Egberto Ribeiro Turato

Amostragem por saturação em pesquisas qualitativas em saúde: contribuições teóricas

The transparency and clarity of research reports, emphasizing the data collection stage, are considered important parameters for evaluating the scientific rigor of qualitative studies. The current paper aims to analyze the use of saturation sampling as a methodological concept, frequently employed in descriptions of qualitative studies in various areas of knowledge, particularly in the field of health care. We discuss and confront the following topics: definition of sampling closure by theoretical saturation; difficulties in the acceptance and operationalization of intentional samples (with examples), adequate size of the intentional sample, the significance of valuing what is repeated or the differences contained in the sample reports, inadequate uses of expressions containing the term saturation, and finally possible metaphors for understanding the concept.The transparency and clarity of research reports, emphasizing the data collection stage, are considered important parameters for evaluating the scientific rigor of qualitative studies. The current paper aims to analyze the use of saturation sampling as a methodological concept, frequently employed in descriptions of qualitative studies in various areas of knowledge, particularly in the field of health care. We discuss and confront the following topics: definition of sampling closure by theoretical saturation; difficulties in the acceptance and operationalization of intentional samples (with examples), adequate size of the intentional sample, the significance of valuing what is repeated or the differences contained in the sample reports, inadequate uses of expressions containing the term saturation, and finally possible metaphors for understanding the concept.

Métodos qualitativos e quantitativos na área da saúde: definições, diferenças e seus objetos de pesquisa

Interesses e realizacoes referentes a pesquisas qualitativas tem sido crescentes no campo da saude. Por consequencia, tem havido maior demanda para os programas de pesquisa institucional e para publicacoes nos periodicos cientificos. Frente a esta realidade, o presente artigo teve os seguintes objetivos: (a) apresentar definicoes de metodos qualitativos usados nas Ciencias do Homem e nas Ciencias da Saude; (b) compara-los com os metodos quantitativos comuns das Ciencias da Saude; (c) ilustrar o assunto com os constructos mais importantes nesses campos metodologicos. Sao fornecidos criterios para julgar a pertinencia do caminho percorrido pelos pesquisadores qualitativistas, desde a elaboracao do plano de pesquisa ate a interpretacao dos resultados.The interest and accomplishments in qualitative research have been increasing in health. As a consequence, there is a greater demand for both institutional research programs and scientific journal publications. This article has the following purposes: (a) to present some definitions in qualitative methods used in Humanities and Health; (b) to compare them to the usual quantitative methods of health sciences; and, finally, (c) to illustrate the subject with the most important constructs in these methodological fields. Above all, the authors scope was to provide criteria to evaluate the pertinence of the path taken by qualitative researchers, from research plan elaboration to result interpretation.

Amostragem em pesquisas qualitativas: proposta de procedimentos para constatar saturação teórica

A qualitative studys methodological transparency is considered a key factor for achieving its reliability and should be guaranteed by the researchers. Closing the sampling process by saturation is a common approach, but it is rarely made explicit in research reports. Qualitative researchers also commonly experience technical difficulties in objectively identifying saturation. This article proposes a method to organize sample closing by saturation, with a sequence of eight procedural steps for treating and analyzing data collected through open or semi-structured interviews or focus groups. The article aims to help researchers objectively explain how and when saturation occurred and to allow their readers to know how this process occurred.

Data collection in clinical-qualitative research: use of non-directed interviews with open-ended questions by health professionals

Entrevistas nao-dirigidas constituem o principal instrumento de coleta de dados nas pesquisas qualitativas no campo da saude. Estes estudos estao consolidados na literatura internacional. Para os profissionais de saude, saber o que as pessoas sentem e imaginam permite-nos uma relacao clinico-paciente mais adequada. E indispensavel saber o que os fenomenos da vida significam para os individuos, porque os significados tem uma funcao estruturante: em torno do que as coisas significam para nos, organizamos nossas vidas, incluindo os cuidados com nossa propria saude. A partir de pesquisas concluidas junto ao Laboratorio de Pesquisa Clinico-Qualitativa da Universidade Estadual de Campinas, Brasil, os autores abordam, neste artigo, os seguintes pontos: caracterizacao de entrevistas nao-dirigidas, diretividade das entrevistas, tecnicas de abordagem, observacao de manifestacoes nao-verbais e para-verbais, tecnicas de registro e transcricao do discurso e validade/confiabilidade das entrevistas nao-dirigidas. O texto quer ser util para interessados em pesquisa da graduacao e pos-graduacao.Non-directed interviews constitute the main data collection instrument in qualitative health research. Studies in which this is evident are well documented in international literature. For health professionals, knowing what people feel and imagine makes it possible to develop a more adequate clinician-patient relationship. It is indispensable to know what the life phenomena mean for individuals, because the meanings have a structuring function. People organize their lives around the meaning they attribute to situations or object. This is also relevant to their health care. From research conducted at the Laboratory of Clinical-Qualitative Research, State University of Campinas, Campinas (São Paulo), Brazil, the authors address, in this article, the following matters: characterization of non-directed interviews, directiveness of interviews, approach techniques, observation of non-verbal and paraverbal manifestations, registry techniques / speech transcription, and validity/reliability of non-directed interviews. This is useful for people interested in research at graduate and undergraduate level.

