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Public Opinion Quarterly - 2025 Special Qualitative Issue - Call for Papers

Qualitative research: advancing the social & behavioural sciences deadline: december 18, 2023.

Public Opinion Quarterly invites papers for a cross-disciplinary special issue on qualitative public opinion and social research, including qualitative-only designs and mixed methods designs where qualitative research forms the dominant component. The emphasis of this special issue is on articles that further the use of qualitative methods to inform and empirically advance substantive issues in the social and behavioral sciences. The special issue will be published in 2025.

We seek submissions that utilize qualitative (or qualitative-dominant) research to study substantive issues including, but not limited, to:

Hard-to-reach and vulnerable populations

Healthcare-related attitudes and behavior

Diversity, equity, and inclusion

Elections, voting behavior, and other political issues

Online behavior and social media

Social and civic communication

Additionally, we welcome papers that highlight the novel contributions of particular qualitative methods to the study of public opinion and social research.

Submissions should not only demonstrate the important contribution that qualitative methods make to advancing knowledge but also discuss the quality elements of the research design, including scope (e.g., sample design and sampling), data gathering (e.g., construct validity, bias, nonresponse), and analysis (e.g., data format and tools, procedures, inter- or intra-coder reliability). In the interest of transparency and transferability, successful submissions will include data collection instrument (s), coding protocols, and other details of the research design and its implementation that would enable another scholar to conduct similar research in a different context, as required by Public Opinion Quarterly 's authorship guidelines.

Submitted manuscripts will be reviewed by the editorial team on three overriding factors: the demonstration of an important contribution attributed to a qualitative approach, the quality principles employed in the research design and implementation, and the level of transparency.

The deadline for manuscript submissions is December 18, 2023 . Public Opinion Quarterly 's " Author Guidelines " provide general instructions and information on the review process. Note that original article submissions should not exceed 6,500 words of text and notes, excluding figures, tables, references, and appendices.

Please submit papers online through Manuscript Central and include "special qualitative issue" in your cover letter.

If you have any questions, please contact Margaret Roller at [email protected] and/or Zachary Smith at [email protected] .

We look forward to reviewing your paper and potential contribution to this historic special issue of Public Opinion Quarterly .

Margaret R. Roller Zachary R. Smith Paul J. Lavrakas Co-editors

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Call for Papers

20 th International Congress of Qualitative Inquiry

May 15-18, 2024 (in person)

May 29-31 (virtual)

We shall not cease from exploration/ And the end of all our exploring/ Will be to arrive where we started/ And know the place for the first time (T. S. Eliot, No. 4 of Four Quartets, 1942).

The 20 th International Congress of Qualitative Inquiry will be held in-person at the University of Illinois, Urbana-Champaign from May 15-18, 2024, with a subsequent virtual Congress to be held May 29-May 31.

The theme of the 2024 Congress is “ Qualitative Inquiry in the Present Tense: Writing a New History ”. We are in a new space, living through the lingering, traumatic effects of a global pandemic. Couple that with political and economic strife, intensifying effects of climate change, the ravages of poverty and war, and so on, and the horizons of hope and possibility begin to whither if not fade. Within and against these changing and evolving conditions under which qualitative research is thus conducted, performed, and enacted, we must imagine new ways we can write our way into and out of these spaces, imagine how we can write a new history of the present in which qualitative researchers intervene into and affect change in everyday life. To this end, we need a new language, a post-pandemic pedagogy of new terms and practices for the conduct of our research—one that considers competing if not contested pasts, presents, and futures of a qualitative research project continually in transition.

To this end, the charge of the 2024 Congress is to consider ways to better link our research and our attendant interventions to those institutional sites where private troubles are turned into public issues and public issues transformed into social policy. For we must continue to look for new ways of connecting persons and their personal troubles with social justice methodologies—toward ways of bringing about change in and with our research. In these uncertain, we need to look forward with a renewed sense of hope, but a hope that remains grounded in the reality that much work lies ahead. Collectively and collaboratively, this moment calls for a critical, performative, social justice inquiry directed at the multiple crises of our historical present. We need a rethinking of where we have been, and, crucially, where we are going–and how we will get there. Our inquiry must meet the demands of our hopeful–but evolving–future. It is in the hands of the diverse and ever-evolving qualitative research community to intervene into the challenges and demands that we face–to be present to the history that we all shape. These challenges and demands may require us to rethink our ethical, political, and methodological moorings–create new alliances and collaborations.  Although we do not know what the future may hold, we must ensure our voices will be heard as we continue to intervene into the spaces of the everyday–working toward a more diverse, inclusive, and transformative present.

We invite papers and sessions addressing a wide array of topics and themes, including but not limited to :

• Contemporary social phenomena , including those related to higher education, identity politics, globalization, and health and well-being,
• Methodological innovations and advancements , including those related to ethnographic practices, intersectionality, post-humanism, and collaborative research across the disciplines
• Social Justice and Equity , including those related to marginalized voices, activism and social change, and policy development
• Narrative and Storytelling , including poetic, performative, and arts-based approaches
• Digital Methods , including netnography, social media, and ethical issues
• Politics of Science, Research, and Inquiry , including funded research, audit culture, and research marketplaces
• Co-Production , including stakeholder involvement and community impact

Sessions in the 2024 Congress will take up these topics, as well as those related to and/or utilizing: feminist inquiry; Critical Race Theory; intersectionality; queer theory; critical dis- ability research; phenomenology; Indigenous methodologies; postcolonial and decolonized knowing; poststructural engagements; diffraction and intra-action; digital methodologies; autoethnography; visual methodologies; thematic analysis; performance; art as research; critical participatory action research; multivocality; collaborative inquiry; and the politics of evidence. Sessions will also discuss threats to shared governance; attacks on freedom of speech; public policy discourse; and the changing nature of qualitative inquiry itself.

Scholars from around the world come to the Congress to resist, to celebrate community, to experiment with traditional and new methodologies, with new technologies of representation. Together we seek to develop guidelines and exemplars concerning advocacy, inquiry and social justice concerns. We share a commitment to change the world, to engage in ethical work that makes a positive difference. As critical scholars our task is to bring the past and the future into the present, allowing us to engage realistic utopian pedagogies of hope.

In consideration of our evolving (post-)Covid landscape, the 2024 the Congress will be offered in two formats.

The first will be an in-person Congress hosted on the campus of the University of Illinois (May 15-18, 2024).

The second will be a virtual Congress, held two weeks later (May 29-31, 2024).

We will begin accepting abstract submissions beginning on September 20, 2023.

When submitting your abstract, you must select the format in which you wish to present: in person only; virtual online only; in-person and virtual.

In-person Format:

The in-person format is the traditional mode of delivery for the Congress, taking place on the campus of the University of Illinois at Urbana-Champaign. This year, the in-person Congress will feature pre-conference SIG days, workshops, parallel sessions, plenary sessions, and keynote addresses, as well as a special celebration in honor of Norman K. Denzin.

As part of the in-person registration fee, those attending the in-person Congress will also receive access to the virtual Congress sessions, and the option to also present their same paper at the virtual Congress. In-person attendees will also receive a copy of the annual Congress volume, a one-year subscription to the  International Review of Qualitative Research , and an opening food reception.

Virtual Format:

The virtual format is the format that we successfully used during the pandemic for the 2021 and 2022 Congresses. Parallel sessions will be streamed live via the virtual Congress conference provider, CVent. Participants in the virtual format will also have access to recordings of the keynotes and select plenary sessions.

As part of the virtual registration fee, those attending the virtual Congress will receive access to all virtual Congress sessions, an eBook version of the Congress volume, and a one-year subscription to the  International Review of Qualitative Research .

Celebrating Norman K. Denzin

Lastly, we would be remiss if we did not acknowledge the passing of Norman K. Denzin, who founded ICQI in 2005 and served as Director and then Emeritus Director until 2023, and through his scholarship and mentorship created and supported numerous spaces through which the qualitative research community could continue to grow and flourish. We are devastated by this loss, and will endeavor to uphold his vision for qualitative research as the Congress moves forward.

A special celebration in honor of Norman will be held on Thursday, May 16. More information on this celebration will be added in due course.

For more about Norman’s life, please see the obituary available at  https://www.renner-wikoffchapel.com/obituary/Norman-DenzinPhD

About Journal

American Journal of Qualitative Research (AJQR)  is a quarterly peer-reviewed academic journal that publishes qualitative research articles from a number of social science disciplines such as psychology, health science, sociology, criminology, education, political science, and administrative studies. The journal is an international and interdisciplinary focus and greatly welcomes papers from all countries. The journal offers an intellectual platform for researchers, practitioners, administrators, and policymakers to contribute and promote qualitative research and analysis.

ISSN: 2576-2141

Call for Papers- American Journal of Qualitative Research

American Journal of Qualitative Research (AJQR) welcomes original research articles and book reviews for its next issue. The AJQR is a quarterly and peer-reviewed journal published in February, May, August, and November.

We are seeking submissions for a forthcoming issue published in February 2024. The paper should be written in professional English. The length of 6000-10000 words is preferred. All manuscripts should be prepared in MS Word format and submitted online: https://www.editorialpark.com/ajqr

For any further information about the journal, please visit its website: https://www.ajqr.org

Submission Deadline: November 15, 2023

Announcement 

Dear AJQR Readers, 

Due to the high volume of submissions in the American Journal of Qualitative Research , the editorial board decided to publish quarterly since 2023.

