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Pohontsch NJ, Hense H, Lentsch V. [Introduction to qualitative evidence synthesis - Variants and application]. DIE REHABILITATION 2024. [PMID: 38588694 DOI: 10.1055/a-2263-1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Qualitative evidence syntheses (QES) are still uncommon in German rehabilitation research, although robust syntheses of qualitative evidence may lead to more strongly scientifically based decisions in health care. This article introduces the topic of qualitative evidence synthesis by describing three different synthesis methods - thematic synthesis, meta-ethnography, and grounded theory synthesis - and illustrating them with examples from rehabilitation research. This is followed by guidance on selecting the appropriate QES-method and reflections on the challenges of QES that are associated with the literature search and quality assessment of the studies to be included in the synthesis. Likewise considerations on quality criteria and their application are taken into account. GRADE-CERQual provides guidance for assessing confidence of findings from QES. Finally the value of QES for rehabilitation research is discussed.
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Affiliation(s)
| | - Helene Hense
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden
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Knoop T, Scheiblich N, Dettmers S, Meyer-Feil T. [Social work in medical rehabilitation - Development of an empirically grounded programme theory]. DIE REHABILITATION 2023. [PMID: 37923305 DOI: 10.1055/a-2134-2243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE Social workers are part of the interprofessional rehabilitation team. However, evidence for the effectiveness and a theoretically compatible description of their work are lacking. The aim of the research project "Sozialarbeiterischer Wirkmechanismen in der medizinischen Rehabilitation (SWIMMER)" was the development of a programme theory of social work in medical rehabilitation. METHODS In this qualitative research project, we conducted interviews with social workers and leading staff, recorded counselling sessions, and made participant observation in rehabilitation facilities. Sampling and analysis were based on grounded theory. RESULTS Data from 42 interviews, 14 counselling sessions and 140 hours of participant observations were analysed. Three core categories of a programme theory regarding practice of social work were developed: (i) work types (e. g., information work and supporting applications), (ii) interaction settings (exchange with rehabilitants, the rehabilitation team and external actors) and (iii) tasks of social services (e. g., development of vocational perspectives or professional/social participation, financial and social security). The consequences of social work practice were differentiated into output (e. g., number of applications submitted or options mentioned for a return to work) and outcome factors (e. g., participation in the society or a perspective on this and the well-being of the rehabilitants). A central characteristic is presented (co-production with the rehabilitants). CONCLUSION The hypotheses of the mechanisms of action are grounded in the data and should be explored in further studies. In addition to being useful for practitioners, the model is also suitable for classifying the results of scientific studies.
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Affiliation(s)
- Tobias Knoop
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Halle
- Stiftungsprofessur Rehabilitationswissenschaften, Rehabilitative Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Nadja Scheiblich
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Halle
- Stiftungsprofessur Rehabilitationswissenschaften, Rehabilitative Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Stephan Dettmers
- Institut für Soziale Arbeit im Lebensverlauf, OST-Ostschweizer Fachhochschule - Campus St. Gallen, Schweiz
| | - Thorsten Meyer-Feil
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Halle
- Stiftungsprofessur Rehabilitationswissenschaften, Rehabilitative Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld
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von Kutzleben M, Baumgart V, Fink A, Harst L, Wicking N, Tsarouha E, Pohontsch NJ, Schunk M. [Mixed Methods Studies in Health Services Research: Requirements, Challenges and the Question of Integration - a Discussion Paper from the Perspective of Qualitative Researchers]. DAS GESUNDHEITSWESEN 2023; 85:741-749. [PMID: 37253371 PMCID: PMC10444519 DOI: 10.1055/a-2022-8326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
With this discussion paper, the subgroup Mixed Methods of the working group Qualitative Research Methods in the non-profit organization German Network Health Services Research (DNVF) is taking up the topic of three previous discussion papers on the significance and potentials of qualitative research methods in health services research. Mixed methods are being increasingly used and demanded in health services research. However, there are also areas of conflict in the planning and implementation of mixed methods studies, and these are addressed in this paper from the perspective of qualitative research. Special attention is given to the aspect of integration as the fundamental signature of mixed methods research. With this discussion paper, our aim was to stimulate critical as well as constructive exchange of ideas on what constitutes high-quality health services research characterised by a diversity of methods and the framework conditions under which this can succeed.
