Unstructured Qualitative Interviews Research Articles

The changing face of heroin use in the United States: a retrospective analysis of the past 50 years.

Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations. To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin. Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (n = 2797) and (2) data from unstructured qualitative interviews with a subset of patients (n = 54) who completed the structured interview. In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids. Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants' Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the "high" produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids. Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.

Factors influencing soccer referee’s intentions to quit the game

The number of football referees in England has declined significantly over recent years, posing a threat to the future of competitive soccer. This exploratory study investigates the factors which influence referee’s intention to quit the game. Unstructured qualitative interviews (N = 12) were conducted with 3 past and 9 present referees. Interviews were transcribed and analysed using inductive content analysis. Three higher order dimensions emerged: Organizational factors (e.g. support, training and feedback on performance), Personal factors (e.g. psychological impact, intention to quit and personal benefits) and Match factors (e.g. psychological intimidation, physical intimidation and RESPECT protocol). Organizational factors were cited more than any others in relation to intention to quit and thus, ultimately, have the most impact on attrition. Ways in which the findings might inform efforts to retain referees are discussed.

Researching the researcher-as-instrument: an exercise in interviewer self-reflexivity.

Because the researcher is the instrument in semistructured or unstructured qualitative interviews, unique researcher characteristics have the potential to influence the collection of empirical materials. This concept, although widely acknowledged, has garnered little systematic investigation. This article discusses the interviewer characteristics of three different interviewers who are part of a qualitative research team. The researcher/interviewers - and authors of this article - reflect on their own and each other's interviews and explore the ways in which individual interview practices create unique conversational spaces. The results suggest that certain interviewer characteristics may be more effective than others in eliciting detailed narratives from respondents depending on the perceived sensitivity of the topic, but that variation in interviewer characteristics may benefit rather than detract from the goals of team-based qualitative inquiry. The authors call for the inclusion of enhanced self-reflexivity in interviewer training and development activities and argue against standardization of interviewer practices in qualitative research teams.

Researching the researcher-as-instrument: an exercise in interviewer self-reflexivity

Because the researcher is the instrument in semistructured or unstructured qualitative interviews, unique researcher characteristics have the potential to influence the collection of empirical materials. This concept, although widely acknowledged, has garnered little systematic investigation. This article discusses the interviewer characteristics of three different interviewers who are part of a qualitative research team. The researcher/interviewers – and authors of this article – reflect on their own and each other’s interviews and explore the ways in which individual interview practices create unique conversational spaces. The results suggest that certain interviewer characteristics may be more effective than others in eliciting detailed narratives from respondents depending on the perceived sensitivity of the topic, but that variation in interviewer characteristics may benefit rather than detract from the goals of team-based qualitative inquiry. The authors call for the inclusion of enhanced self-reflexivity in interviewer training and development activities and argue against standardization of interviewer practices in qualitative research teams.

Staff and patient views of the concept of hope on a stroke unit: a qualitative study

This study explores the experience of hope for patients and staff in the context of a British stroke unit. Hope is identified as a useful concept for exploring how people find meaning in recovery from illness. Uncovering the experience of hope in acute stroke care has provided evidence that can be used to facilitate rehabilitation. The methodology drew on the principles of ethnography, undertaking unstructured qualitative interviews with ten patients, ten multidisciplinary staff and 21 hours of participant observation including informal discussions with staff and patients. Data collection took place between November 2007 and November 2008. Four themes were identified: suffering, struggling with no hope and despair, hope for recovery and realistic hopefulness. Hope was experienced in the context of suffering a stroke demonstrated as loss of function, loss of mental capacity and dependency. Patients struggled to maintain a sense of hopefulness while feeling close to a slippery slope towards despair and death. Hope was expressed as a strong desire to recover, get back to normal and a time to reflect on their lives so far. Staff identified realistic hopefulness as focused on keeping things real while balancing giving hope and avoiding false hope. Hope is placed within the emotional challenges of suffering and struggle inherent in recovery from stroke. The staff work with patients' hopes but offer realistic hopefulness as a practical strategy for recovery. Further interventions are required for working with feelings of despair or no hope.

