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The Sort and Sift, Think and Shift qualitative data analysis approach is an iterative process where analysts dive into data to understand its content, dimensions, and properties, and then step back to assess what they have learned and to determine next steps. Researchers move from establishing an understanding of what is in the data (“Diving In”) to exploring their relationship to the data (“Stepping Back”). This process of “Diving In” and “Stepping Back” is repeated throughout analysis. To conclude, researchers arrive at an evidence-based meeting point that is a hybrid story of data content and researcher knowledge. To illustrate core tenets of Sort and Sift, Think and Shift, we analyzed three focus group transcripts from a study of postnatal care referral behavior by traditional birth attendants in Nigeria; these transcripts came from Syracuse University’s Qualitative Data Repository and were unfamiliar to the analytic team prior to this exercise. We focused on letting the data be our guide into not only the explicit purpose of the interviews, but also into the unexpected discoveries that arise when inquiring about people’s lived experiences. Situating our efforts within an Initial Learning Period, each member of the team closely read each transcript, and then identified powerful quotations that made us pause and take note. We documented what we learned from each transcript in an episode profile which contained diagrams and memos. Episode profiles were shared and discussed across the team to identify key points of interest, such as the role of faith in women’s decision-making processes related to their pregnancy and delivery preferences, and concepts of who bears what knowledge about reproductive health. Our engagement in this analytic exercise demonstrates the applicability of qualitative inquiry and Sort and Sift as flexible approaches for applied research.

\"Almost a decade ago, in 2004, noted anthropologist Louise Lamphere observed a \"sea change\" in anthropology, with the interests of applied, practicing, and public interest anthropologists converging around the themes of increased collaborations and partnerships, outreach to the public, and efforts to influence policy. The sea change was concretized in anthropology's flagship journal, American Anthropologist, with the 2010 inauguration of the \"Public Anthropology Reviews\" section. Public anthropology, arguably the convergence that Lamphere foretold, represents an expansion of the value and relevance of anthropology, as well as a shift in the production and dissemination of knowledge. Furthermore, as Nancy Scheper-Hughes articulated in 2009, public anthropology involves not only responding to public issues but making public issues. Anthropologists working in the federal sector, such as the Veterans Administration (VA), realize the challenges and rewards of practicing public anthropology on a daily basis. The movement of anthropologists into the largest integrated health care system in the U.S. exemplifies the sea change toward public anthropology, particularly with regard to the contributions our discipline can make to improving health care. This volume addresses three key aspects of the contributors' voices within a growing anthropology in/of/for the VA. First, we describe pathways and approaches to practicing anthropology in the VA. Second, we characterize anthropological contributions to Veteran empowerment efforts. Finally, we illustrate how anthropology informs current dialogues and policies related to Veterans at the margins of health and social services. Within and across these themes, issues of praxis, ethics, action, and service are highlighted. Collectively the contributors resonate with--and exemplify--Scheper-Hughes's contention that public anthropology is a precious right and a privilege\"--Publisher's description (viewed January 24, 2015)

Policy Points Community‐engaged research (CEnR) engenders meaningful academic‐community partnerships to improve research quality and health outcomes. CEnR has increasingly been adopted by health care systems, funders, and communities looking for solutions to intractable problems. It has been difficult to systematically measure CEnR's impact, as most evaluations focus on project‐specific outcomes. Similarly, partners have struggled with identifying appropriate measures to assess outcomes of interest. To make a case for CEnR's value, we must demonstrate the impacts of CEnR over time. We compiled recent measures and developed an interactive data visualization to facilitate more consistent measurement of CEnR's theoretical domains. Context Community‐engaged research (CEnR) aims to engender meaningful academic‐community partnerships to increase research quality and impact, improve individual and community health, and build capacity for uptake of evidence‐based practices. Given the urgency to solve society's pressing public health problems and increasing competition for funding, it is important to demonstrate CEnR's value. Most evaluations focus on project‐specific outcomes, making it difficult to demonstrate CEnR's broader impact. Moreover, it is challenging for partnerships to identify assessments of interest beyond process measures. We conducted a mapping review to help partnerships find and select measures to evaluate CEnR projects and to characterize areas where further development of measures is needed. Methods We searched electronic bibliographic databases using relevant search terms from 2009 to 2018 and scanned CEnR projects to identify unpublished measures. Through review and reduction, we found 69 measures of CEnR's context, process, or outcomes that are potentially generalizable beyond a specific health condition or population. We ed data from descriptions of each measure to catalog purpose, aim (context, process, or outcome), and specific domains being measured. Findings We identified 28 measures of the conditions under which CEnR is conducted and factors to support effective academic‐community collaboration (context); 43 measures evaluating constructs such as group dynamics and trust (process); and 43 measures of impacts such as benefits and challenges of CEnR participation and system and capacity changes (outcomes). Conclusions We found substantial variation in how academic‐community partnerships conceptualize and define even similar domains. Achieving more consistency in how partnerships evaluate key constructs could reduce measurement confusion apparent in the literature. A hybrid approach whereby partnerships discuss common metrics and develop locally important measures can address CEnR's multiple goals. Our accessible data visualization serves as a convenient resource to support partnerships’ evaluation goals and may help to build the evidence base for CEnR through the use of common measures across studies.

