Qualitative Health Research

In this article, we describe our approach and philosophical methodology of teaching and doing phenomenology. The human science seminar that we offer involves participants in the primary phenomenological literature as well as in a variety of carefully engaged writing exercises. Each seminar participant selects a personal phenomenological project that aims at producing a publishable research paper. We show how the qualitative methodology of hermeneutic phenomenology requires of its practitioner a sensitivity and attitudinal disposition that has to be internalized and that cannot be captured in a procedural or step-by-step program. Our experience is that seminar participants become highly motivated and committed to their phenomenological project while involved in the rather intense progression of lectures, workshop activities, readings, and discussions.

What is it like for a child to live with an artificial heart? The use of some medical therapies in children requires developmental considerations, is associated with psychosocial consequences, and calls for ethical sensitivities. A critical case is the ventricular assist device (VAD), a mechanical pump used to support the functioning of a failing heart. As a pediatric therapy, the device can be used as a temporary solution for poor heart function, a bridge to transplantation or recovery, or as a destination therapy. While the mechanical-technical operation of the VAD is well understood, the clinical-technical aspects of young people living with this device are largely unexplored. Drawing on interviews of school-aged children, the aim of this phenomenological study is to explore how a VAD may structure or condition a child’s meaningful experience of their world outside the hospital. The driveline of an implanted VAD is the peripheral attachment, extruding through the skin to connect the controller-power supply. The materiality of the device may be interruptive, restrictive, and disturbing to the psycho-physical being and sense of self-identity of the child as a child. And while a child equipped with a VAD is not necessarily conspicuous among other children, the child may experience the device as an exposing presence, while living with the worry of a caregiver who takes on the role not simply of parent but of watchful health professional. A phenomenological understanding of the VAD should assist parents and caregiving health professionals knowing how to deal with specific issues arising in the life of the VAD child.

What is given in observation? A basic tenet of empirical science is that reliable knowledge results from observation, with natural perception and with refined instruments, which is repeatable and verifiable by impartial observers in standard conditions. An observer’s observation, in the first-person singular, is then equivalent and interchangeable with those of others. But what is really observed and given in such observation? There is a task here for phenomenology: to discern just what is given and how. What does a particular scientific discipline determine to count as an observation? In what language is the observation to be recorded? What counts as evidence? What counts as a description or an argument? What theories are implicated in the observational statements? Next, the phenomenologist asks, “What is given in experience? What is the phenomenological account?”

In this article, I try to think through the question, “What distinguishes phenomenology in its original sense?” My intent is to focus on the project and methodology of phenomenology in a manner that is not overly technical and that may help others to further elaborate on or question the singular features that make phenomenology into a unique qualitative form of inquiry. I pay special attention to the notion of “lived” in the phenomenological term “lived experience” to demonstrate its critical role and significance for understanding phenomenological reflection, meaning, analysis, and insights. I also attend to the kind of experiential material that is needed to focus on a genuine phenomenological question that should guide any specific research project. Heidegger, van den Berg, and Marion provide some poignant exemplars of the use of narrative “examples” in phenomenological explorations of the phenomena of “boredom,” “conversation,” and “the meaningful look in eye-contact.” Only what is given or what gives itself in lived experience (or conscious awareness) are proper phenomenological “data” or “givens,” but these givens are not to be confused with data material that can be coded, sorted, abstracted, and accordingly analyzed in some “systematic” manner. The latter approach to experiential research may be appropriate and worthwhile for various types of qualitative inquiry but not for phenomenology in its original sense. Finally, I use the mythical figure of Kairos to show that the famous phenomenological couplet of the epoché-reduction aims for phenomenological insights that require experiential analysis and attentive (but serendipitous) methodical inquiry practices.

