Mark Luborsky

Sampling in Qualitative Research: Rationale, Issues, and Methods

In gerontology the most recognized and elaborate discourse about sampling is generally thought to be in quantitative research associated with survey research and medical research. But sampling has long been a central concern in the social and humanistic inquiry, albeit in a different guise suited to the different goals. There is a need for more explicit discussion of qualitative sampling issues. This article will outline the guiding principles and rationales, features, and practices of sampling in qualitative research. It then describes common questions about sampling in qualitative research. In conclusion it proposes the concept of qualitative clarity as a set of principles (analogous to statistical power) to guide assessments of qualitative sampling in a particular study or proposal.

What do we know about older adults and HIV? a review of social and behavioral literature

Abstract The fastest growing segment of the United States HIV population is people aged 50 and older. This heterogeneous group includes people with diverse pathways into HIV positive status in later life, including aging with the disease as well as later life-acquired infections. As people with HIV live into older ages, solving problems of successful secondary prevention and ongoing treatment requires more specific knowledge of the particular aging-related contextual sociocultural, psychosocial, and personal factors salient to the situations of persons living with HIV. Greater knowledge of these factors will help solve challenges to reducing psychological burden and promoting health maintenance for people with HIV. Yet, the current literature on aging and HIV remains nascent. To assess the state of knowledge of the sociocultural and behavioral factors associated with aging with HIV, we conducted a systematic critical content review of peer-reviewed social and behavioral research on aging and HIV to answer the question, “How have older age, and social, cultural, and behavioral aspects of the intersection of HIV and age been addressed in the literature?” We searched First Search, Proquest, Psych Info, Pub Med, Wilson Select Plus, and World Cat and identified 1549 articles. We then reviewed these to select peer-reviewed articles reporting results of research on the social and behavioral aspects of living with HIV at age 50 and older. Fifty-eight publications were identified that met study inclusion criteria. While few publications reported clear age-related differences, there were significant ethnic differences in living with HIV in later life and also differences among older people when groups were defined by mode of transmission. Findings are discussed in light of constructs from gerontology which may contribute to clarifying how later life, life course stage, and psychological development intersect with, influence, and are influenced by HIV disease and long-term anti-retroviral therapy use.

How qualitative methods contribute to understanding combination antiretroviral therapy adherence

Summary:Strict adherence to medication regimens is generally required to obtain optimal response to combination antiretroviral therapy (ART). Yet, we have made limited progress in developing strategies to decrease the prevalence of nonadherence. As we work to understand adherence in developed countries, the introduction of ART in resource-poor settings raises novel challenges. Qualitative research is a scientific approach that uses methods such as observation, interviews, and verbal interactions to gather rich in-depth information about how something is experienced. It seeks to understand the beliefs, values, and processes underlying behavioral patterns. Qualitative methods provide powerful tools for understanding adherence. Culture-specific influences, medication beliefs, access, stigma, reasons for nonadherence, patterns of medication taking, and intervention fidelity and measurement development are areas ripe for qualitative inquiry. A disregard for the social and cultural context of adherence or the imposition of adherence models inconsistent with local values and practices is likely to produce irrelevant or ineffective interventions. Qualitative methods remain underused in adherence research. We review appropriate qualitative methods for and provide an overview of the qualitative research on ART nonadherence. We discuss the rationales for using qualitative methods, present 2 case examples illustrating their use, and discuss possible institutional barriers to their acceptance.

THE CULTURAL ADVERSITY OF PHYSICAL DISABILITY: Erosion of Full Adult Personhood.

Adversities facing people with disabilities include barriers to meeting daily needs and to social life. Yet, too, fundamental social devaluation erodes an individuals capacity to retain title to the cultural category of a full person. These cultural adversities are important components in the disablement process. The cultural meanings for physical dependency convey images of childlike, dependent, incomplete persons near death. Using interviews with middle aged and elderly polio survivors, the author identifies key cultural categories, the expectations and values linked with disability and describe the strategies people use to confront, or not, the erosion of personhood. The importance of understanding the category of the person, its historical setting, and evolution are highlighted. Finally, the inversion of traditional cultural logics for defining the personhood of individuals with disabilities is illustrated.

Sero-positive African Americans’ Beliefs about Alcohol and Their Impact on Anti-retroviral Adherence

Alcohol consumption has been associated with HIV disease progression; yet, the nature of this association is poorly understood. This study sought to determine the influence of patient beliefs about alcohol on ART adherence, and elucidate clinician beliefs about drinking and taking ART. Most patients (85%) believed alcohol and ART do not mix. The three alcohol consumption groups, light, moderate, and heavy, differed in their beliefs about drinking and ART with 64% of light and 55% of moderate drinkers skipping ART when drinking compared to 29% of heavy drinkers. Beliefs were derived from folk models of alcohol–ART interaction. Patients 50 and older were less likely to skip ART when drinking. Alcohol appears to affect adherence through decisions to forgo ART when drinking not through drunken forgetfulness. Furthermore, over one-half of clinicians believed alcohol and ART should not be taken together. These findings have implications for patient care and physician training.

