"Lives and times": The case for qualitative longitudinal research in anatomical sciences education.

Qualitative longitudinal research (QLR) focuses on changes in perceptions, interpretations, or practices through time. Despite longstanding traditions in social science, QLR has only recently appeared in anatomical sciences education (ASE). While some existing methodology papers guide researchers, they take a narrow view of QLR and lack specificity for ASE. This discursive article aims to (1) describe what QLR is and its benefits, its philosophies, methodologies and methods, considerations, and quality indicators, and (2) critically discuss examples of QLR in ASE. Underpinned by relativist ontology and subjectivist epistemology, time can be understood as fluid/subjective or fixed/objective. QLR is a flexible, creative, and exploratory methodology, often associated with other methodologies. Sampling is typically purposive, with repeated and recursive data collection methods, and complex three-strand analyses (themes, cases, and time), enabling cross-sectional and longitudinal analyses. QLR involves ethical, relationship, analytical, dissemination, and funding considerations. Key quality indicators relate to qualitative research as well as temporal aspects. Most of the nine ASE papers reviewed explored changes in anatomy learners, but few labeled their methodology as QLR. Just under half described their sampling as purposive, most employed pre-planned and standardized repeated interviews, analyzed their data cross-sectionally, and utilized qualitative data analysis software. Most cited the confirmability and transferability of their studies, but few cited credibility and dependability elements. Study timeframes and tempos were generally clear, but details of longitudinal retention/attrition were often lacking, and longitudinal data analysis was not often conducted. We therefore provide recommendations for the conduct of QLR in ASE.

The care pathway experienced by cutaneous melanoma survivors: A qualitative longitudinal study.

BACKGROUND: The optimal management of cutaneous melanoma is based on implementing a multidisciplinary tumour board. No studies report cutaneous melanoma patients' perspective along the whole care pathway, taking us through their care experience longitudinally. AIMS: To explore the patients' perspective on the cutaneous melanoma care journey in a skin cancers' tertiary referral centre. METHODS: A longitudinal qualitative study was designed, using semi-structured interviews. Cutaneous melanoma patients were interviewed three times (T0, after diagnosis; T1, after the first postoperative visit; and T2, at the follow-up). Data were analysed using the inductive framework method. RESULTS: Fifteen patients agreed to participate, and 8 completed all three interviews. We generated three themes describing how patients experienced the care pathway: (i) the evolving need for support during the care pathway, (ii) the development of emotions and expectations for the journey's end, (iii) the changing perceptions of hospital services, the care pathway itself, and the Skin Cancer Unit. We have emphasised the shifts in the experience of receiving assistance from the diagnosis to the follow-up stage. The more the care process progressed, the stronger the need for a relationship with healthcare professionals. The emotional impact of becoming a cancer survivor exacerbated the experience and reflected on patients' perceptions of the care pathway. CONCLUSIONS: Adopting a relational approach to reassuring melanoma patients is essential. Our participants expressed needing a medical reference figure as a favourable element. When this is unfeasible, inter-professional training is desirable to help professionals cooperate in a multidisciplinary group and make this collaboration visible to patients.

Exploring preparedness transitions in medicine and pharmacy: a qualitative longitudinal study to inform multiprofessional learning opportunities.

Despite extensive preparedness literature, existing studies fail to adequately explore healthcare graduates' feelings of preparedness longitudinally across new graduate transition journeys, nor do they compare different healthcare professions to ascertain what opportunities exist for multiprofessional transition interventions. Therefore, this Australian study, underpinned by temporal theory, explores the preparedness transitions of medicine and pharmacy graduates. Our 6-month qualitative longitudinal study involved 12 medicine and 7 pharmacy learners after purposive sampling. They participated in an entrance interview before starting internship, longitudinal audio-diaries during their first three months of internship, and an exit interview. Framework analysis explored patterns in the data cross-sectionally and longitudinally for the whole cohort (thinking over time), with pen portraits illustrating individuals' journeys (thinking through time). Preparedness and unpreparedness narratives involved practical skills and tasks, interpersonal skills, knowledge, and professional practice for medicine and pharmacy. However, narratives for practical skills and tasks, and professional practice were dominant amongst medicine graduates, while narratives for interpersonal skills and knowledge were dominant amongst pharmacy graduates. We found numerous cohort changes in feelings of preparedness over time, but the illustrative pen portraits demonstrated the complexities and nuances through time, including feelings of preparedness before internship becoming unpreparedness during internship (e.g., cannulas), improving preparedness through time (e.g., cover shifts), and persistent feelings of unpreparedness (e.g., patient interactions). While our cross-sectional findings are reasonably consistent with existing research, our comparative and longitudinal findings are novel. We recommend that educators build learners' preparedness through uniprofessional transition interventions involving practical skills and tasks, and professional practice in medicine, and interpersonal skills and knowledge in pharmacy. More importantly, we recommend multiprofessional transition interventions for medicine and pharmacy learners before internship focusing on knowledge, and during internship focusing on practical skills and tasks.

