The impact of hypodontia: a qualitative study on the experiences of patients

Congenital absence of teeth affects 2-6 per cent of the population, but its impact on quality of life (QoL) is not fully understood. The symptoms of hypodontia can vary and therefore also the treatment and management of this condition. Determining and understanding the possible impact of hypodontia on patients could inform and improve the management of such patients. A purposive sample of 10 participants aged 16-25 years (five males and five females) with mild, moderate, or severe hypodontia at various stages of treatment was recruited. The participants had previously completed a 49-item Oral Health Impact Profile (OHIP) questionnaire with summary scores ranging from 24 to 143. All subjects participated in semi-structured interviews, and these were transcribed and analysed using NVivo software. The results show that the role of hypodontia patients in the treatment decision-making process changes significantly as they move from childhood to adulthood. Participants indicated dissatisfaction with the lack of communication with dental services throughout early adolescence as they became more cognizant of their condition which in turn led to concerns with regard to appearance which impacted on their psychosocial well-being. Hypodontia patients expect improved communication with dental practitioners and services as they become more cognizant of their condition and wish to become more actively involved in the decision-making process regarding their current and future treatment.

The role of school psychologists in child protection and safeguarding

Child protection and safeguarding are important aspects of work for all professionals working with children. The current article outlines the international context of school psychologists’ work in relation to child protection and safeguarding and describes the United Kingdom context in more detail. Given the relatively recent broadening of the UK legislative focus, to include safeguarding in addition to child protection, a review of current practice is needed. A UK survey was commissioned and undertaken in order to identify the current and potential contributions of school psychologists in relation to child protection and safeguarding. This mixed methods survey included an initial focus group with school psychologists, a questionnaire survey of all school psychology services in the UK, and site visits to four selected school psychology services. The research found that school psychologists undertake a wide range of child protection and safeguarding work at universal, targeted and specialized levels. This work includes partnership with a wide variety of other professionals. Future development of school psychology’s role in child protection and safeguarding in the UK is discussed, and implications for school psychologists in other countries are considered.

Understanding managerial behaviour during initial steps of a clinical information system adoption

BACKGROUND

While the study of the information technology (IT) implementation process and its outcomes has received considerable attention, the examination of pre-adoption and pre-implementation stages of configurable IT uptake appear largely under-investigated. This paper explores managerial behaviour during the periods prior the effective implementation of a clinical information system (CIS) by two Canadian university multi-hospital centers.

METHODS

Adopting a structurationist theoretical stance and a case study research design, the processes by which CIS managers' patterns of discourse contribute to the configuration of the new technology in their respective organizational contexts were longitudinally examined over 33 months.

RESULTS

Although managers seemed to be aware of the risks and organizational impact of the adoption of a new clinical information system, their decisions and actions over the periods examined appeared rather to be driven by financial constraints and power struggles between different groups involved in the process. Furthermore, they largely emphasized technological aspects of the implementation, with organizational dimensions being put aside. In view of these results, the notion of 'rhetorical ambivalence' is proposed. Results are further discussed in relation to the significance of initial decisions and actions for the subsequent implementation phases of the technology being configured.

CONCLUSIONS

Theoretical and empirically grounded, the paper contributes to the underdeveloped body of literature on information system pre-implementation processes by revealing the crucial role played by managers during the initial phases of a CIS adoption.

Lack of awareness of kidney complications despite familiarity with diabetes: a multi-ethnic qualitative study

BACKGROUND

Comparing South Asians with White Europeans and examining the cultural context of any observed differences is a necessary step in achieving culturally competent services and in helping to reduce inequalities which exist in outcomes for South Asian patients with End Stage Renal Disease.

METHODS

Newly referred South Asian and White adult patients with diabetes were recruited from nephrology outpatient clinics in three UK centres--Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 48 patients and a thematic analysis of the data produced is reported.

RESULTS

Access to knowledge about renal complications of diabetes, was related to referral to renal services and recent monitoring and not to previous medical encounters. South Asian patients were aware of the high prevalence of diabetes within South Asian communities and a small number reported experience of kidney problems in other family members although any connection with diabetes was not made.

CONCLUSION

Ongoing renal care information should be provided to people with diabetes and the cultural context of any information exchange needs to be addressed.

Ethical decision-making in nursing homes: Influence of organizational factors

In this article we report findings from a qualitative study that explored how doctors and nurses in nursing homes describe professional collaboration around dying patients. The study also examined the consequences this can have for the life-prolonging treatment of patients and the care of them and their relatives. Nine doctors and 10 nurses from 10 Norwegian nursing homes were interviewed about their experience of decision-making processes on life-prolonging treatment and care. The findings reveal that the frameworks for the professional collaboration and organization of physicians and nurses prevent patient treatment and care complying with ethical considerations and the law. These conditions have a challenging impact on the care of dying patients and their relatives.

