Being dialysis-dependant: a qualitative perspective

The technology of renal dialysis offers a way in which life can be sustained, so it is not surprising that the complex, diverse and evolving iatrogenic aspects of dialysis-dependency continue to be researched. However, there has been a tendency to take for granted the human process of making sense of the intrusiveness of dialysis. This study was designed to explore the meanings of dialysis-dependency. The study sample was 10 participants: five female, five male; five on peritoneal dialysis, five on haemodialysis; whose ages ranged from 22 to 68 years. Using a narrative methodology the following methods were used: in-depth interviews, narrative and thematic analysis, fieldwork/notes from five renal units, participant validation, and journal reflections. A thematic analysis revealed the continuum themes of Freedom-Restrictions, Being Normal-Being Visible, Control-Acquiesce, Hope-Despair and Support-Abandon. The themes portrayed as continuums serve to remind health care professionals that those with chronic illnesses strive to make sense of what is happening to them. Variations within each of these themes can occur daily, weekly or monthly. Acceptance may never be reached or may be tentative. Some clients will strive for control and freedom to choose for themselves, others will acquiesce to the overwhelming changes wrought in their lives. Thus, health care professionals might consider placing the personal meanings of those who are dialysis-dependent to the fore, being sensitive to the sufferings wrought by the regime, which treats but does not cure, which sustains life but does not heal.

Reflections of a research inside conducting qualitative research in sign language

Deaf people who use sign language are potential users of emerging telecommunications innovations such as videotelephony There has been little research that explores their thoughts and experiences in the use of this technology. In this paper, the experiences of a Deaf person as a research insider in a current telecommunications study are described and issues of researcher-participant relationship, data integrity, interview and interpreter skills, communication and cultural aspects of the participating community and the impact of this type of research are explored.

In their own words : a qualitative study of the reasons Australian university students plagiarise

The ways in which universities and individual academics attempt to deter and respond to student plagiarism may be based on untested assumptions about particular or primary reasons for this behaviour. Using a series of group interviews, this qualitative study gathered the views of 56 Australian university students on the possible reasons for plagiarism within their institution. The results indicate a wide and disparate range of possible contributing reasons for plagiarism, including: institutional admission criteria; student understanding of plagiarism; poor academic skills; a range of teaching and learning factors; personality factors; and external pressures. These findings are compared with other findings about reasons for student plagiarism in Australasia. The implications of these findings are considered for universities and individual academics seeking to better engage with their students to minimize or marginalize plagiarism.

Parent-proxy and child self-reported health-related quality of life: using qualitative methods to explain the discordance

Background: Although parent-proxy reports of health-related quality of life (HRQOL) are only moderately correlated with child reported HRQOL, it remains unknown why these scores differ. The aim of this study was to use a qualitative methodology to examine why parents and children report different levels of HRQOL.

Method: The sample consisted of 15 parent–child pairs. A think-aloud technique was used where parents and children were given a generic HRQOL instrument (KIDSCREEN) and instructed to share their thoughts with the interviewer. Qualitative analyses were conducted to assess whether parents and children base their answer on different experiences or reasoning, have different response styles, or interpret the items differently.

Results: There was discordance between parents and children, in terms of rating scale and in terms of the reasoning for their answer. Children tended to have different response styles to parents, where for example, children tended to provide extreme scores (highest or lowest score) and base their response on one single example, more than parents. Parents and children interpreted the meaning of the items very similarly.

Discussion: This study provides evidence to suggest that discordance among parent-child pairs on KIDSCREEN scores may be as a result of different reasoning and different response styles, rather than interpretation of items. These findings have important implications when parent-proxy reported HRQOL is used to guide clinical/treatment decisions.

Experiences of men with breast cancer: a qualitative study

Background
Recent reports indicate that male breast cancer rates are increasing in North America. While there have been numerous large-scale studies examining women's experiences with breast cancer, to date there have been no North American studies examining what a man experiences with a breast cancer diagnosis. The objective of this qualitative study was to describe the experiences of a sample of Canadian men diagnosed with breast cancer.

Methods
After written informed consent, unstructured audio-taped interviews were conducted with 20 men. Since little is known about a man's experience with breast cancer, an exploratory qualitative approach was utilized.