Volume 8, Issue 2

Current issue - in progress.

The COVID-19 pandemic has highlighted and exacerbated the difficult juggling act women in the U.S. have to do between parenting their children and working outside the home. The pandemic has also led to a decline in maternal mental health, particularly among mothers with young children, mothers of color, and those with previous mental health issues. The authors noted these experiences in their own lives as mothers with children and observed them in the lives of the women around them. These observations informed the design of this narrative inquiry study, in which we used semi-structured interviews to explore mothers’ shifting ideas and experiences of mothering, work, and family life during a global pandemic. We used creative analytic practice (CAP) to compose reflexive researcher conversations around the interview data that enabled us to highlight nuances in the data, show more transparently our meaning-making, make visible our researcher subjectivities, show uncertainties about aspects of data interpretation, and create a more accessible data representation.

Keywords: Mothering, COVID-19 pandemic, U.S. women, Narrative inquiry, Creative analytic practice.

The COVID-19 pandemic put France’s healthcare system under extreme tension and led to significant levels of stress among healthcare professionals in general and nurses in particular. Research has shown how these elements affected nurses’ physical and psychological health and manifested as insomnia, anxiety, and depressive syndromes. The present qualitative study aimed to explore the lived experiences of France’s nurses as a function of their level of exposure to the virus and whether they worked in the hospital sector or practiced privately in the community during the pandemic’s first wave. It also sought to describe the resources nurses used to maintain their overall health. We administered 19 qualitative interviews to 19 nurses in the autumn of 2021. The present study revealed that nurses were subjected to significant stress during the pandemic. Our data analysis enabled us to draw out three principal themes: 1) Being on the edge in stormy period ; 2) Personal impact on several levels and 3) Floating together and learning. There were no significant differences between the groups that were subjected to different levels of exposure to COVID-19. All the groups were affected by the pandemic that struck a healthcare system that was already systematically fragile. Nurses were severely tested by the COVID-19 pandemic, but their consciousness of the importance of their role grew, despite questioning what meaning there was to their profession, perhaps even to their lives . The trauma still felt fresh 18 months later, during the interviews, and this cannot be ignored in future healthcare policymaking .

Keywords: COVID-19, nurses, salutogenesis, stressors, health resources.

Annual mammography screening is recommended by the US Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) to reduce mortality through early detection of breast cancer. In rural Appalachia, rates of later-stage breast cancer incidence and mortality are higher than national averages. We explored the ways that providers and staff at breast cancer screening facilities employed novel approaches to overcome patient- and facility-level barriers to access to breast cancer screening in the Appalachian region. We conducted 23 semi-structured interviews with 28 clinical providers and staff of breast health facilities in Appalachia. Themes reflect how limiting features of breast screening facilities influenced access to care; the way patient-level barriers presented challenges to access to breast screening; and that external and regulatory forces presented obstacles to access to care. In addition, the unique geographical and geographical attributes of the Appalachian region shaped access and adherence to mammography screening recommendations. Thematic findings highlight that facilities implemented patient-centered strategies to overcome access-related barriers. Results may inform the ways breast cancer screening facilities address suboptimal access to breast health screening. They may also inform future resource allocations to enable facilities to reach breast cancer screening performance goals.

Keywords: rural health, breast cancer, preventive health care, women’s health.

Paternal parenting affects child development; hence, the father’s absence has a deleterious effect on the male child. The literature on parenting shows limited focus on how parenting impacts children by gender. This qualitative hermeneutic phenomenological study investigated the key question, “How does a father’s absence during childhood influence a man’s subsequent parenting of his son(s)?” An integrated theoretical framework was used to guide the study: Parenting Style Theory, Social-Cognitive Theory, and Bioecological Systems Theory. Nine Trinidadian males aged 20 to 35 years who were parenting sons were recruited to participate using snowball sampling. Data on men’s adverse childhood experiences were gathered using semi-structured interviews. Content and thematic analyses were done using DELVE software. Key findings include the influence of stereotypical cultural constructs, the church’s critical role in addressing childhood trauma, the transmission of father absence across generations, and the relationship between neurodevelopment and adverse childhood experiences. Implications of these findings will benefit child and adolescent advocacy, inform policymaking, aid professional intervention in mental health and education, and strengthen familial systems and ecclesiastical contexts. Future research should explore the lived experiences of men who crave emotional connection with their sons yet struggle with the stereotypical cultural perception of manhood.

Keywords: father absence, brain development, childhood trauma, intergenerational, the transmission of behavior.

The purpose of this qualitative transcendental phenomenological study was to understand the essence of the shared lived experiences of undergraduate college students with anxiety disorders at two universities in the Southeastern United States. Ellis’s cognitive theory, rational emotive behavior therapy, guided the study which took place at a mid-sized, public nonsectarian university and a small, private liberal arts college. The central research question elicited rich data regarding the shared lived experiences of the study participants. The four research sub-questions address participants’ perceptions regarding the impact of their disorders on their lifestyles and academic performance. A purposeful criterion sample was used to select the participants who completed a questionnaire, open-ended individual interviews, a single focus group interview, and participant journals. Phenomenological reduction was used to create a composite integration of meaning and the essence of the lived experience of the participants. Data results identified five themes: (a) social fears, (b) stressor issues, (c) generational issues, (d) academic performance barriers, and (e) institutional education and accommodation preferences.

Keywords: Alexithymia, anxiety, disorder, qualitative, stressors

School shootings are traumatic events that can lead to anxiety, depression, and post-traumatic stress disorder among students who experience these events. It is important to find effective strategies to help students cope with their return to school, as well as their anxiety and stress levels while on campus. There exists a gap in the literature on the effects of therapy dogs on students who have witnessed a school shooting. This current study used a retrospective mixed-methods survey that was sent to recent graduates of Marjory Stoneman Douglas High School (located in Parkland, Florida) who witnessed the February 2018 shooting. Data were collected to assess how the therapy dogs affected students' willingness to return to school and their stress/anxiety levels while on campus. Identified themes indicated that the therapy dogs helped with anxiety levels, stress levels, and overall moods of Marjory Stoneman Douglas High School students. These findings provide important implications for community leaders and school administrators who want to promote healing and well-being in a community that has experienced violence.

Keywords: Therapy dog, school shooting, community violence.

Identifying the relation between the processes of programming and foreign language writing may lead to new directions for programming language and natural language focused instructional design. The present qualitative case study supported by quantitative data investigated foreign language writing experiences of computer engineering students taking an object-oriented programming course. Forty-five sophomores learning programming and academic English simultaneously in a foundation university in Ankara, Turkey, were selected purposefully for the case study. There were two data sources (students’ opinions and documents) and three data collection tools (a semi-structured interview, a short diary, and a composition. In terms of the findings of the research, four themes were obtained; however, only the use of metacognitive strategies will be explained in detail due to the length of the study. Participants stated that they feel the positive effects of programming experience on the use of self-evaluation strategy and that there are similarities and differences between the processes of programming and foreign language writing. Participants’ views on the effect of programming on foreign language writing did not differ according to their writing and programming performance scores. Participants stated that programming experience may have an effect on the use of metacognitive language learning strategies in the writing process. Upon analyzing participants’ comments, it is understood that programming experience does not hinder the use of metacognitive strategies but has a role in supporting and reinforcing their use. It is suggested that multiple case studies be done for similar views on the effects of programming and that each finding be proven by quantitative studies.

Keywords: programming, foreign language writing, metacognitive strategies.

The significance of participatory decision-making in educational institutions is widely acknowledged as essential in school management and administration. This study aimed to determine how involved teachers are in making decisions in their schools and what role they think they play in shaping different parts of school policies and procedures. It also looked at their perspectives on how decisions made by others are carried out in schools. Semi-structured interviews with 10 secondary school teachers focused on teachers' role in decision-making related to their routine school tasks, strategic decision-making, participatory role in making school decisions, and their willingness to participate in decision-making. This study showed that teachers' low participation is attributed to their shared desire to be involved in school management and administration-related decisions. Teachers expressed that participatory school-based decision-making can promote collaboration and collectivism among the school staff, and it plays a significant role in shaping their work satisfaction and motivation. By gaining insights into teachers' perspectives, this study aims to contribute to the broader understanding of participatory school decision-making in the Rwandan secondary education system and communicate potential improvements for fostering a more collaborative and inclusive educational environment.

Keywords: teachers’ perceptions, qualitative research, decision-making, secondary schools.

Call for Papers 2024

The 40 th Annual Qualitative Analysis Conference:

“Origin Stories:” Tracing the Origins of Ideas, Selves, and Communities

Wilfrid Laurier University

Brantford, Ontario

June 26-28, 2024

Abstract Submission Extended Deadline:  March 1, 2024

As qualitative researchers, we often consider the origins of new identities, institutions, and ideas in the cultural and subcultural worlds we study. For example, in the sociology of ideas, one might chart the “origin stories” of intellectual exemplars, asking how their ideas took hold within a social context or in relation to their own identities. Of course, our many social institutions also have origins and offshoots – these are worth thinking about if we are to better understand contemporary organizational arrangements. Even each qualitative research process itself has origins (e.g., learning the ropes, getting in, achieving rapport) that often opens (or curtails) our next steps. Conceptual ideas, hopefully, hatch along the way, though not always from the most likely places or times in the field, the literature, or elsewhere.  Origins also allude to the new and innovative, as we try to identify “originality” within the subcultural groups we study, our own circles of academia, and our institutional reward systems.    

