Jenna Breckenridge

The reflexive role of tanka poetry in domestic abuse research

Domestic abuse research can be emotionally challenging, particularly for qualitative researchers who are immersed in sensitive, and sometimes distressing, participant stories. Reflexivity is essential in sensitive research; however, researchers typically focus their reflexive efforts on how their own perspectives may have influenced the data, rather than how they may have been personally affected by the stories they analyse. In this paper, I reflect on how using poetry in domestic abuse research can help to increase researchers’ sensitivity to emotion, heighten their empathic responses to participants’ stories and promote reflexivity. The use of poetry has gained popularity and various poetic forms have been used to collect, analyse and present qualitative data. Using examples from a recently completed study on domestic abuse, I show how tanka poems can be developed from existing qualitative data to draw together researcher and participant perspectives within the same poem. Originating in 7th-century Japan, the tanka is a short, structured poem that conveys strong emotion and authentic voice. To date, tankas are underutilised in poetic inquiry research and, in sharing my own reflections, I advocate tanka poetry as a creative way of engaging with qualitative data and a useful means of reflexivity in domestic abuse research.

Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review

BackgroundAlthough disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services.MethodsEleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement.ResultsFindings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse.ConclusionsBased upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base.

The state of qualitative research in health and social science literature: a focused mapping review and synthesis

Abstract Pluralism and creativity are inherent and important parts of the qualitative endeavour. The multiplicity of approaches and methods can, however, be confusing. We undertook a focused mapping review and synthesis to obtain a snap-shot profile of the state of qualitative research in health and social science literature. We retrieved 102 qualitative articles published between January and March 2015 from six leading health and social science journals. Articles were scrutinised for alignment between researchers’ reported orientation (methodological or philosophical positioning) and the techniques used (methods). In the sampled articles level of alignment was generally high, with considerable mastery of qualitative approaches evident. However, the complexity of the qualitative landscape highlighted in our review, led us to develop a diagrammatic representation: The Qualitative Research Level of Alignment Wheel™. This educational resource/teaching aid is designed to assist qualitative researchers (particularly those more novice) and research students to locate the orientation and techniques of their studies. As an important contribution to the international field of qualitative inquiry, it will assist in understanding and accounting for points at which techniques are melded and orientations blended. In turn this will lead to the individual and collective qualitative endeavour as being a coherent one.

Disabled women’s experiences of accessing and utilising maternity services when they are affected by domestic abuse: a critical incident technique study

BackgroundWomen and their babies are entitled to equal access to high quality maternity care. However, when women fit into two or more categories of vulnerability they can face multiple, compound barriers to accessing and utilising services. Disabled women are up to three times more likely to experience domestic abuse than non-disabled women. Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services. Despite this, little is known about the compounding effects of disability and domestic abuse on women’s access to maternity care.MethodsThe aim of the study was to identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want. We conducted a qualitative, Critical Incident Technique study in Scotland. Theoretically we drew on Andersen’s model of healthcare use. The model was congruent with our interest in women’s intended/actual use of maternity services and the facilitators and barriers impacting their access to care. Data were generated during 2013 using one-to-one interviews.ResultsFive women took part and collectively reported 45 critical incidents relating to accessing and utilising maternity services. Mapped to the underpinning theoretical framework, our findings show how the four domains of attitudes; knowledge; social norms; and perceived control are important factors shaping maternity care experiences.ConclusionsPositive staff attitude and empowering women to have control over their own care is crucial in influencing women’s access to and utilisation of maternity healthcare services. Moreover these are cyclical, with the consequences and outcomes of healthcare use becoming part of the enabling or disabling factors affecting future healthcare decisions.Further consideration needs to be given to the development of strategies to access and recruit women in these circumstances. This will provide an opportunity for under-represented and silenced voices to be heard.

Priorities and strategies for improving disabled women’s access to maternity services when they are affected by domestic abuse: a multi-method study using concept maps

BackgroundDomestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies.MethodsThis multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen’s model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women’s access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach.ResultsThe three most highly ranked barriers to women’s access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women’s fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were also considered very feasible. The qualitative analysis identified a range of psychosocial and environmental barriers experienced by this group of women in accessing maternity care. Congruent with the quantitative results, the main themes were lack of awareness and fear of disclosure. Key strategies were identified as demystifying disclosure and creating physical spaces to facilitate disclosure.ConclusionsThe study supports findings of previous research regarding the barriers that women face in accessing and utilising maternity services, particularly regarding the issue of disclosure. But the study provides new evidence on the perceived importance and feasibility of strategies to address such barriers. This is an important step in ensuring practice-based acceptability and ease with which improvement strategies might be implemented in maternity care settings.

Alcohol use amongst older adults: knowledge and beliefs of occupational therapists working in physical health care settings.

Introduction There is little discussion in the United Kingdom occupational therapy literature surrounding the topic of older people and alcohol, despite the growing prevalence of alcohol-related health problems in older adults resulting from an ageing population and changing patterns of consumption. Occupational therapists in physical health care settings are likely to work with older people whose drinking pattern may not be alcohol dependent, but may put their physical or psychological health at risk. Method A survey methodology was employed using open and closed questions, recruiting occupational therapists (band 5 to 9) (n = 122) working with older people (65+ years) in physical health care settings across all, except one, National Health Service Regional Health Boards in Scotland. Results Responses highlight gaps in occupational therapists’ knowledge around alternative ‘safe limits’ of alcohol intake for older people. Belief in professional role was evident, but the perception was that this was not supported by undergraduate education. Occupation focused theory and assessment were not prioritized when considering alcohol in the older adult. Conclusion This study has highlighted a need to develop pre- and post-qualification education for occupational therapists, to enhance understanding of theory, assessment and knowledge of alcohol with older adults in physical health care settings.

