Method

Aim

This study aims to understand polio survivors’ childhood experiences of corrective surgery and rehabilitation in post-war Finland during the 1950s and 1960s. These experiences were situated in hospitals, children’s hospitals, and specialist rehabilitation centers. The treatment encompassed diverse rehabilitative interventions, including practicing the movement of paralyzed limbs, relearning to walk, and other physical exercises aimed at restoring functional capacity, as well as corrective surgical procedures, such as tendon transfers, joint fusions, and epiphysiodesis performed to halt asymmetric bone growth. This article does not address self-directed rehabilitation conducted at home.

A Descriptive Oral History

Oral history research was conducted using a descriptive qualitative approach (Doyle et al., 2020), which guided data collection and the systematic progression of the analysis, while an interpretative oral history framework and a constructivist approach (Abrams, 2010) directed the interpretation of the data and the understanding of the constructivist nature of memory. The two approaches thus complemented one another across a process spanning from data collection to interpretation. As Nelson (2002) argued, nursing history should not be treated merely as one qualitative method among others, but pursued rigorously as a discipline requiring both nursing and historical expertise.

Oral history is an interactive process in which meaning is co-constructed between the researcher and narrator through dialogue (Abrams, 2010). Its key strength is giving voice to groups outside conventional historiography, with the aim of accessing individual experiences rather than producing a definitive history (Shopes, 2011; Thompson, 2000). Recollections are shaped by the intersubjective dynamics of the interview situation (Abrams, 2010; Thompson, 2000), and in childhood memory research, the narrating adult and the child re-emerging through recollection are always present simultaneously (Fass, 2010). Participants are understood as active co-constructors of their narratives rather than passive sources of information (Abrams, 2010; De Wilde et al., 2020).

The experiences revealed in this study must be contextualized within post-war Finland. The development of Finnish healthcare was delayed by the civil war, the economic depression of the 1930s, and the Second World War (Mattila, 2011). In the early 1960s, the ratio of physicians to population was one per 1,700 inhabitants nationally; in rural areas, this was as low as one per nearly 9,000 residents (Keskimäki, 2022). Polio patients were treated in infectious disease units or central hospitals, with rehabilitative and surgical care available exclusively in Helsinki (Muiluvuori, 2010), meaning that geographical location was a significant determinant of the care experience. Nurses practiced within the prevailing behaviorist philosophy of pediatric nursing of the time (Jolley & Shields, 2009).

Data Collection and Participants

A combination of semi-structured and dialogical interview methods was employed (Abrams, 2010; Shopes, 2011). The semi-structured interview topics included background information about the participants and their families, their childhood and family life before falling ill, the onset of their illness, the hospital care during the acute phase, their corrective surgeries, the rehabilitation phase, their return home, the impact of illness on their family, and the support of their family. The dialogical interview method invited the participants to bring meaningful objects related to past events, including photographs, diaries, newspapers, magazines, and other memorabilia. During each interview, the researcher and the participant reviewed the objects together, facilitating the recall of past experiences and the activation of sensory memory (Denzin, 2001; Kvale, 2006; Tanggaard, 2009).

The interviews were conducted in Finnish by the researcher (MEK) between September 29, 2018 and June 30, 2019. Forty participants were interviewed, while one participant wrote about their experiences to researcher. The participants (N = 41) were Finnish polio survivors who had undergone corrective surgery and/or demanding inpatient rehabilitation during childhood. The participants included 13 men and 28 women born between 1940 and 1963, with a mean age of 76.4 years at the time of the interviews. The majority were born during the late 1940s and early 1950s, reflecting the peak years of the polio epidemic in Finland. Of the participants, 33 had undergone surgical treatments, while the remaining eight had experienced demanding inpatient rehabilitation periods without surgery. The interviews, conducted in participants’ homes, were audio-recorded and transcribed verbatim. The duration ranged from 35 to 278 minutes, with a mean duration of 89.2 minutes.

The Finnish Polio Association assisted with participant recruitment. The researcher contacted prospective participants by telephone, explained the research’s nature and themes, and provided both oral and written information. The participants were permitted to have a relative or next of kin present during the interview. All the interviews concluded with a discussion of the participants’ present lives and positive life events. The researcher monitored each participant’s emotional wellbeing throughout the interview and, if necessary, was prepared to refer them to a healthcare provider. No participant experienced distress during the interview or wished to withdraw. Each participant was given the opportunity to freely share their experiences, as an expression of mutual trust and empathy is central to oral history research (Strandén, 2009).

Data Analysis

The data were analyzed using reflexive thematic analysis (Braun & Clarke, 2006; Braun et al., 2022). The analysis followed the six phases described by Braun and Clarke (2006): familiarization with the data; coding and development of preliminary themes; reviewing and further refining the themes; defining and clarifying the themes; naming the themes; and writing the research report. The analysis began with the verbatim transcription of the interview recordings, after which the data were read repeatedly to develop a comprehensive understanding of the material. In the initial phase, the analysis focused on identifying semantic, surface-level content. As familiarity with the data deepened through repeated reading, the analysis progressed toward the identification of latent codes and meanings beyond the explicit content. This transition into the reflexive phase enabled the researcher to place their own role and experiences in active dialogue with the research material, and themes were understood as interpretive accounts shaped by the researcher’s subjectivity and by a situated reading of the data (Braun et al., 2022). Through the reflexive interpretation of both the semantic and latent codes in dialogue with the data, the overarching theme, the main themes and subthemes were constructed (Braun & Clarke, 2006; Braun et al., 2022). All phases of the analysis were conducted by the researcher (MEK).

Ethical Considerations

A commitment to informed consent, intellectual honesty, and confidentiality was maintained throughout all stages of the research process (De Wilde et al., 2020; Lusk, 1997). The study followed the guidelines issued by the Finnish National Board on Research Integrity (2023). A preliminary ethical evaluation was requested from the Tampere Area Ethics Committee for Humanities, maintained by Tampere University, in 2018 (Request for opinion 18/2018; opinion 31/2018), and the committee’s opinion was favorable. The relevant research permits were obtained prior to data collection. All the participants received both written and verbal information about the research, and written informed consent was obtained before the interviews. All the participants were assigned codes; no names appear in the recordings or transcripts, and the data were stored in a secure, data-protected environment. The participants’ childhoods, illnesses, and treatment histories were explored. Prior knowledge of the population indicated that discussing these experiences carried the risk of provoking vulnerability and psychological distress (Halbmayr, 2009). The researcher continuously monitored participants’ emotional states, offering breaks and the option to bypass questions. No participant became unwell or wished to interrupt the interview.