Varal da Saúde Mental e Rodas de Diálogo: técnicas e métodos ativos na investigação qualitativa em saúde e educação

This article aims to present and describe the techniques of the mental health clothesline and the dialogue circle, as participatory, dialogical and meaningful strategies of qualitative research in health and education. Considering the importance of allowing the inclusion of diversity and plurality of voices and experiences, active methods represent a broad and contextualized approach for this purpose. This is a qualitative study, using two active and participatory research techniques on the mental health of educators in a school community. The "Mental Health Clothesline" aims to understand negative and positive experiences related to people's mental health. The "Dialogue Circles" are used as formative techniques, promoting the expression of feelings, thoughts and behaviors related to health and education. The main cores of meaning related to the negative experiences of educators were the experiences of illness and conflicts at work and personal life. The positive ones were personal and professional relationships and hope. The dialogic experience led participants to work on meanings from a deeper focus on mental health, producing sensitive knowledge with acceptance.

The authors report the latest findings from a 32-year longitudinal study of 269 back-ward patients from Vermont State Hospital. This intact cohort participated in a comprehensive rehabilitation program and was released to the community in a planned deinstitutionalization effort during the mid-1950s. At their 10-year follow-up mark, 70% of these patients remained out of the hospital but many were socially isolated and many were recidivists. Twenty to 25 years after their index release, 262 of these subjects were blindly assessed with structured and reliable protocols. One-half to two-thirds of them had achieved considerable improvement or recovery, which corroborates recent findings from Europe and elsewhere.

In a controlled study of Recovery, Inc., a self-help program for people with psychiatric problems, the author found a decline in both symptoms and concomitant psychiatric treatment after subjects had joined the group. Scores for neurotic distress reported after joining were considerably lower than those reported for the period before joining. Scores for psychological well-being of longstanding Recovery members were no different from those of community control subjects, and fewer long-term members than recent members were being treated with psychotropic medication and psychotherapy. The author concludes that peer-led self-help groups have value as an adjunct to psychiatric treatment.

Plain English summaryPatient engagement (or patient and public involvement) in health research is becoming a requirement for many health research funders, yet many researchers have little or no experience in engaging patients as partners as opposed to research subjects. Additionally, many patients have no experience providing input on the research design or acting as a decision-making partner on a research team. Several potential risks exist when patient engagement is done poorly, despite best intentions. Some of these risks are that: (1) patients’ involvement is merely tokenism (patients are involved but their suggestions have little influence on how research is conducted); (2) engaged patients do not represent the diversity of people affected by the research; and, (3) research outcomes lack relevance to patients’ lives and experiences.Qualitative health research (the collection and systematic analysis of non-quantitative data about peoples’ experiences of health or illness and the healthcare system) offers several approaches that can help to mitigate these risks. Several qualitative health research methods, when done well, can help research teams to: (1) accurately incorporate patients’ perspectives and experiences into the design and conduct of research; (2) engage diverse patient perspectives; and, (3) treat patients as equal and ongoing partners on the research team.This commentary presents several established qualitative health research methods that are relevant to patient engagement in research. The hope is that this paper will inspire readers to seek more information about qualitative health research, and consider how its established methods may help improve the quality and ethical conduct of patient engagement for health research.BackgroundResearch funders in several countries have posited a new vision for research that involves patients and the public as co-applicants for the funding, and as collaborative partners in decision-making at various stages and/or throughout the research process. Patient engagement (or patient and public involvement) in health research is presented as a more democratic approach that leads to research that is relevant to the lives of the people affected by its outcomes. What is missing from the recent proliferation of resources and publications detailing the practical aspects of patient engagement is a recognition of how existing research methods can inform patient engagement initiatives. Qualitative health research, for example, has established methods of collecting and analyzing non-quantitative data about individuals’ and communities’ lived experiences with health, illness and/or the healthcare system. Included in the paradigm of qualitative health research is participatory health research, which offers approaches to partnering with individuals and communities to design and conduct research that addresses their needs and priorities.DiscussionThe purpose of this commentary is to explore how qualitative health research methods can inform and support meaningful engagement with patients as partners. Specifically, this paper addresses issues of: rigour (how can patient engagement in research be done well?); representation (are the right patients being engaged?); and, reflexivity (is engagement being done in ways that are meaningful, ethical and equitable?). Various qualitative research methods are presented to increase the rigour found within patient engagement. Approaches to engage more diverse patient perspectives are presented to improve representation beyond the common practice of engaging only one or two patients. Reflexivity, or the practice of identifying and articulating how research processes and outcomes are constructed by the respective personal and professional experiences of researchers and patients, is presented to support the development of authentic, sustainable, equitable and meaningful engagement of patients as partners in health research.ConclusionsResearchers will need to engage patients as stakeholders in order to satisfy the overlapping mandate in health policy, care and research for engaging patients as partners in decision-making. This paper presents several suggestions to ground patient engagement approaches in established research designs and methods.

