Kathleen A. Knafl

Within-Case and Across-Case Approaches to Qualitative Data Analysis

The generalizations developed by qualitative researchers are embedded in the contextual richness of individual experience. Qualitative data management strategies that depend solely on coding and sorting of texts into units of like meaning can strip much of this contextual richness away. To prevent this, some authors have recommended treating individual accounts as whole cases or stories, but whole cases are difficult to compare with one another when the goal of the research is to develop generalizations that represent multiple accounts. In this article, the authors describe the ways in which three different qualitative researchers combined across-case coding and sorting with a variety of within-case data management and analysis techniques to produce contextually grounded, generalizable findings.

African-American spirituality: A concept analysis

Culturally competent care for African Americans requires sensitivity to spirituality as a component of the cultural context. To foster understanding, measurement, and delivery of the spiritual component of culturally competent care, this article presents an evolutionary concept analysis of African-American spirituality. The analysis is based on a sample of multidisciplinary research studies reflecting spirituality of African Americans. Findings indicate that African-American spirituality involves quintessential, internal, external, consoling, and transformative attributive dimensions. Findings are considered in relation to previous conceptual analyses of spirituality and suggest that defining attributes of African-American spirituality are both global and culturally prominent. Implications for practice and research are discussed.

Further Refinement of the Family Management Style Framework

This article reports the authors’ efforts to expand the family management style framework and describes the revised framework. Framework development was based on a review of results from 46 studies focusing on family response to childhood chronic conditions. The review contributed to modification of the original framework and further specification of the three major components of the framework—definition of the situation, management behaviors, and perceived consequences. The implications of the revised framework for family research and practice and current efforts to develop a standardized measure of family management style are discussed.

Families and Chronic Illness: A Synthesis of Current Research

The purpose of this review of 73 articles reporting family research was to identify major areas of inquiry and to draw conclusions about what is known about families in which a member has a chronic illness. The review identified two distinct clusters of research in which knowledge is being generated. The first cluster included descriptive studies of family response to illness. The second cluster included explanatory studies of variables contributing to response to chronic illness. Within each of these two broad clusters, focused areas of inquiry were identified and the results of these studies were synthesized. The findings of the review are discussed in terms of their implications for developing nursing interventions and future research.

Assessment of the Psychometric Properties of the Family Management Measure

OBJECTIVE This paper reports development of the Family Management Measure (FaMM) of parental perceptions of family management of chronic conditions. METHOD By telephone interview, 579 parents of children age 3 to 19 with a chronic condition (349 partnered mothers, 165 partners, 65 single mothers) completed the FaMM and measures of child functional status and behavioral problems and family functioning. Analyses addressed reliability, factor structure, and construct validity. RESULTS Exploratory factor analysis yielded six scales: Childs Daily Life, Condition Management Ability, Condition Management Effort, Family Life Difficulty, Parental Mutuality, and View of Condition Impact. Internal consistency reliability ranged from .72 to .91, and test-retest reliability from .71 to .94. Construct validity was supported by significant correlations in hypothesized directions between FaMM scales and established measures. CONCLUSION Results support FaMMs; reliability and validity, indicating it performs in a theoretically meaningful way and taps distinct aspects of family response to childhood chronic conditions.

Childhood Chronic Illness: A Comparison of Mothers’ and Fathers’ Experiences

Despite a growing emphasis on gender differences in parental response to childhood illness and disability, relatively few studies have compared how mothers and fathers adapt to having an ill child. This article explores how mothers and fathers of a child with a chronic illness viewed their experience and its impact on family life. Within families, parents typically had a shared view of the experience and its impact on their life as reflected in both the qualitative interview data and quantitative measures of family and individual functioning. In the minority of cases where parents held discrepant views, it was the mother who emphasized the negative aspects of the chronic illness situation. The results of this analysis support the growing emphasis among family researchers on exploring family strengths in the face of illness challenges and collecting data from multiple family members.

Continued development of the family management style framework.

Based on a review of 64 published reports, this article addresses the implications of current research for the further development of the Family Management Style Framework (FMSF). Articles are published in 46 different journals, including 13 in nursing and 12 in interdisciplinary outlets. Most studies are based on samples of less than 50 individuals. The review provides continuing support for the 8 dimensions of the framework, with between 8 and 16 reports supporting the relevance of each. Changes to the sociocultural component of the framework are proposed as well as wording changes to reflect the broader applicability of the framework. The family’s social network, health care and education professionals, and resources predominate as key influences on family management.

Determining content validity of a self-report instrument for adolescents using a heterogeneous expert panel.

Background: The use of experiential experts, especially children and adolescents, in content validity evaluations of new instruments has not been described well. Objective: To describe the use of experiential experts in a content validity evaluation of a new instrument. Methods: Experiential (adolescents and parents, n = 11) and professional (diabetes clinicians and researchers, n = 17) expert judges evaluated the content validity of a new instrument that measures self-management of Type 1 diabetes in adolescents. The content validity index for each of 99 items (I-CVIs) for the total group of experts (n = 28; I-CVI-ALL) and for the experiential experts only (I-CVI-EXPERIENTIAL) were calculated, respectively, and both were used to inform decisions about whether to retain, eliminate, or revise each item. Results: There were 20 items where the I-CVI-ALL was ≥.80 and the I-CVI-EXPERIENTIAL was <.80. Each of these 20 items was evaluated critically. Some were retained (n = 3), some were eliminated (n = 7), and some were revised as suggested by the experts (n = 10). Discussion: Using experiential content validity experts (adolescents and parents) and critically evaluating their recommendations regarding items can result in further elimination and revision of items beyond what is suggested by content validity assessment done by professional experts. The result may be a more thorough content validity assessment of the instrument, leading to an instrument with greater relevance for the target population.

Women’s Experience of Group Prenatal Care

Group prenatal care (GPNC) is an innovative alternative to individual prenatal care. In this longitudinal study we used ethnographic methods to explore African American and Hispanic women’s experiences of receiving GPNC in two urban clinics. Methods included individual, in-depth, semistructured interviews of women and group leaders in GPNC, participant observation of GPNC sessions, and medical record review. GPNC offered positive experiences and met many of women’s expressed preferences regarding prenatal care. Six themes were identified, which represented separate aspects of women’s experiences: investment, collaborative venture, a social gathering, relationships with boundaries, learning in the group, and changing self. Taken together, the themes conveyed the overall experience of GPNC. Women were especially enthusiastic about learning in groups, about their relationships with group leaders, and about having their pregnancy-related changes and fears normalized; however, there were also important boundaries on relationships between participants, and some women wished for greater privacy during physical examinations.

Family-Based Interventions for Childhood Obesity: A Review

The purpose of this article is to critically evaluate the evidence related to family-based interventions designed to treat childhood obesity. A MEDLINE, PSYCLIT, and CINAHL search identified articles published between January 1980 and January 2004 relating to family-based interventions. Thirteen studies were included, and all of the interventions used nutrition education, exercise, and behavioral interventions, including behavioral modification, behavioral therapy, or problem solving. Behavioral modification interventions targeted children and parents together or separately and were reported to be successful in improving weight-loss outcomes in both parents and children. Behavioral therapy interventions targeting children and parents together or the parents of children separately improved weight outcomes. Problem-solving interventions that targeted parents of children showed improved weight outcomes for their children. However, when problem solving was used with both parents and children together or children alone, weight outcomes did not improve. A majority of the studies have some methodological weaknesses.