Qualitative Health Research

Uncertainty is a consequential aspect of chronic illness for patients as well as their family and friends, yet little research has focused on how non-ill individuals experience uncertainty about the condition of someone in their social network. Thirty-one individuals with loved ones who had a communication-debilitating illness or injury (CDI) participated in one-on-one interviews about their experiences. We analyzed transcripts for participants' sources of uncertainty and for ways that they managed the uncertainty. Participants' experiences with uncertainty included questions about the condition itself and involved the impaired communication resulting from the CDI. Participants described managing uncertainty through information seeking, changing the ways they communicated with the person with the CDI, and creating schemata to help reduce uncertainty. We discuss the findings in terms of predominant conceptualizations of uncertainty in illness and address the prevalence of communication as both a significant source of uncertainty and an important means of managing uncertainty.

The authors examine the impact of childhood leukemia on the career development of 11 young adult survivors, using consensual qualitative research. They discuss the results and implications of childhood leukemia on the survivor's career, family, and future expectations, and provide recommendations for addressing the critical coping and management challenges encountered by survivors, their families, and the helping professionals who treat them.

A Heideggerian hermeneutical phenomenological research method was used to investigate the experience of memory loss in twelve individuals with early Alzheimer's disease or mild cognitive impairment. Data analysis proceeded as described by Diekelmann, Allen, and Tanner (1989), and incorporated the methods of Benner (1994), Thomas and Pollio (2002), and van Manen (1990). Three constitutive patterns with relational themes were identified. The first pattern, experiencing breakdown, consisted of two themes: awakening to breakdown and living with forgetting. The second pattern, temporality, consisted of three themes: being in the nothing, forgetting the past, and looking ahead. The third pattern, managing forgetting, consisted of the themes: remembering with cues, writing things down, recognizing what made remembering better or worse, and using laughter. The finding show that early Alzheimer's disease is more than an illness of cognitive losses and that forgetting is significant in light of the meaning that it has within everyday life.

We explain why some caretakers opt for alternative medicine for the treatment of children's asthma whereas others do not. In the past 15 years, asthma care has been standardized, with clinical practice guidelines centered on advanced pharmacological regimes. Clinicians argue that with proper biomedical treatment and environmental control, asthma should be a manageable chronic disease. Yet many patients forego available pharmacological treatments for alternative medicine or complement prescribed drugs with unconventional treatments. On the basis of open-ended, in-depth qualitative interviews with 50 mothers of children with asthma, we argue that the experience with biomedical treatments, social influence in mother's network of care, concerns about adverse and long-term effects, health care providers' responsiveness to such concerns, and familiarity with alternative treatments explain why some families rely on alternative medicine and others do not.

The prostate specific antigen (PSA) test is widely used to screen men for prostate cancer, but its value in diagnosing prostate cancer in asymptomatic men is controversial. In 2001, the U.K. Department of Health introduced the Prostate Cancer Risk Management Programme (PCRMP), through which men are given relatively detailed information before they make a final decision about a test. Little is known about men's experiences of the test since this program was introduced. We report an analysis of interviews with 30 men who were tested, or considered having a test, since the PCRMP was introduced. Our analysis suggests that men's views of the PSA test are dominated by their construction of testing as responsible health behavior and their perception of PSA as “just a blood test.” Men's accounts also suggest that poor communication about the uncertainty of the test—and about treatment for prostate cancer—also persists.

This study explores the construction of risk and patient identity in medical discourse directed toward women with breast cancer. Eleven documents produced by the National Cancer Institute on the topic of breast cancer are studied using narrative analysis. A distinct patient narrative presents all women as at risk for breast cancer and creates an idealized patient identity that serves a prescriptive function for women. The narrative constructs an early-cancer experience where the patient is treatable and cancer is cured or controlled. There are no significant changes in the narrative after time.

This study explores the relationship between child sexual abuse and adolescent motherhood, using a life story interview method. The sample consists of 27 mothers participating in a home-visitation parenting program for mothers at risk of child maltreatment. The failure to articulate the violation of child sexual abuse and to appropriately construct blame resulted in a range of self-destructive behaviors, some of which placed mothers at greater risk of teen pregnancy. Repressed feelings associated with the trauma often resurfaced with motherhood as victims reexperienced their innocence and vulnerability as children.

People experiencing disability and chronic disease often feel powerless, relinquishing medical control to “more knowledgeable” professionals. This article presents qualitative and quantitative results from three individual patients experiencing an emerging procedure called Recovery Preference Exploration (RPE). To inspire greater patient involvement, self-direction, and individual choice, we instructed participants to create an imagined recovery path, exposing recovery preferences while learning about clinical rehabilitation concepts. Results uncovered important values and feelings about disability, providing a richer context for patient evaluation and treatment goal modification. Applying mixed methods, RPE is presented as an explanatory process for quantifying recovery preferences in a way that stimulates rich narrative of how people see different types of disabilities. RPE shows promise for increasing depth of discussions among patients, family, and clinicians. RPE may promote greater quality of life through patient empowerment by directed learning, increased communication, and enhanced self-knowledge.

Studies predict that the number of HIV infections among commercial sex workers (CSWers) in India may rise to 3.93 million. Efforts have been made to stem the tide. But most campaigns have been designed to ensure condom compliance among CSWers by spreading awareness and increasing availability. Absent from the discursive space of such campaigns are the agency of CSWers and their ability to resist dominant social structures. The authors respond to this lacuna in health communication by foregrounding voices of CSWers participating in two HIV/AIDS interventions in India. Based on the culture-centered approach to health communication and subaltern studies theory, it examines data from two sites to analyze how communicative narratives of agency and resistance are enacted in the marginalized lives of sex workers.

The purpose of this article is to illustrate both the processes of data analysis and the methodological development involved in adopting the sequential use of two data analysis methods applied to the same data set. Understanding of the phenomena of interest was sought through examining both the content and the form of nurses' accounts of practice experiences. Initially, a method of thematic content analysis was applied to understand what the nurses said about their experiences. The core theme of nurses' change agency derived from this analysis was examined further through a method of narrative analysis. In the second analysis, the focus was shifted to how the nurses accounted for their experiences. The innovative use of iterative, sequential methods of analysis revealed greater complexity and depth of understanding of the phenomena than would have been achieved with one method alone.

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.