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Affiliation(s)
- Milena von Kutzleben
- Department für Versorgungsforschung, Abteilung
Organisationsbezogene Versorgungsforschung, Carl von Ossietzky Universitat
Oldenburg, Oldenburg, Germany
| | - Verena Baumgart
- Department für Angewandte Gesundheitswissenschaften,
Studienbereich Ergotherapie, Hochschule für Gesundheit Bochum, Bochum,
Germany
| | - Astrid Fink
- Fachbereich Gesundheit, Kreis Groß-Gerau, Groß-Gerau,
Germany
| | - Lorenz Harst
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Medizinische
Fakultät Carl Gustav Carus an der Technischen Universität
Dresden, Dresden, Germany
| | - Nele Wicking
- Zahnärztliche Professionsforschung, Institut der Deutschen
Zahnärzte, Koln, Germany
| | - Elena Tsarouha
- Institut für Arbeitsmedizin, Sozialmedizin und
Versorgungsforschung, Universitätsklinikum Tübingen, Tubingen,
Germany
| | | | - Michaela Schunk
- Klinik und Poliklinik für Palliativmedizin, LMU Medizinische
Fakultät, München, Germany
- Fakultät für Angewandte Gesundheits- und
Sozialwissenschaften, Technische Hochschule Rosenheim, Germany
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Graf I, Enders A, Karbach U, Mihailovic T, Kruse T, Pollklas M, Höfer K, Zöller J, Braumann B. Does one size fit all? A qualitative study about the need for individualized information transfer for orthognathic patients. Head Face Med 2022; 18:22. [PMID: 35773730 PMCID: PMC9245358 DOI: 10.1186/s13005-022-00321-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022] Open
Abstract
Aims For any orthodontic-orthognathic treatment, it is crucial that patients are provided with enough and proper information in order to make evidence-based decisions- not only prior to treatment start, but also throughout the course of therapy. Thus, the objectives of this qualitative study were to identify information needs of patients undergoing combined orthodontic-orthognathic treatment. Additionally, professionals’ perspectives were evaluated. Methods A qualitative research approach was chosen in order to determine crucial aspects of information needs before and throughout treatment. With respect to a purposive sampling strategy and thematic saturation, we conducted ten semi-structured interviews with patients who had finished their orthodontic-orthognathic surgery treatments (five women, five men; being 21 to 34 years old). The indications for the combination treatment were severe skeletal Class IIs to Class IIIs with various vertical and transverse discrepancies. In addition, a multidisciplinary focus-group with six professionals from the maxillofacial surgery and orthodontic department (three women, three men; being 30 to 38 years old) helped to reflect about the experts’ point of views. After transcription, data was categorized and analyzed by Mayring’s content analysis. Results We identified three key themes. During this analysis, we focused on theme (1) ‘information transfer’ with its corresponding categories ‘information needs’ – depending on different treatment stages –, ‘source of information’ and ‘doctor-patient-communication’. The affected patients ranked individualized patient information and empathetic doctor-patient-communication high. This was mostly in line with the professionals’ point of view. Verbal communication was seen as being the best way to communicate throughout treatment. The role of the internet as a source of information was seen diversely. Conclusion This qualitative study highlights the need for individualized patient information and reveals both met and unmet information needs by patients. Although evidence-based written information is highly necessary for orthognathic patients and their families alike, it cannot replace an empathetic way of direct verbal doctor-patient-communication. It seems crucial to give specific individualized information at different treatment stages, starting at a thoroughly interdisciplinary screening at the very beginning.
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Affiliation(s)
- Isabelle Graf
- Department of Orthodontics, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany.