Keeping the broadly conceived issue of “origins” in mind, we invite a range of theoretical, methodological, and empirical papers on this theme. As usual, we also welcome abstract submissions on all aspects of interpretive theory and qualitative research, and from a broad range of academic disciplines.  

Abstracts can be submitted online at www.qualitatives.ca/submit-abstract . If you have any questions, please contact us at [email protected] . 

Stacey Hannem, Wilfrid Laurier University

Foroogh Mohammadi, Acadia University

Pouya Morshedi, Memorial University

Antony Puddephatt, Lakehead University

Jeffrey van den Scott, Memorial University

Lisa-Jo van den Scott, Memorial University

Examining the world through qualitative inquiry

Call for Papers: Qualitative Research Methodologies/Methods for Theory Building in HRD

HRDR  Special Issue (March 2023)

To continue our celebrations of  Human Resource Development Review’s 20th anniversary (2022) and to inform future HRD research, we invite articles on qualitative research methodologies/methods for theory building. This special issue is scheduled for publication in March 2023.

Guest Editor: Dr. Jessica Nina Lester, Indiana University, USA Proposal Submission:  January 15, 2022 Full Manuscript Submission: June 15, 2022

Purpose This special issue of  HRDR  will expand the types of qualitative research methodologies/methods used by HRD scholars, as well as present innovative ways to use qualitative approaches and techniques to build theory in the field of HRD. The special issue seeks methodological articles (e.g., Braun & Clarke, 2006; Chang et al., 2013; Lester et al., 2018) that describe and illustrate:

• Traditional qualitative approaches (e.g., case study, grounded theory)
• Newer applications of “older” approaches (e.g., digital ethnography, counter-storytelling)
• Qualitative research methods that might have been used for interdisciplinary research
• Innovative, qualitative approaches (e.g., collaborative autoethnography) for theory development

Such a focus will serve to generate opportunities to envision new possibilities for engaging qualitative research methodologies/methods in the field of HRD. Further, the included articles will provide concrete suggestions and conceptualizations for how to use these qualitative research methodologies/methods. This will serve to generate a key resource for HRD scholars, practitioners, and students who seek to conduct qualitative research and to build theory in HRD.

Research Questions All submitted manuscripts must be focused on introducing a qualitative research methodology or method for building theory in HRD. To that end, authors are encouraged to consider the following questions:

• How has a particular qualitative research methodology/method been used in the field of HRD?
• If the qualitative research method has not been applied within HRD, how could it be used to improve HRD research, and why?
• What are the core assumptions of this qualitative research methodology/method?
• What kinds of data are generated typically with this qualitative research methodology/method?
• How is data analysis carried out when using this qualitative research methodology/method?
• In what ways might this qualitative research methodology/method be used to build theoretical understanding?
• How might scholars who use this qualitative research methodology/method establish and defend the quality of a given study’s design and results?
• What are the limitations of this qualitative research methodology/method as related to theory development?

Full Manuscript Submission We welcome proposals from authors in HRD and related fields. A proposal should include a rationale, an outline, implications, references, and author bios.

Format : A single-spaced, 12 pt. Times-Roman font, two-page word document including a rationale for the topic selection, an outline of the manuscript, implications for HRD research and practice, key references, and author bios (up to 150 words) at the end including names of all authors, affiliations, and contact information (e.g., emails).

This two-page word document should follow APA (7th ed.) style.

Timeline for Proposal

• January 15, 2022 : Deadline for proposal submission.
• January 31, 2022 : Contributing authors will be announced. The number of accepted proposals will be determined depending upon the quality of the submissions. Authors of the proposals that are not selected for the special issue will be encouraged to submit their manuscripts to  HRDR .
• February to June 2022 : Manuscripts will be prepared according to  HRDR ’s submission guidelines, including the main body, references, tables, and figures, following APA (7th ed.) style, in a maximum of 40 double-spaced pages.
• June 15, 2022 : Full manuscript submission deadline.
• June to October 2022 : Manuscripts will not be submitted for external blind peer review; instead,  HRDR ’s EB members who are not authors will review submissions. Authors will work on manuscript revisions with the review team led by the guest editor.
• November 1, 2022 : Deadline for final manuscript submission.
• March 2023 : Publication in the March 2023 issue.

For further information, see: https://www.ahrd.org/BlankCustom.asp?page=2021-Digest-September#HRDR

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Published by qualpage

Kathy Roulston is a professor in the Qualitative Research program in the Department of Lifelong Education, Administration and Policy at the University of Georgia, Athens, GA, USA. She teaches qualitative research methods, and has written on qualitative interviewing. https://orcid.org/0000-0002-9429-2694 Kathryn J. Roulston on ResearchGate My books include: Interviewing: A guide to theory and practice, see: https://us.sagepub.com/en-us/nam/interviewing/book272521 Interactional studies of qualitative interviews. See: https://benjamins.com/catalog/z.220 View all posts by qualpage

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Call for Chapters: Qualitative Research Methods for Dissertation Research

Call for Chapters: Qualitative Research Methods for Dissertation Research This guide provides doctoral scholars and researchers with the conventions of qualitative research for dissertation research. As an essential source, the collection is comprised of diverse resources from various perspectives for the methods and strategies to utilize the conventions of qualitative inquiry to prepare and advise doctoral scholars for rigorous qualitative dissertation research. The guide offers transdisciplinary perspectives across business, education, computer science, social and behavioral science, and the health sciences with a pathway to support a rationale for the choice of the qualitative method for the dissertation study and the subsequent design and implementation decisions needed thereafter for a qualitative dissertation study.

See submission details  https://www.igi-global.com/publish/call-for-papers/call-details/7482

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Call for Chapters: Applying Qualitative Research Methods to Science and Management

Call for chapters, introduction.

The book discusses the integration of qualitative analysis into academic research and empirical projects. Balanced between application and theory, the text covers the latest technological, organizational and methodological developments in qualitative research. This book fills a need for an up-to-date reference on qualitative research, with a pedagogical approach and practical contributions directly applicable in the field.

It aims to provide a comprehensive overview of different qualitative approaches and methods, a practical and concrete guide to implementing qualitative studies, details of the key stages of a qualitative approach (sampling, data collection and analysis, reporting) and a discussion of the benefits and limitations of qualitative studies. Its aim is to enable social science researchers to perfect their knowledge of qualitative methods, to provide students with a reference manual for their qualitative work and dissertations, to enlighten public and private decision-makers on the value of qualitative studies for understanding certain social phenomena, and to contribute to the development and valorization of qualitative approaches in academic research. The book offers a unique synthesis of all qualitative approaches, a theoretical and practical perspective, with numerous concrete examples, simplified access to sometimes complex concepts and methods, an in-depth discussion of the epistemological issues involved in qualitative studies, and possible use in qualitative methodology training courses.

Target Audience

This text is aimed at people who use qualitative studies and qualitative research. The target audience is mainly researchers and practitioners in this field, but the book may also be useful to students. These include students of the social sciences (sociology, anthropology, education sciences, social psychology, etc.), teachers and trainers in research methodology, current researchers wishing to deepen their knowledge of qualitative methods, research professionals in consultancies, polling institutes, marketing, human resources and public or private decision-makers commissioning qualitative studies.

With its broad coverage of the different qualitative approaches and its practical dimension, this book is aimed at a diverse readership, from students to professionals, who can use it both for training and as a regular reference in their research practice. It can be used to support qualitative dissertations and theses, as a methodological support for researchers designing qualitative studies, as a monitoring and self-training tool for research professionals, as a guide for decision-makers in understanding and commissioning qualitative studies, and as a source of inspiration for methodological innovation in qualitative research.

Recommended Topics

Submission procedure.

Researchers and practitioners are invited to submit on or before April 7, 2024 , a chapter proposal of 1,000 to 2,000 words clearly explaining the mission and concerns of his or her proposed chapter. Authors will be notified by April 21, 2024 about the status of their proposals and sent chapter guidelines.Full chapters are expected to be submitted by June 9, 2024 , and all interested authors must consult the guidelines for manuscript submissions at https://www.igi-global.com/publish/contributor-resources/before-you-write/ prior to submission. All submitted chapters will be reviewed on a double-blind review basis. Contributors may also be requested to serve as reviewers for this project.

Note: There are no submission or acceptance fees for manuscripts submitted to this book publication, Applying Qualitative Research Methods to Science and Management. All manuscripts are accepted based on a double-blind peer review editorial process.

All proposals should be submitted through the eEditorial Discovery ® online submission manager.

This book is scheduled to be published by IGI Global (formerly Idea Group Inc.), an international academic publisher of the "Information Science Reference" (formerly Idea Group Reference), "Medical Information Science Reference," "Business Science Reference," and "Engineering Science Reference" imprints. IGI Global specializes in publishing reference books, scholarly journals, and electronic databases featuring academic research on a variety of innovative topic areas including, but not limited to, education, social science, medicine and healthcare, business and management, information science and technology, engineering, public administration, library and information science, media and communication studies, and environmental science. For additional information regarding the publisher, please visit https://www.igi-global.com . This publication is anticipated to be released in 2024.