Public attitudes toward persons with mental illness.

A total of 143 clients and their case managers in a Veterans Affairs (VA) intensive case management program modeled on the Program for Assertive Community Treatment rated their therapeutic alliance after two years in the program. Strong case-manager-rated alliance was associated with reduced symptom severity and improved global functioning as rated by independent assessors; it was also associated with higher client ratings of community living skills and more positive outcome as perceived by both clients and case managers. Strong client-rated alliance was associated only with more positive client-perceived outcome. Alliance ratings were not associated with use of inpatient psychiatric hospitalization. The case manager-client alliance appears to be a significant component of therapeutic effectiveness.

Little attention outside the therapeutic setting has been given to specifying the aspects of social relationships that might be helpful for patients recovering from psychotic episodes. The authors studied 20 patients who had been hospitalized for a psychotic episode for 1 year following discharge to examine the role their social relationships played during this period. The data show that 12 functions of social relationships were important and that there were two phases of social needs--convalescence and rebuilding--over the recovery period. The authors discuss the theoretical and clinical implications of these findings.

Experiences of and Attitudes Toward Mental Health Services Among Older Youths in Foster Care

The aim of this study was to confirm and extend the authors' previous work indicating that symptoms of traumatic grief are predictors of future physical and mental health outcomes. The study group consisted of 150 future widows and widowers interviewed at the time of their spouse's hospital admission and at 6-week and 6-, 13-, and 25- month follow-ups. Traumatic grief was measured with a modified version of the Grief Measurement Scale. Mental and physical health outcomes were assessed by self-report and interviewer evaluation. Survival analysis and linear and logistic regressions were used to determine the risk for adverse mental and physical health outcomes posed by traumatic grief. Survival and regression analyses indicated that the presence of traumatic grief symptoms approximately 6 months after the death of the spouse predicted such negative health outcomes as cancer, heart trouble, high blood pressure, suicidal ideation, and changes in eating habits at 13- or 25-month follow-up. The results suggest that it may not be the stress of bereavement, per se, that puts individuals at risk for long-term mental and physical health impairments and adverse health behaviors. Rather, it appears that psychiatric sequelae such as traumatic grief are of critical importance in determining which bereaved individuals will be at risk for long-term dysfunction.

