Becoming a Rare Disease Parent: An Interpretative Phenomenological Analysis of Parent-Caregivers' Postpartum Experiences

Development and evaluation of RhizoQOL, a quality-of-life caregiver-reported survey for rhizomelic chondrodysplasia punctata, a rare peroxisomal disorder

BACKGROUND

Rhizomelic chondrodysplasia punctata (RCDP) is a rare genetic disorder characterized by symptoms such as respiratory dysfunction, seizures, orthopedic issues, and neurodevelopmental delay. Potential therapeutics for RCDP warrant the development of clinical outcome assessments to assess the efficacy of treatment and the well-being of patients. Our study aimed to develop a valid quality-of-life (QOL) caregiver-reported survey instrument, RhizoQOL, to be used as a supportive endpoint in RCDP clinical trials.

METHODS

Development of the RhizoQOL survey tool included three RCDP caregiver focus groups to elicit concepts to serve as potential domains in a QOL survey instrument for RCDP, pilot survey development and initial testing, cognitive interviewing of revised survey drafts to determine content validity, as well as a three-month longitudinal study for reliability and internal consistency of the survey instrument.

RESULTS

Twenty-eight caregivers participated in the focus groups, reporting that concepts that could be appropriate domains of QOL in RCDP include psychosocial behavior, feeding symptoms, mobility symptoms, respiratory symptoms, seizures and related activity, and impact of treatment. Following pilot survey testing (n = 22) and stakeholder feedback, a revised pilot survey instrument was administered to five caregivers for cognitive interviewing. This resulted in a revised survey instrument with 31 question items, six domains, and a 1-5 Likert scale item response assessing frequency or severity of event in the question item. Longitudinal testing (n = 18) of the revised survey instrument found the average response score was 1.98 ± 0.97 for all question items, and a Cronbach's alpha value of 0.856, suggesting strong intra-survey question reliability. Using individual question item results from reliability testing, linear regression modeling, and testing for required magnitude of significant treatment effects, eight question items were removed from the survey instrument, resulting in a total of 23 question items within 6 discrete domains.

CONCLUSIONS

The final RhizoQOL survey instrument, consisting of 23 questions, assesses the symptoms and experiences of RCDP patients as observed by caregivers and serves as a novel clinical outcome assessment for RCDP therapeutic clinical trials to assess the impacts of RCDP and support the overall effectiveness of treatments.

Wide-Ranging Responses to Temporary Abstinence Challenges Among UK-Based Heavier Drinkers: A Three-Wave Longitudinal Interpretative Phenomenological Analysis

Temporary abstinence challenges (TACs) encouraging people to abstain from alcohol for typically 1 month time periods have acquired considerable popularity. TACs may promote longer-term reductions in alcohol consumption, but it is unclear how TACs influence behavior changes and whether positive changes are held among adults identifiable as relatively heavy drinkers. Drawing on a UK-based sample of six heavier drinkers, we measured self-reported alcohol consumption and drink-refusal self-efficacy and conducted interviews at three timepoints: pre-TAC participation (T1), and immediately following (T2) and 6 months post-TAC (T3) participation. Using longitudinal interpretative phenomenological analysis, an analytic technique for understanding change over time, and via integration with quantitative self-report measures, we identified three patterns of evidence about longer-term change (or not) in alcohol use linked to TAC participation: "mainly clear change," "unclear/complicated change," and "no change or limited change," each with narrative illustrations from two participants. We found evidence of greater reflection about alcohol consumption at T2 and lower levels of T3 alcohol intake among four of six participants. For some, TAC participation revealed downsides of drinking, and linked participation to reductions in their alcohol consumption. However, other interviews suggested ambivalence about and "backfire effects" associated with TAC participation, in that positives of alcohol consumption were highlighted, with apparently linked negligible changes in consumption practices. Research implications suggest that inoculation against renewed alcohol appreciation may strengthen TAC campaign successes. Future research must test the tenability of our identified trajectories and explore, experimentally, drinking trajectories among registered versus unregistered TAC participants.

The intersection between logical empiricism and qualitative nursing research: a post-structuralist analysis

PURPOSE

To shed light on and analyse the intersection between logical empiricism and qualitative nursing research, and to emphasize a post-structuralist critique to traditional methodological constraints.

METHODS

In this study, a critical examination is conducted through a post-structuralist lens, evaluating entrenched methodologies within nursing research. This approach facilitates a nuanced exploration of the intersection between logical empiricism and qualitative nursing research, challenging traditional methodological paradigms.

RESULTS

The article focusing on the "what abouts" of sample size, analytic framework, data source, data analysis, and rigour and methodological considerations, challenging the predominance of semi-structured interviews and the reliance on spoken voice as primary data sources, and re-evaluating the conventional notion of "rigour".

CONCLUSIONS

I advocate for a shift from qualitative positivism towards more interpretive and post-qualitative inquiries, this work proposes new trajectories through interpretive, critical, post-qualitative, and artistic turns in nursing research, aiming to transcend positivist limitations and foster a plurality of perspectives and research as praxis. Implications emphasize the need for nursing researchers to expand methodological horizons, incorporating visual and artistic methods to enrich understanding and representation of health experiences, moving beyond positivist norms towards a more inclusive and ethically sound research paradigm.