Important Dates

April 7, 2024 : Proposal Submission Deadline April 21, 2024 : Notification of Acceptance June 9, 2024 : Full Chapter Submission July 14, 2024 : Review Results Returned August 11, 2024 : Final Acceptance Notification August 18, 2024 : Final Chapter Submission

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This paper is in the following e-collection/theme issue:

Published on 26.4.2024 in Vol 26 (2024)

Understanding Symptom Self-Monitoring Needs Among Postpartum Black Patients: Qualitative Interview Study

Authors of this article:

Original Paper

• Natalie Benda 1 , PhD   ; 
• Sydney Woode 2 , BSc   ; 
• Stephanie Niño de Rivera 1 , BS   ; 
• Robin B Kalish 3 , MD   ; 
• Laura E Riley 3 , MD   ; 
• Alison Hermann 4 , MD   ; 
• Ruth Masterson Creber 1 , MSc, PhD, RN   ; 
• Eric Costa Pimentel 5 , MS   ; 
• Jessica S Ancker 6 , MPH, PhD  

1 School of Nursing, Columbia University, New York, NY, United States

2 Department of Radiology, Early Lung and Cardiac Action Program, The Mount Sinai Health System, New York, NY, United States

3 Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States

4 Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States

5 Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States

6 Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States

Corresponding Author:

Natalie Benda, PhD

School of Nursing

Columbia University

560 West 168th Street

New York, NY, 10032

United States

Phone: 1 212 305 9547

Email: [email protected]

Background: Pregnancy-related death is on the rise in the United States, and there are significant disparities in outcomes for Black patients. Most solutions that address pregnancy-related death are hospital based, which rely on patients recognizing symptoms and seeking care from a health system, an area where many Black patients have reported experiencing bias. There is a need for patient-centered solutions that support and encourage postpartum people to seek care for severe symptoms.

Objective: We aimed to determine the design needs for a mobile health (mHealth) patient-reported outcomes and decision-support system to assist Black patients in assessing when to seek medical care for severe postpartum symptoms. These findings may also support different perinatal populations and minoritized groups in other clinical settings.

Methods: We conducted semistructured interviews with 36 participants—15 (42%) obstetric health professionals, 10 (28%) mental health professionals, and 11 (31%) postpartum Black patients. The interview questions included the following: current practices for symptom monitoring, barriers to and facilitators of effective monitoring, and design requirements for an mHealth system that supports monitoring for severe symptoms. Interviews were audio recorded and transcribed. We analyzed transcripts using directed content analysis and the constant comparative process. We adopted a thematic analysis approach, eliciting themes deductively using conceptual frameworks from health behavior and human information processing, while also allowing new themes to inductively arise from the data. Our team involved multiple coders to promote reliability through a consensus process.

Results: Our findings revealed considerations related to relevant symptom inputs for postpartum support, the drivers that may affect symptom processing, and the design needs for symptom self-monitoring and patient decision-support interventions. First, participants viewed both somatic and psychological symptom inputs as important to capture. Second, self-perception; previous experience; sociocultural, financial, environmental, and health systems–level factors were all perceived to impact how patients processed, made decisions about, and acted upon their symptoms. Third, participants provided recommendations for system design that involved allowing for user control and freedom. They also stressed the importance of careful wording of decision-support messages, such that messages that recommend them to seek care convey urgency but do not provoke anxiety. Alternatively, messages that recommend they may not need care should make the patient feel heard and reassured.

Conclusions: Future solutions for postpartum symptom monitoring should include both somatic and psychological symptoms, which may require combining existing measures to elicit symptoms in a nuanced manner. Solutions should allow for varied, safe interactions to suit individual needs. While mHealth or other apps may not be able to address all the social or financial needs of a person, they may at least provide information, so that patients can easily access other supportive resources.

Introduction

This study focused on designing a culturally congruent mobile health (mHealth) app to support postpartum symptom monitoring, as the current practice does not adequately support patients in identifying the warning signs of pregnancy-related death (PRD). First, we describe the public health case for symptom monitoring and decision support for PRD, specifically among US-based, Black patients, a group that faces severe disparities [ 1 , 2 ]. Next, we discuss why the current mechanisms for symptom monitoring and decision support are insufficient. We then outline the existing solutions while also emphasizing the need for new interventions, particularly why those using a combination of mHealth and patient-reported outcomes (PROs) may be appropriate. Finally, we introduce a conceptual model used to accomplish our study objectives.

PRD and Associated Health Disparities

The pregnancy-related mortality ratio has increased by >200% in the United States in the past 2 decades, and in a recent review of PRDs, experts estimated that 80% of the deaths were preventable [ 3 ]. The Centers for Disease Control and Prevention (CDC) defines PRD as “the death of a woman while pregnant or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy” [ 4 , 5 ]. Mental health conditions (22.7%), hemorrhage (13.7%), cardiac and coronary conditions (12.8%), infection (9.2%), thrombotic embolism (8.7%), and cardiomyopathy (8.5%) have been cited as the most common causes for PRD [ 3 ]. Although the global maternal mortality rate has declined, the global rates are still high with 287,000 people dying following childbirth in 2020. There are significant disparities in maternal mortality based on a country’s income, with almost 95% of the cases occurring in low- and middle-income countries [ 6 ]. Stark disparities in pregnancy-related outcomes in the United States, such as PRD, exist based on race. Specifically, Black or African American (henceforth, referred to as “Black”) perinatal patients experience PRD 3 times more than White perinatal patients [ 1 , 2 , 7 - 10 ].

The disparities in maternal health outcomes experienced by Black patients in the United States are based on inequitable access to care, biased treatment, and inadequate communication, driven by systemic racism and all the cascading effects it creates. Black perinatal patients are significantly more likely to be uninsured and significantly less likely to have a usual source of medical care (eg, a primary care clinician) than White patients [ 7 , 10 ]. When Black patients seek care, they face implicit biases that negatively affect care quality and health outcomes [ 1 , 7 , 10 - 12 ]. Unsurprisingly, these biases have led to reduced trust in the health care system among Black patients [ 13 - 17 ]. Black patients also receive less patient-centered communication and feel that they have poorer access to communication with their medical team [ 10 , 18 , 19 ]. Our study aimed to improve the patient centeredness of information and support for Black patients in the postpartum period through a participatory design, an approach by which representative end users are involved throughout the design process [ 20 - 23 ]. While this study focused on Black postpartum patients in the United States, we believe that our findings may provide insights for improving perinatal support for patients from minority groups globally.

Challenges to Supporting Symptom Recognition and Treatment Seeking Post Partum

Patients encounter several challenges recognizing concerning postpartum symptoms. First, the initial postpartum visit occurs 6 weeks after birth, and 86% of PRD cases occur within the first 6 weeks post partum [ 24 , 25 ]. Second, most strategies for improving postpartum outcomes focus on hospital-based solutions, which rely on people recognizing symptoms and contacting a health professional [ 7 ]. Most counseling regarding the warning signs of PRD occurs during the discharge process following delivery, when people are physically exhausted from childbirth and primarily focused on infant care [ 24 ]. As such, this is a suboptimal time for patient education about postpartum risk factors. Discharge nurses report spending <10 minutes on the warning signs of postpartum issues, and most nurses could not correctly identify the leading causes of PRD, making it unlikely that their patients could recognize the warning signs [ 26 ]. There are many measures for postpartum symptom reporting, but the most common instruments focus narrowly on specific mental health issues, many of which are not specific to postpartum mental health or postpartum health–related quality of life [ 27 ]. While these are helpful measures to use in a clinic or hospital setting, they do not provide real-time decision support regarding the full spectrum of severe symptoms that may be indicative of PRD.

Suitability of Different Solutions for Supporting Symptom Monitoring

mHealth can address the need for tailored, dynamic symptom monitoring and support. The Association of Women’s Health, Obstetric, and Neonatal Nurses and the CDC have developed 1-page summaries to help patients identify the warning signs of PRD, such as the Urgent Maternal Warning Signs (UWS) [ 28 , 29 ]. These tools represent a positive step toward improving symptom management, but these solutions do not provide real-time, tailored support. Telephone-based support staffed by health professionals has been demonstrated to decrease postpartum depression and improve maternal self-efficacy [ 30 - 33 ]. However, 24-hour hotlines can be resource intensive, and people may still experience bias when accessing these services. The goal of this study was to conduct a qualitative needs assessment for the Maternal Outcome Monitoring and Support app, an mHealth system using PROs to provide decision support for postpartum symptom monitoring.

Mobile phones offer a viable, inclusive option for intervention delivery for Black people of childbearing age. In 2020, data from the Pew Research Center indicate that 83% of Black people owned smartphones, which is comparable to smartphone ownership among White people (85%). Smartphone ownership is also higher among people aged <50 years (96%), which encompasses most postpartum patients [ 34 ]. However, Black people are twice as likely as White people to be dependent on smartphones for internet access [ 35 ]. mHealth-based apps for blood pressure and weight tracking during pregnancy have demonstrated success among diverse groups, providing evidence that mHealth may be an acceptable means for symptom reporting in the target population [ 36 - 38 ].

