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Lower respiratory tract illnesses (LRT-illnesses) in children under 5 years (U5s) are a leading cause of morbidity, hospitalisations and mortality worldwide, particularly in low-income countries. It is pertinent to understand possible inconsistent management. This study explored perceptions and practices among caregivers and health professionals on recurrent LRT-illnesses in U5s. Semi-structured interviews with 13 caregivers to U5s with recurrent LRT-illnesses and with 22 primary care health professional interviews in two rural provinces in Kyrgyzstan were triangulated. Data were thematically analysed. The majority (8/13) of caregivers described their young children as having recurrent coughing, noisy breathing and respiratory distress of whom several had responded positively to acute salbutamol and/or had been repeatedly hospitalised for LRT-illness. Family stress and financial burdens were significant. The health professionals classified young children with recurrent LRT-illnesses primarily with pneumonia and/or a multitude of bronchitis diagnoses. Broad-spectrum antibiotics and supportive medicine were used repeatedly, prescribed by health professionals or purchased un-prescribed by the caregivers at the pharmacy. The health professionals had never applied the asthma diagnosis to U5s nor had they prescribed inhaled steroids, and none of the interviewed caregivers' U5s were diagnosed with asthma. Health professionals and caregivers shared a common concern for the children's recurrent respiratory illnesses developing into a severe chronic pulmonary condition, including asthma. In conclusion, the study identified an inconsistent management of LRT-illnesses in U5s, with exorbitant use of antibiotics and an apparently systemic under-diagnosis of asthma/wheeze. When the diagnosis asthma is not used, the illness is not considered as a long-term condition, requiring preventer/controller medication.

Qualitative methodology is gaining increasing attention and esteem in medical research, with general practice research taking a lead. With these methods, human and social interaction and meaning can be explored and shared by systematic interpretation of text from talk, observation or video. Qualitative studies are often included in Ph.D. theses from general practice in Scandinavia. Still, the Ph.D. programs across nations and institutions offer only limited training in qualitative methods. In this opinion article, we draw upon our observations and experiences, unpacking and reflecting upon values and challenges at stake when qualitative studies are included in Ph.D. theses. Hypotheses to explain these observations are presented, followed by suggestions for standards of evaluation and improvement of Ph.D. programs. The authors conclude that multimethod Ph.D. theses should be encouraged in general practice research, in order to offer future researchers an appropriate toolbox.

Background: Vision impairment can have an impact on cognition, health, and social function. Vision loss may be avoided if detected early and treated promptly. Eye health is a minor topic in general practice, but the ongoing relationship between doctor and patient has the potential to assist the patient in navigating the healthcare system and guaranteeing timely healthcare service delivery. Aim: To explore the attitudes of older members of the public (aged =60 years) towards navigating primary sector eye health care in Denmark, with a focus on optometrists, practising ophthalmologists (POs), and GPs. Design & setting: Qualitative study in Copenhagen, Denmark. Method: Focus group interviews were performed in the spring of 2022 with 21 older members of the public. Results: Older members of the public perceived optometrists and POs to be the most relevant health professionals to consult about eye health. Opportunities were identified for enhancing the function of general practice including detecting early signs of visual impairment, being in charge of further referrals, and managing issues affecting quality of life such as dry eyes. Conclusion: Older members of the public sought help from health professionals who are directly qualified to treat symptoms of vision impairment that patients are experiencing or expect to face in the near future. Participants identified a potential for GPs to address vision impairment. This included focusing on the patient's general health and function, as well as potential comorbidities influencing treatment trajectories. The current denigration of general practice risks missing out on the potential benefits of robust engagement from general practice in eye health. [ABSTRACT FROM AUTHOR]

Background: Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties. Methods: We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group. Results: GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations. Conclusion: The GPs' interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group. [ABSTRACT FROM AUTHOR]

Objectives: Adherence to treatment has proven to require the involvement of patients in treatment and care planning. This process involves incorporating patient knowledge, or knowledge about the patients' everyday life, into the clinical encounter. This article explores the disclosure practices of such knowledge from older adults with multimorbidity. Methods: This was an 18-month qualitative study among 14 older adults with multimorbidity living in Denmark. A thematic analysis was applied, focusing on perceptions of patient knowledge and disclosure practices among the participating patients. Results: Older adults with multimorbidity have various reasons for not disclosing personal knowledge. The results present three different domains of what we termed discarded patient knowledge: (1) knowledge that had no direct biomedical relevance from participants' perspective; (2) knowledge considered too private; and (3) knowledge assumed to position one as inferior. Discussion: The participants made judgments on what they believed was welcome in the clinical encounter, framing their knowledge within the purview of biomedicine. Participants' disclosure practices showed that personal knowledge is sometimes not recognized as important for health and care by participants themselves. Knowledge that could have influenced practitioners' understanding of the problem and provided different solutions, is argued to be discarded patient knowledge. [ABSTRACT FROM AUTHOR]