Pregnancy after bariatric surgery: a current view of maternal, obstetrical and perinatal challenges.

With the increase in the number of bariatric surgeries being performed in women of childbearing age, physicians must have concerns regarding the safety of pregnancy after bariatric surgery. The aim of this review is to summarize the literature reporting on maternal, obstetrical and perinatal implications of pregnancy following BS.MethodsEnglish, Spanish and Portuguese-language articles were identified in a PUBMED search from 2005 to February 2011 using the keywords for pregnancy and bariatric surgery or gastric bypass or gastric banding.ResultsThe studies show improved fertility and a reduced risk of gestational diabetes, pregnancy-induced hypertension and pre-eclampsia, macrosomia in pregnant women after bariatric surgery. The incidence of intrauterine growth restriction and small for gestational age are increased. No conclusions can be drawn concerning the risk for cesarean delivery and the best surgery-to-conception interval. Deficiencies in iron, vitamin A, vitamin B12, vitamin K, folate and calcium can result in maternal and fetal complications.ConclusionsPregnancy outcome of women who delivered after BS, as compared to obese populations, is better and safer and comparable to the general population. Close supervision before, during and after pregnancy following bariatric surgery and nutrient supplementation adapted to the patient’s individual requirements can prevent nutrition-related complications and improve maternal and fetal health.

Content analysis in studies using the clinical-qualitative method: application and perspectives

Analise de conteudo abrange um conjunto de tecnicas de organizacao de comunicacoes/informacoes - um procedimento frente a dados qualitativos para fazer emergir temas/topicos e conceitos/conhecimentos. O conteudo de uma comunicacao, considerando o discurso humano falado ou escrito, e complexo e apresenta valiosa caracteristica polissemica. Com a difusao do metodo de pesquisa clinico-qualitativo dentre nos, a utilizacao da analise de conteudo, importante ferramenta metodologica, traz questoes teorico-praticas que necessitam ser bem apreciadas para a utilizacao academicamente precisa. Dessa forma, objetivou-se neste artigo enumerar elementos particulares da tecnica de analise de conteudo, discutindo sua adequacao a metodologia clinico-qualitativa, que casa os genericos metodos qualitativos, construidos nas Ciencias do Homem e da Cultura, com o campo das Ciencias da Saude. Foram selecionados conceitos visando sua pertinencia, emprego e eventuais adaptacoes para o citado metodo.Content analysis comprises a set of techniques for organizing communication/information - a procedure used with qualitative data to make themes/topics and concepts/knowledge emerge. Communication content, considering human written or spoken discourse, is complex and presents valuable polysemous characteristic. With the dissemination of the clinical-qualitative method, the use of content analysis, considered an important methodological tool, raises theoretical-practical issues that need to be taken into consideration for its academically precise use. Thus, this article aimed to enumerate specific elements of the content analysis technique and discuss its suitability for the clinical-qualitative method that combines generic qualitative methods from Human and Cultural Sciences with the area of Health Sciences. Concepts were selected due to their pertinence, use and eventual adaptation to the method focused on.

Psychocultural meanings of urinary incontinence in women: a review

The purpose of the present study was to identify and analyze studies in health literature about the psychocultural meanings reported by women who experience urinary incontinence (UI). A bibliographical search was executed in the following databases: Lilacs, Medline, Pubmed and Medscape. The present review showed that studies note several meanings. The articles were grouped in three categories defined as significant: according to age experiences, cultural-religious experiences and experiences in self-care. The studies revealed that the degree of anguish and the range of the difficulties experienced are related both with age, ethnic group or religion and with the perception each individual has of her incontinence, which will lead to different levels of emotional disorders and to seeking (or not seeking) treatment. Besides, barriers regarding self-care are perceived. It is concluded that the UI may cause suffering and incontinent women have difficulties to deal with this problem.The purpose of the present study was to identify and analyze studies in health literature about the psychocultural meanings reported by women who experience urinary incontinence (UI). A bibliographical search was executed in the following databases: Lilacs, Medline, Pubmed and Medscape. The present review showed that studies note several meanings. The articles were grouped in three categories defined as significant: according to age experiences, cultural-religious experiences and experiences in self-care. The studies revealed that the degree of anguish and the range of the difficulties experienced are related both with age, ethnic group or religion and with the perception each individual has of her incontinence, which will lead to different levels of emotional disorders and to seeking (or not seeking) treatment. Besides, barriers regarding self-care are perceived. It is concluded that the UI may cause suffering and incontinent women have difficulties to deal with this problem.

