Displaying all 18 publications

  1. Swarna Nantha Y, Haque S, Paul Chelliah AA, Md Zain AZ, Kim Yen G
    J Prim Care Community Health, 2020 2 6;11:2150132719900710.
    PMID: 32009509 DOI: 10.1177/2150132719900710
    Background: There has been an unabated rise in the prevalence of type 2 diabetes (T2D) worldwide. Although T2D is highly preventable, these trends suggest that a paradigm change is much needed in the way both clinicians and policy makers view what effective T2D strategies conventionally entail. Hence, it is becoming increasingly clear that T2D patients require more than just a pharmacological approach to their disease. Evidence indicate that culturally specific mediators can help foster better self-management practices. We intend to discover psychosocial mediators that influence and support self-management beliefs in T2D patients. Methods: We adopted the grounded theory approach to guide in-depth interviews with T2D patients and health care professionals (HCP) at a regional primary care clinic in Malaysia. Twenty-four T2D patients and 10 HCPs were recruited through purposive sampling method to examine the inner psychological narratives about how they perceive and what they believe beliefs about the disease. Two focus group discussions were also were conducted for data triangulation. Results: A functional framework for the psychosocial mediators influencing self-management beliefs in T2D patients was designed and characterized by 4 major processes: (1) health promotion, (2) personal expectations, (3) person-centered care, and (4) psychosocial support. The fulfillment of patients' personal expectations is central to better self-management beliefs. Conclusions: Positive emotional states are important in providing a positive environment to nurture self-management practices. A person-centered consultation that focuses on empathy and cultural sensitivities has the potential to foster behavioral change required to sustain self-care practices.
    Matched MeSH terms: Grounded Theory
  2. Cathrine Binti Masingan, Sabariah Bte Sharif
    Kajian ini bertujuan untuk meneroka kefahaman Pengetahuan Pedagogi Kandungan (PPK) guru bukan pengkhususan mata pelajaran Reka Bentuk dan Teknologi (RBT) di Sekolah Menengah. Kajian ini adalah kajian kualitatif single case yang melibatkan dua orang guru bukan pengkhususan mata pelajaran RBT dipilih sebagai peserta kajian. Pengumpulan data menggunakan kaedah temu bual, pemerhatian dan juga analisis dokumen. Proses analisis data melibatkan tiga peringkat koding dalam Grounded Theory iaitu open coding, axial coding dan selective coding. Hasil kajian mendapati kedua peserta belum memahami dan menguasai sepenuhnya hala tuju, matlamat dan fokus KSSM RBT. Selain itu, mereka juga masih menghadapi masalah dalam menguasai isi kandungan mata pelajaran tersebut dengan baik. Dari aspek pengetahuan pedagogi, walaupun peserta kajian sedar tentang pendekatan-pendekatan PdPc yang dicadangkan dalam DSKP KSSM mata pelajaran RBT, namun mereka kurang menggunakan pendekatan tersebut dan masih cenderung menggunakan pendekatan pengajaran tradisional yang lebih berpusatkan kepada guru dan menggunakan kaedah syarahan semasa proses PdPc.
    Matched MeSH terms: Grounded Theory
  3. Vijayasingham L, Jogulu U, Allotey P
    Soc Sci Med, 2020 01;245:112699.
    PMID: 31785425 DOI: 10.1016/j.socscimed.2019.112699
    Reports of work change and transitions are common amongst individuals with chronic illnesses such as multiple sclerosis (MS). However, there is little research on the lived experience of these work transitions. The scarcity of this research is particularly evident within low-and-middle-income countries, where protection laws and resources such as anti-discrimination laws and reasonable work modifications may not exist or be well enforced. In this paper, we explore how and why individuals with MS seek and achieve work transitions in the structural context of Malaysia. We interviewed ten working individuals with MS (July-december 2015) using a joint hermeneutic phenomenology and constructivist grounded theory approach. Using a broad conceptual lens of 'sustainable careers', we examine their careers as a series of experiences, decisions, and events, paying attention to the influences of context, time, their personal levels of agency and sense of meaning. Participants described work transitions as early as within the first year of diagnosis, that were prompted by voluntary, involuntary and semi-voluntary reasons. Key aspects of the process of seeking new roles included an exploration of alternative roles and paths, and then acquiring, trialing/adapting and remaining engaged in their new roles. Participants identified the perception and experience of 'being unemployable', based on how their diagnosis and short-term symptoms were responded to by employers. Nevertheless, participants used various strategies and career resources to obtain and maintain meaningful work roles. However, success in obtaining or maintaining new roles were not equally achieved. This research draws attention to the cumulative economic disadvantage of a chronic illness diagnosis, even at milder and episodic stages. Furthermore, it reiterates the need for cohesive structural protection in low-and-middle-income countries to facilitate a more equal ability to remain economically resilient and capable of engaging in meaningful long-term careers when living with a chronic illness.
    Matched MeSH terms: Grounded Theory
  4. Swarna Nantha Y, Chelliah AAP, Haque S, Md Zain AZ
    PLoS One, 2021;16(4):e0249620.
    PMID: 33848301 DOI: 10.1371/journal.pone.0249620
    BACKGROUND: A paradigm shift in the disease management of type 2 diabetes is urgently needed to stem the escalating trends seen worldwide. A "glucocentric" approach to diabetes management is no longer considered a viable option. Qualitative strategies have the potential to unearth the internal psychological attributes seen in people living with diabetes that are crucial to the sustenance of self-management behaviour. This study aims to identify and categorize the innate psychological dispositions seen in people with type 2 diabetes in relation to self-management behaviour.

