Phenomenologically inspired qualitative methods in health research have spent decades seeking legitimacy within the evidence hierarchy by presenting themselves as rigorously inductive. This pursuit of legitimacy, we argue, has come at an epistemological cost: it obscures what these approaches actually do when they work at their best and forecloses their most radical potential. Drawing on Feyerabend's philosophy of science, and specifically on his concept of counter-induction, this paper proposes a reframing. Counter-induction, for Feyerabend, is not an alternative method but a discovery revealed by the history of science: major scientific advances have often proceeded not by building on established facts and theories but by maintaining hypotheses that actively resist and challenge them. We argue that phenomenologically inspired qualitative health research is structurally counter-inductive: it proceeds from lived experience as potential counter-evidence against established clinical constructs, nosological categories, and biomedical models. This counter-inductive character operates differently across two families of approaches: methods grounded in suspension (epoché, bracketing) enact counter-induction retrospectively, in analysis and discussion; and methods grounded in front-loading of phenomenological concepts (phenomenologically grounded qualitative research; front-loaded phenomenology) can enact it prospectively, at the design stage, provided the choice of concepts is motivated by their capacity to reveal what dominant clinical constructs cannot see. Making this counter-inductive logic explicit, we contend, transforms the epistemological standing of qualitative health research, not as a complement to evidence-based medicine, but as an irreplaceable mechanism for the revision and critical interrogation of clinical knowledge.
In many qualitative studies, recruiting general practitioners (GPs), also known as family doctors or primary care physicians, has become increasingly challenging. This is due, in part, to the strain on GP capacity driven by greater service demand. In the United Kingdom, this demand coupled with increased general practice involvement in research has led to GPs experiencing research fatigue. This may be particularly apparent in qualitative studies, in which clinical impacts are often further upstream, and is yet more challenging if a research topic is seen as having lower clinical priority and/or is potentially controversial. In a recent qualitative study on work and health, we aimed to address this challenge through what we call large-scale professional/social network snowball sampling, using GP WhatsApp group chats. Using a GP gatekeeper to share study information in one of these groups, we could invite several hundred GPs. Following this, we asked GPs we interviewed to share study information in other group chats they were members of, allowing our snowball to grow increasingly large at a rapid pace. In this article, we reflect on this approach and argue that whilst this method can solve a practical recruitment problem, it also gives rise to numerous methodological considerations. This includes the credibility and trustworthiness of the research; the diversity of the sample recruited; consideration of saturation; and the increasingly problematic issue of 'imposter participants'. We critically explore these issues and, through this, challenge the notion that snowballing sampling necessarily privileges the convenience of participant availability over sample depth and diversity.
In this study, self-talk is conceptualized as a self-regulatory intrapersonal communication process that integrates emotional, cognitive, and social dimensions. Unlike prior studies that focus on the frequency or valence of self-talk, as well as the effectiveness of psychoeducational interventions, nearly always using quantitative methods, this study uses a qualitative approach to identify dynamic transitions and socio-contextual embedding of self-talk across the breast cancer trajectory. Adopting the interpretive paradigm, the qualitative study was conducted in Poland and Croatia. Data were gathered through in-depth interviews and lifeline drawings from a purposive sample of 24 breast cancer patients aged 34-76. As a result of reflexive thematic analysis, five interconnected themes were developed: embodied experience of illness, emotional roller coaster, cognitive and control-oriented strategies, socio-contextual self-talk, and dynamics of transitions in self-talk. They represent the multidimensional nature of self-talk, spanning somatic, emotional, cognitive, spiritual, and social spheres. Self-talk remains emotional, memorable, and open to reconstruction, as well as variable and dynamic throughout the cancer trajectory. It fulfills regulatory functions such as monitoring, evaluation, and behavioral guidance, encompassing both current events and strategic preparation for future challenges. The content, function, and context of self-talk should be jointly assessed to clarify its adaptive vs. maladaptive roles in populations with illness. Adaptive self-talk is characterized as self-supporting and self-compassionate; goal-driven, action-oriented, and task-focused; time-bound; and self-distanced. Maladaptive self-talk is self-critical, repetitive, associated with a loss of control, future-oriented rumination, and self-immersion. The results provide guidance for educating patients and clinicians on self-talk.
