Karen Willis

Generating best evidence from qualitative research : the role of data analysis

Objective: To outline the importance of the clarity of data analysis in the doing and reporting of interview‐based qualitative research.

What have sampling and data collection got to do with good qualitative research

Objective: To highlight the importance of sampling and data collection processes in qualitative interview studies, and to discuss the contribution of these processes to determining the strength of the evidence generated and thereby to decisions for public health practice and policy.

The essential role of social theory in qualitative public health research

Objective: To define the role of social theory and examine how research studies using qualitative methods can use social theory to generalise their results beyond the setting of the study or to other social groups.

Perils and possibilities: achieving best evidence from focus groups in public health research

Objective: Focus group research is often seen as a cost‐effective way of gathering evidence from multiple research participants about the diversity of their views, experiences or beliefs. Our objective is to argue that focus group research only fulfils its potential if analysis of individual views is extended to include analysis of interaction between participants, so that we learn more why people hold these views.

Comparing satisfaction and burnout between caseload and standard care midwives: findings from two cross-sectional surveys conducted in Victoria, Australia

BackgroundCaseload midwifery reduces childbirth interventions and increases women’s satisfaction with care. It is therefore important to understand the impact of caseload midwifery on midwives working in and alongside the model. While some studies have reported higher satisfaction for caseload compared with standard care midwives, others have suggested a need to explore midwives’ work-life balance as well as potential for stress and burnout. This study explored midwives’ attitudes to their professional role, and also measured burnout in caseload midwives compared to standard care midwives at two sites in Victoria, Australia with newly introduced caseload midwifery models.MethodsAll midwives providing maternity care at the study sites were sent questionnaires at the commencement of the caseload midwifery model and two years later. Data items included the Midwifery Process Questionnaire (MPQ) to examine midwives’ attitude to their professional role, the Copenhagen Burnout Inventory (CBI) to measure burnout, and questions about midwives’ views of caseload work. Data were pooled for the two sites and comparisons made between caseload and standard care midwives. The MPQ and CBI data were summarised as individual and group means.ResultsTwenty caseload midwives (88%) and 130 standard care midwives (41%) responded at baseline and 22 caseload midwives (95%) and 133 standard care midwives (45%) at two years. Caseload and standard care midwives were initially similar across all measures except client-related burnout, which was lower for caseload midwives (12.3 vs 22.4, p = 0.02). After two years, compared to midwives in standard care, caseload midwives had higher mean scores in professional satisfaction (1.08 vs 0.76, p = 0.01), professional support (1.06 vs 0.11, p <0.01) and client interaction (1.4 vs 0.09, p <0.01) and lower scores for personal burnout (35.7 vs 47.7, p < 0.01), work-related burnout (27.3 vs 42.7, p <0.01), and client-related burnout (11.3 vs 21.4, p < 0.01).ConclusionCaseload midwifery was associated with lower burnout scores and higher professional satisfaction. Further research should focus on understanding the key features of the caseload model that are related to these outcomes to help build a picture of what is required to ensure the long-term sustainability of the model.

Women's experiences of cognitive changes or ‘chemobrain’ following treatment for breast cancer: A role for occupational therapy?

BACKGROUND/AIM Changes to functioning and cognition are commonly reported following chemotherapy. These changes are highly individual, and may not be fully recognised or understood. Breast cancer is the most common cancer diagnosed in women worldwide, yet little is known about the impact of cognitive changes for these women following treatment and many do not benefit from occupational therapy services. The aim was to describe changes in cognitive function experienced by women who had undergone chemotherapy, and the strategies used to overcome the associated challenges. METHOD This was a qualitative phenomenological study conducted with nine women, aged between 39 and 67 years, from New South Wales. Participants were breast cancer survivors who had received chemotherapy treatment, and self-reported chemobrain symptoms. Data were collected through semi-structured in-depth telephone and face-to-face interviews. Data were transcribed, coded and thematically analysed. RESULTS Six themes described the chemobrain experience for these women. They were: uncertainty about the origin of the chemobrain experience; persistent but inconsistent impacts on function; simple function turned complex; losing functional independence in family life; strategies to maintain function; and the need for recognition of the subjective experience of cancer treatment. CONCLUSION The experiences of cognitive and functional changes following chemotherapy for those reporting chemobrain symptoms are highly individual, and include the need for adaptive strategies. Some similarities in the types of impairments were experienced. As breast cancer survivorship rates continue to rise, there is a need for occupational therapy services to assist women in returning to daily occupations during or following their cancer treatment.

Participating in Research Exploring Participation and Engagement in a Study of Self-Management for People With Chronic Obstructive Pulmonary Disease

With growing emphasis on the importance of scientific evidence through clinical trials, qualitative studies have been used to deepen our understanding of research from participants’ perspectives. For people with a chronic illness, research participation could represent an additional impost on lives already overwhelmed with medical and care issues, and little is known about participants’ motivations when the research requires them to think differently about their illness and participate over an extended period. We interviewed participants with chronic obstructive pulmonary disease participating in a trial of a chronic disease self-management (CDSM) program. Our finding that people participate in research for altruistic reasons has similarities with other studies. We then extend our understanding of why people participate to explore how they participate. We argue that motivation based on dominant voluntaristic or altruistic values can be problematic for researchers attempting to demonstrate the benefits of CDSM strategies.

Constructing health consumers: Private health insurance discourses in Australia and the United Kingdom

Abstract Significant transformations of the health care services sector over the past three decades have seen an increasing reliance on the private provision of health care services mediated through private health insurance. In countries such as Australia and the UK, private health insurance is promoted as providing a greater choice for individuals and easing the burden on the public system. While these claims, the policy contexts and the decision-making processes of individual consumers have attracted some sociological attention, little has been said about the role of private insurers. In this article we present a comparative analysis of the websites of private health insurers in Australia and the UK. Our analysis highlights adoption by private health insurers of neoliberal discourses of choice and individual responsibility, partnership and healthy lifestyles. In these respects, similarities between the discourses over-ride national differences which might otherwise be expected given their contrasting health care traditions and contexts.

Personal choice/social responsibility Women aged 40–49 years and mammography screening

Screening for breast cancer is a key public health policy for women. However, there is controversy about when women should commence screening because the evidence of benefit for women younger than 50 years remains unclear. In Australia women who are aged 40–49 years are allowed to participate in breast cancer screening, although government policy indicates that participation should be based on these women making an ‘informed choice’ about participation. This article reports on research investigating the idea of choice and screening. Semi-structured interviews were held with women in rural Tasmania who have participated in screening for breast cancer before turning age 50. The study finds that these ideas of choice and personal responsibility for health have social dimensions that are critical to understanding the decision to participate in screening.

Healthcare choice: Bourdieu’s capital, habitus and field

The promotion of choice is a common theme in both policy discourses and commercial marketing claims about healthcare. However, within the multiple potential pathways of the healthcare ‘maze’, how do healthcare ‘consumers’ or patients understand and experience choice? What is meant by ‘choice’ in the policy context, and, importantly from a sociological perspective, how are such choices socially produced and structured? In this theoretical article, the authors consider the interplay of Bourdieu’s three key, interlinked concepts – capital, habitus and field – in the structuring of healthcare choice. These are offered as an alternative to rational choice theory, where ‘choice’ is regarded uncritically as a fundamental ‘good’ and able to provide a solution to the problems of the healthcare system. The authors argue that sociological analyses of healthcare choice must take greater account of the ‘field’ in which choices are made in order to better explain the structuring of choice.