Qualitative Health Research

The purpose of this article is to examine health/service providers’ perspectives of barriers to healthy weight gain and physical activity for urban, pregnant First Nations women in Ottawa, Canada. Through the use of semi-structured interviews, we explored 15 health/service providers’ perspectives on the complex barriers their clients face. By using a postcolonial feminist lens and a social determinants of health framework, we identified three social determinants of health that the health/service providers believed to have the greatest influence on their clients’ weight gain and physical activity during pregnancy: poverty, education, and colonialism. Our findings are then contextualized within existing Statistics Canada and the Ottawa Neighbourhood Study data. We found that health/service providers are in a position to challenge colonial relations of power. We conclude by urging health/service providers, researchers, and policymakers alike to take into consideration the ways in which these social determinants of health and their often synergistic effects affect urban First Nations women during pregnancy.

Dominant health care professional discourses on cancer take for granted high levels of individual responsibility in cancer prevention, especially in expectations about preventive screening. At the same time, adhering to screening guidelines can be difficult for lower income and under-insured individuals. Colorectal cancer (CRC) is a prime example. Since the advent of CRC screening, disparities in CRC mortality have widened along lines of income, insurance, and race in the United States. We used a community-engaged research method, Photovoice, to examine how people from medically under-served areas experienced and gave meaning to CRC screening. In our analysis, we first discuss ways in which participants recounted screening as a struggle. Second, we highlight a category that participants suggested was key to successful screening: social connections. Finally, we identify screening as an emotionally laden process that is underpinned by feelings of uncertainty, guilt, fear, and relief. We discuss the importance of these findings to research and practice.

Bipolar disorder (BD) has been related to heightened creativity, yet core questions remain unaddressed about this association. We used qualitative methods to investigate how highly creative individuals with BD understand the role of symptoms and treatment in their creativity, and possible mechanisms underpinning this link. Twenty-two individuals self-identified as highly creative and living with BD took part in focus groups and completed quantitative measures of symptoms, quality of life (QoL), and creativity. Using thematic analysis, five themes emerged: the pros and cons of mania for creativity, benefits of altered thinking, the relationship between creativity and medication, creativity as central to one’s identity, and creativity’s importance in stigma reduction and treatment. Despite reliance on a small sample who self-identified as having BD, findings shed light on previously mixed results regarding the influence of mania and treatment and suggest new directions for the study of mechanisms driving the creative advantage in BD.

Gay men living with HIV (GMLWH) who smoke are less responsive to generalized smoking reduction and cessation (SRC) programs than heterosexual persons. This study explored perspectives of GMLWH during the design of a web-based SRC intervention. Participatory design techniques were used to guide the creation of personas that are composite representations of a person who would use the web-based SRC intervention. Researcher-participants (n = 13) created all data. Data analysis involved thematic coding drawing from an ethnographic perspective. Thematic analysis revealed seven intersecting themes related to SRC among participants, and an overarching theme navigating life. Concepts drawn from our ethnographic approach highlight cultural differences between GMLWH and mainstream society. Personas offer a mechanism for interpreting experiences and traditions of GMLWH. SRC interventions with GMLWH must address their social realities that include tools for navigating life, disease, and social identity.

The factors driving the disparity in health outcomes between Indigenous and non-Indigenous Australians include socio-economic factors, racism, and history. The current study focused on exploring Indigenous participants’ perspectives of the factors that affect the health behavior of their community members. Participatory action research methodology and a grounded theory approach were utilized. In total, 120 members of two urban West Australian Indigenous communities participated in focus group discussions. There was substantial similarity between the themes that emerged within the discussions held in the two communities. Factors relating to culture, social connections, racism, communication, and personal aspects were particularly salient to health behavior of the participants. Several of the themes including culture, racism, communication, and distrust highlight the tension caused by being a member of a minority cultural group that has been marginalized by the practices and attitudes of the dominant cultural group. Personal choice was sometimes prioritized over health.

Community-based participatory research (CBPR) is a collaborative research approach that has two purposes: (a) to generate knowledge about and (b) to take action to improve the lives of people facing health, social, economic, political, and environmental inequities. The foundation of all CBPR projects is its partnership—its cooperative relationship between community members, service providers, program planners, policy makers, and academics. It is with people—and through relationships—that partnerships are built and sustained. Although relationships between academics and community members are critical to creating knowledge and change, they are overlooked in the literature. We often hear about CBPR “gone wrong,” when tensions and conflicts arise because relationship boundaries become blurred. Our purpose is to expose the muddled relationships that can be created between academics and community members in CBPR projects. Drawing upon our experiences presented in a series of vignettes, we consider the nature of these relationships. We explore whether we conduct, in CBPR, good research at the expense of muddling relationships. Despite the potential for muddled relationships, we believe that CBPR is the best approach for research aimed at achieving a more equitable and just society.