Experiences and needs of those bereaved by suicide of another person—suicide survivors—are severely under-explored in Czechia. Grounded in the sociology of death, dying, and bereavement, as well as death studies, this paper focuses on the processes of grief, bereavement, and mourning. Drawing on nine in-depth interviews and employing interpretative phenomenological analysis (IPA), four key themes emerged: (1) Those, who remained and those, who are gone; (2) Family, friends, and the great silence; (3) Institutional failure and the shifting of agency; and (4) Grief-worthiness and the proper way to mourn. The findings suggest that reconstructing a new identity involves more than the commonly cited emotions of guilt or anger; it also includes feelings such as protectiveness toward the deceased. While bereaved bear the burden of suicide’s stigmatizing nature and may feel abandoned by, or failed by, institutional systems, instances of good practice did occur, albeit despite the system rather than because of it. Finally, survivors’ experiences of disenfranchised grief reflect prevailing societal expectations and norms surrounding bereavement after suicide.
Rural gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) youth face heightened suicidality risk due to social and structural health inequities, including isolation, stigma, and inaccessible mental health services. However, little is known about how LGBTQ+ youth seek help when experiencing suicidality. This constructivist grounded theory study examines the help-seeking processes of rural LGBTQ+ youth experiencing suicidality. Drawing on semi-structured interviews with 15 rural-based LGBTQ+ youth (aged 16-25) in Quebec, Canada, we inductively developed the Theory Map of Suicidality Help-Seeking among Rural LGBTQ+ Youth. This theory conceptualizes help-seeking as a cyclical and iterative social process shaped by the interplay between constraints and agency. The first thematic process, concealing LGBTQ+ identities and suicidality, showed how rural conservative social norms (particularly cis-heteronormative expectations) led participants to conceal both their LGBTQ+ identity and their suicidal distress, thereby delaying help-seeking. The second process, confronting systemic barriers, captured how participants confronted geographic isolation, limited availability of formal mental health resources, and inconsistent LGBTQ+ competence among providers. The third process, bridging support, highlighted how participants adjusted to navigate community-based strategies, online resources, and trusted adults to bridge informal supports. Taken together, these processes reveal that help-seeking for suicidality among rural LGBTQ+ youth is dynamic and indelibly shaped by social and structural rural contexts. The Theory Map of Suicidality Help-Seeking among Rural LGBTQ+ Youth offers insights to guide tailored suicide prevention interventions that align with and respond to the unique help-seeking experiences of rural LGBTQ+ youth.
This study explores the lived experience of remission in chronic skin disease (CSD), a clinically significant but underexamined phase of the chronic relapse-remission cycle. Although the psychological burden of active CSD is well established, far less is known about how individuals experience periods of skin improvement or clearance. Using interpretative phenomenological analysis, semi-structured interviews were conducted with six participants previously discharged from a London-based National Health Service (NHS) psychodermatology service. Four themes were developed: (1) More than meets the eye captured a dissonance between physical and psychological recovery, with ongoing shame, vulnerability, and treatment burden despite visible improvement. (2) A wordless experience reflected the difficulty of accessing, naming, and retaining remission experiences, in contrast to vivid accounts of flare-ups. (3) All-consuming: overwhelmed by fear and powerlessness described remission as marked by sustained vigilance, anticipation of relapse, and vulnerability to withdrawal of care; within this, the study introduces the concept of 'Relapse Anxiety' to capture the persistent expectation of symptom recurrence. (4) Unsolvable dilemmas of remission captured treatment-related harms, attempts to regain agency, and harsh self-judgements surrounding the pursuit of relief. Remission was not experienced as a straightforward endpoint of recovery but as a psychologically active and poorly understood phase of adjustment. Visible improvement coexisted with ongoing distress, identity-level impacts, and treatment burden. Greater conceptual and clinical attention to remission may support more nuanced, patient-centred understandings, with further qualitative research needed to inform measurement and intervention.