Family carer personal concerns in Huntington disease

AIM

To examine and compare the personal concerns of family members providing care for people with Huntington disease in the United Kingdom and the United States.

BACKGROUND

Family carers of people with Huntington disease may feel burdened by caregiving responsibilities and concerned about illness risk for relatives.

METHOD

A mailed personal concerns survey was completed by 108 United Kingdom and 119 United States adult family carers of people with Huntington disease in 2006 and 2007. Survey responses included frequency and intensity of concerns, and narrative comments. Data were analysed using descriptive statistics of the products of frequency and intensity of reaction scores to identify a personal concerns index for items with the twelve highest combined scores. Factor analysis identified three factors, which were compared between respondents by factor and items within factors using t tests mean frequency by intensity scores. Narrative comments were thematically analysed.

RESULTS

Three main factors were labelled impact of role change, sense of isolation and concerns for children. Within the role change factor, United States family caregivers had significantly higher concerns about family finances and United Kingdom carers expressed significantly greater personal sadness. Both groups expressed concern about isolation from family. Although family carers in both countries expressed concern about their children, those of United States caregivers were significantly higher.

CONCLUSION

Further studies are required to identify benefits of support services that are specific to carer concerns and consistent with national healthcare systems.

Fertility and cancer--a qualitative study of Australian cancer survivors

PURPOSE

This study aims to assess the fertility concerns among cancer survivors aged 50 and under as part of a larger study investigating the survivors' concerns regarding fertility, sexuality and parenting.

METHODS

Cancer survivors who were at least 1 month post-treatment were invited to a recorded interview. The patients were identified from an oncology database and invited to participate via letter or during clinic consultation. The participants were recruited until saturation of themes was achieved. Transcripts were coded thematically, with greater emphasis given to frequently raised themes.

RESULTS

Twenty-five survivors (19 women) were interviewed. The median age was 37 (range 24-50). Median time since completion of treatment was 7 months. Twenty were married or in a relationship; 18 had children at the time of diagnosis. Two became pregnant after treatment. Four themes were identified: (1) Fertility represents more than child-bearing capacity: potential fertility loss was a concern for participants, irrespective of their desire for future children; (2) Assumed infertility: There was a tendency for participants to assume that they were infertile; (3) Lack of information regarding decision-making and fertility: The respondents reported a perceived lack of consideration of fertility at diagnosis by medical professionals, and this impacted upon the decision-making process; and (4) Participant recommendations: The respondents wanted more information and for support services to be offered.

CONCLUSIONS

Fertility is an important concern for young cancer survivors. There is a need for strategies regarding information provision and support for cancer patients with regard to these concerns.

A qualitative investigation of the views of primary care dentists on participating in prospective studies in the North-West of England

BACKGROUND

There is a poor understanding of to how to recruit and involve primary care dentists in clinical trials.

AIM

To use a qualitative paradigm to explore the views of primary care dentists towards participating in clinical trials and develop an understanding of the factors that facilitate and prevent their involvement. DESIGN, SETTING, SUBJECTS AND METHODS: An iterative approach was undertaken using a focus group (n = 6) followed by phased semi-structured interviews (n = 18). Data were analysed using thematic analysis and constant comparative analysis.

FINDINGS

The semi-structured interviews generated nine codes which were organised into three themes: technical issues for trials in primary dental care, practical issues for research in primary dental care and primary care dentists as research consumers. Overall, primary care dentists had a poor understanding of research methodology and clinical research. Barriers to participation included loss of clinical freedom and control, practice disruption, patient welfare, staff workload, financial loss and time.

CONCLUSIONS

Barriers to primary dental care research need to be overcome through appropriate protocols, funding, training and support. Joint working of primary dental care teams and academic researchers is essential, along with a constructive and open dialogue, if clinical trials are to be successfully undertaken in a practice environment.

Beyond ballistics: expanding our conceptualization of men's health-related help seeking

Although the literature on men's help seeking offers important insights into health service engagement patterns within this population, there remain gaps in our understanding. In addition to insufficient attention to a range of male experiences and a restricted focus on sex-specific or associated diseases, much of the extant work is limited by insufficient attention to how men navigate needs and supports across illness and a narrow conceptualization of the core concept of help seeking. Specifically, as research focuses on masculinity as a determinant of the decision to seek medical help (emphasis on prediction), less is known about how men, as gendered beings, are experiencing help seeking over the course of illness (emphasis on understanding). In this article, it is argued that research on men's help seeking can benefit from the integration of a dynamic conceptualization of help seeking that is considerate of shifting needs and a diversity of supports and which emphasizes the subjective, interactive, and ongoing patterns in how men are perceiving, interpreting, and responding to the challenges of illness.

Preferred information sources for clinical decision making: critical care nurses' perceptions of information accessibility and usefulness

BACKGROUND

Variability in clinical practice may result from the use of diverse information sources to guide clinical decisions. In routine clinical practice, nurses privilege information from colleagues over more formal information sources. It is not clear whether similar information-seeking behaviour is exhibited when critical care nurses make decisions about a specific clinical practice, where extensive practice variability exists alongside a developing research base.

