KWALON - Volume 25, Issue 3, 2020

This introduction summarizes the different articles in the current issue of KWALON and describes variations in qualitative methods reported in health research discussed in KWALON over the last 25 years.

This paper offers a personal reflection of two researchers on the development of qualitative research in health and healthcare in the past thirty years in the Netherlands. We explore the rise in international publications, as well as the themes that researchers address and the methodologies they use. We conclude that in recent decades the importance and number of qualitative studies in the field of health and care has increased substantially in the Netherlands. However, at the same time it seems that the debate about qualitative research has stopped. Reflections on their use are needed to maintain and develop the quality of the methods, particularly in a period in which qualitative research methods are accepted and widespread.

This article describes the first three stages of an action research project. Following eight methodological principles of participatory action research, this article aims to give insight in the nature of the challenges and dilemmas involving internists, patients and patient representatives in the research process mention. Dilemmas included giving space versus limiting participation together with operating efficiently versus being flexible and honoring the input of all participants equally. It was a challenge to reflect not only on the content and procedures but also on everybody’s role in the learning process. In conclusion, action research offers a critical base for a participative and reflective method but it is also a challenge for busy healthcare practices that focus on content and concrete action and less on the learning process. Because reflection on the learning process is important for scientific standards, we suggest to give monitoring and reflection a central place in the action research cycle.

This is a reply to the contribution entitled: ‘Learning together is changing together: A participatory action research project on the role of the internist in promoting a healthy lifestyle’. Here the authors highlight the complexity of facilitating participatory action research (PAR) in a clinical practice setting and reflect on the first three stages of their research through eight principles that could guide PAR, as described by Van Lieshout et al. (2017). As we developed these principles, we explain the principles of participation, reflexivity, contextuality and transformation in greater detail in relation to the context of this study. The authors made suggestions to change the five-phased model of PAR to get a better grip on the process. The authors rightly highlighted some limitations in the labeling of some phases. However, it is the reflexivity on the multiple perspectives that facilitators encounter and the relationships they engage with during the process, as well as acknowledging the iterative process of PAR, which needs to be embraced and experienced during the entire process of study.

In our response we further clarified how we interpreted and applied the contextuality, participation and reflexivity principles of action research. We also further explained our suggestions to adapt the framework/research cycle and how we understood the various terms used in the framework. As could be expected from a cultural perspective, language is not neutral and depends on the various authors’ context and frame of reference.

This article presents a phenomenological study on embodied experiences based on interviews with 25 patients with severe chronic cancer-related fatigue (CCRF). Insight into the patient’s perspective can help to facilitate personalized treatment in CCRF. Theoretically resorting to philosophical phenomenology, we explored embodied experiences of living with CCRF. Using interpretative phenomenological analysis, we identified four superordinate themes: (1) Worn out; (2) Diminishment of one’s ‘I can’; (3) Socially invisible objectification of the body; and (4) Restoring one’s ‘I can’. For clinical practice, these results suggest that focusing on the body and restoring one’s ‘I can’ could be helpful during treatment of CCRF. Future research should focus on measuring individual patterns of CCRF symptoms in order to personalize treatment.

Movement and sleep are both crucial for the elderly in terms of healthy ageing. Staying physically active as people age is positively associated with better sleep and health outcomes. But despite the growing attention to healthy ageing, the elderly don’t always keep up with the applicable guidelines in terms of movement. Furthermore, health workers don’t always know how to measure movement and sleep in elderly in order to advise and help them to better adhere to guidelines. Literature lacks a summary of accessible objective and subjective ways to measure movement and sleep in the elderly. This study combines both objective and subjective measuring methods and elaborates on the practical aspects of their use. This paper highlights the advantages of mixed methods when measuring movement and sleep in elderly people and aims to inform health workers who want to evaluate their patients’ movement and sleep in order to guide them towards a healthier lifestyle.

A qualitative study on the (psychological) characteristics of young, former elite athletes with chronic, non-specific pain complaints was initiated to answer the following questions: (1) Which factors could play a role in the development of chronic, non-specific pain in young, former elite athletes? And (2) How can we optimize treatment for young, former elite athletes with chronic, non-specific pain? A master student in Mental Health first interviewed six young former elite athletes with non-specific pain complaints who were receiving treatment in the rehabilitation clinic. The student analyzed the data. As data analysis based on six interviews is rather limited and the findings did not lead to unambiguous conclusions, several parts of the interview were re-coded by researcher 1, leading to different conclusions. We then decided to re-code all interviews in a new project by researcher 1, have researcher 2 double code several interviews and recruit at least six more participants to expand the qualitative sample. Reflecting on working with students in our qualitative study, we found another researcher coding the interview data to be important as it minimizes interpretation bias and allows for a check of the thoroughness of the interview content. Secondly, master students writing their thesis have limited time for these projects, which may lead to a small number of participants in the study. This holds especially when recruiting from a patient population, as availability depends on the number of suitable patients during this period of time.

Dit onderdeel bevat de Engelstalige samenvattingen van de artikelen in dit nummer.