Introduction PART ONE: CONTRIBUTIONS OF QUALITATIVE RESEARCH There's More to Dying Than Death: Qualitative Research on the End-of-Life - Stefan Timmermans Healer-Patient Interaction: New Mediations in Clinical Relationships - Arthur W. Frank, Michael K. Corman, Jessica A. Gish and Paul Lawton Qualitative Contributions to the Study of Health Professions and Their Work - Johanne Collin Why Use Qualitative Methods to Study Health-Care Organizations? Insights from Multilevel Case Studies - Carol A. Caronna How Country Matters: Studying Health Policy in a Comparative Perspective - Sirpa Wrede Exploring Social Inequalities in Health: The Importance of Thinking Qualitatively - Gareth Williams and Eva Elliott PART TWO: THEORY Theory Matters in Qualitative Health Research - Mita Giacomini Ethnographic Approaches to Health and Development Research: The Contributions of Anthropology - Rebecca Prentice What Is Grounded Theory and Where Does It Come from? - Dorothy Pawluch and Elena Neiterman Qualitative Methods from Psychology - Helen Malson Conversation Analysis and Ethnomethodology: The Centrality of Interaction - Timothy Halkowski and Virginia Teas Gill Phenomenology - Carol L. McWilliam Studying Organizations: The Revival of Institutionalism - Karen Staniland History and Social Change in Health and Medicine - Claire Hooker PART THREE: COLLECTING AND ANALYZING DATA Qualitative Research Review and Synthesis - Jennie Popay and Sara Mallinson Qualitative Interviewing Techniques and Styles - Susan E. Kelly Focus Groups - Rosaline S. Barbour Fieldwork and Participant Observation - Davina Allen Video-Based Conversation Analysis - Ruth Parry Practising Discourse Analysis in Healthcare Settings - Srikant Sarangi Documents in Health Research - Lindsay Prior Participatory Action Research: Theoretical Perspectives on the Challenges of Researching Action - Louise Potvin, Sherri L. Bisset and Leah Walz Qualitative Research in Programme Evaluation - Isobel MacPherson and Linda McKie Auto-Ethnography: Making Sense of Personal Illness Journeys - Elizabeth Ettore Institutional Ethnography - Marie L. Campbell Visual Methods for Collecting and Analysing Data - Susan E. Bell Keyword Analysis: A New Tool for Qualitative Research - Clive Seale and Jonathan Charteris-Black PART FOUR: ISSUES IN QUALITATIVE HEALTH RESEARCH Recognizing Quality in Qualitative Research - Kath M. Melia Mixed Methods Involving Qualitative Research - Alicia O'Cathain A Practical Guide to Research Ethics - Laura Stark and Adam Hedgecoe Using Qualitative Research Methods to Inform Health Policy: The Case of Public Deliberation - Julia Abelson Cross National Qualitative Health Research - Carine Vassy and Richard Keller PART FIVE: APPLYING QUALITATIVE METHODS Researching Reproduction Qualitatively: Intersections of Personal and Political - Kereen Reiger and Pranee Liamputtong Understanding the Shaping, Incorporation and Co-Ordination of Health Technologies through Qualitative Research - Tiago Moreira and Tim Rapley Transgressive Pleasures: Undertaking Qualitative Research in the Radsex Domain - Dave Holmes, Patrick O'Byrne and Denise Gastaldo The Challenges and Opportunities of Qualitative Health Research with Children - Ilina Singh and Sinead Keenan The Dilemmas of Advocacy: The Paradox of Giving in Disability Research - Ruth Pinder Qualitative Approaches for Studying Environmental Health - Phil Brown

Health Research, Qualitative

754 Many thanks to Dipesh Chakrabarty, Geoff Eley, Dana Luciano, Nasser Hussain, Roger Rouse, Adam Thurschwell, and Martha Umphrey for their meticulous engagements, as well as to audiences at Amherst, Johns Hopkins, the University of Wisconsin, the University of Chicago, American Political Science Association, American Studies Association, and Cleveland State. Special nostalgic thanks to Virginia Chang, my original collaborator in the Obesity and Poverty conference (2002). 1. See David Harvey, “The Body as Accumulation Strategy,” Spaces of Hope (Berkeley, 2000), pp. 97–116. To call Harvey polemical is not to devalue his profound contributions to understanding the productive destructiveness of capital; in his work, a polemic is a call for precision, not a way of drowning it out. Slow Death (Sovereignty, Obesity, Lateral Agency)

Multidisciplinary research priorities for the COVID-19 pandemic

Nurses suffering in silence: Addressing the stigma of mental health in nursing and healthcare.

Applied health research methods are evolving to meet the demands of increasingly complex health research needs. Qualitative health research, focused on individual perspectives of health, wellness, illness and recovery, has emerged as a unique discipline of this field. With distinct foci, methods and rules, qualitative health research has the potential to answer applied health research questions to inform practice, education and policy. Despite this potential, there are challenges to the application of qualitative health research methods in nutrition and dietetics research. These include limited training and mentorship availability for the rigorous application of these methods, as well as misaligned goals between the traditional social science-based qualitative approaches and emerging applied nutrition science needs. Recognising these limitations, this review aims to provide guidance to the nutrition scientist conducting applied qualitative health research. Using nutrition and dietetic examples from the literature, this review defines qualitative health research and advances the Emphasis-Purposeful sample-Phenomenon of interest-Context (EPPiC) framework as a tool for constructing structured overarching research questions and introduces four qualitative health research designs (qualitative description, interpretive description, case study and focused ethnography) relevant to applied nutrition science. This includes guidance on defining the sample, identifying strategies for data collection, analytic techniques and data reporting.