Qualitative Health Research Articles

Diverse and inclusive patient recruitment in health research is essential for addressing health disparities and ensuring generalizability of findings. However, recruiting underrepresented populations remains a persistent challenge due to barriers such as language, cultural differences, sociohistorical factors, and technological limitations. Utilizing an intersectional lens, this paper presents recruitment strategies and lessons learned from engaging a diverse, multilingual postpartum patient sample in qualitative health research. Key strategies to address intersectional barriers included the following: (1) Responding to Participant Needs, (2) Utilizing a Multilingual Research Team, (3) Ensuring Social Identity Congruence among Team and Participants, (4) Cultural Humility Training, (5) Engaging Advisory Board Collaboration, (6) Utilizing Provider-Facilitated Referrals, (7) Addressing Technological Barriers with Flexible Digital Platforms, and (8) Using Text Messaging for Outreach. By applying an intersectional lens, this study expands upon existing recruitment approaches, offering a contextually relevant framework for advancing equitable participation in health research. Including those most impacted by health disparities in research is an ethical imperative, necessary for producing findings that reflect the experiences of historically marginalized communities and ensuring they are meaningfully represented in scientific inquiry.

Researchers are increasingly using qualitative health methodologies to inform patient-centered healthcare practice. However, in doing so, they are often dismissing the inherent subjectivity of qualitative research to conform to quantitative standards of objectivity. Acknowledging that all aspects of research inquiry are influenced by situated researchers, I explore the co-use of interpretive description (ID), an applied qualitative health methodology, and reflexive thematic analysis (RTA), a thematic analysis approach that foregrounds researcher subjectivity. By examining the philosophical foundations, use of theory, analytical strategies, and indicators of research quality between ID and RTA, I conceptualize a methodologically coherent approach to their co-use that remains transparent about, and values, researcher subjectivity and reflexivity. This article also includes accessible explanations of complex methodological and philosophical concepts, practical examples for operationalizing reflexivity, and 22 guiding questions to support researchers in the coherent co-use of ID and RTA.

This paper contributes to ongoing conversations about the ethical and practical integration of generative artificial intelligence (GAI) in qualitative health research by focusing on an often-overlooked aspect of research-dissemination. Given GAI's capacity to translate complex ideas into accessible summaries, simplify jargon, adapt to different comprehension levels, and enhance understanding through analogies, we explore its potential to support knowledge translation. Specifically, we examine the use of GAI podcasts for public-facing dissemination. Drawing on our experience testing three GAI-assisted podcasting platforms-with features ranging from automated scriptwriting to audio production-we assess their affordances and limitations. Our experience with these platforms suggests that the effectiveness of GAI depends less on the tools themselves and more on how researchers critically engage with and shape their use. We conclude by emphasizing the importance of balancing artificial intelligence's promise of speed and reach with concerns about bias, mistrust, and limited artificial intelligence literacy-recognizing GAI as a partner, not a substitute, in meaningful communication.

This systematic review examined the health risk assessment methods of studies of whole-body vibration exposure from occupational vehicles or machines utilizing the International Standard ISO 2631-1 (1997) and/or the European Machine Directive 2002/44. This review found inconsistent reporting of measurement parameters in studies on whole-body vibration (WBV) exposure. Although many authors treat the ISO 2631-1 HGCZ as a medical health standard with defined threshold levels, the epidemiological evidence for these limits is unclear. Similarly, the EU Directive offers more comprehensive risk management guidance, but the numeric limits are equal without supporting scientific evidence. Both guidelines likely represent the prevailing societal and interdisciplinary consensus at the time. Authors note discrepancies between international and national standards and adverse WBV exposure outcomes are reported below given boundaries. Future publications should report all relevant parameters from ISO 2631-1 and clearly state study limitations, exercising caution when applying ISO 2631-1 HGCZ in health and safety assessments and considering different susceptibility of diverse populations. We advise reducing WBV exposure to the lowest technically feasible limits wherever possible and applying the precautionary principle with attention to individual differences, instead of depending solely on numeric limits.

