Different concepts have been presented which denote driving forces and strengths that contribute to a person's ability to meet and handle adversities, and keep or regain health. The aim of this study, which is a part of The Umea 85+ study, was to describe resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health in a sample of the oldest old. The study sample consisted of 125 participants 85 years of age or older, who ranked themselves on the Resilience Scale, Sense of Coherence Scale, Purpose in Life Scale and Self-Transcendence Scale and answered the SF-36 Health Survey questionnaire. The findings showed significant correlations between scores on the Resilience Scale, the Sense of Coherence Scale, the Purpose in Life Test, and the Self-Transcendence Scale. Significant correlations were also found between these scales and the SF-36 Mental Health Summary among women but not among men. There was no significant correlation between perceived physical and mental health. The mean values of the different scales showed that the oldest old have the same or higher scores than younger age groups. Regression analyses also revealed sex differences regarding mental health. The conclusions are that, the correlation between scores on the different scales suggests that the scales measure some dimension of inner strength and that the oldest old have this strength at least in the same extent as younger adults. Another conclusion is that the dimensions that constitute mental health differ between women and men.

Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old

BACKGROUND
Methods for reviewing and synthesising findings from quantitative research studies in health care are well established. Although there is recognition of the need for qualitative research to be brought into the evidence base, there is no consensus about how this should be done and the methods for synthesising qualitative research are at a relatively early stage of development.


OBJECTIVE
To evaluate meta-ethnography as a method for synthesising qualitative research studies in health and health care.


METHODS
Two full syntheses of qualitative research studies were conducted between April 2002 and September 2004 using meta-ethnography: (1) studies of medicine-taking and (2) studies exploring patients' experiences of living with rheumatoid arthritis. Potentially relevant studies identified in multiple literature searches conducted in July and August 2002 (electronically and by hand) were appraised using a modified version of the Critical Appraisal Skills Programme questions for understanding qualitative research. Candidate papers were excluded on grounds of lack of relevance to the aims of the synthesis or because the work failed to employ qualitative methods of data collection and analysis.


RESULTS
Thirty-eight studies were entered into the medicine-taking synthesis, one of which did not contribute to the final synthesis. The synthesis revealed a general caution about taking medicine, and that the practice of lay testing of medicines was widespread. People were found to take their medicine passively or actively or to reject it outright. Some, in particular clinical areas, were coerced into taking it. Those who actively accepted their medicine often modified the regimen prescribed by a doctor, without the doctor's knowledge. The synthesis concluded that people often do not take their medicines as prescribed because of concern about the medicines themselves. 'Resistance' emerged from the synthesis as a concept that best encapsulated the lay response to prescribed medicines. It was suggested that a policy focus should be on the problems associated with the medicines themselves and on evaluating the effectiveness of alternative treatments that some people use in preference to prescribed medicines. The synthesis of studies of lay experiences of living with rheumatoid arthritis began with 29 papers. Four could not be synthesised, leaving 25 papers (describing 22 studies) contributing to the final synthesis. Most of the papers were concerned with the everyday experience of living with rheumatoid arthritis. This synthesis did not produce significant new insights, probably because the early papers in the area were substantial and theoretically rich, and later papers were mostly confirmatory. In both topic areas, only a minority of the studies included in the syntheses were found to have referenced each other, suggesting that unnecessary replication had occurred.


LIMITATIONS
We only evaluated meta-ethnography as a method for synthesising qualitative research, but there are other methods being employed. Further research is required to investigate how different methods of qualitative synthesis influence the outcome of the synthesis.


CONCLUSIONS
Meta-ethnography is an effective method for synthesising qualitative research. The process of reciprocally translating the findings from each individual study into those from all the other studies in the synthesis, if applied rigorously, ensures that qualitative data can be combined. Following this essential process, the synthesis can then be expressed as a 'line of argument' that can be presented as text and in summary tables and diagrams or models. Meta-ethnography can produce significant new insights, but not all meta-ethnographic syntheses do so. Instead, some will identify fields in which saturation has been reached and in which no theoretical development has taken place for some time. Both outcomes are helpful in either moving research forward or avoiding wasted resources. Meta-ethnography is a highly interpretative method requiring considerable immersion in the individual studies to achieve a synthesis. It places substantial demands upon the synthesiser and requires a high degree of qualitative research skill. Meta-ethnography has great potential as a method of synthesis in qualitative health technology assessment but it is still evolving and cannot, at present, be regarded as a standardised approach capable of application in a routinised way.


