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Bright KL, Lichtman K. An ethnographic study of a community dentistry network serving Latine migrant farmworkers in Vermont: Barriers and access to care during the COVID-19 pandemic and beyond. Community Dent Oral Epidemiol 2024; 52:59-67. [PMID: 37501550 DOI: 10.1111/cdoe.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/09/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary dental healthcare services are not accessible for a majority of Latino/a/e migrant farmworkers in the United States. Unmet dental health needs are well documented in larger states like California, Florida and New York, but the dental healthcare picture in smaller states is not well understood. The goal of this qualitative ethnographic study was to understand the delivery model of a free dentistry network serving Latine farmworkers in rural Vermont and specific barriers experienced at the network during the COVID-19 pandemic. METHODS Semi-structured ethnographic interviews were carried out with clinicians and transcripts were analysed using the constant comparison method to identify salient concerns and recommendations about barriers and delivery of care. RESULTS Clinicians highlighted structural issues including farmworkers' lack of time off work and absence of transportation to attend appointments, concerns about COVID-19 safety, concerns about immigration surveillance and language barriers. Providers outlined steps for improved service delivery including mobile care at local farms, enhanced intercultural training for providers, recognizing dentistry as essential healthcare at the state level and the leverage of existing appointments for preventive health. Drawing on anthropological frameworks of place-based care and deservingness of healthcare, our ethnographic findings emphasize the role of community dentistry in bridging gaps in migrant healthcare during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Kristin L Bright
- Department of Anthropology, Middlebury College, Middlebury, Vermont, USA
| | - Kayla Lichtman
- Department of Anthropology, Middlebury College, Middlebury, Vermont, USA
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Jeschke EA, Baker JB, Wyma-Bradley J, Dorsch J, Huffman SL. Conventional Resilience and the Impact of Catastrophic Injury Exposure on Special Operations Surgical Teams. J Spec Oper Med 2023:FHIP-DWHB. [PMID: 37169528 DOI: 10.55460/fhip-dwhb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This article presents a justification for using an ethnographic approach to research resilience. Our hypothesis is that the conventional resilience construct is ineffective in achieving its stated goal of mitigating diagnosable stress pathologies because it is grounded in a set of assumptions that overlook human experience when examining human performance in combat. To achieve this goal, we (1) describe the evolution of the strategic framework within which the conventional resilience construct is defined; (2) highlight certain limiting assumptions entailed in this framework; (3) explain how bottom-up ethnographic research relates the medic's practical performance to military requirements and mission capabilities; and (4) articulate the unique elements of our study that widen the aperture of the conventional resilience construct. We conclude by gesturing to initial research findings.
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Abstract
OBJECTIVES The Bringing Art to Life (BATL) program was created as an art therapy intervention to increase social engagement, intergenerational engagement, and creative expression among persons living with dementia (PWD) in an adult day service. This is an evaluation of BATL program efficacy. METHODS A modified behavioral observation tool was used to quantify meaningful engagements as recorded in ethnographic field notes and test the hypotheses that: 1) engagements increase across art therapy sessions, and 2) engagements were more social than activity or art related. RESULTS The increase in engagement across session was not significant. However, social engagements (M = 9.61, SD 4.6) were more prevalent than art engagements (M = 5.23, SD = 3.1) in each session (t(99) = 9.52,). A thematic analysis of social interactions recorded in the ethnographic field notes revealed themes related to reminiscence. CONCLUSIONS The quantitative and qualitative data supported the BATL program as effective in engaging participants in social interaction and art activities. Specifically, quantitative data showed participants were engaged in conversations around reminiscence and discussion of creative expression with students. CLINICAL IMPLICATIONS Intergenerational social interaction between PWD and college students is a critical and meaningful part of the BATL program, and the intervention created a safe space with focused activity through engagement with art, and this facilitated PWD in self-expression, including humor, advice, and legacy.