Background The use of rapid qualitative methods has increased substantially over the past decade in quality improvement and health services research. These methods have gained traction in implementation research and practice, wherein real-time adjustments are often made to optimize processes and outcomes. This brisk increase begs the questions: what does rigor entail in projects that use rapid qualitative analysis (RQA)? How do we define a pragmatic framework to help research teams design and conduct rigorous and valid rapid qualitative projects? How can authors articulate rigor in their methods descriptions? Lastly, how can reviewers evaluate the rigor of rapid qualitative projects?. Methods A team of seven interdisciplinary qualitative methods experts developed a framework for ensuring rigor and validity in RQA and methods suitable for this analytic approach. We conducted a qualitative evidence synthesis to identify gaps in the literature and then drew upon literature, standard procedures within our teams, and a repository of rapid qualitative training materials to create a planning and reporting framework. We iteratively refined this framework through 11 group working meetings (60-90 minutes each) over the course of one year and invited feedback on items to ensure their completeness, clarity, and comprehensibility. Results The Planning for and Assessing Rigor in Rapid Qualitative Analysis (PARRQA) framework is organized progressively across phases from design to dissemination, as follows: 1) rigorous design (rationale and staffing), 2) semi-structured data collection (pilot and planning), 3) RQA: summary template development (accuracy and calibration), 4) RQA: matrix analysis (matrices), and 5) rapid qualitative data synthesis. Eighteen recommendations across these sections specify best practices for rigor and validity. Conclusions Rapid qualitative methods play a central role in implementation evaluations, with the potential to yield prompt information and insights about context, processes, and relationships. However, guidance on how to assess rigor is nascent. The PARRQA framework enhances the literature by offering criteria to ensure appropriate planning for and assessment of rigor in projects that involve RQA. This framework provides a consensus-based resource to support high-level qualitative methodological rigor in implementation science.

Background Electronic health record (EHR) implementations, whether replacing paper or electronic systems, are major social and organizational transformations. Yet studies of EHR-to-EHR transitions have largely neglected to elucidate accompanying social and organizational changes. One such underexplored change is the standardization of clinical practice in the context of EHR transitions. The Department of Veterans Affairs (VA) has begun a decade-long process of replacing the approximately 130 separate versions of its homegrown EHR with a single commercial EHR system. This provides an opportunity to explore the standardization of clinical practice amidst an EHR transition. Objective To identify, in the context of a large-scale EHR transition, (1) the scope and content of clinical standardization and (2) the anticipated implications of such standardization. Design Qualitative study. Participants Twenty-nine members of VA councils established for the EHR transition. Approach We conducted semi-structured interviews, which were professionally transcribed, and analyzed first using rapid analysis methods, followed by coding and content analysis. Key Results Clinical standardization across facilities was a central goal of the EHR transition, encompassing computerized recommendations, order sets, professional roles/permissions, and clinical documentation. The anticipated implications of this standardization include (i) potential efficiency gains, with less duplicated effort across facilities; (ii) expanded bureaucracy; and (iii) increased uniformity, reducing both wanted and unwanted variation in care. Conclusions EHR systems shape a wide range of clinical processes, particularly in a large organization like VA with a long history of EHR use. This makes standardization of EHR content a powerful mechanism for standardizing clinical practice itself, which can bring dramatic collateral consequences. Organizations undergoing EHR transitions need to recognize the important role that clinical standardization plays by treating EHR transitions as major organizational transformations in the governance of clinical practice.

