Earlier Qualitative Study Research Articles

Guidelines; from foe to friend? Comparative interviews with GPs in Norway and Denmark

BackgroundGPs follow clinical guidelines to varying degrees across practices, regions and countries, but a review study of GPs' attitudes to guidelines found no systematic variation in attitudes between studies from different countries. However, earlier qualitative studies on this topic are not necessarily comparable. Hence, there is a lack of empirical comparative studies of GP's attitudes to following clinical guidelines. In this study we reproduce a Norwegian focus group study of GPs' general attitudes to national clinical guidelines in Denmark and conduct a comparative analysis of the findings.MethodsA strategic sample of GP's in Norway (27 GPs) and Denmark (18 GPs) was interviewed about their attitudes to guidelines, and the interviews coded and compared for common themes and differences.ResultsSimilarities dominated the comparative material, but the analysis also revealed notable differences in attitudes between Norwegian and the Danish GPs. The most important difference was related to GP's attitudes to clinical guidelines that incorporated economic evaluations. While the Norwegian GPs were sceptical to guidelines that incorporated economic evaluation, the Danish GPs regarded these guidelines as important and legitimate. We suggest that the differences could be explained by the history of guideline development in Norway and Denmark respectively. Whereas government guidelines for rationing services were only newly introduced in Norway, they have been used in Denmark for many years.ConclusionComparative qualitative studies of GPs attitudes to clinical guidelines may reveal cross-national differences relating to the varying histories of guideline development. Further studies are needed to explore this hypothesis.

Does change process healthiness reduce the negative effects of organizational change on the psychosocial work environment?

This study aimed to investigate whether the detrimental effects of organizational change on the psychosocial work environment are reduced by the “healthiness” of change processes. This includes the management's awareness that the change may be experienced differently by various individuals and groups (diversity); availability of the manager during the process; the degree to which conflicts are resolved constructively; and the degree to which the new roles to be taken on are clarified. Two studies are presented. Using a randomized sample of the Norwegian working population (N = 2389), the first study showed that there were both direct and indirect positive relationships between organizational change and stress, with job demands (but not control and support) as a mediator. In the second study a healthy change process index (HCPI) was developed from dimensions of healthy change that had emerged in an earlier qualitative study. Using data from seven Norwegian enterprises undergoing change (N = 561), this study showed that the healthiness of the change process was related negatively to stress and positively to Control and Support, but not to Demands. Overall, these findings support the idea that a healthy process may not reduce the additional demands produced by organizational change. However, a healthy process may still be able to reduce the experience of stress and facilitate coping with stress and associated increased demands through enhancing the psychosocial work environment.

Role Transition During RN-to-FNP Education

This study examines the role transition that occurs during RN-to-family nurse practitioner (FNP) education, described in an earlier qualitative study that identified a role transition framework of influential positive forces and obstacles. The purposes of the study were to validate the educational phase of the original framework and explore other role transition issues. The study used a descriptive correlational design by asking all FNPs in two rural western states to participate by answering a questionnaire. Findings evidenced a stronger level of agreement with the positive forces than with the obstacles. In addition, two significant relationships were found between the positive forces and obstacles and personal life circumstances. These included personal support systems, which were significant for those who had to travel to class, and personal sacrifices, which were significant for those who had children at home. Further research will focus on testing across nurse practitioner specialties nationally.

Two Dimensions of Participation in Very Old Age and Their Relations to Home and Neighborhood Environments

This study aimed to capture and operationalize the concept of participation among people who are very old (age > 80) and to investigate whether and how aspects of housing and neighborhood environments relate to participation in very old age. Two dimensions of participation--performance-oriented participation and togetherness-oriented participation---emerged from an earlier qualitative study and were operationalized and validated in this study with quantitative variables. Both objective and perceived housing and neighborhood aspects were significantly related to, in particular, performance-oriented participation and, to a lesser extent, to togetherness-oriented participation. Most interventions in occupational therapy are accomplished within the home for very old people, but our results imply that there are potential interventions to accomplish on a societal level as well. In this respect, our study contributes to the knowledge in the field and has the potential to support the development of novel occupational therapy interventions targeting society at large.

