Browsing by Subject "Qualitative research"

Background: Autism Spectrum Disorder (ASD) is a major global health challenge as the majority of individuals with ASD live in low- and middle-income countries (LMICs) and receive little to no services or support from health or social care systems. Despite this global crisis, the development and validation of ASD interventions has almost exclusively occurred in high-income countries, leaving many unanswered questions regarding what contextual factors would need to be considered to ensure the effectiveness of interventions in LMICs. This study sought to conduct explorative research on the contextual adaptation of a caregiver-mediated early ASD intervention for use in a low-resource setting in South Africa.

Methods: Participants included 22 caregivers of children with autism, including mothers (n=16), fathers (n=4), and grandmothers (n=2). Four focus groups discussions were conducted in Cape Town, South Africa with caregivers and lasted between 1.5-3.5 hours in length. Data was recorded, translated, and transcribed by research personnel. Data was then coded for emerging themes and analyzed using the NVivo qualitative data analysis software package.

Results: Nine contextual factors were reported to be important for the adaptation process including culture, language, location of treatment, cost of treatment, type of service provider, familial needs, length of treatment, support, and parenting practices. One contextual factor, evidence-based treatment, was reported to be both important and not important for adaptation by caregivers. The contextual factor of stigma was identified as an emerging theme and a specifically relevant challenge when developing an ASD intervention for use in a South African context.

Conclusions: Eleven contextual factors were discussed in detail by caregivers and examples were given regarding the challenges, sources, and preferences related to the contextual adaptation of a parent-mediated early ASD intervention in South Africa. Caregivers reported a preference for an affordable, in-home, individualized early ASD intervention, where they have an active voice in shaping treatment goals. Distrust of community-based nurses and health workers to deliver an early ASD intervention and challenges associated with ASD-based stigma were two unanticipated findings from this data set. Implications for practice and further research are discussed.

Background: Hypertension and related complications are major contributors to deaths and disabilities in Nepal. We aim to explore existing work flows, needs and challenges to hypertension care coordination and assess feasibility of establishing a FCHV-based hypertension management program in Kavre, Nepal.

Design: We conducted 23 in depth-interviews and one focus group discussion that consists of nine patients with hypertension, six health workers, four health officials, and 12 FCHVs in two village development committees of Kavre district, Nepal. Applied thematic analysis was performed using NVivo 12.

Results: Health literacy related to hypertension was low. Delay in treatment initiation and lost to follow up were common patterns despite comply with antihypertensive medication. Underutilization of primary healthcare institutions, communication gap and lack of grass-roots level educational campaigns were identified as major health system-related barriers. Community pharmacies, monthly health camps and increasing governmental attention to NCDs were favorable for hypertension management. This study also showed FCHVs have the potential to promote hypertension educational, screening and referral in their catchments, with adequate training and proper motivation.

Conclusions: Barriers and facilitators identified in this study have implications for future hypertension management intervention design. We recommend grassroot level hypertension education and screening across the Nepal. FCHVs have the potential to take on these responsibilities, once they are empowered with appropriate training and motivated by proper incentives.

Keywords: hypertension management, barriers, facilitators, community health workers, female community health volunteers, Nepal, qualitative research

This dissertation explores the conceptual frameworks, social structures, and practices that organize communities of faith during periods of adaptive change. Combining methods and theories from qualitative research, practical theology, and organizational theory, it undertakes an extended study of two cases in the Pacific Northwest that are responding to adaptive challenges through collaborative approaches to religious organization, education, and leadership. Three interrelated questions organize a descriptive and normative inquiry: (1) What are the challenges confronting communities of faith in a context marked by religious entrepreneurship and a marginal social position for religious organizations? (2) What patterns of actual communal life, organizational structure, and leadership practice (both theoretical and empirical) best support individuals’ and communities’ engagement with the challenges they face? And (3) What implications follow for the practice of leadership and the study of religious organization amid periods of institutional change? An in-depth analysis of the two cases, which are identified as ‘hubs,’ extrapolates a response to the latter two questions, noting the challenges, social structure, practical wisdom, and practices of leadership that organize each site. This dissertation argues ecclesial imagination and Christian practical wisdom order and nurture the conditions, collaborations, and forms of leadership that enable each hub’s adaptive response, thereby enabling communities to live in light of the reality and promises of God.

Four parts encompassing seven chapters advance this argument. Part I is a case description of each hub, introducing the histories, missions, partnerships, and social structures that organize them. Part II continues an in-depth analysis by presenting the challenges and organizational structure that organize their collaborative work. As developed in conversation with Ronald Heifetz’s account of ‘adaptive work,’ seven primary challenges confront these hubs: relational engagement; leadership development; Boundary Zone work; post-Christendom; financial stability; loneliness and isolation; and connection to place. Further, organizational theory provides interpretive insights to describe these hubs as a novel organizational form within a broader organizational ecology.

