Daniel H. Grossoehme

Overview of qualitative research.

Qualitative research methods are a robust tool for chaplaincy research questions. Similar to much of chaplaincy clinical care, qualitative research generally works with written texts, often transcriptions of individual interviews or focus group conversations and seeks to understand the meaning of experience in a study sample. This article describes three common methodologies: ethnography, grounded theory, and phenomenology. Issues to consider relating to the study sample, design, and analysis are discussed. Enhancing the validity of the data, as well reliability and ethical issues in qualitative research are described. Qualitative research is an accessible way for chaplains to contribute new knowledge about the sacred dimension of peoples lived experience.

We Can Handle This: Parents' Use of Religion in the First Year Following Their Child's Diagnosis with Cystic Fibrosis

The diagnosis of a childs life-shortening disease leads many American parents to utilize religious beliefs. Models relating religious constructs to health have been proposed. Still lacking are inductive models based on parent experience. The specific aims of this study were: 1. develop a grounded theory of parental use of religion in the year after diagnosis; 2. describe whether parents understand a relationship between their religious beliefs and their follow-through with their childs at-home treatment regimen. Fifteen parent interviews were analyzed using grounded theory method. Parents used religion to make meaning of their childs cystic fibrosis (CF) diagnosis. Parents imagined God as active, benevolent, and interventionist; found hope in their beliefs; felt supported by God; and related religion to their motivation to adhere to their childs treatment plan. Religious beliefs are clinically significant in working with many parents of children recently diagnosed with CF. Interventions that improve adherence to treatment may be enhanced by including religious aspects.

Religious coping and the use of prayer in children with sickle cell disease

While adolescents and adults with sickle cell disease (SCD) have reported using religion to cope with SCD, there is no data examining religious coping in young children with SCD. The purpose of this qualitative study was to: (1) describe the types of religious coping used by children with SCD; (2) describe the content and frequency of prayer used in relation to SCD; and (3) examine how children viewed God/Higher Power in relation to their SCD.

Using Spirituality After an Adult CF Diagnosis: Cognitive Reframing and Adherence Motivation

Chronic illness is a significant stressor; the majority of Americans cope utilizing spirituality. Numerous studies demonstrate links between spiritual coping and health outcomes. The purpose of this study was to determine whether persons diagnosed with cystic fibrosis (CF) as adults use spirituality to cope and influence disease management. Semi-structured interviews were completed and analyzed using grounded theory. Data saturation was reached following twelve interviews (83% female); representing 100% participation of those approached and 48% of eligible adults. Persons with late-life CF diagnoses used spirituality to make meaning, understanding themselves in a collaborative partnership with their pulmonologist and God. Supporting themes were: (a) Gods intervention depended on treatment adherence and (b) spiritual meaning was constructed through positively reframing their experience. The constructed meaning differed from that of adult parents of children with CF. Late-life diagnosed adults focused on personal responsibility for health. Clinical and research implications for chaplains are presented.

Spirituality's Role in Chronic Disease Self-Management: Sanctification of the Body in Families Dealing With Cystic Fibrosis

Sanctifying the Body (imbuing the body and its care with spiritual significance) is associated with pro-healthy behaviors and may be associated with adherence in families with chronic diseases. Our objective was to determine this constructs relevance to cystic fibrosis (CF) families and test the reliability and validity of a shortened Sanctification measure. The “Sacred Qualities of the Body” and “Manifestation of God in the Body” scales were completed by parents (N = 92) and adolescents with CF (N = 32) in a CF Clinic or by mail. Internal consistency reliability and factor analysis were performed on the parent sample. Parents and adolescents endorsed the construct. Internal consistency and validity was shown for adults and factor analysis showed two factors. Adolescent interest in an electronic spirituality chatroom correlated with increased sanctification. Sanctification is a relevant, measurable construct representing an under-appreciated aspect of the web of values contributing to adherence and health and bears further examination.