    METHODS: We adopted a grounded theory approach to guide in-depth interviews of individuals with type 2 diabetes and healthcare professionals (HCP) at a regional primary care clinic in Malaysia. Twenty-four people with type 2 diabetes and 10 HCPs were recruited into the study to examine the inner narratives about disease management. Two focus group discussions (FGD) were also conducted for data triangulation.

    RESULTS: Participants' internal dialogue about the management of their disease is characterized by 2 major processes- 1) positive disposition and 2) negative disposition. Optimism, insight, and awareness are important positive values that influence T2D self-care practices. On the other hand, constructs such as stigma, worries, reservations, and pessimism connote negative dispositions that undermine the motivation to follow through disease management in individuals with type 2 diabetes.

    CONCLUSIONS: We identified a contrasting spectrum of both constructive and undesirable behavioural factors that influence the 'internal environment' of people with type 2 diabetes. These results coincide with the constructs presented in other well-established health belief theories that could lead to novel behavioural change interventions. Furthermore, these findings allow the implementation of psychosocial changes that are in line with cultural sensitivities and societal norms seen in a specific community.

    Matched MeSH terms: Grounded Theory*
  5. Mortell, Manfred, Khatijah L. Abdullah, Chean Ahmad, Al Mutair, Adel F.M.
    Introduction: Patient advocacy is a central concept for the profession of nursing as it assures patient rights and safety. This article presents the findings from a study which explored the perceptions of patient advocacy from Muslim ICU nurses. Methods and participants: Our study utilized a constructivist grounded theory approach. Thirteen registered intensive care nurses from an adult critical care setting in a tertiary academic teaching hospital in Riyadh, Saudi Arabia, participated in the study. The researcher employed semi-structured interviews that were digitally recorded and transcribed verbatim, with an additional data collection strategy of reflective journaling. A reflective journal was provided to all study participants following each interview. Results: The study generated codes which connected to vulnerable patients, and subsequently identified a core category of “Caring critically” which was exemplified by six additional inter-related advocacy categories of “Essential caring”; “Vulnerable-acy”; “Familial-acy”; “Cultural-acy”; “Religion-acy”; and “Human-acy”. These categories generated the model for patient advocacy. Conclusion: The pyramid of patient advocacy can be applied in clinical practice to guide Muslim nurses, in addition to being utilized in the educational setting as a standard to teach registered nurses about the role and responsibilities of a patient advocate.
    Matched MeSH terms: Grounded Theory
  6. Ilias K, Cornish K, Park MS, Toran H, Golden KJ
    Front Psychol, 2018;9:2275.
    PMID: 30670992 DOI: 10.3389/fpsyg.2018.02275
    Little is known about the coping and resilience experiences of parents of children with autism spectrum disorder (ASD) in the Malaysian cultural context. This study utilized a qualitative methodological approach adopting constructive grounded theory. The study sought to address the lack of research to date exploring the risk and protective experiences that contribute to parental stress and resilience for parents of primary school age children with ASD in the Malaysian setting. Twenty-two parents of children with ASD (13 mothers and 9 fathers) participated in semi-structured interviews. A strength of the study was the inclusion of both mother and father participant perspectives. The interviews lasted 50-80 min (mean: 67.5 min). The 22 parents had a total of 16 children (12 males; 4 females) formally diagnosed with ASD. Child age ranged between 5 and 12 years (mean age: 8.44). Overall, analysis of the 22 interviews revealed four prominent themes - "initial reaction to child's ASD symptoms and diagnosis," "family life affected by a child with ASD," "awareness about ASD in Malaysia," and "coping strategies, wellbeing, and becoming resilient." The first three themes revolved around stress and adversity, and, the adaptabilityandacceptance of the parents. These processes illustrated the risks experienced by the parents of children with ASD in Malaysia. The last theme especially highlighted the strengths and determination of the parents and illustrated the protective experiences and processes that helped parents to develop and enhance resilience. Overall, the findings revealed that resilience develops synergistically and dynamically from both risk and protective experiences across different levels - individual, family, community, society and government. The findings motivated the development of our theoretical model of resilience that can help health and education professionals tailor assessment and interventions for parents of children with ASD in the Malaysian context. Clinical, policy, and research suggestions were discussed.
