Qualitative research in Medical Respite Care

Joanne Johnson
Joanne Johnson

Hey there! I’m Joanne, an MPH student in the Global Health concentration. Born and raised in Minneapolis, I completed a BA in biology & geography in 2016 and worked in healthcare information technology (IT) as a project manager for 5 years before moving to North Carolina to attend the Gillings School of Public Health. For my summer practicum, I am working on a pilot research study with Dr. Tim Daaleman at UNC Family Medicine, and in collaboration with the national Respite Care Providers Network, that aims to investigate Medical Respite Care (MRP) for persons experiencing homelessness (PEH).

Medical respite refers to short term residential acute or post-acute care for PEH who are not ill enough to be hospitalized, but also cannot support themselves on their own. It occurs in nursing homes, homeless shelters, transitional housing, and freestanding facilities. Although there are approximately 120 MRP facilities in 25 different states, there is little research or existing guidelines about how to effectively measure MRP quality and PEH care experiences. Our team aims to develop a protocol and collect mixed methods data to investigate the relationship between MRP characteristics and care experience outcomes. Specifically, I am conducting individual interviews and surveys with MRP staff, providers, and patients, and writing a protocol paper, documenting our process for data collection and analysis.

A doctor examines a patient at Center for Respite Care in Cincinnati, Ohio, one of the pilot study research sites. (Source: Center for Respite Care)
A doctor examines a patient at Center for Respite Care in Cincinnati, Ohio, one of the pilot study research sites. (Source: Center for Respite Care)

I am excited about this opportunity, because I have little qualitative research experience, and none in my area of professional interest – working with marginalized populations. Also, I will be working on an interdisciplinary team of public health professionals and providers that will provide guidance, mentorship, and feedback throughout the process. Altogether, this practicum allows me to delve into the complicated world of healthcare access and quality for PEH, an underserved and ignored population that I would like to continue to work with throughout my public health career.

-Joanne

Starting anew

New Look!

New site. New look. New bloggers. We needed a change and wanted to start of the summer with a new site and look! Every year we have our Master of Public Health (MPH) students blog about their practicum experience. The practicum is a planned, mentored, and evaluated work experience (paid or unpaid) that enables students to integrate and apply their Gillings MPH training in a professional public health setting, locally or globally. This year we have a record 38 students blogging this summer! We are happy that some of our students will be based internationally, while others will be based locally.

We have a diverse group of bloggers from the MPH concentrations of:

  • Applied Epidemiology
  • Global Health
  • Health Behavior
  • Leadership in Practice
  • Maternal, Child, and Family Health
  • Nutrition and
  • Population Health for Clinicians

We hope you enjoy reading about our students summer experiences!

Staying Connected

Melissa in a field of sunflowers at the NC Museum of Art.

Enjoying the colorful sunflowers, cosmos and zinnas at the NC Museum of Art.

As I was driving a familiar route on I-40, admiring the lit up American Tobacco Trail bridge against the various hues in a beautiful Carolina sunset.  I wondered, “What does a sunset over Lusaka, Zambia look like?” if I were there for my practicum.  I have only heard of my colleagues and friends’ experiences as they lived and traveled there.  I understood it to be a place that drew someone I admired and respected back so many times that when we ordered her retirement party cake, it had the colors of the Zambian flag on it.  I searched for images online, and as I scanned the landscapes, buildings, and people in photographs, in that moment, I wished that I could be there experiencing a universal, cyclic sunset that is familiar yet different everywhere you experience it. When I applied for this practicum, I knew that it would be understandably remote as we are still in a pandemic, but I still wished I could travel and meet with my colleagues in person.  The past year has been a roller coaster ride of emotions through the challenges and opportunities while being remote pursuing an MPH with a concentration in Nutrition at the UNC Gillings School of Global Public Health and working full-time as a project coordinator also at UNC.