Objectives Research on successful aging gives limited attention to the role of suffering from multiple chronic conditions (multimorbidity) in combination with notions of masculinity. We address this by bringing into focus how older men with multimorbidity within the Nordic Model welfare system relate to successful aging. The objective is to bring new insights into key elements of how masculinity, multimorbidity and cultural context create alternative individual versions of successful aging. Method The article draws on a long-term fieldwork (18 months) among older men (n=7), who were part of a larger study that also included older women. The fieldwork consisted of 28 interviews with participating men. These data were supplemented by 124 hr of informal chats and observations as well as 32 hr of clinical encounters with health services. Data analysis followed a thematic approach. Results Analysis revealed that older men with multimorbidity understood core components of successful aging, yet did not closely follow them, and instead came up with alternative, gendered interpretations. This process involved three themes centered around independency of: (a) unaided successful aging, (b) vicarious successful aging, and (c) masculine successful aging. Discussion Our study contributes to research on perceptions of successful aging with insights to the role of cultural context, gender and multimorbidity. Living with multimorbidity challenges the ability of the men to positively frame themselves as successfully aging older adults; however, they navigate this dilemma by constructing their own experiences in their own terms of independence. [ABSTRACT FROM AUTHOR]

Assessing and managing risk are central to participation in preventive health checks, as the purpose is to identify adverse health behaviours and risk factors. Drawing on the cultural theory of risk, we explore why people without formal education participate in preventive health checks and discuss how this is related to their understandings of risk and health. With this aim, we conducted semi-structured qualitative interviews with people without formal education who participated in the intervention study Check-in. Check-in evaluated the effect of an invitation of people aged 45–64 without formal education beyond lower secondary school (grades 7–9) to a prescheduled preventive health check in general practice. In this way, Check-in provided the empirical context of this study. Within our analysis we identified four participation styles representing different ways of participating in preventive health checks: 1) selective participation, 2) participation to control uncertainty, 3) feeling an obligation to participate and 4) participation to change the healthcare system. Across the participation styles, we found that participants attended the preventive health check for reasons other than getting help to change their health behaviour and that the accounts of participation were socially embedded. Participants ascribed and assessed risk and health in relation to their immediate network and everyday lives and thereby presented risk perceptions differently from the general preventive messages. From these findings we suggest that preventive health checks should be based on participants' context-dependent needs. [ABSTRACT FROM AUTHOR]

Objective:Little is known about how strategies of retaining patients are acted out by general practitioners (GPs) in the clinical encounter. With this study, we apply Grimens’ (2009) analytical connection between trust and power to explore how trust and power appear in preventive health checks from the GPs’ perspectives, and in what way trust and power affect and/or challenge strategies towards retaining patients without formal education. Design:Data in this study were obtained through semi-structured interviews with GPs participating in an intervention project, as well as observations of clinical encounters. Results:From the empirical data, we identified three dimensions of respect: respect for the patient’s autonomy, respect for professional authority and respect as a mutual exchange. A balance of respect influenced trust in the relationship between GP and patients and the transfer of power in the encounter. The GPs articulated that a balance was needed in preventive health checks in order to establish trust and thus retain the patient in the clinic. One way this balance of respect was carried out was with the use of humour. Conclusions:To retain patients without formal education in the clinical encounter, the GPs balanced trust and power executed through three dimensions of respect. In this study, retaining patients was equivalent to maintaining a trusting relationship. A strategic use of the three dimensions of respect was applied to balance trust and power and thus build or maintain a trusting relationship with patients.KEY POINTS  Little is known about how strategies for retaining patients are acted out by GPs in preventive health checks. •  Retaining patients requires a balance of trust and power, which is executed through three dimensions of respect by the GPs. •  Challenges of recruiting and retaining patients in public health initiatives might be associated with the balance of respect. [ABSTRACT FROM PUBLISHER]

