A Transparency Checklist for Qualitative Research

Who is sensitising whom? A participatory interview guide development as an awareness tool within a health care research project

Qualitative research has an important place within evidence-based health care (EBHC), contributing to policy on patient safety and quality of care, supporting understanding of the impact of chronic illness, and...

To err is human. This statement is true for all activities where human beings are involved. If safety-critical work has to be performed—independent of the type of industry (aviation, nuclear or medicine)—certain structures and concepts have to be implemented to achieve a high level of safety. Table 1 shows the average mean time between failures (MTBFs) when different tasks have to be performed by human beings. We learn from research work done by Professor Bubb of the Technical University of Munich that we have to expect an average of 15 work errors per person per working day. This is true only for a relaxed working atmosphere. If time pressure and stress increase, the MTBF decreases to one error every half minute. Most of the errors are identified immediately after they happen, but some remain undetected. We need special strategies to neutralize the errors, omissions and mistakes before they cause major problems. A first and important step to reduce the number of errors is to structure the work process. The probability that important work steps are omitted or are done at the wrong time during a certain procedure has to be reduced. The easiest way to help the human operator is to use checklists. They help to identify and correct work errors and omissions before things go wrong or irreversible steps are taken in the wrong direction. As mentioned in Clark et al. [1], checklists have to be tailored to the actual work situation. On the one hand, they have to be as precise and accurate as possible and, on the other hand, they should be as short and self-explanatory as possible. Checklists have to cover safety-critical working steps. Preparing a powerful and helpful checklist is a very difficult and demanding task. Therefore, checklists should be developed only by specialists and professionals who use them in their own work. The use of checklists has to be taught and the procedures have to be updated whenever new information for the system’s optimization becomes available. The use of a checklist has to be emphasized by the top management of an organization and the rules have to be observed by all members of a team. The team leader’s adherence to the procedure is especially important. In aviation, the obligatory use of checklists could increase the safety of a flight by more than a factor of 10. Besides a well-structured working concept, which is ‘protected’ by checklists, there is another area which determines the risk of any operation where human performance is a factor: as shown in Santos et al. [2], we have to deal with communication concepts. A detailed investigation of the work environment combined with the analysis of the flight recorder data and the voice recording of cockpit communication provides a clear picture of the working conditions and the errors that lead to a catastrophe. Accident statistics prove that it is the human being in the cockpit who causes approximately three-quarters of all aviation accidents. The large proportion of human error has given rise to the seemingly brilliant solution of replacing the fallible human being with an ‘infallible’ digitally operated computer. This measure was meant to eliminate all human insufficiencies from the man/machine control loop. A computer never gets tired, is not emotional, does not need a holiday and has a constant level of motivation, etc. A considerable share of human work has been taken over by robots. In many cases, this measure has an increased productivity and has guaranteed an unchanging product quality. In aviation, however, an increased degree of automation has not changed the share of human errors in causing the accidents. Even after the introduction of the so-called HITEC airplanes, the ‘human error’ factor still accounts for 75% of all accidents (Fig. 1). Up to now, the assumption that an increased degree of automation will necessarily lead to an increase in safety has not been proven true. However, if the computer is ruled out as the ultimate safety system, how else can complex operations involving quick and difficult decisions be controlled? We must seek new answers in fields of activity that depend on the smoothest and safest possible interaction of a man and a machine. In this context, the findings of biology, psychology and the social sciences are gaining in importance.

Based on current weaknesses in the understanding of the mechanisms, factors and positive effects involved in checklist usage, as well as a scarcity of qualitative approaches, the aim of this study was to explore surgical personnel experiences with the World Health Organization's Surgical Safety Checklist, 2 years after implementation. Three focus group interviews were conducted with surgical personnel. An interview guide was designed to assist the interview process, comprised of broad, open-ended questions. Notes and audio recordings were fully transcribed verbatim and subsequently analysed using qualitative content analysis in order to identify emergent meaning units, categories and themes. The checklist improves confidence, team communication and sharing of critical information in the surgical team. However, informants described the occurrence of wrong-site surgery not prevented by the checklist due to preoperative wrong-site marking combined with automated checklist use in the operating room. Using the checklist as a 'tic box exercise' was recognized as a safety challenge by all professions, especially during routine surgery. The surgical team balances safety and effectiveness constantly in the operating room. Challenges that need to be addressed include making the Sign-in part a team effort and taking the accompanying pause in performance during the Time-out and the Sign-out, with cross-check of items, in order to avoid automated checklist use. We suggest surgical team training that includes checklist performance, in order to enhance the quality of checklist use.