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Affiliation(s)
- Candice D Reel
- Psychology Department, The University of Alabama, Tuscaloosa, USA
| | - Rebecca S Allen
- Psychology Department, The University of Alabama, Tuscaloosa, USA
| | - Bailey Lanai
- Psychology Department, The University of Alabama, Tuscaloosa, USA
| | - M Caroline Yuk
- Psychology Department, The University of Alabama, Tuscaloosa, USA
| | - Daniel C Potts
- Psychology Department, The University of Alabama, Tuscaloosa, USA
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Bryce S, Scales I, Herron LM, Wigginton B, Lewis M, Lee A, Ngaanyatjarra Pitjantjatjara Yankunytjatjara Npy Women's Council. Maitjara Wangkanyi: Insights from an Ethnographic Study of Food Practices of Households in Remote Australian Aboriginal Communities. Int J Environ Res Public Health 2020; 17:E8109. [PMID: 33153133 DOI: 10.3390/ijerph17218109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023]
Abstract
Many historical, environmental, socioeconomic, political, commercial, and geographic factors underscore the food insecurity and poor diet-related health experienced by Aboriginal people in Australia. Yet, there has been little exploration of Aboriginal food practices or perspectives on food choice recently. This study, with 13 households in remote communities on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, fills this gap using ethnographic and Indigenist methods. Results highlight Anangu resourcefulness, securing food despite poverty and adversity, and provide unique insights into factors influencing the three major types and range of dietary patterns identified. These factors include household economic cycles and budgeting challenges; overcrowding and family structures, mobility and ‘organization’; available food storage, preparation and cooking infrastructure; and familiarity and convenience. Structural and systemic reform, respecting Aboriginal leadership, is required to improve food security.
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Orchard T, Murie A, Salter K, Elash HL, Bunch M, Middleton C, Benoit C. Balance, Capacity, and the Contingencies of Everyday Life: Narrative Etiologies of Health Among Women in Street-Based Sex Work. Qual Health Res 2020; 30:518-529. [PMID: 31216937 DOI: 10.1177/1049732319855967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is an abundance of health research with women in street-based sex work, but few studies examine what health means and how it is practiced by participants. We embrace these tasks by exploring how a convenience sample of sex workers (n = 33) think about and enact health in their lives. Findings reveal pluralistic notions of health that include neoliberal, biomedical, and lay knowledge. Health is operationalized through clinic/hospital visits and self-care practices, which emerge as pragmatic behaviors and ways to resist or compensate for exclusionary treatment in health care systems. Participants also use symbols of biomedical authority to substantiate their lay interpretations of certain conditions, revealing complex forms of moral reasoning in their health etiologies. We conclude that doing health and constructing rich narratives about it are constituent elements of the women's everyday praxis and subjectivities in relation to the broader socioeconomic and political worlds of which they are a part.
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Affiliation(s)
| | | | | | | | - Mary Bunch
- York University, Toronto, Ontario, Canada
| | | | - Cecilia Benoit
- University of Victoria, Victoria, British Columbia, Canada
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Abstract
This methodological commentary focuses on the use of ethnography for health and rehabilitation practitioners. In recent years, ethnography has become a methodology of choice amongst diagnostic radiography researchers at uncovering phenomena pertinent to the clinical setting. This paper adds to the evidence base by providing not only a methodology account from two experienced researchers, but also offers a paradigmatic approach to ethnography that incorporates qualitative and quantitative approaches. It details an alternate ideological discourse in alignment with the role of a diagnostic radiographer, which can be replicated in other disciplines and thus offering an array of empirical opportunity for prospective health and rehabilitation practitioners.IMPLICATIONS FOR REHABILITATIONThis paper provides an introduction into the use of ethnography for health and rehabilitation practitioners.The authors reflect on the value of ethnography in order to satisfy a researcher's aims and objectives.The authors provide an "umbrella strategy" that can be used by other prospective health and rehabilitation researchers.It is argued here that this methodology offers an alternate strategy of uncovering new ideas and research data.
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Affiliation(s)
- Christopher M Hayre
- Faculty of Science, Department of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, Australia.,University of Suffolk, School of Health Sciences, Ipswich, UK
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Li HY, Zhu GJ, Zhang YZ, Zhang LB, Hagan EA, Martinez S, Chmura AA, Francisco L, Tai H, Miller M, Daszak P. A qualitative study of zoonotic risk factors among rural communities in southern China. Int Health 2020; 12:77-85. [PMID: 32040190 PMCID: PMC7017878 DOI: 10.1093/inthealth/ihaa001] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/18/2019] [Accepted: 01/08/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Strategies are urgently needed to mitigate the risk of zoonotic disease emergence in southern China, where pathogens with zoonotic potential are known to circulate in wild animal populations. However, the risk factors leading to emergence are poorly understood, which presents a challenge in developing appropriate mitigation strategies for local communities. METHODS Residents in rural communities of Yunnan, Guangxi and Guangdong provinces were recruited and enrolled in this study. Data were collected through ethnographic interviews and field observations, and thematically coded and analysed to identify both risk and protective factors for zoonotic disease emergence at the individual, community and policy levels. RESULTS Eighty-eight ethnographic interviews and 55 field observations were conducted at nine selected sites. Frequent human-animal interactions and low levels of environmental biosecurity in local communities were identified as risks for zoonotic disease emergence. Policies and programmes existing in the communities provide opportunities for zoonotic risk mitigation. CONCLUSIONS This study explored the relationship among zoonotic risk and human behaviour, environment and policies in rural communities in southern China. It identifies key behavioural risk factors that can be targeted for development of tailored risk-mitigation strategies to reduce the threat of novel zoonoses.