| | - Anna Enders
- Department for Research and Quality Management, Federal Centre for Health Education (BZgA), Cologne, Germany
| | - Ute Karbach
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculties of Medicine and Human Sciences, University of Cologne, Cologne, Germany
| | - Tatjana Mihailovic
- Department of Orthodontics, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
| | - Teresa Kruse
- Department of Orthodontics, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
| | - Melanie Pollklas
- Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Karolin Höfer
- Department of Operative Dentistry and Periodontology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Joachim Zöller
- Department of Dental Surgery and Oral, Maxillofacial and Plastic Facial Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Bert Braumann
- Department of Orthodontics, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
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Ullrich C, Queder A, Anders C, Poß-Doering R, Nöst S. [Utilization and reporting of qualitative research methods in health services research in Germany: a scoping review on original research publications (2010-2019)]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 173:75-84. [PMID: 35739057 DOI: 10.1016/j.zefq.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/17/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Qualitative research methods offer a unique perspective on health care services. However, little is known about the actual application of qualitative methods in health services research. Therefore, the aim of this study was to gain an overview of volume and variety of the use of qualitative research methods in health services research in Germany. METHODS By means of a scoping review, a systematic literature search of the database PubMed was conducted in September 2020. We included (1) qualitative studies in (2) a health services setting (3) in Germany, (4) published in either German or English as (5) original research in a journal (6) between 2010 and 2019. After removing duplicates, tandem teams of researchers first performed a title and abstract screening, followed by a full text screening. Data was extracted by using a category grid considering research focus, study design and reporting. RESULTS In total, 759 articles were included in the title and abstract screening. After applying the exclusion criteria, 97 articles were included in the data extraction. The studies investigating mainly subjective perspectives of different stakeholders, especially physicians and patients, covered 13 areas of health care. Interviews were the dominant form of data collection (n=64). Data analysis was mainly conducted using content analysis (n=65). CONCLUSION A clear absolute increase in publications since the mid-2010s can be observed. At the same time, there has been a strong tendency towards certain methods being used for data collection and analysis. Compared to reporting standards and guidelines (e.g., COREQ), incomplete reporting of research methods has been noted. The results show that both an extension of the range of methods and the quality of reporting need to be discussed.
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Affiliation(s)
- Charlotte Ullrich
- Abt. Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| | - Annika Queder
- Abt. Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Carolin Anders
- Abt. Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland; Institut für medizinische Informatik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Regina Poß-Doering
- Abt. Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Stefan Nöst
- Studienfachbereich Gesundheit, Fakultät Wirtschaft, Duale Hochschule Baden-Württemberg, Stuttgart, Deutschland
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Dederichs M, Weber J, Pischke CR, Angerer P, Apolinário-Hagen J. Exploring medical students' views on digital mental health interventions: A qualitative study. Internet Interv 2021; 25:100398. [PMID: 34026567 PMCID: PMC8122007 DOI: 10.1016/j.invent.2021.100398] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Medical students show a relatively high prevalence for common mental disorders. Only few of those in need for treatment seek professional help. Therefore, easily accessible interventions are required. While several evidence-based internet- and mobile-based interventions (IMIs) have been proposed, little is known about medical students' attitudes towards using them. OBJECTIVE We aimed to explore the views of medical students on IMIs as well as facilitators and barriers to use them and gain first insights into their preferences for tailored IMIs. METHODS We conducted four focus groups with 26 medical students enrolled at a German medical school in March 2020. Focus groups were audio-recorded, transcribed and analyzed following established approaches for qualitative content analysis. RESULTS Medical students valued IMIs for their low-threshold and flexible access, their potential to bridge waiting times and as a first step towards face-to-face-therapy. However, medical students preferred face-to-face interventions in case of severe mental health problems. The main disadvantages named by students included difficulties to find or decide on suitable IMIs based on clear quality criteria, fear of a misdiagnosis and lack of personalisation and human interaction. Some students also questioned the effectiveness of IMIs. Easy handling, flexible use, data safety and easily understandable terms of use were believed to facilitate the uptake of IMIs, whereas technical problems, frequent notifications, required internet access, need to register, lack of anonymity, high time expenditure and costs were reported to hinder their use. Most students did not prefer IMIs tailored to medical students but rather wanted to use IMIs suitable for students of all disciplines. CONCLUSION Our results suggest overall positive views regarding IMIs for mental health promotion but concerns regarding their use for severe mental disorders and acute crises. Our findings indicate that IMIs may represent promising tools for stress prevention and early interventions for medical students. Students explicitly stated to prefer quality-approved IMIs recommended and provided by their university.
