Women exposed to intimate partner violence : expectations and experiences when they encounter health care professionals : a meta-analysis of qualitative studies

Background The appropriate response of health care professionals to intimate partner violence is still a matter of debate. This article reports a meta-analysis of qualitative studies that answers 2 questions: (1) How do women with histories of intimate partner violence perceive the responses of health care professionals? and (2) How do women with histories of intimate partner violence want their health care providers to respond to disclosures of abuse?

Methods Multiple databases were searched from their start to July 1, 2004. Searches were complemented with citation tracking and contact with researchers. Inclusion criteria included a qualitative design, women 15 years or older with experience of intimate partner violence, and English language. Two reviewers independently applied criteria and extracted data. Findings from the primary studies were combined using a qualitative meta-analysis.

Results Twenty-nine articles reporting 25 studies (847 participants) were included. The emerging constructs were largely consistent across studies and did not vary by study quality. We ordered constructs by the temporal structure of consultations with health care professionals: before the abuse is discussed, at disclosure, and the immediate and further responses of the health care professional. Key constructs included a wish from women for responses from health care professionals that were nonjudgmental, nondirective, and individually tailored, with an appreciation of the complexity of partner violence. Repeated inquiry about partner violence was seen as appropriate by women who were at later stages of an abusive relationship.

Conclusion Women’s perceptions of appropriate and inappropriate responses partly depended on the context of the consultation, their own readiness to address the issue, and the nature of the relationship between the woman and the health care professional.

A qualitative study exploring barriers to a model of shared care for pre-school children`s oral health

Objective To explore the oral health beliefs and practices of primary health care professionals which may act as barriers to the development of a model of shared care for the oral health of pre-school children.

Design Qualitative focus group discussions and semi-structured interviews.

Setting Four rural local government areas in Victoria, Australia, 2003.

Subjects and methods Subjects: maternal and child health nurses, general medical practitioners, dental professionals and paediatricians working in the four local government areas. Data collection: discipline specific focus groups and semi-structured interviews. Data analysis: transcription, coding, clustering and thematic analysis.

Results Several strong themes emerged from the data. All participants agreed that dental caries is a significant health issue for young children and their families. Beliefs about the aetiology of dental caries and its prevention were variable and often simplistic, focusing predominantly on diet. Dental professionals did not believe that they had a primary role in the oral health of pre-school aged children but that others particularly maternal and child health nurses did. However other health care professionals were not confident in assuming this role.

Conclusions This study has identified important barriers and possible strategies for the development of an integrated and shared approach to preventing dental caries in pre-school aged children. Clear and consistent oral health information and agreed roles and responsibilities need to be developed.

A qualitative examination of the experience of 'depression' in hospitalized medically ill patients

Background: Research into depression in the medically ill has progressed without sufficient attention being given to the validity, in this group, of the taxonomic categories. We aimed to describe, using qualitative interviews, the experience of 'being depressed', separating experiences that are unique to depression from experiences that are common to being ill and in hospital.
Method: Forty-nine patients hospitalized for medical illness underwent a 30-min interview in which they were asked to 'Describe how you have been unwell and, in particular, how that has made you feel.' From the transcripts, a 'folk' taxonomy was constructed using a phenomenological framework involving four steps: frame elicitation to identify the important themes, componential analysis to systematically cluster the attributes into domains, a comparison of the experiences of patients screening depressed and  not-depressed, and a theoretical analysis comparing the resulting taxonomy with currently used theoretical constructs.
Results: Experiences common to all patients were being in hospital, being ill or in pain, adjusting to not being able to do things, and having time to think. In addition, all participants described being depressed, down or sad. Patients who were identified by screening as being depressed described unique experiences of depression, which included 'having to think about things' (a forceful intrusive thinking), 'not being able to sleep', 'having to rely on others', 'being a burden' to others (with associated shame and guilt), feelings of 'not getting better' and 'feeling like giving up'. Theoretical analysis suggested that this experience of depression fitted well with the concept of demoralization described by Jerome Frank.
Conclusions: Demoralization, which involves feelings of being unable to cope, helplessness, hopelessness and diminished personal esteem, characterizes much of the depression seen in hospitalized medically ill patients

A qualitative variant of the friendship scale: bereaved young adults and social isolation

This paper will examine how qualitative research into bereaved young adults’ experiences of social isolation can constitute a qualitative variant on the study of social isolation to Hawthorne’s quantitative ‘Friendship Scale’ (FS). As an instrument for measuring social isolation, the FS derives primarily from a particular dimension of social support; that is, the individual’s sense of connection to other people. This sense of connection to others is similarly a principal concern in the author’s study of bereaved young siblings (aged 18-30). The death of a close family member is commonly identified by researchers as the most debilitating stressor in everyday life. How then does this major life stressor impact on the individual’s sense of social connectedness?