FUNDING
Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research.

Evaluating meta ethnography: systematic analysis and synthesis of qualitative research (poster presentation)

Background: Methods for reviewing and synthesising findings from quantitative research studies in health care are well established. Although there is recognition of the need for qualitative research to be brought into the evidence base, there is no consensus about how this should be done and the methods for synthesising qualitative research are at a relatively early stage of development.Objective: To evaluate meta-ethnography as a method for synthesising qualitative research studies in health and health care.Methods: Two full syntheses of qualitative research studies were conducted between April 2002 and September 2004 using meta-ethnography: (1) studies of medicine-taking and (2) studies exploring patients? experiences of living with rheumatoid arthritis. Potentially relevant studies identified in multiple literature searches conducted in July and August 2002 (electronically and by hand) were appraised using a modified version of the Critical Appraisal Skills Programme questions for understanding qualitative research. Candidate papers were excluded on grounds of lack of relevance to the aims of the synthesis or because the work failed to employ qualitative methods of data collection and analysis.Results: Thirty-eight studies were entered into the medicine-taking synthesis, one of which did not contribute to the final synthesis. The synthesis revealed a general caution about taking medicine, and that the practice of lay testing of medicines was widespread. People were found to take their medicine passively or actively or to reject it outright. Some, in particular clinical areas, were coerced into taking it. Those who actively accepted their medicine often modified the regimen prescribed by a doctor, without the doctor?s knowledge. The synthesis concluded that people often do not take their medicines as prescribed because of concern about the medicines themselves. ?Resistance? emerged from the synthesis as a concept that best encapsulated the lay response to prescribed medicines. It was suggested that a policy focus should be on the problems associated with the medicines themselves and on evaluating the effectiveness of alternative treatments that some people use in preference to prescribed medicines. The synthesis of studies of lay experiences of living with rheumatoid arthritis began with 29 papers. Four could not be synthesised, leaving 25 papers (describing 22 studies) contributing to the final synthesis. Most of the papers were concerned with the everyday experience of living with rheumatoid arthritis. This synthesis did not produce significant new insights, probably because the early papers in the area were substantial and theoretically rich, and later papers were mostly confirmatory. In both topic areas, only a minority of the studies included in the syntheses were found to have referenced each other, suggesting that unnecessary replication had occurred.Limitations: We only evaluated meta-ethnography as a method for synthesising qualitative research, but there are other methods being employed. Further research is required to investigate how different methods of qualitative synthesis influence the outcome of the synthesis.Conclusions: Meta-ethnography is an effective method for synthesising qualitative research. The process of reciprocally translating the findings from each individual study into those from all the other studies in the synthesis, if applied rigorously, ensures that qualitative data can be combined. Following this essential process, the synthesis can then be expressed as a ?line of argument? that can be presented as text and in summary tables and diagrams or models. Meta-ethnography can produce significant new insights, but not all meta-ethnographic syntheses do so. Instead, some will identify fields in which saturation has been reached and in which no theoretical development has taken place for some time. Both outcomes are helpful in either moving research forward or avoiding wasted resources. Meta-ethnography is a highly interpretative method requiring considerable immersion in the individual studies to achieve a synthesis. It places substantial demands upon the synthesiser and requires a high degree of qualitative research skill. Meta-ethnography has great potential as a method of synthesis in qualitative health technology assessment but it is still evolving and cannot, at present, be regarded as a standardised approach capable of application in a routinised way.Funding: Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research.

/pdf/evaluating-meta-ethnography-systematic-analysis-and-3wwez9e6s4.pdf

Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research.

Inner strength--a theoretical analysis of salutogenic concepts.

This article addresses psychoneuroimmunology (PNI) as an integrative paradigm for advancing both theoretical and empirical knowledge of physiological patterns that contribute to the dynamics of health. We depict relationships among relevant psychobehavioral and physiological components in a PNI-based framework. We then provide examples of how this framework guided 2 clinical trials designed to assess the effectiveness of selected nursing interventions to reduce stress and enhance coping, one in persons with human immunodeficiency viral disease and the other in persons with cancer. The examples address disease-specific measures for assessing the components of the PNI-based framework.

