Qualitative Health Research

The author investigated sociocultural barriers that constrain use of complementary and alternative medicine (CAM) in the lives of people with HIV. Qualitative interviews with 62 persons with HIV revealed that 73% (n = 45) of interviewees were classified as potential users of CAM. These included both users and nonusers who expressed interests in using CAM or specific modalities but did not use. The demand for CAM was constrained to the extent that participants were unable to incorporate CAM into their health strategies. Three main CAM constraints dealt with obstacles stemming from the Culture of Medicine, the Social Organization of Alternative Medicine, and Everyday Life. From these constraints, the author drew conclusions about sociocultural factors that slow the diffusion ofCAMinto mainstream health practices.

Of 50 women seeking an abortion in Rochester, New York, between November 1999 and January 2001, 35 went on to complete an in-depth interview from 1 to 6 weeks after their followup clinical visit. Ahigher proportion of women who defined their pregnancy as a baby indicated emotional distress during their in-depth interview compared to those who saw their pregnancy as only having the potential to become a baby. The authors conclude that abortion might be made less difficult through public education about the different views of pregnancy and abortion throughout U.S. history. It might be important for abortion counselors to first ask a woman how she defines her pregnancy. A larger study is warranted.

This article represents one facet of the author’s research on women’s experiences of embodiment after breast cancer. Herein, women’s reliance on and rejection of medicalized understandings of this condition are explored via participants’ descriptions of memories of treatment. Data collection consisted of 24 in-depth interviews with 12 women, using phenomenological and feminist approaches. Five themes emerged: (a) issues of control, (b) suffering, (c) encountering medicine, (d) visible loss, and (e) leaving active treatment. Participants found the medicalization of breast cancer to be problematic, but they were also reluctant to leave the realm of acute care. Although a large volume of breast cancer research now exists, the women’s accounts demonstrate that further research into the experience of breast cancer is necessary.

Joining the discussion regarding the future of alternative and traditional medical practices and beliefs, the author explores how operating within the dominant sociopolitical system challenges alternative health care providers' definitions of themselves, their practices, and their systems of beliefs. Specifically, this case study articulates the experiences of one group of birth care providers (both certified nurse and nonlicensed, apprentice-trained midwives) as a web of paradox that simultaneously marginalizes parts of their occupational identity while allowing them to operate within the dominant sociopolitical system.

A division of labor exists between nurses and doctors in a surgical intensive care unit. Nurses perform a culturally identified feminine expressive role, caring about patients as well as for them. Doctors perform a culturally identified masculine instrumental role, concerned with curing patients’ bodies. The nurses are interested in the patients’ stories; the doctors attempt to ignore the stories to concentrate on returning patients to function. Based on the patient’s story, however, the nurses make severe judgments as to moral worth. Such judgments can impair medical care. Must doctors, then, disregard patients’ stories? In other words, must they limit themselves to caring for patients’ bodies, attempting to ignore the individuals, situated in a web of social relationships, who inhabit those bodies?

In this article, the authors address the boundaries of institutional structures, the dynamics of their configuration, and the nature of their permeability. The authors explored these issues in Israel, where the changing relationship of bio and alternative medicine elucidates recent processes of professional boundary redefinition. They used qualitative methods to analyze in-depth interviews in clinics and hospitals where alternative and biomedical practitioners work under the formal auspices of publicly sponsored biomedical organizations. The findings show an incursion by alternative practitioners into territories viewed until fairly recently as the exclusive domain of biomedicine. However, the “alternatives” are not defined as regular staff members, and their marginality is elucidated by a variety of visible structural, symbolic, and geographical cues. The authors used decoupling theory in interpreting the findings. Changed boundary contours signal underlying processes of social change that could have meaningful implications in defining membership criteria in the biomedical community.

The authors explored treatment-seeking behavior among people with tuberculosis (TB) in Bali, Indonesia. They conducted in-depth interviews with 5 people who had been diagnosed with TB and 6 people who were suspected of having TB but who had not yet received a diagnosis. Participants reported frequent delays in obtaining a diagnosis of TB and obtaining adequate treatment. The authors describe issues associated with treatment-seeking behavior using the following five main themes: awareness of TB—causes, symptoms, and seriousness; influence of others; treatment quality; treatment barriers and default; and stigma and fear. Their findings reinforce the importance of a comprehensive TB control program that provides quality diagnostic and treatment services, and patient and community education, and enables patient involvement in treatment.

In this article, the author draws on interview data collected during an ethnographic field study of the informed consent process and HIV/AIDS clinical trial work. She held interviews to explore how individuals decide to enroll in a clinical trial and uses the concept of contingency to illustrate how individuals interpret and act on the uncertainties of clinical research. Findings show that people with HIV/AIDS consider three kinds of contingencies— clinical, social, and technical—before enrolling in a clinical trial. The author offers suggestions for how the concept of contingency might be used in future studies on informed consent and for how the concept might be used in discussions between research professionals and patients on human subject research.

There has been an upsurge of academic interest in using focus groups (FGs) as a main or stand-alone qualitative method. In this article, the authors introduce a recently developed ancillary method to FGs called interviewing the moderator. The method is employed immediately after an FG and consists of a one-on-one interview with the FG moderator by another member of the research team. The authors argue, with reference to a specific study, that interviewing the moderator adds a new and valuable dimension to group interviews used in research. They describe how this method came about and provide a concrete example of its use in a recently completed research project. They discuss several advantages of the interview, among them that it provides information about group interaction and participant behavior, and furnishes additional data on what is discussed when the tape recorder is turned off.

Anumber of articles in the nursing literature discuss the differences between descriptive and interpretive approaches to doing phenomenology. A review of studies demonstrates, however, that many researchers do not articulate which approach guides the study, nor do they identify the philosophical assumptions on which the study is based. Such lack of clarity makes it difficult for the reader to obtain a sense of how the knowledge produced by the study is to be evaluated and used. In this article, the authors compare the philosophical components of descriptive and interpretive approaches to doing phenomenology and illustrate types of knowledge produced by each through reviewing specific studies. They focus on the various uses of phenomenology in generating useful knowledge for health care practice. Keywords: qualitative; hermeneutic; critical theory; Husserl; Heidegger; existentialism; phenomenology