Symptom education and PRO-based interventions have demonstrated success in improving knowledge, self-efficacy, and outcomes. Use of PROs has improved symptom knowledge, health awareness, communication with health care professionals, and prioritization of symptoms in patients with chronic disease and cancer [ 39 - 44 ]. Multiple studies have also demonstrated that educational interventions regarding expected symptoms in the postpartum period can improve self-efficacy, resourcefulness, breastfeeding practices, and mental health [ 12 , 38 , 45 - 47 ]. However, given the issues related to trust and disparities in patient-centered communication, it is critical to understand Black patients’ perspectives about how such a system should be designed and implemented.

Conceptual Model

To study the issue of supporting symptom monitoring, we combined 2 theoretical frameworks ( Figure 1 ): the common sense model of self-regulation (health behavior) by Diefenbach and Leventhal [ 48 ] and the model of human information processing (human factors engineering) by Wickens [ 49 ]. The model by Diefenbach and Leventhal [ 48 ] depicts patients as active problem solvers with a mental model of their conditions. Patients process their symptoms, both cognitively and emotionally, and then evaluate whether action is needed [ 48 ]. The patient’s mental model of their condition, personal experiences, and sociocultural factors impact processing, evaluation, and action. In the information processing model by Wickens [ 49 ], action occurs in 2 steps—selection and execution [ 48 ]. Environmental or organizational factors also affect patients’ selection of actions and whether they can execute an action. For example, a patient may suspect that they should visit the emergency room but may not go because they do not have insurance, transportation, or childcare. Our qualitative inquiry investigated how to better support symptom processing and appropriate response selection, while also uncovering the barriers to action that may need to be mitigated.

The goal of this study was to identify the design and implementation needs of an mHealth-based symptom self-monitoring and decision-support system to support Black patients in determining when to seek care from a health professional for signs of PRD in the postpartum period. This tool will support both somatic and psychological symptoms given their complex, critical, and connected presentation. We used the described conceptual model in qualitative inquiry and pragmatic intervention design to provide contributions regarding the following: (1) relevant symptom inputs for postpartum support, (2) drivers that may affect symptom processing, and (3) how the previous 2 aspects highlight the design needs for symptom self-monitoring and patient decision support. To address our study objective, we conducted semistructured interviews with postpartum Black patients, obstetrics health professionals, and mental health professionals.

The study was conducted in 3 tertiary care hospitals and affiliated clinics within the same health system in New York City. The 3 hospitals, taken together, are involved in the delivery of >14,000 babies annually. All participants were either patients who received obstetric care in the included sites or health professionals affiliated with the sites.

Eligible patients were identified by the institutions’ research informatics team using electronic health record data. First, the patients’ providers consented to their patients being contacted, and patients’ charts were reviewed by the primary obstetrician or designate to ensure that the patient was eligible for the study and that they had a delivery experience that would allow them to participate in the interview without undue stress. Next, the patients were sent an invitation to participate via the email address listed in their record. We also posted fliers in 2 high-risk, outpatient obstetric clinics.

Obstetric and mental health professionals were eligible if they were affiliated with one of the institutions in the obstetrics or mental health department. Brief presentations were given at relevant faculty meetings, and participants were contacted individually via email or through departmental listserves.

Interested participants from all groups used a link to schedule a time to speak with a researcher.

Ethical Considerations

The study was approved by the affiliated medical schools’ institutional review board (protocol number 20-08022582). All participants provided written informed consent. Study data were coded (ie, all identifying information was removed) to protect participant privacy. Each participant was compensated US $50 for their time via a physical or electronic gift card.

Study Design and Sample

The study used semistructured interviews with 3 key stakeholder groups: recent postpartum Black patients, obstetric health professionals, and mental health professionals. Eligible patients were within 12 months post partum of a live birth, self-identified their race as Black or African American, and had at least 1 somatic or psychological high-risk feature associated with their pregnancy. High-risk features included attendance at a high-risk clinic for prenatal or postnatal care, inpatient hospitalization within 12 months post partum, a prescription of an antidepressant or benzodiazepine within 12 months of the pregnancy, or a new diagnosis of depression or anxiety within 12 months of the pregnancy. High-risk clinics treated various conditions, but the most common conditions were gestational hypertension and gestational diabetes.

We adopted an interpretivist qualitative research paradigm to study patient and health professionals’ perspectives of how symptom recognition and care seeking may be better supported [ 50 ]. Our methodological orientation involved directed content analysis, adopting an abductive reasoning approach. First, we used the previously specified conceptual model to construct questions and thematically categorize responses [ 48 ]. Then, we allowed unique subthemes to inductively emerge from the data collected [ 51 ].

Interview Guide Development

Interview guides were iteratively developed by our team of researchers with expertise in obstetrics, perinatal mental health, nursing, consumer informatics, inclusive design, and qualitative methods. The guide for each stakeholder group was reviewed and piloted before enrollment of the first participant. Interview guides were tailored for patients or health professionals but followed a similar structure, based on our conceptual model ( Figure 1 ), such that participants were first asked about barriers to and facilitators of processing symptoms cognitively and emotionally (eg, Do they notice the symptom or realize its severity?), making decisions about symptoms they are experiencing (ie, When to seek help from a health professional?), and taking action on problematic symptoms. Probing questions encouraged participants to elaborate on experiential, educational, sociocultural, organizational, environmental, or health systems–level drivers of patients’ symptom management. Then, participants were asked a series of questions related to their thoughts regarding the design of the mHealth system, including how to best report symptoms, the wording of system decision support, the desired level of involvement of the obstetrics health professionals, the means for facilitating outreach to a health professional, additional information resources, and preferences for sharing information included in the system with a trusted friend or family members. During this process, obstetrics and mental health professionals were also shown a handout that outlined the draft of the symptom management algorithm for the system being developed (CDC’s UWS) and asked if they would make any changes, additions, or deletions [ 29 ]. Full interview guides are included in Multimedia Appendix 1 .

Data Collection

All interviewees provided consent electronically before the interview. A PhD-trained qualitative research expert (NB) completing a postdoctoral study in health informatics and population health conducted all the interviews via Zoom (Zoom Video Communications) or telephone. Participants had the option to request an in-person interview, but none of them chose this option. Interviews lasted 30 to 60 minutes and were audio recorded. We explicitly described the study objectives to each participant before the interview. Following the interview, participants completed a demographics survey electronically. All electronic survey information was collected using REDCap (Research Electronic Data Capture; Vanderbilt University).

Data Preparation and Analysis

Audio recordings were converted into transcripts using an electronic software (NVivo Transcription; QSR International) and manually checked for accuracy by a study team member who did not conduct the initial interviews. We completed all data analyses using NVivo (versions 12 and 13), but we manually analyzed the data and did not use computer-aided techniques (eg, computerized emotion detection or autocoding).

Data were analyzed using thematic analysis and the constant comparative process [ 51 - 53 ]. Specifically, each analyst open coded the transcripts, by coding segments that pertained to the research questions, as opposed to coding all words and phrases. We used thematic analysis to detect the common and divergent needs for postpartum symptom monitoring. We chose this method over other approaches such as grounded theory or sentiment analysis because our needs were pragmatic to solution design, and we were not attempting to establish theory, describe phenomena, or represent collective feeling about a topic.

The first deductive analysis was conducted using an initial theoretical model derived from the common sense model by Diefenbach and Leventhal [ 48 ] and the model of human information processing by Wickens [ 49 ] ( Figure 1 ). To promote reliability, 2 coders in addition to the interviewer were involved in the analysis, and each transcript was first analyzed independently by at least 2 people (NB, SW, or SNdR), followed by meetings to resolve discrepancies based on consensus coding. The analysis team created initial codes based on the conceptual model and added new items to the codebook inductively (ie, post hoc instead of a priori, as they arose in the data). The team used NVivo to maintain a working codebook of themes, definitions, and relevant quotes derived from the data. The codebook was periodically presented to coinvestigators with expertise in obstetrics and perinatal psychiatry to improve external validity [ 51 , 52 ]. The sufficiency of sample size was assessed according to the theoretical saturation of themes encountered, specifically based on the need to add additional subthemes to the codebook [ 54 , 55 ]. After all the transcripts had been coded, at least 2 members of the coding team reviewed the data code by code to ensure that meaning remained consistent throughout the analysis and to derive key emerging themes [ 51 ].

Participant Characteristics

This study included 36 participants—15 (42%) obstetrics health professionals, 10 (28%) mental health professionals, and 11 (31%) recent postpartum Black patients. Table 1 presents the self-reported demographic information. As shown, 19% (7/36) of the health professionals and 11% (4/36) of the patients had missing data (ie, did not complete the questionnaire). Participants could also selectively choose not to answer questions. “Other” affiliations were possible for health professionals because those who had a secondary affiliation with one of the included sites but primary affiliation with another organization were eligible.

a N/A: not applicable.

b Health professionals’ self-reported role of resident psychiatrist, chief resident in psychiatry, psychologist, and patient care director was combined into the other category for analysis purposes.

Structure of Themes

Our initial theoretical model, derived from the common sense model by Diefenbach and Leventhal [ 48 ] and the model of human information processing by Wickens [ 49 ] ( Figure 1 ), described that patients experience some inputs (psychological and somatic symptoms of PRD). Then, there is a series of drivers that affect how patients cognitively and emotionally process (eg, notice and realize symptom severity), make decisions about, and act on symptoms they are experiencing. The nature of these symptoms, how they are processed, how decisions are made, and how they are acted upon then drive a conversation regarding the design needs for symptom monitoring and decision support for PRD. The emerging themes were organized into the following categories: (1) symptoms of PRD; (2) drivers of processing, decision-making, and action; and (3) design needs for a symptom-reporting and decision-support system. Quotes are labeled with study-specific identifiers: OB denotes obstetric health professional, MHP denotes mental health professional, and PT denotes patient.