/pdf/implementing-a-comprehensive-approach-to-the-study-of-health-23cpvz24iy.pdf

Implementing a comprehensive approach to the study of health dynamics using the psychoneuroimmunology paradigm.

Inner Strength in Women: Metasynthesis of Qualitative Findings in Theory Development

Inner Strength: A Concept Analysis

The phenomenon of inner strength has been studied in women with various chronic illnesses (Dingley, 1997; Dingley, Bush, & Roux, 2001; Koob, Roux, & Bush, 2002; Roux, Bush, & Dingley, 2001), demonstrating commonalities in the experiences that bridge the boundaries created by disease taxonomy or individual circumstance. Despite the richness of previous qualitative studies, the current state of the science reflects the interpreted reality of inner strength from the perspective of primarily middle class Caucasian women. Therefore, the purpose of this qualitative descriptive study was to explore the experience of inner strength in older Hispanic women living with chronic illness. The primary research question was: How do older Hispanic women experience inner strength as they live with chronic illness? The purposive sample consisted of women who met the criteria for the term "Hispanic", were 60 years of age or older, and had been diagnosed with a chronic illness. Data generation methods included observation and semi-structured interviews. Data analysis was based on qualitative methodology informed by grounded theory and the constant comparative method. Findings from the current study suggested the experience of inner strength in older Hispanic women involved the following interrelated dimensions: (a) Drawing Strength from the Past, (b) Focusing on Possibilities, (c) Being supported by Others, (d) Knowing One's Purpose, and (e) Nurturing the Spirit. The current study contributes to a cumulative program of research on the phenomenon of inner strength, furthering theory generation, cultural awareness, and future intervention studies.

Inner strength in older Hispanic women with chronic illness.

. The aim of this research brief is to describe the results of psychometric evaluation of a new instrument to measure inner strength in women with chronic illness. Inner strength is defined as a central human resource that promotes well-being and healing (Roux, Dingley, & Bush, 2002). The instrument can be used in clinical settings to examine women's inner strengths associated with cognitive, social, physical, and mental needs to improve health outcomes and enhance well-being. The theory of inner strength has important implications for health care providers to improve health outcomes and symptom management for women living with chronic illness. Key Words: Development, Testing, Inner Strength Questionnaire Item Development and Initial Instrument Testing The items for the Inner Strength Questionnaire (ISQ) were generated using results of qualitative studies in women with chronic illness that have been conducted over 12 years (Dingley, Roux, & Bush, 2000; Dingley, Bush, & Roux, 2001; Koob, Roux, & Bush, 2002; Roux, Bush, Dingley, 2001; Roux, Dingley, & Bush, 2002). Using results of these studies, items were generated to measure the five hypothesized dimensions of inner strength: knowing and searching, connectedness, physical self-spirit, and mental self-spirit, and the new normal. Tests of face and content validity were conducted with professional experts and clients prior to administration. Connectedeness Scale Initially, the connectedness scale of the instrument was pilot tested on a sample of 207 community members. Since this scale was the longest and had sensitive questions regarding spirituality, it was pilot tested before evaluating the entire instrument. Principal component analysis demonstrated two factors: spiritual connectedness and connectedness with self and others. Six items were deleted, with a final version of 19 items. A Cronbach's alpha for this sample was .89. The coefficient alpha for the spirituality subscale of the connectedness scale was The Inner Strength Questionnaire Following evaluation of the connectedness scale, the psychometric properties of the entire ISQ were tested on women with major chronic health conditions. The sample included 154 women aged 22-83 residing in 14 states in the Midwest and Mid-Atlantic. African American women comprised 35% of the sample. Participants reported having the following chronic health conditions: breast cancer, diabetes, heart disease, osteoporosis, and transplantation. Using principal component analysis with varimax rotation, the theoretical components of the ISQ were evaluated. Using an eigenvalue of 1.0, the factors were analyzed to minimize multicollinearity and maximize parsimony. …

Development and testing of the inner strength questionnaire.

Inner Strength in Women with Breast Cancer

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