Qualitative Health Research

Adolescence is a critical time for developing lifelong healthy behaviors, including active lifestyles. Participation in sport and physical activity, however, declines during adolescence, and few studies have comprehensively identified why, particularly among rural girls. This article identifies a range of independent and interacting factors that influence sport and physical activity participation of rural adolescent girls. The socioecological model of health was used to guide four focus group discussions with Grade 7 girls (n = 34). The results showed that adolescent girls were positively influenced when sports or physical activities were fun, when they involved being with friends, and when they were supported by families and teachers through role modeling and positive feedback. A range of intrapersonal and organizational factors affected perceived self-competence, particularly the coeducational nature of school physical education classes and peer teasing, which supported social comparisons of skill level. In promoting sport and physical activity to rural adolescent girls, focus must be directed on developmentally appropriate activities that are fun, offering opportunities for single-sex classes, and generating cultural changes that encourage noncompetitive and self-referencing activities.

Evidence suggests that physical activity improves quality of life and physical functioning among breast cancer patients and survivors. However, previous studies have tended to focus on younger patients, despite higher incidence and lower survival among older breast cancer survivors. In this study we explored physical activity preferences of older breast cancer survivors to inform the development of future targeted interventions. Twenty-nine female breast cancer survivors (1 to 5 years postdiagnosis) aged 59 to 86 (mean 66.54, SD 6.50) took part in either a semistructured interview or a focus group exploring physical activity patterns, motivators, facilitators, barriers, and preferences. The main factors influencing physical activity were body image, weight issues, vitality, mood, and the desire to carry on as normal. Preference was expressed for activities that were gentle, tailored to age and cancer-related abilities, holistic, involving other older breast cancer survivors, and with an instructor who was knowledgeable about both breast cancer and aging.

The main objective of this exploratory study was to assess children's perceptions of their activity choices as they began a weight-management program for overweight children and their families. During pretesting of a 10-week weight-management program, participating children were asked to draw pictures of themselves doing something. The drawings of 35 children, ages 8 to 12, were qualitatively analyzed. The analysis focused on (a) the type of activities (i.e., physical or sedentary) children chose to convey, (b) the specific focus of the activities described, (c) the children's future activity choices, and (d) the children's responses to the activities they drew. Seventy-one percent of the participating children drew themselves engaged in a physical activity. These results are notable and suggest positive perceptions of physical activities. Children's views related to their activity choices might play a role in designing weight-management programs that successfully increase children's adherence to long-term physical activity.

Active and sensitively managed patient involvement in medical education is vital in the drive toward the development of tomorrow's doctors' patient-centered professionalism. Bedside teaching encounters (BTE) involve clinicians, medical students, and patients, and comprise a formative and focused activity through which students learn both the “whats” and “hows” of physicianship. We present four case studies from our analysis of six BTEs, drawing on Goffman's dramaturgy theory and broader interactional research. We demonstrate the multiple roles participants play within BTEs, including actor, director, audience, nonperson, and prop. Although patients sometimes participated as team members, even taking the role of director, they were commonly positioned in less active roles: as audience, nonperson, and prop. In this article we discuss critically this commonality across the BTEs: the patient role as passive object at the point at which the serious act of teaching physical examination begins, even when patients actively reject this passive role.

How does a newly diagnosed user get inducted into a forum dedicated to people suffering from bipolar disorder? Is their opening message “matched” by the forum's reply? We add to the literature on social support online by using conversation analysis (CA) to explore an apparent contradiction between a new user's first post and forum members' replies with ostensibly unsolicited advice. CA reveals the intimate relation between turns in sequence, an aspect of online communication largely ignored in existing work on social support. Seen from this perspective, giving unsolicited advice, although apparently a “mismatch,” turns out to be a consequence of the open design of the new user's initial posting. We speculate that such unsolicited advice might function at the ideological level to induct the new user into the mores of the group, not only in the kind of support it countenances giving, but into the very meaning of bipolarity itself.

General internal medicine (GIM) is a communicatively complex specialty because of its diverse patient population and the number and diversity of health care providers working on a medicine ward. Effective interprofessional communication in such information-intensive environments is critical to achieving optimal patient care. Few empirical studies have explored the ways in which health professionals exchange patient information and the implications of their chosen communication forms. In this article, we report on an ethnographic study of health professionals' communication in two GIM wards through the lens of communication genre theory. We categorize and explore communication in GIM into two genre sets—synchronous and asynchronous—and analyze the relationship between them. Our findings reveal an essential relationship between synchronous and asynchronous modes of communication that has implications for the effectiveness of interprofessional collaboration in this and similar health care settings, and is intended to inform efforts to overcome existing interprofessional communication barriers.

