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The Population-Centered Medical Model: A Theory Of Practice For Public Health And Preventive Medicine, Sudit Ranade

Electronic Thesis and Dissertation Repository

Introduction

Public health physicians occupy a unique place in the fields of both medicine and public health. Trained in each field, and often holding positions of authority in public health systems, public health physicians are sometimes challenged to identify their roles in either field of practice. Public health physicians work to achieve population health, but there has been limited theoretical development in this field of practice.

Objectives

The objective of this research was to develop an empirical theory of practice for public health physicians.

Methods

A literature review of current practice models applicable to public health physicians was performed. A …

Mental Health Professionals And Family Burden: Ways To Improve Training And Treatment, Johnnie Lee Jenkins, Iii

Walden Dissertations and Doctoral Studies

During deinstitutionalization, schizophrenia treatment shifted from state facilities to communities and families. This change stressed families. This study investigated mental health professionals' (MHPs) knowledge and training about this stress also called family burden (FB). The study had three research questions. These addressed MHPs’ view of FB, what barriers exist in treating FB, can multiple viewpoints define FB, and if these views influence MHPs to reduce it. This grounded theory study used 22 MHPs in seven focus groups (FGs). The participant recruitment process included email, list serves, phone calls, and one state conference. The participants were MHPs licensed for 3 years …

The Fatigue Paradox: Team Perceptions Of Physician Fatigue, Emily Field, Lorelei Lingard, Richard Cherry, Julie Ann Van Koughnett, Sandra Deluca, Taryn Taylor

Obstetrics & Gynaecology Publications

OBJECTIVES: Ongoing calls to implement fatigue risk management in residency education assume a shared understanding of physician fatigue as a workplace hazard, yet we lack empirical evidence that all health care team members maintain this assumption. Thus, this study seeks to explore how health care team members understand the role of physician fatigue in an effort to inform the implementation of fatigue risk management in residency training and medical practice.

METHODS: This study uses constructivist grounded theory to explore perceptions of workplace fatigue and its impact on clinical practice. We conducted individual semi-structured interviews with physicians, nurses and senior residents …

Processes Used By Mothers In Opioid Recovery To Manage The Needs Of The Maternal-Infant Dyad: A Grounded Theory Study, Nicole M. Mattson

Dissertations (1934 -)

Maternal opioid use during pregnancy and the postpartum period has significant impact on the mother and infant. Maternal well-being and early maternal-infant contact can impact the early attachment and bonding of the dyad. Additionally, the stigma surrounding opioid use in pregnancy can have detrimental effects on the dyad during pregnancy and in the postpartum period. Theory driven nursing interventions to promote mother-infant dyadic care for pairs impacted by maternal opioid use disorder (OUD) are needed. First, it was necessary to understand the current processes used by mothers with OUD to manage the unique needs of their dyad. The purpose of …

Processes Used By Mothers In Opioid Recovery To Manage The Needs Of The Maternal-Infant Dyad: A Grounded Theory Study, Nicole M. Mattson

Dissertations (1934 -)

Maternal opioid use during pregnancy and the postpartum period has significant impact on the mother and infant. Maternal well-being and early maternal-infant contact can impact the early attachment and bonding of the dyad. Additionally, the stigma surrounding opioid use in pregnancy can have detrimental effects on the dyad during pregnancy and in the postpartum period. Theory driven nursing interventions to promote mother-infant dyadic care for pairs impacted by maternal opioid use disorder (OUD) are needed. First, it was necessary to understand the current processes used by mothers with OUD to manage the unique needs of their dyad. The purpose of …

Innovating The Study Of Context: Using A Qualitative Study On Subjugation And Resistance To Explore The Utility Of Foucauldian Governmentality As A Framework For Enriching Situational Analyses, Hannah Kia, Carol Strike, Daniel Grace, Lori E. Ross

The Qualitative Report

Situational analysis has, as an emerging poststructuralist approach to grounded theory, recently grown in use across a diverse range of disciplines and substantive areas. In this paper, we consider the complementarity of Foucauldian governmentality as a theoretical framework for supporting and enriching situational analyses. Our work is based on the findings of a recent study, informed by situational analysis, in which we interviewed 27 HIV-positive (n=16) and HIV-negative (n=11) gay men ages 50 and over about their health care experiences, and used these data to examine processes of subjugation and resistance reflected in their accounts. Drawing on our analytical process, …

