Kazemi Najm Milad, Imanifar Nasrin
Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran.
Instructor and Faculty Member of the Department of Nursing, Khor.C. Islamic Azad University, Khorramabad, Iran.
Int J Qual Stud Health Well-being. 2025 Dec;20(1):2522442. doi: 10.1080/17482631.2025.2522442. Epub 2025 Jun 27.
This letter critically evaluates the methodology of Eva Hjort Telhede's qualitative study exploring insomnia experiences among nursing homes. While the study contributes valuable insights into subjective sleep challenges, its methodological rigour warrants scrutiny to inform future research.
The study employed a qualitative descriptive design with semi-structured interviews ( = 19 participants) and inductive content analysis. Data collection occurred in nine Swedish nursing homes, with purposive sampling based on insomnia criteria (ICD-10) and cognitive competence (S-MMSE ≥20). Analysis followed Graneheim and Lundman's qualitative content analysis framework.
Key methodological strengths included purposive sampling, data saturation, and reflexive practices. Limitations identified were single-researcher bias, lack of intercoder reliability checks, gender imbalance (4 men, 15 women), and exclusion of variables such as cognitive diagnoses and medication use. Environmental factors (e.g. noise and lighting) were self-reported without objective validation, and contextual transferability was constrained by limited demographic diversity.
The reliance on a single coder and absence of triangulation may compromise the depth of thematic analysis. Recommendations include: (1) multi-researcher collaboration to enhance credibility; (2) inclusive sampling of residents with dementia; (3) mixed-methods designs integrating objective sleep measures; and (4) staff training in sleep hygiene to address institutional barriers. Strengthening methodological transparency and addressing contextual factors could improve future interventions for insomnia in nursing homes.
这封信批判性地评估了伊娃·赫约特·特尔海德关于养老院失眠经历的定性研究方法。虽然该研究为睡眠方面的主观挑战提供了有价值的见解，但其方法的严谨性仍需审视，以便为未来的研究提供参考。
该研究采用定性描述性设计，进行半结构化访谈（19名参与者）并采用归纳式内容分析。数据收集在瑞典的九家养老院进行，基于失眠标准（ICD - 10）和认知能力（简易精神状态检查表≥20）进行目的抽样。分析遵循格拉内海姆和伦德曼的定性内容分析框架。
关键的方法优势包括目的抽样、数据饱和和反思性实践。识别出的局限性有：单一研究者偏差、缺乏编码员间信度检查、性别失衡（4名男性，15名女性），以及排除了认知诊断和药物使用等变量。环境因素（如噪音和照明）是自我报告的，没有客观验证，且背景可转移性受到有限的人口统计学多样性的限制。
依赖单一编码员且缺乏三角互证法可能会影响主题分析的深度。建议包括：（1）多研究者合作以提高可信度；（2）对患有痴呆症的居民进行包容性抽样；（3）采用整合客观睡眠测量的混合方法设计；（4）对工作人员进行睡眠卫生培训以消除机构障碍。加强方法的透明度并解决背景因素问题，可能会改善未来养老院失眠症的干预措施。