    Matched MeSH terms: Grounded Theory
    The learning curve for doing a good qualitative study is steep because qualitative methodologies are often vague and lack explicit steps. We detail the formulation of the grounded theory approach in a study of patients with type 2 diabetes mellitus who made decisions while strategizing their treatment types. This undertaking is to demonstrate how this systematic and yet flexible methods contributed to the understanding of the issue we were investigating. The process from deciding on research objectives and research questions, follow with systematic process for data collection and analysis allows us to generate a substantive theoretical model. By paying critical attention to theoretical saturation, grounded theory approach enabled us to construct all possible explanatory concepts related to decision making in strategizing diabetes treatment. We also describe the challenges throughout the whole research journey, including getting permission to interview patients, gaining the trust of research participants and staying open to the participants’ views.
    Matched MeSH terms: Grounded Theory
  8. Hasan H, Parker A, Pollard SJT
    Sci Total Environ, 2021 Feb 10;755(Pt 1):142868.
    PMID: 33348485 DOI: 10.1016/j.scitotenv.2020.142868
    We explore the interplay between preventative risk management and regulatory style for the implementation of water safety plans in Malaysia and in England and Wales, two jurisdictions with distinct philosophies of approach. Semi-structured interviews were conducted with 32 water safety professionals in Malaysia, 23 in England and Wales, supported by 6 Focus Group Discussions (n = 53 participants). A grounded theory approach produced insights on the transition from drinking water quality surveillance to preventative risk management. Themes familiar to this type of regulatory transition emerged, including concerns about compliance policy; overseeing the risk management controls of regulatees with varied competencies and funds available to drive change; and the portfolio of interventions suited to a more facilitative regulatory style. Because the potential harm from waterborne illness is high where pathogen exposures occur, the transition to risk-informed regulation demands mature organisational cultures among water utilities and regulators, and a laser-like focus on ensuring risk management controls are delivered within water supply systems.
    Matched MeSH terms: Grounded Theory
  9. Ramdzan SN, Khoo EM, Liew SM, Cunningham S, Kendall M, Sukri N, et al.
    Arch Dis Child, 2020 09;105(9):819-824.
    PMID: 32620567 DOI: 10.1136/archdischild-2019-318127
    OBJECTIVE: We aimed to explore the views of Malaysian children with asthma and their parents to enhance understanding of early influences on development of self-management skills.

    DESIGN: This is a qualitative study conducted among children with asthma and their parents. We used purposive sampling and conducted focus groups and interviews using a semi-structured topic guide in the participants' preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo and analysed using a grounded theory approach.

    SETTINGS: We identified children aged 7-12 years with parent-reported, physician-diagnosed asthma from seven suburban primary schools in Malaysia. Focus groups and interviews were conducted either at schools or a health centre.

    RESULTS: Ninety-nine participants (46 caregivers, 53 children) contributed to 24 focus groups and 6 individual interviews. Children mirrored their parents' management of asthma but, in parallel, learnt and gained confidence to independently self-manage asthma from their own experiences and self-experimentation. Increasing independence was more apparent in children aged 10 years and above. Cultural norms and beliefs influenced children's independence to self-manage asthma either directly or indirectly through their social network. External influences, for example, support from school and healthcare, also played a role in the transition.

    CONCLUSION: Children learnt the skills to self-manage asthma as early as 7 years old with growing independence from the age of 10 years. Healthcare professionals should use child-centred approach and involve schools to facilitate asthma self-management and support a smooth transition to independent self-management.

