Search

This is one of the few studies that explores preferences of and experiences with integrated sexual and reproductive health (SRH)-HIV care among users of mainstream family planning and postnatal care services who are women living with HIV (WLWH). This paper reports on the quantitative data from 179 clients attending public sector clinics and from 30 qualitative in-depth interviews with WLHIV in Kenya. Quantitative data show that integration is happening for the vast majority of these clients at their last HIV visit. However, qualitative data show that very often the care received by WLWH is fragmented as providers do not offer multiple same-day appointments for FP and ARV refills. Our study has shown factors that could either prevent or enable receipt of integrated SRH and HIV care for WLWH. To address these factors, management systems need to be able to support providers to make flexible decisions and facilitate better coordination and communication across clinics within facilities.

Tutkimuksessa tarkastellaan asiakkaiden hoitoon ja kohteluun liittyviä kokemuksia yliopistollisen sairaalan ja erikoissairaanhoidon kontekstissa. Hyvää hoitoa ja kohtelua määritellään erilaisissa säädöksissä ja organisaatioiden ohjeistuksissa. Tässä tutkimuksessa hyvää hoitoa ja kohtelua tarkastellaan Potilaslaissa (1992/785) julkilausuttujen potilaan oikeuksien pohjalta. Keskeisimpänä tutkimustehtävänä on tarkastella, mihin asiakkaat ovat tyytymättömiä hoidossa ja kohtelussa ja miten asiakkaiden tyytymättömyys huomioidaan erikoissairaanhoidossa. Kriittisten palvelukokemusten tarkastelu mahdollistaa myös tulkintojen tekemisen siitä, mitä asiakkaat toivovat hoidolta ja kohtelulta erikoissairaanhoidossa. Tutkimuksessa hyödynnetään eri tiedonantajaryhmiltä kerättyä aineistoa. Aineistoina ovat erikoissairaanhoidon kuntoutustutkimuspoliklinikan entisten asiakkaiden teemahaastattelut (n=10), yhden yliopistollisen sairaalan muistutusasiakirjat (n=229) vuodelta 2012 tietyin rajauksin ja niihin sairaalan antamat vastaukset (n=226) sekä sairaalan vastauksen vuonna 2012 saaneille suunnatun kyselyn vastaukset (n=93). Jokaisella osatutkimuksella on ollut omat erilliset tutkimustehtävänsä, mutta luvun kuusi meta-analyysissä osatutkimusten tuloksia tarkastellaan Luhmannin systeemiteorian ohjaamana, sosiaalisten järjestelmien teoriaan painottuen. Analyysimenetelminä osatutkimuksissa käytetään teoriaohjaavaa ja teorialähtöistä sisällönanalyysiä sekä temaattista analyysiä. Lisäksi osatutkimuksessa IV on vaikutteita Harvey Sacksin jäsenkategorisoinnin analyysimenetelmästä. Osatutkimusten meta-analyysissä hyödynnetään teoriaohjaavaa sisällönanalyysiä. Tutkimusaineistoissa asiakkaiden kokemukset esiintyvät lähinnä kriittisinä palvelukokemuksina. Teemahaastatteluaineiston (osatutkimukset I ja IV) analyysin tuloksista on nähtävissä, miten käsityksiä palvelun laadusta päivitetään ja muutetaan kohtaamiskokemusten jälkeen. Potilasmuistutusaineisto (osatutkimukset II ja III) puolestaan viittaa asiakkaiden toiveiden toteutumattomuuteen, joille asiakkaat lähtevät hakemaan oikeutusta. Yleisin seuraus muistutusprosessista on luottamuksen menettäminen muistutuksen kohteena olevaa työntekijää ja/tai yksikköä kohtaan. Lisäksi muistutuksen laatineet henkilöt raportoivat omien käsitystensä ja toimintatapojensa muuttumisesta vaativampaan suuntaan muistutusprosessin myötä. Aikaisemmat myönteiset kokemukset näyttävät kuitenkin ennaltaehkäisevän tyytymättömyyden vahvistumista ja laajentumista. Sairaalan sisäinen muistutusprosessi pettymyksen poistamisen mekanismina ei nykymuodossaan vaikuta kovin toimivalta. Enemmistö kyselytutkimukseen vastanneista oli tyytymättömiä muistutusprosessin toimivuuteen ja sairaalan antamaan vastaukseen. Pettymys hoitoon ja kohteluun herättää asiakkaissa turvattomuuden tunteita. Tästä syystä asiakkaiden toiveita olisi hyvä kartoittaa säännöllisesti ja reagoida pettymystä aiheut taneisiin tilanteisiin mahdollisimman varhain, siellä missä ne ovat syntyneet. Sairaala organisaation sisäisen muistutusprosessin kehittämiselle kannattaa varata aikaa, mikäli halutaan välttää kaikkia osapuolia kuormittavia valitusprosesseja. Asiakkaiden toiveiden kartoitus ennen hoidon aloitusta ja välitön palautekeskustelu toimenpiteen tai hoidon jälkeen lisäisi asiakastyytyväisyyttä ja säästäisi todennäköisesti sekä ajallisia että taloudellisia resursseja. Tämän tutkimuksen pohjalta kehittämisen kohteet näyttävät olevan tyytymättömyyden hallinnoinnissa, asiakkaan toiveiden kartoittamisessa ja pettymysten ennakoinnissa. Niille henkilöille, jotka eivät kykene ajamaan omia oikeuksiaan, tulisi nimetä koordinoiva vastuuhenkilö. This doctoral dissertation explores clients’ experiences of care and treatment in the context of a university hospital and specialized health care. Good care and treatment are defined in various regulations and organization guidelines. In this study, good care and treatment are examined on the basis of the rights of the patient declared in the Patient Act (1992/785). The most important research task is to look at what clients are dissatisfied with in terms of care and treatment and how clients’ dissatisfaction is taken into account in special health care. Reviewing critical service experiences also makes it possible to make interpretations of what clients want from care and treatment in specialized health care. The study utilizes data collected from different reporting groups. The data is the theme interviews of former clients of the Rehabilitation Assessment Outpatient Clinic of specialized health care (N=10), patient complaint documents of one university hospital (N=229) for 2012, responses from the hospital (N=226) and answers to the questionnaire sent to those who received the response from the hospital in 2012 (N=93). Each sub-study has had its own separate research aims, but in the meta-analysis of chapter six the results of sub-studies are examined under the guidance of Luhmann’s system theory, with emphasis on social systems theory. As analytical methods, sub-studies use theoretical and theory guided content analysis as well as thematic analysis. In addition, the analysis of sub-study IV is influenced by Harvey Sacks’s membership categorization device. In the meta-analysis of sub-studies, theory-guided content analysis is used. In the research data, clients’ experiences mainly appear as critical service experiences. The results of the analysis of theme interviews (sub-studies I and IV) show how the anticipated wishes of the quality of service are updated and changed after face-to-face encounters. Patient complaint data (sub-studies II ja III), in turn, refers to the nonachievement of wishes as clients want to stick to their wishes and go for legitimacy. The most common consequence of the comlaint process is to lose confidence in the employee and/or unit reminded. Additionally, the writers of the patient complaints reported that their own opinions and behavior had changed in a more demanding direction with the complaint process. Past positive experiences, however, seem to prevent the strengthening and expansion of dissatisfaction in advance. The hospital’s internal complaint process as a mechanism for eliminating disappointment does not look too competent in its current form. The majority of the survey respondents were dissatisfied with the functionality of the complaint process and the hospital response. Disappointment with care and treatment awakens clients with feelings of insecurity and, from the point of view of the organization’s internal security, it is important to scan client wishes regularly and respond to situations that are disappointing as early as possible where they occur. It is a good idea to reserve time to develop the internal complaint process of the hospital organization in order to avoid complaint processes burdening all parties. The anticipatory inventory of client wishes before the start of treatment and an immediate feedback discussion after the operation or treatment would increase client satisfaction and probably save both temporal and financial resources. On the basis of this research, the objects of development seem to be in the management of dissatisfaction, the mapping of the client’s wishes and the anticipation of disappointments. To those who are unable to exercise their own rights a coordinating person should be appointed.