Resettled refugees experience chronic stress as they navigate adaptation across the life course, often within communal frameworks that emphasize collective responsibility, interdependence, and shared identity. This study examines how refugees from communally oriented cultures make meaning of resettlement stress, drawing on interpretative phenomenological analysis to analyze the narratives of 13 participants, representing different adult life course stages, from five ethnic groups forcibly displaced from Burma and resettled in the United States. Findings highlight the centrality of communal processes in structuring adaptation, as participants described resettlement stress, not as an individual burden but as a collective experience negotiated through intergenerational role shifts, communal support networks, and shared responsibilities. Younger adults assumed roles as cultural brokers, navigating institutions on behalf of their families, while older adults relied on communal ties to sustain well-being in resettlement. Participants’ experiences underscore how adaptation unfolds within collective, rather than solely individual, trajectories, reinforcing the need for culturally congruent mental health and social support interventions. These findings extend life course theory by demonstrating how communal resilience operates across historical time and place, shaping intergenerational strategies for adaptation. Implications emphasize group-based mental health interventions that align with communal coping strategies, investment in youth leadership programs to support cultural brokers, and community-engaged translational research to co-develop sustainable, capacity-building initiatives that empower resettled communities. By centering communal adaptation and agency, this study contributes to a deeper understanding of how resettled refugees sustain resilience and well-being beyond individual frameworks.
Illness identity refers to the way people integrate health conditions into their sense of self and plays a vital role in managing chronic illness. While most research has examined illness identity in relation to a single diagnosis, this study addressed the added complexity of living with multiple conditions in later life. The aim was to examine how illness identity shapes self-management among older persons with multimorbidity (PwMs) and to refine the relevance of existing illness identity categories by deepening understanding of how evolving identities influence adaptive self-management practices. Semi-structured interviews were conducted with 40 older PwMs in Ireland. Collaborative thematic analysis was used to analyse the data, and a hybrid approach combining inductive and deductive methods was employed. Transcripts were open-coded, discussed collaboratively to deepen interpretation, and then examined in relation to four established dimensions of the illness identity framework: engulfment, rejection, acceptance, and enrichment. In addition to the four established categories, the study identified a further theme linking illness identity with experiences of ageing. Findings showed that older adults with multimorbidity negotiate several, fluid, and context-dependent illness identities rather than a single fixed one. This study extends our understanding of illness identity in the context of multimorbidity and ageing and points to concrete implications for how clinicians communicate with patients, how self-management support can protect autonomy, and how care can be integrated for older adults living with multiple conditions.
Many young women seek physiotherapy for long-term health disorders. To address the complexity of such conditions, physiotherapists are encouraged to use a biopsychosocial model of care that includes biological, emotional, and social aspects of patients' lives. However, knowledge of how the complexity of these disorders is addressed in psychomotor physiotherapy practice remains limited. By exploring clinical encounters between psychomotor physiotherapists and young women with long-term health disorders, we aimed to generate knowledge about therapeutic practices that may inform improvements to treatment. We conducted a narrative analysis of 10 observed clinical encounters between psychomotor physiotherapists and young women in primary healthcare in Norway, alongside individual interviews with the participants involved. Our findings highlight how the patient's life becomes interwoven with treatment through embodied therapist-patient collaboration and co-creation of meaning. Inspired by Mattingly's concept of clinical emplotment, we developed the encounters into clinical plots. We present three illustrative examples. The first plot highlights how a patient's way of standing is connected to how she relates to others. The second highlights how exploring a patient's breathing is connected to her search for recognition of her illness experiences. The third plot highlights how subtle acts of care are connected to a patient's former experiences of neglect and abuse. Overall, the findings emphasize the potential of inviting patients to actively participate in making meaning of physiotherapy and using their bodily experiences as a foundation for dialog. This may aid physiotherapists in addressing the complexities of long-term health disorders in clinical practice.
