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Methods in Health Geography

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Title: Methods in Health Geography


1
Methods in Health Geography
  • QUANTITATIVE REVOLUTION
  • In 1950s geographers generally adopted
    statistical methods/quantitative methods
  • Descriptive statistics ? mathematical modeling
  • spatial analysis
  • QUALITATIVE EXPLORATION
  • - Late 1960s, early 1970s concern focused on
    the peopling of human geography (Cloke et al.,
    1991)

2
Humanism
  • Based in humanist thought (humanities)
  • Reaction to positivist spatial science
  • Behavioural geography was the bridge to the
    development of a real evolution of humanistic
    geography
  • Shift in focus from humans acting in the world to
    humans simply reacting to it (environmental
    determinism)
  • Humanistic geography came into existence in late
    1960s early 1970s

3
Humanism
  • An approach in human geography distinguished by
    the central and active role it gives to human
    awareness and human agency, human consciousness
    and creativity
  • at once an attempt at understanding meaning,
    value and the human significance of life
    events (Buttimer, 1979) and
  • an expansive view of what the human person is
    and can do (Tuan, 1976)

4
Humanism
  • Attention paid to geographer (actively
    participating in research writing)
  • Attention given to the crucial role played by
    humans (perceiving, interpreting, shaping)
  • Focus on place ways in which people relate to
    the places around them
  • Intimate emotional, practical, political other
    attachments

5
Holistic
  • Geography of everyday life anchored in the
    differing
  • Economic
  • Social
  • Political circumstances of different places
  • Attention paid to context

6
Qualitative Research, defn.
  • Ways of examining the social world, whereby
    central importance is given to the actors
    definitions and behaviour. The term covers a
    wide variety of approaches and is used
    interchangeably with field, research, ethnography
    interpretative research.

7
Methods
  • Qualitative (interpretative/ethnographic)
  • Participant observation
  • Key-informant interviews
  • In-depth interviewing
  • Non-structured, Semi-structured, Structured
  • Focus groups (as above)
  • Case studies
  • Videography/photography
  • Field notes
  • other

8
Methods of Data Analysis
  • Develop a preliminary coding system
  • Prepare the transcript for analysis
  • Ascribe codes to text
  • Retrieve similarly coded text
  • Review the data by themes

9
Changing Geographies of Care Examining
Palliation on Home Space
10
Caregiver Burden Increasing
  • In quantity and quality (becoming more intense)
  • Move toward community care/hospital-in-the-home
  • 3 aspects of caregiving identified (Qureshi
    Walker1989)
  • physical labour,
  • emotional labour
  • management of care

11
Research Objective Methods
  • explore the impact, experience, and meaning of
    home-based palliative care on informal caregivers
    living caring for a dying patient at home
  • caregivers perspective sought
  • assisted by formal (publicly provided) home care
  • Comparative rural/urban sample frame employed to
    capture service differentiation
  • qualitative research techniques used to capture
    the representations of home space holistically

12
Case Study Research
  • defined by interest in phenomenon studied rather
    than method of inquiry
  • seeks to learn what is common (generalizable)
    across cases, as well as what is particular in
    each case
  • mixed methods employed
  • orient to complexities connecting ordinary
    practice in natural habitats to the abstractions
    and concerns of diverse academic disciplines.
    (Stake, 2000)

13
Qualitative Methods
  • Collective case study using a thematic analysis
    approach
  • ideally semi-structured in-depth interviews
    videography (for descriptive purposes)
  • defined by each of Pattisons (1978) three
    clinical phases of dying (1) Acute crisis phase,
    (2) Chronic living-dying phase, (3) Terminal
    phase
  • defined by Randos (1995) three bereavement
    periods (1) Avoidance phase, (2) Confrontation
    phase, (3) Accommodation phase
  • palliative Home Care Case Managers with Saskatoon
    Palliative Home Care Program (SDH) employ
    purposive sampling definition of phases/periods
  • 3 cases in total two contrasting cases presented

14
Results Thematic Categories
  • Home Place
  • Intra-Household Adjustments
  • Material Culture
  • Services
  • Caregiver Role

15
CASE 1 Home Place (1 bedroom apartment)
  • apartment chosen for convenience, location, cost
  • very small, not wheel-chair accessible
  • patient originally from farm and has lived in
    northern city for vast majority of life
  • caregiver grew up in northern city, lived in
    Saskatoon for university, overseas since

16
Meaning of Home (lt1 year)
  • The apartment is just a building, it is what
    inside, this energy inside. You can have a home
    anywhere -- we can be living on the street, but
    if it doesnt have good energy and happiness it
    is not a home. (I1)
  • It is still the same it is still where the
    heart is. Still where the heart is, still where
    the cat is, very important. (I2)

17
Home as Sanctuary
  • I do not like people in the house with negative
    energy. People coming to visit Mom, if they are
    going to cry we just say excuse me, you have to
    leave because this is a home of happy energy .
    And they have to respect that. They just say
    Well, you are not allowing us to grieve, I am
    like Well, you have to respect the dying person
    here. She doesnt need this and she doesnt want
    this. It brings her down, it destroys her energy
    and it destroys energy in the house. (I1)

18
Intra-Household Adjustments (Physical Environment)
  • living room focus of home (TV, telephone)
  • medicalization of the home
  • electric condenser with 25 ft of hose, wheelchair
    (later with tray, I2), Hoyer lift (later, I2)
  • most change in bathroom -- support bars on
    toilet, hydraulic bath lift