Transdisciplinarity (TD) is a participatory research approach in which actors from science and society work closely together. It offers means for promoting knowledge integration and finding solutions to complex societal problems, and can be applied within a multiplicity of epistemic systems. We conducted a TD process from 2011 to 2014 between indigenous Mayan medical specialists from Guatemala and Western biomedical physicians and scientists to study cancer. Given the immense cultural gap between the partners, it was necessary to develop new methods to overcome biases induced by ethnocentric behaviors and power differentials. This article describes this intercultural cooperation and presents a method of reciprocal reflexivity (Bidirectional Emic–Etic tool) developed to overcome them. As a result of application, researchers observed successful knowledge integration at the epistemic level, the social-organizational level, and the communicative level throughout the study. This approach may prove beneficial to others engaged in facilitating participatory health research in complex intercultural settings.

Photovoice, a community-based participatory research method, was utilized to delineate the health-related needs of a small rural community in Kenya. Within the Cherangany Constituency, 13 women were recruited and trained in digital photography and appropriate ethical conduct in photography (respect for privacy, consent, and confidentiality). Both individual and group interviews were conducted with the participants, and data were transcribed and analyzed for common themes by both the participants and the researcher. Common themes present in the photos were coded and prioritized in order of importance: (a) school fees, (b) water, (c) hospital fees, (d) sanitation, (e) orphans, (f) widows, (g) lack of jobs/capital, (h) disabilities, and (i) presence of disease. Data from this study will be utilized for (a) development of culturally competent health education, (b) site-specific education/training of incoming medical teams, and (c) informative meetings with local leaders regarding health and associated challenges.

Although the concept of empowerment is a key principle of community-based participatory research (CBPR), little is known about how academic and community partners perceive empowerment during a CBPR process. CBPR partners’ perceptions of the process were explored using semi-structured interviews with both partners in 10 CBPR partnerships that had completed projects addressing social determinants of health. Dyadic interview analysis was employed to understand dynamics within and across partnerships. Five partnerships showed no differences in perceptions of empowerment. Four had minor discrepancies. Only one partnership varied considerably between partners, where the community partner perceived less empowerment regarding determining the study topic and overall control, influence, and respect throughout the process. This article discusses implications of findings for CBPR. Evaluating partners’ perceived empowerment throughout a CBPR project might reveal areas to adjust, as not all projects with quantifiably successful outcomes involve processes that are successful in terms of empowerment.

A national community-based participatory research (CBPR) team developed a conceptual model of CBPR partnerships to understand the contribution of partnership processes to improved community capacity and health outcomes. With the model primarily developed through academic literature and expert consensus building, we sought community input to assess face validity and acceptability. Our research team conducted semi-structured focus groups with six partnerships nationwide. Participants validated and expanded on existing model constructs and identified new constructs based on “real-world” praxis, resulting in a revised model. Four cross-cutting constructs were identified: trust development, capacity, mutual learning, and power dynamics. By empirically testing the model, we found community face validity and capacity to adapt the model to diverse contexts. We recommend partnerships use and adapt the CBPR model and its constructs, for collective reflection and evaluation, to enhance their partnering practices and achieve their health and research goals.

In this article, we anthropologically explore one part of the process of Community-Based Participatory Research (CBPR): participation. Participation in CBPR is usually conceptualized as whether, and the degree to which, community members are involved in the research process. Our focus regarding participation is less on quantity and more on quality of the interaction between community members and researchers; within this context, we elaborate the concept of “bridging” as it is understood in CBPR. Using data from our ongoing “Water Project” in the Peruvian Andes, we explore how interaction, as a participative act of the research interview, creates the space for participating and imagining. Out of this interaction come data that are elaborated, contextualized, and, ultimately, from a CBPR perspective, made useful for meaningful engagement and community action.

We reflect on the experiences of a researcher conducting a pilot exercise project with marginalized research participants within the substance use disorder treatment field, in a language that was nonnative to her. While the project collected and analyzed quantitative data, the researcher was motivated by qualitative inquiry’s commitment to reducing participant–researcher distance and power differences. Despite multiple sources of power imbalances favoring the researcher, the ability of participants to speak their native language to a nonnative researcher, and the researcher’s active recognition of her linguistic vulnerability, appeared to afford them an unexpected source of power within the context of the project. We discuss the researcher’s observations of these power dynamics and their implications for cross-cultural research and when working with marginalized research participants.