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Affiliation(s)
- Melina Dederichs
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
| | - Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
| | - Claudia R. Pischke
- Institute of Medical Sociology, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
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Oslislo S, Kümpel L, Cantu RR, Möckel M, Heintze C, Holzinger F. [Am I an emergency patient? Emergency perception and decision-making competence in acute situations: a qualitative study of ED patients]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 165:43-50. [PMID: 34391683 DOI: 10.1016/j.zefq.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The number of patients visiting emergency departments (ED) due to acute but less than urgent treatment needs is increasing. A deeper understanding of emergency perception and decision-making competencies of patients is fundamentally important for developing strategies to reduce ED utilization. The aim of this study was to assess ED patients' subjective understanding of an emergency in general as well as relating to their own specific consultation. Additionally, the patients' perspective on the ability to make appropriate decisions in acute situations should be explored. METHODS Seventeen qualitative semi-structured patient interviews were conducted and analyzed using qualitative content analysis. RESULTS The majority of participants attributed their ED consultation to a subjectively perceived emergency situation. Interviewees mostly understood an emergency as a serious or life-threatening constellation associated with impending long-term health damage. They believed that uncertainty concerning the interpretation of their symptoms and associated anxiety may particularly promote situations in which referring to an ED appears to be the only alternative. Patients' health competencies were assessed negatively by a majority of interviewees with regard to assessment of complaints and decision-making in acute situations ("insecure patients"). In contrast, few patients, including those with chronic disease and experience in dealing with health problems, were considered to have a high level of competence ("confident patients"). CONCLUSION Improving patients' health literacy skills to strengthen their assessment of acute situations and their decision-making is important in order to promote appropriate ED utilization.
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Affiliation(s)
- Sarah Oslislo
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin.
| | - Lisa Kümpel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin
| | - Rebecca Resendiz Cantu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin; Charité - Universitätsmedizin Berlin, corporate member of Freien Universität Berlin and Humboldt Universität zu Berlin, Arbeitsbereich Notfallmedizin/Rettungsstellen, Campus Virchow Klinikum und Campus Charité Mitte
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freien Universität Berlin and Humboldt Universität zu Berlin, Arbeitsbereich Notfallmedizin/Rettungsstellen, Campus Virchow Klinikum und Campus Charité Mitte
| | - Christoph Heintze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin
| | - Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin
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Helbig C, Wollny A, Altiner A, Diener A, Kohlen J, Ritzke M, Frech S, Guthoff RF. Treatment Complexity in Primary Open-Angle Glaucoma (POAG): Perspectives on Patient Selection in Micro-Invasive Glaucoma Surgery (MIGS) Using Stents. Klin Monbl Augenheilkd 2020; 238:302-310. [PMID: 33254258 DOI: 10.1055/a-1241-4489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary open-angle glaucoma (POAG) is still one of the most common causes of impaired vision worldwide, despite the further development of therapy options, and can lead to blindness. Micro-invasive glaucoma surgery (MIGS) using stents aims at reducing intraocular pressure (IOP), as it is the main risk factor. With regard to adherence and adverse drug reactions it also aims at reducing the drug burden on patients. The study investigates under everyday conditions the criteria according to which ophthalmologists in Germany select patients for MIGS using stents. In addition, it will be investigated which patients (could) benefit most from the therapy. MATERIAL AND METHODS In this qualitative study, 11 narrative interviews were conducted between May 2017 and July 2018 with ophthalmologists working in the hospital or in a private practice. They were interviewed on their experiences in the treatment of POAG with microstents. The interviews were analysed by an interdisciplinary team using the qualitative content analysis. RESULTS The stages of therapy escalation form the frame of reference for patient selection in MIGS using stents. Only if the IOP cannot be sufficiently reduced by drop therapy or when this causes drug-related side effects that are intolerable for the patients, stents are apparently used as the next higher escalation stage. The intensive post-operative medication and the frequent check-up appointments are perceived as barriers by the interviewees, especially for people with or without disabilities, who are dependent on external help and/or those living in rural areas. The active cooperation of the patients in the demanding aftercare seems to be indispensable for the ophthalmologists. In addition, necessary revisions are sometimes stressful for patients (physical/psychological) and doctors (work organisation/therapy). Against the background of the organisational and economic challenges in the outpatient spectrum of tasks, especially physicians in private practice seem to weigh up carefully for which patients microstent therapy would be reasonable. CONCLUSION In view of the therapeutic requirements, the current microstent therapy seems to be used in a selected, adherent patient group. Further qualitative and quantitative studies (in other health care regions and structures) are necessary to verify and extend the available results.
