Assessing quality with qualitative research

Abstract

Epidural analgesia is currently the most effective method available to control pain in labour and has become a popular choice for labouring women in North America. In Canada, epidural analgesia was used in nearly half (45.7%) of all vaginal deliveries in 2001-2002. 1 In the United States, a sample from seven states suggests that 68% of women received neuraxial labour analgesia in 2003. 2 Ideally, labour analgesia should be tailored to the individual patient's labour, medical condition, preferences, and goals. 3 To this end, current literature most clearly addresses interactions between neuraxial labour analgesia and the progress of labour, mode of delivery, complication rates, and a number of medical conditions. In comparison, less evidence is available to measure the effectiveness of various analgesic techniques in addressing women's preferences and goals for analgesia during labour and delivery.Maternal satisfaction with pain relief is a common measure used in quantitative trials of various analgesic techniques in order to capture effectiveness in meeting women's expectations, preferences, and goals. However, satisfaction is a multidimensional construct influenced by analgesic experience, delivery outcomes and complications, human interactions, and other factors. 4 As a result, a global measure of satisfaction with analgesia may or may not discriminate successfully between a high-quality and a low-quality analgesic experience.The limitation of relying on global satisfaction to signal high-quality analgesia is apparent when considering the group of randomized controlled trials that compared epidural analgesia with non-epidural analgesia or no analgesia. 5 Five of these trials included a measure of satisfaction with analgesia among the outcomes, and metaanalysis suggests no significant difference between groups (relative risk 1.18, 95% confidence interval 0.92 to 1.50; n = 1,940 women).In pursuit of a more robust method to evaluate the factors that determine high-quality neuraxial analgesia from women's perspectives, Dr. Pamela Angle and her colleagues have initiated an ambitious program of mixedmethods research. Published in the current issue of the Journal, their article describes a series of interviews and focus groups that aimed to identify themes relevant to the experience of childbirth pain and epidural analgesia. 6 The purpose of this qualitative study was to define the specific factors that may be important for an overall measure of high-quality analgesia. Participants were women of mixed parity who had received epidural labour analgesia and who had met with the investigators to discuss their experience of epidural labour analgesia within 72 hr following delivery.The major themes that emerged suggest women are concerned primarily that effective analgesia should be readily available, free of effects on labour progress, and established without complications. If trade-offs become necessary, rather than avoidance of other side effects, such as pruritis, continuous pain control is most important, followed by...

Satisfaction maternelle de la prise en charge anesthésique durant l’accouchement: une étude de cohorte rétrospective

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Organizational leisure benefits – a resource to facilitate employees’ work-life balance?

“…The researchers discussed any coding differences, and all transcripts and audio files were exchanged and cross-checked. This "interviewer triangulation" as data triangulation method (Denzin, 1989) improved the validity and observational reliability of the transcription and analysis process (Mhyre, 2010). In this manner, the risk of interviewer bias was reduced, while methodological rigor was ensured.…”

Turi̇st Rehberli̇ği̇nde Meslek Eti̇ği̇ İlkeleri̇ni̇n Faydaci Eti̇k Yaklaşimi İle Beli̇rlenmesi̇

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