Promoting positive change in the face of adversity: experiences of cancer and post-traumatic growth

The increasing population of cancer survivors underscores the need to develop a complete understanding of the survivorship experience, including positive aspects. The aim of this study was to explore people's experiences of cancer to assess the relevance of the post-traumatic growth (PTG) construct and to identify potentially modifiable factors that may promote PTG. Group interviews were conducted with 15 people (eight men, seven women) aged between 36 and 85 who had been diagnosed with cancer and completed treatment. Participants identified that while a cancer diagnosis is a traumatic event and has an immense impact, there is potential for PTG. Participants described examples of positive change within their relationships, perceptions of self and life in general perception, and spirituality. Various modifiable factors were identified as enabling participants to experience growth including social support, finding information, complementary therapy use, lifestyle changes and physical activity. Modifiable factors such as physical activity and searching for information have the potential to influence the development of PTG by providing cancer survivors with an opportunity to regain control. Encouraging and developing research that examines the relationship between modifiable factors and PTG will assist in the development of interventions that address the unique needs of cancer survivors.

Knowledge brokers in a knowledge network: the case of Seniors Health Research Transfer Network knowledge brokers

Background

The purpose of this paper is to describe and reflect on the role of knowledge brokers (KBs) in the Seniors Health Research Transfer Network (SHRTN). The paper reviews the relevant literature on knowledge brokering, and then describes the evolving role of knowledge brokering in this knowledge network.

Methods

The description of knowledge brokering provided here is based on a developmental evaluation program and on the experiences of the authors. Data were gathered through qualitative and quantitative methods, analyzed by the evaluators, and interpreted by network members who participated in sensemaking forums. The results were fed back to the network each year in the form of formal written reports that were widely distributed to network members, as well as through presentations to the network’s members.

Results

The SHRTN evaluation and our experiences as evaluators and KBs suggest that a SHRTN KB facilitates processes of learning whereby people are connected with tacit or explicit knowledge sources that will help them to resolve work-related challenges. To make this happen, KBs engage in a set of relational, technical, and analytical activities that help communities of practice (CoPs) to develop and operate, facilitate exchanges among people with similar concerns and interests, and help groups and individuals to create, explore, and apply knowledge in their practice. We also suggest that the role is difficult to define, emergent, abstract, episodic, and not fully understood.

Conclusions

The KB role within this knowledge network has developed and matured over time. The KB adapts to the social and technical affordances of each situation, and fashions a unique and relevant process to create relationships and promote learning and change. The ability to work with teams and to develop relevant models and feasible approaches are critical KB skills. The KB is a leader who wields influence rather than power, and who is prepared to adopt whatever roles and approaches are needed to bring about a valuable result.

Patients' expectations of acute low back pain management: implications for evidence uptake

Background

In many countries, general practitioner (GP) care of acute low back pain often does not adhere to evidence-based clinical guidelines. There has been little exploration of this deviation from evidence-based care from the patients’ perspective, particularly in relation to patients’ care expectations. The aim of this study was to explore the care expectations in patients who present to their GP with acute low back pain, influences on expectation development, and congruence of these expectations with clinical guideline recommendations.

Methods

Qualitative study in an inner urban general practice in Brisbane, Australia. Semi-structured interviews were conducted with 11 patients who presented to their GP with acute low back pain.

Results

Patients had a biomechanical understanding of back pain, how it should be tested and treated, and a poor understanding of its natural history. Most expected x-rays, believing they were necessary to identify the “cause of the pain” without belief of any downsides to x-rays. Patients’ expectations were primarily influenced by the experiences of family and friends, their own previous experiences of low back pain care, and comments from other health professionals they were consulting. The GP-patient relationship was important in influencing patient satisfaction of care provided. Most patient expectations, and some of the care that they reported receiving, were incongruent with guideline recommendations.

Conclusions

A biomechanical approach to management rather than an awareness of empirical evidence was evident in patients’ expectations. Communication and education by the GP that includes specifically enquiring about patients’ expectations, provides an opportunity to correct misperceptions, explain acute low back pain natural history, and the rationale for test and treatment recommendations.

One size fits all? The discursive framing of cultural difference in health professional accounts of providing cancer care to Aboriginal people

OBJECTIVES

Cancer is the second biggest killer of Aboriginal Australians. For some cancers, the mortality rate is more than three times higher in Aboriginal people than for non-Aboriginal people. The Aboriginal Patterns of Cancer Care Study explored barriers to and facilitators of cancer diagnosis and treatment among Aboriginal and Torres Strait Islander people in New South Wales.

