Gloria Joachim

Chronic Illness Experience: Insights from a Metastudy

Concurrent with the recent enthusiasm for qualitative research in the health fields, an energetic call for methods by which to synthesize the knowledge has been generated on various substantive topics. Although there is an emerging literature on meta-analysis and meta-synthesis, many authors overestimate the simplicity of such approaches and erroneously assume that useful knowledge can be synthesized from limited collections of study reports without a thorough analysis of their theoretical, methodological, and contextual foundations and features. In this article, the authors report some of the insights obtained from an extensive and exhaustive metastudy of qualitative studies of chronic illness experience. Their findings reveal the complexities inherent not only in any phenomenon of interest to health researchers but also in the study of how we have come to know what we think we know about it.

Embedded Assumptions in Qualitative Studies of Fatigue

Qualitative researchers have long recognized that fatigue is a common concern among those with chronic illness; however, the insights derived from this body of inquiry have not been synthesized into a coherent body of clinical knowledge that could provide direction for nursing practice. Using a synthesis approach of meta-study, the authors identify four predominant assumptions embedded in qualitative studies that have influenced the way researchers have interpreted and made sense of their findings about fatigue in chronic illness over the past two decades. They argue that these assumptions may have inhibited the development of more dynamic, comprehensive understandings of fatigue. They conclude that addressing some of the methodological issues within this body of research might lead to a more accurate portrayal of the complexity, fluidity, and contextual nature of the fatigue experienced in chronic illness.

Influence of the Research Frame on Qualitatively Derived Health Science Knowledge

Although qualitative researchers generally acknowledge that their theoretical location and methodological orientation will influence the findings of their inquiries, it has been less well understood how the body of knowledge within a substantive field might be shaped by these factors. In this article, the authors draw on insights obtained from their experiences attempting to synthesize qualitative research findings. From that reflective process, they raise questions about the manner in which qualitatively derived knowledge from various orientations can be interpreted and understood.

Responses of people with inflammatory bowel disease to foods consumed.

The purpose of this study was to assess the reactions of people with IBD to foods consumed. A database was created to capture the season of data collection, the disease, the food, and the subjects reaction to each food. A 122-item food list was used. Sixty patients with IBD (n = 33 persons with Crohns disease, n = 27 persons with ulcerative colitis) completed the questionnaire about foods and their reactions to the foods in the fall and spring representing summer and winter consumption. Foods that made the subjects feel better and worse were identified. Although the original purpose of the study was to assess people with IBD as a group, it became apparent that reactions to foods were different according to whether a subject had Crohns disease or ulcerative colitis. Failure to distinguish between the two diseases and use only the pooled data made the data meaningless. The importance of this finding and themes related to foods that had a positive or negative effect on the subjects is discussed in this article.

Supply and demand: a framework for explaining variability in dietary intake and its impact on data.

Nutrition has an important relationship with health and illness. One difficulty in measuring intake is related to variability. The purpose of this paper is to examine 1) the impact of supply and demand on variability in data collected for dietary studies and 2) the relationship between data and estimates of usual intake. The forces of supply and demand over time generate a consumption curve for each food. Two types of consumption curves are identified. One curve is horizontal and represents staples that are steadily consumed. The other curve exhibits peaks and dips and is unique for each food whose consumption varies with time. The measurement of usual intake is discussed in. light of these two types of curves. Usual intake of foods whose consumption curve is horizontal could be read at any time since consumption does not vary with time. For all other foods, measuring usual consumption presents problems since the data vary with time. This examination indicates that foods whose consumption varies with time have unique properties that must be considered when attempting to calculate consumption. Suggestions are given to enhance measurement of consumption of these foods. Although excellent methodology currently exists for the calculation of intake, attention to the force of supply and demand with only serve to strengthen existing methods.

An assessment of social support in people with inflammatory bowel disease.

