Unspoken phenomena: using the photovoice method to enrich phenomenological inquiry.

Photovoice is a powerful method that is gaining momentum in nursing research. As a relatively new method in nursing science, the situatedness of photovoice within or alongside various research methodologies in a single study remains in a stage of early development. The purpose of this paper is to discuss the photovoice method as a means to elicit phenomenological data when researching the lived experience. While the foundational bases of phenomenology and photovoice differ substantially, the argument presented in this paper suggests that the photovoice method can be successfully used in phenomenological inquiry provided that significant rigour checks are pursued. This includes reflecting upon the origins and understandings of both methodology and method to promote methodological congruency. Data collection and analysis approaches that contribute to phenomenological inquiry using the photovoice method in addition to rigour and ethical considerations are discussed. The use of data generated from photovoice in phenomenological inquiry may fill a void of understanding furnished by limitations of traditional phenomenological inquiry and of spoken language and can enhance understanding of the lived experience, which may not always be best understood by words alone.

Women's health promotion in the rural church: a Canadian perspective.

The rural church may be an effective health resource for rural Canadian women who have compromised access to health resources. The purpose of this paper is to explore the relevance of the Christian church and faith community nurses in promoting the health of rural Canadian women in the evolving rural context. The findings from an extensive literature search reveal that religion and spirituality often influence the health beliefs, behaviors, and decisions of rural Canadian women. The church and faith community nurses may therefore be a significant health resource for rural Canadian women, although this phenomenon has been significantly understudied.

Using photovoice methodology to investigate facilitators and barriers to food acquisition and preparation by rural older women.

This research investigates facilitators and barriers that rural women aged 65 to 75 years in Southwestern Ontario experience in acquiring and preparing food through the use of photovoice methodology. Eighteen participants in five rural communities used a camera and log book to document their experiences and perspectives relating to the acquisition and preparation of food, and they each participated in two focus groups to engage in critical dialogue and knowledge sharing regarding the meaning and significance of the pictures they took. Analysis of photographs, log books, and focus group data revealed 13 themes, 3 emerging as facilitators to food acquisition and preparation (availability of food, social networks and values, personal values and resources), 5 as barriers (adjusting to changing family size, winter weather, food labeling issues, grocery shopper resources, limited physical capacity), and 5 as both facilitators and barriers (economics, valuing a healthy diet, technology changes, transportation, location and nature of grocery stores). Data also revealed rurality, age, and gender as foundationally influential factors affecting rural older women's food acquisition and preparation.

"I can't imagine my life without it!" Curling and health promotion: a photovoice study.

The sport of curling is an important activity in rural Canada, with many female participants. The health of women in rural Canada is much compromised compared to that of their urban counterparts, yet little research has explored ways to promote the health of rural women. This study examined the influence of curling on the health of women in rural Canada. A sample of 15 women and girls aged 12 to 72 from 2 communities in southwestern Ontario took pictures, kept logbooks, and participated in 2 group sessions to discuss the influence of curling on their health. The findings reveal that curling facilitates social connections, enhances physical and mental health, and provides a valued and visible way to support rural life. Clearly, curling promotes the health and community life of rural women in significant ways. More support for curling in rural settings is needed, and additional research on the topic of curling and the health of rural women is indicated.

The transition experience of rural older persons with advanced cancer and their families: a grounded theory study.

BACKGROUND: Transitions often occur suddenly and can be traumatic to both patients with advanced disease and their families. The purpose of this study was to explore the transition experience of older rural persons with advanced cancer and their families from the perspective of palliative home care patients, bereaved family caregivers, and health care professionals. The specific aims were to: (1) describe the experience of significant transitions experienced by older rural persons who were receiving palliative home care and their families and (2) develop a substantive theory of transitions in this population. METHODS: Using a grounded theory approach, 27 open-ended individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved family caregivers. Four focus group interviews were conducted with 12 palliative care health care professionals. All interviews were transcribed verbatim, coded, and analyzed using Charmaz's constructivist grounded theory approach. RESULTS: Within a rural context of isolation, lack of information and limited accessibility to services, and values of individuality and community connectedness, older rural palliative patients and their families experienced multiple complex transitions in environment, roles/relationships, activities of daily living, and physical and mental health. Transitions disrupted the lives of palliative patients and their caregivers, resulting in distress and uncertainty. Rural palliative patients and their families adapted to transitions through the processes of "Navigating Unknown Waters". This tentative theory includes processes of coming to terms with their situation, connecting, and redefining normal. Timely communication, provision of information and support networks facilitated the processes. CONCLUSION: The emerging theory provides a foundation for future research. Significant transitions identified in this study may serve as a focus for improving delivery of palliative and end of life care in rural areas. Improved understanding of the transitions experienced by advanced cancer palliative care patients and their families, as well as the psychological processes involved in adapting to the transitions, will help health care providers address the unique needs of this vulnerable population.