DESIGN

Our team--which includes both Aboriginal and non-Aboriginal researchers--conducted in-depth interviews between 2009 and 2010 with Aboriginal people with cancer, their carers and health professionals who care for them. In this paper, we identify recurrent patterns of 'discursive framing' in the 16 interviews with health care professionals. We are particularly interested in how these frames assisted participants in constructing a professional position on what 'cultural difference' means for the design and delivery of cancer care services to Aboriginal people.

RESULTS

Despite geographical, organisational, disciplinary and cultural diversity, these interview participants consistently drew upon six discursive frames, which we have interpreted as either eliding a discussion of difference ('everyone is the same' and 'everyone is different') or facilitating that discussion ('different priorities,' 'different practices' and 'making difference safe'). An additional strategy appeared to actively resist either of these positions but then tended to ultimately prioritise the eliding frames.

CONCLUSIONS

While none of our participants were dismissive of the idea that cultural identity might matter to Aboriginal people, their reliance upon familiar narratives about what that means for cancer care services has the potential to both symbolically and practically exclude the voices of a group of people who may already feel disenfranchised from the mainstream health care system. Critically unpacking the 'taken for granted' assumptions behind how health care professionals make sense of cultural difference can enrich our understanding of and response to the care needs of indigenous people affected by cancer.

Implementing a community-based obesity prevention programme: experiences of stakeholders in the north east of England

Recent literature indicates the potential of community-based obesity prevention programmes in the endeavour to reduce the prevalence of obesity in developed nations. Considerable suggestion and advocacy come from theoretical standpoints and little is known on actual practical application of this type of multi-component health promotion programme. This article explores the experiences of 'implementation' by stakeholders of a large community-based obesity prevention programme, facilitated by a National Health Service Care Trust in the north-east of England, UK. Three stakeholder groups (senior health officials, public health workers and community members) who had administrated and experienced the programme since its conception in 2006 provide perspectives on the aspects of local delivery and receipt. Semi-structured interviews and focus groups were conducted with stakeholders (28 participants in total). The participants felt there were three broad aspects which shaped and constrained the delivery and receipt of the programme, namely partnership working, integration of services and quality issues. Data indicated that it had taken time to establish working partnerships between the multi-agencies involved in the community-based obesity programme. Strategic management would aid the processes of communication and collaboration between agencies and also the local community involved in the administration, delivery and participation of interventions in the programme. Secondly, the way in which the programme is justified and sustained will have to be reviewed, with the intention of using a suitable evaluative framework or tool for monitoring purposes.

A qualitative exploration of whether lesbian and bisexual women are ‘protected’ from sociocultural pressure to be thin

Heterosexual women in Western cultures are known to experience body image concerns, dieting and disordered eating as a result of intense social pressures to be thin. However, it is theorised that lesbian and bisexual women belong to a subculture that is ‘protective’ of such demands. Fifteen non-heterosexual women were interviewed about their experiences of social pressure. Thematic analysis of their accounts suggests that such theorising may be inaccurate, because these lesbian and bisexual women did not feel ‘protected’ from social pressures and experienced body dissatisfaction. While they might attempt to resist thin idealisation, resistance is not centred around their sexuality.

Using intervention mapping to develop a work-related guidance tool for those affected by cancer

BACKGROUND

Working-aged individuals diagnosed and treated for cancer require support and assistance to make decisions regarding work. However, healthcare professionals do not consider the work-related needs of patients and employers do not understand the full impact cancer can have upon the employee and their work. We therefore developed a work-related guidance tool for those diagnosed with cancer that enables them to take the lead in stimulating discussion with a range of different healthcare professionals, employers, employment agencies and support services. The tool facilitates discussions through a set of questions individuals can utilise to find solutions and minimise the impact cancer diagnosis, prognosis and treatment may have on their employment, sick leave and return to work outcomes. The objective of the present article is to describe the systematic development and content of the tool using Intervention Mapping Protocol (IMP).

METHODS

The study used the first five steps of the intervention mapping process to guide the development of the tool. A needs assessment identified the 'gaps' in information/advice received from healthcare professionals and other stakeholders. The intended outcomes and performance objectives for the tool were then identified followed by theory-based methods and an implementation plan. A draft of the tool was developed and subjected to a two-stage Delphi process with various stakeholders. The final tool was piloted with 38 individuals at various stages of the cancer journey.