Inputs: Psychological and Somatic Symptoms of PRD

Concerning and routine symptoms were reported both from a psychological and somatic perspective. Sometimes, the distinction between routine and concerning symptoms was clear. Other times, it was more challenging to differentiate routine versus concerning symptoms particularly because they were related to psychological health. Mental health professionals also noted the challenge that routine symptoms can progress to something more serious over time:

In my mind, like normal becomes abnormal, when there is any kind of functioning [loss] that like withstands two to three weeks. [MHP 04]

We really hear a lot about postpartum depression and stuff...A lot of women think...postpartum depression is you just don’t want to. You don’t have it. You go into depression where you can’t take care of your child and you don’t want to hold your child. You don’t feel connected to your child. And I learned...it can be so many different things. [PT 09]

A clear distinction was not always present between psychological and somatic symptoms:

If someone...has pain in their chest or shortness of breath, the first thing you want to think about is it sort of like clots and other kind of physiologic reasons for that. Those are also very implicated and sort of obviously [associated with] panic attacks and anxiety. So, I think though those symptoms are also relevant of physical symptoms, [they] are also relevant for mental health. [MHP 05]

Drivers of Processing, Decision-Making, and Action Based on the Symptoms Experienced

Several drivers were reported to affect symptom processing (ie, whether they noticed the symptom and its severity), patients’ capacity to decide what should be done (ie, make decisions), and whether they were able to act on concerning symptoms ( Table 2 ).

Table 2 presents exemplary quotes for emerging themes under a single driver, but many quotes were coded under multiple drivers in our analysis process. The following passage, for example, highlights how self-perception, sociocultural concerns, and the health system can overlap to present a complex set of factors that may prevent women from receiving the care they need for the symptoms they are experiencing:

A lot of times I think that does get overlooked because people feel like, well, you’re OK, you’re fine. But what research shows us is that especially for Black women, it really doesn’t matter how much money you make or your income level, like our postpartum and perinatal health outcomes are the same across the board, which is really detrimental. So, yeah, I think they get overlooked because of that. I think they get overlooked or we get overlooked in the health care system. But I also think we get overlooked by our family and friends because we’re the strong ones. So, if anybody can deal with this, it’s you. [MHP 10]

a MHP: mental health professional.

b PT: patient.

c OB: obstetric health professional.

Design Needs for a Symptom-Reporting and Decision-Support System

Obstetric health professionals, mental health professionals, and patients discussed multiple needs for improved PRD symptom reporting and decision support. The key design requirements are embedded and italicized in the following text.

Participants generally agreed that although the proposed system focuses on postpartum symptoms, it would be advantageous to introduce the system during pregnancy, particularly in the third trimester :

You have to reach women before they give birth. They might look, they might not look, they might look at it and be concerned. But then they might forget about it and not have time to call. Those first six weeks are really chaotic. [MHP 06]

I think in the third trimester would be great because often we don’t really have anything to talk about in the office. It’s very quick visits like blood pressure and you’re still pregnant and we’re just waiting. And so, I think and they start to have a lot of questions about like, well, when I get home and how’s this going to go? So, I think that time is a good time. We’re all kind of just waiting for labor to happen or full term to get there, and this kind of gives them something to feel like they can prepare for. [OB 08]

Patients were open to reminders regarding entering symptoms they were experiencing, and participants described a desire for just-in-time symptom reporting and decision support, so that they could get quick feedback as they were experiencing the symptoms:

When people get home so much in their life has changed. And it’s probably a very hectic time. So maybe I think that’s a great idea reaching out again, either a few days or a week later to make sure they’re really able to use it and engage with it to the extent that’s helpful to them. [OB 02]

I think it would be a good idea to have like a system where you can report whenever you want. [PT 03]

I think for me, I would say in the moment. But then also having something at the end of every week to just, you know, to check in with yourself. I think that would be good as well. [PT 09]

In addition to considerations about how symptoms would be recorded, participants stressed the importance of the wording of the decision-support messages that patients receive . For messages that inform the patient that their symptom did not seem to require immediate medical attention, it was important to ensure that the patient still felt heard and that they did not leave the interaction feeling stuck with nothing to do regarding a symptom that was concerning to them:

Reframe the message. You know...we apologize that you were experiencing this. We just want to reassure you that this is normal. [PT 01]

[You] don’t want to make anyone feel like their feelings aren’t valid because that’s a horrible thing, especially in health care, especially if a person is convinced that something is wrong with them and you’re telling them that it’s normal and is perfectly fine. So, in that situation, I would just, depending on what the issue is, I would also share information of what to look out for. [PT 05]

The first thing is that it’s normal, but also something that you want to be able to do for comfort. For me, I don’t have to do too much, especially if I’m having anxiety, like if I get a text back that says here are some things you can do in this very moment to handle it. And then also, here are some links or information that you can also look up. [PT 09]

In the events where a concerning symptom was reported and it was recommended that the patient should reach out to a health professional, importance of conveying a sense of urgency without scaring the patient:

You don’t want to scare people, but it’s kind of hard to get around that when something is serious, and you don’t want to dumb it down. [PT 01]

Participants wanted multiple, easy-to-do methods for connecting with their health professional team, including having the number to call pop up, scheduling a time for someone to call them, and being able to start a live web-based chat:

I like all the options, especially that form or chat you can have like, you know, those online chat where like you really chatting with someone for those who like the type. I’m the type of person I just want to make a phone call, right? So, like for me, [it] will be a call. Maybe say maybe if it’s five, five or ten minutes then that will be great. Like especially, it’s going to make me feel like, OK, there’s someone out there that will care about my health. [PT 06]

However, participants noted that they would prefer not to use a symptom-reporting and decision-support tool, but instead reach out directly via phone if they were experiencing issues.

Participants, particularly mental health professionals, described a need for improved nuance or details regarding the different psychological symptoms patients could experience that are indicative of severe mental health issues:

Thoughts of hurting yourself or someone else is a good one...I would say I would add difficulty bonding. It would add something about not being able to sleep, even if you could sleep, you know, like or your anxiety that doesn’t go away, that changes your behavior. So, it changes the way that you interact with the baby or kind of do childcare. I guess I would want to say something about. psychotic thoughts, like fear that someone else may be hurting you or...recurrent worries or anxieties that don’t go away. [MHP 02]

Patients had differing opinions regarding whether the system should be integrated with other health technologies, particularly the patient portal:

I love the patient portal. I was able to be traveling to reach out to my OB, to reach out to all, you know, the nurses and stuff like that and just experience things that I needed. [PT 09]

I feel like...it’s an integral part of my medical history. So, even if it may seem somewhat insignificant for whatever reason, I would still want to have access. [PT 09]

I didn’t find it [the patient portal] very helpful... [PT 03]

On the basis of the feedback from health professionals that it may be challenging for postpartum patients to process and recognize certain symptoms, especially those related to mental health, we explored whether patient participants would be open to sharing educational information about symptoms to expect (rather than sharing the actual symptom reports) with trusted friends or family members. Similar to other design considerations, results were mixed, but it seemed helpful to have a patient-driven option for sharing symptom-related educational information with chosen friends or family members :

I think that there’s so much going on it would help to have someone with a different perspective equipped with this information. [PT 02]

There’s a lot of shame that comes with this. I’m not sure people would actually want other people to know. I can’t speak for the majority, but I didn’t really want people to know because I don’t want the kind of energy that came with people knowing. [PT 05]

We also discovered the competing needs of balancing the patient’s desire for their health professionals to be involved in symptom reporting with the need to avoid significant increases to health professional workload :

I sort of wonder from the health care provider perspective, how involved is the provider in that in the app? Like, do they get like a PDF of all the information? Is that more work for the provider? How does the provider interpret that data? [MHP 03]

I feel like they [the health professional] should be super involved. Especially because I’m not just going off of my experience because, you know, I don’t want to feel like they’re not really like I’m experiencing. And so, it’s scaring me. So, I just want to know that, you know, you’re hands on with everything. [PT 01]

Finally, the participants desired information beyond PRD symptoms to entice them to use the system . They were supportive of including various types of information, such as breastfeeding support resources, milestones and information regarding their child, other websites and apps with trusted maternal and child health information, further support resources for how they feel mentally, and links to social services (eg, food, housing, or other assistance).

Principal Findings

In this qualitative study, we interviewed obstetric health professionals, mental health professionals, and Black postpartum patients. Our findings helped to identify the design and implementation needs of an mHealth-based, symptom self-monitoring and decision-support system designed to support Black patients in determining when to seek care from a health professional for signs of PRD in the postpartum period. We encountered important findings related to (1) inputs, including psychological and somatic symptoms; (2) drivers of processing, decision-making, and action based on the symptoms experienced; and (3) design needs for a symptom-reporting and decision-support system. We have discussed how our findings may be helpful to other postpartum populations as well as the implications of our study for patient decision-support in other clinical settings.

