Qualitative Health Research

Experience-based co-design (EBCD) is a qualitative form of participatory action research supported by a toolkit providing guidance and recommendations. The toolkit is intentionally non-prescriptive, allowing EBCD practitioners the freedom to flex the approach to cater to the needs of their specific populations and contexts. For less experienced researchers, the lack of specificity can be a challenge when navigating activities such as data analysis, particularly as wider literature provides limited insights to methods, processes, methodological critique, and lessons learned. Despite increasing use of EBCD, few practitioners publish details of their methods, processes, or decision-making for how they adapt EBCD for their studies, focusing more often on findings and outcomes. This can impact understanding and development of rigor in EBCD literature. In this methodology paper, we respond to this gap by providing a case example and step-by-step guide for application of reflexive thematic analysis to EBCD, with consideration of reflexivity, a conceptual framing for interpreting experiences, opportunities for greater participant involvement, and strengths and challenges of using reflexive thematic analysis within EBCD.

Interprofessional collaborative practice (IPC) occurs when health professions work collaboratively to improve quality of care and enhance patient outcomes. Yet myriad challenges to enacting collaborative practice exist. Interprofessional education for collaborative practice (IPECP) is foundational for promoting collaboration among health professions, yet there is a gap in understanding how students perceive their readiness for IPC and how early socialization experiences may contribute to developing a dual—uni-professional and interprofessional—identity. This study seeks to understand how new practitioners perceive and experience IPC upon entry to practice, and identify individual and systemic factors that facilitate and impede dual identity development. An interpretive, narrative methodology was used to understand the IPC and early professional practice experiences of 24 individuals from a longitudinal study of five health professions. Facilitators to interprofessional identity development included exposure to/working with interprofessional teams, settings, role models, and directly experiencing benefits of collaborative practice during patient care. Impediments include settings and situations where professional stereotyping and hierarchies were reinforced by the dominant uni-professional culture of work environments. Interprofessional socialization and identity development are contingent on exposure to interprofessional role models and settings. Healthcare professionals’ dual identity development begins in pre-licensure IPECP but is shaped by socialization experiences within practice. Healthcare institutions need to provide nourishing collaborative environments (time, settings, and contexts) that foster interprofessional collaboration and behaviors and empower dual identity formation. Post-licensure IPECP for healthcare professionals to continue to learn with, from, and about one another in practice is essential for collaborative interprofessional healthcare teams/systems.

Younger children’s voices are often overlooked in research and policy, yet their perceptions and experiences are crucial in understanding their needs in planning responses to crisis, such as the COVID-19 pandemic. Existing studies on children’s experiences of crises often rely on adult perspectives or are adult-led; a more child-centric approach could be to analyze children’s drawings. The aim of this study was to explore Swedish 7- to 11-year-old children’s experiences and knowledge of the COVID-19 pandemic, as expressed in their drawings. Drawings from N = 454 children with accompanying texts, from various Swedish municipalities with different socio-economic profiles, were analyzed using a combination of semiotic visual analysis and content analysis. Three main themes emerged: (a) Fun, friends, and freedom are cancelled which pointed to societal changes as a result of the pandemic that impacted the children’s own lives, causing high levels of frustration; children saw contrasts between what had been, what is, and what is to come; (b) The world is all upside down, in which the children highlighted their understanding of the virus, how it has changed and impacted the world, as well as existential reflections of their lives and surrounding environment; and (c) The Virus: evil, scary, and dangerous, but masks and sanitizer can help showed the children’s understanding of the pandemic as a global event and showed high level of health literacy related to COVID-19. Children were very perceptive and astute to the societal issue at hand. Despite Sweden’s relatively lenient measures, the pandemic significantly affected their lives and autonomy.

There is a growing body of literature around ageing well for Indigenous Peoples internationally. However, the perspectives of Torres Strait Islander Peoples, one of two First Nations groups in Australia, have not been documented. This qualitative study aims to explore what ageing well means to people living in the Torres Strait and Northern Peninsula Area (NPA) of Australia. Ten yarning circles were conducted with 45 participants from four island and five NPA communities across the region. Reflexive thematic analysis was used to identify seven themes of ageing well. A metaphor of a wongai tree—an endemic Torres Strait region tree—was used to describe those findings. The roots were used to represent the Torres Strait Islander way of life. The trunk represented practicing Torres Strait Islander identity. The branches represented a holistic approach to living a healthy lifestyle. The leaves represented strong leadership and role models. The fruit depicted passing on knowledge, tradition, and cultural practices. A cyclone, an adverse event, represented the challenges to ageing well, with the regrowth representing strong sustained life. Findings highlighted the importance of the cultural determinants of health, which significantly contribute to ageing well. These cultural determinants must be considered when addressing the health of First Nations Peoples, and as such, First Nations voices must be central in the design and implementation of practices and policies that affect them.

