RESUMO
Epidemics of dengue, chikungunya, and Zika have been threatening the Caribbean. Since risk communication (RC) plays a fundamental role in preventing and controlling diseases understanding how RC works is essential for enabling risk-reducing behavior. This multimethod qualitative study compares news reports with local's and health professional's perspectives, currently lacking in RC research. It was found that RC strategies were obstructed by a lack of governmental structure, organization, and communication. The content analysis showed that the majority of newspaper articles contained negative reporting on the government. Furthermore, this study shows how trust and heuristics attenuate or amplify people's risk perceptions and possibly positively and negatively influence people's risk-reducing behavior. A transcending approach (e.g., structural, cooperative, and multidisciplinary) of the prevention and control of vector-borne diseases and the corresponding RC is recommended.
Assuntos
Febre de Chikungunya , Dengue , Epidemias , Comunicação em Saúde , Infecção por Zika virus , Zika virus , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/prevenção & controle , Curaçao , Dengue/epidemiologia , Dengue/prevenção & controle , Humanos , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controleRESUMO
BACKGROUND: Following self-managed abortion (SMA), or a pregnancy termination attempt outside of the formal health system, some patients may seek care in an emergency department. Information about provider experiences treating these patients in hospital settings on the Texas-Mexico border is lacking. METHODS: The study team conducted semi-structured interviews with physicians, advanced practice clinicians, and nurses who had experience with patients presenting with early pregnancy complications in emergency and/or labor and delivery departments in five hospitals near the Texas-Mexico border. Interview questions focused on respondents' roles at the hospital, knowledge of abortion services and laws, perspectives on SMA trends, experiences treating patients presenting after SMA, and potential gaps in training related to abortion. Researchers conducted interviews in person between October 2017 and January 2018, and analyzed transcripts using a thematic analysis approach. RESULTS: Most of the 54 participants interviewed said that the care provided to SMA patients was, and should be, the same as for patients presenting after miscarriage. The majority had treated a patient they suspected or confirmed had attempted SMA; typically, these cases required only expectant management and confirmation of pregnancy termination, or treatment for incomplete abortion. In rare cases, further clinical intervention was required. Many providers lacked clinical and legal knowledge about abortion, including local resources available. CONCLUSIONS: Treatment provided to SMA patients is similar to that provided to patients presenting after early pregnancy loss. Lack of provider knowledge about abortion and SMA, despite their involvement with SMA patients, highlights a need for improved training.
Assuntos
Aborto Induzido , Aborto Espontâneo , Feminino , Hospitais , Humanos , México , Gravidez , TexasRESUMO
BACKGROUND: Qualitative research has provided knowledge about the subjective experiences of therapists and patients regarding the psychotherapy process and its results. Only few studies have attempted to integrate both perspectives, considering the influence of a patient's characteristics and diagnosis in the construction of this experience. AIM: To identify aspects of psychotherapy that contribute to therapeutic change based on the experience of a patient and her therapist, and to construct an integrated comprehension of the change process of a patient with Borderline Personality Disorder. METHOD: A single case was used to carry out a qualitative analysis of follow-up interviews of the participants of a long-term psychotherapy. Two qualitative approaches were combined into a model entitled "Discovery-Oriented Biographical Analysis" to reconstruct an integrated narrative. RESULTS: This method yielded an integrated narrative organized into four "chapters" that reflect the subjective construction of both the patient's and the therapist's experience of psychotherapy in terms of meaning. DISCUSSION: The understanding of psychotherapy as a multilevel process, in which different themes occur and develop simultaneously, is discussed. From this perspective, psychotherapy can be characterized as a process that involves the recovery of trust in others through corrective emotional experiences and the construction of a shared implicit relational knowledge. Clinical or methodological significance of this article: Research on the subjective experiences of psychotherapy must consider both patient and therapist as privileged but always complementary witnesses of their interaction. In addition, it should be noted that the experience of studying this biographical reconstruction generates a space where research and practice converge. The analysis of participants' narratives provides fascinating windows into their perceptions of psychotherapy and the process of change (Safran, 2013); here, the researcher is not merely a advantaged observer or a good summarizer: He/she has the chance to imbue the psychotherapy with a new meaning by connecting it with a common set of knowledge and a body of socially shared experience.
