Socio-political context and accounts of national identity in adolescence

Psychological research into national identity has considered both the banal quality of nationalism alongside the active, strategic construction of national categories and boundaries. Less attention has been paid to the conflict between these processes for those whose claims to national identity may be problematic. In the present study, focus groups were conducted with 36 Roman Catholic adolescents living in border regions of Ireland, in which participants were asked to talk about their own and others' Irish national identity. Discursive analysis of the data revealed that those in the Republic of Ireland strategically displayed their national identity as obvious and 'banal', while those in Northern Ireland proactively claimed their Irishness. Moreover, those in Northern Ireland displayed an assumption that their fellow Irish in the Republic shared their imperative to assert national identity, while those in the Republic actively distanced themselves from this version of Irishness. These results suggest that for dominant ethnic groups, 'banality' may itself provide a marker of national identity while paradoxically the proactive display of national identity undermines minority groups claims to national identity.

Practicing the awareness of embodiment in qualitative health research: methodological reflections

Although the importance of the researcher's embodiment has been noted in health and social sciences research, in many instances, more attention has been paid to the embodiment of the researched. Thus, more in-depth analysis of the embodied researcher can illuminate qualitative inquiry. The influence of the embodied researcher became visible in a recent critical ethnographic study examining the negotiation of religious, spiritual, and cultural plurality in health care. In this article, we do not present research findings per se, but rather methodological reflections. As researchers, we highlight emotional and bodily ways of knowing and experiences of difference such as culture, race, and religion as embodied and a part of researcher-participant encounters. We aim to elucidate the awareness of being embodied researchers, and with this elucidation, we consider implications for knowledge generation for health and social sciences.

'Not of this world': the subjective experience of late-onset psychosis

OBJECTIVES

Psychosis with first onset after the age of 60 arising in the absence of dementia or primary affective disorder is thought to affect 2-4% of older people. Up to half will not respond fully to medication.The subjective experience of living with late-onset psychosis (LOP) has not yet been considered and this study represents a preliminary attempt to explore the subjective experience and psychological features of older people living with LOP.

METHOD

The study was conducted in Ireland. Seven participants between the ages of 67 and 87 years who met diagnostic criteria for very late-onset schizophrenia-like psychosis were interviewed using a semi-structured interview schedule. Participants spoke about previous life experiences as well as the experience of developing and living with LOP. Interpretative phenomenological analysis was used to identify common themes within their accounts.

RESULTS

Four themes emerged which reflected participants' subjective experiences of earlier life stages as well as their current experiences of LOP. Three interrelated themes described participants' experiences of social isolation, a solitary coping style and the experience of the self as 'different'. A final theme reflected participants' attempts to explain and find meaning in their psychotic experiences.

CONCLUSIONS

Results support the view that the experience of LOP emerges in the context of psychosocial vulnerabilities combined with adversities associated with the experience of ageing.

Fathers’ Views and Understanding of their Roles in Families with a Child with Acute Lymphoblastic Leukaemia

This study explored how fathers of children diagnosed with acute lymphoblastic leukaemia (ALL) perceived and understood the roles they had within their family over the course of their child’s illness and treatment. In-depth semi-structured interviews were conducted with five fathers. Transcripts were analysed using interpretative phenomenological analysis (IPA). The major themes that emerged were: adjusting to the diagnosis; the experience of maternal gate-keeping; striving for normalization; experiences of giving and receiving support. Overall, the fathers perceived themselves as having significant responsibility in helping their child and family cope with the illness experience. Clinical implications, including the need for professionals to recognize and more openly acknowledge the father’s position, are considered.

Reducing the health risks of severe winter weather among older people in the United Kingdom: an evidence-based intervention

Excess winter morbidity and mortality among older people remain significant public health issues in those European countries which experience relatively mild winter temperatures, particularly the United Kingdom (UK), Ireland, Portugal and Spain. In the UK, episodes of severe winter weather, when ambient temperatures fall below 5° C, are associated with peaks in general practitioner consultations, hospital admissions, and cardiovascular deaths among those aged over 65. While research indicates that such health risks could be substantially reduced by the adoption of appropriate behavioural strategies, accessible and credible advice on how older people can reduce risk during ‘cold snaps’ is lacking. This paper describes a programme of research that aimed: (a) to translate the relevant scientific literature into practical advice for older people in order to reduce health risk during episodes of severe winter weather; and (b) to integrate this advice with a severe winter weather ‘Early Warning System’ developed by the UK Met Office. An advice booklet was generated through a sequential process of systematic review, consensus development, and focus group discussions with older people. In a subsequent field trial, a combination of the Met Office ‘Early Warning System’ and the advice booklet produced behavioural change among older people consistent with risk reduction. The results also show that long-held convictions about ‘healthy environments’ and anxieties about fuel costs are barriers to risk reduction.