Relationship quality perceived by family caregivers of people with dementia in the context of a psychoeducational intervention: A qualitative exploration.

BACKGROUND: Caring for a person with dementia can be a challenging experience, often associated with chronic stress and a heavy burden on family caregivers. Dementia also impacts the relationship between the caregiver and the person with dementia. The quality of this relationship is, in turn, an important factor influencing the well-being of both dyad members. The psychoeducational intervention "Learning to feel better . . . and help better" has shown positive results regarding family caregivers' subjective burden, psychological distress, and self-efficacy. However, relationship quality has not been addressed in the context of this intervention. METHODS: A longitudinal constructivist grounded theory approach was used to explore relationship quality as perceived by caregivers, possible changes and intervention components facilitating or preventing such changes. Three qualitative, semi-structured interviews (before, during and after the intervention) were performed with 13 family caregivers from three different intervention groups. The resulting 39 interviews were analysed regarding individual caregiver trajectories, per time point for all caregivers and regarding specific caregiver subgroups. FINDINGS: A model focusing on sustaining relationship quality in dementia was developed. It shows strategies that family caregivers develop and apply to facilitate positive interactions and feelings of connectedness with their family members with dementia. It also indicates that mastering such strategies requires reflective skills based on specific knowledge of dementia and coping strategies, which can be enhanced through active skills training, in which caregivers are guided to work on their individual stressful situations. Factors hampering change included difficulties in accepting dementia-related changes. CONCLUSION: Findings suggest that psychoeducation, with active skills training based on caregivers' current daily life situations, providing systematic procedures to handle daily challenges and specific knowledge about the impact of the disease, could support them in developing and applying supportive strategies to sustain or improve their relationship to their family member with dementia.

Revisiting longitudinal qualitative studies in social work: considerations for design and methodological insights.

This paper undertakes an analysis and discussion of the methodological challenges and insights derived from three longitudinal qualitative studies, all conducted in Chile during the COVID-19 pandemic and subject to comprehensive theoretical-methodological reflection processes centred on their respective designs. This analysis makes a significant contribution to interdisciplinary discussions within social research, with a particular emphasis on longitudinal trajectories. First, we present a comparative analysis of three studies in social work, utilising Saldaña's questions addressing changes and learning in longitudinal studies. The first study explores the labour trajectories of researchers, the second focuses on the educational trajectories of students, and the last examines therapeutic alliance trajectories between social workers and families within the child protection system. Following this, we delve into the methodological decisions made by the research group during the execution of these longitudinal studies. This encompasses an examination of participant involvement, temporal definitions of the adopted designs, and the most suitable methodological tools for analysing change processes over time. The outcomes of this comparative analysis reveal the distinctive characteristics of the three longitudinal studies, providing insights into how the time dimension is explored within them. We highlight key criteria essential for consideration in longitudinal qualitative research, particularly regarding participants and methodology. In conclusion, we advocate for an expanded reflection within the realm of longitudinal qualitative methodology, encompassing aspects such as design choices, approaches to data analysis, integration of technology in information processing, and strategies for maintaining participant engagement.

'Matters-of-concern' associated with discontinuation of long-acting injectable buprenorphine: Findings from a longitudinal qualitative study.

