Qualitative Health Research

To be psychometrically valid, standard questions are meant to be delivered as they appear on the interview schedule—or by nonleading paraphrase—and the respondents’ answers exactly recorded. Yet, inspection of a set of transcripts of quality-of-life assessments of people with a learning disability (in North American terminology, mental retardation) shows massive deviation from this ideal. What is unsurprising is that interviewers frequently edit questions to address their interviewees’ limited cognitive competence. What is more pragmatically and interactionally interesting is that interviewers also redesign questions “sensitively” in ways that lower the social and personal criteria for a high score. Unofficially lowering the bar in this way might seem generous, but it constructs the respondent as impaired. It also means that respondents may end up getting high quality-of-life scores on unambitious questions one would not ask of people without a learning disability and that do not appear on the official questionnaire.

This article is a reflexive analysis of a grounded theory study, and it addresses certain dilemmas inherent in a research design in which the authors, being family physicians, interviewed their own women patients. Interview situations featuring tension and contradictions were identified. The interviewers’ reactions were scrutinized and related to the interaction of the research. It was detected that the interviewers reacted according to three different positions—as physicians, women, and researchers—and an awareness of this was crucial to the interpretations. Power asymmetry was found to be an aggravating circumstance in the interviews. However, it was possible to reduce it by discussing it with the participants. These findings contribute to the knowledge about interaction in research interviews and clinical consultations. The analysis also contributed to an understanding of the participants’ experiences.

The study described in this article examined the lived experience of mothers who provide care for their children with End Stage Renal Disease (ESRD). A total of 32 mothers participated in interviews, and 8 were observed in their natural setting for a prolonged period. Findings illuminated unique meanings about maternal caregiving that were individually constructed by each caregiving mother. These meanings appeared to be related to previous maternal life experiences and future expectations for mothers’ lives. Implications call for sufficiently flexible resources that allow mothers to renegotiate care in ways that are consistent with unique maternal meanings and needs.

The grounded theory study described in this article explored social support processes in low-income African American women during high-risk pregnancy and early parenthood. Participants included 10 pregnant African American women, 3 close support providers, and 11 health care providers. Investigators served as participant observers and conducted audiotaped interviews. The substantive theory of support that emerged from the data was labeled “mutual intentionality.” This term described the active role that both pregnant woman and support givers played in the helping process. The phrase “being there” summarized the women’s definition of support, implying that the support giver was available and willing to provide help when needed. Support was further described as “caring,”“respecting,”“sharing information” with, “knowing,”“believing in,” and “doing for” the other. For support to happen, mutuality must be established within the relationship, and both support giver and recipient intentionally aim to meet the recipient’s identified needs.

Preterm birth, preceded by preterm labor, is a significant perinatal problem. This article describes a qualitative, grounded theory study in which 25 women treated at home for preterm labor were interviewed. The purpose was to investigate how women managed this treatment, specifically bed rest, within the context of their day-to-day life. Three management phases were identified: Phase 1, the diagnostic phase, encompassed the circumstances around the diagnosis and subsequent realization that one was at risk to deliver preterm; in Phase 2, the negotiation phase, the women confronted their multisituated reality and negotiated their needs and wants that conflicted with it; and in Phase 3, the preparation phase, the women shift their focus from prevention of preterm delivery to preparation for parenthood. The proposed theory that women manage their activity restriction through negotiations in which they attempt to balance their perceived risk against a calculus of salient variables represents a new perspective in preterm birth prevention.

In this article, the social economic practices related to perinatal death, based on Rando’s model of complicated mourning and on an analysis of interactions with social institutions identified in the literature as relevant to perinatal death, are examined. Data are reported from semistructured interviews with 22 individuals who lost children to perinatal death. Parents’ stories indicate that they were not provided with material social supports that normally would be provided to individuals in the case of a “real” birth or death. Family and community gestures, workplace measures, and medical and legal supports were either discouraged or actively withheld. This lack of financial and material support creates an informal social economy of perinatal death that conveys clear messages to parents regarding their rights and claims to support. It is evident that these practices contribute to feelings of non-legitimacy and to complicated mourning.

The purpose of the ethnographic report described in this article is to discuss midlife women’s perceptions of their changing bodies within the Western cultural context and to provide a basis for health care with women. The narratives of 11 midlife women (ages 40-53) were obtained. Data were analyzed using Spradley’s (1979) Developmental Research Sequence Method. Results of the study indicate that women’s midlife experience of their changing bodies encompasses a broad spectrum, full of contradiction and change. Issues of loss, cultural influences that perpetuate ageism and sexism, lack of consistent information about menopause, questioning, redefining self, and self-care, all played a central role in the women’s lives during this time of transition.

This article argues that the concept of grounded theory, widely used in research in the human sciences, has not been adequately analyzed as to its structure as a theory. Analyzing grounded theory from predictionist and accommodationist views, as well as focusing on the issue of inference to the best explanation, it is concluded that this form of theorizing is basically accommodationist. Moreover, grounded theory, in terms of providing explanations, is simply a different version of a standard inductive argument. However, grounded theory’s strength lies in its potential to articulate a unique context and logic of discovery.

Although qualitative research has considerable strengths both in assessing the effectiveness of organizational models of health care provision and in contributing to their development, its impact on local and national decision making in the United Kingdom appears to be negligible. This article examines three obstacles to the acceptance of qualitative research, illustrating some ways around them drawn from recent research at the Centre for Mental Health Services Development. However, our illustrations throw into relief the potential for tensions between the pragmatic world of health care management and the quality and integrity of qualitative research. The authors, therefore, examine these tensions with reference to recent work on the development of quality criteria and discuss some of the solutions they have attempted.

A naturalistic field study was used to evaluate a fluid sample population in an addiction treatment program. This article presents the methodological and ethical issues in program evaluation confronted by the author and the approaches developed to address them. Methodological issues include credibility and fittingness of instruments, lack of standardization of histories, replication, trust issues of subjects, attrition, client follow-up, and rapidly changing subject population. Ethical issues include informed consent, interpretation of data from a cultural bias-free perspective, and client follow-up. A semistructured interview schedule allowed for standardization of the questioning format and replication of data gathering. Triangulation of data enhanced validity and internal stability. A fluid sample frame can optimally reflect the population in the program under study if available resources are used effectively while protecting patient rights to privacy, confidentiality, and freedom from manipulation.