Virginia Dickson-Swift

Doing sensitive research: what challenges do qualitative researchers face?

As health researchers we need to investigate a wide range of topics to enhance our understanding of the many issues that affect health and well-being in todays society. Much of the health research undertaken today involves face-to-face encounters with participants using qualitative methodologies. There is a growing recognition that undertaking qualitative research can pose many difficulties for researchers. However, very little research has focused directly on the experiences of researchers while undertaking qualitative research and the issues that their involvement in the research raises for them. To explore these issues, one-to-one interviews were conducted with 30 qualitative health researchers. A grounded theory analysis revealed that researchers can face a number of challenges while undertaking qualitative research. These include issues relating to rapport development, use of researcher self-disclosure, listening to untold stories, feelings of guilt and vulnerability, leaving the research relationship and researcher exhaustion. These results are discussed and recommendations for researchers involved in qualitative research are made.

Blurring Boundaries in Qualitative Health Research on Sensitive Topics

Qualitative health researchers immerse themselves in the settings that they are studying. This immersion involves personal interaction with their participants, with the result that the boundaries between the researcher and the group of people under study can easily become blurred. Although health researchers have been undertaking qualitative research for many years, recognition of boundary issues inherent in this type of research have received little attention. To investigate such issues, the authors conducted interviews with 30 qualitative health researchers. A grounded theory analysis of the interview transcripts revealed that researchers can identify a number of boundaries in their research, including the boundaries between researcher and friend, researcher and counselor or therapist, and professional boundaries. The authors discuss the findings and offer recommendations for qualitative health researchers involved in researching sensitive topics, including the need for researchers to consider the impacts that undertaking research might have on them.

Risk to Researchers in Qualitative Research on Sensitive Topics: Issues and Strategies

Traditionally, risk assessments in research have been limited to examining the risks to the research participants. Although doing so is appropriate and important, there is growing recognition that undertaking research can pose risks to researchers as well. A grounded theory study involving a range of researchers who had undertaken qualitative health research on a sensitive topic was completed. Analysis of the in-depth, face-to-face unstructured individual interviews with 30 Australian public health researchers provided evidence that researchers do confront a number of physical and emotional risks when undertaking research. Training, preparation, and supervision must be taken into account so that the risk to researchers can be minimized. Researchers need to consider occupational health and safety issues in designing research projects that deal with physical and emotional risks. Recommendations for professional supervision, policy development, and minimum training standards for researchers are provided.

Methodology or method? A critical review of qualitative case study reports

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12), social sciences and anthropology (n=7), or methods (n=15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12), social sciences and anthropology (n=7), or methods (n=15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

Community participation in rural health: a scoping review.

BackgroundMajor health inequities between urban and rural populations have resulted in rural health as a reform priority across a number of countries. However, while there is some commonality between rural areas, there is increasing recognition that a one size fits all approach to rural health is ineffective as it fails to align healthcare with local population need. Community participation is proposed as a strategy to engage communities in developing locally responsive healthcare. Current policy in several countries reflects a desire for meaningful, high level community participation, similar to Arnstein’s definition of citizen power. There is a significant gap in understanding how higher level community participation is best enacted in the rural context. The aim of our study was to identify examples, in the international literature, of higher level community participation in rural healthcare.MethodsA scoping review was designed to map the existing evidence base on higher level community participation in rural healthcare planning, design, management and evaluation. Key search terms were developed and mapped. Selected databases and internet search engines were used that identified 99 relevant studies.ResultsWe identified six articles that most closely demonstrated higher level community participation; Arnstein’s notion of citizen power. While the identified studies reflected key elements for effective higher level participation, little detail was provided about how groups were established and how the community was represented. The need for strong partnerships was reiterated, with some studies identifying the impact of relational interactions and social ties. In all studies, outcomes from community participation were not rigorously measured.ConclusionsIn an environment characterised by increasing interest in community participation in healthcare, greater understanding of the purpose, process and outcomes is a priority for research, policy and practice.

A critical review of population health literacy assessment.

BackgroundDefining health literacy from a public health perspective places greater emphasis on the knowledge and skills required to prevent disease and for promoting health in everyday life. Addressing health literacy at the community level provides great potential for improving health knowledge, skills and behaviours resulting in better health outcomes. Yet there is a notable absence of discussion in the literature of what a health literate population looks like, or how this is best assessed.DiscussionThe emphasis in assessing health literacy has predominantly focused on the functional health literacy of individuals in clinical settings. This review examines currently available health literacy assessment tools to identify how well suited they are in addressing health literacy beyond clinical care settings and beyond the individual. Although public health literature appears to place greater emphasis on conceptualizing critical health literacy, the focus continues to remain on assessing individuals, rather than on health literacy within the context of families, communities and population groups. When a population approach is adopted, an aggregate of individual health literacy assessment is generally used. Aggregation of individual health literacy fails to capture the dynamic and often synergistic relationships within communities, and fails to reflect societal influences on health knowledge, beliefs and behaviours.We hypothesise that a different assessment framework is required to adequately address the complexities of community health literacy. We assert that a public health approach, founded on health promotion theories provides a useful scaffold to assess the critical health literacy of population groups. It is proposed that inclusion of community members in the research process is a necessary requirement to coproduce such an appropriate assessment framework.SummaryWe contend that health literacy assessment and potential interventions need to shift to promoting the knowledge and skills essential for critical health literacy at a societal level. The challenge for researchers is to negotiate the myriad of complexities associated with each concept and component required for this task.