Exploring patient involvement in healthcare decision making across different education and functional health literacy groups

Education and health literacy potentially limit a person's ability to be involved in decisions about their health. Few studies, however, have explored understandings and experiences of involvement in decision making among patients varying in education and health literacy. This paper reports on a qualitative interview study of 73 men and women living in Sydney, Australia, with varying education and functional health literacy levels. Participants were recruited from a community sample with lower educational attainment, plus an educated sample of University of Sydney alumni. The transcripts were analysed using the 'Framework' approach, a matrix-based method of thematic analysis. We found that participants with different education conceptualised their involvement in decision making in diverse ways. Participants with higher education appeared to conceive their involvement as sharing the responsibility with the doctor throughout the decision-making process. This entailed verifying the credibility of the information and exploring options beyond those presented in the consultation. They also viewed themselves as helping others in their health decisions and acting as information resources. In contrast, participants with lower education appeared to conceive their involvement in terms of consenting to an option recommended by the doctor, and having responsibility for the ultimate decision, to agree or disagree with the recommendation. They also described how relatives and friends sought information on their behalf and played a key role in their decisions. Both education groups described how aspects of the patient-practitioner relationship (e.g. continuity, negotiation, trust) and the practitioner's interpersonal communication skills influenced their involvement. Health information served a variety of needs for all groups (e.g. supporting psychosocial, practical and decision support needs). These findings have practical implications for how to involve patients with different education and literacy levels in decision making, and highlight the important role of the patient-practitioner relationship in the process of decision making.

Mastectomy, body deconstruction, and impact on identity: a qualitative study

OBJECTIVES

This qualitative study aims at understanding the consequences of body deconstruction through mastectomy on corporality and identity in women with breast cancer.

DESIGN

Nineteen women were contacted through the hospital. All had to undergo mastectomy. Some were offered immediate breast reconstruction, others, because of cancer treatments, had no planned reconstruction. A qualitative reflexive methodological background was chosen.

METHOD

Women were invited to participate in three semi-structured interviews, one shortly before or after mastectomy, and the other interviews later in their illness courses, after surgery. All interviews were transcribed verbatim. Thematic analysis was performed. The analysis of the first interview of each woman is presented in this article.

RESULTS

Mastectomy provokes a painful experience of body deconstruction. Even when immediate reconstruction is proposed, contrasted feelings and dissonance are expressed when comparing the former healthy body to the present challenged body entity. Body transformations are accompanied with experiences of mutilation, strangeness, and modify the physical, emotional social, symbolic and relational dimensions of the woman's gendered identity. Although the opportunity of breast reconstruction is seen as a possible recovery of a lost physical symmetry and body integrity, grieving the past body and integrating a new corporality leads to a painful identity crisis.

CONCLUSION

With mastectomy, the roots of the woman's identity are challenged, leading to a re-evaluation of her existential values. The consequences of mastectomy transform the woman's corporality and embodiment, and question her identity. Psychological support is discussed in the perspective of our results.

Cultural orientation as a moderator of the relationship between Chinese American adolescents' discrimination experiences and delinquent behaviors

The purpose of this study was to examine the relationships among Chinese American adolescents' discrimination experiences, cultural orientations, and delinquent behaviors. Data were collected from three hundred and eleven Chinese American adolescents (58% girls) and their parents when the adolescents were 7th or 8th graders and again 4 years later. The data analyses demonstrated that adolescents' perceptions of discrimination and victimization experiences were significantly related to their delinquent behaviors conditionally based upon their cultural orientation. Specifically, adolescents' high Chinese cultural orientation amplified the negative impact of discriminatory experiences on delinquent behaviors whereas high Western cultural orientation protected them against that impact. The significance of both ethnic and mainstream cultural orientations for understanding ethnic minority adolescents' adjustment and improving their adjustment outcomes is discussed.