Part III is a critical and constructive theological account of adaptive work that draws on field-driven concepts in conversation with Craig Dykstra and Dietrich Bonhoeffer. In response to each hub’s stated aim to “reimagine church,” Dykstra’s work directs attention to the diverse “places” (e.g., congregations, higher education institutions, and theological educational institutions) that support adaptive change and how a broader ecclesial ecology serves as a “prism,” refracting leaders’ and communities’ engagement. Further, as explored in conversation with Bonhoeffer’s work, a Christo-ecclesial understanding of communities and organizations provides a basis for the organizational and ecclesial transformation each hub pursues.

Part IV builds a theoretical structure to understand the Christian practical wisdom that sustains conditions for each hub’s adaptive work. Specifically, six modes of leadership offer complementary ways of being with communities, organizations, and neighborhoods: a Caretaker, a Catalyst, a Champion, a Connector-Convener, a Surveyor, and a Guide. The project concludes by drawing out the implications of this analytical and theoretical work for these hubs, for a broader ecclesial ecology, and for the changing landscape of religious life beyond the Pacific Northwest.

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This dissertation takes up questions of how theologies and practices of baptism shape visions of what it means to be a disciple of Jesus and a participant in Christian ecclesial communities. In particular, the dissertation investigates how baptism as the paradigmatic initiatory practice of the Church might transform communities to cultivate radical belonging for people with intellectual and developmental disabilities.

In order to address these questions, the dissertation engages a variety of methods, including historical and thematic analysis of theological texts (particularly in the field of disability theology), theological engagement of New Testament texts and biblical scholarship on the Pauline epistles, as well as an analysis of qualitative research conducted by the dissertation’s author (in-depth, semi-structured interviews) among adults with intellectual and developmental disabilities, their families and key support persons, as well as clergy and lay leaders in Christian denominations across the ecumenical spectrum. An integrative analysis of theological texts, biblical texts, and narratives arising from the qualitative research analysis provides a foundation for constructive theological suggestions, in a practical and pastoral register, at the conclusion of the dissertation.

This dissertation concludes that a baptismal hermeneutic provides a critical lens to faithfully reflect on disability, as well as transformative practices to support the flourishing, belonging, and witness of people with intellectual and developmental disabilities in Christian faith communities. Baptismal theologies and practices suggest the centrality of communal, Jesus-centered, and participatory accounts of Christian identity in the Church – the community this dissertation names as the baptized Body. In particular, the dissertation commends practices of baptismal preparation, testimony, and reaffirmation as key avenues for participation of all people in ecclesial spaces (robustly inclusive of people with intellectual and developmental disabilities). These practices constitute transformative pathways to affirm the centrality of baptismal identity and baptismal vocation to discipleship for an ongoing, radical transformation of ecclesial life, empowered and sustained by the Holy Spirit. In addition, the baptismal hermeneutic and baptismal practices explored throughout the dissertation critically expand discourse on intellectual and developmental disabilities in the field of Christian theology.

AbstractBackground: In 2020, Tanzania struggled with significant HIV-related challenges, including 1.4 million people living with HIV (PLWH), 33,000 new infections, and 22,000 AIDS-related deaths. Suicide emerged as a main cause of mortality among PLWH, accounting for over a quarter of all suicides. Despite these alarming statistics, mental health resources remained scarce, with only 55 psychologists and psychiatrists in the country. Clinic staff in HIV care were tasked with providing counseling despite limited mental health training, primarily focusing on HIV education. This study aimed to delve into the lived experiences of PLWH with recent suicidal ideation to inform tailored mental health interventions. Methods: Participants were screened for suicidal ideation during routine HIV clinic visits, with qualitative interviews conducted thereafter. Data was analyzed using thematic analysis facilitated by NVivo 12 software. Results: PLWH experiencing suicidal ideation encounter significant mental health challenges originating from factors such as their HIV diagnosis, societal stigma, financial stress, and broader social determinants. Death is sometimes perceived as an escape from the challenges associated with HIV. Coping mechanisms include seeking assistance from religious leaders. While participants expressed openness to counseling, limited treatment options hinder access. Conclusion: Suicide is an urgent public health challenge among PLWH in Tanzania, exacerbated by unique stressors like socioeconomic challenges, stigma, discrimination, and psychological distress. Despite the seriousness of these challenges, options for mental health treatment are scarce and not tailored to the needs of PLWH. Our findings can inform the improvement of mental health care for PLWH in Tanzania and other low-resource settings.

Key Words: Tanzania, HIV, Suicide, Suicidal ideation, Mental health, lived experience, Qualitative research, Stigma, Coping mechanisms, Counseling intervention, Socioeconomic challenges, Discrimination, Psychological distress, Treatment options and Low-resource settings.