Underreporting of workplace violence: comparison of self-report and actual documentation of hospital incidents

This study examined differences between self-report and actual documentation of workplace violence (WPV) incidents in a cohort of health care workers. The study was conducted in an American hospital system with a central electronic database for reporting WPV events. In 2013, employees (n = 2010) were surveyed by mail about their experience of WPV in the previous year. Survey responses were compared with actual events entered into the electronic system. Of questionnaire respondents who self-reported a violent event in the past year, 88% had not documented an incident in the electronic system. However, more than 45% had reported violence informally, for example, to their supervisors. The researchers found that if employees were injured or lost time from work, they were more likely to formally report a violent event. Understanding the magnitude of underreporting and characteristics of health care workers who are less likely to report may assist hospitals in determining where to focus violence education and prevention efforts.

Moving Beyond ‘Aging In Place’ to Understand Migration and Aging: Place Making and the Centrality Of Occupation

‘Aging in place’ has become a key conceptual framework for understanding and addressing place within the aging process. However, aging in place has been critiqued for not sufficiently providing tools to understand relations or transactions between aging and place, and for not matching the diversity of contemporary society in which people are moving between and across nations more than ever before. In this article, the authors draw from concepts of place and migration that are becoming increasingly visible in occupational science. The concept of ‘aging in place’ is critically examined as an example of an ideal where the understanding of place is insufficiently dynamic in a context of migration. The authors suggest that the concept of place making can instead be a useful tool to understand how occupation can be drawn upon to negotiate relationships that connect people to different places around the world, how the negotiated relations are embedded within the occupations that fill daily lives, and how this process is contextualized and enacted in relation to resources and capabilities.

Organizational Climate Determinants of Resident Safety Culture in Nursing Homes

PURPOSE OF THE STUDY In recent years, there has been an increasing focus on the role of safety culture in preventing costly adverse events, such as medication errors and falls, among nursing home residents. However, little is known regarding critical organizational determinants of a positive safety culture in nursing homes. The aim of this study was to identify organizational climate predictors of specific aspects of the staff-rated resident safety culture (RSC) in a sample of nursing homes. DESIGN AND METHODS Staff at 4 Michigan nursing homes responded to a self-administered questionnaire measuring organizational climate and RSC. Multiple regression analyses were used to identify organizational climate factors that predicted the safety culture dimensions nonpunitive response to mistakes, communication about incidents, and compliance with procedures. RESULTS  The organizational climate factors efficiency and work climate predicted nonpunitive response to mistakes (p < .001 for both scales) and compliance with procedures (p < .05 and p < .001 respectively). Work stress was an inverse predictor of compliance with procedures (p < .05). Goal clarity was the only significant predictor of communication about incidents (p < .05). IMPLICATIONS Efficiency, work climate, work stress, and goal clarity are all malleable organizational factors that could feasibly be the focus of interventions to improve RSC. Future studies will examine whether these results can be replicated with larger samples.

Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports

AIM To explore catalysts to, and circumstances surrounding, patient-to-worker violent incidents recorded by employees in a hospital system database. BACKGROUND Violence by patients towards healthcare workers (Type II workplace violence) is a significant occupational hazard in hospitals worldwide. Studies to date have failed to investigate its root causes due to a lack of empirical research based on documented episodes of patient violence. DESIGN Qualitative content analysis. METHODS Content analysis was conducted on the total sample of 214 Type II incidents documented in 2011 by employees of an American hospital system with a centralized reporting system. FINDINGS The majority of incidents were reported by nurses (39·8%), security staff (15·9%) and nurse assistants (14·4%). Three distinct themes were identified from the analysis: Patient Behaviour, Patient Care and Situational Events. Specific causes of violence related to Patient Behaviour were cognitive impairment and demanding to leave. Catalysts related to patient care were the use of needles, patient pain/discomfort and physical transfers of patients. Situational factors included the use/presence of restraints; transitions in the care process; intervening to protect patients and/or staff; and redirecting patients. CONCLUSIONS Identifying catalysts and situations involved in patient violence in hospitals informs administrators about potential targets for intervention. Hospital staff can be trained to recognize these specific risk factors for patient violence and can be educated in how to best mitigate or prevent the most common forms of violent behaviour. A social-ecological model can be adapted to the hospital setting as a framework for prevention of patient violence towards staff.

Alchemists' Visions: Cultural Norms in Eliciting and Analyzing Life History Narratives.

Comparative study within a group of systematically elicited life narratives revealed key variations in narrative sequencing and conceptual templates. These dimensions are associated with significant differences in subjective meaning, frames for interpreting experience, and personal adjustment. This paper describes the study methods and results, and proposes that life histories be studied in the context of other similarly collected narratives, instead of one at a time. It outlines limitations of current methods of eliciting, analyzing, and writing up texts which may systematically obscure important dimensions of subjectivity and of cultural norms.