Background: Given the rise of Internet-based treatments (IBTs) as an effective therapeutic tool for psychological disorders, it is necessary to carry out research that examines clients’ experiences with this type of intervention. The qualitative methodology has been found to be useful for analyzing clients’ perceptions in terms of facilitators and barriers, acceptability, and negative effects of IBTs. However, a lack of integration of these primary studies has kept the results from being applied in new research studies and in clinical practice. Objective: The objective of the present paper is to describe the protocol for a meta- synthesis of qualitative studies exploring the experiences of clients who underwent an IBT. Methods: Elliot and Timulak’s meta-synthesis approach will be used to review and synthesize qualitative studies related to clients’ experiences in terms of the barriers and facilitators they perceived when undergoing IBTs. For each search string, the different aspects included in the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) tool will be considered. Electronic databases (PubMed, PsycINFO and Web of Science) will be searched. Two independent reviewers will analyze the material in order to determine whether the eligibility criteria are fulfilled. Findings will make it possible to create a hierarchy of domains in terms of their relevance across all the primary studies. The data obtained from primary studies will be cross-analyzed by utilizing descriptive and interpretative procedures. Results: To date, the search strategy is being conducted. It is aimed to complete the study at the end of 2018. Conclusions: A conceptual framework of the barriers and facilitators perceived by the clients will be developed. Implications and recommendations for clinical practice, research, and training will be suggested.