First, our findings related to symptom inputs revealed the challenges caused by the overlapping presentation of somatic and psychological symptoms. This provides support for our approach of including psychological and somatic issues in a single app, particularly given that mental health conditions are a leading cause of PRD. A 2021 review found 15 PRO measures for assessing postpartum recovery. The measures typically focused on mental health or health-related quality of life, but few included both psychological and somatic outcomes, and none were targeted for PRD, such as the system [ 56 ].

Moreover, related to symptom inputs, we found that current tools for pinpointing severe symptoms, such as the CDC’s UWS did not provide sufficient nuance for concerning psychological symptoms. Symptom-reporting tools for PRD will either need to consider incorporating structured assessments, such as the Edinburgh Postnatal Depression Scale (EPDS) [ 56 ], or incorporating additional symptoms. The latter approach may have advantages as the EPDS focuses on depression (while providing subscales for anxiety) and PROs evaluated for use with anxiety disorders have limitations [ 57 ]. Furthermore, the EPDS has been validated in in-person laboratory settings but not in community settings or for web-based entry [ 58 ]. We must also consider how mistrust in the health system may lead to less truthful answers. Issues expressed around stigma related to mental health indicate that the way in which these symptoms are elicited may require further assessment to promote the normalcy of the symptoms and improve candid reporting. Technology-based approaches for supporting perinatal mental health have been described as uniformly positive but having limited evidence for use [ 59 ], suggesting that further exploration is needed in this area, also considering how adding somatic issues may be perceived by patients.

Second, there were several drivers that affected symptom processing, decision-making, and action that cannot typically be solved through a symptom-reporting and decision-support system. Challenges related to self-perception and lack of experience or expectations may be addressed based on the wording for how the symptoms are elicited and by providing concise, easy-to-understand depictions of what should be expected versus what are the causes for concern. However, many of the other issues described related to sociocultural, financial, and environmental factors and the health systems’ systemic racism issues cannot be addressed directly in a simple PRO-based app and decision-support system. Directly addressing these issues will likely require more systematic, multipronged approaches. Therefore, it seems advisable to couple patient decision-support aids with other social support interventions for perinatal health [ 60 , 61 ].

Drivers of processing, decision-making, and action are still important contextual elements to be considered in the design of the system. Another study tailoring an mHealth app for Latina patients to support health during pregnancy also found it important to address issues related to financial barriers, social support, health care accessibility, and cultural differences [ 62 ]. Our best attempt to address these issues may be to promote information transparency and inclusive design. For example, there may be a “frequently asked questions” section of an app, where patients can explore things such as supportive resources for childcare while they seek medical attention or information they may show their friends or family members regarding postpartum symptoms of concern. The system may also use common human-computer interaction principles, such as information filtering [ 63 ] and organizing the suggested resources (eg, for mental health care) based on whether they accept the patient’s insurance. The built environment can also be changed through the system, but it may offer mechanisms for remote monitoring, such as telemedicine-based support or linking the system to a blood pressure cuff, when clinically appropriate [ 64 , 65 ]. As noted, the system obviously cannot address issues related to systematic racism directly [ 66 ]. Instead, we used a participatory design approach, with the hope that the nature of the information presented may be more patient centered, acceptable, and better aligned with the beliefs and values of Black patients [ 67 ]. Issues related to systematic racism have commonly been described in the US health care system, but structural inequities also exist on a global scale. Future studies should investigate how our findings regarding design needs may extend to other minoritized perinatal patient groups.

A systematic review of patient decision aids for socially disadvantaged populations across clinical settings found that such tools can improve knowledge, enhance patient-clinician communication, and reduce decisional conflict [ 68 ]. However, descriptions of patient decision aids focus on the type of tool (eg, paper vs digital), how it was delivered, when it was delivered, and by whom, as opposed to describing the content the aid provides. Therefore, it is challenging to determine how other decision-support tools have addressed information regarding environmental, financial, or health system–level factors that may affect care seeking based on the decision aid. Some tools seem to address sociocultural needs by tailoring to the target population, but the aforementioned systematic review did not find differential effects on outcomes when tools were tailored versus not tailored [ 16 ]. Future studies on patient decision aids may benefit from including non-symptom related information. Providing appropriate informational support may involve a deeper study of the systemic needs that patients may have, even if these needs may not directly be addressed by the decision aid.

Third, descriptions of the design needs for PRD symptom monitoring revealed that there is likely not a one-size-fits-all solution related to reminders, involvement of health professionals, and how the tool is incorporated with other systems (eg, the patient portal). “User control and freedom” and “flexibility of use” are two of the key items in commonly used heuristics for user interface design [ 69 ]; therefore, it is important to include options for customization and varied but safe pathways for interaction with the proposed system. For example, some participants described that they may not be likely to access the symptom-reporting system through the patient portal. Although there may be safety and convenience-related reasons for having the system as part of the patients’ medical record, if the patient chooses, the system could, on the front end, appear more like a stand-alone app than something that must be accessed through the patient portal. Patients also had varying opinions related to how they may want to reach out to a health professional if a problematic symptom was reported. These preferences may differ from instance to instance; therefore, it is helpful to ensure that patients have a choice regarding how to reach out, but system designers must also create workflows with feedback loop, so that patients who are reporting problematic symptoms are not missed (ie, if patients do not reach out themselves, they never receive attention). Patient-level customizations and options for interaction also respects patients as individuals and may promote patient-centered interactions.

Furthermore, related to design needs, participants indicated that the wording of the decision-support messages was critical. Specifically, for reports that did not include currently urgent symptoms, it was important that the message still conveyed support and validation, clarified that the patient could still reach out for help, and provided additional means for managing their symptoms, so the patient did not feel frustrated by their report [ 70 ]. Regarding messages that recommended patients to reach out to their health professional team, it was crucial to note what the symptom meant (eg, what kind of disease it could indicate), encourage the patient to reach out without increasing anxiety, and provide different avenues for easy outreach. Going forward, we plan to incorporate the aforementioned elements into the messages built into the system. We will then complete additional acceptance and comprehension testing with a larger sample of postpartum patients. These findings also indicate that care must be taken in translating such tools, and the translated materials should be reviewed with the target end user groups before implementation. This may mitigate unintended consequences or inadvertent inclusion of language that does not support the needs of minoritized groups.

Strengths and Limitations

Our study highlighted the limitations and areas that would benefit from further exploration. First, our study involved recruitment sites that were within a single health system in New York City. Second, while we achieved thematic saturation of qualitative themes (a means for determining sample sufficiency in qualitative studies) [ 54 , 55 ], our conclusions are based on a sample of 36 participants from 3 stakeholder groups. Third, given the documented disparities, we deliberately focused on the needs of Black postpartum patients, but this may not represent the needs of the postpartum patients of other races. Furthermore, our sample should not be viewed as encompassing the opinions of all Black postpartum patients. Our findings revealed the need for individual customization and varied interaction patterns on a case-by-case basis. Fourth, all interviews were conducted remotely (via Zoom or telephone), which can have effects on the interaction. On the one hand, it may be harder to connect with the interviewee, and on the other hand, people may feel more anonymous and comfortable with sharing information. Finally, although we attempted to promote external validity through the review of the coding scheme by a subject matter expert, we did not have the opportunity to perform triangulation of the findings by returning the results to participants. To address these limitations, it would be beneficial to survey a larger group of postpartum patients, powered to assess the differences based on race and ethnicity. This would allow us to come to a stronger consensus regarding design choices, assess whether there are differences in design needs or preferences, and gain feedback from patients in areas outside New York City. Future studies may also explore how other underserved groups, such as those with limited English proficiency, may benefit from tailored symptom self-monitoring and decision support.

Conclusions

In this qualitative study regarding postpartum symptom monitoring and decision support, we found that the current structured reporting measures do not include the combination of somatic and psychological symptoms that may be indicative of severe outcomes in the postpartum period. While not explicitly related to symptom reporting and decision support, patient decision aids, particularly those focusing on minoritized groups, should consider how the aids may be coupled with other structural support interventions or, at least, information about how other resources may be accessed. As stated in the commonly accepted design heuristics, we also found that user control and freedom unsurprisingly remain important for a patient decision-support aid for Black postpartum patients. Finally, decision aid–related phrases must take care to convey urgency without inducing anxiety when action may be indicated and consider respect and empathy for the patients’ symptoms when action may not be indicated to ensure that they do not feel unheard and are empowered to report new or worsening symptoms.

Acknowledgments

This study was supported by the National Institute on Minority Health and Health Disparities (K99MD015781; principal investigator: NB).

Data Availability

The data sets generated and analyzed during this study are not publicly available due to institutional review board regulations but are available from the corresponding author on reasonable request.

Authors' Contributions

NB conceptualized the study and acquired funding under the advisement of RBK, LER, AH, RMC, and JSA. NB collected the data. NB, SW, and SNdR analyzed the data with input from all other authors. ECP completed the literature review and descriptive analysis of participants’ characteristics. NB drafted the paper and received substantial inputs from all other authors.

Conflicts of Interest

LER is an Up to Date contributor and an advisory board member for the New English Journal of Medicine, and Contemporary OB/GYN. She has also been a speaker for Medscape is an an expert reviewer for Pfizer on the RSV Vaccine. AH is an Up to Date contributor, a co-founder and medical consultant for Iris Ob Health, and a consultant for Progyny.

Semistructured interview guide questions for patients and health professionals.

