Annals of family medicine
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Annals of family medicine · Nov 2021
Case Study With a Participatory Approach: Rethinking Pragmatics of Stakeholder Engagement for Implementation Research.
The case study design is particularly useful for implementation analysis of complex health care innovations in primary care that can be influenced by the context of dynamic environments. Case studies may be combined with participatory approaches where academics conduct joint research with nonacademic stakeholders, to foster translation of findings results into practice. The aim of this article is to clarify epistemological and methodological considerations of case studies with a participatory approach. ⋯ We then compare the epistemological posture of 3 prominent case study methodologists, Yin, Stake, and Merriam, to present the epistemological posture of case studies with a participatory approach. The relevance, applications, and procedures of a case study with a participatory approach methodology are illustrated through a concrete example of a primary care research program (PriCARE). We propose 12 steps for designing and conducting a case study with a participatory approach that may help guide researchers in the implementation analysis of complex health care innovations in primary care.
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At age 11, my child Neo told me he was a boy and not a girl, as assigned at birth. Despite my training as a child and adolescent psychiatrist, I struggled to accept his declaration and had to learn how to best support him. ⋯ Although I initially felt a sense of loss and hurt about Neo being transgender, these feelings changed to acceptance and pride as I watched Neo change and grow. Neo taught me to challenge societal dichotomies and taught me about how physicians in particular can support families with gender-creative children.
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Continuity of care has long held a hallowed place in the halls of family medicine. Indeed, it is one of the 4 pillars of an ideal family practice, along with first contact, comprehensive, and coordinated care. But what does it mean to the patient, the doctor, and our sense of identity and purpose? And why, in recent years, has it receded from the discourse of family medicine values? This author suggests that continuity is an expression of the value we place on human relationships, a contract of sorts with the people we care for both inside and outside the office. Such relationships are not lightly discarded, for they serve us best in the long haul when our own sense of identity and purpose is tested and worn.