RESULTS

The tool was designed to be a self-led tool that can be used by any person with a cancer diagnosis and working for most types of employers. The pilot study indicated that the tool was relevant and much needed.

CONCLUSIONS

Intervention Mapping is a valuable protocol for designing complex guidance tools. The process and design of this particular tool can lend itself to other situations both occupational and more health-care based.

Parents' experiences and satisfaction with care during the birth of their very preterm baby: a qualitative study

Objective

To assess parents' experiences and satisfaction with care during very preterm birth and to identify domains associated with positive and negative experiences of care.

Design

Qualitative study using semi-structured interviews.

Setting

Three neonatal units in tertiary care hospitals in South-East England.

Population

Thirty-two mothers and seven fathers who had a baby born before 32 weeks of gestation and spoke English well.

Methods

Semi-structured interviews were conducted. Results were analysed using thematic analysis.

Main outcome measures

Participants' experiences and satisfaction with care during the birth of their preterm baby.

Results

Overall, 80% of participants were extremely satisfied with the care during the birth of their preterm baby, seven were generally satisfied but felt some things could be improved and one was dissatisfied. Four key determinants of experiences of care were identified: staff professionalism, which included information and explanation, being calm in a crisis, appearing confident and in control, and conversely not listening to the woman; staff empathy, which included caring and emotional support, and encouragement and reassurance; involvement of the father; and birth environment.

Conclusions

Although the determinants of experiences of care are generally consistent with previous research on term births, unique factors to preterm birth were identified. These were the importance of the staff appearing calm during the birth, and the staff portraying confidence and taking control during the birth. Women valued being listened to, and both they and their partners valued staff helping fathers to feel involved during the birth.

A literature-based intervention for older people living with dementia

Background:

While several studies have explored the impact of literature and reading on mental health, there has been relatively little work done on how a literature-based intervention might impact on the behaviours of those living with dementia. The present report addresses the effect that a specific literature-based intervention – Get into Reading, designed and practised by national charity The Reader Organisation – might have on the health and well-being of people living with dementia.

Aims:

This present study arises out of a service evaluation that specifically assessed to what extent the shared-reading intervention impacted upon behaviours symptomatic of dementia. Its aims were: (1) to understand the influence that reading has on older adults with dementia in different health-care environments; (2) to identify staff perceptions of the influence that engagement in a reading group has on older adults living with dementia; and (3) to investigate any changes in dementia symptoms of older adults participating in a reading group.

Methods:

The study employed a mixed-method design conducted within three health-care environments: three care homes, two hospital wards and one day centre. The Neuropsychiatric Inventory Questionnaire (NPI-Q) assessed staff views of any changes in dementia symptom severity for participants in reading groups conducted in the care homes. Semi-structured qualitative interviews were then conducted with staff who attended the reading groups and/or had extensive knowledge of service users involved in all of the health-care settings. Responses to questions were recorded verbatim and then subject to thematic analysis.

Results:

61 service users and 20 staff members took part in the overall project. The NPI-Q results indicate that symptom scores were lower during the reading group period than at baseline. These findings were supported by the qualitative interviews, which suggested that three themes were perceived to be important to effective engagement with the reading groups: (1) the components of the reading group intervention; (2) enjoyment, authenticity, meaningfulness and renewed sense of personal identity; and (3) enhancement of listening, memory and attention.

Conclusions:

In light of quantifiable data of limited but indicative status, together with strongly corroborative qualitative evidence, engagement in reading-group activity appeared to produce a significant reduction in dementia symptom severity. Staff interviews indicated the contribution of reading groups to well-being.

Patients' and practitioners' views on health behaviour change: a qualitative study

OBJECTIVE

This study was designed to examine patients' and health professionals' perspectives on lifestyle behaviour change and to inform the development of a lifestyle behaviour change intervention to be used in primary care.

DESIGN

Focus groups were conducted with seven patients and 13 health professionals where they were asked to discuss lifestyle behaviour change in relation to the design and development phase of a tailored lifestyle behaviour change intervention package.

RESULTS

An inductive thematic analysis of transcripts suggested a range of issues that are relevant to the development and implementation of lifestyle change interventions such as time, lack of resources and starting interventions too late, as well as personal circumstances and the continuous effort that behaviour change requires. They were interpreted as two superordinate themes of 'internal and external influences on behaviour change' and 'behaviour change initiation and maintenance'. The results are discussed in relation to the implications they may have for researchers and health service commissioners designing interventions and practitioners implementing lifestyle change interventions in primary care.