Assuntos
Transtorno da Personalidade Borderline/terapia , Satisfação do Paciente , Avaliação de Processos em Cuidados de Saúde/métodos , Relações Profissional-Paciente , Processos Psicoterapêuticos , Adulto , Feminino , Humanos , Pesquisa QualitativaRESUMO
BACKGROUND: Client-centered contraceptive counseling is critical to meeting demand for contraception and protecting human rights. However, despite various efforts to optimize counseling, little is known outside of the United States about what individuals themselves value in counseling. In the present study we investigate women's preferences for contraceptive counseling in Mexico to inform efforts to improve service quality. METHODS: We conducted applied qualitative research, using six focus group discussions with 43 women in two cities in Mexico with distinct sizes and sociocultural contexts (Mexico City and Tepeji del Río, Hidalgo) to assess contraceptive counseling preferences. We used a framework approach to thematically code and analyze the transcriptions from focus groups. RESULTS: Consistent with quality of care and human rights frameworks for family planning service delivery, participants expressed a desire for privacy, confidentiality, informed choice, and respectful treatment. They expanded on usual concepts of respectful care within family planning to include avoidance of sexual assault or harassment-in line with definitions of respectful care in maternal health. In contrast to counseling approaches with method effectiveness as the organizing principle, participants preferred counseling centered on personalized assessments of needs and preferences. Many, particularly older, less educated women, highly valued hearing provider opinions about what method they should use, based on those personalized assessments. Participants highlighted the necessity of clinical assessments or physical exams to inform provider recommendations for appropriate methods. This desire was largely due to beliefs that more exhaustive medical exams could help prevent negative contraceptive outcomes perceived to be common, in particular expulsion of intra-uterine devices (IUDs), by identifying methods compatible with a woman's body. Trust in provider, built in various ways, was seen as essential to women's contraceptive needs being met. CONCLUSIONS: Findings shed light on under-represented perspectives of clients related to counseling preferences. They highlight specific avenues for service delivery improvement in Mexico to ensure clients experience privacy, confidentiality, informed choice, respectful treatment, and personalized counseling-including around reasons for higher IUD expulsion rates postpartum-during contraceptive visits. Findings suggest interventions to improve provider counseling should prioritize a focus on relationship-building to foster trust, and needs assessment skills to facilitate personalization of decision-making support without imposition of a provider's personal opinions. Trust is particularly important to address in family planning given historical abuses against women's autonomy that may still influence perspectives on contraceptive programs. Findings can also be used to improve quantitative client experience measures.
Assuntos
Comportamento do Consumidor , Anticoncepção , Aconselhamento , Serviços de Planejamento Familiar , Qualidade da Assistência à Saúde , Anticoncepcionais , Feminino , Grupos Focais , Humanos , México , GravidezRESUMO
The aim of this paper is to contribute to the exploration of environmental modeling methods based on the elicitation of stakeholders' mental models. This aim is motivated by the necessity to understand the dilemmas and behavioral rationales of individuals for supporting the management of environmental problems. The methodology developed for this paper integrates qualitative and quantitative methods by deploying focus groups for the elicitation of the behavioral rationales of the target population, and grounded theory to code the information gained in the focus groups and to guide the development of a dynamic simulation model. The approach is applied to a case of urban air pollution caused by residential heating with wood in central Chile. The results show how the households' behavior interrelates with the governmental management strategies and provide valuable and novel insights into potential challenges to the implementation of policies to manage the local air pollution problem. The experience further shows that the developed participatory modeling approach allows to overcome some of the issues currently encountered in the elicitation of individuals' behavioral rationales and in the quantification of qualitative information.
Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/prevenção & controle , Monitoramento Ambiental/métodos , Modelos Teóricos , Poluição do Ar/análise , Chile , Calefação/métodos , Habitação , Humanos , MadeiraRESUMO
This article discusses the use of intervention-research as a qualitative method that aims at exploring how knowledge production can be affected and transformed by intervention. It describes and examines four levels of reflexive feedback in an intervention experience based on information and communication technology (ICT) workshops in a mental health clinic for children and teens in Porto Alegre/Brazil. It is argued that an intervention can offer a rich reflexive experience that challenges the research group’s misconceptions, the participants’ reflexive notions, institutional common sense and the research direction. We posit that the methodology also enables the exploration of new capacities and emotions not only by the young participants, but by everyone involved in the process.
O presente artigo discute o uso da pesquisa-intervenção como um método qualitativo que tem por objetivo explorar como a produção de conhecimento pode ser afetada e transformada pela intervenção. Em particular, descreve e analisa quatro níveis de retroalimentação reflexiva em uma experiência de intervenção utilizando oficinas de tecnologias de informação e comunicação (TIC) em um serviço de saúde mental para crianças e jovens de Porto Alegre/Brasil. Argumenta que a pesquisa-intervenção pode oferecer uma importante experiência reflexiva que questiona as concepções da equipe de pesquisa, as noções dos participantes e o senso-comum institucional e todos esses fatores podem deslocar as direções da pesquisa. A metodologia também permite a exploração de novas capacidades e emoções, não somente para crianças e jovens, mas para todos os envolvidos no processo.