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Affiliation(s)
- Hong-Ying Li
- EcoHealth Alliance, 460 West 34th Street, New York, NY 10001, USA
| | - Guang-Jian Zhu
- EcoHealth Alliance, 460 West 34th Street, New York, NY 10001, USA
| | - Yun-Zhi Zhang
- Institute of Preventive Medicine, Dali University, Dali, 671000, China
| | - Li-Biao Zhang
- Guangdong Institute of Applied Biological Resources, Guangdong Academy of Sciences, #105 Xingang Road West, Guangzhou, 510260, China
| | - Emily A Hagan
- EcoHealth Alliance, 460 West 34th Street, New York, NY 10001, USA
| | | | - Aleksei A Chmura
- EcoHealth Alliance, 460 West 34th Street, New York, NY 10001, USA
| | - Leilani Francisco
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Hina Tai
- School of Medicine, St. George's University, Great River, NY 11739, USA
| | - Maureen Miller
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Peter Daszak
- EcoHealth Alliance, 460 West 34th Street, New York, NY 10001, USA
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Chaaban T, Ahouah M, Lombrail P, Febvre HL, Mourad A, Morvillers JM, Rothan-Tondeur M. Decisional issues in antibiotic prescribing in French nursing homes: An ethnographic study. J Public Health Res 2019; 8:1533. [PMID: 31819866 PMCID: PMC6886007 DOI: 10.4081/jphr.2019.1533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/30/2019] [Indexed: 11/22/2022] Open
Abstract
Background:Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses' influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. Design and methods:An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. Results:Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents' infections. Conclusion: if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency.
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Affiliation(s)
| | - Mathieu Ahouah
- Nursing Sciences Research, LEPS, University Paris 13, Sorbonne, Paris, France
| | - Pierre Lombrail
- Nursing Sciences Research, LEPS, University Paris 13, Sorbonne, Paris, France
| | - Héléne Le Febvre
- Faculty of Nursing Sciences, Montréal University, Centre-Ville, Montréal, Canada
| | - Adnan Mourad
- Islamic University of Lebanon (IUL), Faculty of Public Health, Beirut, Lebanon
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Elmusharaf K, Byrne E, Manandhar M, Hemmings J, O’Donovan D. Participatory Ethnographic Evaluation and Research: Reflections on the Research Approach Used to Understand the Complexity of Maternal Health Issues in South Sudan. Qual Health Res 2017; 27:1345-1358. [PMID: 27811290 PMCID: PMC5476190 DOI: 10.1177/1049732316673975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many methodological approaches have been used to understand cultural dimensions to maternal health issues. Although a well-designed quantitative survey with a representative sample can provide essential information on trends in behavior, it does not necessarily establish a contextualized understanding of the complexity in which different behaviors occur. This article addresses how contextualized data can be collected in a short time and under conditions in which participants in conflict-affected zones might not have established, or time to establish, trust with the researchers. The solution, the Participatory Ethnographic Evaluation and Research (PEER) approach, is illustrated through a study whereby South Sudanese marginalized women were trained to design research instruments, and collect and analyze qualitative data. PEER overcomes the problem that many ethnographic or participatory approaches face-the extensive time and resources required to develop trusting relationships with the community to understand the local context and the social networks they form.