BACKGROUND: Discontinuation of medications such as methadone and buprenorphine amongst patients receiving opioid agonist treatment (OAT) is an international phenomenon. Recent developments in OAT medication include depot-injections of buprenorphine. Circumstances underlying discontinuation of these new formulations of medication are not fully understood from a qualitative perspective. METHODS: Data derive from a longitudinal qualitative study of patients' experience of long-acting injectable buprenorphine (LAIB), involving semi-structured telephone-interviews held at six-points in time. The relevant dataset for this article consists of 44 interview transcripts, generated from 8 participants who were each affected by discontinuation of LAIB prescriptions (during the first 12-months of treatment). Analyses sought to identify circumstances associated with LAIB discontinuation and data were further situated within a framework of 'evidence making intervention' and associated 'matters-of-concern'. Matters-of-concern relate to the ways in which an intervention is 'made' and constructed through engagement and practice, from the perspective of the recipient. FINDINGS: In this study, participants experienced either 'discontinuation of LAIB prescriptions by treatment services' or patient-led 'opt-out' from treatment. Matters-of-concern underlying the former were associated with late attendance for scheduled appointments, non-prescribed substance use or receiving a custodial sentence. Matters-of-concern relating to patient-initiated discontinuation were associated with personal circumstances that affected treatment motivation, side-effects (of buprenorphine), a preference to resume heroin use, or because individual treatment goals had been achieved. CONCLUSION: The assorted matters-of-concern that influence discontinuation of LAIB demonstrate that such OAT is complex and multi-faceted, is neither fixed nor stable, and does not generate universally shared outcome. Experiences of LAIB discontinuation are shaped by a wide range of social, temporal and treatment-related effects that include disconnected therapeutic alliance between patient and treatment providers. In order to maximise the benefits of LAIB it is necessary to develop meaningful therapeutic alliances (notwithstanding policy boundaries) to enable exploration of matters-of-concern during treatment.

Frames of agency in a school with poor indoor-air quality: A longitudinal composite narrative study.

Problems with schools' indoor-air quality are common, and they can cause health problems to adolescents. However, no previous research has examined how adolescents make sense of such contaminated socio-material environments or what kinds of agency those environments afford. Taking an ecological psychology perspective informed by frame analysis, we analysed longitudinal focus group interviews with adolescents in a Finnish school with longstanding indoor-air problems. We constructed three composite first-person narratives that reflected different experiential frames, with corresponding forms and changes of agency. We found that our adolescents made sense of the same socio-material environment and its affordances in very different ways, and this process afforded them to develop many kinds of agency that changed over time.

Using longitudinal qualitative research to explore the experience of receiving and using augmentative and alternative communication.

BACKGROUND: People who have communication difficulties may benefit from using augmentative and alternative communication (AAC). Understanding and measuring outcomes from the use of AAC is an important part of evaluating the impact of devices and services. Outcome measurement needs to reflect the changing nature of the impact of using AAC on an individual's ability to participate in activities of daily life. There is a limited understanding of the concepts that should inform the evaluation of outcomes from AAC device provision, nor how people's expectations from AAC may change over time. AIMS: To inform the development of a patient-reported outcome measure for AAC by understanding more about people's expectations from AAC and how these change over time. METHODS & PROCEDURES: A longitudinal qualitative research study was designed and carried out with seven participants over a period of 2 years. Participants were recruited from a regional specialist assessment service for AAC in the south-west of the UK. Four semi-structured interviews were carried out: (1) before assessment for AAC, (2) after assessment, (3) directly after provision of an AAC device and (4) between 6 and 12 months after provision. An original analytic method was used in this study that built on the principles of longitudinal interpretative phenomenology analysis, applied with a dialogic theoretical lens. This approach enabled the inclusion of a range of multimodal and embodied data collected to this study and allowed the research team to draw out salient themes across the cohort group while attending to the influence of time and context on experience. OUTCOMES & RESULTS: The results confirm and extend the three core concepts that were used to guide analysis: changes; contexts; future possibilities. The contextual and temporal influences on outcomes attainable from AAC for this cohort were also identified and illustrated through cross-case comparison. Deeper, analytic, and conceptual engagement with theory, which was then applied to analysis of the data, provided methodological rigour in the study. The results enhance our understanding of people's hopes and expectations from AAC and how these change over time. CONCLUSIONS & IMPLICATIONS: This qualitative longitudinal research study provides new insights into the journeys of people who experience communication disability, and the shifting nature of their sense of identity as they engage with, and learn from using, AAC. The study is significant as it attends to the dynamic nature of experience and how contextual and experiential factors influence people's hopes and expectations from AAC. The paper presents an original application of longitudinal qualitative research methodology with people who use AAC which can be further applied and tested in the field of communication disability research. WHAT THIS PAPER ADDS: What is already known on this subject We did not know the impact that time has on the concepts that have been identified to represent important outcomes from AAC. The existing concepts used to define outcomes from AAC were not adequately conceptualized to develop a patient-reported outcome measure. This study sought to extend our knowledge about outcomes from AAC. What this paper adds to the existing knowledge This study adds to the methodological toolkit available for qualitative inquiry in the field of communication disability research by presenting a longitudinal qualitative research methodology. It adds depth to our understanding of the concepts that underpin outcomes from AAC and highlights the dynamic nature of contexts and how this influences desired outcomes. What are the potential or actual clinical implications of this work? This longitudinal qualitative research study provides a broader perspective on the experience of getting AAC. It will enable clinicians to better navigate the contextual and transitionary factors that influence people's experience of acquiring AAC devices. The enhanced concepts described will also support clinical conversations that consider the wider facets of communication and what AAC can add to existing communicative tool kits beyond getting a message across.