Time as symbolic currency in knowledge work

The paper discusses the issue of time slips in software development. Increasing time sacrifices toward work constitutes an important part of modern organizational environment. In fact, the reign over time is a crucial element in controlling the labor process. Yet a lack of cultural studies covering different approaches to this issue remains—particularly those focusing on high-skilled salaried workers. This article is a small attempt to fill this gap, based on an analysis of unstructured qualitative interviews with high-tech professionals from a B2B software company. It focuses on the issue of timing in IT projects, as perceived by software engineers. The findings indicate that managerial interruptions in work play an important part in the social construction of delays. However, interruptions from peer software engineers are not perceived as disruptive. This leads to the conclusion that time is used in a symbolic way, both for organizational domination and solidarity rituals. The use of time as a symbolic currency in knowledge-work rites is presented as often influencing the very process of labor and schedules. It is revealed to be the dominant evaluation factor, replacing the officially used measures, such as efficiency, or quality.

When a child says ‘no’: experiences of nurses working with children having invasive procedures

Experiencing invasive medical procedures can be a devastating experience for some children and their parents. The potential impact on staff who perform the procedure and who may have to restrain the child who is unwilling to have an essential procedure is a neglected area of research. Children's distress and their coping are affected by those around them so it is important to understand how nurses react in these situations. To explore the experiences of nursing staff involved in facilitating invasive procedures for children who do not want them. Participants were selected at random from staff lists of one hospital in the West Midlands. Data collection was undertaken using unstructured qualitative interviews with ten paediatric nurses and in two focus groups. Theories generated from each interview were tested and validated with participants in subsequent interviews and then in the focus groups. The most common experiences reported by the participants were 'getting upset' and 'getting stressed' by some aspect of the medical procedure, either because the child or parents became upset or the procedure had gone wrong in some way. Procedural protocols that exist to protect children, for example, by limiting the number of unsuccessful attempts to undertake the procedure, also protect staff by providing a framework to manage emotions during the procedure. Being able to explain the process and need for the procedure to the child and parents, obtaining consent where possible for the use of certain techniques, such as restraint, and having the time to adequately prepare a child for a procedure, all helped minimise the likelihood of an unsuccessful procedure, thereby reducing the risk of the nurse being emotionally affected by a distressed child. Nurses working with children who are unwilling to undergo invasive procedures experience negative emotions but these are short lived due to a combination of protective factors and coping strategies. Further research is needed to understand the experiences of medical staff and of nurses working outside paediatric environments who may not experience the same support and protection as those in paediatric settings.

Discontinuation and Modification of Highly Active Antiretroviral Therapy in HIV-Infected Ugandans

Data on discontinuation and modification of highly active antiretroviral therapy (HAART) are scarce among sub-Saharan African populations. We sought to estimate the prevalence and to identify factors associated with these phenomena in our resource-limited setting. Patients were recruited into this cross-sectional study from 2 treatment centers in Kampala, Uganda. Discontinuation and modification were assessed by self-report using semistructured quantitative and unstructured qualitative interviews. Discontinuation was defined as the simultaneous stopping of all antiretrovirals for at least 1 month, and modification as the changing of at least 1 antiretroviral used in an initial HAART regimen. Factors independently associated with each outcome were assessed using multivariate logistic regression. Of 686 subjects evaluated, 94 (13.7%) had ever discontinued therapy, whereas 175 (25.5%) had ever modified their regimen. The median CD4 count was 175 (interquartile range: 66-297) cells/microL. Factors associated with discontinuation were HAART experience before starting the current regimen (odds ratio [OR] = 3.70, 95% confidence interval [CI]: 2.13 to 6.25), use of alternative medicines (OR = 2.18, 95% CI: 1.06 to 4.47), hospitalization (OR = 2.36, 95% CI: 1.32 to 4.20), and 1 year or less on HAART (OR = 11.11, 95% CI: 5.00 to 25.00). Modification was associated with more than 3 months' duration on HAART (OR = 3.13, 95% CI: 1.16 to 8.33) and being unmarried (OR = 1.64, 95% CI: 1.02 to 2.70). The proportions of discontinuation and modification of antiretroviral therapy (ART) observed in our resource-poor setting pose a challenge to the limited treatment options presently available. Drug cost as a major reason for discontinuation of HAART has major implications for ART programs that charge fees in resource-limited settings.

Perceived Barriers to Participation in a Supplemental Nutrition Program Among Low-Income Women on the US/Mexico Border

The benefits of supplemental nutrition programs have been well established. In order to gain an insight into perceived barriers to participation in such programs on the US/Mexico border, unstructured qualitative interviews were conducted with former participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The main barrier to program participation was a lack of time. Other barriers to participation included confusion about program eligibility and the perceived stigma associated with receiving assistance from WIC. Generally, participants felt that WIC was a beneficial program and would recommend it to others. Expanded hours of operation that address the needs of working mothers were recommended in order to increase the recruitment and retention of program participants.

