scholarly journals Health professionals’ identified barriers to trans healthcare: a qualitative interview study

2021 ◽  
pp. BJGP.2021.0179
Author(s):  
Magdalena Mikulak ◽  
Sara Ryan ◽  
Richard Ma ◽  
Sam Martin ◽  
Jay Stewart ◽  
...  
Keyword(s):  
Professional Education ◽  
Health Professionals ◽  
Qualitative Interview ◽  
Interview Study ◽  
Structural Level ◽  
Snowball Sampling ◽  
Gender Diverse ◽  
Trans People ◽  
Qualitative Interview Study ◽  
And Gender

Background: Trans people face multiple barriers within healthcare. Primary care practitioners are key to trans healthcare but they often lack training in, and understanding of trans identities, and healthcare options. Few studies have examined health professionals’ understanding of the barriers that exist in healthcare for trans people. Aim: To map out barriers to providing good quality healthcare to trans and gender diverse people and ways to address them. Design and setting: A qualitative interview study involving 20 health professionals working with trans and gender diverse people. Method: Participants were recruited through purposive and snowball sampling. Data were generated using semi-structured qualitative interviews. A thematic analysis involved coding and categorising data using Nvivo software and further conceptual analysis in which developing themes were identified. Results: The study identified four barrier domains to good quality care for trans and gender diverse people: structural (related to lack of guidelines, long waiting times, shortage of specialist centres), educational (based on lack of training on trans health), cultural and social (reflecting negative attitudes towards trans people) and technical (related to information systems and technology). Conclusion: There is an urgent need to address the barriers trans and gender diverse people face in healthcare. Structural level solutions include health policy, professional education and standards; at the practice level, GPs can act as potential drivers of change in addressing the cultural and technical barriers to better meet the needs of their trans and gender diverse patients.

scholarly journals Herbal medicine for acute bronchitis: A qualitative interview study of patients’ and health professionals’ views

2020 ◽  
Vol 55 ◽  
pp. 102613
Author(s):  
Dia Soilemezi ◽  
Geraldine M. Leydon ◽  
Ruiyang Yan ◽  
Catherine Simpson ◽  
Margaret Bell ◽  
...  
Keyword(s):  
Herbal Medicine ◽  
Health Professionals ◽  
Acute Bronchitis ◽  
Qualitative Interview ◽  
Interview Study ◽  
Qualitative Interview Study

scholarly journals Integrating patient perspectives in medical decision-making: a qualitative interview study examining potentials within the rare disease information exchange process in practice

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ana Babac ◽  
Verena von Friedrichs ◽  
Svenja Litzkendorf ◽  
Jan Zeidler ◽  
Kathrin Damm ◽  
...  
Keyword(s):  
Decision Making ◽  
Rare Disease ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Qualitative Interview ◽  
Healthcare Systems ◽  
Interview Study ◽  
Medical Decision ◽  
Shared Decision ◽  
Qualitative Interview Study

Abstract Background Many European countries have recently implemented national rare disease plans. Although the network is strengthening, especially on the macro and meso levels, patients still go a long way through healthcare systems, with many health professionals involved and scarce evidence to gather. Specifically, patient involvement in the form of shared decision-making can offer further potential to increase healthcare systems’ efficiency on a micro level. Therefore, we examine the implementation of the shared decision-making concept thus far, and explore whether efficiency potentials exist—which are particularly relevant within the rare disease field—and how they can be triggered. Methods Our empirical evidence comes from 101 interviews conducted from March to September 2014 in Germany; 55 patients, 13 family members, and 33 health professionals participated in a qualitative interview study. Transcripts were analyzed using a directed qualitative content analysis. Results The interviews indicate that the decision-making process is increasingly relevant in practice. In comparison, however, the shared decision-making agreement itself was rarely reported. A majority of interactions are dominated by individual, informed decision-making, followed by paternalistic approaches. The patient-physician relationship was characterized by a distorted trust-building process, which is affected by not only dependencies due to the diseases’ severity and chronic course, but an often-reported stigmatization of patients as stimulants. Moreover, participation was high due to a pronounced engagement of those affected, diminishing as patients’ strength vanish during their odyssey through health care systems. The particular roles of “expert patients” or “lay experts” in the rare disease field were revealed, with further potential in integrating the gathered information. Conclusions The study reveals the named efficiency potentials, which are unique for rare diseases and make the further integration of shared decision-making very attractive, facilitating diagnostics and disease management. It is noteworthy that integrating shared decision-making in the rare disease field does not only require strengthening the position of patients but also that of physicians. Efforts can be made to further integrate the concept within political frameworks to trigger the identified potential and assess the health-economic impact.

scholarly journals Influence and management of conflicts of interest in randomised clinical trials: qualitative interview study

BMJ ◽  
2020 ◽  
pp. m3764
Author(s):  
Lasse Østengaard ◽  
Andreas Lundh ◽  
Tine Tjørnhøj-Thomsen ◽  
Suhayb Abdi ◽  
Mustafe H A Gelle ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Conflicts Of Interest ◽  
Management Strategies ◽  
Qualitative Interview ◽  
Educational Background ◽  
Interview Study ◽  
Political Agenda ◽  
Snowball Sampling ◽  
Qualitative Interview Study ◽  
Financial Conflicts Of Interest

Abstract Objective To characterise and analyse the experiences of trial researchers of if and how conflicts of interest had unduly influenced clinical trials they had worked on, what management strategies they had used to minimise any potential influence, and their experiences and views on conflicts of interest more generally. Design Qualitative interview study. Participants Trial researchers who had participated in at least 10 clinical trials with methodological or statistical expertise. Researchers differed by geographical location, educational background, and experience with different types of funders. Interviewees were identified by searches on Web of Science and snowball sampling. 52 trial researchers were approached by email; 20 agreed to be interviewed. Setting Interviews conducted by telephone, recorded, transcribed verbatim, imported to NVivo 12, and analysed by systematic text condensation. Semistructured interviews focused on financial and non-financial conflicts of interest. Results The interviewees had participated in a median of 37.5 trials and were mainly male physicians who had experience with commercial and non-commercial trial funders. Two predefined themes (influence of conflicts of interest and management strategies) and two additional themes (definition and reporting of conflicts of interest) emerged. Examples of perceived influence of conflicts of interest were: choice of inferior comparator, manipulation of the randomisation process, prematurely stopping the trials, fabrication of data, blocking access to data, and spin (eg, overly favourable interpretation of the results). Examples of strategies to manage conflicts of interest were: disclosure procedures, exclusion of the funder from design and analysis, independent committees, contracts ensuring complete access to the data, and no restriction by the funder on analysis and reporting. Interviewees used different definitions or thresholds for what they considered to be conflicts of interest, and they described different criteria for when to report them. Some interviewees considered non-commercial financial conflicts of interest (eg, funding of trials by governmental health agencies with a political agenda) to be equally or more important than commercial financial conflicts of interest (eg, funding by drug and device companies), but more challenging to report and manage. Conclusion This study described how trial researchers perceive conflicts of interest unduly influencing clinical trials they had worked on, and the management strategies they used to prevent these influences. The results indicated considerable variability in researchers’ understanding of what conflicts of interest are and when they should be reported.

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