An interpretive qualitative approach insists on the plural and negotiated nature of the meanings that humans attach to their social realities. Thus, the qualitative researcher must navigate multiple and sometimes conflicting commitments to method, data, oneself, participants, and one’s reader. This can lead us to obscure the messiness of data analysis in final research reports and to downplay how methodological choices can make our participants ‘say things.’ In this article, we compare two interpretive methods, thematic and narrative analysis, including their shared epistemological and ontological premises, and offer a pedagogical demonstration of their application to the same data excerpt. However, our broader goal is to use the divergent results to critically examine how our choice of analytic method in interpretive research influences how we (researcher + method) ‘author’ data stories. Ultimately, researcher reflexivity must go beyond acknowledging how one’s position may influence the data analysis or the participant.

Background: Physicians must have an understanding of patients' medication beliefs in order to enhance medication adherence. To increase understanding, this study examined how beliefs about medication and four osteoporosis treatments influenced treatment selection and adherence. Methods: Six focus groups, three with 28 African Americans and one with 11 non-Hispanic white women, were conducted in English. Two groups with 16 Hispanics were conducted in Spanish. The convenience sample was recruited from senior centers and housing in lower socioeconomic geographic areas. The average age was 74.8 ± 1.1 years. Results: Adherence was associated with recognition of the serious consequences of nonadherence, realization of the beneficial effects, and the belief that medicines are not harmful. Doubts about physicians' competence to prescribe appropriate drugs were also revealed. Women who thought they were unlikely to fracture or perceived fracture outcomes as not severe chose no treatment. If they identified a need, they weighed benefits against the attendant risks to find the best alternative among the affordable options. Price considerations eliminated raloxifene and alendronate. Consideration of side effects eliminated estrogen and raloxifene. Calcium was viewed as a low-cost, low-risk alternative. Those who could afford alendronate and who viewed its side effects as preventable preferred it. Benefit and risk assessments may have been biased by fear of cancer and thromboembolic events. Conclusions: Women's beliefs about necessity of treatment, medication safety, cost of treatment, and treatment goals appear critical to osteoporosis treatment selection and adherence.

The purpose of this study was to prospectively evaluate the impact of smoking cessation on hormonal concentrations, sex hormone-binding globulin (SHBG) and markers of bone turnover in postmenopausal women. Sixty-six women who were either users or non-users of estrogen replacement therapy (ERT) were randomly assigned, using a weighted randomization scheme, to smoking cessation (SC) or to smoking cessation after 6 weeks of monitoring (wait-list control group, WLC). We measured hormones [estrone, estradiol, testosterone, parathyroid hormone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS) and androstenedione] and SHBG, markers of bone turnover [procollagen peptide (PINP), bone alkaline phosphatase (BAP), and osteocalcin (OC), N - and C -terminal collagen cross-links (NTx and CTx)], and cotinine, at baseline and again at 6 weeks in women who reported smoking cessation and in women randomized to the WLC group. Analyses included 20 subjects who quit or significantly reduced their smoking and 18 subjects in the WLC group. After controlling for differences in age and ERT use between groups, we found a significant change in SHBG in the SC vs. the WLC group (−8% vs. +5%, respectively; p = 0.01), and in DHEA (-18% vs. −5%, respectively; p = 0.04), but not in other hormonal concentrations. We also noted a significant change in NTx in the SC vs. WLC group (−5% vs. +56%, respectively, p = 0.01), but not in other markers of bone turnover. Percentage changes in SHBG and NTx were correlated with changes in plasma cotinine (r = 0.48; p = 0.004 and r = 0.36; p = 0.04, respectively). Six weeks of smoking abstinence produces reductions in SHBG and NTx. This may partly explain how smoking contributes to osteoporosis in postmenopausal women.

The Reconceptualized Uncertainty in Illness Theory (RUIT) was used to investigate antecedents to, appraisals of, and ways of coping with stressful caregiving. Four focus groups with caregivers (8 males and 16 females) of relatives with dementia were conducted; 15 cared for their parents and the remainder cared for their spouses. They were recruited from an adult care center and other community settings in a metropolitan area in New England. The discussions were audiotaped and transcribed verbatim. Two researchers independently coded the transcripts. Thematic analysis was structured according to the RUIT. The study is unique in its application to caregivers as opposed to patients and to all of the elements of the RUIT. Caregivers experience uncertainty in similar ways to patients with life-altering illness. Symptom severity—lack of personal boundaries, repetitive and aggressive behaviors, and the need for constant care—was the most frequent source of stress. The appraisals were mostly negative and included feelings of resentment, a lack of support from family members, financial strains, and loss of freedom. Self-improvement and self-care were important aspects of coping. Spirituality and humor were other coping skills that respondents used. Not all respondents said they were coping and some also reported that support from health care providers was not always helpful. Nurses can help improve coping by explaining the factors that contribute to caregiver strain and uncertainty, and by assisting caregivers to anticipate the effects of the caregiving role.

Objectives: The study examined whether ethnicity or socioeconomic status influenced a group’s ability to meet eligibility criteria and willingness to enroll. Method: The eligibility and enrollment status of 904 women aged 65 years and older who responded to recruitment efforts of an estrogen and osteoporosis clinical trial were analyzed. Results: Among women screened, 59% were White, 27% African Americans, and 14% Hispanics; average age was 75 years; 57.6% were eligible, of which 32% enrolled. High-income area residents were more likely to be eligible than lowincome residents. African Americans were less likely to be eligible for medical reasons than non-African Americans. Eligible Hispanics were more likely to be enrolled than non-Hispanics. African Americans were equally willing to enroll as Whites. Minority residents of low-income areas were more likely to enroll than minority residents of high-income areas. Discussion: Recruitment efforts should address barriers to eligibility and barriers to willingness to enroll.

The Alzheimer’s Service Coordination Program (ASCP) was developed based on the rationale that family caregivers of people with dementia could benefit in measurable ways from a care partnership arrangement linking primary care physicians with a community organization that specializes in dementia education and support. In metropolitan Cleveland, Ohio, USA, 29 physicians referred 62 family caregivers to a Service Coordinator (SC), who provided individualized consultation to family caregivers and capable patients with dementia regarding all non-medical aspects of dementia care and available resources in the community. Over a six-month intervention period, 44 caregivers with complete follow-up data reported statistically significant increases in self-efficacy for managing dementia symptoms, and self-efficacy for using community support services. Caregivers and participating physicians reported satisfaction with the ASCP. Despite relatively small numbers of participants, the service coordination and individualized consultation model featured in the ASCP has been adapted for two larger randomized trials in the USA.