Transforming From Cocoon to Butterfly: The Potential Role of the Body in the Process of Posttraumatic Growth

The diagnosis of cancer has the potential to elicit positive change (posttraumatic growth [PTG]) through the experience of trauma and adversity. However, psychology and clinical practices and most recently positive psychology have been criticized for their indifference toward the influence of the body on positive psychological functioning. The aim of this study was to broaden the understanding of PTG, including its process and outcomes, using interpretive phenomenological analysis. Ten female breast cancer survivors, from an already existing study, participated in an individual, open-ended interview. These were transcribed verbatim and analyzed for themes that reflected the women’s experience of growing from adversity. The role of the body was found to be a vital component to the process and outcomes of PTG and was deconstructed into three smaller themes: fear of new body, negative effects of chemotherapy on the body (fatigue, loss of desire), and reconnection with body (cocoon to butterfly, listening to body, body as a barometer/monitoring). In addition, the analysis revealed how these 10 women perceived the body as an integral component to their self-identity and how this affected their achievement of PTG. Future research should begin to acknowledge and conduct further study into the neglected role of the body as a contributor or determinant of the PTG process.

From Practice to Praxis: Reconnecting Moral Vision with Philosophical Underpinnings

In this article, it is argued that in order to meet the profession's ethical and moral obligations, occupational therapists need to ensure that they are connected to the philosophical foundations of occupational therapy. By making occupational therapy practice occupation-focused, therapists guarantee that they provide a unique and valuable contribution to multidisciplinary teams and that they help to meet all the needs of patients. The findings from an action research study of 15 occupational therapists' practice in an urban Australian acute hospital setting are used to illustrate that occupational therapy practice can and should be occupation-focused.

Research data were gathered through audio-recording and transcribing individual interviews and research group meetings. The data were analysed qualitatively using non-linear formal and informal processes. The findings were as follows: having a clear professional vision increased the confidence of co-researchers; attending to patients' occupational needs increased the therapists' motivation to engage in more occupation-focused practice; and therapists felt increased satisfaction when their practice was occupation-focused. The article concludes by advocating that occupational therapists can be wiser and more ethical practitioners by engaging in praxis, a form of moral, reflective practice scholarship, particularly through participating in communities of practice that focus on understanding and developing ways of enabling occupation.

A qualitative exploration of communication within the community mental health team

This qualitative study sought to explore conceptual models employed by community mental health team (CMHT) staff in the care of their clients and how CMHT clinicians communicated with one another, particularly in relation to complex clinical work. The qualitative method of interpretive phenomenological analysis was used, and semistructured in-depth interviews with seven UK CMHT clinicians were conducted and analyzed. Four themes were evident in the data and showed that clinicians face complex and competing demands and draw on a range of therapeutic models in their work. It was also clear that much discussion centred primarily on pragmatic issues and lacked conceptual depth. The results underline the complex and challenging nature of CMHT work and suggest that a more systematic approach to interdisciplinary training within teams could be beneficial in increasing clinicians' knowledge, skills, and their understanding of the conceptual models used across different disciplines.

John Anderson's development of (situational) realism and its bearing on psychology today

In 1927, the Scottish philosopher John Anderson arrived in Australia to take up the chair of Philosophy at the University of Sydney. By the late 1930s, the "macrostructure" of his realist system was in place. It includes a theory of process and a substantial metaphysics, one that opposes positivism, linguistic philosophy and all forms of idealism. However, beyond Australia it remains largely unknown, despite its bearing on a number of current issues in psychology and the social sciences generally. This article outlines Anderson's transition from Hegelian idealism to realism, describes aspects of his ontology and epistemology, compares some of Anderson's ideas with Dewey's pragmatism and explains their relevance to present-day psychology.

Accounts of HIV seroconversion among substance-using gay and bisexual men

Statistical associations between substance use and seroconversion among gay and bisexual men abound. However, these associations often ignore men's own interpretations of their seroconversion. Using in-depth interviews with gay and bisexual men who reported using drugs or alcohol at the time of their seroconversion, we identify how these men explain the events that led to HIV transmission. Whereas a small minority of respondents reported substance use to explain their seroconversion, the majority reported three competing explanations. These participants claimed that they lacked sufficient knowledge about the behavioral risks that led to their seroconversion; that their decision to engage in unsafe sex was because of negative personal affect; and that they "trusted the wrong person." We link these findings to prevention and suggest that gay and bisexual men who use substances for recreational purposes will benefit from prevention efforts designed to address issues of gay and bisexual men rather than substance-using men.

Alkohol och äldre

M. Abrahamson: Old people's values and ideals in the public call for writing “Alcohol in my life”

The aim was to investigate how old people – who during their lives have experienced the displacement of drinking's moral border from soberness to moderate drinking – are presenting themselves, and their values, and attitudes towards alcohol. Thirty-one answers to the autobiographical question list “Alcohol in my life” from informants born between 1914 and 1930 were scrutinized using a qualitative thematic analysis. The results displayed two different repertoires for writing about the shifting experiences of alcohol during the life course: the sober repertoire and the moderate repertoire. Within the sober repertoire alcohol was important and abstention was an organizing principle for life. Within the moderate repertoire, however, alcohol was presented as natural and unimportant. In common for both repertoires was the significance of alcohol in the context of social intercourse. In the sober repertoire it was crucial to show the sobriety in such a way that it should not bother people around. In the moderate repertoire it was crucial to take part in the social drinking without seemingly being affected by alcohol and at the same time stress the personal lack of need for alcohol. Even though both repertoires were filled with moral values of right and wrong they were characterized by an absence of moralistic judgements of others’ alcohol habits, with the exception of young people's drinking habits. Then values appeared which put forward young people's life in former times as good examples.

