Maintaining the Integrity of Qualitatively Driven Mixed Methods: Avoiding the "This Work Is Part of a Larger Study" Syndrome.

Severing a mixed method study into several publications is antithetical to the purpose and principles of mixed method designs. In this editorial, I explore the ramifications of such "splitting".

Dynamic reflexivity in action: an armchair walkthrough of a qualitatively driven mixed-method and multiple methods study of mindfulness training in schoolchildren.

Dynamic reflexivity is central to enabling flexible and emergent qualitatively driven inductive mixed-method and multiple methods research designs. Yet too often, such reflexivity, and how it is used at various points of a study, is absent when we write our research reports. Instead, reports of mixed-method and multiple methods research focus on what was done rather than how it came to be done. This article seeks to redress this absence of emphasis on the reflexive thinking underpinning the way that mixed- and multiple methods, qualitatively driven research approaches are thought about and subsequently used throughout a project. Using Morse's notion of an armchair walkthrough, we excavate and explore the layers of decisions we made about how, and why, to use qualitatively driven mixed-method and multiple methods research in a study of mindfulness training (MT) in schoolchildren.

Moving on: researching, surviving, and thriving in the evidence-saturated world of health care.

In the worlds inhabited by qualitative inquirers working in health-related areas, health care, evidence, qualitative research, and qualitative researchers are four areas of potential tension and, at times, collision. These areas, or at least aspects of them, are constantly reinvented and realigned as the effects of such encounters are navigated. This article is about some of these close encounters, what we might learn from them, and how we might use this to "survive" as qualitative inquirers in an evidence-based world of health care and health care delivery.

The research/practice nexus: underlying assumptions about the nature of research uptake into practice in literature pertaining to care of the older person.

Much has been written about the link between practice and research in the nursing and health literature. The literature from fields of practice relating to care of the older person is no exception. Enhancing best practice to effectively meet the needs and desires of older people, and provide an optimal working environment for those providing that care, requires sustainable synergies between research and practice. However, the perception of a gap(s) between 'what we know' and 'what we do' persists in the writing in relation to the care of older people, as it does in healthcare more broadly. Rather than attempting to provide an exhaustive descriptive review of the literature, this paper reports on, and provides an analysis of, two broad thematic areas that are reflected in much of the writing about research and practice relevant to the care of older people. The first thematic area relates to literature that presupposes a linear/passive view of research uptake. The second thematic area includes literature that conceptualizes research uptake as dynamic/active. The discussion focuses on what these thematic areas can tell us about enhancing and optimizing synergies and connections between research and practice relating to care of the older person.

Taking action to close the research/practice divide.

In this paper we focus at the level of individual project to explore aspects of the nexus between research and practice. Using a research project that sought to explore and understand care transitions for older people as the vehicle for our discussion, we examine how the process by which a research project itself is thought about, conceptualized, developed and conducted influences knowledge translation and ways to get research into practice, and conversely practice into research. Processes and strategies we engaged in throughout this research project to promote the transfer of knowledge both among and between researchers, practitioners and the wider practice community are highlighted.

Connecting what we do with what we know: building a community of research and practice.

How to think about, develop, maintain and optimize connections between research and practice remains a vexed and contested area in the increasingly complex multidisciplinary and inter-professional practice that constitutes contemporary healthcare and service delivery. A body of literature challenging linear and passive notions of research uptake has emerged which views research uptake as a dynamic, contextualized and active process. This paper explores the development of a successful and exciting community of research and practice involving a university and an aged care organization in Australia. The community of research and practice is premised on dynamic, contextual and active interaction between research and practice; where the categories of research and practice are not mutually exclusive or static; and where community is more than just a structure to facilitate collaborative research projects. It is proposed that the idea of a community of research and practice is a useful one in terms of seeking to better understand and provide strategies for knowledge translation between researchers and practitioners and those who are both.

Researching collaboratively: implications for qualitative research and researchers.

Often discussions about collaborative research, and collaboration generally, begin at the point of how to collaborate, who to collaborate with, and what to collaborate about. Rarely do they include equally important questions of why we are having discussions about collaboration, where such an impetus and emphasis is coming from, and how it connects to the contemporary political research context. In a recent editorial in Qualitative Health Research, Janice Morse highlighted the need for reflection about collaboration. This article responds to that call, providing reflections on collaboration, the imperative to collaborate, and what this all might mean for both qualitative research and qualitative researchers. I hope to stimulate new points of departure for thinking and action shaping collaborative research endeavors without-and just as crucially, within-qualitative research.

Healthism: a new conservatism?

Health care is a space occupied, shaped, and colonized by a variety of players at a variety of times. Such players include health practitioners of different kinds; individuals referred to variously and even simultaneously as consumers/patients/clients/customers, depending on who is doing the speaking and in what contexts; families and significant others; managers; accountants; lawyers; educators; and researchers, as well as governments both local and national. Players move in and out of this space (or are allowed in or are moved out) all the time. They might find parts of themselves/their lives/their situations in this space, whereas other parts are not found there. Health care is indeed a contested and troubled space, one that is increasingly uncertain and ambiguous. In this article, I explore aspects of this uncertainty and ambiguity in current health care practice and what this might mean for individuals receiving the services and those providing and/or researching those services.

Governing the contagious body: genital herpes, contagion and technologies of the self.