Return to R&D Investment and Spillovers in the Chinese Semiconductor Industry: A Tale of Two Segments

This study asks how a firm’s market orientation influences its returns to R&D investment and its capability to benefit from external technology opportunities brought about by the globalization of manufacturing and innovation activities. We use a panel of firm-level data on production and R&D activities to study China’s semiconductor industry. Building upon an earlier qualitative study, we find supporting evidence that this dynamic industry sector is characterized by two segments with very different market orientation: a domestically focused one with lagged technology, and a globally focused one employing advanced technology. While the former comprised the bulk of revenue and employment in the industry in 1998, the latter segment has grown substantially faster, and has now overtaken the former. We hypothesize that these two segments will differ in their R&D productivity, and ability to absorb external R&D. We test this hypothesis by examining the productivity consequence of in-house R&D investment and spillovers for each industry R&D investment. More specifically, we hypothesize that firms in the globally oriented sectors are more likely to receive higher returns to in-house R&D investment and positive spillovers from external R&D capital, especially from multinational firms, compared with domestically oriented firms. As a result, we expect that firms with higher in-house R&D capital will be more likely to receive positive spillovers from external knowledge. The empirical results support some but not all of our hypotheses. We find that firms in the global-oriented segment enjoy higher returns to R&D investment than those in the domestic- oriented segment and a larger positive spillover from external R&D capital. As the globally focused segment has grown to become the majority of firm activity in the industry, though, the competitive effects of more firms exporting appear to reduce the spillover benefits such firms enjoy from external R&D resources.

Cationic Nanoparticles Stabilize Zwitterionic Liposomes Better than Anionic Ones

Building upon the finding that zwitterionic liposomes can be stabilized against fusion up to very high surface coverage by the adsorption to submonolayer (≈25%) surface coverage of nanoparticles (Zhang, L.; Granick, S. Nano Lett. 2006, 6, 694), here we compare the efficacy of cationic and anionic nanoparticles for the stabilization of DLPC, 1,2-dilauroyl-sn-glycero-3-phosphocholine. This is rationalized by considering that because the phospholipid zwitterionic headgroup terminates with positive charge, lipids beneath an adsorbed nanoparticle bind more weakly when the nanoparticle charge is cationic. Going beyond the earlier qualitative study, here single-particle tracking using epi-fluorescence imaging is used to quantify the mobility of individual liposomes. The distribution of diffusion coefficients between different liposomes in the sample is quantified. In contrast to the colloid behavior of traditional monodisperse hard-sphere colloids, these soft, flexible, colloidal-sized objects remain fluid at 50...

Women, men and coronary heart disease: a review of the qualitative literature

This paper presents a review of the qualitative literature which examines the experiences of patients with coronary heart disease. The paper also assesses whether the experiences of both female and male patients are reflected in the literature and summarizes key themes. Understanding patients' experiences of their illness is important for coronary heart disease prevention and education. Qualitative methods are particularly suited to eliciting patients' detailed understandings and perceptions of illness. As much previous research has been 'gender neutral', this review pays particular attention to gender. Published papers from 60 qualitative studies were identified for the review through searches in MEDLINE, EMBASE, CINAHL, PREMEDLINE, PsychINFO, Social Sciences Citation Index and Web of Science using keywords related to coronary heart disease. Early qualitative studies of patients with coronary heart disease were conducted almost exclusively with men, and tended to generalize from 'male' experience to 'human' experience. By the late 1990s this pattern had changed, with the majority of studies including women and many being conducted with solely female samples. However, many studies that include both male and female coronary heart disease patients still do not have a specific gender focus. Key themes in the literature include interpreting symptoms and seeking help, belief about coronary 'candidates' and relationships with health professionals. The influence of social roles is important: many female patients have difficulties reconciling family responsibilities and medical advice, while male patients worry about being absent from work. There is a need for studies that compare the experiences of men and women. There is also an urgent need for work that takes masculinity and gender roles into account when exploring the experiences of men with coronary heart disease.

Adolescents' and Young Adults' Expectations of Parental Responsibilities in Stepfamilies

This current study investigates adolescents' and young adults' expectations of parenting by mothers following remarriage. Based on an earlier qualitative study of parent-child relationships, it was hypothesized that young people expect parents to maintain parenting responsibilities, including warmth/support and discipline behaviors, towards children following remarriage. It was also hypothesized that adolescents and young adults expect parents to give them priority relative to the stepparent. Sixty-five participants between the ages of 18 and 25 completed a questionnaire that included a stepfamily vignette and 4 questions designed to elicit expectations of how mothers behave following remarriage. The results partially support each of the hypotheses. The majority of participants saw the mother as having primary responsibility for disciplining children. Approximately half of the participants thought that the mother ought to give priority to children, while the other half thought that she ought to give priority to both the children and her partner. The participants also confirmed that warmth and support roles are important following remarriage, suggesting that children will want love, reassurance, support, time, and attention from the mother. The results suggest that young people may hold a conservative view of family relations following remarriage, expecting the biological parent to maintain primary responsibility for the children and the stepparent to play a more minor role.