Teacher identification of children at risk for language impairment in the first year of school

While the first 3 years of formal schooling have obvious importance for the transition to literacy, it must be remembered that learning to read is a linguistically-based task that draws heavily on mastery of key oral-language skills such as phonemic and morphological awareness, vocabulary development, and early syntax. In order to support the transition to literacy, and because oral language competence is important in its own right, it is vital that early-years teachers are skilled at identifying children who may be at risk of oral language impairment. In this study, 15 teachers completed the Childrens Communication Checklist (second edition) on children in their first year of school (n = 149), and ratings were compared with results of screening using the Clinical Examination of Language Fundamentals Screening Test (fourth edition). Teacher ratings showed poor sensitivity and specificity in identifying children whose oral language skills require further investigation. Results are discussed in the light of recommendations for teacher pre-service education, SLP advocacy for oral language competence as a life-long determinant of health, issues in screening during the early years of school, and implications for further research.

Community participation for rural health: a review of challenges

Internationally, community participation is highlighted in health policy reform as good for rural communities. Implicit in this policy is the message that the complexities of the rural environment are too difficult for easy solutions and that community participation will somehow build resilient, self‐determining communities capable of dealing with complex rural access and equity issues and poorer health outcomes. The underpinning proposition is that by giving decision‐making powers to community members, health care will be locally responsive, costs will be contained, and health outcomes will improve. What happens in the practice of enacting community participation in health‐care decision making is less clear.

Rural Australian community pharmacists' views on complementary and alternative medicine: a pilot study

BackgroundComplementary and alternative medicines (CAMs) are being used increasingly across the world. In Australia, community pharmacists are a major supplier of these products but knowledge of the products and interactions with other medicines is poor. Information regarding the use of CAMs by metropolitan pharmacists has been documented by the National Prescribing Service (NPS) in Australia but the views of rural/regional community pharmacists have not been explored. The aim of this pilot study was to explore the knowledge, attitudes and information seeking of a cohort of rural community pharmacists towards CAMs and to compare the findings to the larger NPS study.MethodsA cross sectional self-administered postal questionnaire was mailed to all community pharmacists in one rural/regional area of Australia. Using a range of scales, data was collected regarding attitudes, knowledge, information seeking behaviour and demographics.ResultsEighty eligible questionnaires were returned. Most pharmacists reported knowing that they should regularly ask consumers if they are using CAMs but many lacked the confidence to do so. Pharmacists surveyed for this study were more knowledgeable in regards to side effects and interactions of CAMs than those in the NPS survey. Over three quarters of pharmacists surveyed reported sourcing CAM information at least several times a month. The most frequently sought information was drug interactions, dose, contraindications and adverse effects. A variety of resources were used to source information, the most popular source was the internet but the most useful resource was CAM text books.ConclusionsPharmacists have varied opinions on the use of CAMs and many lack awareness of or access to good quality CAMs information. Therefore, there is a need to provide pharmacists with opportunities for further education. The data is valuable in assisting interested stakeholders with the development of initiatives to address the gaps in attitudes, knowledge and to improve effectiveness of information seeking behaviour.

`It usually happens in older women': Young women's perceptions about breast cancer

Objective The aim of the current study was to explore young womens perceptions of breast cancer. Design This study used a qualitative descriptive paradigm. Participants were required to participate in a one-hour, tape-recorded, semi-structured interview. Data obtained were then coded and analysed using thematic analysis. Method A convenience sample of six young women participated in the study. Participants were all in their early twenties, with most being 21 years of age. All were university students who were studying a range of courses. Results The young women had very low levels of knowledge and understanding about breast cancer. Although they identified it was a serious illness, they were not aware of much else about the disease except for treatments. They could only identify two main risk factors, age and family history, and believed in common myths such as getting hit in the breast causing breast cancer. Overall, they did not feel that breast cancer was something that they needed to be concerned about, although they did perceive the need for more age appropriate breast health information to be made available to young women. Conclusions All women need to be educated about breast cancer and to learn early intervention techniques such as breast self examination at an early age. Lack of knowledge about breast cancer and breast cancer risk may lead to inaccurate perceptions of the disease and a lack of utilization of early detection techniques. Low levels of knowledge and a lack of perceived risk coupled with the inundation of breast cancer information that focuses on older women reinforces the belief that young women are not at risk and do not need to be aware of breast cancer. Furthermore, these data strongly support the need for breast health and breast cancer education in young women.