOC leached from plants over the 36-day incubations ranged from 13.0 to 55.2 g C kg−1 dry weight. This amount was lower in w/o NaN3 treatments (more DOC was consumed by microbes than produced) except for periphyton. During the first 2 weeks of the 5 week incubation period, 60–85% of the total amount of DOC was leached, and exponential decay models fit the leaching rates except for periphyton w/o NaN3. Leached DOC (w/ NaN3) contained different concentrations of sugars and phenols depending on the plant types (1.09–7.22 and 0.38–12.4 g C kg−1 dry weight, respectively), and those biomolecules comprised 8–34% and 4–28% of the total DOC, respectively. This result shows that polyphenols that readily leach from senescent plants can be an important source of chromophoric DOM (CDOM) in wetland environments. The O-alkyl C was found to be the major C form (55±9%) of UDOM in plant leachates as determined by 13C CPMAS NMR. The relative abundance of alkyl C and carbonyl C was consistently lower in plant-leached UDOM than that in natural water UDOM in the FCE, which suggests that these constituents increase in relative abundance during diagenetic processing. TMAH thermochemolysis analysis revealed that the phenolic composition was different among the UDOM leached from different plants, and was expected to serve as a source indicator of UDOM in natural water. Polyphenols are, however, very reactive and photosensitive in aquatic environments, and thus may loose their plant-specific molecular characteristics shortly. Our study suggests that variations in vegetative cover across a wetland landscape will affect the quantity and quality of DOM leached into the water, and such differences in DOM characteristics may affect other biogeochemical processes.

Migration and Perception of Health Status: a Qualitative Study in Kazakh Chinese

This qualitative study explored the rural to urban migration’s effect and its related factors on later life health status and health perception among Kazakh Chinese. The participants were same sex sibling pairs, of which one moved from rural to urban areas in early life and the other stayed in rural areas. Rural participants tend to have more selected chronic diseases conditions and other self-reported conditions than urban participants but less physical limitations in older age. There is no clear difference on the health perceptions between rural and urban participants. Health care access and environmental factors are the major differences that may affect health in later life for rural participants.

Effective Behaviors of Expert Rowing Coaches: A Qualitative Investigation of Canadian Athletes and Coaches

Ten Canadian expert rowing coaches and 10 Canadian elite rowers were interviewed regarding their perceptions of effective coaching behaviors. The questions of the interview guide focused on coaches' behaviors in training, competition, and organization settings. Qualitative data analyses revealed seven behaviors elicited by coaches and athletes. Effective coaching behaviors perceived as important by both athletes and coaches were; 1) plan proactively, 2)create a positive training environment, 3)facilitate goal setting, 4)build athletes' confidence, 5) teach skills effectively, 6)recognize individual differences, and 7)establish a positive rapport with each athlete.