Answers:
 1. Background Of The Study
A) Briefly Describe The Issue On Which The Study Is Focused.

The study conducted by Lidén, Björk-Brämberg & Svensson, (2015) is focused on the issue of medically unexplained symptoms (MUS) that affects the primary care patients and their daily life. It also encompasses the perceptions of the patients living with MUS. The issue related to MUS is that it is largely viewed as a medical perspective with a failure of diagnosis and fails to address the capability and potential of a person to live with MUS and ways to manage life. These issues are addressed in the research study.

 B) What Is The Significance Of The Study?

The significance of this study is that it helps to describe the experiences of the patients living with MUS in primary health care settings. It elucidates the patients’ perceptions who are suffering from MUS and their way of living with the condition. The study is also significant as MUS is a very serious condition affecting a majority of people left with unexplained reasons for their health problems. This study is significant as it focuses on the resources and possibilities for the physical and mental well-being of the patients suffering from MUS.

 Overview Of Research Design
 2. A) What Was The Aim Of The Research?

The aim of the research was to describe and interpret the MUS patients’ experiences to live with their condition in primary health care settings. The study is focused on the way MUS patients learn to live with the condition despite of the chaotic life and unpredictable future in which they are intended to live. This study is also aimed at addressing what they learn from their experiences while living with MUS. It also illustrated the way people try to cope up with the symptoms and try to manage and live with the MUS condition.

 B) What Research Design Was Used?

The research design used for this study is the phenomenological-hermeneutic method. In this method, the themes like textual, interpretation, dialogue, meaning and pre-understanding and tradition are involved. It is a qualitative research method where the authors were intended to describe the experiences of the patients living with MUS as phenomena which appear in their daily life before they have been interpreted and explained and made attempts despite of the fact that they are tentative and never complete. Kornelsen et al., (2016) also employed this method that helped to know the perspectives and consequences of the people suffering from MUS.

  C) Was It Appropriate? Why/Why Not?

 This method is appropriate as it was helpful in covering the wide range of experiences of the patients living with MUS. It is highly fast and economical and is helpful in understanding the meaning of living with MUS in a primary health care setting as it involves phenomenology. This method is flexible and adjusting with the new emerging issues and ideas related to the MUS patients in their daily life. The method is natural and is relevant to fulfil the aims of the research study. This method is useful as it has provided better understanding of the peoples’ perceptions of their way of living with the condition as it involves a philosophical movement which fulfils the criteria of the aim of the research.

 3. Sampling
  A) Who Were The Study Participants?

 The study participants were of the age 24-61 years old who were suffering from MUS. The study participants were patients from the two suburban primary healthcare centres in Sweden. The majority of patients were from immigrant background.

 B) What Are The Inclusion And Exclusion Criteria Of The Sample?

The minimal and extensive data collection has been adopted for the sampling in the research study. In the inclusion criteria, patients were telephoned of the age 18-65 that at least had eight visits with a physician or nurse at the primary healthcare centres in Sweden during the previous twelve months. These patients did not have any specific psychiatric or organic cause for the frequent visit to the centres and consisted of 50% of the patients who reported medically unexplained symptoms.

There was identification of the potential participants through screening of the incoming telephone calls from the patients to the healthcare centres. After screening, patients were contacted through telephone and around 20 patients were screened and they agreed to participate in the research. However, many participants were recruited through extensive data collection method from the period September to November 2011. From the extensive data collection, 1379 participants were selected. Out of which, 1328 were excluded and 51 were eligible. At the same time, 87 participants were included and 923 were excluded in the minimal data collection for assessing the eligibility out of 1010 participants in the age 18-65 years. Finally, 10 participants were selected, out of which, seven were women and three were men of the age 24 to 61 years. Out of ten, seven were from immigrant backgrounds who agreed to participate.

 C) Why Is It Important To Have These Criteria Identified Before Recruitment?

 This inclusion and exclusion criteria is important as it helps to determine the validity and scope of the results. It helped the researchers to design the research and execute the study correctly and select the participants who fulfilled the criteria for desired outcomes. Inclusion criteria helped the researchers to include the subjects that are suitable for the study and the exclusion criteria helped to disqualify the participants from the inclusion in the research study.

 D) What Sampling Technique Was Employed In This Study?

Purposeful sampling was employed in the study where the participants were selected after pre-selected criteria of the research question.

 E) Was It Appropriate For The Research Design? Why/Why Not?

   This technique was appropriate as the participants were pre-determined based on the criteria for the research study where the data was collected from the MUS patients of the age 24-61 years.

  F) How Was The Sample Size Determined?

 The sampling size was determined by the inclusion and exclusion criteria. In this, the minimal data collection and extensive data collection were employed in which the sample size was selected. The sample size was determined based on criteria of MUS patients of 24-61 years in a primary healthcare setting.