Impact assessment is commonly presented as a central pillar of evidence-based policy-making and the solution to making ‘better’ regulation. It has also been identified as a mechanism by which the Health in All Policies (HiAP) agenda might be advanced, ensuring that the health impacts of all interventions - whether originating in the health sector or not - are taken into account by policymakers. Yet, it remains difficult to identify, quantify and balance health impacts, to integrate qualitative and longer-term health costs and benefits into analysis, and ensure that the findings and nuances of impact assessment are considered within the policy process. Moreover, challenging current political developments may reduce input legitimacy and increase corporate capture of the impact assessment process, as seen in cases such as the tobacco industry. EUPHA has a well-established programme of work in this space, critiquing and advancing the practice of impact assessment in the public health field. Drawing on this expertise and adding value by combining it, this workshop brings together representatives from the Public Health Politics and Policy (PHPP), Health Impact Assessment (HIA) and Public Health Economics (PHE) sections of EUPHA. A panel of experts will examine the role of impact assessment in health policy and address a core challenge to it; namely, the capacity for impact assessment to make the policy process more amenable to public health concerns. Presentations (using the 15x15 format) will introduce the European Commission's approach to (health) impact assessment (Orhan Pees), explore existing methodologies of HIA and the challenges that they face (Martin), critique the applicability of dominant pharmacoeconomics approaches to assessment of public health interventions (Vasco Santos), examine the relevance of health system performance assessment to impact assessment exercises (Blümel et al.). Each panellist will be asked to close their presentation by addressing the following question: to what extent is impact assessment a valuable tool for delivering policy that is good for health?Key messages• Impact assessment has advanced significantly in recent years, but its ability to deliver better policy outcomes for health requires continual, multidisciplinary appraisal.• Sound evaluation of health impact requires clinical, economic and political expertise, an interface which EUPHA is uniquely situated to promote.Speakers/PanellistsRana Orhan PeesEcorys, Rotterdam, NetherlandsPiedad Martin-OlmedoEscuela Andaluza de Salud Pública, Granada, SpainJoão Vasco SantosUniversity of Porto / CINTESIS / ARS Norte, Porto, PortugalMiriam BlümelBerlin University of Technology, Berlin, Germany

Food and fuel insecurity have been rising in Scotland since 2021, yet very little exists on the dual burden of these poverties. This study, by way of a qualitative interpretative health policy analysis, seeks to better understand the policies and programmes available to mitigate food and fuel insecurity and the associated health burdens in Scotland. Thirty semi-structured key informant interviews were undertaken between April and December 2023 with policy experts in these fields. Interviews were transcribed, abductively coded, analysed, and triangulated with academic, policy and grey literature to compare and contrast policy responses. Given the importance of income when discussing multidimensional poverty, it is unsurprising that a major intervention towards ending food and fuel insecurity is the benefit system at large, which was overall described as insufficient and poorly organised. A cash first approach has been identified as paramount to address food insecurity and take over the ever-growing charity efforts (food bank larders, cooked meals, etc), which are largely considered “sticking plasters” by stakeholders. Fuel insecurity has been increasingly modelling food insecurity tactics - growing charity sector led approach such as introducing fuel banks and warm spaces. While these efforts are often similarly described as “sticking plasters,” many experts report that given the complexity of the issue - poor housing stock, unfair payment systems, lack of trained personnel, and market mis-regulation - increased income alone is insufficient to tackle fuel insecurity, stressing the need for a multidimensional approach to poverty. The health system, while increasingly burdened by both dimensions, was described as having little bandwidth for prevention and saw the role instead up to government and charities. Working with health systems may, however, help to identify those most impacted by food and fuel insecurity such as people with kidney failure.

One-to-one interviews and focus groups are used to generate qualitative data about patients' health outcomes and inform the development of patient-reported outcome measures (PROMs). In the development of PROMs for young people, visual elicitation tools can be used with one-to-one interviews and focus groups to enhance the datageneration process and data quality. This article aims to (1) provide a detailed description of how visual elicitation tools can be applied in the development of youth-specific PROMs using the GENDER-Q Youth study as an example and (2) share the lessons learned from the GENDER-Q Youth study with PROM developers who are considering using visual elicitation tools in their own virtual qualitative studies. This article discusses processes that took place within the context of a mixed-methods, multi-step study to develop a PROM for youth receiving gender-affirming carecalled GENDER-Q Youth. Step one was an applied qualitative health research study using an interpretive description approach. Virtual conceptelicitation interviews were conducted with transgender and gender diverse youth aged 12-18 years at recruitment using an optional timeline-based visual elicitation tool (i.e., before interviews, youth were invited to create a timeline about their gender-affirming care journeys). The research team navigated ethical and logistical challenges associated with using timeline activities during the datageneration process. These challenges occurred during the pre-interview stage (e.g., mailing activity supplies) and during interviews (e.g., incorporating the timeline activity into the interview). Details about the approach used by the research team, challenges faced, and lessons learned are discussed. When conducting one-to-one virtual conceptelicitation interviews, visual elicitation tools have the potential to enhance the quality of data generated about participants' outcomes and experiences of healthcare. Visual elicitation tools can also improve the interview experiences of both participants and researchers and are feasible to implement within the context of qualitative PROM development research with young people.