    TRIAL REGISTRATION NUMBER: Malaysian National Medical Research Register (NMRR-15-1242-26898).

    Matched MeSH terms: Grounded Theory
  10. Zakaria N, Mat Akhir NS
    J Relig Health, 2017 Apr;56(2):507-520.
    PMID: 27145944 DOI: 10.1007/s10943-016-0246-3
    Some Malaysian scholars believe that the theoretical basis and models of intervention in Islamic counseling practices in Malaysia are deficient and not eminently identified. This study investigated and describes the nature of current Islamic counseling practices including the theories and modules of Islamic counseling that are been practiced in Malaysia. This qualitative research has employed data that mainly consist of texts gathered from literatures and semi-structured interviews of 18 informants. It employed grounded theory analysis, and the result shows that most of the practitioners had applied integrated conventional counseling theories with Islamic rituals, references, interventions and ethics. Some had also applied Islamic theories and modules formulated in Malaysia such as iCBT, al-Ghazali counseling theories, Cognitive ad-Deen, KBJ, Prophetic Counseling and Asma Allah al-Husna Counseling Therapy.
    Matched MeSH terms: Grounded Theory
  11. Low LL, Tong SF, Low WY
    PLoS One, 2016;11(1):e0147127.
    PMID: 26812053 DOI: 10.1371/journal.pone.0147127
    BACKGROUND: Diabetes Mellitus is a multifaceted chronic illness and its life-long treatment process requires patients to continuously engage with the healthcare system. The understanding of how patients manoeuvre through the healthcare system for treatment is crucial in assisting them to optimise their disease management. This study aims to explore issues determining patients' treatment strategies and the process of patients manoeuvring through the current healthcare system in selecting their choice of treatment for T2DM.

    METHODS: The Grounded Theory methodology was used. Twelve patients with Type 2 Diabetes Mellitus, nine family members and five healthcare providers from the primary care clinics were interviewed using a semi-structured interview guide. Three focus group discussions were conducted among thirteen healthcare providers from public primary care clinics. Both purposive and theoretical samplings were used for data collection. The interviews were audio-taped and transcribed verbatim, followed by line-by-line coding and constant comparison to identify the categories and core category.

    RESULTS: The concept of "experimentation" was observed in patients' help-seeking behaviour. The "experimentation" process required triggers, followed by information seeking related to treatment characteristics from trusted family members, friends and healthcare providers to enable decisions to be made on the choice of treatment modalities. The whole process was dynamic and iterative through interaction with the healthcare system. The decision-making process in choosing the types of treatment was complex with an element of trial-and-error. The anchor of this process was the desire to fulfil the patient's expected outcome.

    CONCLUSION: Patients with Type 2 Diabetes Mellitus continuously used "experimentation" in their treatment strategies and help-seeking process. The "experimentation" process was experiential, with continuous evaluation, information seeking and decision-making tinged with the element of trial-and-error. The theoretical model generated from this study is abstract, is believed to have a broad applicability to other diseases, may be applied at varying stages of disease development and is non-context specific.
    Matched MeSH terms: Grounded Theory
  12. Tong SF, Ng CJ, Lee VKM, Lee PY, Ismail IZ, Khoo EM, et al.
    PLoS One, 2018;13(4):e0196379.
    PMID: 29694439 DOI: 10.1371/journal.pone.0196379
    INTRODUCTION: The participation of general practitioners (GPs) in primary care research is variable and often poor. We aimed to develop a substantive and empirical theoretical framework to explain GPs' decision-making process to participate in research.
    METHODS: We used the grounded theory approach to construct a substantive theory to explain the decision-making process of GPs to participate in research activities. Five in-depth interviews and four focus group discussions were conducted among 21 GPs. Purposeful sampling followed by theoretical sampling were used to attempt saturation of the core category. Data were collected using semi-structured open-ended questions. Interviews were recorded, transcribed verbatim and checked prior to analysis. Open line-by-line coding followed by focus coding were used to arrive at a substantive theory. Memoing was used to help bring concepts to higher abstract levels.
    RESULTS: The GPs' decision to participate in research was attributed to their inner drive and appreciation for primary care research and their confidence in managing their social and research environments. The drive and appreciation for research motivated the GPs to undergo research training to enhance their research knowledge, skills and confidence. However, the critical step in the GPs' decision to participate in research was their ability to align their research agenda with priorities in their social environment, which included personal life goals, clinical practice and organisational culture. Perceived support for research, such as funding and technical expertise, facilitated the GPs' participation in research. In addition, prior experiences participating in research also influenced the GPs' confidence in taking part in future research.
    CONCLUSIONS: The key to GPs deciding to participate in research is whether the research agenda aligns with the priorities in their social environment. Therefore, research training is important, but should be included in further measures and should comply with GPs' social environments and research support.
    Matched MeSH terms: Grounded Theory
  13. Swarna Nantha Y, Haque S, Swarna Nantha H
    Fam Pract, 2019 10 08;36(5):581-586.
    PMID: 30534941 DOI: 10.1093/fampra/cmy119
    BACKGROUND: There has been a shift in worldwide disease burden from infections to non-communicable diseases, especially type 2 diabetes (T2D). Behavioural change and self-management are key to optimal T2D control. Several universal models of diabetic care have been proposed to help explain the dimensions of T2D self-care such as medication adherence, physical activity, diet and patient-doctor interaction. These models do not allow an objective and quantifiable measurement of the problems faced by patients in terms of medication compliance.