Results
Participants experienced concerns related to the lack of awareness of male breast cancer within both public and health professional groups. Many men suffered stress related to the cancer diagnosis, body image concerns and role strain. The lack of male-specific breast cancer information was identified as a major concern. All denied interest in traditional support groups. In retrospect, a number of men felt the breast cancer experience vastly improved their lives.

Conclusions
Needs identified by participants include increased public and health professional awareness of male breast cancer, written information specific for men, and male participation in breast cancer research. Further study is also necessary to identify supports considered helpful by men with breast cancer and other malignancies.

Factors that influence women's disclosures of substance use during pregnancy : a qualitative study of ten midwives and ten pregnant women

The present study was designed to examine the factors that motivate or act as barriers to disclosure of substance use by pregnant women. Participants included 10 midwives and 10 pregnant women who attended two ante-natal clinics at an Australian maternity hospital. One clinic specialized in women who were substance users and one clinic was specifically for young women (under 19 years of age). Midwives and pregnant women were interviewed in-depth about disclosure of substance use. Interview transcripts were analyzed, and the results revealed six main themes: practice style, assessment of substance use, practice environment and privacy, child protection issues, health of the baby, and continuity of care. The findings are discussed in relation to recommendations for best practice in midwifery care when working with pregnant women who use substances.

Generating best evidence from qualitative research: the role of data analysis

Objective: To outline the importance of the clarity of data analysis in the doing and reporting of interview-based qualitative research.

Approach: We explore the clear links between data analysis and evidence. We argue that transparency in the data analysis process is integral to determining the evidence that is generated. Data analysis must occur concurrently with data collection and comprises an ongoing process of 'testing the fit' between the data collected and analysis. We discuss four steps in the process of thematic data analysis: immersion, coding, categorising and generation of themes.

Conclusion: Rigorous and systematic analysis of qualitative data is integral to the production of high-quality research. Studies that give an explicit account of the data analysis process provide insights into how conclusions are reached while studies that explain themes anchored to data and theory produce the strongest evidence.

What have sampling and data collection got to do with good qualitative research?

Objective: To highlight the importance of sampling and data collection  processes in qualitative interview studies, and to discuss the contribution of  these processes to determining the strength of the evidence generated and  thereby to decisions for public health practice and policy.

Approach: This discussion is informed by a hierarchy-of-evidence-for-practice  model. The paper provides succinct guidelines for key sampling and data  collection considerations in qualitative research involving interview studies. The  importance of allowing time for immersion in a given community to become  familiar with the context and population is discussed, as well as the practical  constraints that sometimes operate against this stage. The role of theory in  guiding sample selection is discussed both in terms of identifying likely sources  of rich data and in understanding the issues emerging from the data. It is noted  that sampling further assists in confirming the developing evidence and also  illuminates data that does not seem to fit. The importance of reporting sampling  and data collection processes is highlighted clearly to enable others to assess  both the strength of the evidence and the broader applications of the findings.

Conclusion: Sampling and data collection processes are critical to determining  the quality of a study and the generalisability of the findings. We argue that  these processes should operate within the parameters of the research goal, be  guided by emerging theoretical considerations, cover a range of relevant   participant perspectives, and be clearly outlined in research reports with an  explanation of any research limitations.

Qualitative exploration of the nature of grief-related beliefs and expectations

Societal expectations of grief impact the experience of bereavement. The congruence of societal expectations with current scientific understanding of grief is unknown. Therefore two qualitative studies explored community perceptions of grief. In study one, three small focus groups (N = 9) examined grief-related expectations associated with hypothetical scenarios of bereavement. In study two, the impact of grief-related perceptions on the lived experience of bereavement for 11 individuals was explored through semi-structured interviews. Across both studies, elements of a traditional stage model view of grief were evident, with participants viewing emotional expression of grief as important. An avoidant coping style in the bereaved was considered problematic. Findings of study two suggested that grief-related beliefs may impact the bereavement experience via appraisal of the grief response and willingness to support bereaved individuals. The studies suggested that stage model assumptions in the beliefs of the general population persist, although there was a recognition of diversity in the grief response.