ABSTRACTIntroductionDespite high coverage of routine childhood vaccines, uptake of the human papillomavirus (HPV) vaccine in the Pacific Island nation of Tonga has been slow. Culturally appropriate communication resources on the importance, safety, and effectiveness of the HPV vaccine are critical to support acceptance and uptake. To develop these resources, it is important to understand what people want to know. We aimed to explore HPV vaccine information needs among communities in Tonga, to inform a tailored HPV vaccine resource to support uptake.MethodsWe conducted a two phase qualitative study involving stakeholder consultation and feedback to inform the development of a vaccine educational resource. From June to October 2023 (Phase 1), eight focus groups and one interview were conducted with 24 adolescent girls, 32 parents, 15 teachers, seven nurses, and five immunisation program staff in Nuku'alofa, Tonga. Findings informed a flip chart on the HPV vaccine which was qualitatively piloted with nine community members and nine nurses in October 2023 (Phase 2).ResultsParents, girls, and teachers wanted clear information on the benefits and risks of the HPV vaccine. Immunisation providers lacked culturally specific resources in Tongan, and nurses requested a flip chart. All participants wanted Tongan or Pacific‐specific data on HPV and cervical cancer disease burden. The flip chart was finalised in collaboration with the Tonga Ministry of Health and a local graphic designer. Piloting identified the need for training of nurses on the flip chart, and the potential for the resource to provide information to parents, school students and teachers.ConclusionTo support HPV vaccine acceptance and uptake in Tonga, we integrated qualitative community and health provider insights to develop and pilot a culturally appropriate resource with locally designed images. Nationwide distribution will now support nurses and community leaders to share information about the HPV vaccine with their communities and additional resources will be developed for adolescent girls.

In this essay, I offer my take on contemporary matters relevant to the existing, emerging, and imagined intersections between qualitative health research (QHR) and generative artificial intelligence (GenAI). The essay's central argument is that the increasing reliance on GenAI in QHR is eroding scholarly craftspersonship and should be challenged. In order to present and justify this argument, I posit five coordinated observations: The growing body of literature on using GenAI in qualitative research is reducing qualitative research to coding and pattern recognition; the turn to GenAI disincentivizes reading and stultifies qualitative health researchers; the infatuation with GenAI amplifies the process of McDonaldization of QHR; the time that GenAI saves us isn't being used to become better researchers; and our tendency to humanize GenAI may dehumanise us, whereas craftspersonship is a state of being human. Grounding on such observations, I make a case for embedding a techno-negative stance called neo-luddism in the political culture of QHR. I suggest that this might be an urgent task, for the relation of cruel techno-optimism that some qualitative researchers have established with GenAI can rapidly lead to their own obsolescence. Needless to say, no GenAI has been purposely employed to craft this article.

precision nutritional epidemiology studies require the development of initiatives to obtain objective population data that enable the implementation of health strategies. Therefore, the integration of health determinants and risk factors is essential to ensure the quality of life associated with nutrition through the use of new health indicators such as nutritypes and nutritional indices. the aim of the PLENUFAR 7 project was to design and promote the use of nutritypes and nutritional indices, integrating metabolic variables and nutritional markers of the Spanish population through nutritional education. the project was developed in two phases. The first phase involved training and evaluating healthcare professionals. The second phase recruited 5,496 volunteers, collecting information on health, habits, and quality of life. Machine learning tools were used to classify population subgroups through an algorithm, and quantitative nutritypes were employed to determine metabolic risks. the nutritional indices indicated an adequate health status: MEDLIFE (9.3/21 p), HHS (13/100 %), and MHL (2.4/5 p). Additionally, five nutritypes were identified for the Spanish population based on dietary patterns and metabolic determinants: westernized millennial, healthy, active Mediterranean, dysmetabolic, and metabolically vulnerable. the Spanish population exhibits a Mediterranean lifestyle with westernized influences, maintaining good health. PLENUFAR 7 trained professionals to provide personalized dietary advice, considering habits and lifestyles, supported by advanced computational tools.