Written prayers and religious coping in a paediatric hospital setting

Hospitalised children represent a threatened future to parents. Such stressors call forth peoples coping styles. Some individuals cope religiously or spiritually, and religious coping through prayer may be utilised. A sample of prayers written in a paediatric hospital chapel was coded by styles of religious coping evident within them. Styles associated with coping to gain control of their situation and with coping by seeking comfort from God were present. Seeking to cope for gaining control of a situation was more common than seeking comfort from God during the event. Written prayers did not contain evidence of coping by making meaning. Regression analysis showed that the probability of writing a prayer to gain control decreased over time and a trend towards increasing probability of writing a prayer expressing coping by seeking Gods comfort. Clinical implications are discussed. Future research should include a larger sample and cognitive interviews with prayer writers.

Adolescent Perceptions of Meaningfulness of Psychiatric Hospitalization

Positive patient outcomes are related to patient satisfaction and the meaningfulness of their hospital experience. Limited attention has been paid to how adolescent psychiatric in-patients experience their treatment course. This study was developed to examine how hospitalized adolescents experience the treatment milieu during an acute hospitalization in a crisis stabilization unit. The study consisted of a survey administered to 105 in-patients at the time of their discharge from the unit. The most meaningful experiences were those in which adolescents focused on issues related to hospitalization and learned skills for breaking problems down into manageable pieces which included setting realistic and achievable goals. Males and females did not significantly differ in their experience of the unit. Identifying the adolescents’ needs and teaching them goal-setting appears to be very important in acute in-patient care. Adolescents reported peer contact and goal-setting work to be the most meaningful experiences.

Adherence to therapies in cystic fibrosis: a targeted literature review

ABSTRACT Introduction: Cystic fibrosis (CF) is a life-shortening condition with no cure. Available therapies relieving the symptoms of CF are complex and time-consuming. A comprehensive review assessing adherence to different CF therapies, association of adherence with outcomes, and factors influencing adherence could inform optimal patient management strategies. Areas covered: A targeted literature review of studies published from 2010–2016 assessed adherence to CF therapies. Nineteen studies qualified for inclusion. Adherence to CF therapies was sub-optimal, and varied by treatment, mode of treatment administration, age, season, time and method of adherence measurement. Adherence to ivacaftor and inhaled antibiotics were reported higher than dornase alfa or hypertonic saline, oral pancreatic enzyme and vitamin supplements, and airway clearance therapy. Several patient, healthcare provider and treatment related factors influenced adherence. Sub-optimal adherence was shown to impact clinical and economic burden of the disease. Expert commentary: Higher adherence to CF therapies can lower disease burden, and improve patient outcomes. Healthcare providers and policy makers should devise patient-centered and caregiver-enabled interventions to improve adherence. Research on long-term adherence and outcomes associated with promising oral treatments such as CFTR modulators is needed. Identifying ways to overcome key barriers to adherence can positively affect outcomes associated with CF.

I honestly believe god keeps me healthy so i can take care of my child: parental use of faith related to treatment adherence.

A limited number of studies address parental faith and its relationship to their childrens health. Using cystic fibrosis as a disease exemplar in which religion/spirituality have been shown to play a role and parental health behaviors (adherence to their childs daily recommended home treatments) are important, this study explored whether parents with different levels of adherence would describe use of faith differently. Twenty-five interviews were completed and analyzed using grounded theory methodology. Some parents described no relationship between faith and treatment adherence. However, of those who did, higher-adherence parents believed God empowered them to care for their child and they used prayer to change themselves, while lower-adherence parents described trusting God to care for their child and used prayer to change God. Clinical implications for chaplains’ differential engagement with parents are presented.

Analyzing longitudinal qualitative data: the application of trajectory and recurrent cross-sectional approaches

BackgroundLongitudinal qualitative research methods can add depth and understanding to health care research, especially on topics such as chronic conditions, adherence and changing health policies. In this manuscript we describe when and how to undertake two different applied approaches to analyzing longitudinal qualitative data: a recurrent cross-sectional approach and a trajectory approach.ResultsA recurrent cross-sectional approach is most appropriate when the primary interest is comparing two time points, such as before and after a policy change, or when a cohort cannot be maintained, such as a study in which some participants are expected to die. In contrast, a trajectory approach is most appropriate when the purpose of the research is to understand individuals’ experiences over time or to understand longitudinal healthcare processes.ConclusionsLongitudinal qualitative research has the potential to be a powerful approach to understanding the complexities of health care: from relationships between providers and patients, to the experience of chronic disease, to the impact of health policy. Such research will be strengthened by careful consideration of the research question at hand, followed by application of the appropriate analytic approach.