Title: Methods in Health Geography
1Methods 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)
2Humanism
- 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
3Humanism
- 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)
4Humanism
- 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
5Holistic
- Geography of everyday life anchored in the
differing - Economic
- Social
- Political circumstances of different places
- Attention paid to context
6Qualitative 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.
7Methods
- 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
8Methods 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
9Changing Geographies of Care Examining
Palliation on Home Space
10Caregiver 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
11Research 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
12Case 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)
13Qualitative 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
15CASE 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
16Meaning 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)
17Home 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) -
18Intra-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
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21Placement 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)
22Limitations 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)
23Outcome
- 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
24CASE 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
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26Meaning 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)
27Home 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
29Outcome
- 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
30Summary 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
31Summary 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
33Policy 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
34Rigour
- 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
35Rigour
- 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
36Qualitative 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