Conceptualising retention in treatment with long-acting injectable buprenorphine (for opioid use disorder) as a journey: Findings from a longitudinal qualitative study.

BACKGROUND: Conceptualisations of the 'patient journey' are popular within health service research. Patient journeys provide a person-centred approach to health care that typically prioritise subjective patient experience with the aim of improving relevant forms of intervention. This article explores the conceptualisation of retention in treatment for opioid use disorder (OUD) using long-acting injectable buprenorphine (LAIB) as a journey. METHODS: Data derive from a longitudinal qualitative study, involving semi-structured interviews (held at six time-points), with participants who each initiated LAIB for the first time. Data analysis for this article focuses exclusively upon the experiences of those who had continued with LAIB treatment throughout one year (11 participants). Framework and thematic narrative analyses of 64 interviews with 11 participants sought to identify 'retention-narratives' that would indicate a 'retention journey' associated with LAIB treatment. FINDINGS: Shared treatment experiences consisted of three distinct phases (Withdrawal and Separation, Transformation, and Engagement) that progressed in a linear and intersecting manner through time. Each phase had features that defined treatment experiences at a given time but changed as treatment progressed. All 11 participants experienced multiple features within each of the three treatment phases and all participants reported separation from their respective service provider throughout the first 12 months of treatment. Although some valued the latter separation, most were dissatisfied by reduced levels of contact. CONCLUSION: Retention in treatment for OUD with LAIB, for at least 12-months, can be conceptualised as a journey. This conceptualisation emphasises the benefits (and challenges) clinicians and patients may expect to encounter during the first year of a LAIB treatment programme. An added implication of conceptualising LAIB treatment in this manner is that optimal benefits of the medication (as observed by participants) began to emerge during 'months 7-12' of the retention journey.

Non-Prescribed Substance Use during the First Month of Treatment by People Receiving Depot Buprenorphine for Opioid Use Disorder.

Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants' reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients' initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.

Korean mothers' career aspirations in the context of the COVID-19 pandemic: a longitudinal qualitative study.

Working mothers face challenges in pursuing their career aspirations due to work-family conflict. The recent COVID-19 pandemic has posed added challenges for working mothers by increasing care demands while also causing numerous health, economic and social disruptions. In this paper, we examine the impact of COVID-19 on Korean working mothers' career aspirations. We employ a longitudinal qualitative design by analysing 64 in-depth interviews with 32 mothers of young children in South Korea. By interviewing the same women before (2019) and during the COVID-19 pandemic (2020), we are able to document how working mothers' career aspirations were impacted by COVID-19. Findings show that all working mothers in the sample experienced increased care demands due to COVID-19. However, the influence of COVID-19 on working mothers' career aspirations hinged on gendered beliefs related to childcare responsibility. When working mothers believed or were subjected to beliefs that mothers should be the primary caregiver for children (gendered care belief), their career aspirations were tempered or relinquished. On the other hand, those who believed that mothers should not be held solely responsible for childcare (gender egalitarian care belief) continued to pursue their career aspirations or experienced career advancements during COVID-19. Findings suggest that beliefs related to care responsibilities play an important role in working mothers' pursuit of their career aspirations, and potentially their future careers.