Individual patient's preferences for hypertension management: A Q-methodological approach

Objective To systematically explore and elicit individual patient's preferences in the management of their hypertension using Q-methodology. Methods Using Q-methodology, 120 patients ranking 42 statements according to their agreement or disagreement when considering appropriate hypertension management. The statements were derived from an earlier qualitative study. Factor analysis of the data was undertaken using PQMethod software to determine if any patterns were discernible. Results Ninety-two patients clustered to five factors, which all varied in the degree of involvement patients had, or wished to have, in their hypertension management. The 42 patients who loaded to factor 1 considered that appropriate antihypertensive treatment involved leaving medical decisions to their GPs and trusting their judgement in such matters. The patients ( n = 31) who positively loaded to factor 2 suggested that an autonomous relationship with their healthcare professional(s) was an important issue when considering treatment. Conclusion It is concluded that this study has successfully used Q-methodology to systematically investigate people's subjectivity and developed a novel approach to elicit the views of individual patients, as well as explore and differentiate between groups of patients. Practice implications The formation of true partnerships between patients and healthcare professionals which will enhance individual patients’ ability to self-manage chronic disease.

Clinicians’ reported use of clinical priority assessment criteria and their attitudes to prioritization for elective surgery: a cross‐sectional survey

To explore the attitudes of clinicians working in New Zealand publicly funded hospitals towards prioritizing patients for elective surgery, and their reported use of clinical priority assessment criteria (CPAC). A cross-sectional study using a postal questionnaire. The questionnaire drew on themes identified from an earlier qualitative study. Questions were closed and information was sought about perceptions of the need to prioritize patients, effective ways of doing so and the use of CPAC. New Zealand. A national sample of cardiologists, cardiac, general and orthopaedic surgeons, and registrars. Three hundred and thirty-two clinicians responded to the survey (74.1%). Respondents generally agreed that a nationally consistent method of prioritizing patients for surgery was required but felt their clinical judgement was the most effective way of prioritizing patients. Current CPAC were considered to be administrative tools and there was marked variation in their reported use. Consistent use of CPAC using the constructs provided was more likely to be reported by cardiac specialists than general or orthopaedic surgeons. Other features of the hospital system in which surgeons worked also had a major impact on access to elective surgery. Clinicians recognized the need for a nationally consistent method of prioritizing patients. Although most did not consider current CPAC were effective in achieving this, many felt there was some potential in further development of tools. However, further development is problematic in the absence of objective measures of need and ability to benefit.

Hepatitis B testing among Vietnamese American men

Vietnamese American men are over 10 times more likely to be diagnosed with liver cancer than their white counterparts. This health disparity is attributable to high rates of hepatitis B virus (HBV) infection. Our study objective was to examine factors associated with HBV testing among Vietnamese men. A population-based survey was conducted in Seattle. The questionnaire content was guided by an earlier qualitative study and the Health Behavior Framework. The survey was completed by 345 men (response rate: 80%). About one-third (34%) of the respondents reported they had not been tested for HBV. The following factors were associated ( P<0.01) with previous testing in bivariate comparisons: having a regular source of care and regular provider; knowing that HBV can be spread during childbirth; believing HBV can cause liver cancer; and doctor(s) had recommended testing as well as had asked doctor(s) for testing. Three variables were independently associated with HBV testing in a logistic regression model: regular source of care (OR=4.5; 95% CI=2.6–7.9), physician recommendation (OR=2.3, 95% CI=1.3–4.0), and knowing HBV can be spread during childbirth (OR=2.1; 95% CI=1.2–3.9). Low levels of HBV testing remain a public health problem in some Vietnamese American sub-groups. Health education about HBV transmission may stimulate patients to seek testing. Intervention programs should specifically target Vietnamese men without a regular source of health care and physicians who serve Vietnamese communities.

Rheumatology: a study of patient satisfaction with follow-up monitoring care.

This paper reports the findings of a quantitative study to determine the satisfaction of rheumatology patients receiving follow-up monitoring care within primary and secondary locations. The aim of the study was to compare and contrast the satisfaction of patients with rheumatoid arthritis following two different routes of care. The objective was to explore the dimensions of care identified in an earlier qualitative study. A convenience sample of 80 participants was used; 40 from each care location. Data were collected using the Leeds Satisfaction Questionnaire, which explores the dimensions of satisfaction previously identified as being important to this group of patients. The secondary care group showed significantly higher levels of satisfaction in respect of general satisfaction, provision of information and continuity of care and a significant difference in relation to empathy, technical ability and attitude to the patient. While patients from both locations were satisfied with the care they received, those receiving specialist nursing care in the secondary location were more satisfied. Increased emphasis on care in the community and the evolution of nurse specialist roles indicate the need for further qualitative work to inform the future planning of care provision for rheumatology patients in this area.

