This issue spotlights vulnerable populations but it is the qualitative research that shines brightest. The lived experience for patients and healthcare professionals must be explored in a way that numbers and an algorithm can’t reach alone. Qualitative research in the BJGP should be accessible and relevant to primary care practice and policy. Yet, that’s no licence for superficiality and we want to support those papers that have deeper theoretical foundations and go further with engagement. Four papers in this issue showcase the richness of these explorations utilising varied qualitative approaches.
Butler et al undertook an interpretative phenomenological analysis of the lived experience of GPs in the most deprived practices in Northern Ireland.1 Some of the findings relate to the ‘Troubles’ and general practice in the context of a post-conflict society. The authors discuss this intergenerational legacy and the motivations of the GPs working in these Deep End practices: ‘I trained for this very reason. These are the patients that need us most. And I wouldn’t want to work anywhere else.’
The Deep End project started in 2009 in Glasgow and is now an international movement that recognises the unique challenges of working in some of the most socioeconomically deprived communities. Another study based in Glasgow used an ethnographically informed case study approach to look at multimorbidity.2 It reinforces the importance of patient-centred care in the context of people who have a shared community experience of stigma.
Two studies explored concerns in people from ethnic minorities. Smyth et al is a good example, digging into long COVID and the experience of ethnic minorities.3 They used thematic analysis, a relatively common approach, but the execution is impressive. Epistemic injustice casts a long shadow and this study is an exemplar of engagement with strong involvement with patient and expert advisory groups plus online public stakeholder workshops with 150 people.
Farhana Islam et al used a critical realist approach to explore the experience of digital primary care for minoritised ethnic communities in the UK.4 The headline may not be surprising: ‘There is a need for more anti-racist, culturally competent, and user-friendly access avenues to ensure the effective delivery of “digital first’ primary care services”. The authors have coined the term ‘digital precarity’ that captures how ethnicity, poverty, age, migration status, and, at times, gender influences access to digital health care.
| Few populations are as vulnerable as the homeless person and a refugee fleeing torture. We’ve Editorials on both and we go deep with an Analysis of the potential models for providing health care to people experiencing homelessness. Another Editorial considers how we address long-term care in the community post-stroke. Further research addresses how we can help young people who self-harm; a prognostic model to improve prediction of psychosis; and reviews the qualitative literature on lived experiences of end-of-life care at home. There’s also a Clinical Practice article on muscle weakness in long COVID. |
So, there it is: phenomenology, critical realism, thematic analysis, and ethnography nestling next to quantitative studies. Lord Darzi may have suggested a ‘tilt towards technology’ in his Independent Investigation of the National Health Service in England but patient empowerment and staff re-engagement were also cited.5 We will continue to support qualitative studies — we need the full epistemological range of research to move forward and build better fairer services.
- © British Journal of General Practice 2024
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