Evaluation in everyday occupational therapy practice: Should we be thinking about treatment fidelity?

Evaluation is a core component of the occupational therapy process. To draw meaningful conclusions about the effectiveness of occupational therapy practice, it is essential that therapists consider not only what outcomes are achieved, but also reflect on how interventions are delivered. We suggest that incorporating the concept of ‘treatment fidelity’ into clinical practice offers therapists a means of differentiating between interventions and demonstrating clearer links between occupational therapy practice and successful client outcomes. In so doing, practitioners can highlight more explicitly the unique contribution of occupational therapy interventions.

Mobilising knowledge between practitioners and researchers to iteratively refine a complex intervention (DAFNEplus) pre-trial: protocol for a structured, collaborative working group process.

BackgroundRandomised controlled trials (RCTs) of complex interventions often begin with a pilot phase to test the proposed methods and refine the intervention before it is trialled. Although the Medical Research Council (MRC) recommends regular communication between the practitioners delivering the intervention and the researchers evaluating it during the pilot phase, there is a lack of practical guidance about how to undertake this aspect of pre-trial work. This paper describes a novel structured process for collaborative working, which we developed to iteratively refine a complex intervention prior to an RCT. We also describe an in-built qualitative study to learn lessons about how this approach could be used by future study teams.MethodsThis work forms part of a broader research programme to develop and trial a complex intervention for people with type 1 diabetes, called DAFNEplus. The intervention is being piloted in three National Health Service (NHS) diabetes centres in two waves, with refinements being incrementally implemented between each wave in response to real-time, collective learning (combining practitioner experience, process evaluation data and patient and public involvement via an advisory group). A structured ‘Collaborative Working Group’ (CWG) process, comprising monthly teleconferences and four strategically timed face-to-face meetings, is being used to identify and respond systematically to emerging implementation challenges and research findings. The group involves 25 members of the study team, including the multi-disciplinary practitioners delivering the intervention, the research teams conducting the process evaluation, the study manager and Chief Investigator. An in-built qualitative study comprising documentary analysis of meeting materials, discourse analysis of meeting transcripts, reflexive note taking, and thematic analysis of focus groups and interviews with CWG members is being undertaken to explore how the CWG works and how its processes and procedures might be improved.DiscussionThe CWG process offers a potential model for collaborative working in future pre-trial pilot phases and intervention development studies that operationalises MRC guidance to progressively develop a complex intervention and foster shared ownership through genuine collaboration. The findings from the qualitative study will provide insight into how to best support collaborative working to achieve optimal intervention design.

Conducting Sensitive Research With Disabled Women Who Experience Domestic Abuse During Pregnancy: Lessons From a Qualitative Study

This research-methods case study shares some practical and methodological reflections on doing sensitive research with participants who are typically underrepresented. We focus specifically on the challenges researchers facing during recruitment and data collection. We reflect on the opportunities and challenges created by engaging with gatekeepers to access “hard to reach groups,” particularly within the context of sensitive research. We also offer practical examples and solutions to help ensure that research interviews are conducted in an accessible and inclusive way. These challenges and solutions are illustrated by examples from a recently completed research project on how domestic abuse affects disabled women’s access to maternity care. Disabled women (women with a long-term health condition or impairment) are at significantly higher risk of experiencing domestic abuse (physical, emotional, sexual, or financial abuse from an intimate partner) than nondisabled women. Pregnancy is a particularly vulnerable period for all women experiencing domestic abuse, but internationally, very few studies have explored how domestic abuse affects disabled mothers. Both disability and domestic abuse are associated with late or poor access to maternity services, and the aim of our study was to understand the particular barriers and facilitators to accessing care when disability and domestic abuse coexist. The study took place during 2012-2014 and involved three phases: a systematic review, interviews with women, and focus groups with maternity care practitioners. The learning from our study is relevant and useful to anyone planning and doing sensitive research with underrepresented populations.

Two to Tanka: poetry as a duoethnographic method for exploring sensitive topics

Duoethnography is a method of dialogical reflection that combines different voices and juxtaposing worldviews in order to glean fresh perspectives on wider social or professional issues. In this paper we use poetry to support an inter-professional duoethnographic exploration of sensitive issues in nursing and healthcare. Using a method of linked tanka poetry, we bring together perspectives from our respective work in nursing and occupational therapy to explore the sensitive issues of loss, death, dementia, cultural conflict and trauma. We demonstrate collaborative poetry writing as a novel, useful approach in duoethnography, demonstrating how tanka poems – short, structured poems originating from 7th-century Japan – are effective in supporting reflexive dialogue. Drawing on theoretical underpinnings and practical experience, we highlight the opportunities and challenges of using tanka poetry to facilitate collaborative discussion and problem-solving. We highlight how tanka could support difficult conversations between practitioners, researchers, service users, educators and students through its succinct immediacy. Moreover, by showcasing the use of collaborative poetry writing as a method of inquiry, this paper offers a novel methodological contribution to the broader area of qualitative research for education, research and practice.