CONCLUSION

Many factors are involved in patients' and health care professionals' understanding of interventions and lifestyle behaviour change. These should be taken into consideration when designing interventions based on behaviour change theories.

The seriously mentally ill older adult: perceptions of the patient-provider relationship

PURPOSE

The purpose of this study was to give voice to the lived experiences of older adults with serious mental illness and their perceptions of the healthcare provider relationship.

DESIGN AND METHODS

A qualitative phenomenological research design was used. In-depth interviews were conducted with eight members of a mental health clubhouse.

FINDINGS

Study themes revealed not only elements of goodwill toward providers but also elements of concern about the reliability and quality of healthcare provider relationships. Findings provided theoretical support for using Peplauian approaches in clinical practice.

PRACTICE IMPLICATIONS

Partnering with patients, utilizing peer support networks, and placing a broader emphasis on the recovery model should be explored.

Addressing the gap between public health emergency planning and incident response: Lessons learned from the 2009 H1N1 outbreak in San Diego County

Objectives: Since 9/11, Incident Command System (ICS) and Emergency Operations Center (EOC) are relatively new concepts to public health, which typically operates using less hierarchical and more collaborative approaches to organizing staff. This paper describes the 2009 H1N1 influenza outbreak in San Diego County to explore the use of ICS and EOC in public health emergency response.

Methods: This study was conducted using critical case study methodology consisting of document review and 18 key-informant interviews with individuals who played key roles in planning and response. Thematic analysis was used to analyze data.

Results: Several broad elements emerged as key to ensuring effective and efficient public health response: 1) developing a plan for emergency response; 2) establishing the framework for an ICS; 3) creating the infrastructure to support response; 4) supporting a workforce trained on emergency response roles, responsibilities, and equipment; and 5) conducting regular preparedness exercises.

Conclusions: This research demonstrates the value of investments made and that effective emergency preparedness requires sustained efforts to maintain personnel and material resources. By having the infrastructure and experience based on ICS and EOC, the public health system had the capability to surge-up: to expand its day-to-day operation in a systematic and prolonged manner. None of these critical actions are possible without sustained funding for the public health infrastructure. Ultimately, this case study illustrates the importance of public health as a key leader in emergency response.

In Search of Critical Thinking in Psychology: An Exploration of Student and Lecturer Understandings in Higher Education

This qualitative study of understandings of critical thinking in higher education aimed to identify themes that could help to demystify critical thinking and inform its more explicit incorporation in the psychology curriculum. Data collected from focus groups with 26 undergraduate psychology students and individual semistructured interviews with 4 psychology lecturers were examined using thematic analysis. The same key themes were identified from both student and lecturer data: ‘vague beginnings’, ‘conceptualizations’, ‘development and transitions’, and ‘learning strategies’. Both students and lecturers described critical thinking as implicit knowledge that develops through social interactions. The findings indicate the importance of explicit discussion about critical thinking, and could be used to inform the design and delivery of instructional methods to promote critical thinking.

Exploring the cultural context of HIV stigma on antiretroviral therapy adherence among people living with HIV/AIDS in southwest Nigeria

This study explored the cultural context of HIV stigma on antiretroviral therapy adherence among people living with HIV/AIDS (PLWHA) in southwest Nigeria. Using purposive sampling, participants were recruited through a community-based organization. Consenting PLWHA participated in in-depth interviews and focus group discussions that were audio-taped. Using Deacon's conceptual framework of stigma, four opinion guides facilitated the interviews and discussions. Interviews and discussions were conducted in three languages, and lasted from 45 min to 2 h. A total of 35 women and men participated in the study. Participants ranged in age from 22 to 58 years, with an average of 4 years since clinical diagnosis of HIV/AIDS. All participants were receiving ART, and self-reported high adherence level. Using thematic analysis, three themes emerged: life before ART, life after ART, and strategies used in ART adherence. In describing their lives before ART, participants reported experiencing self, anticipated and enacted stigmas due to their sickly appearance from HIV-related complications. After initiating ART, participants talked about friends and families "returning to them" and "apologizing for abandoning" them once they started "looking well." In response to anticipated stigma, many reported sticking to their medications. Drawing from the cultural milieu as part of their strategies, participants discussed the use of plastic bags for medications and àkònpó, as ways of diverting attention from their use of many medications. Implications for ART program policies and stigma interventions were discussed, along with limitation of a short-term ART study on stigma since long-term use of ART can contribute to stigma by way of lipoatrophy as PLWHA age.