There is little understanding of challenges encountered when recruiting people who frequently use urgent and emergency care (UEC) services to qualitative research. This is despite considerable evidence that people who frequently use healthcare services are a heterogenous group, who are under-served in qualitative research with voices that are seldom heard. This is particularly problematic when their use of healthcare services is often associated with unmet complex health or social care issues, chronic health conditions, and factors such as lower socioeconomic status; also associated with lack of involvement in health research and challenges to health status. This paper provides insight into recruiting this under-served and seldom-heard population to qualitative research studies and suggests how identified challenges could be overcome in future research. Using Rolfe et al.’s Reflective Framework (2001), we examine processes and outcomes of five studies with differing methodological recruitment approaches to identify common challenges and facilitators of recruitment success. All studies aimed to recruit people who frequently used one or more UEC service. In comparing approaches, we identified two key stages of the research process that most contributed to difficulties and successes in recruitment of service users, and thus are deemed to be critical junctures: (1) Research Planning and Design, and (2) Research Delivery. The first contained themes around systems factors and study design factors , whilst the second included relational factors and personal factors . Recruitment was challenging across all studies due to unpredictable interplay of these four factors, indicating that there is no ‘one size fits all’ approach for future research. This reflects the heterogeneous nature of the group, and suggests that multiple, targeted approaches to recruitment need to be co-designed with multiple service users from the outset. We make further recommendations that may also be transferred to other under-served and seldom-heard populations.

ABSTRACTBackground:The lack of general medical practitioners’ knowledge of oral disease contributes to delays in referral and treatment.Aim:To assess the awareness of dental problems/conditions and its related dental specialty that treat them, among the medical trainees and teaching faculty of a medical college.Results:The majority (88.5%) of the subjects were aware of dentistry.Conclusion:An adequate level of understanding and cooperation is therefore needed between medical and dental health teams to ensure qualitative health care delivery.

After the COVID-19 pandemic, online recruitment became a critical component of qualitative research in health care fields. However, fraudulent participants targeting research incentives have become more prevalent in health studies, raising significant issues for research ethics, data integrity, and the inclusion of diverse patient voices. While qualitative health research aims to listen to and amplify patients’ and communities’ voices, such fraud can severely impact research quality and foster mistrust toward participants. This issue is particularly critical in qualitative studies, where careful communication, engagement, and mutual trust between researchers and participants are hallmarks of the research process, especially when working with populations considered marginalized. Behaviors that researchers may associate with fraudulent participants also appear in the communication patterns of groups considered marginalized, especially when discussing sensitive topics. This similarity could lead to misplaced suspicion, unintentionally disadvantaging populations considered marginalized when they attempt to share their experiences. In this paper, 3 qualitative nursing researchers reflect on their experiences with recruitment and data collection in recent studies and provide recommendations based on their experiences and a review of relevant literature. These include methods for addressing challenges related to potentially fraudulent participants and balancing ethical approaches with justice and inclusivity while preserving research integrity, drawing on existing strategies from previous studies facing similar issues. The paper also identifies unaddressed areas requiring future attention and highlights the importance of promoting inclusivity for diverse populations and populations considered marginalized who may be disproportionately affected by mistrust in participant integrity.

Research interviews are widely used in qualitative health professions education (HPE) research. However, producing rich interview data that address a researcher’s aims is no easy feat. Based on methodological guidance from multiple disciplines and our own experience as qualitative researchers, educators, and mentors in HPE, this AMEE guide discusses the purpose of and approach to qualitative research interviews and provides comprehensive guidance for designing, preparing for, conducting, and documenting on qualitative research interviews. The guide includes practical tips that illustrate different purposes of and approaches to interviewing, drawing on and contrasting examples from published studies within in two methodologies – narrative inquiry and constructivist grounded theory.

