Multidisciplinary research teams that include faculty, students, and volunteers can be challenging and enriching for all participants. Although such teams are becoming commonplace, minimal guidance is available about strategies to enhance team effectiveness. In this article, the authors highlight strategies to guide qualitative teamwork through coordination of team members and tasks based on mutual adjustment. Using a grounded theory exemplar, they focus on issues of (a) building the team, (b) developing reflexivity and theoretical sensitivity, (c) tackling analytic and methodological procedures, and (d) developing dissemination guidelines. Sharing information, articulating project goals and elements, acknowledging variation in individual goals, and engaging in reciprocity and respectful collaboration are key elements of mutual adjustment. The authors summarize conclusions about the costs and benefits of the process.

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Highly active antiretroviral therapy (HAART) adherence research has focused predominantly on individuals with less than optimal clinical outcomes; therefore, little is known about the experiences of individuals who sustain undetectable viral loads. The present study used a qualitative method to explore how individuals who have sustained undetectable viral loads account for their success, and to identify challenges, as well as possible needs, for continued success. Participants were 20 patients at an outpatient infectious disease clinic in an urban center. Participants completed two 60-minute interviews. The Critical Incident Technique was used to identify and classify critical incidents linked with sustaining treatment success. Of the 438 critical incidents collected, 316 were identified as helpful and 122 were identified as unhelpful. Helpful categories included resolving ambivalence, using personal strengths, and fostering helpful relationships. Unhelpful categories were mood, lack of social support, financial difficulties, and medication factors. Doing well on antiretroviral therapy is a dynamic process that requires ongoing attention from both the patient and care provider. The results of this study highlight the efforts of patients to maintain their health and remind care providers not to assume that patients are not facing continuous challenges. Findings from the present study suggest that psychosocial factors do contribute to improved clinical outcomes in patients taking HAART.

The efficacy of highly active antiretroviral therapy (HAART) has been well documented, particularly among HIV-infected individuals with CD4 cell counts below 200/mm(3). Despite this, eligible individuals may continue to show some reluctance to use HAART. The present study explored the factors influencing patients' decision not to take HAART even though it was medically indicated according to current treatment guidelines and available at no cost to the individual. Fifteen eligible patients at an urban HIV clinic were interviewed regarding the barriers that affected their decision to decline HAART. Most participants had previous experience with antiretroviral therapy and though most believed that HAART was beneficial and felt confident that they could adhere to treatment, they did not feel HAART was the right choice for them at the present time. The Critical Incident Technique was used to identify and classify incidents participants identified as influencing their decision not to take HAART. A total of four categories emerged from the data: Medication Factors, Mood, Lack of Support, and Outcome Expectancies. The results of this study highlight the ambivalence individuals may feel when faced with the prospect of taking HAART. The extent to which each of these factors influenced their decision differed substantially among participants. Suggestions for possible clinical interventions that can be used to address these concerns are offered.

Multi-drug rescue therapy (MDRT) is often used for the treatment of highly experienced patients who harbor HIV variants with decreased susceptibility to multiple antiretrovirals. Patients on MDRT typically have limited treatment options, and without treatment, their prognosis can be poor. Yet the decision to go on MDRT is not always straightforward as MDRT can be associated with significant challenges including multiple daily doses, higher pill burden, emerging toxicities, and drug interactions. All of these may compromise adherence, which is often a major reason why patients may need MDRT in the first place. Little is known about how patients and health care providers (HCPs) experience MDRT. This study sought to explore areas of convergence and divergence between patients and HCPs in order to identify gaps in treatment and factors that may impact adherence to MDRT. A qualitative interview method based on grounded theory was used. Twelve patients and seven HCPs completed a 60-minute semistructured interview. Patients were asked about challenges, facilitative aspects of staying on MDRT, the decision to initiate treatment, their role, and the role of HCPs in their health care. HCPs were asked about their experience working with MDRT patients, their role, and the role of the patient. Congruent themes emerged from the two groups: developing a working relationship, treatment factors, information requirements, and readiness for treatment. There were no discrepancies in role perspectives. Patients and HCPs agreed on the need to optimize patients' readiness, willingness, and ability to embark on MDRT to maximize adherence. HCPs assumptions about beginning MDRT based solely on medical indications must be checked and discussed to ensure patients' motivation. In conclusion, adherence to MDRT demands a substantial behavior change, recognized as a major challenge by patients. Allocating the time to make a commitment to treatment can optimize adherence. It is therefore crucial that patients be provided with time to make informed decisions, explore and resolve their willingness and readiness to commit to treatment, and maintain supportive relationships with their HCPs, all of which can optimize adherence to MDRT.

Our aim was to explain how female clerical workers manage work-related distress, using a feminist grounded theory method. Thirty-seven interviews were conducted with 24 female clerical workers. They engage in the process of gauging visibility to manage a recognition-vulnerability paradox. To gauge visibility, they take the lay of the land by attending to threats, resources, and supports within withering or flourishing work conditions. When distressing events occur, they select tactics of taking it in, taking it on, or letting it go, which are influenced by the quality of their work conditions. Their efforts to manage distress affect their workplace visibility, potentially enhancing their recognition or exacerbating their vulnerability. Gauging visibility can either diminish or enhance employees' health and well-being. Our findings emphasize social processes and structural conditions, shift attention to organization-wide efforts to alter workplace conditions, and suggest initiatives that enhance employees' opportunities for recognition, safety, and collective actions.

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