Texting for health: the use of participatory methods to develop healthy lifestyle messages for teens

OBJECTIVE

To develop and test messages and a mobile phone delivery protocol designed to influence the nutrition and physical activity knowledge, attitudes, and behavior of adolescents.

DESIGN

Nine focus groups, 4 classroom discussions, and an 8-week pilot study exploring message content, format, origin, and message delivery were conducted over 12 months using a multistage, youth-participatory approach.

SETTING

Youth programs at 11 locations in Arizona.

PARTICIPANTS

Recruitment was coordinated through youth educators and leaders. Eligible teens were 12-18 years old and enrolled in youth programs between fall 2009 and 2010.

PHENOMENON OF INTEREST

Adolescent preferences for messages and delivery of messages.

ANALYSIS

Qualitative data analysis procedures to generate themes from field notes.

RESULTS

One hundred seventy-seven adolescents participated in focus groups (n = 59), discussions (n = 86), and a pilot study (n = 32). Youth preferred messages with an active voice that referenced teens and recommended specific, achievable behaviors; messages should come from nutrition professionals delivered as a text message, at a frequency of ≤ 2 messages/day.

CONCLUSIONS AND IMPLICATIONS

More than 300 messages and a delivery protocol were successfully developed and tested in partnership with adolescents. Future research should address scalability of texting interventions; explore dose associated with changes in knowledge, attitudes, and behaviors; and offer customized message subscription options.

Community reintegration of sex offenders of children in new zealand

Reintegration of offenders following incarceration is most successful if matched to the needs of offenders, victims, and the community. This study explored child sex offenders' expectations for and experiences of reintegration into the community. A longitudinal design was used in which semistructured interviews covered issues identified in the literature as being related to reintegration. Nine offenders were interviewed within 1 week prior to release, 3 months post release, and 6 months post release. Interviews were analysed using thematic analyses producing six key themes. The interviews revealed that most of the participants feared their release from prison into the community and once released struggled to live in society. Overall, reintegration planning was simplistic and aimed primarily to manage risk factors rather than promote reintegration. Those participants who reported most satisfaction with their adjustment following release had more comprehensive reintegration plans, which enabled them to visualise what life would be like after release.

An investigation of the motivations driving the online representation of self-injury: a thematic analysis

The objetive of the study was to identify a) the motivations for communicating about non-suicidal self-injury (NSSI) in a publicly accessible online forum, b) The significance (if any) of the "publicness" of the behavior. Using a Thematic Analysis of 423 text-based posts from an online NSSI forum, 5 motivations for using the site were identified: confessional, marking a turning point, acting as a deterrent, dispelling myths and offering or seeking support. Motivations for using the site differ markedly from motivations for engaging in NSSI and tend to be more outwardly focused. The publicness of the site therefore seems to be significant in terms of bearing witness, providing the opportunity to confront negative stereotypes, and the ability to seek and offer support to like-minded individuals.

Smoking restrictions on campus: changes and challenges at three Canadian universities, 1970-2010

This article examines the restriction of smoking on university campuses in the Canadian context. Indoor smoking on campus is now completely prohibited by law, and universities are increasingly moving to restrict, or prohibit, outdoor smoking on their grounds. The research focuses on three case studies to identify changes in spatial restrictions on campus smoking over the last four decades (1970-2010), and to determine the challenges involved in establishing bans in outdoor areas of campus. The three universities were selected for their different approaches to the issue of outdoor smoking. Data collection involved semi-structured interviews with 36 key informants, conducted from September 2010 to January 2011, supplemented by documentary information. Interview data were analysed thematically. Protection against environmental tobacco smoke (ETS) on campus proceeded incrementally, via policy-making at the provincial, municipal and institutional levels. Historically, institutional bans on indoor smoking were particularly significant, but their health benefits could be limited by the presence of private property on campus. Universities continue to initiate smoking restrictions today, with respect to outdoor bans. However, respondents reported myriad challenges in developing, implementing and maintaining such bans. Five principal concerns were articulated: the need for ongoing policy communication; management of community relations as smokers are displaced from campus; enforcement to ensure that the policy has practical effect; safety concerns; and difficulties relating to campus layout. Because challenges are diverse and contextual, effective protection against outdoor ETS on campus is likely to require an ongoing commitment on the part of administrators.