Redressing injustices: how women students enact agency in undergraduate medical education.

This study presents descriptions of epistemic injustice in the experiences of women medical students and provides accounts about how these students worked to redress these injustices. Epistemic injustice is both the immediate discrediting of an individual's knowledge based on their social identity and the act of persistently ignoring possibilities for other ways of knowing. Using critical narrative interviews and personal reflections over an eight-month period, 22 women students during their first year of medical school described instances when their knowledge and experience was discredited and ignored, then the ways they enacted agency to redress these injustices. Participants described three distinct ways they worked to redress injustices: reclaiming why they belong in medicine, speaking up and calling out the curriculum, and uplifting one another. This study has implications for recognizing medical students as whole individuals with lived histories and experiences and advocates for recognizing medical students' perspectives as valuable sources of knowledge.

Tracking involvement over time: a longitudinal study of experiences among refugee parents involved as public contributors in health research.

PURPOSE: Patient and public involvement (PPI) is becoming more common in research, but has been problematized for lack of diversity. While PPI literature increasingly focuses on assessment of PPI on research, a focus on the contributors is less common. This study tracked the experiences of involvement among four refugee parents involved as public contributors in a child mental health trial, over three years. METHODS: The study used a longitudinal qualitative design with focus group discussions. Data were analysed using thematic analysis combined with a longitudinal analysis approach. RESULTS: The refugee parents' motivations for being involved changed from focusing on individual benefits to societal change. They initially viewed themselves as guests, which transformed into utilizing the group for social support. Time impacted trust-building positively, with continued collaboration strengthening trust. Practical aspects were dominant in the beginning, which shifted over time to allow more focus on research. They identified several learnings they gained from involvement. A discrepancy in how parents and researchers viewed involvement was identified, where parents saw researchers as owners of the research. CONCLUSIONS: To sustain successful PPI collaboration over time, researchers need to prioritize investment in time and resources, in communication, including working with interpreters, and in continued adjustments.

Using the Concept of Health Literacy to Understand How People Living with Motor Neurone Disease and Carers Engage in Healthcare: A Longitudinal Qualitative Study.

The growing body of information-seeking and decision-making literature in motor neurone disease (MND) has not yet explored the impact of health literacy. Health literacy relates to the skills people have to access, understand, and use health information and is influenced by motivation to engage with healthcare. We aimed to better understand how people affected by MND engage in healthcare by examining longitudinal interview data using the construct of health literacy. Semi-structured interviews were conducted with 19 persons living with MND and 15 carers recruited from a specialist MND clinic using maximum variation sampling. Transcripts were deductively coded using a framework of health literacy behaviours. The analysis used a matrix-based approach for thematic analysis of longitudinal data. People living with MND and carers sought nuanced information dependent on their priorities and attitudes. Information uptake was influenced by perceived relevancy and changed over time. Time allowed opportunity to reflect on and understand the significance of information provided. The findings indicate that persons living with MND and carers benefit when information and consultations are adapted to meet their communication needs. The results highlight the potential benefits of gaining an early understanding of and accommodating the communication needs, personal preferences, and emotional readiness for information for persons living with MND and their carers.

Series: Practical guidance to qualitative research. Part 6: Longitudinal qualitative and mixed-methods approaches for longitudinal and complex health themes in primary care research.

This article, the sixth in a series aiming to provide practical guidance for qualitative research in primary care, introduces two approaches for addressing longitudinal and complex health themes in primary care research. The first approach - longitudinal qualitative research - supports the study of change during the life course. The second approach - mixed-methods research - integrates quantitative and qualitative research to gain new insights to address the complex and multifaceted themes in primary care.We discuss the context, what, why, when and how of these approaches and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.