Application Of Rigour And Credibility In Qualitative Document Analysis: Lessons Learnt From A Case Study, Leanne M. Wood, Bernadette Sebar, Nerina Vecchio

The Qualitative Report

This paper probes functions and processes of qualitative document analysis (QDA), a method widely used in case study research. It firstly demonstrates the application of a QDA framework to inform a case study of women entrepreneurs in rural Australia; and provides insights into the lessons learnt, including strengths and limitations of QDA. Secondly, the paper provides guidelines for novice researchers seeking to use thematic analysis in a QDA process, arguing for rigour in naming assumptions and explicitness about the procedures employed. The paper contributes to discussion in the literature that positions QDA not only as a convenient tool, but as …

Barriers To Ghanaian Midwives’ Ability To Provide Quality Care: A Glaserian Grounded Theory Study, Yakubu Ismaila

Theses: Doctorates and Masters

The midwifery model of care that promotes the employment of trained and regulated midwives for the provision of maternal and neonatal care has been found to be beneficial, especially in Low and Middle-Income Countries that have high maternal and neonatal mortalities. Midwives in those setting are however, facing a myriad of barriers which negatively affect their ability to provide optimal care. Although Ghana is implementing the midwifery model of care, maternal and neonatal mortality remains high in the country. Little is known from the point of view of midwives, who are the primary providers of maternal and neonatal care, about …

Perseverance, Faith And Stoicism: A Qualitative Study Of Medical Student Perspectives On Managing Fatigue, Taryn S Taylor, Alexandra L Raynard, Lorelei Lingard

Obstetrics & Gynaecology Publications

CONTEXT: Fatigue risk management (FRM) strategies offer a potential solution to the widespread problem of fatigued trainees in the clinical workplace. These strategies assume a shared perception that fatigue is hazardous. Despite the growing body of evidence suggesting that fatigue leads to burnout and medical errors, previous research suggests that residents perceive fatigue as a personal, surmountable burden rather than an occupational hazard. Before we can implement FRM, we need a better understanding of when and how such problematic notions of fatigue are adopted by medical trainees. Thus, we sought to explore how third-year medical students understand and manage the …

Using Emphasis-Purposeful Sampling-Phenomenon Of Interest–Context (Eppic) Framework To Reflect On Two Qualitative Research Designs And Questions: A Reflective Process, Michael E. Kalu

The Qualitative Report

A satisfactory research question often signifies the beginning point for many researchers. While this can be true for quantitative studies because of pre-defined research questions, qualitative research questions undergo series of revisions through a reflective process. This reflective process provides the framework for the subjectivity associated with qualitative inquiry. The continuous iterative reflective process is an essential component for developing qualitative research questions that correspond with the various qualitative study designs. Although qualitative inquiry is term exclusively subjective, there is a need to use a framework in developing qualitative research questions. The Emphasis- Purposeful sampling- Phenomenon of interest – Context …

Getting Change-Space: A Grounded Theory Study Of Automated Ehealth Therapy, Marianne T. S. Holter, Ottar Ness, Ayna Johansen, Håvar Brendryen

The Qualitative Report

A promising tool for bettering people’s health is eHealth (or “mHealth”) programs: fully automated, web-based health interventions. However, we know surprisingly little about eHealth’s working mechanisms. One possible working mechanism is that program users benefit from a collaborative “relationship”—a “working alliance”—with the program. Although evidence support the existence of a person-to-program alliance it is unclear if and how it influences change. Therefore, we conducted a grounded theory study of how relating to an eHealth program for quitting smoking influenced the participants’ change processes. The ensuing model focuses on how participants got change-space—feeling free from social forcing and able to work …

Women's Decision-Making For Subsequent Pregnancy After A Cesarean Delivery, Melinda Dixon

Dissertations

The purpose of this study is to generate a theory of the decision making process for women as they choose a birth option after a previous Cesarean delivery. The research method of choice when little is known about the phenomena is qualitative research. A qualitative approach was used to generate a substantive theory of decision making for women deciding subsequent pregnancy birth mode after a previous Cesarean delivery. The classical grounded theory methodology including sampling plan, recruitment, data collection and analysis outlined in Glaser and Strauss (1967) guided this study. Twelve study participants with a history of one previous Cesarean …

