Exploring Transitions

With the possible exception of the onset of insidious or silent diseases, attaining health or experiencing illness is a time of change—often dramatic change within the individual. It is a time when individuals may lose connections with their bodies, so they do not feel familiar with themselves, no longer trust their own senses, and often struggle with normal, daily functions. This change is often sudden, unexpected, and arrives with startling force and with baffling consequences. These changes may be temporary and short lived, they may last a lifetime, or, they may result in death. Grounded theorists refer to these changes as transitions within a trajectory, and such changes and the person’s or family’s responses to those changes form the bulk of Qualitative Health Research publications. Transitions may be easy to identify, or occur so slowly that they remain elusive and difficult to document; they may be overt and easy to describe, or so deeply meaningful that the person has difficulty articulating the significance of the changes. In quantitative research, the concept of change centers on time. Documentation of that change over time is the basis of experimental designs of various kinds, the documentation (and explanation) of trends, and so forth. Of greater interest, as you read these articles, the change is based on the changing states within the individuals or groups, and time itself is backgrounded. Of course some qualitative research methods deal with transitions better than others. Grounded theory is the method that was developed for the documentation of change, of actions inherent in the change, or the processes involved in the transition. It is intended to be used for the explication of conditions, strategies, causes, and consequences, with its purpose of helping us understand human responses. Grounded theory provides us, as clinicians, with the theoretical knowledge necessary for us to provide care at this difficult time. But of greater importance, in this issue grounded theory methods do not appear. Rather, the authors used a variety of interpretative and descriptive methods—ethnography (including autoethnography), participant observation, content analysis, phenomenology, and lifeworld research. Which (or what) transitions have been explored in this issue? Four articles focus on changes within the individual: Kelly describes the embodied impact of prostate cancer; and from Israel, Band-Winterstein and her co-authors explore intimate violence across the lifespan. In a pleasant change from a failure-to-cope focus, Kirkpatrick Pinson et al. describe women coping successfully with multiple sclerosis; and, from Canada, Kurtz Landy et al. describe the experiences of socially disadvantaged postpartum women in the first four weeks of mothering. Two more articles are of interest to women’s health: from Germany, Kolip et al. report on postmenopausal women’s attitudes toward long-term hormonal therapy, and from Indiana, Lende and Lachiondo describe embodiment and breast cancer among African American women. The impact of a changing environment is explored in two studies: a quality improvement evaluation by a team of researchers across the nation explores the best method to achieve quality care in an institution, and the trial of a conceptual framework that will enable life history exploration is described by Brown, a researcher from Pennsylvania. An autoethnography describing loss following an ectopic pregnancy comes from Colorado, and researchers from Sweden describe the encounters between informal and professional care. Finally, an article in the Pearls, Pith, and Provocation section completes the issue, with researchers from Israel discussing power relations in qualitative inquiry. Thus, in this issue, we have transitions described externally and environmentally, we have the most meaningful changes described intimately, and various group and individual perspectives between. I hope this issue makes us as clinicians and researchers wiser, and adds to the growing body of useful qualitative research. Janice M. Morse Editor