Developing a factor model of coal miners’ attributions on risk-taking at work

This paper details a survey of coal miners’ views on the bases for risk-taking. While literature exists on the subject of risk-taking in mines, comparatively few studies have sought to elicit the views of mine personnel themselves. An 83-item questionnaire, grounded upon insights from an earlier qualitative study, was developed and distributed to a sample of mine personnel (N=932). Results were analysed by means of principal components, factor analysis, an iterative refinement of the data set resulting in the development of a three-factor model that was considered to reflect potentially important dispositional influences on risk-taking amongst operational staff in mines. Derived constructs, identified as time pressure, management commitment and confidence in ability to control risk, were found to possess moderate to high levels of internal consistency (α statistic) and high face validity. Findings are discussed with reference to insights from both cognitive risk research and more recent work within the safety culture/climate framework.

Wood anatomy of West European Betula: Quantitative descriptions and applications for routine identification in paleoecological studies

In paleoecological and archaeological studies the species present in wood and charcoal samples are often identified to obtain information about past climatic conditions and vegetation. The main references for identification of Betula at the species level are qualitative descriptions of wood anatomy. The aim of the study presented here was to characterize the wood anatomy of West European Betula species more fully, and quantitatively. For this, the size, abundance, and organization of vessels and rays were quantitatively estimated in carbonized wood samples of four Betula taxa: B. pendula, B. pubescens, B. pubescens ssp. tortuosa, and B. nana. Principal components analyses were used to detect statistical differences among species and to identify characters useful for distinguishing species. An anatomical gradient between B. pendula and B. nana was found, in which B. nana was clearly distinct from the three tree species of Betula. Differences were also observed between the tree species, but with less statistical significance. Our quantitative results support earlier, qualitative descriptions in some respects and conflict with them in others. We highlight the occurrence of narrow vessels in the wood that have not been described previously. This feature accounts for both a major portion of the variance in the data and the discrepancies with earlier qualitative studies. We suggest that B. nana and B. pubescens ssp. tortuosa can be distinguished from one another and from B. pendula and B. pubescens. Based on our results, it is not possible to distinguish between B. pendula and B. pubescens, at least in the routine identification of wood charcoal.

The role of positive experiences in living with acquired hearing loss

This paper presents findings from our most recent research investigating positive experiences associated with acquired hearing loss. This work builds upon our earlier qualitative studies but now takes a more quantitative approach. The findings of two separate quantitative questionnaire studies are reported. The aim of the first study was to incorporate and build upon the qualitative work to design a quantitative questionnaire tool. This work produced a 48-item questionnaire measuring the frequency with which people recognized specific positive experiences. The questionnaire was distributed to 174 consecutive patients. The results of principal component analysis identified eight factors comprising 57% of the total variance. The primary factors were labelled ‘Cognitive changes to self-perception’, ‘Successful communication behaviours’, ‘Using hearing aids to self-advantage’, ‘Effort in communication’. ‘Social support’, ‘Social contact’, and ‘Resignation’. The aim of the second study was to reduce and refine the quantitative tool to 20 items. This second tool was distributed to a second sample of 173 consecutive patients. The questionnaires distributed included the revised 20-item positive questionnaire in addition to tour additional outcome measures. A principal component analysis was performed, and six factors emerged, accounting for 60.5% of the total variance. These factors broadly reflect those previously identified, and were labelled (1) ‘Cognitive changes to self-perception’, (2) ‘Using hearing impairment to self-advantage’, (3) ‘Successful communication behaviour’, (4) ‘Resignation’, (5) ‘Effort in communication’, and (6) ‘Technical facilitators’. The first second, second and fourth of these may be regarded as non-auditory factors, and the others as auditory factors. There was little relationship between the two types of factors, and a complex set of relationships with the other outcome measures.

Developing and testing methods for improving patient-oriented mental health care.