Dementia is a growing public health concern in Canada, yet timely access to nonpharmacological interventions (NPIs) for persons with dementia (PWDs) remains poorly understood. This critical ethnographic study explored factors influencing access to NPIs among private-dwelling seniors with mild-to-moderate dementia and their family/friend care partners (CPs) in Alberta, Canada. Guided by McLeroy et al.’s Ecological Perspective and Habermas’ Critical Social Theory, we conducted 53 semi-structured interviews with eight PWDs and 21 CPs across 20 families. Reconstructive, thematic analysis revealed 10 interrelated factors across socioecological domains: intrapersonal (denial, acceptance, and perceived benefits), interpersonal (support from CPs, physicians, and case managers), organizational (program acceptability and accessibility), community (stigma), and policy (funding constraints). Findings illuminate how systemic conditions such as market-driven care models and fragmented care pathways intersect with lifeworld dynamics, including stigma and relational coping, to shape families’ navigation of NPIs. While PWDs relied on their CPs for information and coordination of NPIs, CPs encountered significant informational and navigational barriers. Program invisibility, lengthy referrals, and limited capacity compounded inequities, often leaving families to cope in isolation or seek privatized alternatives. Stigma operated subtly yet systematically, reinforcing therapeutic nihilism, evidence-practice gaps, and policy stagnation. These findings highlight the need to reconceptualize two widely used and valued services, adult day programs and companion care, within a rehabilitative, nonpharmacological framework, strengthen anticipatory guidance, and invest in early, equitable care pathways. Addressing system-lifeworld tensions is essential for dementia care that promotes dignity, connection, and quality of life.
Psychiatric diagnoses can significantly inform identity and self-understanding but hold different meanings to different people. This research takes a symbolic interactionist approach and addresses these matters in relation to anorexia nervosa. Drawing on data collected through in-depth interviews with 13 participants diagnosed with anorexia, I examine the extent to which participants dis/identify with the diagnosis and how it informs their self-understanding. Findings suggest that participants first came to identify with anorexia via self-labelling or being labelled by others, and that an (increasing) identification with anorexia was learned through diagnostic framing in treatment and ongoing identity work. However, participants reflexively engaged with diagnostic definitions and explanations of their struggles resulting in anorexia identities that were differentially ‘clinically’ and ‘critically’ informed and were sometimes ambivalent. I conclude with a discussion of the implications of the research findings for therapeutic approaches to anorexia that seek to address identity.
Fat stigma is a qualitative health research problem because fat bodies encounter persistent moral surveillance in daily life. In response, many fat people present a socially acceptable 'front' to clinicians and researchers. Existing qualitative approaches are therefore somewhat limited to capturing frontstage performances rather than participants' more personal 'backstage' reflections. In response, this methodological paper introduces transformational dramaturgical longitudinalism (TDL), a novel qualitative methodology synthesising Goffman's dramaturgical theory with longitudinal, participant-led design. Comprising a three-stage design, involving two interview cycles and asynchronous written correspondence, TDL was developed via an 18-month study with eight self-identified fat women. This development advances qualitative health research via participant-led pacing and narrative sovereignty; emotional and structural reflexivity as methodological resources; Goffman's dramaturgical architecture operationalised as a design principle not analytic vocabulary; and ongoing consent and narrative revision rights as core ethical architecture. Scope conditions support transferability of TDL to future research projects involving stigma.
Sauna bathing, a centuries-old tradition with roots in Nordic cultures, is increasingly embraced in contemporary wellness practices across Western societies. Although the physiological benefits of sauna use are well documented, its psychological effects remain underexplored. The present study investigated the lived experiences of regular sauna users and their perceptions of its impact on mental well-being. A mixed-methods approach was employed: a preliminary survey identified suitable participants, followed by in-depth semi-structured interviews with 11 regular users of Finnish-style saunas (aged 22-49, all white Europeans). The qualitative data were analysed using interpretative phenomenological analysis. Sauna use was consistently described as supportive of mental well-being by fostering emotional regulation, stress relief, and social connection. Three key domains of psychological engagement were identified: connection to self, to others, and to nature. Across these, sauna bathing was experienced as both a personal and communal ritual-a space for self-care, introspection, and authentic social interaction. Themes included emotional release, personal growth, trust, and sensory immersion in natural elements. Reported psychological effects extended beyond sauna sessions into daily life, including improved mood, pain relief, clarity of thought, and reduced feelings of isolation. Overall, sauna bathing emerged as a low-barrier, non-clinical practice that may support mental health and contribute to public health strategies addressing stress and loneliness.