Genital herpes is a prevalent sexually transmitted viral infection. While genital herpes is not life-threatening, it can cause physical discomfort and psychosocial difficulties, and may increase the risk of contracting HIV. Given that genital herpes cannot be cured, both the condition itself, and the possibility of passing it on to others, becomes a part of the everyday reality of those individuals diagnosed with genital herpes. In this article we explore the ways in which people with genital herpes attending the Sexually Transmitted Infections (STI) clinic govern their 'contagious bodies'. The discussion draws on the Foucauldian concept of governmentality, and uses Foucault's idea of ethics as a framework to identify the technologies of the self by which individuals with genital herpes govern their own thoughts and behaviours in relation to the contagiousness of the condition. Implications for practice and other ways of thinking about what happens in the STI clinic context are suggested.

From retirement village to residential aged care: what older people and their families say.

The majority of older Australians, some of whom live in retirement villages, wish to remain living in their own home, receiving care in the community when their health and/or other circumstances change. Current statistics show that 3.7% of people aged 65 years and over live in a retirement village in Australia. However, residential aged care will still be required for some highly dependent members of the older population. This qualitative Australian study examined the transition into residential care from one form of community housing, the retirement village. In-depth interviews with 33 older people and 48 family members were conducted to illuminate the key issues and factors which influence the move of older people from retirement villages to residential aged care. Analysis of the data revealed the move to be influenced by: health-related crises; the creation of doubt as to ability to cope in the retirement village; the need for more or different care or support services; the desire for independence; assumptions about being able to move into the residential aged care facility co-located with the retirement village; availability of a place; navigating the system; and desirable aspects of a residential aged care facility. The findings of the study provide a description of the transition process from the perspectives of those directly affected, and contribute to the development of best practice in the provision of support to residents living in retirement villages and the community in general.

Making sure the residents get their tablets: medication administration in care homes for older people.

AIM: This paper reports an exploratory study of issues concerning the nursing practice of altering medication dose forms prior to administration of medicines to residents in homes for older people. BACKGROUND: Medication use and administration is a major issue in residential homes for older people. Research suggests that the alteration of medication dose forms in these homes is a widespread practice. Despite its prevalence, there is limited nursing or pharmaceutical literature exploring the decision-making processes surrounding this practice, the methods by which medicines are altered, or the types of medicines which are modified. METHOD: Semi-structured interviews were carried out with 11 Registered Nurses working in a purposive sample of 10 residential homes for older people drawn from each of the six regions of South Australia. The data were collected in 2000. FINDINGS: Nurses felt constrained to ensure that prescribed medication was administered to residents, despite their concern that this was not without risk. Nurses were concerned that they were working in an information vacuum, due to limited information resources and informal communication with other healthcare professionals such as speech pathologists, pharmacists and general practitioners. There was also concern about the difficulty of coordinating information and policies about altering medications and of implementing appropriate procedures in individual facilities. CONCLUSION: Clinical guidelines for the processes surrounding the alteration of medication dose forms and relevant pharmaceutical information are needed in all residential homes for older people. Ongoing education for nurses in this area is also required.

The making of health:: a reflection on the first 10 years in the life of a journal.

This introduction to the Tenth Anniversary Issue surveys articles that have been published in health: since its launch. Reviewing the original aims of the journal, the editors discuss some of the main issues that authors have raised, both about health and illness. Focusing upon articles that have been published in this particular journal, we discuss the way that new medical technologies--particularly global ones--have shaped ideas about disease and its treatment, and in consequence about what 'good health' should be. Related to the growth in medical and other technology--not least the rise of the Internet during the life of this journal--is the number of articles that discuss the rights of patients and the establishment of what might be termed an 'illness culture'. We conclude that there continues to be more to health than it being the background to illness or disease, and ask the question: should the 'taken for grantedness' of health be taken for granted any longer?

Improving the retirement village to residential aged care transition.

Older Australians living in retirement villages are an increasing community segment. These people make choices both about the place at which they live and the support needed at that place to optimise health and wellbeing. However, for some, unmet support needs in the retirement village may result in a transition to a residential aged care facility. This qualitative study explored how and why this transition occurs; how it might be avoided; and, when the move is unavoidable, how the process can be improved. Implications of these findings for the retirement village and aged care sectors are discussed.

The North West Adelaide Health Study: detailed methods and baseline segmentation of a cohort for selected chronic diseases.

The North West Adelaide Health Study is a population-based biomedical cohort study investigating the prevalence of a number of chronic conditions and health-related risk factors along a continuum. This methodology may assist with evidence-based decisions for health policy makers and planners, and inform health professionals who are involved in chronic disease prevention and management, by providing a better description of people at risk of developing or already diagnosed with selected chronic conditions for more accurate targeting groups for health gain and improved health outcomes. Longitudinal data will provide information on progression of chronic conditions and allow description of those who move forward and back along the continuum over time. Detailed methods are provided regarding the random recruitment and examination of a representative sample of participants (n = 4060), including the rationale for various processes and valuable lessons learnt. Self-reported and biomedical data were obtained on risk factors (smoking, alcohol consumption, physical activity, family history, body mass index, blood pressure, cholesterol) and chronic conditions (asthma, chronic obstructive pulmonary disease, diabetes) to classify participants according to their status along a continuum. Segmenting this population sample along a continuum showed that 71.5% had at least one risk factor for developing asthma, chronic obstructive pulmonary disease or diabetes. Almost one-fifth (18.8%) had been previously diagnosed with at least one of these chronic conditions, and an additional 3.9% had at least one of these conditions but had not been diagnosed. This paper provides a novel opportunity to examine how a cohort study was born. It presents detailed methodology behind the selection, recruitment and examination of a cohort and how participants with selected chronic conditions can be segmented along a continuum that may assist with health promotion and health services planning.