Promoting comprehensive sun protection policies and practices in outdoor sports: a qualitative study of perceived priorities and practicalities

Sun protection policies, environments, practices, and attitudes in sporting club contexts might be significant determinants of sun exposure among adult sporting participants. Face-to-face interviews, using standardised, open-ended questions were conducted with 20 club officials from four sports: soccer, hockey, tennis and surf lifesaving. Thematic content analysis identified a number of salient themes. Formal sun protection policies were well-implemented in surf lifesaving, but less so in soccer, hockey and tennis clubs, which often had informal sun protection practices in place. Officials perceived sun protection to be important, which was related to perceived exposure levels, the type of sport, length of time played and the season. Consistent logistical and practical considerations emerged, including limited resources, availability of shade, and lack of control over sporting facilities, uniform regulations and games scheduling. Sun protection efforts often focused on children more than adult players. Reciprocal responsibility was an important theme, where it was perceived that responsibility for sun protection should be equally shared between the club and the member. In this study it was found that reciprocal responsibility, duty of care and sport-specific practical requirements might significantly influence the success of policy, environmental and education initiatives for sun protection in sporting settings.

Understanding public involvement with Australian heritage : a qualitative study using repertory grid analysis

Attempts to increase public participation in heritage related activities have had mixed success. Tourism to heritage sites remains an overt activity that many engage in, but other heritage related activities, such as nominating objects for formal heritage listing, are much rarer. Through a series of qualitative research activities, we examine the public perceptions of what constitutes "heritage" and "heritage - related" behaviours, in order to examine barriers to greater involvement. The findings are that heritage is important to many people, particularly on a personal level. Although initially uncertain about the validity of their views, our respondents defined heritage broadly, believing it to encompass a wide range of objects, places and experiences. Most respondents were undertaking the type of heritage-related behaviours that heritage managers would encourage, however the respondents did not recognise them as being heritage-related. Barriers to greater involvement include this uncertainty over the definition of heritage and a lack of confidence in their ability to effectively recognise and protect heritage. In addition to feeling uncertain about the heritage significance of their own actions and beliefs, the respondents felt even more uncertain about prescribing things of "national heritage value". This uncertainty stifles discussion and action. The solution appears to lay in celebrations of both individual and national heritage, to foster discussions and understanding of communalities across different cultural groups within the nation.

Qualitative analysis of the care of children in hospital in four countries : part 2

As part of a large study of the care of children in Australian, British, Indonesian, and Thai hospitals, qualitative methods were used to examine differences influenced by culture. Two groups were surveyed: parents of hospitalized children, and staff caring for them. Vignettes were used to invoke discussion, and content analysis was used to examine the data. Subjects were interviewed singly, or in focus groups. These interviews were audiotaped and transcribed for analysis. This article is the second of a two-part series, and includes results of the staff's interviews and discussion. The parents' results and discussion were published in Part 1 (Shields [amp ] King, 2001). Staff in all the countries considered communication with parents to be an important part of care of the hospitalized child, and this was consistent with the parents' responses. Staff were mindful of safe practices, though more so in Australia and Britain than Indonesia and Thailand. Cost of treatment for the parents was an important consideration for staff in Indonesia and Thailand when they were planning care for the child. Cultural constructions were more likely to be considered by the Australian and British staff than the Indonesian and Thai staff, and this may have been influenced by the prevailing culture of medical dominance in those countries.

Qualitative analysis of the care of children in hospital in four countries : part 1

As part of a large study of the care of children in Australian, British, Indonesian, and Thai hospitals, qualitative methods were used to examine differences influenced by culture. Two groups were surveyed: parents of hospitalized children, and staff caring for them. Vignettes were used to invoke discussion, and content analysis was used to examine the data. Subjects were interviewed singly, or in focus groups. These interviews were audiotaped and transcribed verbatim. The data were explored by using content analysis to extract themes of understanding of cultural experiences. This article is the first of a two-part series, and includes a review of the literature, description of the methods used, and results of the parents' interviews. The staff results and discussion will be published in Part 2. Analysis revealed that parents in all countries were primarily concerned with treating the child's illness and the child's recovery. Parents were concerned with their work (employment), but this was a much larger consideration in Indonesia and Thailand, where no social security systems exist, than in Australia and Britain. Communication with staff was the most commonly mentioned theme for parents, indicating that irrespective of the culture in which the care was given, good communication between parents and staff was of paramount importance.