Novel Methods for Leveraging Large Cohort Studies for Qualitative and Mixed-Methods Research.

Qualitative research methods, while rising in popularity, are still a relatively underutilized tool in public health research. Usually reserved for small samples, qualitative research techniques have the potential to enhance insights gained from large questionnaires and cohort studies, both deepening the interpretation of quantitative data and generating novel hypotheses that might otherwise be missed by standard approaches; this is especially true where exposures and outcomes are new, understudied, or rapidly changing, as in a pandemic. However, methods for the conduct of qualitative research within large samples are underdeveloped. Here, we describe a novel method of applying qualitative research methods to free-text comments collected in a large epidemiologic questionnaire. Specifically, this method includes: 1) a hierarchical system of coding through content analysis; 2) a qualitative data management application; and 3) an adaptation of Cohen's κ and percent agreement statistics for use by a team of coders, applying multiple codes per record from a large codebook. The methods outlined in this paper may help direct future applications of qualitative and mixed methods within large cohort studies.

In their own words: a qualitative survey of healthcare providers' experiences with personal protective equipment during the COVID-19 pandemic.

BACKGROUND: At the beginning of the coronavirus disease (COVID-19) pandemic, healthcare personnel (HCP) faced a dire shortage of personal protective equipment (PPE). This shortage has been identified as a major source of distress among HCP during the early COVID-19 pandemic, though the specific consequences of this shortage have not been identified in the qualitative literature. METHODS: We sought to fill this gap by conducting a qualitative analysis of PPE related free-text comments from online surveys completed by 923 HCP during Spring 2020. RESULTS: We found that HCP used words such as "required" and "had" to describe how their use of non-standard PPE was imposed on them by their workplace, suggesting that they felt little control over their protection at work. HCP described cleaning PPE with novel methods, such as bleach, alcohol, hydrogen peroxide, and UV light, in addition to creating their own PPE out of materials such as garbage bags, sheets, and cloth. Furthermore, HCP expressed frustration with PPE policies at their workplaces, which continued throughout the early pandemic due to the rapidly changing guidelines and the inability to express their opinions to their institutions. The combination of these concerns left HCP scared of being infected with COVID-19 while at work and subsequently infecting their loved ones at home. CONCLUSION: It is critical that healthcare institutions understand HCP's experiences with and feelings towards PPE, as providing the proper protection is vital in ensuring an adequate HCP workforce.

A qualitative analysis of psychosocial stressors and health impacts of the COVID-19 pandemic on frontline healthcare personnel in the United States.

There is a dearth of qualitative studies exploring the lived experiences of frontline healthcare personnel (HCP) during the coronavirus disease (COVID-19) pandemic. We examined workplace stressors, psychological manifestations of said stressors, and coping strategies reported through coded open-text responses from 1024 online surveys completed over two months by 923 HCP participating in three nationwide cohorts from Spring 2020. Our findings suggest that risk, job insecurity, frustration with hospital administration, inadequate access to personal protective equipment, and witnessing patient suffering and death contributed to deteriorating mental and physical health. Negative health impacts included the onset or exacerbation of anxiety, depression, and somatic symptoms, including weight fluctuation, fatigue, and migraines. Coping mechanisms included substance use and food consumption, meditation and wellness, fitness, socializing with loved ones, and religious activities. Insights garnered from participants' responses will enable more personalized and effective psychosocial crisis prevention and intervention for frontline HCP in future health crises.