Antecedentes da reforma psiquiátrica no Brasil: as contradições dos anos 1970

The article provides a historical reconstruction of the period leading up to what has become known as Brazils Movement for Psychiatric Reform, which runs from the 1967 creation of the national social welfare system (INPS) to 1978, when the Mental Health Workers Movement gained prominence. Focusing on technical criteria influenced by the U.S. prevention model, our discussion examines the contradictions in Brazils official mental health policy and also looks at the practice of financing and strengthening private psychiatric institutions, to the detriment of community action. Although most official documents from the 1970s contain proposals clearly aimed at community actions, what we observe is the crystallization of a model under which the government purchases psychiatric beds in private hospitals.

COLETA DE DADOS NA PESQUISA CLÍNICO-QUALITATIVA: USO DE ENTREVISTAS NÃO- DIRIGIDAS DE QUESTÕES ABERTAS POR PROFISSIONAIS DA SAÚDE

Entrevistas nao-dirigidas constituem o principal instrumento de coleta de dados nas pesquisas qualitativas no campo da saude. Estes estudos estao consolidados na literatura internacional. Para os profissionais de saude, saber o que as pessoas sentem e imaginam permite-nos uma relacao clinico-paciente mais adequada. E indispensavel saber o que os fenomenos da vida significam para os individuos, porque os significados tem uma funcao estruturante: em torno do que as coisas significam para nos, organizamos nossas vidas, incluindo os cuidados com nossa propria saude. A partir de pesquisas concluidas junto ao Laboratorio de Pesquisa Clinico-Qualitativa da Universidade Estadual de Campinas, Brasil, os autores abordam, neste artigo, os seguintes pontos: caracterizacao de entrevistas nao-dirigidas, diretividade das entrevistas, tecnicas de abordagem, observacao de manifestacoes nao-verbais e para-verbais, tecnicas de registro e transcricao do discurso e validade/confiabilidade das entrevistas nao-dirigidas. O texto quer ser util para interessados em pesquisa da graduacao e pos-graduacao.Non-directed interviews constitute the main data collection instrument in qualitative health research. Studies in which this is evident are well documented in international literature. For health professionals, knowing what people feel and imagine makes it possible to develop a more adequate clinician-patient relationship. It is indispensable to know what the life phenomena mean for individuals, because the meanings have a structuring function. People organize their lives around the meaning they attribute to situations or object. This is also relevant to their health care. From research conducted at the Laboratory of Clinical-Qualitative Research, State University of Campinas, Campinas (São Paulo), Brazil, the authors address, in this article, the following matters: characterization of non-directed interviews, directiveness of interviews, approach techniques, observation of non-verbal and paraverbal manifestations, registry techniques / speech transcription, and validity/reliability of non-directed interviews. This is useful for people interested in research at graduate and undergraduate level.

ANÁLISE DE CONTEÚDO EM PESQUISAS QUE UTILIZAM METODOLOGIA CLÍNICO- QUALITATIVA: APLICAÇÃO E PERSPECTIVAS

Analise de conteudo abrange um conjunto de tecnicas de organizacao de comunicacoes/informacoes - um procedimento frente a dados qualitativos para fazer emergir temas/topicos e conceitos/conhecimentos. O conteudo de uma comunicacao, considerando o discurso humano falado ou escrito, e complexo e apresenta valiosa caracteristica polissemica. Com a difusao do metodo de pesquisa clinico-qualitativo dentre nos, a utilizacao da analise de conteudo, importante ferramenta metodologica, traz questoes teorico-praticas que necessitam ser bem apreciadas para a utilizacao academicamente precisa. Dessa forma, objetivou-se neste artigo enumerar elementos particulares da tecnica de analise de conteudo, discutindo sua adequacao a metodologia clinico-qualitativa, que casa os genericos metodos qualitativos, construidos nas Ciencias do Homem e da Cultura, com o campo das Ciencias da Saude. Foram selecionados conceitos visando sua pertinencia, emprego e eventuais adaptacoes para o citado metodo.Content analysis comprises a set of techniques for organizing communication/information - a procedure used with qualitative data to make themes/topics and concepts/knowledge emerge. Communication content, considering human written or spoken discourse, is complex and presents valuable polysemous characteristic. With the dissemination of the clinical-qualitative method, the use of content analysis, considered an important methodological tool, raises theoretical-practical issues that need to be taken into consideration for its academically precise use. Thus, this article aimed to enumerate specific elements of the content analysis technique and discuss its suitability for the clinical-qualitative method that combines generic qualitative methods from Human and Cultural Sciences with the area of Health Sciences. Concepts were selected due to their pertinence, use and eventual adaptation to the method focused on.