Quality standards play an increasingly important role in primary care through their inscription in various technologies for improving professional practice. While 'hard' biomedical standards have been the most common and debated, current quality development initiatives increasingly seek to include standards for the 'softer' aspects of care. This article explores the consequences of both kinds of quality standards for chronic care consultations. The article presents findings from an explorative qualitative field study in Danish general practice where a standardized technology for quality development has been introduced. Data from semi-structured interviews and observations among 17 general practitioners were analysed using an iterative analytical approach, which served to identify important variations in the uses and impacts of the technology. The most pronounced impact of the technology was observed among general practitioners who strictly adhered to the procedural standards on the interactional aspects of care. Thus, when allowed to function as an overall frame for consultations, those standards supported adherence to general recommendations regarding which elements to be included in chronic disease consultations. However, at the same time, adherence to those standards was observed to narrow the focus of doctor-patient dialogues and to divert general practitioners' attention from patients' personal concerns. Similar consequences of quality standards have previously been framed as manifestations of an inherent conflict between principles of patient-centredness and formal biomedical quality standards. However, this study suggests that standards on the 'softer' aspects of care may just as well interfere with a clinical approach relying on situated and attentive interactions with patients. [ABSTRACT FROM AUTHOR]

Objective.The aim of this study is to analyse the interaction between patients and GPs in preventive consultations with an emphasis on how patients answer GPs’ questions about lifestyle, and the conditions these answers impose on the process of establishing agreement about lifestyle as a problem or not.Design.Six general practitioners (GPs) video-recorded 15 annual preventive consultations. From these, 32 excerpts of discussions about lifestyle were analysed using conversation analysis (CA).Results.GPs used an interview format to assess risk in patients’ lifestyles. In some cases patients adhered to this format and answered the GPs’ questions, but in many cases patients gave what we have termed “anticipatory answers”. These answers indicate that the patients anticipate a response from their GPs that would highlight problems with their lifestyle. Typically, in an anticipatory answer, patients bypass the interview format to give their own evaluation of their lifestyle and GPs accept this evaluation. In cases of “no-problem” answers from patients, GPs usually encouraged patients by adding support for current habits.Conclusion.Patients anticipated that GPs might assess their lifestyles as problematic and they incorporated this possibility into their responses. They thereby controlled the definition of their lifestyle as a problem or not. GPs generally did not use the information provided in these answers as a resource for further discussion, but rather relied on standard interview procedures. Staying within the patients’ frame of reference and using the patients’ anticipatory answers might provide GPs with a better point of departure for discussion regarding lifestyle. [ABSTRACT FROM PUBLISHER]

Objective To explore how patients enact presentations of self in consultations dealing with lifestyle in general practice. Methods We conducted a qualitative observational study with thematic, cross-case analysis of video-recorded consultations inspired by discourse analysis. Results Patients presented themselves with an orientation toward responsibility in dialog about lifestyle. They described how they were taking care of themselves and doing their best. In this respect, they demonstrated their achievements as matters of honor. If one lifestyle issue was considered problematic, in some cases patients shifted attention to another, of which they were more proud. In areas where they were not doing well, some patients revealed shame for not acting responsibly. In such cases, patients spoke of themselves in terms of self-deprecation or admitted not living up to expected standards. Conclusion Negotiations of shame and honor, revolving around personal responsibility, are embedded in clinical discourse about lifestyle. Patients take a proactive role in presenting and defending the self against shame. Practice implications GPs should pay more attention to the tacit role of shame in consultations. Failure to do so could lead to distance and hostility while a strategy to acknowledge the impact of shame could help develop and strengthen the doctor–patient relationship. [ABSTRACT FROM AUTHOR]

Abdominal aortic aneurysm (AAA) is a ballooning-out of the aorta that does not normally give any symptoms. Undetected and untreated an aortic aneurysm can rupture, which in most cases is fatal. Mass screening of 65-year old men for the early detection of AAA and, in selected cases, operation seem to reduce mortality due to rupture, although, screening has not reduced the overall mortality in this group. In Västra Götaland, the southwest part of Sweden, screening for AAA amongst 65-year old men started in 2009. There are controversies within the medical community about the benefits and adverse effects of screening. In order to explore men's experiences of being screened and knowing they had an aortic aneurysm, we undertook a qualitative interview study with 15 men who in the screening programme were identified as having an aortic aneurysm and who were to be followed-up with annual ultrasonic examinations for an indeterminate number of years. The interviews were analysed for categories and themes using content analysis. The study found that the men were ambivalent about the knowledge that they had an AAA and about the follow-up monitoring. They appreciated having the knowledge but it was accompanied by worry, feelings of anxiety and existential thoughts about the fragility and finiteness of life. We recommend that before a screening programme is implemented, the psycho-social consequences should be thoroughly investigated. Participants should be given adequate and understandable information about the consequences of screening so that they can make an informed choice whether to participate or not. [ABSTRACT FROM PUBLISHER]