Background The COVID-19 pandemic intersected with a housing crisis for unsheltered Veterans experiencing homelessness (VEHs); congregate settings became high risk for viral spread. The VA Greater Los Angeles responded by creating the Care, Treatment, and Rehabilitation Service (CTRS), an outdoor, low-barrier-to-entry transitional housing program on VA grounds. This novel emergency initiative offered a protected outdoor environment (“sanctioned encampment”) where VEHs lived in tents and had access to three meals a day, hygiene resources, and health and social services. Objective To identify contextual factors that supported and impeded CTRS participants’ access to healthcare and housing services. Design Multi-method, ethnographic data collection. Participants VEHs residing at CTRS, CTRS staff. Approach Over 150 hours of participant observation were conducted at CTRS and at eight town hall meetings; semi-structured interviews were conducted with 21 VEHs and 11 staff. Rapid turn-around qualitative analysis was used to synthesize data, engaging stakeholders in iterative participant validation. Content analysis techniques were used to identify key factors that impacted access to housing and health services among VEHs residing in CTRS. Key Results Staff varied in their interpretation of CTRS’ mission. Some conceptualized access to health services as a central tenet, while others viewed CTRS as an emergency shelter only. Regardless, staff burnout was prevalent, which lead to low morale, high turnover, and worsened access to and quality of care. VEHs endorsed trusting, long-term relationships with CTRS staff as paramount for facilitating access to services. Though CTRS addressed basic priorities (food, shelter, etc.) that traditionally compete with access to healthcare, some VEHs needed on-site healthcare services, at their tents, to access care. Conclusions CTRS provided VEHs access to basic needs and health and housing services. To improve access to healthcare services within encampments, our data suggest the value of longitudinal trusting relationships, adequate staff support, and on-site health services.

Background Ethnography has been proposed as a valuable method for understanding how implementation occurs within dynamic healthcare contexts, yet this method can be time-intensive and challenging to operationalize in pragmatic implementation. The current study describes an ethnographically-informed method of guided discussions developed for use by a multi-project national implementation program. Methods The EMPOWER QUERI is conducting three projects to implement innovative care models in VA women’s health for high-priority health concerns – prediabetes, cardiovascular risk, and mental health – utilizing the Replicating Effective Programs (REP) implementation strategy enhanced with stakeholder engagement and complexity science. Drawing on tenets of ethnographic research, we developed a lightly-structured method of guided “periodic reflections” to aid in documenting implementation phenomena over time. Reflections are completed as 30–60 min telephone discussions with implementation team members at monthly or bi-monthly intervals, led by a member of the implementation core. Discussion notes are coded to reflect key domains of interest and emergent themes, and can be analyzed singly or in triangulation with other qualitative and quantitative assessments to inform evaluation and implementation activities. Results Thirty structured reflections were completed across the three projects during a 15-month period spanning pre-implementation, implementation, and sustainment activities. Reflections provide detailed, near-real-time information on projects’ dynamic implementation context, including characteristics of implementation settings and changes in the local or national environment, adaptations to the intervention and implementation plan, and implementation team sensemaking and learning. Reflections also provide an opportunity for implementation teams to engage in recurring reflection and problem-solving. Conclusions To implement new, complex interventions into dynamic organizations, we must better understand the implementation process as it unfolds in real time. Ethnography is well suited to this task, but few approaches exist to aid in integrating ethnographic insights into implementation research. Periodic reflections show potential as a straightforward and low-burden method for documenting events across the life cycle of an implementation effort. They offer an effective means for capturing information on context, unfolding process and sensemaking, unexpected events, and diverse viewpoints, illustrating their value for use as part of an ethnographically-minded implementation approach. Trial registration The two implementation research studies described in this article have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans (NCT02991534); and Implementation of Tailored Collaborative Care for Women Veterans (NCT02950961).

Qualitative methods are critical to the conduct of Dissemination and Implementation (D&I) research because they illuminate processes, relationships, contexts, and other phenomena known to influence implementation and dissemination. Given the multitude of methods available, choosing appropriate and feasible methods can be challenging, leading many to rely on a limited set of methods. Navigational assistance with methods decision-making, including choosing to use less common methods, is lacking. This paper outlines how to select study methods, beginning with the research goal and the type of research question(s), and presents methods options based on key characteristics of the research. Decision pathways and considerations important to decision-making are featured as well as brief descriptions of the main methods available. Examples are also presented for instructional purposes. This paper supports the field of D&I by addressing a gap in the existing literature about how to conduct qualitative methods D&I research from a methodological perspective.