Instrumental Role Modeling And The Sensitive Topic Of Obesity: A Grounded Theory, Tulie Blot Gay

Walden Dissertations and Doctoral Studies

The nurse practitioner (NP) role is more prominent now than ever before in primary healthcare, positioning them as providers who defend initiatives and ongoing health agendas. Obesity is among those agendas. The concept of instrumental role modeling was explained as a combination of understanding and physical presence that gives meaning and quality to inspire change. It implied that health professionals are not merely insightful clinicians but suggested their expertise is complimented by demonstrations of wellness in knowledge and practice. This topic of weight was perceived as sensitive but must be addressed. In this grounded theory study, the perspectives of NPs …

Is It Who Am I Or Who Do You Think I Am? Identity Development Of Adolescents With Substance Use Disorders, Danielle N. Treiber

Antioch University Dissertations & Theses

The purpose of this study was to unearth how adolescents with substance use disorders achieve the task of identity formation and the construction of self-concept in the midst of the drug culture and society that exists. It sought to uncover the social constructs designed to ignore and/or remove human complexities and allow an intersectional approach to be brought to a study on this population. Historically, there has been a failure to investigate the underlying social attitudes and behaviors that impact the very delicate and vulnerable process of finding self. Psychosocial and relational adjustment are strongly influenced by the extent to …

Putting The Patient Back In Patient Care: Health Decision-Making From The Patient’S Perspective, Bill R. Garris, Amy J. Weber

Bill R. Garris

This research explored health decision-making processes among people recently diagnosed with type 2 diabetes. Our analysis suggested that diagnosis with type 2 was followed by a period of intense emotional and cognitive disequilibrium. Subsequently, the informants were observed to proceed to health decision-making which was affected by three separate and interrelated factors: knowledge, self-efficacy, and purpose. Knowledge included cognitive or factual components and emotional elements. Knowledge influenced the degree of upset or disequilibrium the patient experienced, and affected a second category, agency: the informants’ confidence in their ability to enact lifestyle changes. The third factor, purpose, summarized the personal and …

"Born Out Of Fear": A Grounded Theory Study Of The Stigma Of Bipolar Disorder For New Mothers, Walker Ladd Ph.D.

The Qualitative Report

Childbirth is an established trigger for the onset of bipolar disorders (BD) in the postpartum period, causing significant pathology and disability. Research has shown that the stigma of mental illness for new mothers is a powerful obstacle to care, preventing women from accessing critical treatment and social support. However, the majority of research has examined the relationship between the stigma and postpartum depression, leaving a gap in knowledge regarding stigma and postpartum bipolar disorder. The problem addressed in this grounded theory study was the lack of knowledge regarding the stigma of a diagnosis of bipolar disorder (BD) in the first …

How Do Health Care Providers Identify And Address Lifestyle Factors With Community Dwelling Adults Who Have Chronic Wounds?, Linda Norton

Electronic Thesis and Dissertation Repository

Wound prevention and management best practice guidelines and literature contain recommendations that treatment plans need to consider the client’s lifestyle but offer little guidance about the specific lifestyle factors to be considered, nor how to address these. A post positivist constructivist grounded theory study was used to explore this gap Participants were health care providers with at least 5 years of experience working with community dwelling adults with chronic wounds. Data were transcripts of two semi structured individual interviews, a reflective journal, relevant documents identified by participants and transcripts of focus groups.

A common understanding of lifestyle factors was not …

An Adaptation Of Grounded Theory Using A Modified Convergent Interviewing Technique, Elica Safari Mehr, Peter Carswell, Karen Day

The Qualitative Report

Grounded Theory (GT) researchers have been using adaptations of this methodology to serve theory building purposes, following different theoretical frameworks. However, there is a lack of enough information on the variation of GT used, or their epistemological assumptions in some studies. The purpose of this paper is to provide our experience in a GT study using a modified convergent interviewing technique to help guide other researchers on using this method and build their own research design. We have combined a decision-making technique, called Delphi, with convergent interviewing and provided a clear explanation of the steps required to apply this method …

Putting The Patient Back In Patient Care: Health Decision-Making From The Patient’S Perspective, Bill R. Garris, Amy J. Weber