Rural women and pharmacologic therapy: needs and issues in rural Canada.

INTRODUCTION: The needs and issues of rural women regarding pharmacologic information and therapy are rarely explored. We sought to explore the needs and issues of rural women in Canada regarding drug-related information and prescription and nonprescription pharmaceuticals. METHODS: We used the qualitative methodology of interpretive description. In-depth semistructured face-to-face interviews were conducted with 20 women aged 17-88 years who lived in rural southwestern Ontario. RESULTS: Although rural women accessed prescription medications, complementary and alternative medicine (CAM) was highly favoured, and alcohol and illicit drugs such as marijuana, crystal meth and cocaine were prevalent in rural communities. Factors that affected rural women's decisions about which medications to use included access to health care practitioners, costs of medications, experiences of family members and friends with prescribed and alternative medications, attitudes and approaches of health care providers and health store employees, and the women's own expectations and desires. Factors that affected the use of illicit drugs included availability, boredom, peer pressure and cultural norms. Rural factors that influenced access to drug information and use included presence or lack of confidential care, distance to resources, and presence, accessibility and acceptability of rural resources. CONCLUSION: Rural women use a variety of drug therapies and sources of information, and experience unique socioeconomic and environmental issues that affect access to appropriate drug-related information and therapies. Further research is needed to clarify and articulate pharmacologic needs, issues and solutions for women in diverse rural settings.

Determinants of rural women's health: a qualitative study in Southwest Ontario.

CONTEXT: The influences of gender and geography are increasingly being acknowledged as central to a comprehensive understanding of health. Since little research on rural women's health has been conducted, an in-depth qualitative approach is necessary to gain a better initial understanding of this population. PURPOSE: To explore the determinants of health and their influence on rural women's health. METHODS: From November 2004 to September 2005, 9 focus groups and 3 individual interviews were conducted in 7 rural southwestern Ontario communities. Sixty-five rural residents aged 26 years and older participated in the study. Semi-structured interview questions were used to elicit participants' perceptions regarding determinants of rural women's health. FINDINGS: Four Health Canada determinants (employment, gender, health services, and social environments) and 3 new determinants (rural change, rural culture, and rural pride) emerged as key to rural women's health. CONCLUSIONS: Although health determinants affect both urban and rural people, this qualitative study revealed that rural women experience health determinants in unique ways and that rural residents may indeed have determinants of their health that are particular to them. More research is needed to explore the nature and effects of determinants of health for rural residents in general, and rural women in particular.

Women's health in northern British Columbia: the role of geography and gender.

INTRODUCTION: Although research interest in women's health is growing, much of the literature does not sufficiently describe the importance of geography and gender for the health of women. This qualitative study explored factors in the northern Canadian context that influence women's health by interviewing 25 women in northern Canada. RESULTS: Findings reveal that the importance of the northern context for women's health can be attributed to the north's historical location, and its physical, sociocultural and political environments. The northern context contributes to the marginalization of northern women that is characterized by isolation, limited options, limited power and being silenced. CONCLUSION: Health care practice and policy must attend to contextual as well as individual and sociocultural factors if women's health is to be advanced in northern settings.

Factors that influence students in choosing rural nursing practice: a pilot study.

INTRODUCTION: Nursing shortages continue globally and are especially critical in rural and remote communities. Attracting nurses to work in less populated regions presents challenges that differ from those in urban areas. METHODS: This pilot study focused on self-identified factors of nursing students who expressed an interest in rural practice post-graduation. The sample included students from the USA and Canada, who were enrolled in graduate and under graduate programs of nursing, and were attending an international rural nursing conference. RESULTS: Findings from the pencil and paper short answer survey found those who have life experiences and connections in small communities are more likely to choose this setting. Post-graduation employment preference was reinforced by ongoing exposure to rural theory and practice settings in their programs of study. Nursing scholars may find this study useful to further examine students' employment preferences, and to develop targeted strategies to better prepare those having an interest in rural practice. CONCLUSION: Evidence based findings are critically needed to recruit and retain nurses to address critical nursing shortages in rural regions in North America and globally.

Developing resilience: how women maintain their health in northern geographically isolated settings.

The purpose of this study was to explore how women maintain their health in northern geographically isolated settings, using a feminist grounded theory method. Twenty-five women of diverse backgrounds in northern British Columbia, Canada, engaged in qualitative interviews over a 2-year period to express perspectives about how the north affects their health and how they maintain their health in northern settings. Findings reveal that the women experienced vulnerability to physical health and safety risks, psychosocial health risks, and risks of inadequate health care. The women responded to these vulnerabilities by developing resilience through the strategies of becoming hardy, making the best of the north, and supplementing the north. These strategies, which reflect both individual and collective actions, were determined by the needs and interests of the women and their social and personal resources. The findings have implications for women's health research and health practices and policies in geographically isolated settings.