General practitioners (GPs) treat more than 90% of common mental disorders. Their approaches to psychological interventions have been little studied and their process of understanding patients remains unexplored. This qualitative interview and observation study aimed to explore Danish GPs' approaches to emotional problems and mental disorders in 'talking therapy' and in routine consultations. Different typical approaches were identified and could be described using the concept of mentalisation. Some participants used a basic reflective approach but no well-described method. Others were satisfied with the biomedical professional identity and did not engage in patients' emotional problems. The individual participant's approach in talking therapy was mirrored in routine consultations. Training a mentalising or reflective stance might promote more uniform therapeutic approaches to patients' emotional problems. [ABSTRACT FROM AUTHOR]

Objectives. Parents of sick children frequently visit their general practitioners (GPs). The aim was to explore parents' interpretation of their child's incipient signs and symptoms when falling ill and their subsequent unsatisfactory experience with the GP in order to make suggestions for improvements in the medical encounter. Design. Semi-structured interviews. Setting and subjects. Twenty strategically selected families with a child from a birth cohort in Frederiksborg County, Denmark were interviewed. Results. Parents wanted to consult their GP at the right time, i.e. neither too early nor too late. Well-educated parents experienced a discrepancy between their knowledge about their child, the information they had sought about the illness and the consultation with the GP, when they were dismissed with phrases such as ''it will disappear'' or ''it is just a virus''. The parents went along with the GP's advice if the child only occasionally became sick. However, parents of children with recurrent illnesses seemed very frustrated. During the course of several consultations with their GP, they started to question the GP's competence as the child did not regain health. Conclusions. Parents want to be acknowledged as competent collaborators. The GP's failure to acknowledge the parents' knowledge of their child's current illness, and the parents' attempt to identify what is wrong with the child and make the child feel better before the encounter may have consequences for the GP's credibility. It is therefore recommended that parents of children with recurrent illnesses receive extra attention and information. [ABSTRACT FROM AUTHOR]

General practitioners (GPs) treat more than 90 per cent of patients with mental disease. Time restriction is often seen as a hindrance to their engagement in psychological treatment. This study aimed to explore GPs' experiences of time when delivering 'talking therapy' and to analyse how time influenced the treatment of emotional problems in routine consultations. A qualitative approach was chosen, the data consisted of interviews with 14 GPs and observation of consecutive consultations in four of the participants' practices. Analysis was made by Interpretative Phenomenological Analysis. Eleven participants delivered talking therapy, five (therapeutically minded participants) often. Three aspects of time emerged: (1) the chronological time of the schedule; (2) the inner time with another rhythm and flow of thought; (3) the longitudinal time where meeting repeatedly for short consultations promoted a trusting relationship where problems were disclosed gradually and a narrative was created. With therapeutic participants the same aspects of time could be identified in routine consultations. Stress and a heavy workload counteracted the perception of inner time. Theories of time and narrative from psychotherapeutic thinking could be applied, form links to the unconscious and the narrative time and could possibly be made more explicit in general practice. Awareness of the different time aspects is necessary for improving the treatment of mental health in primary care. Political and organizational willingness to secure the necessary working conditions is, however, equally important for optimal treatment. [ABSTRACT FROM AUTHOR]

Aims : To explore elderly Danish women's ideas about osteoporosis and the possible threat to health. The authors discuss the issue of risk interpretations in itself, using osteoporosis as a case. Methods : A qualitative study based on material from focus‐group discussions. Twenty‐two 60‐ to 61‐year‐old healthy women were selected on the basis of questionnaire answers. Analysis was based on a meaning‐centred approach. Results : Comprehension of osteoporosis was mainly based on images representing various dimensions of osteoporosis. The women drew on experiences with relatives, friends, and health information. Physical appearance seemed to be the most common way of assessing those who had osteoporosis or who might have it in the future. Women's ideas about osteoporosis were influenced by two main, parallel stereotypes of knowledge based on models of ageing with bodily decay and the threat of a preventable disease. They seemed to vacillate, often integrating elements from both models in their comprehension. The scenarios for women with or liable to develop osteoporosis as a disease appeared to be founded on worst‐case scenarios. Conclusion : It is suggested that health professionals pay greater attention to people's models and images of risk conditions and carefully decide which images they wish to promote. Health education regarding osteoporosis comprises an ethical obligation to avert the construction of the more extreme and anxiety‐producing prototypes. This is especially important when informing individuals about risk and prevention and when decisions on screenings and other medical examinations are made. [ABSTRACT FROM AUTHOR]