Este artículo trata acerca del uso de la investigación-intervención como un método cualitativo que tiene como objetivo explorar cómo la producción de conocimiento puede ser afectada y transformada por la intervención. En particular, se describen y examinan cuatro niveles de retroalimentación reflexiva en una experiencia de intervención utilizando talleres de tecnolo-gías de información y comunicación (TIC) en un servicio de salud mental para niños y jóvenes de Porto Alegre/Brasil. Se argumenta que la investigación-intervención puede ofrecer una importante experiencia reflexiva que cuestiona las propias concepciones del equipo de inves-tigación, las nociones de los participantes, el sentido común institucional y (todo esto) puede hacer cambiar las direcciones de la investigación. Se puede decir que la metodología también permite la exploración de nuevas capacidades y emociones, no sólo para los niños o los jóvenes, sino para todos los involucrados en el proceso.
Assuntos
Criança , Saúde Mental , Adolescente , Educação , Metodologia como Assunto , Tecnologia da Informação , BrasilRESUMO
En este avance de investigación proponemos una metodología para el trabajo con niños y niñas, basada en dos dispositivos para la generación de discurso por medio de la actividad lúdica: un dispositivo destinado a la identificación de las dinámicas relacionales en el contexto de la familia, y otro orientado al reconocimiento de las formas en que se reproducen estas dinámicas en el entorno escolar. Igualmente presentamos las categorías analíticas que han servido para definir la situación de la infancia trabajadora, a partir de la identificación de temas centrales en el discurso de revistas especializadas sobre el tema, desplegando estas categorías como los fundamentos hermenéuticos que permitirán identificar a los niños y niñas como actores sociales productivos, y como ciudadanos y ciudadanas con derechos y deberes que demandan ser respetados.
This in-progress research study proposes a methodology for child work, based on two mechanisms for the generation of discourses through ludic activities. The first aims to identify relational dynamics in the family context; the second has the objective of recognizing the ways in which these dynamics are developed in the school environment. This article also presents the analytical categories that have been used to define the situation of the working children, based on the identification of the main topics used in literature from specialized journals. These categories are deployed as hermeneutical principles that will allow for the identification of children as social and productive actors and as citizens with rights and duties that demand to be respected.
Esta investigação propõe uma metodologia para o trabalho com a infância, baseada em dois dispositivos pra geração de discurso por meio da atividade lúdica. Um destinado à identificação das dinâmicas relacionais no contexto da família, outro em relação ao reconhecimento das formas em que se reproduzem estas dinâmicas no âmbito da escola. Igualmente se apresentam as categorias analíticas que servem pra definir a situação da infância trabalhadora, a partir de identificação dos temas centrais no discurso de visitas especializadas no tema, despregando estas categorias como fundamentos hermenêuticos que permitam identificar aos infantes como atores sociais produtivos e como cidadãos com direitos e deveres que pedem ser respeitados.
Assuntos
Trabalho Infantil , Família , PesquisaRESUMO
This study aims to describe the ways in which Mexican adolescents and adults with intellectual disability exercise autonomy. Two focus groups were carried out with family members who are the legal guardians of people with intellectual disability who have received independent living training at the Center for Integral Training and Development (CADI, per its abbreviation in Spansh). Focus group transcripts were analyzed with codes defined a priori, based on an existing theoretical framework on autonomy and quality of life among intellectually disabled persons. Autonomy is exercised by the intellectually disabled in the personal, social, sexual and economic spheres of life. Empowered autonomy implies that the person is taught the necessary skills and then allowed to act upon his or her own interests. Negotiated autonomy includes guidance, explanation and negotiation; it constitutes a learning process. Interpreted autonomy is the most limited type described, and implies protection, interpretation and may involve decision-making by others. These types of autonomy constitute a complex phenomenon and the divisions between them are indistinct.
Este estudio busca describir las maneras en que jóvenes y adultos mexicanos con discapacidad intelectual ejercen la autonomía. Dos grupos focales se llevaron a cabo con familiares de personas con discapacidad intelectual quienes han recibido capacitación para la vida independiente en el Centro de Capacitación y Desarrollo Integral, CADI. Se analizaron las transcripciones con códigos definidos a priori, basados en un marco teórico preexistente sobre autonomía y calidad de vida entre personas con discapacidad intelectual. Las personas con discapacidad intelectual ejercen autonomía en diversos ámbitos: personal, social, sexual y económico. La autonomía empoderada se da cuando se le enseña a la persona las habilidades necesarias y luego se le permite actuar con base en sus propios intereses. La autonomía negociada implica ser guiado en las acciones, recibir explicaciones y negociar las decisiones; constituye un proceso de aprendizaje. La autonomía interpretada es el tipo más limitado que se describe, e implica protección, interpretación y puede involucrar la toma de decisiones por otros. Estos tipos de autonomía constituyen un fenómeno complejo y las divisiones entre ellas son difusas.