Yes / Gaining access in fieldwork is crucial to the success of research, and may often be problematic because it involves working in complex social situations. This paper examines the intricacies of access, conceptualizing it as a fluid, temporal and political process that requires sensitivity to social issues and to potential ethical choices faced by both researchers and organization members. Our contribution lies in offering ways in which researchers can reflexively negotiate the challenges of access by: 1. Underscoring the complex and relational nature of access by conceptualizing three relational perspectives – instrumental, transactional and relational – proposing the latter as a strategy for developing a diplomatic sensitivity to the politics of access; 2. Explicating the political, ethical and emergent nature of access by framing it as an ongoing process of immersion, backstage dramas, and deception; and 3. Offering a number of relational micropractices to help researchers negotiate the complexities of access. We illustrate the challenges of gaining and maintaining access through examples from the literature and from Rafael’s attempts to gain access to carry out fieldwork in a Police Force.

No / Within this chapter, we explore the use of participant photo-elicitation methods in studying how people manage their daily episodes or incidences of work-life balance. Participant photo-elicitation methods rely upon research participants taking their own photographs of a subject as guided by the researcher(s). In addressing this particular technique, we explore some important methodological issues for HRM researchers who seek to use these methods and explain how this type pop methodology has much to offer when studying HR issues such as work-life balance. We conclude that one of the major benefits of the method is the role of photographs as a "conversational technology" (Gammack & Stephens, 1994, p. 76) in encouraging participants to talk and reflect.

Yes / Purpose - This research explores the perceptions and experiences of early adopters of the technology. Design/Method/Approach - Registered Dietitians (RD´s) (N=14) were recruited from the UK, Canada, South-Africa, Australia, Mexico and Israel. Six qualitative interviews and two focus groups were conducted online using a conference calling platform. Data were recorded, transcribed and thematically analysed. Findings - Early adopters of Nutrigenomics (NGx) were experienced, self-efficacious RD’s who actively sought knowledge of NGx through communication with one another and the broader scientific community. They considered NGx an extension of current practice and believed RD’s had the skills to deliver it. Perceived barriers to widening the application of NGx were linked to skepticism among the wider dietetics community. Proliferation of unregulated websites offering tests and diets was considered ‘pseudoscience’ and detrimental to dietetics fully embracing NGx. The lack of a sustainable public health model for the delivery of NGx was also perceived to hinder progress. Results are discussed with reference to ‘diffusion of innovation theory’. Originality/Value - The views of RD’s who practice NGx have not been previously studied. These data highlight requirements for future dietetic training provision and more inclusive service delivery models. Regulation of NGx services and formal recognition by professional bodies is needed to address the research/practice translation gap.

Parents of children who have been diagnosed with Reactive Attachment Disorder (RAD) often face a challenging dilemma. They are faced with parenting children who often respond from an orientation of feeling unloved and mistrustful of their caregivers. The purpose of this study was to develop a detailed description of the story of four such parents. A multi-case qualitative design and constructivist and coping theoretical frameworks guided the investigation. The constant comparative method of analysis was used to develop three core categories that described the subtitles of parent's experiences. Parent's quotes were used to further embellish the findings. The findings include parent's experiences in recognizing RAD behavior, their response to this behavior, and advice and recommendations they would share with others dealing with this diagnosis. Parents described their child's behavior, resources and methods they used to cope, and had both encouraging and critical reflections of their experiences. / Master of Science