ObjectiveTo examine storytelling interventions as health promotion tools in underserved populations across disease states, including hypertension, diabetes, overall chronic disease, obstetric care, and preventative health to assess intervention design and cultural tailoring and analyze reported quantitative and qualitative health outcomes.Data SourceA comprehensive literature search was performed in PUBMED.Study Inclusion and Exclusion CriteriaStudies were included if they implemented a storytelling intervention to promote health knowledge, behavior change, or health-related outcomes. Excluded studies lacked an evaluated intervention or reported outcomes. Reviews, commentaries, editorials, protocols without outcome data, and duplicate publications without novel findings were excluded. Only English-language studies were included due to reviewer fluency.Data ExtractionTwenty-five studies were included and categorized based on disease focus.Data SynthesisA narrative synthesis and inductive content analysis was performed. Studies were grouped by disease state and analyzed for population demographics, intervention development and delivery, cultural tailoring, storytelling theory, and measured outcomes.ResultsStorytelling, in digital and oral formats, improved health knowledge, self-efficacy, and preventive behaviors. Several methods were employed to culturally tailor interventions. Interventions were based on multiple behavioral theories.ConclusionsWhen culturally tailored and rooted in theory, regardless of delivery format, storytelling can foster behavior change across diverse health conditions.

Young people (YP) have long been underserved in mental health research. Co-production is part of a significant shift in youth mental health research from tokenistic involvement practices towards more genuine, meaningful collaboration with the group that the research affects: young people. This commentary reflects on learnings from a co-production process in the context of Can We Connect (CWC), a qualitative study on where YP seek mental health information online and their attitudes towards what is available. Young researchers were involved in planning, co-conducting the interviews, contributed to the data analysis and dissemination. Based on our shared experiences as a research team, we aim to provide insights into and recommendations for co-production within qualitative youth mental health research. We (n = 12, including 4 young researchers, aged 16–18) reflected on our experiences of either being, or collaborating with, a young researcher in CWC. For us, having young researchers in a research team brings (1) value to YP and (2) value to research. (3) Capitalising on differences is important, (4) having structured support for young researchers and (5) balancing levels of involvement. Open, transparent and honest communication is key to building trust, enabling young researchers to be meaningfully involved members of research teams.

Background:Mental health is a global priority concern. The vast majority of people lack the ability to recognize mental illness and tend to have poor knowledge and attitude toward them. Help-seeking preferences even for common mental disorders remain unsatisfactory.Objectives:To assess the mental health literacy level and health-seeking preferences for common mental disorders among adults above 18 years residing in rural and urban Puducherry.Method:A cross-sectional explanatory mixed-method study was conducted, incorporating both quantitative and qualitative approaches. The quantitative component utilized a structured questionnaire administered through a multistage cluster random sampling technique. The Mental Health Literacy Scale (MHLS), comprising 35 items across six attributes, along with seven case vignettes, was employed to assess participants’ ability to recognize common mental disorders and their preferences for health-seeking. The qualitative component involved two focus group discussions—one in a rural setting and one in an urban setting conducted using a mini-ethnographic approach.Results:A total of 230 participants were surveyed. Responses to the survey indicated an average to poor level of mental health literacy (89.6%). There is adequate knowledge of professional help availability (73%) and where to seek information through resources such as general practitioners, friends, and Internet. However, most participants were inclined to hide (80%) their mental illness due to stigma. Only 14.3% and 9.4% could recognize generalized anxiety disorder and depression as mental illnesses, respectively. In the qualitative part, personal, family, social, and health system factors were identified as barriers to seek professional help for mental illness. The major barriers noted were trust in traditional/faith healers, stigma, low awareness, lack of trust, and confidentiality in the government sector.Conclusion:Mental health literacy among adults was inadequate, and they were unable to recognize common mental health disorders. Professional health-seeking behavior was low due to misconceptions, stigma, and lack of trust in the health system.