In this secondary analysis of videotape data, we describe birth talk demonstrated by caregivers to women during the second stage of labor. Birth talk is a distinctive verbal register or a set of linguistic features that are used with particular behaviors during specific situations, has a particular communication purpose, and is characterized by distinctive language features. Birth talk is found cross-culturally among speakers of diverse languages. Our findings show that birth talk occurred mainly during contractions and co-occurred with two general styles of caregiving: “directed toward forced bearing down” and “supportive of physiologic bearing down.” We also describe talk that occurred during rest periods, which was similar across the two styles. Caregivers' use of language tended to be either procedural (giving directions, instructions) or comfort related (encouraging and supporting). Linguistic features of the talk consisted of utterances of short duration, level pitch patterns with no sudden pitch shifts, and a restricted pitch range.

Research was conducted in rural Northeast Thailand to understand how mothers perceive children's acute illness episodes, and their resulting illness management strategies. Although diarrheal disease is one of the leading causes of illness among young children in Thailand, interviews revealed that mothers frequently do not classify infantile diarrhea as an “illness.” Infantile diarrhea is commonly labeled thai su, a type of diarrhea believed necessary to “lighten the body” so that the infant can attain a new developmental stage, such as sitting up, standing, or walking. Consequently, mothers do not perceive infection-related diarrheal illness as common in infants, and therefore do not direct much attention to prevention, nor manage diarrheal cases in a manner consistent with biomedical recommendations. In this article I describe local explanatory models of diarrheal illness, and discuss the role of situational factors and elder authority in determining how illness episodes are assessed and managed.

For adolescents with celiac disease (CD), a gluten-free diet (GFD) is crucial for health, but compliance is problematic and noncompliance is common even among those aware of the risks. To better understand their lives with the disease, Swedish CD adolescents were invited to take part in focus group discussions. Data were analyzed for recurrent stigma-related themes across the groups. Adolescents described an awareness of being different from others that was produced by meal appearance and the poor availability of gluten-free food. The GFD often required discussions and special requests, so eating in public had the effect of making an invisible condition visible, and thereby creating a context for felt or enacted stigma. Maintaining invisibility avoided negative consequences of stigma, and other strategies were used to reduce the costs of visibility. The results of the study show that the GFD can produce stigma experiences in adolescence, and that dietary compliance (or lack thereof) can be understood in terms of dealing with GFD concealment and disclosure.

Endometriosis is a chronic condition of women in which endometrial tissue is present outside of the uterus. It is characterized by pelvic pain. The aim of this prospective study was to explore women's experience of living with endometriosis. A sample of 30 women was recruited from a dedicated endometriosis clinic. Semistructured interviews were conducted upon recruitment and after one year, these data being supplemented by diary keeping by a volunteer sample. As a storytelling approach was utilized for data collection, narrative analysis was considered most appropriate. The findings are presented using the concept of uncertainty, which has been found in previous research to be a feature of long-term illness. Uncertainty exists around diagnosis, the course of the disease, and the future. It is argued that the way in which the pain of endometriosis is interpreted and managed by women and health professionals is integral to this uncertainty.

In Tegucigalpa, the capital city of Honduras, 22 local women participated in two focus groups. This article was written to give voice to these native Honduran women's unique perspective on their sexuality. We used a phenomenological qualitative approach, and asked them what sexual advice mothers have for their daughters. Data gathering and analysis were conducted using the principles of consensual qualitative research. These sessions were recorded, transcribed, and analyzed for themes. Primary themes include the participants' cultural understanding of respect, women's control of sexual discourse, the role of mothers as protectors, and women's sexual power, attachment, and desire.

Many factors are associated with food insecurity in the United States. We conducted interviews with 25 low-income and/or food-insecure Oregonians to explore their experiences with food insecurity, the role of social support, and whether these experiences differed based on rural/urban residence. Ill health and unemployment emerged as food-insecurity contributors. Coping strategies cited included use of nutrition assistance programs, alternate food sources, and drawing on social support. The findings suggest that policy and practice efforts should be directed at increasing the human capital of low-income Oregonians and the benefit levels of essential nutrition assistance programs.