PURPOSE

This study explored the preferred sources of information intensive care nurses used and their perceptions of the accessibility and usefulness of this information for making decisions in clinically uncertain situations specific to enteral feeding practice.

METHODS

An instrumental case study design, incorporating concurrent verbal protocols, Q methodology and focus groups, was used to determine intensive care nurses' perspectives of information use in the resolution of clinical uncertainty.

FINDINGS

A preference for information from colleagues to support clinical decisions was observed. People as information sources were considered most useful and most accessible in the clinical setting. Text and electronic information sources were seen as less accessible, mainly because of the time required to access the information within the documents.

DISCUSSION

When faced with clinical uncertainty, obtaining information from colleagues allows information to be quickly accessed and applied within the context of a specific clinical presentation. Seeking information from others also provides opportunities for shared decision-making and potential validation of clinical judgment, although differing views may exacerbate clinical uncertainty.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The social exchange of clinical information may meet the needs of nurses working in a complex, time-pressured environment but the extent of the evidence base for information passed through verbal communication is unclear. The perceived usefulness and accessibility of information is premised on the ease of use and access and thus the variability in information may be contributing to clinical uncertainty.

Reasons for participating and genetic information needs among racially and ethnically diverse biobank participants: a focus group study

In order for DNA biobanks to be a valuable reservoir of genetic information, large numbers of participants from all racial and ethnic backgrounds need to be recruited. This study explored reasons for participating in a new biobank among primarily Hispanic and African American individuals, as well as their general attitudes towards genetic research, and their views on obtaining genetic tests. Focus groups were conducted with Mount Sinai Biobank participants recruited from predominantly lower income, minority communities. The topic guide included questions on The Mount Sinai Biobank, genetic research, and genetic testing. All focus groups were audio recorded, transcribed, and analyzed using thematic analysis. The six focus groups comprised 43 participants: 39 females and four males, aged 27-76 years, with a median household income category of $20,000-$39,999. Twenty-one participants were Hispanic, 20 African American, one Asian, and one White. Participants' reasons for participating in the biobank included altruism, personal and family benefit, and general curiosity. Although there was evidence of conflation between genetic research and genetic testing, most participants held positive views of genetic research and expressed interest in receiving personal genetic test results. Participants wanted to learn more about genetic research and suggested various venues such as health fairs for disseminating information. Participation in biobanks by racial and ethnic minorities is apparently driven by altruism, and desire for personal or collective health benefits. Participants had generally positive attitudes, limited understanding of genetics and genetic research, and made useful suggestions regarding information dissemination mechanisms.

Young Australian Women and Their Aspirations

Previous findings from quantitative research have shown that the majority of young Australian women aged 18 to 23 years aspire to be married, with children, and in the paid workforce when they are 35 years of age. However, the Theory of Emerging Adulthood suggests that this period of the lifespan is characterized by a prolonged stage of exploration and self-focussed identity formation, and young women could be expected to be in the process of formulating and changing their future plans and aspirations. Qualitative analysis is conducted on over 600 comments provided by young Australian women from The Australian Longitudinal Study on Women’s Health across three time points, on topics related to these women’s aspirations for the future. This analysis contextualizes existing, quantitative, findings on women’s aspirations for work and family, and provides a richer understanding of women’s thoughts about work and family, and their progression toward decision making around these future roles, in contemporary society.

Recovery issues of fertility-preserving surgery in patients with early-stage cervical cancer and a model for survivorship: the physician checklist

INTRODUCTION

To present a qualitative data analysis of items exploring the treatment, adjustment, and recovery of 33 patients who underwent radical trachelectomy (RT), and to determine the feasibility of using a physician checklist (PCL) as a model for survivorship assessment.

METHODS

This prospective study was approved by the Memorial Sloan-Kettering Cancer Center's Institutional Review Board. Participants completed a survey including exploratory items focused on fertility issues and reproductive concerns, treatment, adjustment, and recovery over 2 years. All responses to the exploratory questions were transcribed verbatim; thematic analysis was used to identify, evaluate, and show patterns within the data set; and descriptive statistics were calculated for thematic categories. A limited waiver of authorization was obtained for medical chart review of these patients (who underwent RT) for 2 years before (January 2006 to December 2007) and 2 years after (January 2008 to December 2009) implementation of the checklist to evaluate its feasibility.