This study aimed to co-design a “Deadly Dental Home” for Australian Aboriginal and Torres Strait Islander people (herein referred to as First Nations). Participatory Action Research-Dadirri-Ganma methods utilized respectful listening (Dadirri), self-reflective knowledge sharing (Ganma), and Yarning to design a model of care for the community. Consumers of dental services, community leaders, healthcare providers, and dental service leaders designed a culturally safe and holistic approach to dental care, bringing together First Nations and Western perspectives. A “Deadly Dental Home” is a dental service that arranges continuously available, comprehensive, coordinated, and culturally appropriate dental care. The expression “deadly” carries a sense of empowerment and positivity within First Nations cultures, representing strength, praise, resilience, and excellence. The research emphasized the integration of cultural needs into dental services. Key themes included Reaching Mob, Dental Care Delivery, and Care Across the Life Journey. Continuous and culturally responsive dental care tailored to different life stages from infancy through elderhood included hands-on education and prevention strategies. The need for a culturally competent workforce, a welcoming dental environment, and flexible appointment scheduling was necessary to foster trust and accessibility. The Deadly Dental Home model promotes a comprehensive approach to care extending beyond traditional dental treatment to address broader health determinants. Continued community engagement, partnership with dental services, and research are essential to refining and implementing this model, ensuring it effectively addresses the unique needs of First Nations people.

As the prices of cancer treatments are constantly rising, reaching tens and hundreds of thousands of euros per patient, this article examines the existence and impact of these prices in everyday hospital practice and in relation to medical autonomy. Our study takes place in the French health care system, which is characterized by the coverage of health care costs by the health insurance system. Through ethnographic observations carried out in hematology and thoracic oncology departments, the study explores how prices, although invisible and excluded from medical practice, can come into play in situations of tension at the boundaries of medical, administrative and financial prescriptive frameworks. However, this paper shows how the innovative and complex nature of these costly treatments can be reinterpreted in terms of value and even become a source of credit.

A new form of social media influencer is the patient influencer, or patients who share “lived experiences” of chronic disease online and who build communities of patients. Trust in the healthcare system is a challenge for people of color due to the systemic racism and other barriers encountered. This article explores the intersection of health communication, patient influencers, and cultural inclusivity. Using the Theory of Planned Behavior’s theoretical constructs (subjective norms, personal attitudes, and perceived behavioral control), thematic analysis was used to understand culturally inclusive health communication strategies used by patient influencers of color. In-depth interviews (N = 18) were conducted. Findings suggest that patient influencers of color have the capacity to promote inclusivity and trust within their social networking communities. Patient influencers want to empower others through their authentic content about living with and managing chronic disease. Theoretical and practical applications are addressed.

Black same gender loving (SGL) men in the United States continue to experience mental, physical, relational, and financial health inequities due to the impact of various systems of oppression. Despite this fact, there are few health interventions developed specifically for Black SGL men that address health outcomes beyond sexual health. Despite strong evidence that spirituality is a cultural strength associated with positive health outcomes for Black SGL men, it has seldom been incorporated into health interventions as a central mechanism for facilitating this group’s well-being. The present qualitative study utilized a hybrid (i.e., codebook and reflexive) approach of thematic analysis to analyze data from individual semi-structured interviews with 29 Black SGL men across the United States. Three themes were generated: (1) Harmful and Nonresponsive Institutions; (2) Diversity, Detail, and Black SGL Men’s Preferences in Intervention Design; and (3) Multilevel Positive Holistic Impact. Findings from this study may be used to develop spirituality-based holistic health interventions for Black SGL men in the United States. Such interventions have the potential to effectively reduce health inequities among this population.

Discriminatory practices within mental healthcare are a major barrier to the equitable provision of care to all mental healthcare service users. Understanding mechanisms of discrimination is a prerequisite for developing suitable measures to address them. Intersectionality, a framework rooted in Black feminism, has proven to be a powerful tool for understanding the specific forms and experiences of discrimination within interconnected systems of oppression. This study is the first to use an intersectional lens to examine discriminatory practices within the German mental healthcare system from the perspectives of service users, providers, and psychosocial counselors. In collaboration with local organizations in Bochum, Germany, we conducted 17 semi-structured interviews. The data were analyzed according to constructed grounded theory methodology. Our results indicate that discriminatory practices undermine access to and quality of healthcare delivery for marginalized mental healthcare service users. On an interpersonal level, these practices included stereotyping, devaluation, Othering, invalidation, silencing, withholding information, and treatment refusals. On an organizational level, care was undermined by a lack of interpretation services, discriminatory admission practices and documentation procedures, a lack of competencies among mental healthcare providers, as well as suitable treatment options and environments for marginalized service users. Service users described various strategies to navigate mental healthcare, including confrontation and selective narration. Mental healthcare providers showed various reactions toward discriminatory practices, ranging from defensiveness to acknowledgment. We discuss the results in their interrelationship with institutional Whiteness, cis-heteronormativity, and mental illness.