Separating women with the coronavirus 2019 from family can affect marital life. Considering psychological vulnerability of women for anxiety and depression disorders, these women may experience more stress due to the loss of work at this time or special reproductive health conditions such as pregnancy, having a baby, or other medical conditions. Considering a limited number of qualitative studies on the need for marital intimacy, this study was conducted to meet marital intimacy needs in women with coronavirus 2019. Framework qualitative content analysis was conducted through participation of 13 key informants (sex therapist, couple therapist, psychologist, and midwifery counselor) and 18 infected women from Yazd, Iran in July 2020 who were selected purposefully and interviewed through the semi-structured in-depth interviews. 3 main categories were: 1) mutual resilience (subcategories: 1. coping strategies; 2. value of marital life; 3. compassionate conflict resolving). 2) skillful relationship (subcategories: 1. assertiveness in sexual expression; 2. self-efficacy in the distance physical connectivity). 3) synergy (subcategories: 1. reframing spirituality closeness; 2. empowering aesthetic creativity; 3. management of family function, and 4. prioritizing). Findings revealed sex and couple therapists, health providers, and policymakers should emphasize on using new forms of digital communication in these couples. Teaching skills that increase partners' creativity and empathy, enable women to fulfill their mental, sexual and reproductive health needs, and lead to more partners responsibility and loyalty, and maintenance of family function. In times of crisis, counseling should be considered in women treatment programs and care guidelines.

ObjectiveTo report on the findings of a systematic review which examined the experiences and views of older people aged 65 years and over on health professionals’ recognition of sexuality and sexual health and whether these aspects of the person are incorporated into care.Review methodsThe review followed the methods laid out by the Joanna Briggs Institute. Eleven electronic databases were searched using the terms sexual*, aged, ageing/aging, attitudes and care in any health‐care setting. Only quantitative and qualitative research and opinion papers written in English and offering unique commentary published between January 2004 and January 2015 were eligible.ResultsA total of 999 papers were initially identified and of these, 148 were assessed by two reviewers. Eighteen studies – seven quantitative, eight qualitative and three opinion papers – met the inclusion criteria and were appraised. The importance of sexuality to well‐being, language used, expressing sexuality, discomfort discussing sexuality, inadequate sexuality health education and treatment and deficient communication with health‐care professionals were all identified as significant issues in a range of settings. Fourteen categories and five syntheses summarize the 43 findings.ConclusionsSexuality remains important for many older people; however, embarrassment, dissatisfaction with treatment, negative attitudes and seeming disinterest by health professionals can all inhibit discussions. Professionals and health‐care services need to adopt strategies and demonstrate characteristics which create environments that are more supportive of sexuality. Issues related to sexuality and sexual health should be able to be discussed without anxiety or discomfort so that older people receive optimal care and treatment.

Qualitative researchers are increasingly called on to take part in research teams with complex mixes of disciplinary, methodological, and global connections. Unfortunately, many are not well prepared to work in these circumstances. Moreover, the leaders of these teams often lack knowledge of the ways qualitative researchers could enrich team processes through the unique characteristics of qualitative research and the special skills those trained in this methodological approach could bring to the project. Social scientists have few curricular materials or instructional models to guide them in learning how to better integrate qualitative researchers on team research projects. This goal of this chapter is to bring attention to this issue and raise key concerns that will require attention to address this issue. The chapter provides an overview of the small body of research that has developed in regard to qualitative research and complex teams and then raises a set of four key issues that need attention: (a) making the best use of qualitative research on a team; (b) selecting digital tools; (c) attending to new developments in writing; and (d) addressing issues of social justice. Also included is a discussion of the curricular issues that must be considered as the field moves forward to consider the ways qualitative researchers can best enter this new world of complex teams.