RESULTS

In response to "how successful you feel you will be at conceiving in the future?" on a scale of 0% to 100%, scores ranged from 54% to 60%. Approximately 70% of the patients reported concerns about conceiving; however, these lessened with time-88% at 6 months to 73% at 24 months. Six percent of women were trying to conceive by 12 months; this increased to 21% by 24 months. Five primary themes emerged from the qualitative analysis that were found to be prevalent across all exploratory items inquiring about difficulties or the hardest adjustment to treatment, recovery, and problems associated with RT; these included menstrual/vaginal issues, emotional impact, life interruptions/return to normalcy, general pain, and recovery process. The PCL identified higher rates of neocervical stenosis (58%), encroachment (54%), vaginal scarring (50%), and dyspareunia (33%) than medical charts, and increased documentation of reproductive consults (54%) and assistance (21%).

CONCLUSION

Global themes expressed by our patients are consistent with those of other cancer survivors. The PCL is an excellent supplement to medical charts by documenting important survivorship issues.

Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers' experiences

BACKGROUND

Many people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators) and how they manage to maintain working (success factors).

METHODS

A semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?"

RESULTS

A total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs.

CONCLUSIONS

Personal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at work are needed to obtain further evidence.

Closing the Gap: An Exploration of First-Year Students' Expectations and Experiences of Learning

In line with Edinburgh Napier University's commitment to enhancing undergraduates' first-year experience (FYE), the aim of this qualitative research project was to examine the development of expectations, learning experiences and study attitudes of new psychology students over their first semester, with a view to informing the design of an intervention to support this transitional process. Support already existed in various forms, but departmental staff wished to establish a more targeted, consistent approach across programmes. Using an action research approach, data collected took the form of students' written reflections, elicited by means of open-ended questionnaires as part of normal induction activities at the start of both first and second semesters. Responses were obtained from two cohorts of first-year psychology students: the 2008–2009 cohort completed the Semester 2 questionnaire only, while the 2009–2010 cohort completed both Semester 1 and Semester 2 questionnaires. Responses were subjected to thematic analysis. Building on the common FYE theme of ‘mismatch’ between student and staff expectations, in this study the ‘psychological contract’ was applied as a theoretical framework for interpretation of findings. The Semester 1 questionnaire data showed realistic expectations but lacked in-depth reflection. The Semester 2 questionnaire responses on ‘experiences’ of the first semester showed a predominant concern with time- and self-management. However, evidence of good study habits, and metacognitive awareness of learning, were scarce, suggesting disparity between student and staff expectations. Interpretation of the data provided a rationale for a first-year intervention, implemented with the 2010–2011 cohort, aimed at ‘closing the gap’ by means of developing appropriate student psychological contracts.

Approaching problem gambling with a discursive sensibility

In this paper, I outline some aspects of what I describe as a "discursive sensibility." Drawing from discourse theory and research, I consider problem gambling in terms of this sensibility: an appreciation for and flexibility in working with differences in how language is used in describing and addressing gambling. I look specifically at how this discursive sensibility can be reflected in particular approaches to practice and research.

Determining what practising clinicians believe about long-acting injectable antipsychotic medication

OBJECTIVE

To explore the factors that influence clinician prescribing choice when using depot anti-psychotics.

METHODS

A two-phase qualitative exploration of the attitudes to and knowledge about risperidone long-acting injection (RLAI) in a group of New Zealand psychiatrists. The first phase was conducted shortly after the treatment was funded (n = 16), the second phase was a year or so later (n = 35). Data was gathered using a focus group technique with scenario stimulus. The data were examined using thematic analysis.

RESULTS

Themes fitted the broad categories of who RLAI was used for, how it was best used, what were the efficacy determinants and what adverse effect monitoring occurred. For many areas of exploration there was a gap between actual practice and what the psychiatrist thought might be best practice. There was considerable variance in details regarding the administration of the treatment including dose, titration and efficacy monitoring.

CONCLUSIONS

The results confirm the utility of quantitative exploration in understanding prescribing choice. The effect of outdated views regarding long-acting injectable (LAI) antipsychotics contributes to a gap between actual practice and what is thought to be desirable. The study targeted RLAI but findings are likely to also pertain to other LAI anti-psychotics.

Befriending for mental health problems: processes of helping

BACKGROUND

One avenue for addressing the social consequences of mental health problems is through befriending, a supportive relationship in which one-to-one companionship is provided on a regular basis. Although there is some evidence that befriending can improve psychological and social functioning, little is known about how it works.

OBJECTIVE

This qualitative study aimed to understand the helping processes occurring in befriending relationships, from the perspectives of both befriendees and befrienders.

METHOD

Semi-structured interviews were conducted individually and jointly with eight befriendees and their corresponding befrienders. Thematic analysis was carried out on the data set of 23 interviews.

RESULTS

The analysis generated nine themes concerning qualities of the relationship valued by befriendees and befrienders (e.g., empathy and mutuality), processes of making meaning (e.g., considering alternative perspectives), and how change was effected in befriendees' lives (e.g., learning how to have healthier relationships with others). The accounts emphasized the importance of the quality of the relationship itself, and highlighted aspects of the relationship that were sometimes difficult to negotiate.