The Qualitative Report

This research explored health decision-making processes among people recently diagnosed with type 2 diabetes. Our analysis suggested that diagnosis with type 2 was followed by a period of intense emotional and cognitive disequilibrium. Subsequently, the informants were observed to proceed to health decision-making which was affected by three separate and interrelated factors: knowledge, self-efficacy, and purpose. Knowledge included cognitive or factual components and emotional elements. Knowledge influenced the degree of upset or disequilibrium the patient experienced, and affected a second category, agency: the informants’ confidence in their ability to enact lifestyle changes. The third factor, purpose, summarized the personal and …

Data Saturation: The Mysterious Step In Grounded Theory Method, Khaldoun M. Aldiabat, Carole-Lynne Le Navenec

The Qualitative Report

The aim of this paper is to provide a discussion that is broad in both depth and breadth, about the concept of data saturation in Grounded Theory. It is expected that this knowledge will provide a helpful resource for (a) the novice researcher using a Grounded Theory approach, or for (b) graduate students currently enrolled in a qualitative research course, and for (c) instructors who teach or supervise qualitative research projects. The following topics are discussed in this paper: (1) definition of data saturation in Grounded Theory (GT); (2) factors pertaining to data saturation; (3) factors that hinder data saturation; …

Training Impact On Novice And Experienced Research Coordinators, Linda S. Behar-Horenstein, Jonell Efantis Potter Ph.D., Alena Prikhidko Phd, Candidate, Stephanie Swords Ma, Ccrp, Stephen Sonstein Phd, H Robert Kolb Rn Bs Ccrc

The Qualitative Report

Competency-based training and professional development is critical to the clinical research enterprise. Understanding research coordinators’ perspectives is important for establishing a common core curriculum. The purpose of this study was to describe participants’ perspectives regarding the impact of online and classroom training sessions. 27 participants among three institutions, completed a two-day classroom training session. 10 novice and seven experienced research coordinators participated in focus group interviews. Grounded theory revealed similarities in novice and experienced coordinator themes including Identifying Preferences for Instruction and Changing Self Perceptions. Differences, seen in experienced participants, focused on personal change, in the theme of Re-Assessing Skills. …

I Want An Omnipotent Doctor: North Korean Defectors’ Unmet Expectations Of South Korean Medical Providers, Soo Jung Hong

The Qualitative Report

This study examines North Korean defectors’ unmet expectations of South Korean medical providers from the perspectives of both North Korean defectors and their medical providers. Seventeen defectors and 12 medical providers were recruited for focus groups and in-depth interviews. Grounded theory was used for data analysis. Data indicates the North Korean defectors were not satisfied with their providers because they (1) preferred human techniques over computerized technology, (2) expected the doctors to be omnipotent, and (3) expected to receive emergency medical service but did not expect to pay for it. Their medical providers felt that it was impossible to satisfy …

The Application Of Grounded Theory: An Example From Nursing Workforce Research, Latoya J. Lewis-Pierre 4572586, Joann Kovacich, Linda Amankwaa

The Qualitative Report

The application of grounded theory was the conduit to theory development in this study. The intent was to explore nurse manager, educator, preceptor, and new graduates’ perceptions of workplace readiness for new graduates entering an Intensive Care Unit. Research participants were drawn from five different ICUs: Medical, Coronary Care, Surgical, Neuroscience, and Trauma. One-on-one interviews were conducted to collect participants’ perspectives on readiness to practice in the ICU. Using grounded theory, four themes emerged giving rise to the novice nurse embracing the ICU theory (NNEIT). Reflections on the type of grounded theory used, reasons for the selection, challenges faced in …

Cross-Cultural Investigation Of Birth Experience : A Comparison Between Mexico And The United States., Alice J Darling

College of Arts & Sciences Senior Honors Theses

This study investigates the maternal birth experience through a cross-cultural lens. While the field of medical anthropology has researched birth practices of many cultures, few cross-cultural studies have been performed and no recent studies have suggested a transition in birthing. Ethnographic interviews with women and practitioners in Yucatán, Mexico and with women in Kentucky, United States allowed for a better understanding of the respective birthing environments. Grounded theory was then employed to develop a birth transition theory explaining changes occurring when society transitions from traditional birth practitioners to allopathic birth practitioners. The themes of knowledge, expectation and power were isolated …