To investigate the decisional needs in Denmark of people with kidney failure, relatives, and health professionals when planning end-of-life care. A qualitative interview study. Individual semi-structured interviews were carried out with people with kidney failure, relatives and health professionals from November 2021 to June 2022. Malterud's systematic text condensation was used to analyse transcripts. A total of 13 patients, 10 relatives, and 12 health professionals were interviewed. Overall, four concepts were agreed on: (1) Talking about end of life is difficult, (2) Patients and relatives need more knowledge and information, (3) Health professionals need more tools and training, and (4) Experiencing busyness as a barrier to conversations about end of life. People with kidney failure, relatives, and health professionals shared certain decisional needs while also having some different decisional needs about end-of-life care. To meet these various needs, end-of-life conversations should be systematic and organized according to the patients' needs and wishes. Non-systematic end-of-life care decision-making processes limit patients' involvement. Patients and relatives need more knowledge about end-of-life care, and health professionals need more competences and time to discuss decisional needs. A shared decision-making intervention for people with kidney failure when making end-of-life care decisions will be developed. This empirical qualitative research is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Patients, relatives, and health professionals have been involved throughout the research process as part of the research team and advisory board. The patients are people with kidney failure and the relatives are relatives of a person with kidney failure. For this study, the advisory board has particularly contributed to the validation of the invitation letter for participation, the interview guides and the preparation of the manuscript.

Faculty members need to assess resident performance using the Accreditation Council for Graduate Medical Education Milestones. In this randomized study we used an objective structured clinical examination (OSCE) around the disclosure of an adverse event to determine whether use of a checklist improved the quality of milestone assessments by faculty. In 2013, a total of 20 anesthesiology faculty members from 3 institutions were randomized to 2 groups to assess 5 videos of trainees demonstrating advancing levels of competency on the OSCE. One group used milestones alone, and the other used milestones plus a 13-item checklist with behavioral anchors based on ideal performance. We classified faculty ratings as either correct or incorrect with regard to the competency level demonstrated in each video, and then used logistic regression analysis to assess the effect of checklist use on the odds of correct classification. Thirteen of 20 faculty members rated assessing performance using milestones alone as difficult or very difficult. Checklist use was associated with significantly greater odds of correct classification at entry level (odds ratio [OR] = 9.2, 95% confidence interval [CI] 4.0-21.2) and at junior level (OR = 2.7, 95% CI 1.3-5.7) performance. For performance at other competency levels checklist use did not affect the odds of correct classification. A majority of anesthesiology faculty members reported difficulty with assessing a videotaped OSCE of error disclosure using milestones as primary assessment tools. Use of the checklist assisted in correct assessments at the entry and junior levels.

The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was designed to enhance quality in the reporting of interview and focus group studies, and it is widely endorsed by journals and publishers. However, it has also been heavily critiqued for its design and application in qualitative health research communities. In this article, we conduct detailed critical text analyses of eight articles and their accompanying self-reported COREQ responses and discuss the performative force of the checklist on the appearance of research quality. The analyses of authors' rhetorical strategies in articles and checklist responses indicated that they sometimes provide misleading, inconsistent, or excessive information, prioritizing checklist completion over substantive engagement with quality principles. While intended to standardize reporting, COREQ's rigid structure often led to overcompliance or inappropriate responses from authors, who strived to meet its criteria, even when they were irrelevant or unsuitable. This "overobedience" reflects a desire to maintain credibility and avoid scrutiny, yet it undermines the depth and rigor of qualitative research. COREQ is an epistemic device, shaping researcher practices and identities beyond its stated purpose, and while COREQ aims to enhance accountability, it perpetuates epistemic dominance, eroding authenticity and critical reflection in qualitative research, ultimately exacerbating the very problems it seeks to solve.

BackgroundCanada is one of the world’s most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents’ sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents’ SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada.ObjectiveThe purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents.MethodsWe will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app.ResultsRecruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024.ConclusionsOur study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale.International Registered Report Identifier (IRRID)PRR1-10.2196/45389