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Affiliation(s)
- Christian Helbig
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Anja Wollny
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Attila Altiner
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Annette Diener
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Juliane Kohlen
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Manuela Ritzke
- Institute of General Medicine, University Medicine Rostock, Germany
| | - Stefanie Frech
- Clinic and Polyclinic for Ophthalmology, University Medicine Rostock, Germany
| | - Rudolf F Guthoff
- Clinic and Polyclinic for Ophthalmology, University Medicine Rostock, Germany
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9
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Xyländer M. [The Qualitative Interview and the Necessary Attitude of Openness]. REHABILITATION 2020; 60:281-286. [PMID: 33152775 DOI: 10.1055/a-1282-8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The article takes a look at the qualitative interviews frequently used in the rehabilitation sciences and their practical implementation. An essential aspect of conducting an interview - in addition to characteristics of processuality and communication - is the attitude of openness. This comprises several aspects in the qualitative research process, which are specifically mentioned here. This begins with a methodological openness in the selection and application of suitable methods for the research object to be investigated. The attitude of openness continues in the research process when possible adjustments in the approach become necessary, which can and should then also be the subject of methodological reflection. Openness thus refers to the entire research process and its unforeseen events and progressions. However, an attitude of openness also and especially means an open-mindedness towards the interviewees as well as towards the interview situation and its framework conditions. Last but not least, this requires openness towards oneself in the sense of a reflection of one's own self-evidence in order to (re-)structure interviews as little as possible.
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Affiliation(s)
- Margret Xyländer
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld.,Kultur-, Sozial- und Bildungswissenschaftliche Fakultät, Institut für Rehabilitationswissenschaften, Abteilung Rehabilitationssoziologie, Humboldt-Universität zu Berlin
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10
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Offenberger U. [Perspectives and Potentials in Qualitative Health Research: A Plea for an Interdisciplinary Approach]. DAS GESUNDHEITSWESEN 2020; 84:80-84. [PMID: 32610353 DOI: 10.1055/a-1173-9940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In order to show perspectives and potentials of qualitative health and health care research, the article explains special features of this research field. It points out the significance of more recent social science theories, which are closely linked to empirical analyses of various disease and health topics. This allows a more systematic view of health care issues, which is illustrated by the example of the increased demands for participation and the importance of patient organizations in planning and designing health care. Thus, these remarks tie in with current debates in (qualitative) health services research and supplement them with further perspectives from social science health research. The aim of the article is to illustrate the benefits of interdisciplinary cooperation between medicine and the social sciences in research. For example, drawing on current social science, theorizing in empirical analyses can bring to the fore historically specific ideas of the ̒good patient̓. By interpreting research results accordingly, the scope for action and reflection of health service professionals can be expanded, and the planning of care-related interventions can receive new impulses. This article should help readers in three ways: to assess the significance of qualitative methods and social science theories for interdisciplinary health research, to see the importance of a focus of health services research on the role of patient organisations and movements, and to understand that health research that is less strongly oriented towards instrumental use and direct application orientation can also provide useful extensions of perspectives for the design of health care in the future.
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Affiliation(s)
- Ursula Offenberger
- Eberhard Karls Universität Tübingen Wirtschafts- und Sozialwissenschaftliche Fakultät, Methodenzentrum, Tubingen
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11
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Weber J, Skodda S, Muth T, Angerer P, Loerbroks A. Stressors and resources related to academic studies and improvements suggested by medical students: a qualitative study. BMC MEDICAL EDUCATION 2019; 19:312. [PMID: 31429744 PMCID: PMC6701044 DOI: 10.1186/s12909-019-1747-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/06/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND Prior evidence suggests that medical students' mental health is poor and deteriorates during the course of academic studies. This qualitative study therefore aims to improve our understanding of medical students' perceptions of i) stressors related to their academic studies, ii) resources that may facilitate coping with those stressors and iii) suggestions to potentially reduce stress. METHODS Eight focus groups were conducted with medical students enrolled at a medical school in Germany until thematic saturation was reached. A topic guide was used to facilitate the discussion. Subsequently, focus group discussions were transcribed and content-analyzed using MaxQDA. RESULTS Organizational factors especially related to inadequate information flow as well as exams (e.g. repeat exams, scheduling, perceived unfair grading), poor theoretical and practical teaching quality, time and performance pressure, social interactions and individual characteristics (e.g. self-expectations, fear of failure) emerged as major contributors to stress. Resources perceived to facilitate coping with those stressors pertained to some other organizational aspects (e.g. flexibility, availability of contact persons), career prospects, practical training, social support, personal characteristics (e.g. knowledge base, past experience) and leisure time. Suggestions for improvement related primarily to organizational measures rather than individual-level measures. CONCLUSIONS Besides well-known stressors (e.g. exams and high performance pressure), some new aspects emerged from our study including stress related to organizational factors and repeat exams. Accordingly, students' wishes for organizational-level interventions, including better information systems and better interweaving of practical and theoretical education, could be first target areas for improvement.
