What does coping mean to the worker with pain-related disability? A qualitative study.

PURPOSE: Pain coping is important in health outcomes. In the current literature, pain coping usually means those goal-directed strategies to manage pain. The study goal was to explore what personal meaning "coping" has for work-disabled individuals in pain. METHOD: Qualitative, in depth interviews with follow-up verification interviews were conducted with 13 volunteers who were off work and in rehabilitation for chronic pain from a musculoskeletal injury. The two main questions were: (1) How did participants understand the term "coping with pain"; and (2) how did they come to this understanding of coping. The theoretical approach was social phenomenology and data were analyzed using thematic analysis. RESULTS: The dominant theme was that pain coping is an intrinsic and life-defining attitude and belief. This understanding primarily arose through early modeling by parents and significant others. Secondary theme was that coping is practical strategies to manage or eliminate pain. This arose through more current interactions with health care providers and others in the social network. CONCLUSIONS: Researchers' and clinicians' view of coping may not always match the views held by individuals with chronic pain. This might impact on the effectiveness of interventions designed to modify coping behaviors, and alternative ways of intervening may be needed.

Levels of reconstruction as complementarity in mixed methods research: a social theory-based conceptual framework for integrating qualitative and quantitative research.

Like other areas of health research, there has been increasing use of qualitative methods to study public health problems such as injuries and injury prevention. Likewise, the integration of qualitative and quantitative research (mixed-methods) is beginning to assume a more prominent role in public health studies. Likewise, using mixed-methods has great potential for gaining a broad and comprehensive understanding of injuries and their prevention. However, qualitative and quantitative research methods are based on two inherently different paradigms, and their integration requires a conceptual framework that permits the unity of these two methods. We present a theory-driven framework for viewing qualitative and quantitative research, which enables us to integrate them in a conceptually sound and useful manner. This framework has its foundation within the philosophical concept of complementarity, as espoused in the physical and social sciences, and draws on Bergson's metaphysical work on the 'ways of knowing'. Through understanding how data are constructed and reconstructed, and the different levels of meaning that can be ascribed to qualitative and quantitative findings, we can use a mixed-methods approach to gain a conceptually sound, holistic knowledge about injury phenomena that will enhance our development of relevant and successful interventions.

Oil workers and seat-belt wearing behaviour: the northern Alberta context.

OBJECTIVES: Seat-belt wearing rates in the North reflect workers in the oil industry, necessitating sociocultural descriptions on the issue. The objective of this study was to describe how the social context influences oil workers' views of risk and seat-belt wearing behaviour in northern Alberta. STUDY DESIGN: The study design was qualitative research. Focus groups were held with oil workers in three northern Alberta locations. METHODS: Forty-five oil industry workers participated in 3 focus groups held in a different northern Alberta location, each consisting of 15 participants. Focus group discourse was centred on a series of questions that were clustered around the following themes: (1) propensity to take risks; (2) work patterns and workplace routines; (3) driving history and patterns; (4) self-disclosed seat-belt wearing behaviour; and (5) social relationships. RESULTS: Northern oil workers believe that taking safety risks is an essential characteristic of who they are and where they work. Employers demand consecutive number of hours on the job and offer attractive incentives for working overtime that encourages risk-taking. Risk-taking also appears in driving where workers take numerous risks to get home after they have worked 12-hour shifts for 14 consecutive days. Most are situational seat-belt wearers, buckling up in inclement weather, at the presence of numerous logging trucks and the threat of drunk and/or fatigued drivers. Without prompting, northern oil workers consider fatigued driving as the most dangerous driving risk they experience in the north. Nearly every respondent has experienced fatigued driving after completing his last work shift in a 14-day rotation. CONCLUSIONS: Seat-belt wearing initiatives for oil workers during off-work driving should be led by the oil industries. For example, they could support and encourage the police to increase their enforcement, lobby the government for higher penalties, punish their workers who are caught not wearing seat belts and collaborate with local communities to develop programs that will increase awareness of seat-belt wearing. Because workers described fatigued driving as the key risk in the North, oil industries should become engaged in interventions, with seat-belt wearing as a vital component of fatigued driving.

The role played by a former federal government residential school in a First Nation community's alcohol abuse and impaired driving: results of a talking circle.