CONCLUSIONS

The findings suggest that befriending shares commonalities with other types of psychological help. However, it is also characterized by some particular challenges, such as establishing an empathic relationship and managing boundaries and endings.

'Not a neutral event': clinical psychologists' experiences of gifts in therapeutic relationships

OBJECTIVES

This study investigated clinical psychologists' experiences of gifts offered by clients in therapeutic relationships. Since limited prior research of gifts has been undertaken, the study was informed by an inter-disciplinary approach, drawing on theories of 'the gift' from anthropology, sociology, and psychoanalysis.

DESIGN AND METHOD

A postal survey was undertaken on a 10% random sample of clinical psychologists living in the UK on the Register for Chartered Psychologists (Clinical Section) (N= 441). Responses to three open-ended questions were analysed qualitatively, using thematic analysis.

RESULTS

The response rate to the questionnaire was 50.57% (N= 223). Three main themes were identified: (1) acceptance as the 'correct' response to a gift, (2) potency of the gift, and (3) the impact of policy on professional autonomy.

CONCLUSIONS

The findings suggested that many participants viewed the gift as a way of the client reciprocating something that was given in the therapy. Within a Maussian account, this notion of reciprocity positions the therapeutic contact as the 'first gift'. Few gifts were refused and frequently occasioned pleasure in the participants. Although some givers were understood as needing to give because of ascribed intra-individual characteristics or 'psychopathology', normative gifting practices were commonly held to apply in therapeutic relationships. Further research should explore clients' perspectives on gifting.

Seeing the beauty in everyday people: a qualitative study of young Australians' opinions on body image, the mass media and models

While governments have called for greater body size diversity in media imagery to promote positive body image and prevent disordered eating, the fashion and advertising industries often argue that average-size models do not appeal to consumers. Focus groups were conducted with 76 young Australian women and men to provide a previously neglected consumer perspective on this debate. Thematic analysis identified dissatisfaction with the restricted range of body sizes, and the objectification of women, in media imagery. Participants indicated a desire for change and positive reactions to average-size models in advertising, but also suggested barriers to their increased use, including concerns about the promotion of obesity. The results suggest that there is some consumer support for increased body size diversity in media imagery. Consumer and industry barriers, however, will need to be addressed in the future if this is to be an effective public health intervention to promote positive body image.

The psychosocial impact of epidermolysis bullosa

Epidermolysis bullosa (EB) is a disease in which the skin blisters in response to minimal friction, causing painful wounds. Despite the potentially severe nature of epidermolysis bullosa, research on the psychosocial issues is scarce. The aims of the study were to explore the psychosocial impact of epidermolysis bullosa on affected adults and to identify associated support needs. We collected data using semistructured interviews and employed inductive thematic analysis to organize and analyze them. Three main themes—beliefs about containing the impact of EB, understandings of the disease, and the disabling impact of EB—describe the ways in which living with EB influences the daily lives of participants at intraindividual, interindividual, and sociocultural levels. The associated support needs ranged in type and intensity, from a preference for brief, skills-based interventions and the facilitation of peer support through to longer-term specialist psychological support. The results highlight how the particular combination of the rarity of the disease, its lifelong and hereditary nature, and its disfiguring impact on the skin differentiate epidermolysis bullosa from other chronic conditions.

Qualitative exporation of relationships with important non-parental adults in the lives of youth in foster care

Foster youth are at risk of poor adult outcomes. Research on the role of mentoring relationships for this population suggests the value of strategies that increase their access to adult sources of support, both while in foster care and as they reach adulthood. We conducted semi-structured, individual qualitative interviews with 23 former foster youth ages 18-25 regarding their relationships with supportive non-parental adults. We sought to identify factors that influence the formation, quality, and duration of these relationships and to develop testable hypotheses for intervention strategies. Findings suggest several themes related to relationship formation with non-parental adults, including barriers (e.g., youth's fears of being hurt) and facilitators (e.g., patience from the adult). Distinct themes were also identified relating to the ongoing development and longevity of these relationships. Youth also described multiple types of support and positive contributions to their development. Proposed intervention strategies include systematic incorporation of important non-parental adults into transition planning, enhanced training and matching procedures within formal mentoring programs, assistance for youth to strengthen their interpersonal awareness and skills, and the targeting of specific periods of need when linking youth to sources of adult support. Recommended research includes the development, pilot-testing, and evaluation of proposed strategies.

Why don't patients take their drugs? The role of communication, context and culture in patient adherence and the work of the pharmacist in HIV/AIDS

OBJECTIVE

This study examined facilitators and barriers to adherence in four South African antiretroviral therapy (ART) clinic sites and explored context and communication factors in relation to the role of the pharmacist.

METHODS

Data were collected from interviews and narratives of patients and health professionals around the issues of adherence and qualitatively analysed using principles of Thematic Content Analysis.