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Affiliation(s)
- Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Stefanie Skodda
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Thomas Muth
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
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Neugebauer EAM, Schrappe M, Pfaff H, Glaeske G. [Health services research : Definition, objective, method and perspectives]. Unfallchirurg 2018; 121:940-948. [PMID: 30315400 DOI: 10.1007/s00113-018-0563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This overview article highlights the central role of health services research (HSR) for the further development of the healthcare system. As a young scientific discipline in Germany, HSR covers five important elements with different weighting in different definitions, which are elaborated in some detail in this article: patient orientation, results and outcome orientation at the patient and population levels, implementation perspectives and context relation, complex interventions and improvement, multidisciplinarity and multiprofessionalism. One of the fundamental pillars of HRS is related to the insufficient implementation of scientifically proven treatment methods and improvement strategies into routine patient care. Healthcare research is therefore the so-called second translation of clinical trials in the routine daily care (from bedside to practice) after the first translation from bench to bedside. The scientific methods used in HSR clearly extend beyond the spectrum of (clinical) epidemiology. The methodological standards are developed as consensus memoranda of members of the German network of HSR, which serve as orientation points for qualitatively good HSR. Finally, various perspectives for the long-term safeguarding and improvement of the quality of HSR in Germany are proposed.
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Affiliation(s)
- E A M Neugebauer
- Dekanat, Medizinische Hochschule Brandenburg - Theodor Fontane, Campus Neuruppin, Fehrbelliner Str 38, 16816, Neuruppin, Deutschland.
| | - M Schrappe
- Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universität zu Köln, Köln, Deutschland
| | - H Pfaff
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR), Universität zu Köln, Köln, Deutschland
| | - G Glaeske
- SOCIUM Forschungszentrum Ungleichheit und Sozialpolitik, Universität Bremen, Bremen, Deutschland
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Karstens S, Kuithan P, Joos S, Hill JC, Wensing M, Steinhäuser J, Krug K, Szecsenyi J. Physiotherapists' views of implementing a stratified treatment approach for patients with low back pain in Germany: a qualitative study. BMC Health Serv Res 2018; 18:214. [PMID: 29592802 PMCID: PMC5872532 DOI: 10.1186/s12913-018-2991-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background The STarT-Back-Approach (STarT: Subgroups for Targeted Treatment) was developed in the UK and has demonstrated clinical and cost effectiveness. Based on the results of a brief questionnaire, patients with low back pain are stratified into three treatment groups. Since the organisation of physiotherapy differs between Germany and the UK, the aim of this study is to explore German physiotherapists’ views and perceptions about implementing the STarT-Back-Approach. Methods Three two-hour think-tank workshops with physiotherapists were conducted. Focus groups, using a semi-structured interview guideline, followed a presentation of the STarT-Back-Approach, with discussions audio recorded, transcribed and qualitatively analysed using content analysis. Results Nineteen physiotherapists participated (15 female, mean age 41.2 (SD 8.6) years). Three main themes emerged, each with multiple subthemes: 1) the intervention (15 subthemes), 2) the healthcare context (26 subthemes) and 3) individual characteristics (8 subthemes). Therapists’ perceptions of the extent to which the STarT-Back intervention would require changes to their normal clinical practice varied considerably. They felt that within their current healthcare context, there were significant financial disincentives that would discourage German physiotherapists from providing the STarT-Back treatment pathways, such as the early discharge of low-risk patients with supported self-management materials. They also discussed the need for appropriate standardised graduate and post-graduate skills training for German physiotherapists to treat high-risk patients with a combined physical and psychological approach (e.g., communication skills). Conclusions Whilst many German physiotherapists are positive about the STarT-Back-Approach, there are a number of substantial barriers to implementing the matched treatment pathways in Germany. These include financial disincentives within the healthcare system to early discharge of low-risk patients. Therapists also highlighted the need for solutions in respect of scalable physiotherapy training to gain skills in combined physical and psychological approaches. Electronic supplementary material The online version of this article (10.1186/s12913-018-2991-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sven Karstens