Carers' perspectives of a weight loss intervention for adults with intellectual disabilities and obesity: a qualitative study

BACKGROUND

To date, no studies have explored the role of carers in supporting adults with intellectual disabilities (ID) and obesity during a weight loss intervention. The present study explored perceptions of carers supporting adults with ID, as they participated in a 6-month multi-component weight loss intervention (TAKE 5).

METHODS

Semi-structured interviews were used to explore the experiences of 24 carers. The transcripts were analysed qualitatively using thematic analysis.

RESULTS

Three themes emerged from the analysis: carers' perceptions of participants' health; barriers and facilitators to weight loss; and carers' perceptions of the weight loss intervention. Data analysis showed similarities between the experiences reported by the carers who supported participants who lost weight and participants who did not. Lack of sufficient support from people from the internal and external environment of individuals with ID and poor communication among carers, were identified as being barriers to change. The need for accessible resources tailored to aid weight loss among adults with ID was also highlighted.

CONCLUSION

This study identified specific facilitators and barriers experienced by carers during the process of supporting obese adults with ID to lose weight. Future research could utilise these findings to inform appropriate and effective weight management interventions for individuals with ID.

Clinical hypnosis and Patanjali yoga sutras

The trance states in yoga and hypnosis are associated with similar phenomena like relaxation, disinclination to talk, unreality, misrepresentation, alterations in perception, increased concentration, suspension of normal reality testing, and the temporary nature of the phenomena. While some researchers consider yoga to be a form of hypnosis, others note that there are many similarities between the trance in yoga and the hypnotic trance. The present study aimed to find similarities between the trance states of hypnosis and Patanjali's yoga sutras. The trance states were compared with the understanding of the phenomena of trance, and the therapeutic techniques and benefits of both. An understanding of the concept of trance in Patanjali's yoga sutras was gained through a thematic analysis of the book Four Chapters on Freedom by Swami Satyananda Saraswati. This led to an understanding of the concept of trance in the yoga sutras. The obtained concepts were compared to the concepts of trance in hypnosis (obtained through the literature on hypnosis) to investigate whether or not there exist similarities. The findings of the study show that there are similarities between the trance in hypnosis and the trance in Patanjali's yoga sutras in the induction and deepening of the trance states in hypnosis and that of Samadhi, the phenomena present in hypnosis and the kinds of siddhis that are obtained through Samadhi, and the therapeutic techniques and the therapeutic process in Patanjali's yoga sutra and hypnosis.

An international survey of the public engagement practices of health technology assessment organizations

OBJECTIVES

Many jurisdictions are moving toward greater public involvement in health technology assessment (HTA) processes. This study aims to provide a broad, cross-sectional indication of the extent and methods of public engagement in HTA, with a focus on which public are engaged, by what mechanisms, and the purpose of public engagement.

METHODS

An international Web-based survey of 217 organizations involved in HTA was undertaken. Contact e-mail addresses for targeted organizations were identified from the Internet.

RESULTS

Individuals from 39 (18%) of the contacted organizations completed a survey. The majority (67%) of responding HTA organizations undertake public engagement activities, predominantly involving lay representatives of organized groups (81%), and to a lesser extent individual patients/consumers (54%) or citizens/community members (54%). For organizations undertaking public engagement, mechanisms based on communication or consultation were the most common, although some organizations have used or intend to use participatory approaches, particularly the Citizens' Jury (8%) or Consensus Council (20%) methods. Respondents identified with a number of rationales and barriers for undertaking public engagement.

CONCLUSIONS

This survey provides further insight into the public engagement approaches that are used by HTA organizations in practice. In particular, it suggests a limited adoption of participatory methods to date, and interest in the use of social media. Study findings require further confirmation, due to limitations related to survey response. There is considerable opportunity for further research into pragmatic, robust, and meaningful approaches to public engagement to strengthen HTA policy and decision-making frameworks. An agenda for future research evolving from the survey responses is proposed.

A process evaluation using a Self Determination Theory measure of the co-delivery of self management training by clinicians and by lay tutors

OBJECTIVE

To evaluate the co-delivery style of lay and clinician co-tutors of courses for patients, and courses for clinicians to support their patients' self-management skills.