OBJECTIVES: The study's objective was to better understand alcohol abuse and impaired driving behaviors in a First Nations community as it reflects systemic issues linked to historical, family and community experiences. STUDY DESIGN AND METHODS: Fifteen 18- to 29-year-old drivers participated in an exploratory eight-hour Talking Circle held according to traditional cultural practice. Four First Nations researchers, trained in Talking Circle protocol, and a Band Elder facilitated the data collection, data analysis according to emerging themes, and data verification. RESULTS: Federal government residential schools contribute to intergenerational effects which impact impaired driving in a northern First Nations community. Traditional parental role modeling has changed dramatically. Rather than guide children through a communally shared development process, many parents now expect their children to assume adult roles by expecting them to take care of their guardians when they drink excessive amounts of alcohol. Because a wall of silence exists between the young and old, many young people seek refuge with friends and peers, who subsequently influence them to abuse alcohol and engage in impaired driving. Many older Band members no longer serve as leaders for young people. Instead, they behave like peers and engage in activities that facilitate alcohol abuse and impaired driving. CONCLUSIONS: Historical institutions like federal government residential schools have contributed to systemic socio cultural problems which influence alcohol abuse and impaired driving. Hence there is a need for community-based intervention strategies that promote cultural healing. The healing journey can start with First Nations communities providing their people opportunities to share their stresses and traumas in supporting and nurturing environments.

Towards a better understanding of First Nations communities and drinking and driving.

OBJECTIVES: First Nations young people are over-represented in fatal alcohol-related crashes, necessitating culturally sensitive data that sheds light on this major health issue. The objective of this study was to understand why young First Nations drivers, aged 18 to 29 years old, become involved in drinking and driving as normal behavior displayed through socio-cultural patterns. STUDY DESIGN AND METHODS: Sixty-five First Nations respondents were individually interviewed in nine Alberta locations. Semi-structured interviews, focusing on socio-cultural patterns, norms and community ethos affecting alcohol consumption, drinking and driving, and drinking and driving interventions, were used. RESULTS: Community norms play a significant role in the drinking and driving behaviors of First Nations people. First Nations communities experience reckless driving, neighbors with alcohol and drug abuse problems, violence, economic disparity, boredom and racism, all of which contribute to responses of alcohol abuse and drinking and driving. Both are considered to be normal, community-endorsed behaviors, reflecting situational needs and ready-at-hand usage. Furthermore, the grid of rural roadways is an important contributor to drinking and driving and a community sense of practical living. Also of importance was the finding that young people embraced their parents' alcohol-related problem behaviors on the basis that "what is okay for the parents is okay for me." Finally, First Nations young people believe in personally stopping a drunken person from driving, but the risk of community censure, social discomfort and risk of physical and verbal abuse mitigate against them taking action. CONCLUSIONS: Living in First Nations communities is socially complex, highly emotionally charged, and peer-pressured. Drinking and driving and alcohol abuse amongst First Nations people reflect the community social structure, daily pressures and norms of behavior. Hence, to reduce drinking and driving casualties amongst First Nations young people, intervention strategies must address systemic issues, namely local people's social realities, norms, as well as local and peer relationships.

Patient payment for emergency medical services treatment and its impact on injury control: an Alberta case.

A province-wide qualitative study on emergency medical services (EMS) in Alberta was initiated to better understand the extent to which patient billing influences EMS performance. After completing lengthy interviews with 108 EMS-related subjects it was learned through qualitative research methods that billing patients for EMS treatment (ambulatory care) has subtle or determined influences on EMS providers' emergency actions. Furthermore the act of billing patients can and does have an impact on patient care. It often leads to patients and/or their representatives refusing treatment and transportation. Testimony indicates that the final result can be and is troublesome to, patient outcomes. The findings support the generalization that in Alberta the patient's responsibility to pay for needed EMS treatment can be a major obstacle for inclusive injury control.

Determinism, risk and safe driving behavior in northern Alberta, Canada.

INTRODUCTION: There is evidence that Alberta's rural north is over-represented in the Canadian province's overall traffic fatality rate, even after weather, travel exposure and highway geometry are controlled for. OBJECTIVE: The objective of this study was to identify underlying reasons and rationales that northern citizens use to accommodate risk and driving behavior. METHODS: A total of 82 individuals participated in 13 focus groups, each with between 5 and 10 participants. Eight focus groups were conducted with general drivers and five with service professionals in five different Alberta locations. Discussions centered on a series of questions that were designed to elicit insight into general characteristics of the participants' world-view and featured two categories of questions, including dimensions of belief systems and driver characteristics and behavior. RESULTS: Although much of the discussions focused on freedom of choice, over half of the interviewees cited determinism as a key feature of responsibility. Three versions of determinism were emphasized as key in roadway safety: religious determinism, 'universal' determinism (fatalism), and humanistic determinism. These observations highlighted peoples' perception of the likelihood of getting into traffic situations outside one's control. CONCLUSION: In order to maximize the effectiveness of traffic safety in the north, professionals need to take an approach which addresses not only safety issues, but also issues regarding responsibility and its links with behavior.