Hermeneutic phenomenology, as a methodology, is not fixed. Inherent in its enactment are contested areas of practice such as how interview data are used and reported. Using philosophical notions drawn from hermeneutic phenomenological literature, we argue that working with crafted stories is congruent with the philosophical underpinnings of this methodology. We consider how the practical ontic undertaking of story crafting from verbatim transcripts is integral with the interpretive process. We show how verbatim transcripts can be crafted into stories through examples taken from interview data. Our aim is to open dialogue with other hermeneutic phenomenological researchers and offer alternate possibilities to conventional ways of work with qualitative data. We argue that crafted stories can provide glimpses of phenomena that other forms of data analysis and presentation may leave hidden. We contend that crafted stories are an acceptable and trustworthy methodological device.

Undertaking philosophically hermeneutic research requires embodying the fundamental hermeneutic notions espoused by Heidegger, Gadamer, and other related philosophers. For both supervisors and students, there is “a way” of working that infuses a hermeneutic project with a particular kind of contemplative openness. In this article, I will draw from my own experience of coming to appreciate the nature of this approach. Reading Gadamer challenged me to see that, before interpreting the meanings inherent in research data, I first needed to grapple with the fact that I brought ready-made prejudices to the interpretation. Further, and perhaps more importantly, was the recognition that while prejudices may have a negative influence, they could also bring a positive view. Just as I needed to understand key Gadamerian notions to shed light on the interpretive nature of philosophical hermeneutics, I will unpack these to underpin the ongoing discussion of hermeneutic research strategies. In articulating “how” to be hermeneutic, I explain how I guide students embarking on hermeneutic research. Discussion centres on surfacing and engaging with preunderstandings through ‘presuppositions interviewing‘, journalling and the careful selection of words that refine and crystallise meanings in ways that reflectively and reflexively engage and expand horizons of understanding. In this article, I use examples from my own experience as a doctoral student and supervisor of doctoral students to assist other supervisors and students understand both the importance of “being hermeneutic” and ways of achieving robust and philosophically congruent hermeneutic research.

We present the findings of our phenomenological interview study concerning the meaning of being an autonomous person while dependent on advanced medical technology at home. This was elucidated in the participants’ narratives as befriending everyday life when bringing technology into the private sphere. We discovered four constituents of the phenomenon: befriending the lived body, depending on good relationships, keeping the home as a private sphere, and managing time. The most important finding was the overall position of the lived body by means of the illness limiting the control over one’s life. We found that the participants wanted to be involved in and have influence over their care to be able to enjoy autonomy. We therefore stress the importance of bringing the patients into the care process as chronic illness will be a part of their everyday life for a long time to come, hence challenging patient autonomy.

This study explores social workers’ perceptions of inequalities in Israel’s national health care system. Unlike previous studies, which relied on patients’ and practitioners’ reports, it is based on interviews with 60 social workers in hospitals and ambulatory clinics. The findings show that although Israeli law provides for (almost) free, universal medical care, the treatment of persons lacking in money, education, and social affiliation may be compromised by difficulties in paying for medications, treatments, and travel to and from hospital; by difficulties in understanding doctors’ instructions; and by reluctance to ask questions. Most doctors tend to focus exclusively on patients’ medical needs, seem to lack sympathy with less educated patients, have little understanding of the life circumstances that impinge on their compliance, and make little effort to speak to them in the language they can understand. Practical suggestions are made with regard to the need to turn doctors’ attention to their patients’ non-medical needs.

According to the dual process model of reasoning, physicians make diagnostic decisions using two mental systems: System 1, which is rapid, unconscious, and intuitive, and System 2, which is slow, rational, and analytical. Currently, little is known about physicians’ use of System 1 or intuitive reasoning in practice. In a qualitative study of clinical reasoning, physicians were asked to tell stories about times when they used intuitive reasoning while working up an acutely unwell patient, and we combine socio-narratology and rhetorical theory to analyze physicians’ stories. Our analysis reveals that in describing their work, physicians draw on two competing narrative structures: one that is aligned with an evidence-based medicine approach valuing System 2 and one that is aligned with cooperative decision making involving others in the clinical environment valuing System 1. Our findings support an understanding of clinical reasoning as distributed, contextual, and influenced by professional culture.