The long-term and multi-faceted consequences of trauma are well documented and health conditions associated with traumatic life events are often those that benefit from early and regular attention from a healthcare provider. However, for many trauma-exposed women, seeking out and receiving healthcare is associated with physical and psychological intrusions that are linked to their traumatic experiences. Implementing trauma-informed care, based in knowledge and understanding of trauma that sensitively meets the needs of survivors, is an effective way to improve trauma survivors’ healthcare experiences. However, implementing such changes in practice to improve care for survivors is often made difficult by the current prevailing characteristics of patient-provider relationships and the U.S. healthcare system. Further, relying on providers to change practice is a disempowering position for survivors; supporting survivors to advocate for their needs within healthcare interactions and the healthcare system could be an efficient, effective and empowering solution to attaining widespread trauma-informed care.

This dissertation addresses current knowledge deficits through: 1) description and comparison of lifetime trauma exposure among community-based women from diverse locations and backgrounds; 2) examination of existing trauma-informed care practices for survivors of physical and sexual violence; and 3) descriptions of the healthcare experiences, needs, and strategies of female survivors of physical and sexual violence with regard to navigating healthcare experiences, provider interactions, and the healthcare system. A descriptive, correlational analysis and a synthesis of current literature were used to address the first and second research aims. Original qualitative interview and participatory Photovoice studies were conducted to address the third research aim.

Findings from the statistical analysis of trauma exposure among four community-based samples of women in Colombia, Hong Kong, and the United States indicate that trauma exposure is more similar than different and that trauma and its effects are pervasive in the lives of women across diverse locations. The synthesis of literature elucidates five thematic elements of trauma-informed care including: sensitive and universal screening, provider-patient relationships, minimizing distress, maximizing autonomy, and providing appropriate collaboration and referral. Findings from the qualitative interview and participatory Photovoice studies highlight imbalances in power dynamics and lack of mutual belief and trust as the most significant challenges to positive provider-patient relationships and healthcare experiences. These findings also indicate that survivors of violence use a variety of strategies to navigate healthcare encounters in the face of system-, agency- and provider-level barriers to positive healthcare experiences.

This dissertation adds to existing evidence on trauma exposure and trauma-informed care, and data on the engagement behaviors and healthcare strategies of survivors of violence addresses substantive gaps in the literature. Further, these findings generate useful frameworks and foundations for future research to continue to explore survivors’ healthcare desires, provider-survivor relationships, and provider- and survivor-led interventions to support the implementation of trauma-informed care.

AbstractBackground: Mental health significantly affects overall well-being, with childhood identified as a critical period for intervention. The family unit plays a pivotal role in shaping children's mental health, serving as both a source of support and, potentially, stress. In low and middle-income countries (LMICs) like Kenya, where access to mental health services is limited, the impact of family dynamics on children's mental health underscores the need for effective, culturally tailored interventions. The Tuko Pamoja program in Kenya offers a novel approach by integrating community-based prevention with targeted family counseling, addressing the gap in family-based mental health interventions within a community-embedded framework. Objective: This study aims to explore the factors influencing family participation in the Tuko Pamoja program, examining the experiences of families who engaged with the program and those who did not. It seeks to understand the interplay between the program's two components –group-based prevention (Tuko Pamoja Family Days) and individual family counseling (Tuko Pamoja Home) and participants' perceptions of their collective influence on family dynamics and mental health. Methods: Employing a qualitative research design, this study included in-depth interviews with 14 caregivers from families identified within the community with high levels of family distress. Thematic content analysis was conducted to identify themes related to participation decisions, program impact, and recommendations for improvement. Results: Findings reveal that non-attenders had positive perceptions of the program but were still unable to attend due to logistical barriers. Among attenders, effective recruitment strategies, clear communication, and logistical support facilitated participation in both tiers of the program. Attenders expressed that participation in TP Family Days played a crucial role in reducing stigma and encouraging participation in the more intensive TP Home counseling tier. Participants who engaged with both tiers reported significant improvements in family communication, parenting practices, and overall family dynamics, with both tiers reinforcing each other's content to enhance the overall impact. Conclusion: The Tuko Pamoja program demonstrates the potential to improve family dynamics and mental health awareness in LMIC settings by synergistically combining prevention and treatment tiers. Attenders felt that the program's prevention component played a crucial role in reducing stigma, improving family communication, and strengthening family relationships. This study contributes to the understanding of implementing family-based mental health interventions in LMICs, offering valuable insights into how integrated approaches can effectively address complex psychosocial needs within family systems. Addressing barriers to participation and enhancing program accessibility will be important for broadening the program's reach and efficacy. Keywords: Family-based interventions, Mental health, LMIC, Community-embedded model, Tuko Pamoja, Tuko Pamoja Home, Tuko Pamoja Family Days, Kenya, Qualitative research.