19
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20
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21
Placement of Furniture
  • She (mother) likes to see the sunsets and the sun
    rises. That is very spiritual for her. And for
    us too, another spiritual one for both of us is
    looking at the sky. You know, she says if I see
    the sky, I know God is there. When you see the
    sky, you know God is happy you know coming from
    the farm (I1)

22
Limitations of Home
  • It Hoyer lift a patient lifting device is a
    very cumbersome, clumsy machine used for lifting
    people. It is not practical in the house . It
    takes longer to hook it up and everything than to
    just pick her (mother) up. If she was a lot
    heavier okay, but she is heavy so it was just
    pick and drag. And so if she has to go to the
    bathroom, the Hoyer lift, you know, take five
    minutes up you need a big room to manoeuvre it
    into. (I2)

23
Outcome
  • Patient put in a long-term care facility and died
    within 6 months
  • Belongings put in storage apartment vacated
  • Caregiver returned overseas after a lengthy
    vacation returned for the funeral
  • Caregiver is very unsatisfied with the outcome
    and is particularly disappointed with the public
    health care system

24
CASE 2 Home Place
  • large home designed by couple
  • built as wheel-chair accessible although shower
    garage not fully accessible
  • residence for 5 years previously lived in
    Saskatoon for the majority of their adult life
  • both originally from rural farm communities

25
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26
Meaning of Home
  • Home is where the heart is. I love our home I
    love the outdoors in particular. Our house is
    wonderful. Its wonderful that (patients name)
    is able to enjoy it. (I1)
  • I like to come home. (I2)

27
Home as Sanctuary
  • I think when we first found out he had lung
    cancer, well initially we did a lot of bawling
    and that didnt please (patients name) so we
    dont do that anymore. (I1)

28
Intra-Household Adjustments (Physical
Environment)
  • kitchen focus of home 90 waking time spent
    there (TV telephone)
  • medicalization of home
  • reclining chair, wheeled walker (purchased),
    electric bed (purchased), multiple floor disks,
    support poles, cushions/sheepskin, Hoyer lift,
    oxygen machine
  • most change in bathroom -- wheeled commode, bath
    bench

29
Outcome
  • Patient died at home with caregiver present
  • Celebratory atmosphere with family and friends
    present
  • Caregiver sorry to see lazy-boy chair returned to
    Health District (removed from kitchen)
  • Ongoing support throughout bereavement by
    family/church/friends
  • Maintains residence possibility of renting
    lower-level as an apartment

30
Summary Home Place
  • SIMILARITIES
  • Meaning of home home as sanctuary
  • DIFFERENCES
  • Size comfort of physical home
  • Longevity of residence (1yr vs. 5 yr)
  • Degree of personalization

31
Summary Intra-Household Adjustments
  • SIMILARITIES
  • Most change in bathroom
  • DIFFERENCES
  • action centre room, where care focused
  • (living room vs. kitchen)
  • Ability to purchase aides (walker, electric bed)
  • Access to physical aides (chair, disks, support
    poles, etc.) due to occupational therapy visits
    informal support

32
Discussion Confirmations
  • Brown et al.s work (1990) that illustrated the
    benefits of palliative home care occur only when
  • there is a willing and able caregiver
  • when home care services are provided to the
    extent required
  • when the physical environment of the home can be
    adapted to meet the patients needs
  • Aranda Knights work (1997), suggesting
    caregiver burden is multidimensional, where
    stress and coping models include numerous
    categorical variables
  • socio-economic status
  • primary stressors and secondary strains

33
Policy Contributions
  • prevention of caregiver burnout
  • provision of appropriate home care services to
    the extent required
  • need for uniform and comprehensive use of allied
    health professionals for specialist support
  • social workers for mental well-being/self-care
  • OT for ergonomics/physical health
  • meet need for communication around
    availability/accessibility of programs/services
  • what is available how can it be accessed? What
    costs and what doesnt? i.e. palliative drug
    plan, nurses versus homemakers,
    equipment/supplies

34
Rigour
  • Credibility
  • purposive sampling
  • prolonged engagement
  • investigator triangulation
  • Transferability
  • purposive sampling
  • Dependability
  • mechanically recorded data (audio-taped)
  • multiple researchers
  • participant checks
  • Confirmability
  • - SDH Palliative Care Team checks
  • - analytical notebook

35
Rigour
  • Credibility
  • purposive sampling
  • prolonged engagement
  • investigator triangulation
  • Transferability
  • purposive sampling
  • Dependability
  • mechanically recorded data (audio-taped)
  • multiple researchers
  • participant checks
  • Confirmability
  • - SDH Palliative Care Team checks
  • - analytical notebook

36
Qualitative VS Quantitative
  • QUALITATIVE
  • Focus is on quality the what, how, when where
    the essence ambiance
  • The meanings, concepts, definitions,
    characteristics, metaphors, symbols, and
    descriptions of things
  • Depth of understanding
  • Time consuming
  • Requires greater clarity of goals during design
    stages
  • QUANTITATIVE
  • Focus in on quantity counts measures of
    things
  • Variables (units of measurement)
  • Clinically collected
  • Collected via survey
  • Collected orally
  • Breadth of understanding
  • Technically dependent
  • Statistical analysis determines relationships
    among variables
  • Tests carefully constructed causal hypotheses
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