Supporting high-risk populations in adopting healthy lifestyles to reduce colorectal cancer risk is a public health priority. While the importance of maintaining healthy behaviors is widely recognized, little is known about what makes these behaviors meaningful for high-risk individuals within their own lifeworlds or how such behaviors are experienced and enacted. This study employed a focused ethnographic approach to explore in depth the motivations and meanings behind the health behaviors of 24 individuals at high risk for colorectal cancer in their daily living environments. The findings reveal that although individuals' approaches to healthy lifestyles differ based on their perceived risk, they consistently engage in multiple forms of meaning negotiation. Three main themes emerged: (1) The Bodily Negotiation of a Simple yet Habituated Lifestyle: Health choices are often dominated by direct bodily sensations and deeply ingrained life habitus. Professional health advice is frequently reinterpreted or integrated through local concepts such as "huó dòng" (activity). (2) Maintaining and Silencing: The Psychological Order of Lifestyle: Individuals employ psychological adaptation strategies like "xiǎng kāi diǎn" (thinking openly) to downplay risk and often maintain emotional silence within family and social relationships to preserve surface harmony and self-identity. (3) The Dualistic Disease Imagery: Dismissal and Fear: Contradictory perceptions of disease risk coexist-both dismissal and fear-and their dynamic interplay directly determines the decision threshold for screening and healthcare-seeking. The study concludes that practicing a healthy lifestyle is an ongoing negotiation of meaning between a "comfort zone" constituted by bodily habitus, somatic experience, and social connections, and a "risk zone" constructed by abstract medical discourse. These insights provide a foundation for developing and implementing culturally congruent health promotion interventions to support sustainable engagement in meaningful health practices among high-risk populations for colorectal cancer in community settings.
Loneliness is a health concern for individuals with chronic disease. Unlike most loneliness interventions that connect people to existing groups, the G roups 4 H ealth (G4H) program builds individuals’ skills to create and sustain meaningful connections. We examine the acceptability of G4H among individuals with chronic disease, focusing on factors facilitating and hindering program completion. Twenty-eight participants took part in either focus groups or individual interviews after completing G4H within a regional nursing and allied health service. Participants described trauma, life stage, and illness-related isolation as key motivators for joining. They valued the group connection, skilled facilitation, and structured, evidence-based content of the program, noting positive impacts on their social confidence. Barriers included social anxiety, content accessibility, and personal circumstances. Participants expressed a preference for self-referral and suggested extended session length and program duration. Findings support the acceptability of G4H in individuals with chronic conditions, while highlighting areas for improvement.
Institution-level interventions can lead to positive health outcomes for individuals and communities. Focusing attention on how the organization of specific institutions leads to negative health outcomes can provide the basis for systemic reform that addresses structural, social, and environmental determinants of health in immediate and practical ways. Enacting policy and practical reforms in institutions requires identifying and overcoming mythical thinking through robust, interdisciplinary qualitative health research that addresses the narratives that stakeholders employ to keep institutions as they are. This article focuses on two contemporary health crises among American adolescents to describe how institutions promote negative health outcomes through commonsense policies and practices that are rooted in American mythic thinking. These institutional practices stand in opposition to scientific, medical, and qualitative evidence that demonstrate the immediate and long-term effects of specific institutional practices, including early school start times and exposure to injury through contact sports. Overcoming the institutional resilience to change depends on identifying norms and their basis in mythic thinking, and, secondarily, supplanting those norms with narratives based in the reality of institutional effects on individual lives and communities. Qualitative health research that draws strengths from across the social sciences, humanities, and arts is poised to aid in these institutional reforms but must shift its focus to institutions as a primary driver in promoting well-being.
I offer this manuscript as a methodological provocation for qualitative health research at a moment when artificial intelligence (AI)-powered translation is becoming increasingly normalised in cross-language interviewing, transcription, and analysis. Rather than reiterate the now-familiar claim that "AI translation can be risky," I argue that the central problem is epistemic: translation technologies are quietly becoming part of the infrastructure of qualitative knowledge production, yet remain methodologically under-disclosed and analytically under-theorised. Drawing on epistemic injustice and cross-language qualitative scholarship, I show how AI translation can flatten culturally saturated narratives. I then explain why Reflexive Thematic Analysis (RTA) functions as a methodological stress test in this terrain: when researchers rely on AI-mediated translations without robust human verification, the interpretive commitments of RTA become difficult to sustain. In response, I propose a guideline: a Minimum Disclosure Standard for AI-mediated translation (MDS-AIMT) in qualitative health research, specifying considerations for authors regarding the selection and use of translation tools, the languages involved, the verification processes employed, data governance protocols, the alignment of analysis methodologies, and the incorporation of AI-specific reflexivity in their work. Finally, I demonstrate a concrete hybrid "repair" strategy-returning to a vignette in which a culturally dense proverb is flattened into "she feels sad about medicine"-to show how AI can assist with access without becoming an unacknowledged co-author of the data. My aim is to move the field toward an ethic of epistemic accountability: technology as an assistant, not an author, and translation as an interpretive practice rather than a methodological footnote.