RESULTS

Findings confirm the complex interplay between illness, communication, sociocultural, economic, context and systemic issues. Analysis suggests adherence is multifaceted and reinforces the critical role of communication factors in achieving concordance between patient and pharmacist.

CONCLUSION

Successful treatment of HIV/AIDS depends on pharmacists and healthcare teams understanding contextual and interactional factors which play a role in adherence.

PRACTICE IMPLICATIONS

The findings reinforce the importance of embedding a patient-centred approach in the training and everyday practice of pharmacists. The value of qualitative methods in understanding barriers to adherence and the potential value of the cultural broker in intercultural settings is discussed. Some suggestions are made as to how adherence counselling can be made relevant and effective.

Technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.

EDUCATIONAL OBJECTIVES

The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.

Development and evaluation of a decision aid for BRCA carriers with breast cancer

BRCA+ breast cancer patients face high risk for a second breast cancer and ovarian cancer. Helping these women decide among risk-reducing options requires effectively conveying complex, emotionally-laden, information. To support their decision-making needs, we developed a web-based decision aid (DA) as an adjunct to genetic counseling. Phase 1 used focus groups to determine decision-making needs. These findings and the Ottawa Decision Support Framework guided the DA development. Phase 2 involved nine focus groups of four stakeholder types (BRCA+ breast cancer patients, breast cancer advocates, and genetics and oncology professionals) to evaluate the DA's decision-making utility, information content, visual display, and implementation. Overall, feedback was very favorable about the DA, especially a values and preferences ranking-exercise and an output page displaying personalized responses. Stakeholders were divided as to whether the DA should be offered at-home versus only in a clinical setting. This well-received DA will be further tested to determine accessibility and effectiveness.

Laughing it off? Humour, affect and emotion work in communities living with nuclear risk

Over the past two decades, an increasing number of risk researchers have recognized that risks are not simply objective hazards but that the meanings of risk are discursively negotiated, dynamic and embedded within the wider social relations that constitute everyday life. A growing interest in the complexity and nuances of risk subjectivities has alerted sociocultural researchers not only to what is said in a risk situation, but also to how it is said and to what is unsaid and even, in a particular context, unsayable; to the intangible qualities of discourse that communicate additional meanings. Humour is both an intangible and marks such intangible meanings, yet it has largely been ignored and insufficiently theorized by risk researchers. In this paper, we draw upon insights from the humour literature - suspending the belief that humour is inherently good - to analyse and theorize humour as a way of examining the meanings and functions of risk. We show how humour can both mask and carefully reveal affectively charged states about living with nuclear risk. As such, it helps risk subjects to live with risk by suppressing vulnerabilities, enabling the negotiation of what constitutes a threat, and engendering a sense of empowerment. We conclude that humorous talk can be serious talk which can enrich our understandings of the lived experience of risk and of risk subjectivities.

"A computer isn't gonna judge you": a qualitative study of users' views of an internet-based cognitive behavioural guided self-care treatment package for bulimia nervosa and related disorders

Little is known about what determines uptake and acceptability of internet-based treatments in eating disorders, and users' experience with such treatments. We investigated these factors in participants of a randomized controlled trial of an internet-based cognitive- behavioural treatment (iCBT) package (Overcoming bulimia online). Nine participants were interviewed using purposive sampling. The content of interviews were analyzed using thematic analysis. Additionally, participants received questionnaires about their impressions of iCBT. Participants talked about their experience of using iCBT, its impact and compared it to other treatments. Questionnaire responses echoed themes identified in the interviews. iCBT was received positively as a way of fitting treatment into busy lives. Comments on the layout of some of the package content and the practitioner support offered were identified as areas that could be modified or improved.

Reported stigma and discrimination by people with a diagnosis of schizophrenia

AIMS

This article examines the extent of stigma and discrimination as reported by people with a diagnosis of schizophrenia. The hypothesis is that when people express in their own words the discrimination they experience such discrimination will be found to be widespread.

METHODS

Seventy-five people with a diagnosis of schizophrenia from 15 different countries were interviewed with a mixed methods instrument to assess reported discrimination. The data were analysed for frequency counts and then a thematic analysis was performed. A conceptual map is provided.

RESULTS

The study was a cross-cultural one but, contrary to expectations, few transnational differences were found. The main hypothesis was supported. Conversely, we found that when participants reported 'positive discrimination', this could as easily be conceptualised as being treated similarly to how others in society would expect to be treated.

CONCLUSION

Negative discrimination is ubiquitous and sometimes connotatively very strong, with reports of humiliation and abuse. 'Positive discrimination' conversely indicates that people with a mental illness diagnosis expect discrimination and are grateful when it does not occur. The literature on self-stigma is discussed and found wanting. Similarly, the theory that contact with mentally ill people reduces stigma and discrimination is not fully supported by our results.