Grounded Theory And The Conundrum Of Literature Review: Framework For Novice Researchers, Mohamed T. El Hussein, Andrea Kennedy, Brent Oliver

The Qualitative Report

The issue of the literature review remains a conundrum and a controversy within the discourse on grounded theory methodology. Grounded theory researchers are expected to minimize preconceptions to ensure the concept of interest is grounded in data, yet at the same time are required to evaluate existing literature to support institutional ethics and scientific review of the research proposal. In addressing this dilemma, we espouse that literature review in grounded theory should comprise a multistage nonlinear approach to the literature and introduce a framework for novice grounded theory researchers. This framework offers a reflexive, dynamic and integrative process for conducting …

“It’S Not A Life Or Death Thing”: A Grounded Theory Study Of Smoking Decisions Among Chinese Americans, Yu Lu

The Qualitative Report

Smoking results in a high mortality rate for Chinese Americans. Little is known, however, about the decisions members of this group make that lead to these unhealthy behaviors. Examining smoking decisions could help us understand these choices as well as develop effective prevention strategies. This grounded theory study was conducted to understand Chinese Americans’ smoking decisions. Fifty-four individual interviews and three focus groups were conducted with Chinese Americans of different smoking statuses. The findings describe five smoking decisions including the trajectory of these behaviors. Optimistic bias is identified as one of the main reasons that regular smokers decide not to …

Qualitative Study Of Primary Care Clinicians' Views On Point-Of-Care Testing For C-Reactive Protein For Acute Respiratory Tract Infections In Family Medicine., Victoria Hardy, Matthew Thompson, Gina A Keppel, William Alto, M Ashworth Dirac, Jon Neher, Christopher Sanford, Jaime Hornecker, Allison Cole

Articles, Abstracts, and Reports

OBJECTIVE: To explore clinicians views of the barriers and facilitators to use of C-reactive protein (CRP) point-of-care tests (POCT) in US family medicine clinics for the management of acute respiratory tract infections (ARTIs) in adults.

SETTING: Five family medicine clinics across two US states.

PARTICIPANTS: 30 clinicians including 18 physicians, 9 physician residents, 2 physician assistants and 1 nurse practitioner, took part in the study.

DESIGN: A qualitative study using a grounded theory approach to thematically analyse focus group interviews.

RESULTS: These clinicians had limited access to diagnostic tests for patients with ARTI, and very little knowledge of CRP POCT. …

Use Of Grounded Theory In Cardiovascular Research, Patrick J. Dunn, Vasileios Margaritis, Cheryl Anderson

The Qualitative Report

While grounded theory is often cited in the qualitative literature as the methodology, there are few good examples of publications that follow the principles of grounded theory and result in an actual theory. The purpose of this paper is to demonstrate how the Corbin and Strauss (2015) method of grounded theory was used in a study looking at how patients with cardiovascular disease and diabetes develop health literacy skills that are used to manage their condition. The key principles of grounded theory include theoretical sampling, constant comparison, open, axial, and selective coding, the use of memoing, and theoretical saturation. Data …

The Components Of Attentiveness In Oncology Care, Klaartje Klaver, Andries Baart

The Qualitative Report

This article presents the first findings of a qualitative empirical study of caregivers' attentiveness in hospital oncology care. It takes a care ethical perspective, in which attentiveness is considered an indispensable element of good care. The data are derived from participant observation at the oncology department of a general hospital in the Netherlands. The analysis shows a descriptive exploratory model of attentiveness, which comprises a coherent set of the clusters perception (A), object finding (B), and space for attentiveness (C). The methodological output of this article is an important one: the presented descriptive model of attentiveness promotes further research into …

Values Of Hospital Chief Executive Officers In Ontario, Alexander Smith

Electronic Thesis and Dissertation Repository

Value-based health systems, where the fundamental goal of the system is to maximize patient value, have been suggested as a means to improve health service delivery. However, our understanding of various stakeholder values in Ontario is limited. This study collected interview responses from 26 Ontario hospital Chief Executive Officers (CEOs) in an attempt to understand their personal values, alignment with health-system values, and use of values to drive decision-making. Results suggest that Ontario hospital CEOs have two value sets; a set of core values (i.e. integrity, compassion, empathy) that are established at a young age and are largely non-negotiable, and …