    OBJECTIVE: To create a comprehensive conceptual model of behavioural change related to T2D medication compliance.

    METHODS: A cross-sectional study will be conducted at a regional primary care clinic using a mixed-method technique. First, a Grounded Theory qualitative inquiry will be used to investigate predictors of medication adherence in T2D patients. Consequently, the elements derived from the interview will be incorporated into the Theory of Planned Behaviour framework to generate an integrated behavioural model. This model will then be used to quantify the factors related to compliance with medication amongst T2D patients.

    DISCUSSION: The framework developed here could help in the design of policies to optimize T2D control by identifying lapses in patients' intake of diabetic medications. This can be done by exploring the patients' fundamental and unarticulated belief system via a naturalistic approach adopted in this study. The properties of the framework can be replicated in other settings to serve as a benchmark for quality improvement in T2D patient care.

    Matched MeSH terms: Grounded Theory
  14. Dai J, Zulkefli NF, Moy FM, Keene D, Humphries D
    Curr Dev Nutr, 2019 Jun;3(Suppl 1).
    PMID: 31224508 DOI: 10.1093/cdn/nzz034.P10-024-19
    Objectives: Malaysia is currently experiencing the nutrition transition, with an increased consumption of refined carbohydrates and fats paralleling an increase in prevalence of obesity and chronic disease. These dietary changes have occurred despite 90% of urban women reporting awareness of the health risks posed by obesity. This study sought to characterize how working women, an understudied population at risk for diet-related chronic disease, navigate food decisions. As Malaysia is a multiethnic nation, we aimed to explore the sociocultural determinants of eating behavior in this unique population.

    Methods: A purposive design in combination with a convenience sampling approach was used to recruit 24 women ages 26 to 55 of Malay, Indian, and Chinese descent across 15 university departments in Kuala Lumpur, Malaysia. Audio recordings of the individual semi-structured interviews were transcribed and analyzed using grounded theory.

    Results: Women identified two important life transitions, getting married and having children, as particularly influential in changing eating behavior. Women reported a desire to eat healthier that was in tension with pressures to cater to the taste preferences of their household members and to accommodate their work schedules. Persistent social norms of eating in group settings and difficulty in accessing foods perceived as nutritious were reported as barriers to changing individual eating behavior. Regardless of education level and marital status, women agreed that the act of eating was closely connected with cultural values and embodied important meanings that took precedence over eating as a health-promoting behavior. While all participants expressed a desire to eat healthier, many reported limited confidence in their ability to consistently give up familiar and tasty foods for healthier alternatives. Shifts in eating behavior such as trying new healthy recipes and adopting a more restrictive diet were reported as most feasible and personally applicable after learning about a family member's declining health.

    Conclusions: In this urban, multiethnic population, increasing the accessibility of nutritious foods and changing cultural perceptions of the relationship between food and nutrition may be important for enabling healthy eating behaviors.

    Funding Sources: Yale Sustainable Food Program, Yale School of Public Health.

    Matched MeSH terms: Grounded Theory
  15. Swarna Nantha Y, Chelliah AAP, Haque S, Yen GK, Md Zain AZ
    PLoS One, 2021;16(1):e0245041.
    PMID: 33444368 DOI: 10.1371/journal.pone.0245041
    BACKGROUND: Qualitative strategies can uncover the relationship between the external realities of people living with type 2 diabetes (T2D) and the barriers that are associated with disease self-management. Information from in-depth interviews (IDI) and focus group discussions (FGD) can be used to devise psychological models that could potentially facilitate behaviour changes in people with T2D. We aim to identify salient factors that govern the external realities of people with T2D in relation to disease management.