Views of cancer care reviews in primary care: a qualitative study

BACKGROUND

The Quality and Outcomes Framework (QOF) provides an incentive for practices to establish a cancer register and conduct a review with cancer patients within 6 months of diagnosis, but implementation is unknown.

AIM

To describe: (1) implementation of the QOF cancer care review; (2) patients' experiences of primary care over the first 3 years following a cancer diagnosis; (3) patients' views on optimal care; and (4) the views of primary care professionals regarding their cancer care.

DESIGN OF STUDY

Qualitative study using thematic analysis and a framework approach.

SETTING

Six general practices in the Thames Valley area.

METHOD

Semi-structured interviews with cancer patients and focus groups with primary care teams.

RESULTS

Thirty-eight adults with 12 different cancer types were interviewed. Seventy-one primary care team members took part in focus groups. Most cancer care reviews are conducted opportunistically. Thirty-five patients had had a review; only two could recall this. Patients saw acknowledgement of their diagnosis and provision of general support as important and not always adequately provided. An active approach and specific review appointment would legitimise the raising of concerns. Primary care teams considered cancer care to be part of their role. GPs emphasised the importance of being able to respond to individual patients' needs and closer links with secondary care to facilitate a more involved role.

CONCLUSION

Patients and primary care teams believe primary care has an important role to play in cancer care. Cancer care reviews in their current format are not helpful, with considerable scope for improving practice in this area. An invitation to attend a specific appointment at the end of active treatment may aid transition from secondary care and improve satisfaction with follow-up in primary care.

Patient involvement in patient safety: Protocol for developing an intervention using patient reports of organisational safety and patient incident reporting

BACKGROUND

Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS), and a patient incident reporting tool (PIRT) - to help the NHS prevent patient safety incidents by learning more about when and why they occur.

METHODS

To develop the PMOS 1) literature will be reviewed to identify similar measures and key contributory factors to error; 2) four patient focus groups will ascertain practicality and feasibility; 3) 25 patient interviews will elicit approximately 60 items across 10 domains; 4) 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis.To develop the PIRT 1) individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2) nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50) will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their priorities for patient safety. A patient panel will provide steering to the research.

DISCUSSION

The PMOS and PIRT aim to provide a reliable means of eliciting patient views about patient safety. Both interventions are likely to have relevance and practical utility for all NHS hospital trusts.

Young adults' interpretations of tobacco brands: implications for tobacco control

INTRODUCTION

Marketers have long recognized the power and importance of branding, which creates aspirational attributes that increase products' attractiveness. Although brand imagery has traditionally been communicated via mass media, packaging's importance in promoting desirable brand-attribute associations has increased. Knowledge of how groups prone to smoking experimentation interpret tobacco branding would inform the debate over plain packaging currently occurring in many countries.

METHODS

We conducted 12 group discussions and four in-depth interviews with 66 young adult smokers and nonsmokers of varying ethnicities from two larger New Zealand cities and one provincial city. Participants evaluated 10 familiar and unfamiliar tobacco brands using brand personality attributes and discussed the associations they had made.

RESULTS

Participants ascribed very different images to different brands when exposed to the packaging alone, regardless of whether they had seen or heard of the brands before. Perceptual mapping of brands and image attributes highlighted how brand positions varied from older, more traditional, and male oriented to younger, feminine, and "cool."

CONCLUSIONS

Our findings emphasize the continuing importance of tobacco branding as a promotion tool, even when communicated only by packaging. The ease with which packaging alone enabled young people to identify brand attributes and the desirable associations these connoted illustrate how tobacco packaging functions as advertising. The results support measures such as plain packaging of tobacco products to reduce exposure to these overt behavioral cues.

Nurses' experiences of a colorectal cancer screening pilot

This article describes a study that set out to explore the experience of endoscopy nurse practitioners participating in the Department of Health-funded UK Nurse-led Flexible Sigmoidoscopy Colorectal Cancer Screening Pilot. Semi-structured interviews were conducted with the three nurse practitioners involved and were analysed using Thematic Analysis, a qualitative method for analysing and reporting patterns (themes) within data. Nurse practitioners found that participating in the study improved their skills and provided job satisfaction despite the hard work it entailed. A varied workload consisting of diagnostic and screening procedures, in addition to the other duties of nurse practitioners, may be desirable for nurses working in the field of gastroenterology.

Implementation and evaluation of brief depression and anxiety screening in clients contacting a drug and alcohol service

INTRODUCTION AND AIMS

High prevalence mental health (HPMH) comorbidity is common in clients seeking alcohol and other drug (AOD) treatment yet can remain undetected. Although research has reported on the introduction of screening into AOD services, little research has reported on the processes surrounding the introduction or evaluated its effectiveness. This study reports on the implementation and evaluation of brief anxiety and depression screening within a specialised, publicly funded AOD service in South-East Victoria.