The thesis examined McMaster University undergraduates’ beliefs about health and contagion, and their implication for antibacterial soap use. A qualitative methodology was used and 30 participants were interviewed, and the transcripts coded and analysed for emergent themes. Students understand health in terms of having energy, being disease free, and as something to be achieved through healthy lifestyle choices and cleanliness. These beliefs form an explanatory model of health that has several key components used to make health decisions, including using or not using antibacterial soap. The participants see their health as continually threatened by sources of illness. Contagion is one of the principal threats identified and understood as transmitted through the air, or on the surfaces of contaminated people and objects. Two modes of defence were articulated in the interviews. Internal components of defence involve maintaining immune rigour; external components drives activities such as personal hygiene and cleaning to protect against pathogens. Men tend to have a more internally focussed explanatory model of health, while women have a more external focus. This seems to explain why the women in this study were eight times more likely to use antibacterial soap than the men, a finding that was statistically significant (p=.027). Social values are expressed through the explanatory model, including social boundaries and morality. The model also aligns very well with the biomedical paradigm in that it reduces health to its physical components, provides a mechanistic explanation of the body, and separates mind and body as discrete entities and as an object of control. Biomedicine seems to be broadening into new social domains, such as gender, social boundaries and morality, which are also reflected in students' beliefs about health. / Thesis / Master of Arts (MA)

Yes / Heart failure is a major global health challenge incurring a high rate of mortality, morbidity and hospitalisation. Effective medicines management at the time of hospital discharge into the community could reduce poor outcomes for people with heart failure. Within the Improving the Safety and Continuity Of Medicines management at Transitions of care (ISCOMAT) programme, the Medicines at Transitions Intervention (MaTI) was co-designed to improve such transitions, with a cluster randomised controlled trial to test effectiveness. The MaTI includes a patient toolkit and transfer of discharge medicines information to community pharmacy. This paper aims to determine the degree to which the intervention was delivered and identify barriers and facilitators experienced by staff for the successful implementation of the intervention. Methods: The study was conducted in six purposively selected intervention sites. A mixed-methods design was employed using hospital staff interviews, structured and unstructured ward observations, and routine trial data about adherence to the MaTI. A parallel mixed analysis was applied. Qualitative data were analysed thematically using the Framework method. Data were synthesised, triangulated and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: With limited routines of communication between ward staff and community pharmacy, hospital staff found implementing community pharmacy-related steps of the intervention challenging. Staff time was depleted by attempts to bridge system barriers, sometimes leading to steps not being delivered. Whilst the introduction of the patient toolkit was often completed and valued as important patient education and a helpful way to explain medicines, the medicines discharge log within it was not, as this was seen as a duplication of existing systems. Within the CFIR the most applicable constructs were identified as ‘intervention complexity’ and ‘cosmopolitanism’ based on how well hospitals were networked with community pharmacies, and the availability of hospital resources to facilitate this. Conclusion: The MaTI was generally successfully implemented, particularly the introduction of the toolkit. However, implementation involving community pharmacy was more challenging and more effective communication systems are needed to support wider implementation.

No / The effects of drug errors and any consequent adverse events frequently impact on patients, their relatives and professional carers. Furthermore, the financial cost to the National Health Service is considerable (DoH, 2000; DoH, 2001; DoH, 2004). In a study of two London teaching hospitals, Vincent et al. (2001) found that 10% of patients are exposed to an adverse event, which adds a mean 8.5 days to their hospital stay. Drug errors are recurrently reported to account for between 10 and 20% of all adverse events (DoH, 2004). In response to Department of Health policy, NHS trusts are changing their approach to the management of error to encourage more reporting. The emphasis is on openness and support, and individual and organisational learning rather than blame. Research designed to increase a knowledge of the aetiology and context of drug errors should be carefully constructed and include qualitative methods which, if implemented according to established convention, can reflect the approaches described above. This paper will critique a recently published study that focused on nursing practice and was, in our view, inappropriately described as ethnographic. The study undoubtedly adds to the body of existing knowledge about drug errors and, crucially, if the study contributes to improved patient safety, it must, fundamentally, be valued. Nevertheless, some qualitative research conventions were broken and, as such, it is suggested, some opportunities for a broader understanding and for learning may have been lost. The critique will lead to a range of recommendations about future qualitative studies in this research domain which, it is argued, could produce a fuller picture of the context, culture and, perhaps, even the cause of error.