Prior to becoming an MPH candidate and returning to work in global health, I earned my culinary arts degree in New York City and worked as a line cook and sales account manager. I also have bachelor’s degrees in Anthropology and East Asian Studies from the University of Virginia.  My partner and I moved to Chapel Hill, North Carolina so I could be an assistant cheesemaker and cheesemonger.  It has been a long journey leaning on my support system of family, friends and mentors to get where I am today able to pursue my passion and studies in global health nutrition.

For my UNC Gillings Zambia Hub practicum, I am part of a qualitative research study funded by the UNC Center for AIDS Research (CFAR).  The study examines the feasibility and acceptability of engaging male partners, grandmothers, and other family members to support HIV-positive mothers in Lusaka, Zambia, to practice recommended infant care and feeding practice and adhere to antiretroviral therapy. The data collectors are trained in Trials of Improved Practices (TIPs), which is a formative research technique, and they counsel women and their families.  Data are collected during a series of three interviews with HIV-positive women, and two interviews with the women’s male partners or family members. TIPs is a consultative methodology that focuses on understanding what is adaptable and feasible for HIV-positive mothers and their partners and families to improve infant feeding and care, bridge the gaps between knowledge, and put improved health for mothers and infants into practice.  I am particularly interested in learning from the Zambia-based team and my preceptor about conducting interviews and using TIPs as a research method and technique to give participants a voice in program planning.  It is vitally important to understand the context and practice cultural humility with stakeholders, which assists with sustainability.  I also like how the participants try out the agreed upon practice and I am eager to learn more about the support system of these women and its impact on their and their infants’ nutrition and prevention of mother-to-child transmission of HIV. During my practicum experience so far, I am learning how to use Ona, an online platform using Open Data Kit (ODK) to collect data and summarize participant characteristics and responses. I have also given feedback on the interview guides and written transcripts.  I look forward to working with the team to create a codebook and code transcripts in Atlas.ti. and synthesizing what we will learn. I also continue to learn from the team on how to conduct qualitative research effectively in interviews and be faithful in translations while maintaining the dignity and privacy of the participants.

My summer days have been flying by as I started a new job within UNC Carolina Population Center (CPC) at the end of May and continued to work full-time in addition to my practicum.  I meet virtually with my preceptor, Dr. Stephanie Martin, and a fellow student every week, and with the Zambia-based team frequently, which keeps me connected and moving forward. I am appreciative and grateful for the team that I work with for their flexibility and understanding. The silver lining that I have found in a remote practicum and hybrid work schedule is I am able to do both. Similarly, to what others have said in this blog space, I reflect upon my current situation daily and strive to change my mindset/perspective by practicing gratitude one day at a time.  I recently watched Chef’s Table: BBQ featuring the James Beard Award winner, Rodney Scott on Netflix.  He said, “Every day is a good day. It doesn’t always go as smooth as we want, but life is what you make it.” “My glass is going to be half full each time.” “What did I do yesterday that I can improve on today?” These words and his approach resonated with me to apply this to life and my practicum experience of doing qualitative research in a pandemic. All research activities in Zambia involving direct contact with participants were temporarily suspended for over a month due to the increase in COVID cases and only recently resumed on August 4.  We have what we planned in the theoretical sense, and then we had to face real-life implementation.  The safety and well-being of those in Zambia were most important. I learned more about communication and how to move forward even during these most challenging times.  Due to the delay in completing data collection and changing timelines in project implementation, my practicum was slightly extended, and I will continue to work with Dr. Martin and the team through an independent study this fall.

Beekeeping boxes.
Backyard beekeeping
Picture of a bunch of different vegetables picked from the garden.
Proud of the harvest from our garden.

In addition to a busy work and school schedule, I am finding respite by taking care of our four beehives and mini homestead garden with my partner, Michael.  I am also spending time with my co-worker and cat daughter, Honey. She reminds me to get up and move away from my computer to pay attention to her and what is going on outside.

Brown, tan, white and grey cat sitting on a chair.
Honey, our amazing and wonderful cat

Melissa