Children cared for in a pediatric intensive care unit (PICU) while experiencing delirium are a vulnerable group, at risk of undergoing traumatic experiences that may lead to negative outcomes post-discharge. Little is known about how children remember and experience their time in a PICU during severe illness, complicating the implementation of child-centered care that could potentially help them cope with these challenging times. Utilizing the photovoice method, this study aimed to explore the PICU experiences of children who had experienced delirium. Post-discharge, children revisited the ward to photograph their former rooms, thereby capturing and reflecting upon their memories from their time in the unit. The interviews, informed by the photographs taken by the children, were analyzed in conjunction with the images using reflexive thematic analysis. The analysis revealed two main themes, seven subthemes, and an overarching theme: "Sudden Deprivation," which serves as a unifying thread throughout the children's narratives, encompassing losses of control, agency, self-identity, physical autonomy, and reality perception. This deprivation was likely amplified by the delirium experienced by all participants. The two main themes, "The Bed: An Unsafe Haven" and "Anchors in the Chaos: Navigating Care and Constraint," capture the children's experiences throughout their care journey, with "Sudden Deprivation" permeating both themes. This deprivation is further underscored by the lack of effective child-centered care in the PICU; despite the intention to pursue such an approach, key aspects were often overlooked, particularly the need to engage children's agency in creating a supportive environment and involve them in decision-making processes.
Terminal extubation, the planned withdrawal of mechanical ventilation from patients who will not recover, presents significant technical, ethical, and emotional challenges for respiratory therapists (RTs), yet their perspectives remain underexamined. Using Max Weber's concept of ideal types, this interpretive description study explored how RTs understand and enact their role at life's end. Twenty-nine RTs (20 in Canada and 9 in the United States) participated in semi-structured video interviews. Analysis revealed a continuum between two orientations: task-centered RTs emphasize technical precision, protocol adherence, and emotional detachment, often relying on informal or maladaptive coping strategies. Event-centered RTs approach extubation as a shared human experience, integrating emotional presence with clinical skill and supporting families and teams, though institutional support for such practices is limited. These orientations are fluid and context-dependent. Findings extend Weberian theory by showing how instrumental, value-rational, affective, and traditional motives converge in a single clinical act. To better support RTs, we recommend (a) inclusion in decision-making and debriefing, (b) training that blends technical and relational competencies, and (c) policies that legitimize diverse ways of "doing" terminal extubation. These shifts could reduce burnout, foster collaboration, and improve end-of-life care for patients and families.
Gypsy, Roma, and Traveller communities experience significant health inequalities, yet alcohol consumption within these communities remains under-researched. This paper offers a methodological and ethical contribution by reflecting on two qualitative studies of alcohol use in Romany Gypsy and Traveller communities in the United Kingdom: project 1 explores youth drinking, and project 2 examines intergenerational drinking narratives. Drawing on a collaborative partnership with Friends, Families and Travellers, we highlight the importance of equitable partnerships and the role of peer researchers in enabling access to seldom-heard communities, particularly when researching sensitive and potentially stigmatised topics. We demonstrate the value of culturally credible methods, including craft-elicitation and story-telling interviews, which align with community traditions, support participant agency, and generate nuanced, relational accounts that challenge stereotypical and pathologising narratives of alcohol use. Participatory data analysis further enabled participants to shape interpretation, repositioning them as active contributors to knowledge production, rather than passive subjects. We also critically reflect on ethical dimensions of the research process, including accessible approaches to informed consent, the complexities and unintended consequences of remuneration, and the importance of prioritising participant comfort, care, and flexibility in research design. We argue that researching alcohol with Romany Gypsy and Traveller communities requires methodological openness, cultural sensitivity, and adaptive, participant-led design. More broadly, the paper contributes practice-based insights that extend debates on participatory and ethical research, offering guidance for qualitative health researchers working with seldom-heard populations on sensitive topics.
