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7. Designing and conducting qualitative research across countries and cultures: challenges for inclusiveness and rigour

Author

Cuoco, Angela, Arcadi, Paola, Figura, Maria Chiara, Piervisani, Loredana, Alvaro, Rosaria, Vellone, Ercole, Durante, Angela, 0000-0002-4659-1569, 0000-0003-4673-7473, and 0000-0003-1034-5988

Subjects
Advanced and Specialized Nursing, Medical–Surgical Nursing, Inclusiveness, Qualitative research, Humans, Rigour, Cardiology and Cardiovascular Medicine, Multicultural research, Qualitative method, Qualitative Research
Abstract

Qualitative research is fundamental to understanding the nature and complexity of human phenomena. While cultural and psychometric validations exist for quantitative tools, the same cannot be said of qualitative ones. There are other many challenges when conducting a multinational qualitative study, which includes different cultural and linguistic ‘biases’. This paper presents some key issues that researchers may encounter when designing and developing multinational and multicultural qualitative studies, and also provides some strategies to overcome difficulties and ensure rigour.

Published
2022

11. Needs and problems related to sociodemographic factors of informal caregiving of people with heart failure: A mixed methods study in three European countries

Author

Angela Durante, Cuoco, Angela, Boyne, Josiane, Bridgette Brawner, Raul Juarez-Vela, Serenella Stasi, Ahtisham Younas, Ercole Vellone, http://orcid.org/0000-0003-1034-5988, http://orcid.org/0000-0003-0157-5319, http://orcid.org/0000-0003-4673-7473, MUMC+: MA Alg Ond Onderz Cardiologie (9), and RS: CAPHRI - R2 - Creating Value-Based Health Care

Subjects
Adult, Heart Failure, Sociodemographic Factors, caregiving, ILLNESS, CARE, family care, Settore MED/45, cross-cultural, nursing, Caregivers, public health nursing, Adaptation, Psychological, QUALITY, Humans, Adult Children, sociodemographic characteristics, BURDEN, Spouses, chronic illness, General Nursing, Qualitative Research
Abstract

Aims To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics. Design A qualitative focused mixed methods design was used. Methods In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven-phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed. Results Three clusters of caregivers were identified: spouses, adult children and non-family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health. Conclusions Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure. Impact A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real-world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi-dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non-family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission. Patient or Public Contribution Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure.

Published
2022

14. Informal caregivers of people with heart failure and resilience: A convergent mixed methods study.

Author

Durante, Angela, Ahtisham, Younas, Cuoco, Angela, Boyne, Josiane, Brawner, Bridgette, Juarez‐Vela, Raul, and Vellone, Ercole

Subjects
RESEARCH, HUMAN research subjects, RESEARCH methodology, MULTIPLE regression analysis, BURDEN of care, MEDICAL cooperation, INTERVIEWING, REGRESSION analysis, PSYCHOLOGICAL tests, INFORMED consent (Medical law), PSYCHOLOGY of caregivers, MENTAL depression, QUESTIONNAIRES, QUALITY of life, DESCRIPTIVE statistics, ANXIETY, STATISTICAL sampling, THEMATIC analysis, CONTENT analysis, DATA analysis software, PSYCHOLOGICAL resilience, HEART failure
Abstract

Aim: To develop a comprehensive understanding of resilience and its associated factors among informal caregivers of people with heart failure. Design: Transnational multicentre convergent mixed methods approach. Methods: This study was conducted in three European countries: Italy, Spain and the Netherlands; during February 2017 and December 2018. In total, 195 caregivers completed the Connor–Davidson Resilience Scale, Caregiver Burden Inventory and Hospital Anxiety and Depression Scale. From a nested sample 50 caregivers participated in semi‐structured face‐to‐face interviews. Data were analysed using qualitative content analysis, multiple regression and joint displays. Results: The caregivers' mean age was over 60 years. The quantitative results showed that caregivers experienced anxiety and depression regardless of a good score of resilience and moderate level of burden. Regression analysis showed that the resilience was associated with caregiver depression. From qualitative findings three resilience inhibiting (psychological outlook, physical weariness and affective state) and two promoting factors (community interconnectedness and self‐comforting activities) were generated. Mixed analysis confirmed that depression decreased caregivers' resilience. Conclusions: Caregivers of people with heart failure experience continuous stress and anxiety resulting in reduced resilience. Collaborative efforts are needed to build multifaceted interventions and programs to enhance caregivers' resilience by targeting the factors identified in this study. Impact: The quality of informal caregiving is affected by the resilience of caregivers. No research has explored the resilience levels and its factors in this population. Depression, psychological outlook, physical weariness and affective state are negative factors of caregivers' resilience. Personal strategies combined with social and community support and belongingness enhance caregivers' resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers' resilience. [ABSTRACT FROM AUTHOR]

Published
2022
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15. Community health services in European literature: A systematic review of their features, outcomes, and nursing contribution to care.

Author

Caponnetto, Valeria, Dante, Angelo, El Aoufy, Khadija, Melis, Maria Ramona, Ottonello, Giulia, Napolitano, Francesca, Ferraiuolo, Fabio, Camero, Francesco, Cuoco, Angela, Erba, Ilaria, Rasero, Laura, Sasso, Loredana, Bagnasco, Annamaria, Alvaro, Rosaria, Manara, Duilio Fiorenzo, Rocco, Gennaro, Zega, Maurizio, Cicolini, Giancarlo, Mazzoleni, Beatrice, and Lancia, Loreto

Subjects
*COMMUNITY health services, *EUROPEAN literature, *POLICY discourse, *STRUCTURAL optimization, *PATIENT compliance, *NURSING interventions, *HEALTH policy
Abstract

Background Introduction Methods Results Discussion Conclusions and implications for health policy To meet the population's needs, community care should be customized and continuous, adequately equipped, and monitored.Considering their fragmented and heterogeneous nature, a summary of community healthcare services described in European literature is needed. The aim of this study was to summarize their organizational models, outcomes, nursing contribution to care, and nursing‐related determinants of outcomes.A systematic review was performed by searching PubMed, CINAHL, Scopus, and Embase in October 2022 and October 2023 (for updated results). Quantitative studies investigating the effects of community care, including nursing contribution, on patient outcomes were included and summarized. Reporting followed the PRISMA checklist. The review protocol was registered on PROSPERO (CRD42022383856).Twenty‐three studies describing six types of community care services were included, which are heterogeneous in terms of target population, country, interventions, organizational characteristics, and investigated outcomes. Heterogeneous services’ effects were observed for access to emergency services, satisfaction, and compliance with treatment. Services revealed a potential to reduce rehospitalizations of people with long‐term conditions, frail or older persons, children, and heart failure patients. Models are mainly multidisciplinary and, although staffing and workload may also have an impact on provided care, this was not enough investigated.Community health services described in European literature in the last decade are in line with population needs and suggest different suitable models and settings according to different care needs. Community care should be strengthened in health systems, although the influence of staffing, workload, and work environment on nursing care should be investigated by developing new management models.Community care models are heterogeneous across Europe, and the optimum organizational structure is not clear yet. Future policies should consider the impact of community care on both health and economic outcomes and enhance nursing contributions to care. [ABSTRACT FROM AUTHOR]

Published
2024
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