Aims: A study was undertaken to explore how menopausal women are affected by awareness of potential risk of osteoporosis. Methods: A qualitative interview study, including analysis of in-depth interviews with 17 women who independently gave views on risk, out of 24 women interviewed about their menopausal symptoms. The women were selected on the basis of a survey including 1261 women chosen at random, to cover a broad spectrum of Danish women, their menopausal experiences, and contact with the healthcare system. The study was part of a larger project targeting menopause. Results: Awareness of osteoporosis risk caused a feeling of uncertainty and worry in some women. Only women reacting in this way seemed to act in order to prevent future fractures. The affected women were puzzled to realize that risk-reducing medication could introduce new hazards. Most of the women had heard about osteoporosis related to menopause as culturally embedded knowledge. Conclusions: Making individual women uncertain and worried must be considered a potentially serious side effect of health promotion. The findings raise the question of whether introducing healthy people to the threat of future diseases is ethically justifiable. As hormonal treatment is no longer recommended for long-term use, it is suggested that the strong link between osteoporosis and menopause should be toned down when counselling menopausal women. [ABSTRACT FROM AUTHOR]

Objective -- To explore women's needs and wants when seeing the GP in relation to menopausal issues. Design -- A qualitative interview study. Setting and subjects -- The study was part of a larger project, targeting menopause. It included in-depth interviews of 24 women aged 52-53 years who came from all over Denmark. The women showed a great variety of menopausal experience of symptoms and treatment. Main outcome measures -- An acquaintance with the women's agendas when seeing the GP about menopausal issues. Results and conclusion -- Women consulting their GPs either wanted to discuss treatment for menopausal symptoms, to have an examination for diseases or to get a risk assessment. Their needs for medication or examination were satisfied but several women wanted more information, especially about the pros and cons of hormone therapy (HT). Risk assessment, if not requested, indicated problems, with some women feeling uncomfortable if the GPs started a discussion about HT and osteoporosis, if they only wanted an examination to be reassured that everything was normal. The authors' findings indicate that GPs encounter a subtle balance in considering the question of risk information to menopausal women who do not request it. [ABSTRACT FROM AUTHOR]

Background: Patients with severe mental illness (SMI) have shorter life expectancy than people without SMI, mainly due to overmortality from physical diseases. They are treated by professionals in three different health and social care sectors with sparse collaboration between them, hampering coherent treatment. Previous studies have shown difficulties involved in establishing such collaboration. As the preparatory phase of an intervention to improve physical health of people with SMI and increase collaboration across sector borders, we explored different actors' experiences of barriers for collaboration. Method: We collected qualitative data from patients, professionals in general practice, psychiatry and social psychiatry involved in the treatment of these patients. Data consisted of notes from meetings and observations, interviews, focus groups and workshops. Analysis was by Interpretative Phenomenological Analysis. Results: The study revealed many obstacles to collaboration and coherent treatment, including the consultation structures in general practice, sectors being subject to different legislation, and incompatible IT systems. Professionals in general practice and social psychiatry felt that they were left with the responsibility for actions taken by hospital psychiatry without opportunity to discuss their concerns with psychiatrists. There were also cultural differences between health care and social psychiatry, expressed in ideology and language. Social psychiatry had an existential approach to recovery, whereas the views of health professionals were linked to symptom control and based on outcomes. Meanwhile, patients were left in limbo between these separate ideologies with no leadership in place to promote dialogue and integrate treatments between the sectors. Conclusion: Many obstacles to integrated trans-sectoral treatment of patients with SMI seem related to a lack of an overriding leadership and organizational support to establish collaboration and remove barriers related to legislation and IT. However, professional and ideological barriers also contribute. Psychiatry does not consider general practice to be part of the treatment team although general practitioners are left with responsibility for decisions taken in psychiatry; and different ideologies and treatment principles in psychiatry and municipal social psychiatry hamper the dialogue between them. There is a need to rethink the organization to avoid that the three sectors live autonomous lives with different cultures and lack of collaboration. [ABSTRACT FROM AUTHOR]