DESIGN AND METHODS

Study one examined the implementation of standardised HPMH screening with 114 adult clients (Mean age=35.49, SD=9.53; 64% male) telephoning an AOD service over a 5week period. Measures included severity of HPMH problems, AOD use, care plans and referrals. Study two used semistructured interviews with nine staff/managers to evaluate the effectiveness of screening and its impact on service delivery.

RESULTS

Ninety-four per cent of clients were identified at risk of anxiety or depression. Most care plans incorporated counselling, and concurrent referrals commonly involved a general practitioner. Staff and management found systematic screening increased identification and understanding of comorbid issues and enhanced client interaction but impacted on resource requirements.

DISCUSSION AND CONCLUSIONS

Most AOD treatment seekers were identified HPMH comorbid and care plans generally included counselling. Adjunctive referrals were more common for severely depressed clients. Screening was effective and enhanced client rapport. Evaluations revealed low confidence in treating HPMH issues in-house. Training may increase worker confidence in managing mental health interventions with subclinical cases, enhancing services' ability to move towards dual diagnosis capability.

How the psychosocial context of clinical trials differs from usual care: a qualitative study of acupuncture patients

Background

Qualitative studies of participants' experiences in randomised clinical trials (RCTs) suggest that the psychosocial context of treatment in RCTs may be quite different to the psychosocial context of treatment in usual practice. This is important, as the psychosocial context of treatment is known to influence patient outcomes in chronic illness. Few studies have directly compared the psychosocial context of treatment across RCTs and usual practice. In this study, we explored differences in psychosocial context between RCT and usual practice settings, using acupuncture as our model.

Methods

We undertook a secondary analysis of existing qualitative interviews with 54 patients. 27 were drawn from a study of western and traditional acupuncture in usual practice (for a range of painful conditions). 27 were drawn from a qualitative study nested in an RCT of western acupuncture for osteoarthritis of the hip or knee. We used qualitative analysis software to facilitate an inductive thematic analysis in which we identified three main themes.

Results

In usual practice, starting acupuncture was more likely to be embedded in an active and ongoing search for pain relief, whereas in the RCT starting acupuncture was opportunistic. Usual practice patients reported few uncertainties and these had minimal consequences for them. In the RCT, patients experienced considerable uncertainties about their treatment and its effectiveness, and were particularly concerned about whether they were receiving real (or fake) acupuncture. Patients stopped acupuncture only at the end of the fixed course of treatment in the RCT, which was similar to those receiving acupuncture in the public sector National Health Service (NHS). In comparison, private sector patients re-evaluated and re-negotiated treatments particularly when starting to use acupuncture.

Conclusions

Differences in psychosocial context between RCTs and usual practice could reduce the impact of acupuncture in RCT settings and/or lead to under-reporting of benefit by patients in trials. New trial designs that ensure participants' experiences are similar to usual practice should minimise differences in psychosocial context and help attenuate these potentially confounding effects.

Isolation and lack of access in multiple chemical sensitivity: A qualitative study

This paper describes a qualitative interview study of 26 persons with multiple chemical sensitivity (MCS), also referred to as chemical intolerance. We used a phenomenological perspective and planned to focus on the impact of MCS on relationships, but found that difficulty with accessing safe spaces at times prevented relationships by limiting access to personal interactions. Thus, persons with MCS either lost or were unable to cultivate new relationships as a result of lack of spatial access. Others' lack of understanding and refusal to make accommodations at times denied spatial access to those with MCS. In this way, relationships (relationality) and spatial access (spatiality) interacted with one another to keep persons isolated. In this paper, we describe informants' detailed experience of living with chemical intolerance in a culture where chemical exposures are commonplace.

I can't get my husband to go and have a colonoscopy: gender and screening for colorectal cancer

It is anticipated that a colorectal cancer (CRC) screening programme will be introduced in New Zealand making it the first screening programme in this country to include both males and females. In-depth interviews were carried out with 80 participants (53 females and 27 males) about their knowledge and attitudes to screening programmes in general, as well as their understanding and perceptions of CRC screening in particular. The study highlighted the perceived marginalization of men's health with a sense that women had advocated for, and therefore monopolized, screening while men's health had been left unattended. There were also perceptions of women's responsibility for ensuring men's access to health services. There are arguments that such perceptions disempower or 'infantalize' men which have no long term benefits. While health is perceived as being a feminine matter, it may be difficult to encourage men to engage in preventative behaviours, such as taking up the offer of screening. This article also highlights the heterogeneity of men, where different performances of masculinities were presented. A stereotypical 'staunch' or 'macho image' discourse was evident in some of the interviews where much emphasis was on maintaining and controlling bodily boundaries. Letting the barrier of embodied 'staunchness' down to access health services is a threat to identity. What is required for successful implementation of the CRC screening programme is a normalization of men's health help-seeking, taking into account the fact that men are not homogenous. Studies in relation to men's health need to attend to cultural diversity which is likely to present a challenge to individualism. Critical studies of men would be enhanced by more engagement with the work of black male scholars.