Background: Given the rise of internet-based treatments as an effective therapeutic tool for psychological disorders, it is necessary to carry out research that examines clients’ experiences with this type of intervention. The qualitative methodology has been found to be useful for analyzing clients’ perceptions in terms of facilitators and barriers, acceptability, and negative effects of internet-based treatments. However, a lack of integration of these primary studies has prevented their findings from being applied to new research and in clinical practice. Objective: The objective of this paper is to describe the protocol for a metasynthesis of qualitative studies exploring the experiences of clients who underwent an internet-based treatment. Methods: Elliot and Timulak’s metasynthesis approach will be used to review and synthesize qualitative studies related to client experiences in terms of the barriers and facilitators they perceived when undergoing internet-based treatment. For each search string, the features in the Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) tool will be considered. Electronic databases (PubMed, PsycINFO, and Web of Science) will be searched. Two independent reviewers will analyze the material in order to determine whether the eligibility criteria are fulfilled. Findings will make it possible to create a hierarchy of domains in terms of their relevance across all the primary studies. The data obtained from primary studies will be cross-analyzed using descriptive and interpretative procedures. Results: The search strategy is currently being conducted. First results are expected to be submitted for publication in 2019. Conclusions: We will develop conceptual framework of the barriers and facilitators perceived by clients and propose their implications and recommendations for clinical practice, research, and training. Trial Registration: PROSPERO CRD42018079894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79894 (Archived by WebCite at http://www.webcitation.org/73C6OtlS7). International Registered Report Identifier (IRRID): PRR1-10.2196/9722

The Boston Psychiatric Rehabilitation Approach (BPR) is person-centered and characterized by being based entirely on the individual’s unique needs and preferences in the areas of working, learning, social contacts, and living environment. Nevertheless, the person-centered approach is lacking firm evidence regarding outcomes, and empirical studies regarding clients’ experiences of this particular model are needed. A qualitative content analysis of 10 transcribed semistructured individual interviews was used to describe and explore clients’ experiences of the BPR during an implementation project in Sweden. The findings from the interviews could be summarized in ‘‘A sense of being in communion with self and others’’ theme, consisting of three categories: increased self-understanding, getting new perspectives, and being in a trusting relationship. The results showed that clients do not always recognize nor are able to verbalize their goals before they have been given the possibility to reflect their thoughts in collaboration with a trusted person. The guidelines of the approach are intended to support the clients’ ability to participate in decision making regarding their own care. More research about efficacy of different rehabilitation approaches and exploration of fidelity to guidelines of rehabilitation programs are required.Key words: Boston Psychiatric Rehabilitation Approach, clients’ experiences, person-centeredness, shared decision making, qualitative content analysis(Published: 8 April 2014)Citation: Int J Qualitative Stud Health Well-being 2014, 9: 22916 - http://dx.doi.org/10.3402/qhw.v9.22916

Capturing and studying the moments in psychotherapy that clients find most important can help us understand more about how psychotherapy works, what the curative ingredients are, and by what processes they are mediated. Qualitative research in this area has, so far, mainly focused on describing, and categorizing clients’ experiences of important factors and events. The methods employed to analyse the data have been rather limited in variation and are usually based on a realist epistemology, according to which data are basically treated as reflections of the clients’ actual experiences. This entails a risk of overlooking and obscuring other aspects of therapy and the therapy process that are equally important to explore, for example the microprocesses of interaction within important events, or how clients’ accounts of their experiences are shaped and limited by the context in which they are produced. The overall aim of this licentiate thesis was to explore client-identified important events in psychotherapy with a focus on studying therapy talk and talk about therapy from a social constructionist point of view, which would allow a closer exploration of the understudied areas mentioned above. In Study I, Conversation Analysis was used to explore the interaction taking place between seven client-therapist dyads in 16 client-identified important events collected from their third sessions. The analysis identified that 12 of the events contained clients’ expressions of disagreement. Three different ways that the therapists handled the disagreement were discerned: The first, and most common, way was to orient to the client’s cues of disagreement by inviting the client to elaborate on his or her point of view and to establish a shared understanding acceptable to both participants. The second way was to orient to the client’s disagreement cues but define the therapist’s own point view as more relevant than the client’s, and the third way was a single case in which the therapist did not in any way orient to the client’s disagreement cues. In Study II, two qualitative methods based on different epistemologies were used to analyse the same set of eight clients’ accounts of 18 important events. The aim was to first identify what types of events clients describe as important, and then explore how their accounts of these events were contextually shaped and organized, and the consequences of this. The first analysis, a content analysis, yielded descriptions of five different types of events, which were similar to the ones found in previous research on important events. The second analysis, a discourse analysis, demonstrated how clients’ accounts were not only influenced by the participants’ ability to accurately remember and report their experience, but also by what was sayable within the context of the research interview. In conclusion, the two studies demonstrate how qualitative methods based on a socialconstructive perspective can contribute to our understanding of clientidentified important events by highlighting and describing participants’ use of language in interaction, and its forms and functions within therapy sessions and in research interviews. The findings point out the need to broaden the range of qualitative methods used in psychotherapy research in general and indicate the potential value of methods like CA and DA to psychotherapy process research and research on important events in particular.