Flora Fit street : a qualitative evaluation

This report summaries a qualitative evauation of the Flora Fit Street community based health living initiative.

An evaluation framework for the qualitative investigation of a physical activity prescription program in rural Victoria

Physical activity (PA) has consistently been shown to improve ones' physical, social and mental health. Hence, the rationale for promoting regular physical activity is relatively straightforward. However, what is less clear from the literature is the mix of strategies, (i.e. 'what is working and why?'), to increase in physical activity levels within a population. Of particular interest to primary care is the concept of Physical Activity Prescription Programs (PAPPs) delivered by general practitioners (GPs).

Several examples of a PAPP exist within England, America, New Zealand and Australia. These all aim to encourage GPs to deliver physical activity advice to their patients effectively and in a timely manner. Notwithstanding, the authors of a recent review of published literature on PAPPs, reveal a deficit of evidence regarding the components for successful PA interventions.

This research through an ethnographic enquiry aims to build on the evidence formulated to date. Through a case study research design, the researcher has developed a methodology to define what is/is not working within this recent trend.

In two rural Divisions of GP, participants have been identified as key stakeholders in the implementation of a PAPPs. They are categorised according to three theoretical paradigms, namely, Policy Makers, Linkers and Adaptors. Following this the three paradigms will be studied on the contextual factors, the characteristics and behaviours of members within all three paradigms. The study has also further defined certain elements for investigation, these include the:
intention of the players
effort undertaken by players, and
effect of parties within.

Primarily qualitative data will be collected; through Desk Analysis (Policies, Strategic and Business plans), Site Visits (Participant Observation) and semi-structured interviews. This presentation defines a qualitative framework and methodology for investigating the outcome of programs that historically has been evaluated using quantitative measures. Hence, the author of this study aims to present a qualitative investigation and subsequent results, defining aspects of a PAPP that allow for successful and sustainable implementation.

A qualitative examination of police officers' questioning of children about repeated events

For an offender to be convicted in relation to repeated child abuse, most jurisdictions require that each separate act be identified with reasonable precision with reference to time, place, or some other unique contextual detail (S v. R, 1989). The current study provided a qualitative examination of the way in which police officers assist children to identify and distinguish between occurrences of a repeated event. Field, as well as mock interviews (about an innocuous staged event) were examined, with child witnesses' ages ranging from 3 to 16 years. Overall, several problems in the questioning were highlighted. These included: over-reliance on specific questions, use of 'labels' for occurrences without inquiring as to whether these were unique, and frequent shifting of the focus between occurrences. The implications of these findings are discussed.

A qualitative study of primary health care access, barriers and satisfaction among people with mental illness

Research has found that a substantial proportion of individuals with mental illness have high morbidity and mortality rates, and high under-diagnosis of major physical illnesses. Furthermore, people with a mental illness tend not to seek out or utilise health care services. The reasons for the negative attitudes and behaviour towards health care services among this population have not been investigated. This paper presents findings from a study that investigated the health care service needs of people with mental illness (n = 20), and views from health care providers (n = 16) regarding access to these services by people with a mental illness. Results indicated that psychiatric patients identified a range of barriers to their health care usage and low levels of health care satisfaction. These views were shared with health care professionals. Reasons for these findings and strategies to address these problems so that there is better access to health care services for people with mental illness are discussed.

Depression training program for caregivers of elderly care recipients : implementation and qualitative evaluation

The prevalence of untreated depression is high among older adults who receive care in residential facilities or in their own omes and is associated with reduced quality of life and other medical conditions, Research has suggested a number of rea-p sons for the low detection and treatment rates for this problem, including lack of knowledge and efficacy among those who provide direct care and poor communication between these caregivers and senior staff, and between senior staff and genera practitioners. In this study, we report on the implementation of a training program for care staff that aims to address these issues. Focus groups with participants who completed the training indicated a high level of satisfaction with the program and reported improvements in knowledge, self-efficacy, and communication within services. It is recommended that the program be more systematically evaluated in relation to its longer term effects on care provider practices and the well-being of depressed elderly care recipients.