Background: This paper focuses on the impacts of climate change on vulnerable ecosystems and its implications for the health and well-being of populations. It specifically examines the semi-arid region of Brazil, where the introduction of a social climate adaptation tool, cisterns, has brought about significant positive changes. Cisterns, a low-cost climate adaptation technology, can be replicated globally, reducing the negative health impacts of frequent droughts, especially for vulnerable groups in remote rural areas. Objective: We analyze the impact of the "One Million Cisterns Program" (P1MC) on health by synthesizing the literature and modeling its interactions with climatic and environmental factors with the Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework. Methods: Our case study employs a multidisciplinary approach, focusing on two key objectives: (i) synthesizing the literature on the implementation of the P1MC and its association with health outcomes, using search criteria that specifically target articles linking the program to health impacts; and (ii) developing a conceptual framework to model the relationship between climatic and environmental factors, adaptive ecosystems, and health outcomes. The DPSEEA framework evaluates the structural connections between climate change and human health. Findings: The study found a significant gap in the literature concerning the relationship between P1MC and health outcomes. Cisterns target the pressure/state linkages related to contextual factors and health effects, addressing the root causes of drought-related health issues. This framework also provides a foundation for collaboration among health, environmental, and policy sectors to address shared challenges, such as water security and health outcomes. Conclusion: We offer a multidisciplinary analytical framework that can be used to explore various perspectives-environmental, social, and health-related-with experts and stakeholders to develop and improve adaptive social technology strategies for living in the era of climate change. This framework also facilitates the implementation of qualitative and quantitative well-being and health assessments.

Conducting applied qualitative health research studies often involves discussion of sensitive topics that may impact the emotional safety of participants and researchers. While generic guidance exists to support researchers in prioritizing participant and researcher emotional safety, specific considerations for conducting virtual qualitative interviews to develop patient-reported outcome measures (PROMs) remain limited. This article provides a framework to support PROM developers in prioritizing participant and researcher emotional safety when conducting virtual qualitative interviews. This framework is informed by the strategies developed and applied in the GENDER-Q Youth study, an interpretive descriptive study to develop a PROM for youth receiving gender-affirming care (GENDER-Q Youth). The GENDER-Q Youth study involved virtual concept elicitation interviews with transgender and gender diverse youth (aged 12 years and older) to understand important care-related experiences and outcomes. The interview data were then used to develop draft scales. Virtual cognitive debriefing interviews were conducted with concept elicitation participants to obtain feedback on the draft scales. Strategies to promote participant and researcher emotional safety were developed and implemented throughout data generation (i.e., concept elicitation and cognitive debriefing interviews) and data analysis. On the basis of knowledge gained from creating and applying safety strategies in the GENDER-Q Youth study, a framework was developed to support researchers in prioritizing participant and researcher emotional safety when conducting their respective virtual PROM development studies. This framework offers considerations to support researchers before data generation (e.g., scheduling interviews when support will be available, should an emotional safety concern arise), during data generation (e.g., conducting check-ins with participants), after data generation (e.g., providing opportunities for the interviewingresearcher to debrief), and during data analysis (e.g., conducting check-ins with research team members). This framework can help PROM developers identify threats to emotional safety that may occur before, during, and after virtual data generation and during data analysis and facilitate the development of strategies and plans to mitigate these risks.

ABSTRACT Background: Data Note articles describe openly available research datasets. They detail how and why the data were created, with the aim of increasing research transparency and facilitating data reuse. However, existing guidelines and templates for Data Note articles have been designed for quantitative research datasets and are unsuitable for qualitative research datasets. As qualitative health and social care datasets have unique sensitivities, they must be treated and reported differently to quantitative datasets. Aim: To describe the protocol for developing a novel reporting guideline for Data Note articles describing qualitative health and social care datasets (i.e. the DeNOTE reporting guideline). Methods: The DeNOTE study includes (i) a rapid scoping exercise of existing documents and expert knowledge to identify and synthesise relevant reporting ‘items’ or ‘statements’ for a Data Note article describing qualitative health and social care data, (ii) an online questionnaire with expert participants to rate their agreement with items identified in (i) and to propose new or amended items, (iii) an online workshop with participants to co-develop the reporting items and reach consensus, (iv) eliciting participant feedback on the draft reporting guideline, and (v) finalising the guideline. Conclusion: Our plans to develop the DeNOTE reporting guideline are registered on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The guideline will support researchers producing Data Note articles describing qualitative health and social care data. We will create a tailored resource to address the needs of qualitative researchers to facilitate transparency and to support data reuse.