  G) Was It Appropriate? Why/Why Not?

It was appropriate as the selected sample size fulfilled the criteria that address the aim of the research study. The inclusion and exclusion criteria helped to ensure that the data is relevant for the research study.

Data Collection
     A) How Was The Data Collected?

 In the given research study, the researchers collected the data through primary data collection method. The data was directly collected from the patients through the interviews. This ensures reliability as the data is collected directly from the participants.

 B) Was The Data Collection Method Appropriate For The Study Question And The Research Design? Why/Why Not?

 This method of primary data collection is appropriate as the data was directly taken from the selected sample that is the 10 MUS patients of the age group 24-61 years. This helped the researchers to know the perceptions of the MUS patients living with the condition collected through interviews.

C) Define The Concept Of Rigor.

Rigor in qualitative research is used to show the research tools that are employed to meet the aims and objectives of the research. The determination of truth worthiness is defined as rigor that is used to identify the questions that are considered to be of paramount importance in the research. The research philosophy is also referred as rigor that is used in the collection of data.

D) Discuss Two Measures Taken/Not Taken To Ensure Rigor.

 In the given research study, measures were taken to ensure rigor is that the data collection was done in an authentic manner. The data was collected from the participants of the determined age and criteria.

Data Analysis/Results
 A) Identify And Describe The Method Of Data Analysis

 Data analysis was carried out via three steps: naive reading, structural analysis and comprehensive understanding. The narrative interviews provided by the patients were first read for a number of times to grasp the text that is called naive understanding. Then, in the next step, structural analysis was done where the validation of the text was done by interpretation of the naive understanding. Finally, the text was divided into meaning units and categorized into themes and subthemes.

B) Was It Appropriate? Why/Why Not?

 It was not an appropriate method for the research that helped to analyse the narrative interview of the patients and in understanding the perceptions while living with MUS condition. However, in a study conducted by Aamland, Werner & Malterud, (2013) the data analysis was done by systematic text condensation. This data analysis method is more appropriate as the study involved the phenomenological framework that includes total impression, identification of meaning units and condensation of codes to draw meanings.

 C) What Were The Findings?

 The findings of the research were divided into themes and subthemes based on the narratives. The naive understanding showed that patients live due to shattered opportunities for normal life.  Patients living with MUS face struggle in interpreting their symptoms and in managing their daily lives. The themes are the feeling of the patients that the symptoms overwhelm their life and they accept it to gain insight of the condition and move on to live with the disease. The subthemes are they are restricted and greatly dependent on their daily life. They also lose the sense of self due to the condition of MUS condition. As they have MUS, they keep searching for explanations. In the process of searching explanations for their symptoms, they learn to take care of themselves. Most importantly, they learn to accept their condition and become mindful in moving on with their life.

D) Can The Study Findings Be Used In Other Settings? Why/Why Not?

These findings can be utilised in other settings in the development of psychological interventions that might be delivered by the healthcare professionals in providing patient centred care.

Evidence Utilization
 A) Would You Recommend The Findings Of This Study Be Implemented In Clinical Practice? Why/Why Not?

 The findings of this study can be implemented in clinical practice. The perceptions of the patients living with MUS is would initiate to develop patient centred care that addresses the needs of the MUS patients. The chaos and frustrations that are created due to the unexplained medical diagnosis becomes an obstacle in providing the patient centred care and in understanding the perceptions of the patients living with MUS. In a study conducted by Aiarzaguena et al., (2013) the perceptions of the patients living with MUS have significance as the interpretation would help to develop psychological interventions to meet the psychological needs of the patients with MUS. These findings are also helpful in promoting healthcare methods like mindfulness in a primary healthcare setting. When the perceptions of the patients are known, it is helpful in understanding the patients and in providing them the plan of care.

References

Aamland, A., Werner, E. L., & Malterud, K. (2013). Sickness absence, marginality, and medically unexplained physical symptoms: a focus-group study of patients’ experiences. Scandinavian journal of primary health care, 31(2), 95-100.

Aiarzaguena, J. M., Gaminde, I., Clemente, I., & Garrido, E. (2013). Explaining medically unexplained symptoms: somatizing patients’ responses in primary care. Patient education and counseling, 93(1), 63-72.

Kornelsen, J., Atkins, C., Brownell, K., & Woollard, R. (2016). The meaning of patient experiences of medically unexplained physical symptoms. Qualitative health research, 26(3), 367-376.

Lidén, E., Björk-Brämberg, E., & Svensson, S. (2015). The meaning of learning to live with medically unexplained symptoms as narrated by patients in primary care: A phenomenological-hermeneutic study. International journal of qualitative studies on health and well-being, 10.