METHODS

Motivational style of course delivery was assessed in 37 patient course sessions and 14 clinician workshops by independent observers using four Self Determination Theory rating scales and ethnographic notes. Forty-five tutors and 35 attendees were interviewed about their experience of co-delivered courses.

RESULTS

Lay and clinician tutors had similar motivational styles, with significant differences between the four motivational style scales; patient courses (F(3, 216)=3.437, p=.018); and clinician courses (F(3, 78)=3.37, p=.025). The courses were experienced as co productive in style as suggested during interviews, but adherence to manuals limited the tutors' contributions. Lay and clinician tutors scored higher on providing structure and engaging participants than they scored on supporting autonomous decision making and involvement.

CONCLUSION

Co-delivery was a successful model, affording opportunities to demonstrate co-production skills.

PRACTICE IMPLICATIONS

There is more scope to enable lay and clinician tutors to use their respective expertise in supporting self-management, and for tutor training to encourage a less didactic delivery style.

Revictimization and recovery from sexual assault: implications for health professionals

Twenty-seven adult females' responses from an online qualitative questionnaire were analyzed to explore their views on being recovered from an experience of sexual assault, and identify aspects of their postassault health service encounters that facilitated or impeded their recovery process. Being recovered involved accepting the experience, being freed from negative states, regaining control and trust, and receiving help from and being believed by others. Participants predominantly reported negative experiences with health services. Factors perceived as impeding the recovery process include health professionals' inexperience in dealing with survivors of sexual assault, adhering to rape myths and stereotypes, and disrespectful or inconsiderate treatment of survivors. We argue that these postassault negative experiences revictimized survivors. Addressing these factors may reduce revictimization, facilitate recovery, and decrease assaulted women's long-term use of health services.

“I’m Over It”: Survivor Narratives AfterWoman-to-Woman Partner Abuse

This article uses qualitative data gathered through semi-structured, in-depth interviews with 40 women in the United Kingdom who identified as having experienced abuse (physical, sexual, emotional, and/or financial) in a previous same-sex relationship. Participants’ narratives of “life after abuse” are examined through two lenses; the first contributing to understandings of the varied and enduring material, psychological and relational impacts of abuse, and the second offering insights into the cultural values that shape such narratives. Applying Arthur Frank’s (1995) illness narratives, this article argues that narratives emphasizing recovery (“restitution”) or transformation (“quest”) are culturally privileged over a “chaos” narrative. It also proposes a fourth narrative of “active recovery.” The article concludes that recovery from partner abuse is neither a linear process nor one guaranteed to reach an end point. Further research is needed to understand how to better support survivors of partner abuse to move toward recovery.

Interdisciplinarity and Undergraduate Psychology Education

This work identifies the human service sector as an important and growing destination for psychology graduates. It further identifies a number of key themes which flow from that observation and which are important to configuring psychology education in a way which takes account of emerging trends. The major theme identified in the research is the importance of breadth. The theme of the importance of breadth takes two related and repeated forms. The first is that graduates need to be thinkers rather than doers. The second is that employers in the human services stress the need for broad-based thinking and analytical skills to reflect social and contextual awareness of therapeutic situations and human service programmes and interventions. Stakeholders broadly commented that graduates seeking employment in the human service sector need upskilling in terms of a contextual awareness of the ‘real world’. One idea which emerged in this research is that real-world multidisciplinarity is best underpinned by an interdisciplinary approach to teaching and learning.

'Talk to us like we're people, not an X-ray': the experience of receiving care for chronic pain

Chronic pain is a commonly reported problem in primary care, and is Australia’s third most costly health problem. Despite advances in the understanding and treatment of pain, many people with chronic pain do not receive the best available care. This paper examines the health care experiences of people with chronic pain and focuses discussion on the impact that institutional and cultural factors can have on individual experience. Unstructured narrative interviews were conducted with a convenience sample of 20 people with chronic pain. Participants’ experiences pointed to several factors that can affect the outcome of the health care they receive, including: the belief that all pain is due to identifiable injury or disease; a commitment to finding a diagnosis and cure; problematic patient−provider communication; and poor integration of health services. Comprehensively addressing these factors cannot be achieved by focusing interventions at the individual level. A multifaceted response, which includes public health and systemic initiatives, is required.