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Affiliation(s)
- Khalifa Elmusharaf
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- Reproductive and Child Health Research Unit (RCRU), University of Medical Sciences and Technology, Khartoum, Sudan
| | - Elaine Byrne
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Manandhar
- Renewing Efforts Against Child Hunger (REACH), United Nations, Yangon, Myanmar
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DiStefano AS, Takeda M. HIV Pre-Exposure Prophylaxis and Postexposure Prophylaxis in Japan: Context of Use and Directions for Future Research and Action. AIDS Patient Care STDS 2017; 31:60-77. [PMID: 28170304 DOI: 10.1089/apc.2016.0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Biomedical HIV prevention strategies are playing an increasingly prominent role in addressing HIV epidemics globally, but little is known about their use in Japan, where persistent HIV disparities and a recently stable, but not declining, national epidemic indicate the need for evolving approaches. We conducted an ethnographic study to determine the context of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) use and to identify directions for future research and action in Japan. We used data from observational fieldwork in the Kansai region and Tokyo Metropolitan Area (n = 178 persons observed), qualitative interviews (n = 32), documents and web-based data sources (n = 321), and email correspondences (n = 9) in the period 2013-2016. Drug approvals by Japan's regulatory agencies, insurance coverage for medications, and policies by healthcare institutions and government agencies were the main factors affecting PrEP and PEP legality, use, and awareness. Awareness and the observable presence of PrEP and PEP were very limited, particularly at the community level. PrEP and PEP held appeal for Japanese scientists and activists, and for study participants who represented various other stakeholder groups; however, significant concerns prevented open endorsements. Japanese health officials should prioritize a national discussion, weigh empirical evidence, and strongly consider formal approval of antiretroviral (ARV) medications for use in PrEP and both occupational and nonoccupational PEP. Once approved, social marketing campaigns can be used to advertise widely and increase awareness. Future research would benefit from theoretical grounding in a diffusion of innovations framework. These findings can inform current and future ARV-based prevention strategies at a critical time in the international conversation.
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Affiliation(s)
- Anthony S. DiStefano
- Department of Health Science, California State University, Fullerton, Fullerton, California
| | - Makiko Takeda
- Program in Comparative Cultures, Graduate School of Humanities, Josai International University, Togane, Japan
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Potkin S, Bera R, Zubek D, Lau G. Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia. BMC Psychiatry 2013; 13:261. [PMID: 24131801 DOI: 10.1186/1471-244X-13-261] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/26/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The research goal is to better understand prescriber, patient, and caregiver perspectives about long-acting injectable (LAI) antipsychotic therapy and how these perspectives affect LAI use. Addressing these perspectives in the clinic may lead to greater success in achieving therapeutic goals for the patient with schizophrenia. METHODS Ethnographic information was collected from a non-random sample of 69 prescriber-patient conversations (60 with community mental health center [CMHC] psychiatrists; 9 with nurse-practitioners) recorded during treatment visits from August 2011 to February 2012, transcribed and analyzed. Discussions were categorized according to 11 predetermined CMHC topics. In-person observations were also conducted at 4 CMHCs, including home visits by researchers (n = 15 patients) prior to the CMHC visit and observations of patients receiving injections and interacting with staff. Telephone in-depth interviews with psychiatrists, patients, and caregivers to gather additional information on LAI discussion, prescription, or use were conducted. RESULTS Antipsychotic treatment decisions were made without patient or caregiver input in 40 of 60 (67%) of psychiatrist-patient conversations. Involvement of patients or caregivers in treatment decisions was greater when discussing LAI (15 of 60 [25%]) vs oral antipsychotic treatment (5 of 60 [8%]). LAIs were not discussed by psychiatrists in 11 of 22 (50%) patients taking oral antipsychotics. When offered, more LAI-naïve patients expressed neutral (9 of 19 [47%]) rather than favorable (3 of 19 [16%]) or unfavorable (7 of 19 [37%]) responses. Prescribers were most concerned about potentially damaging the therapeutic relationship and side-effects when discussing LAIs while patient resistance was often related to negative feelings about injections. Psychiatrists had some success in overcoming patient objections to LAIs by addressing and decomposing initial resistance. More than half (11 of 19 [58%]) of LAI-naïve patients agreed to start LAI treatment following office visits. Patient-described benefits of LAIs vs orals included perceived rapid symptom improvement and greater overall efficacy. CONCLUSIONS In this study, many psychiatrists did not offer LAIs and most patients and caregivers were not involved in antipsychotic treatment decision making. Opportunities to increase active patient engagement, address resistances, guide patient drug-formulation selection, and provide better LAI-relevant information for more individualized approaches to treating the patient with schizophrenia were present.
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