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Using photo elicitation to introduce a network perspective on attachment during middle childhood
(2018)
In this article, we develop a child-centered network approach to attachment during middle childhood. Following monotropic ideas, current attachment research focuses on parental attachment figures despite the expansion of the children’s social environment during middle childhood, failing to generate a comprehensive and structured overview of all individuals who ensure the children’s feeling of safety. Relying on quantitative methods, these studies are also dominated by an adult perspective, limiting the children’s contributions. While there have been theoretical drafts of attachment networks during childhood, this article constitutes the first practical implementation. Using photo elicitation interviews and participant observations, we developed an innovative assessment strategy that allows children to exhaustively identify and characterize all their attachment figures on sociostructural and functional dimensions, thus positioning the children at the center of their comprehensive attachment networks that collectively contribute to their feeling of security. We combine qualitative and quantitative data to assess the children’s own understanding of their feeling of security and to locate the individual attachment figure on context-specific social dimensions, thus making the research setting, a clan in Cameroon, an inherent part of the methodological development. The data are translated into multidimensional network diagrams to visualize the children’s perception of their attachment environment and the emerging patterns of their selection. We present an exemplary network, supplementing it with observational data to discuss the ecological validity of our approach.
Background:
Specialised palliative home-care supports patients with life-limiting diseases in their familiar surroundings. The number of palliative care teams and patients being cared for is increasing worldwide. To assess and improve quality, it is needed to understand, how specialised palliative home-care can be provided successfully. For this purpose we examined the views of all involved stakeholders.
Aim:
To identify the issues that patients, their relatives and involved health professionals view as important in ensuring the success of specialised palliative home-care.
Design:
We used a qualitative design based on participant observations, interviews and focus groups following the principles of a Grounded Theory approach.
Setting/participants:
All specialised palliative home-care teams (n = 22) caring for adults in Hesse, Germany, participated. We conducted participant observations (n = 5), and interviewed patients (n = 14), relatives (n = 14) and health professionals working in or collaborating with specialised palliative home-care (n = 30). We also conducted focus groups (n = 4) with health professionals including a member check.
Results:
Successful specialised palliative home-care needs to treat complex symptoms, and provide comprehensive care including organisation of care, involving relatives and addressing issues of death and dying. Sense of security for patients and relatives is key to enable care at home. Care delivery preferences include a focus on the quality of relationships, respect for individuality and the facilitation of self-determination.
Conclusions:
Consideration of the identified key issues can help to ensure successful specialised palliative home-care. Knowledge of these should also be considered when researching and assessing quality of care.
Trial registration:
German Clinical Trials Register DRKS-ID: DRKS00012421; http://www.germanctr.de.