Experiences and Perceived Outcomes of Low-Income Adults During and After Participating in the British Columbia Farmers' Market Nutrition Coupon Program: A Longitudinal Qualitative Study.

BACKGROUND: The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) is a farmers' market food subsidy program that provides low-income households with coupons valued at $21/wk for 16 weeks to purchase healthy foods at participating BC Association of Farmers' Markets members' markets. OBJECTIVE: This study aimed to explore changes, differences, and similarities in participants' experiences and perceived short-term outcomes during and after participating in the FMNCP. DESIGN: A longitudinal qualitative research approach was used to conduct a recurrent cross-sectional analysis. Data generation and analysis were guided by Freedman et al's theoretical framework of nutritious food access. Data generation occurred during 2019 FMNCP program (time 1) and 4 to 7 weeks after (time 2) the program year ended. Data at each time point were analyzed separately using directed content analysis, followed by a comparative analysis to identify changes, differences, and similarities between time points. PARTICIPANTS: Twenty-eight adult participants were interviewed during the program; 24 were re-interviewed post program. SETTING: Three communities in British Columbia, Canada. RESULTS: Three themes were generated: temporary relief and engagement; lasting experiences and outcomes; enhancing participant experiences and outcomes. The first theme related to how participants' experiences and perceived outcomes, such as increased financial support and improved diet quality and health, were temporary. The second theme reflected positive lasting experiences and outcomes from participating in the FMNCP, including increased food and nutrition knowledge and enhanced social ties. The third theme focused on enhancing participants' program experiences and outcomes, including increasing the duration of food subsidies. CONCLUSION: The FMNCP temporarily enhanced access to nutritious foods and had lasting positive effects on participants' nutrition-related knowledge and social outcomes. Nevertheless, participants struggled to maintain healthy eating practices post program due to financial constraints. Expanding farmers' market subsidy programs may improve access to nutritious foods; maintain positive dietary, social, and health outcomes for participants; and reach more low-income households.

Influences on the physical activity of Syrian migrants in Germany: results of a qualitative study.

Due to the ongoing Syrian conflict, Syrian migrants represent the third-largest group of immigrants in Germany. They are, therefore, potential addressees for health-promotion programs, such as physical activity (PA). Thus, this study aimed to explore the relevance of PA, how PA may change with increasing length of stay and what are the facilitators and barriers of PA in the host country. Using a longitudinal, qualitative study design, 30 semi-standardized qualitative interviews with Syrian migrants were conducted in 2018 and 17 migrants could be followed-up after 12 months in 2019 and were asked for changes in their PA-behavior. Interviews were conducted in German, English or Arabic, transcribed and translated into English if necessary. For analysis, an abbreviated version of the Grounded Theory was used. We identified three PA phases that Syrian immigrants underwent during their first years in Germany. Phase 1 includes bureaucratic matters. Health-promoting behaviors, such as PA, are not relevant. Phase 2 comprises the establishment of basic structures. PA can gain importance and (new) behaviors can be established. In Phase 3, immigrants feel under pressure to successfully complete an (academic) education in Germany. Feelings toward PA can become ambivalent. Overall, health-promoting behaviors, such as PA, are often of secondary priority and factors influencing PA are heterogeneous not only on an individual but also societal and institutional level. PA-programs should be advertised bilingually, offered low-threshold and at low cost in order to reach the target group. In addition, there is a high demand for mental health services.

Due to the ongoing Syrian conflict, Syrian immigrants represent the third-largest group of immigrants in Germany and are, therefore an important target group for health-promotion programs, such as physical activity (PA). To better understand, how important PA is for Syrian migrants, how their PA-behavior in Germany differs compared to Syria and what factors have an impact on PA, we conducted 30 interviews with Syrian migrants. After 12 months, we re-contacted the same 30 people, to ask for a second interview, of whom 17 agreed. All 47 interviews were conducted in German, English or Arabic, transcribed and translated into English if necessary. The interview narratives reveal that health-promoting behaviors, such as PA, are often secondary priorities. This is not only true for the beginning of migrants' stays in their host country, but also as the duration of their stays increases. Processing major life changes and traumatic experiences, meeting acculturation requirements and managing everyday life in a foreign country require migrants' full attention. Public health efforts must be more responsive to Syrian migrants' specific needs. Future research should continue to focus on Syrian migrants' living, working and social conditions and their impacts on health-related behaviors.