    METHODS: A qualitative study was conducted at a regional primary care clinic in Malaysia using a Grounded Theory Approach. People with T2D were recruited through purposeful sampling to determine their living experiences with the disease. A total of 34 IDIs with 24 people with T2D and 10 health care professionals, followed by two FGDs with people with T2D, were conducted.

    RESULTS: Three major processes that arbitrate self-management practices include- 1) external reality, 2) internal reality, 3) mediators of behaviour. Within the context of external reality, three important sub-themes were identified-intrinsic background status, personal experience, and worldview. Lifestyle habits of persons with T2D play a central role in their disease management. Another common recurring concern is the issue of a low-quality food environment in the country. More importantly, individuals with T2D have a high degree of expectations for a more person-centered approach to their illness.

    CONCLUSIONS: We identified modifiable and non-modifiable behavioural factors that influence the daily living environment of people with T2D. This information can be used to customize the management of T2D through targeted behavioural interventions.

    Matched MeSH terms: Grounded Theory
  16. Tan MPC, Kwan SSM, Yahaya A, Maakip I, Voo P
    J Occup Health, 2020 Jan;62(1):e12192.
    PMID: 33368878 DOI: 10.1002/1348-9585.12192
    OBJECTIVES: Workplace sexual harassment is a prominent issue in Malaysia. Although the subject of sexual harassment has been researched for over two decades, information on how organizations could effectively prevent workplace sexual harassment is limited. The researchers investigated the importance of organizational climate for psychosocial safety of workplace sexual harassment prevention.

    METHODS: Purposive random sampling was utilized to recruit participants in the study. Semi-structured interviews were then conducted with Malaysian employees (N = 20) from various organizations. The study applied the Grounded Theory Approach (Glaser & Strauss, 1976) to identify the participants' coping strategies in dealing with sexual harassment that occurred at their workplace.

    RESULTS: The interviews revealed that both genders were potential victims or witnesses of workplace sexual harassment. Since many Malaysian organizations do not implement any workplace sexual harassment prevention, most of the victims and witnesses tend to use passive self-coping approaches. Typically, policy and guidelines implementation would encourage employees to voice their concerns; however, we discovered that participants' motivation to use active coping strategies depended on organizational role rather than the policy and guidelines implementation. Surprisingly, we also found out that participants from zero policy organizations used active coping strategies when the sexual harassment reached intolerable levels.

    CONCLUSION: Organizations play a critical role in helping and supporting both victims and witnesses deal with sexual harassment at the workplace. Organizational climate for psychosocial safety is therefore crucial in the primary and secondary prevention of sexual harassment at work.

    Matched MeSH terms: Grounded Theory
  17. Aborigo RA, Allotey P, Reidpath DD
    Soc Sci Med, 2015 May;133:59-66.
    PMID: 25841096 DOI: 10.1016/j.socscimed.2015.03.046
    Traditional medical systems in low income countries remain the first line service of choice, particularly for rural communities. Although the role of traditional birth attendants (TBAs) is recognised in many primary health care systems in low income countries, other types of traditional practitioners have had less traction. We explored the role played by traditional healers in northern Ghana in managing pregnancy-related complications and examined their relevance to current initiatives to reduce maternal morbidity and mortality. A grounded theory qualitative approach was employed. Twenty focus group discussions were conducted with TBAs and 19 in-depth interviews with traditional healers with expertise in managing obstetric complications. Traditional healers are extensively consulted to manage obstetric complications within their communities. Their clientele includes families who for either reasons of access or traditional beliefs, will not use modern health care providers, or those who shop across multiple health systems. The traditional practitioners claim expertise in a range of complications that are related to witchcraft and other culturally defined syndromes; conditions for which modern health care providers are believed to lack expertise. Most healers expressed a willingness to work with the formal health services because they had unique knowledge, skills and the trust of the community. However this would require a stronger acknowledgement and integration within safe motherhood programs.
    Matched MeSH terms: Grounded Theory
  18. Bojko MJ, Mazhnaya A, Marcus R, Makarenko I, Islam Z, Filippovych S, et al.
    J Subst Abuse Treat, 2016 07;66:37-47.
    PMID: 27211995 DOI: 10.1016/j.jsat.2016.03.003
    Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February to April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers.
    Matched MeSH terms: Grounded Theory
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