Yes / How to meaningfully partner with patients as data analysts remains obscure. A process evaluation of the ‘Improving the Safety and Continuity Of Medicines management at care Transitions’ (ISCOMAT) cluster randomised control trial of an intervention for improving medicines use for people living with heart failure is being conducted. The intervention includes patient held information on heart medicines and care, enhanced communication between hospital and community pharmacists, and increased engagement of community pharmacists with patient care post-hospital discharge. ISCOMAT patients living with heart failure were interviewed about experiences with the intervention. We sought to gain insights from patients on data collected to enhance our understanding of experiences with the intervention. To develop a method for involving patients as analysts of qualitative data in a process evaluation. Design: Patients and researchers co-analysed qualitative data. A framework method was applied involving; familiarisation, coding, developing an analytical framework and interpretation. The process was facilitated through home working and a workshop with a training component. Results: The co-designed framework enabled researchers to map all further patient interview data. Patients' specialist knowledge enhanced understanding of how the ISCOMAT intervention can be best implemented. Conclusions: Patients’ unique experiences can enhance validity and rigour in data analysis through sharing their interpretations of qualitative data. The involvement process is crucial in elucidating knowledge and avoiding tokenism. As analysts, patients gain an appreciation of research processes, building trust between researchers and patients. Group dynamics and involving patients throughout the whole research process are important considerations. / NIHR Grant RP-PG-0514-20009. NIHR Yorkshire and Humber Patient Safety Translational Research Centre.

Yes / This qualitative study was designed to understand the impact of social distancing measures on people with dementia and carers living in the community in England and Wales during a period of social restrictions before the COVID-19 vaccination roll-out. We conducted 12 semi-structured interviews with people with dementia aged 50-88 years, living alone or with a partner, and 10 carers aged 61-78 years, all living with the person with dementia. Three of the interviews were with dyads. Participants were recruited during November and December 2020. We used framework analysis to identify themes and elicit suggestions for potential solutions. We identified three interrelated themes. People with dementia experienced a fear of decline in capabilities or mood and attempted to mitigate this. Carers noticed changes in the person with dementia and increased caring responsibilities, and for some, a change in the relationship. Subsequently, reduced confidence in capabilities to navigate a new and hostile environment created a cyclical dilemma of re-engaging where an inability to access usual activities made things worse. People with dementia and carers experienced neglect and being alone in their struggle, alongside feeling socially excluded during the pandemic, and there was little optimism associated with the upcoming vaccine programme. People found their own solutions to reduce the effects of isolation by keeping busy and being socially active, and practising skills deemed to help reduce the progression of dementia. This and some limited local public initiatives for the general public facilitated feelings of social inclusion. This study adds understanding to existing evidence about the longer-term experience of social isolation several months into the pandemic. It highlights the importance of health and community groups and suggests how services can find ways to support, include, and interact with people with dementia and carers during and after social restrictions. / Economic and Social Research Council. Grant Numbers: ES/V004964/1, L001853, V004964. National Institute for Health and Care Research. Grant Number: ES/L001853/2. Department of Health. UK Research and Innovation. Health and Care Research Wales

Yes / There is a growing evidence base that identifying positive experiences in providing care can have a beneficial influence on carer wellbeing. However, there is a need to better understand what carers identify as the positive aspects of care-giving. The aim of this study is to explore the satisfying aspects of providing care to people with dementia. This study utilised Time 1 data from 1,277 carers of people in the mild-to-moderate stages of dementia taking part in the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort study. Responses from 900 carers who answered the open-ended question ‘What is your greatest satisfaction in caring for your relative/friend?’ were analysed using thematic analysis. From the responses, 839 carers detailed satisfactions. Eight themes were identified, pertaining to three groups of beneficiaries: carers, people with dementia and the dyad. Perceived benefits for carers included identifying aspects of personal growth, seeing glimpses of the person, feeling they were making a difference and doing their duty. For the person with dementia, these included retaining independence, receiving good quality care and being happy. Dyadic benefits concerned the continuation of the relationship between carer and person with dementia. The findings highlight the need to take a dyadic approach when conceptualising positive experiences in providing care. Further research is needed to understand the role these positive experiences play and to develop interventions. Professionals working with carers should identify and validate these experiences. / ‘Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study’ was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) (grant number ES/L001853/2); ‘Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study’ is funded by the Alzheimer's Society (grant number 348, AS-PR2-16-001)