The purpose of this descriptive study was to assess the perceived level of social support in a sample of people with inflammatory bowel disease. This assessment was to serve as the basis for the development and evaluation of a program of social support. The Personal Resource Questionnaire (PRQ-85), which measures perceived level of social support, was mailed to all members (n = 300) of the Northwestern Society for Intestinal Research. Adults who met the eligibility criteria were invited to participate. Questionnaires and consent forms were completed and returned by 97 subjects. Results indicated that subjects would use a variety of resources if confronted with situations that required social support. The perceived level of social support was high, with mean scores for this inflammatory bowel disease sample reported at 143.86 of a possible 175. A two-tailed t-test suggests there is no significant difference in perceived level of social support between those subjects with Crohn disease and those with ulcerative colitis at the 0.05 level of significance. Because the level of social support was so high in this sample, plans to develop a program of support were abandoned. The meaning of these results including an analysis of the scores and a critique of the questionnaire are discussed.

The birth and dissolution of an inflammatory bowel disease support group: lessons in providing support.

In response to requests from the members of the local Crohns and Colitis Foundation chapter, a nurse-facilitated support group was formed. Its goals were to provide support and information for people coping with inflammatory bowel disease (IBD). Despite the interest expressed by the membership, attendance at the monthly meetings was sporadic and sparse. Eventually the group ceased to exist. To understand why the group dissolved, each member was interviewed and asked the following open-ended questions: (1) What did you want from a support group? (2) Why did you not attend meetings regularly? (3) What, if anything, would have kept you coming to the group? Despite coping with IBD, most people described a normal life in which support from the family and established relationships was sufficient to meet their needs. Extra support, such as group support, was only perceived to be needed at certain key times. Innovative methods for providing support, when needed, are discussed.

Sources of Variability in the Reproducibility of Food Frequency Questionnaires

The reproducibility of food frequency questionnaires varies widely. Since reports of past intake are known to be biased toward the present and the forces of supply and demand affect what people eat at a given point in time, the questionnaire may capture an atypical snapshot of consumption rather than the intended view of usual consumption. The consumption of regularly consumed foods is the same throughout the year. The consumption of these foods is likely to be highly reproducible at another point in time. The consumption of seasonally consumed foods, however, fluctuates throughout the year, and may have peaks in winter or summer or particular holidays. There may be no common denominator among these foods necessary for the purpose of assessing reproducibility. Therefore, questionnaires that contain a combination of regularly and seasonally consumed foods, will be likely to have problems with reproducibility, the variance depending upon the number of seasonally consumed foods in the questionnaire. This explanation for variability in reproducing food frequency questionnaires raises a question about the importance of assessing reproducibility as a way of evaluating the worth of questionnaires. Perhaps an improved method of collecting data for seasonal foods is what is really needed to improve the quality of data collected.

Are reliability, reproducibility and validity the correct terms to assess the correctness of dietary studies?

Nutritional studies often use the terms reliability, reproducibility and validity to indicate the correctness of the study. These terms do not appear to have a universal meaning to all researchers. The components of a dietary study are the input, the data collection instrument and the compiled data. Frequently the data collection questionnaire/tool/instrument is tested for reliability, reproducibility or validity. The data collection questionnaire/tool/instrument is simply a structure, a vehicle for gathering data. An argument is presented that demonstrates the reasons that such a structure cannot be tested for reliability, reproducibility or validity. The logical approach to the use of the terms reliability, reproducibility and validity is presented. Reliability refers to the input component of the study, reproducibility may or may not lead to strengthening the study and validity refers to the truthfulness of the database generated. Validity must be derived from reliable and reproducible data.

An update on inflammatory bowel disease.

The occupational health nurse (OHN) is the nursing professions jack-of-alltrades. The OHN is appointed by management to a key position which on one hand promotes employee productivity by decreasing the number of days employees are absent from work, and, on the other hand, promotes and protects the well-being of employees. Human resources are a companys most important asset and the OHN is responsible for safeguarding them. Unlike the OHNs nursing colleagues in the hospital who might specialize in a single area and work in that area for years, the OHN is challenged continuously to be knowledgeable in all areas. This paper will attempt to update the OHNs knowledge and provide current information about a relatively unknown but rapidly increasing disorder inflammatory bowel disease (IBD).