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Abbreviations

Edited by A Mavragani; submitted 22.03.23; peer-reviewed by C Laranjeira; comments to author 15.01.24; revised version received 20.02.24; accepted 08.03.24; published 26.04.24.

©Natalie Benda, Sydney Woode, Stephanie Niño de Rivera, Robin B Kalish, Laura E Riley, Alison Hermann, Ruth Masterson Creber, Eric Costa Pimentel, Jessica S Ancker. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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Authors are encouraged to submit a separate ZIP file that contains further supplementary material like data or source code, when applicable.

You must format your submission using the NeurIPS 2024 LaTeX style file which includes a “preprint” option for non-anonymous preprints posted online. Submissions that violate the NeurIPS style (e.g., by decreasing margins or font sizes) or page limits may be rejected without further review. Papers may be rejected without consideration of their merits if they fail to meet the submission requiremhttps://www.overleaf.com/read/kcffhyrygkqc#85f742ents, as described in this document. 

Paper checklist: In order to improve the rigor and transparency of research submitted to and published at NeurIPS, authors are required to complete a paper checklist . The paper checklist is intended to help authors reflect on a wide variety of issues relating to responsible machine learning research, including reproducibility, transparency, research ethics, and societal impact. The checklist forms part of the paper submission, but does not count towards the page limit.

Supplementary material: While all technical appendices should be included as part of the main paper submission PDF, authors may submit up to 100MB of supplementary material, such as data, or source code in a ZIP format. Supplementary material should be material created by the authors that directly supports the submission content. Like submissions, supplementary material must be anonymized. Looking at supplementary material is at the discretion of the reviewers.

We encourage authors to upload their code and data as part of their supplementary material in order to help reviewers assess the quality of the work. Check the policy as well as code submission guidelines and templates for further details.

Use of Large Language Models (LLMs): We welcome authors to use any tool that is suitable for preparing high-quality papers and research. However, we ask authors to keep in mind two important criteria. First, we expect papers to fully describe their methodology, and any tool that is important to that methodology, including the use of LLMs, should be described also. For example, authors should mention tools (including LLMs) that were used for data processing or filtering, visualization, facilitating or running experiments, and proving theorems. It may also be advisable to describe the use of LLMs in implementing the method (if this corresponds to an important, original, or non-standard component of the approach). Second, authors are responsible for the entire content of the paper, including all text and figures, so while authors are welcome to use any tool they wish for writing the paper, they must ensure that all text is correct and original.

Double-blind reviewing:   All submissions must be anonymized and may not contain any identifying information that may violate the double-blind reviewing policy.  This policy applies to any supplementary or linked material as well, including code.  If you are including links to any external material, it is your responsibility to guarantee anonymous browsing.  Please do not include acknowledgements at submission time. If you need to cite one of your own papers, you should do so with adequate anonymization to preserve double-blind reviewing.  For instance, write “In the previous work of Smith et al. [1]…” rather than “In our previous work [1]...”). If you need to cite one of your own papers that is in submission to NeurIPS and not available as a non-anonymous preprint, then include a copy of the cited anonymized submission in the supplementary material and write “Anonymous et al. [1] concurrently show...”). Any papers found to be violating this policy will be rejected.

OpenReview: We are using OpenReview to manage submissions. The reviews and author responses will not be public initially (but may be made public later, see below). As in previous years, submissions under review will be visible only to their assigned program committee. We will not be soliciting comments from the general public during the reviewing process. Anyone who plans to submit a paper as an author or a co-author will need to create (or update) their OpenReview profile by the full paper submission deadline. Your OpenReview profile can be edited by logging in and clicking on your name in https://openreview.net/ . This takes you to a URL "https://openreview.net/profile?id=~[Firstname]_[Lastname][n]" where the last part is your profile name, e.g., ~Wei_Zhang1. The OpenReview profiles must be up to date, with all publications by the authors, and their current affiliations. The easiest way to import publications is through DBLP but it is not required, see FAQ . Submissions without updated OpenReview profiles will be desk rejected. The information entered in the profile is critical for ensuring that conflicts of interest and reviewer matching are handled properly. Because of the rapid growth of NeurIPS, we request that all authors help with reviewing papers, if asked to do so. We need everyone’s help in maintaining the high scientific quality of NeurIPS.  

Please be aware that OpenReview has a moderation policy for newly created profiles: New profiles created without an institutional email will go through a moderation process that can take up to two weeks. New profiles created with an institutional email will be activated automatically.

Venue home page: https://openreview.net/group?id=NeurIPS.cc/2024/Conference

If you have any questions, please refer to the FAQ: https://openreview.net/faq

Ethics review: Reviewers and ACs may flag submissions for ethics review . Flagged submissions will be sent to an ethics review committee for comments. Comments from ethics reviewers will be considered by the primary reviewers and AC as part of their deliberation. They will also be visible to authors, who will have an opportunity to respond.  Ethics reviewers do not have the authority to reject papers, but in extreme cases papers may be rejected by the program chairs on ethical grounds, regardless of scientific quality or contribution.  

Preprints: The existence of non-anonymous preprints (on arXiv or other online repositories, personal websites, social media) will not result in rejection. If you choose to use the NeurIPS style for the preprint version, you must use the “preprint” option rather than the “final” option. Reviewers will be instructed not to actively look for such preprints, but encountering them will not constitute a conflict of interest. Authors may submit anonymized work to NeurIPS that is already available as a preprint (e.g., on arXiv) without citing it. Note that public versions of the submission should not say "Under review at NeurIPS" or similar.

Dual submissions: Submissions that are substantially similar to papers that the authors have previously published or submitted in parallel to other peer-reviewed venues with proceedings or journals may not be submitted to NeurIPS. Papers previously presented at workshops are permitted, so long as they did not appear in a conference proceedings (e.g., CVPRW proceedings), a journal or a book.  NeurIPS coordinates with other conferences to identify dual submissions.  The NeurIPS policy on dual submissions applies for the entire duration of the reviewing process.  Slicing contributions too thinly is discouraged.  The reviewing process will treat any other submission by an overlapping set of authors as prior work. If publishing one would render the other too incremental, both may be rejected.

Anti-collusion: NeurIPS does not tolerate any collusion whereby authors secretly cooperate with reviewers, ACs or SACs to obtain favorable reviews. 

Author responses:   Authors will have one week to view and respond to initial reviews. Author responses may not contain any identifying information that may violate the double-blind reviewing policy. Authors may not submit revisions of their paper or supplemental material, but may post their responses as a discussion in OpenReview. This is to reduce the burden on authors to have to revise their paper in a rush during the short rebuttal period.

After the initial response period, authors will be able to respond to any further reviewer/AC questions and comments by posting on the submission’s forum page. The program chairs reserve the right to solicit additional reviews after the initial author response period.  These reviews will become visible to the authors as they are added to OpenReview, and authors will have a chance to respond to them.

After the notification deadline, accepted and opted-in rejected papers will be made public and open for non-anonymous public commenting. Their anonymous reviews, meta-reviews, author responses and reviewer responses will also be made public. Authors of rejected papers will have two weeks after the notification deadline to opt in to make their deanonymized rejected papers public in OpenReview.  These papers are not counted as NeurIPS publications and will be shown as rejected in OpenReview.

Publication of accepted submissions:   Reviews, meta-reviews, and any discussion with the authors will be made public for accepted papers (but reviewer, area chair, and senior area chair identities will remain anonymous). Camera-ready papers will be due in advance of the conference. All camera-ready papers must include a funding disclosure . We strongly encourage accompanying code and data to be submitted with accepted papers when appropriate, as per the code submission policy . Authors will be allowed to make minor changes for a short period of time after the conference.

Contemporaneous Work: For the purpose of the reviewing process, papers that appeared online within two months of a submission will generally be considered "contemporaneous" in the sense that the submission will not be rejected on the basis of the comparison to contemporaneous work. Authors are still expected to cite and discuss contemporaneous work and perform empirical comparisons to the degree feasible. Any paper that influenced the submission is considered prior work and must be cited and discussed as such. Submissions that are very similar to contemporaneous work will undergo additional scrutiny to prevent cases of plagiarism and missing credit to prior work.

Plagiarism is prohibited by the NeurIPS Code of Conduct .

Other Tracks: Similarly to earlier years, we will host multiple tracks, such as datasets, competitions, tutorials as well as workshops, in addition to the main track for which this call for papers is intended. See the conference homepage for updates and calls for participation in these tracks. 

Experiments: As in past years, the program chairs will be measuring the quality and effectiveness of the review process via randomized controlled experiments. All experiments are independently reviewed and approved by an Institutional Review Board (IRB).

Financial Aid: Each paper may designate up to one (1) NeurIPS.cc account email address of a corresponding student author who confirms that they would need the support to attend the conference, and agrees to volunteer if they get selected. To be considered for Financial the student will also need to fill out the Financial Aid application when it becomes available.

Advancing social justice, promoting decent work ILO is a specialized agency of the United Nations

Migrated Content

Deadline for submission: 20 July 2023

The project ‘Promoting Sustainable Enterprises in India or PSEI’ invites applications from qualified individuals experienced in designing and formatting of technical research studies as working papers for bilateral / multilateral agencies, in particular, UN for the assignment, ‘Copyediting and Proofreading of three (3) research papers’

Date of publication

11 July 2023

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