Conducting qualitative research through time: how might theory be useful in longitudinal qualitative research?

This paper explores the use of theory in longitudinal qualitative research, an approach to research which explores lived experiences as they unfold. The authors illustrate how the complexity of conducting qualitative research through time drives an understanding and use of theory that differs from other research approaches. Longitudinal qualitative research considers time as fluid, subjective, and unbounded-in contrast to the more common taken-for-granted understanding of time as fixed, objective, and linear. Furthermore, longitudinal qualitative research is predicated on a premise of trust in the context of enduring research relationships. Therefore, while subject-matter theories used to investigate topics of interest to health professions educators may be useful frameworks for other types of research, longitudinal qualitative research needs theories that accommodate the myriad of changes in lived experiences through time. The authors share their decade-long, longitudinal qualitative research story, highlighting their decision points and insights. In doing so, they foreground issues such as time as fluid as an important contribution to health professions education literature.

Contraceptive trajectories postpartum: A longitudinal qualitative study of women living with HIV in Cape Town, South Africa.

BACKGROUND: Supporting the ability of women living with HIV (WLWH) to avoid unintended pregnancy during the postpartum period decreases the number of new pediatric HIV infections, reduces pregnancy-related morbidity and mortality, and is a cost-effective strategy for the elimination of mother-to-child transmission. However, little is currently known about the contraceptive intentions and experiences of reinitiating family planning use among mothers living with HIV as they transition from pregnancy into postpartum. STUDY OBJECTIVES: To (1) understand the contraceptive trajectories of women living with HIV during pregnancy and postpartum in Cape Town, South Africa, and (2) identify factors shaping differing contraceptive trajectories during the postpartum period. METHODS: Thirty pregnant WLWH were interviewed during their eighth month of pregnancy and completed follow-up interviews at 6-8 weeks and 9-12 months postpartum (n = 81 total interviews). Interview topics included postpartum contraception intentions, contraceptive use, and experiences accessing family planning services. Trajectory analysis of contraceptive intentions was applied after initial thematic coding. RESULTS: While nearly half of women interviewed during pregnancy expressed an intention to utilize a non-injectable contraceptive option after childbirth (e.g. implant, IUD, sterilization, oral contraceptive pills), all women interviewed at one year postpartum had received at least one injection. Three main contraceptive trajectories were identified. (1) realization of contraceptive intentions postpartum; (2) unrealized contraceptive intentions postpartum; and (3) change in contraceptive intention over time. Provider influence, coordination of services, and low contraceptive inventory were identified as potential factors shaping the contraceptive trajectories of participants enrolled in the study. CONCLUSION: Disparities between contraceptive method intentions articulated by WLWH during pregnancy and methods attained postpartum suggest that significant barriers remain for women who are unsatisfied with injectable contraception. Failing to provide postpartum mothers living with HIV their intended family planning method undermines efforts to prevent unintended pregnancy, a key pillar of elimination of mother-to-child transmission.

Probing the Processes: Longitudinal Qualitative Research on Social Determinants of HIV.

Longitudinal qualitative research can provide rich understanding of the life circumstances of vulnerable groups who experience health inequities, of whether, how and why these circumstances change, and of how these circumstances and processes of change impact health. But, this rich understanding is not automatic and requires systematic and thoughtful approaches to data collection and analysis. The purpose of this paper is to describe two longitudinal qualitative studies embedded in mixed-methods studies of social determinants of HIV in the United States and the Dominican Republic. We compare these two studies to critically reflect on specific techniques that facilitate longitudinal and iterative data collection, management, and analysis, in particular the use of participant-specific matrices and analytic summaries across the distinct phases of the research. We conclude that combining cross-sectional and longitudinal analysis that engages with both themes and processes of change can contribute to improved contextualization and understanding of social determinants of HIV.