Constant or special observations of inpatients presenting a risk of aggression or violence: nurses’ perceptions of the rules of engagement

In acute psychiatric settings the practice of 'observation' is commonly employed. Increased levels of observation, 'constant' or 'special' are used for those perceived as presenting a 'higher' risk. As an intervention it is used most frequently for those at risk of self-harm or suicide, the practice is also however, used for those thought to present a risk of violent behaviour. In this descriptive study the perceptions of 1st level registered mental nurses (RMNs) gave an account of observation for those perceived to be at risk of violence or aggression and insight into what was considered important and desirable in practice. Unstructured qualitative interviews were conducted with a purposive sample of six RMNs from a psychiatric intensive care unit. Three major categories, Procedure, Role, and Skills emerged which revealed a complex practice far removed from its literal description as merely 'watching'. Six subcategories emerged from the Role. (1) intervening; (2) maintaining the safety of the patient and others; (3) prevention de-escalation and the management of aggression and violence; (4) assessing; (5) communication; and (6) therapy. Skills in these and, experience were thought to IMPACT on the success of the practice. The description of this and the skills involved offer a definition of the 'rules of engagement' which give insight to the practice and the training needs of staff advocated for 'observation'. The acronym IMPACT may be useful in this.

Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy

Our objective was to determine the level of adherence and reasons for non-adherence to antiretroviral therapy (ART) among HIV-positive (HIV+) people on ART in a resource-limited setting. Patients receiving ART were recruited into the cross-sectional study from three treatment centres in Kampala, Uganda. The number of missed doses over the last three days was assessed by structured patient interviews and dichotomized at +/-95% adherence. Reasons for non-adherence were assessed with both structured patient interviews and unstructured qualitative interviews. Independent predictors of non-adherence were assessed with multivariate logistic regression. In all, 304 HIV-infected persons on ART were enrolled into the study. Factors associated with non-adherence were marital status (odds ratio (OR) = 2.93, 95% confidence interval (CI) 1.32-6.50) and low monthly income <50 US$ [OR = 2.77, 95% CI 1.64-4.67]. We concluded that levels of self-reported adherence in patients receiving ART in Kampala are comparable to levels in resource-rich settings with inability to purchase and secure a stable supply as a major barrier to adherence.

Bullying in the nursing profession.

Self-esteem is a major predictor of behaviour. Nurses with healthy self-esteem are likely to deliver therapeutic patient care, while those with low self-esteem are less likely to do so. The aim of the 3-year study discussed here was to explore students' self-esteem and how their experiences of preregistration education influenced its development over the period of the programme. Students participated in unstructured qualitative interviews at the beginning and end of their 3-year preregistration course and a grounded theory approach was used for data collection and analysis. Bullying was found to be commonplace in the transition to becoming a nurse. Students were bullied and also witnessed patients being bullied by qualified nurses. The internalization of nursing norms meant that students then bullied others. Students' self-esteem was low. Bullying, and its effects on self-esteem, are perpetuated by practices within nursing. This situation will only be changed if nurses and educators transform their practice and the context in which bullying occurs. Otherwise, each new generation of nurses will continue to be socialized into negative practices which undermine both their own feelings of self-worth and standards of nursing care.

Organizational Factors Influencing Nurse Practitioners' Role Implementation in Acute Care Settings

The purpose of this study was to explore the influence of organizational factors on the Acute Care Nurse Practitioner (ACNP) role implementation. A descriptive correlational design, incorporating quantitative and qualitative methods for data collection was used. The sample of convenience consisted of 57 ACNPs assigned to various medical and surgical programs within acute care hospitals. Ten ACNPs participated in the unstructured qualitative interviews. In addition to the interviews, data pertinent to various organizational factors, including role formalization, receptivity of the role by others, perceived autonomy, role strain, and additional factors that may interfere with role implementation, were collected through a self-report structured questionnaire. A four-diary day was completed to gather data on role implementation. Descriptive and correlational statistics were used to analyze the quantitative data. The qualitative data were content analyzed. The ACNPs engaged most frequently in activities reflective of the clinical practice component of the role and less frequently in the non-clinical components (i.e., education, administration, and research). Results of the quantitative and qualitative analyses indicated that lack of formal clear job description, conflicting demands and expectations, lack of receptivity of the role by others, lack of autonomy, and increased workload were negatively correlated with the ACNP role implementation. The ACNP role implementation varies across practice settings. This variability should be accounted for when examining outcomes of ACNP care.