There is a trend in nursing policy and practice towards allowing patients to participate actively in their treatment and the services they use. The author concludes, based on an earlier qualitative study, that psychiatric patients in a hospital environment want a more active role in their treatment and that psychiatric nurses also aim at more active patient participation. In mental health care, professionals often define the needs of patients in terms of their own expertise and tend to overlook the variety of the service users' needs. The need to improve and empower psychiatric patients is a considerable challenge to present-day nursing. The purpose of this paper is to describe the theoretical background of tools used to assess patients' involvement in mental health care and the process by which credibility can be determined in rating the panel phase of instrument construction. The instruments, based on a qualitative study using grounded theory, produced a model of patient initiatives in psychiatric nursing. Content validity refers to the determination of the substantive representativeness or relevance of the items of an instrument. Face validity has been defined as validity conferred by a lay persons' acceptance that a procedure, statement or instrument appears to be sound or relevant. In the panel rating, the raters were experts. They evaluated the readability, consistency and content validity of the instruments' items. In the instrument for nurses, the content validity was 0.84 and consistency 0.91; this corresponds to 0.91 and 0.95, respectively, in the instrument for patients.

Factors associated with breast and cervical cancer screening behaviours

To investigate the factors associated with the use of screening mammography for breast cancer and cervical smear tests for cervical cancer, a theoretical framework was used comprising elements from the Health Belief Model, the Theory of Reasoned Action, and illness representations from the self‐regulatory model. Items reflecting older women’s illness representations about cancer and cancer screening were derived from an earlier qualitative study. Using a highly structured interview schedule, telephone interviews were conducted with 1,200 women aged 50‐70 years. There were considerable similarities between the factors associated with both mammography and cervical smear test behaviours. The factors associated with screening mammography behaviour were: perceived barriers, perceived benefits, social influence, the illness representations, and marital status. The factors associated with cervical smear test behaviour were: perceived barriers, perceived benefits, emotions as a cause of cancer, feeling frightened of cancer, the illness representations, having a usual general practitioner, and being younger.

Binding of an RNA Trafficking Response Element to Heterogeneous Nuclear Ribonucleoproteins A1 and A2

Heterogeneous nuclear ribonucleoprotein (hnRNP) A2 binds a 21-nucleotide myelin basic protein mRNA response element, the A2RE, and A2RE-like sequences in other localized mRNAs, and is a trans-acting factor in oligodendrocyte cytoplasmic RNA trafficking. Recombinant human hnRNPs A1 and A2 were used in a biosensor to explore interactions with A2RE and the cognate oligodeoxyribonucleotide. Both proteins have a single site that bound oligonucleotides with markedly different sequences but did not bind in the presence of heparin. Both also possess a second, specific site that bound only A2RE and was unaffected by heparin. hnRNP A2 bound A2RE in the latter site with a K(d) near 50 nm, whereas the K(d) for hnRNP A1 was above 10 microm. UV cross-linking assays led to a similar conclusion. Mutant A2RE sequences, that in earlier qualitative studies appeared not to bind hnRNP A2 or support RNA trafficking in oligodendrocytes, had dissociation constants above 5 microm for this protein. The two concatenated RNA recognition motifs (RRMs), but not the individual RRMs, mimicked the binding behavior of hnRNP A2. These data highlight the specificity of the interaction of A2RE with these hnRNPs and suggest that the sequence-specific A2RE-binding site on hnRNP A2 is formed by both RRMs acting in cis.

Assessing topographic exposure

AbstractTopographic exposure is a variable which represents the degree of shelter afforded to a location. A detailed knowledge of exposure is useful for a wide variety of applications, ranging from the dynamics of drifting snow to the optimal location of wind‐farms. The degree of exposure can be calculated by considering the relative heights and distances of the horizon surrounding the point of study. Numerous approaches have been developed to measure this useful variable, from the early qualitative studies of wind‐shaped trees to Pyatts's quantitative TOPEX assessment. However, these studies have been superseded by the use of computers and in particular the application of digital terrain models. These provide a fast office‐based solution, virtually eliminating the need for fieldwork. Copyright © 2000 Royal Meteorological Society

The perception of aggression.

Several academic and clinical disciplines are involved in clarifying the concept of aggression by formulating operational and descriptive definitions. In the present paper the validity of the definitions of aggression, reported by nurses in an earlier qualitative study, is examined, using a survey approach among nurses of five general psychiatric hospitals in the Netherlands. Three dimensions of aggression were found; aggression as a normal, adaptive reaction, aggression as a violent reaction and aggression as a functional reaction. These findings match the results of the qualitative study. It was investigated whether there was a relation between personal and environmental characteristics of the nurses and the way they perceive aggression. The gender of the respondents, the setting in which they were working, the degree to which they used constraint measures and whether patients were voluntarily admitted or not, were related to the perception of aggression. The study points out that different instruments are needed to measure the prevalence or incidence of aggression and to diagnose or to intervene on aggression in clinical practice.