Responses to online photographs of non-suicidal self-injury: a thematic analysis

There is concern that graphic pictures of non-suicidal self-injury (NSSI) may detrimentally impact vulnerable viewers--namely those who may self-injure. How individuals (most who have, but some of whom have not, self-injured) respond to photographs of NSSI is currently unknown. Thematic analysis was used to assess testimony regarding NSSI imagery online. Analysis of testimony regarding NSSI photographs revealed a dichotomy. Individuals reporting positive perceptions said the photographs reduced loneliness and NSSI enactment. People reporting negative perceptions argued photographs reinforce and encourage NSSI. Experiences of being triggered by NSSI images were described by several participants. Photographs of NSSI posted online may have several risks for viewers. It is important to achieve a greater understanding of the effects of various forms of online NSSI content and to develop supportive NSSI resources on the Internet.

A critical exploration of the management of self-harm in a male custodial setting: qualitative findings of a comparative analysis of prison staff views on self-harm

There are a growing number of prisoners who self-harm in prisons in England and Wales despite adopting a safer custody ethos. An in-depth study of staff views of self-harm from various agencies within the prison and the integration of their different forms of expertise and perspectives to address this problem is lacking. Negative attitudes to self-harm have been identified as an additional risk factor to this problematic behavior.

AIM

This study identified and compared relevant attitudinal dimensions of custodial and healthcare staff on prisoners who self-harm in an Adult Male "Local" Category B prisons (referred to as the study prison) where self-harm was twice the national average (14%).

METHOD

Semistructured interviews were conducted with 37 prison staff (14 nurses and 23 prison officers) as part of a mixed methods research study where documentary evidence and a self-harm questionnaire were also used. This paper discusses and presents the findings for the thematic analysis of the semistructured interviews.

FINDINGS

The key themes identified were understanding self-harm, building relationships, organizational issues, occupational issues, and care management of self-harm. The findings suggest that most prison staff felt unsupported and inadequately equipped to manage self-harm, and reported interdisciplinary conflict on its collective management.

The workings of homonormativity: lesbian, gay, bisexual, and queer discourses on discrimination and public displays of affections in Portugal

This article analyzes how heteronormative discourse may be (re)produced by the very same people it serves to oppress, binding heteronormativity to a specific form of homonormativity. Furthermore, this article also links Portuguese history and society by discussing the context and the recent legal changes that led to legislation providing for same-sex marriage. Using thematic analysis of 14 interviews, this article demonstrates how heteronorms are upheld in the discourses of the lesbian, gay, bisexual, and queer (LGBQ) participants. Themes linked to public displays of affection and discrimination emerged from the interviews. Participant discourses are analyzed in terms of their incorporation of heteronorms. Homonormativity is present in both the themes subject to analysis. Analysis of the interviews shows how transgressing the heteronorm implies costs and is ultimately perceived as a personal risk. This article concludes that the lack of discursive resistance denies the possibility of re-signification and subversion even in LGBQ discourses. This clearly indicates the pervasiveness of discourses reiterating heteronorms, even those issued by those most oppressed by such norms.

Neurobiology in public and private discourse: the case of adults with ADHD

How do people describe their health? How do their descriptions relate to public definitions? This article focuses on adult attention deficit hyperactivity disorder (ADHD). We look at Dutch adults who adopt the ADHD label and ask: which discourses structure their descriptions of ADHD? How do these relate to the dominant public discourse on ADHD? Do people use, for example, neurobiological explanations of ADHD? The research makes use of Q-methodology, which combines a discursive relational approach with factor analysis. We examine five different personal discourses that partly differ from the public discourse. People borrow neurobiological, psychological, sociological and even holistic arguments from public discourse to come up with a distinct set of discourses. Neurobiology resonates among adults with ADHD but does not dominate their thinking. Contrary to our expectation, this supports reflexivity instead of discipline theory.

Treatment implications arising from a qualitative analysis of letters written by the nonoffending partners of men who have perpetrated child sexual abuse

There is a dearth of current empirical research exploring the experiences of nonoffending partners, or women whose partners have perpetrated child sexual abuse. Existing literature is dated and focuses disproportionately on intrafamilial abuse. This research explores how nonoffending partners construct and understand their experiences using thematic analysis within a social constructionist framework. Findings indicate that discovery of a partner's sexual offending is a profoundly distressing experience. It can inhibit a woman's ability to process the broader implications of her partner's behavior, including issues of risk, the impact on the victim, and the additional protective responsibilities she must adopt in the future. Implications for future research and clinical practice are discussed.