Effectively addressing wicked health problems, that is, those arising from complex multifactorial biological and socio-economic causes, requires transdisciplinary action. However, a significant body of research points toward substantial difficulties in cultivating transdisciplinary collaboration. Accordingly, this article presents the results of a study that adapts Systems Ethnography and Qualitative Modeling (SEQM) in response to wicked health problems. SEQM protocols were designed to catalyze transdisciplinary responses to national defense concerns. We adapted these protocols to address cancer–obesity comorbidity and risk coincidence. In so doing, we conducted participant-observations and interviews with a diverse range of health care providers, community health educators, and health advocacy professionals who target either cancer or obesity. We then convened a transdisciplinary conference designed to catalyze a coordinated response. The findings offer productive insights into effective ways of catalyzing transdisciplinarity in addressing wicked health problems action and demonstrate the promise of SEQM for continued use in health care contexts.

While much has been said about the risks and safety issues experienced by female sex workers in India, there is a considerable dearth of information about the difficulties and problems that sex work researchers, especially female researchers, experience when navigating the highly political, ideological, and stigmatized environment of the Indian sex industry. As noted by scholars, there are several methodological and ethical issues involved with sex work research, such as privacy and confidentiality of the participants, representativeness of the sample, and informed consent. Yet, there has been reluctance among scholars to comment on their research process, especially with regard to how they deal with the protocols for research ethics when conducting social and behavioral epidemiological studies among female sex workers in India and elsewhere. Drawing on my 7 months of field-based ethnographic research with “flying” or non-brothel-based female sex workers in Kolkata, India, I provide in this article a reflexive account of the problems encountered in implementing the research process, particularly the ethical and safety issues involved in gaining access and acceptance into the sex industry and establishing contact and rapport with the participants. In doing so, it is my hope that future researchers can develop the knowledge necessary for the design of ethical and non-exploitative research projects with sex workers.

The patient-centered medical home (PCMH) is a model of care that emphasizes the coordination of patient treatment among health care providers. Practice transformation to this model, however, presents a number of challenges. One of these challenges is getting the buy-in of all personnel to commit to making organizational changes in the journey to becoming a nationally recognized medical home. This study investigated internal messages of buy-in as communicated by practices transitioning to this type of care. Grounding itself in stakeholder theory, this study analyzed interviews with staff, administration, and practitioners from 20 medical practices in a mid-Atlantic state. The analysis revealed three overarching themes: (a) communication among staff that is open, consistent; (b) implementation of reinforcement techniques; and (c) access to a change implementer who encourages successful evolution. Discussion of these themes provides recommendations for communication approaches to organizational buy-in for medical practices hoping to become a PCMH.

Photovoice and photo-elicitation are two common methods of participant photography used in health research. Although participatory photography has many benefits, this critical reflection provides fellow researchers with insights into the methodological and ethical challenges faced when using such methods. In this article, we critically reflect on two studies that used participatory photography in different cultural contexts. The first study used photo-elicitation to investigate mothers’ experiences of infant settling in central Vietnam. The second study used photovoice to explore pregnant embodiment in Australia. Following a discussion of the literature and a detailed overview of the two studies, we examine the methodological challenges in using participant photography before, during and after each study. This is followed by a discussion of ethical concerns that arose in relation to the burden of participation, confidentiality, consent, and the photographing of families and children. To conclude, we highlight implications for using participatory photography in other settings.

The young adult (YA) cancer community represents an understudied population in interpersonal and health communication scholarship. Through qualitative analysis, this study sought to advance a dark side perspective by exploring the content of messages shared in an online support forum for YAs with cancer. Our findings highlight a variety of complexities YAs face in an online cancer support community, including the light and dark of soliciting support, disclosing to a community, advocacy online, negative sentiment evaluating health care services, and asynchronous communication. Understanding the light and dark nuances involved with participating in an online YA support forum advances a dark side perspective on the scholarly research in health communication that can ultimately help care providers recommend resources and coach YAs to optimally and effectively use and navigate online support groups.