- Department of Computer Science; Therapeutic Sciences, Trier University of applied Science, Trier, Germany. .,Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
| | - Pauline Kuithan
- Department of Therapeutic Sciences, SRH Hochschule Heidelberg, Heidelberg, Germany; M.Sc. Sport Physiotherapy, German Sport University Cologne, Cologne, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital of Tuebingen, Tuebingen, Germany
| | - Jonathan C Hill
- Research Institute of Primary Care and Health Sciences, Keele University, Keele/Stoke-on-Trent, UK
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Jost Steinhäuser
- Institute of Family medicine, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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How Do Patients with Chronic Neck Pain Experience the Effects of Qigong and Exercise Therapy? A Qualitative Interview Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:8010891. [PMID: 27418938 PMCID: PMC4932153 DOI: 10.1155/2016/8010891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/13/2016] [Accepted: 05/22/2016] [Indexed: 11/18/2022]
Abstract
Background. The high prevalence of chronic neck pain in high income countries impacts quality of life and the social and work-related activities of those afflicted. We aimed to understand how mind-body therapies and exercise therapy may influence the experience of pain among patients with chronic neck pain. Methods. This qualitative interview study investigated how patients with chronic neck pain experienced the effects of exercise or qigong therapy at two time points: during an intervention at three months and after the intervention at six months. Interviews were analysed thematically across interviews and within person-cases. Based on other qualitative studies, a sample size of 20 participants was deemed appropriate. Results. The sample (n = 20) consisted of 16 women and four men (age range: 29 to 59). Patients' experiences differed according to the therapies' philosophies. Exercise therapy group interviewees described a focus on correct posture and muscle tension release. Qigong group interviewees discussed calming and relaxing effects. Maintaining regular exercise was easier to achieve with exercise therapy. Conclusions. The findings of this study may help health care providers when counselling chronic pain patients on self-help interventions by informing them of different bodily and emotional experiences of mind-body interventions compared to exercise therapy.
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Hoffmann L, Schumann N, Fankhaenel T, Thiel C, Klement A, Richter M. Methamphetamine use in Central Germany: protocol for a qualitative study exploring requirements and challenges in healthcare from the professionals' perspective. BMJ Open 2016; 6:e011445. [PMID: 27256092 PMCID: PMC4893851 DOI: 10.1136/bmjopen-2016-011445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The synthetic drug methamphetamine with its high addiction potential is associated with substantial adverse health effects. In Germany, especially Central Germany, the increase in the consumption of methamphetamine has exceeded that of other illegal drugs. The treatment system and service providers are facing new challenges due to this rise in consumption. This qualitative study will explore the demand created by the increasing healthcare needs of methamphetamine-addicted persons in Central Germany, and the difficulty of rehabilitating addicted people. METHODS AND ANALYSIS The collection of empirical data will take place in a consecutive, two-stage process. In the first part of data collection, the experiences and perspectives of 40 professionals from numerous healthcare sectors for methamphetamine-addicted persons will be explored with the help of semistructured face-to-face interviews and probed by the research team. These findings will be discussed in 2 focus groups consisting of the participants of the face-to-face interviews; these group discussions comprise the second part of the data collection process. The interviews will be audio recorded, transcribed, and then subjected to qualitative content analysis. ETHICS AND DISSEMINATION All interviewees will receive comprehensive written information about the study, and sign a declaration of consent prior to the interview. The study will comply rigorously with data protection legislation. The research team has obtained the approval of the Ethical Review Committee at the Martin Luther University Halle-Wittenberg, Germany. The results of the study will be published in high-quality, peer-reviewed international journals, presented at several congresses and used to design follow-up research projects. TRIAL REGISTRATION NUMBER VfD_METH_MD_15_003600.
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Affiliation(s)
- Laura Hoffmann
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nadine Schumann
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Thomas Fankhaenel
- Section of General Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Carolin Thiel
- Section of General Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas Klement
- Section of General Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Halle, Germany
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