Introduction: The use of robotic surgery has revolutionised surgical procedures, offering benefits such as less blood loss, faster recovery and fewer post-operative complications. However, the increase in surgical time and technical challenges impose the need for systematic perioperative nursing interventions to guarantee patient safety and the efficiency of the process. Aim: To systematise the nursing interventions in the pre-, intra- and post-operative phases of robotic surgery that generate safety in the perioperative period. Method: Systematic literature review using the Joanna Briggs Collaboration methodology and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension. The MEDLINE, CINAHL, LILACS, SCOPUS and Cochrane Library databases were searched and 16 primary and secondary studies published between January 2014 and May 2024 were included. The data were extracted and analysed independently by two reviewers. Results: Nursing interventions in the pre-operative phase were characterised by rigorous technical preparation, effective communication and the use of checklists. In the intra-operative phase, team communication and coordination, proper patient positioning and the use of support surfaces were crucial. In the post-operative phase, continuous monitoring, pain management, self-care training and emotional and educational support were identified as fundamental. Conclusion: Nursing interventions play a crucial role in the safety and effectiveness of perioperative care in robotic surgery. Continuous training, technological adaptation and the use of systematic approaches are essential to maximise the benefits of this technology, as well as promoting patient safety and wellbeing.

IntroductionPulmonary arterial hypertension (PAH) is a complex condition affecting quality of life, characterised by high blood pressure in the pulmonary arteries leading to heart strain. PAH’s impact extends beyond physical...

Primary Subject areaGlobal Child and Youth HealthBackgroundBased on the 2014 census, 35% of Uganda’s population is between 10-24 years old. Health indicators show concerning sexual and reproductive health (SRH) trends such as high teen pregnancy, unsafe abortions, limited contraceptive use, and access to antenatal and postnatal care. However, the barriers to adolescents seeking and receiving care are complicated due to pre-existing social structures in smaller, closely linked communities.ObjectivesTo understand the social structures and motivation of communities in western Ugandan districts that impact SRH in adolescents to better implement Healthy Adolescent and Young people (HAY!).Design/MethodsIn September 2020, a qualitative study was conducted in 2 districts, in southwestern Uganda. Fourteen focus group discussions and 3 key informant interviews consisted of 94 participants were carried out with a purposive sample of adolescents, parents, community health workers (CHWs), community leaders, health facility staff, and district health officers. Ethics approval was obtained and COVID-19 prevention guidelines were strictly followed. Data was audio-recorded, transcribed, and thematically analyzed.ResultsBased on our qualitative inquiry, participants recognized that adolescents face numerous SRH challenges and expressed their tension for change and motivation to support interventions that may positively impact SRH behavior and outcomes in adolescents. However, participants who were mothers highlighted that their motivation was due to better marriage prospects for their daughters, which is determined by respect and social standing in the community. In situations of unwanted pregnancies, participants shared that because of the fear of shame, and desire to keep adolescents in school, mothers often supported unsafe abortion to maintain community standing. This is an unusual and interesting finding. Similarly, aunties and uncles were traditionally regarded as champions for protecting and guiding adolescents, but participants highlighted a negative shift in this dynamic; aunties and uncles put female adolescents at risk by connecting them with interested men in exchange for gifts and money. Consequently, they are no longer trusted. Despite these gaps, volunteer CHWs who work closely within their communities by conducting home visits, educating, and providing referrals, emerged as a trusted resource by adolescent participants in accessing SRH related information. CHW participants also shared that adolescents often confided in them when unable to speak openly with their parents.ConclusionAlthough participant groups were motivated towards supporting adolescents, interventions must first understand and navigate complex community structures to deliver a comprehensive and targeted intervention to improve SRH outcomes in adolescents.

SYNOPSIS: The purpose of this study is to guide practice and future research by examining contemporary fraud brainstorming practices. Using field data collected from audits conducted during 2013–2014, we investigate team characteristics, attendance and communication, brainstorming structure, timing, and effort, and brainstorming quality. Results show that although some practices are similar to those reported in earlier field studies, there are interesting differences (e.g., decreased use of checklists, shorter sessions, and risk-based deployment of resources in brainstorming). These differences suggest brainstorming has evolved throughout the intervening period during which new audit standards became effective and the PCAOB criticized auditors' performance in fraud risk identification and risk response generation. We also examine differences in audit team characteristics and brainstorming practices across risk and trading-status partitions. Results reveal auditors deploy more resources to brainstorming when engagement risk is heightened (i.e., publicly traded clients with high fraud and/or high inherent risk); correspondingly, brainstorming quality is higher on these engagements. Collectively, our findings indicate risk-based resource allocations in brainstorming and diligent responses to regulatory concerns.