Qualitative research on pain

PURPOSE OF REVIEW

This review brings together developments over the past year in pain research using qualitative methodologies. In line with the goals of the current biopsychosocial model of pain, such a research framework offers in-depth understanding of the experience of pain within its cultural, familial and socioeconomic environmental context.

RECENT FINDINGS

Using 'qualitative' and 'pain' as title and keyword Medline and CSA database searches, the pain literature revealed four main areas where qualitative studies have contributed significantly to knowledge development. These are: general chronic pain care: perspectives of patients and practitioners; pain experience across the lifespan; psychosocial aspects of back pain; and experience of underresearched conditions.

SUMMARY

The detailed insight into subjective experiences of the pain sufferer or healthcare provider offered by qualitative research can make important contributions to evaluating and improving practice and also in theory development.

Comparing views of patients, parents, and clinicians on emotions in anorexia

Patients with anorexia nervosa (AN) may experience difficulties in emotional processing that can adversely affect treatment and maintenance of the illness. Focus groups or questionnaires were undertaken with patients with AN, parents and clinicians, with the aim to explore the most salient issues pertaining to emotions and social cognition in AN. Qualitative thematic analysis was used to analyse the data. Seven primary themes were identified showing congruence across groups: ‘emotional awareness and understanding’; ‘emotional intolerance’; ‘emotional avoidance’; ‘emotional expression and negative beliefs’; ‘extreme emotional responses’; ‘social interactions and relationships’; and ‘lack of empathy’. Clinical and empirical implications are discussed.

Oh Stuff It! The Experience and Explanation of Diet Failure

Successful long-term weight-loss is exceptional, even with the best dietary and psychological interventions. Nomothetic accounts of diet failure focus on cognitive processes and emotional regulation. However, qualitative research suggests that successful dieters draw on wider understandings in explaining their success; this study extends this literature to address diet failure. Individual interviews with 10 self-selected UK dieters are analysed using IPA. Understandings of diet failure are explored and situated within wider cultural discourses. Five themes are identified: ‘Dieting mode’; ‘Multime’; ‘Not me’; ‘Modern life’; and ‘Challenges of emotional and social eating’. Implications for weight-loss interventions are explored.

Evaluation of workforce and organizational issues in establishing primary angioplasty in England

OBJECTIVE

To assess workforce and organizational issues in establishing a primary angioplasty service in England.

METHODS

Staff associated with the heart attack pathway at seven acute hospitals participating in the National Infarct Angioplasty Project (NIAP) completed a questionnaire, participated in focus groups and interviews, and observations were undertaken in catheter laboratories.

RESULTS

All seven hospitals implemented primary angioplasty though not all provided a 24-hour service. Hospitals varied in size, number of staff involved in the delivery of angioplasty and the volume of cases. Hospitals that developed the service by incremental expansion encountered more problems than hospitals that planned for a full service at the outset. Simple, direct access to a catheter laboratory reduced delays and could be facilitated by an angioplasty gatekeeper. Little attention was paid to later cardiac rehabilitation. Multiskilling and the ability to work across traditional professional boundaries appeared to provide substantial advantages. Building relationships with key staff and auditing the heart attack pathway were critical to successful service development. Differences in remuneration and rest for staff undertaking out-of-hours working threatened sustainability.

CONCLUSIONS

Primary angioplasty was feasible in varied settings and generally supported by staff. However, the participating hospitals were selected enthusiasts, only some implemented a 24-hour service and activity levels were relatively low. Organizational and workforce issues need to be addressed to achieve an efficient and sustainable service.

Thematic analysis and its reconceptualization as 'saliency analysis'

Thematic analysis is characteristic of most qualitative research. Themes are groups of codes that recur through being similar or connected to each other in a patterned way. Thematic analysis ignores codes that do not recur yet may nonetheless be important. This paper proposes the concept of 'saliency analysis' as an enhancement of thematic analysis. Saliency analysis assesses the degree to which each code recurs, is highly important or both. Codes of high importance are ones that advance understanding or are useful in addressing real world problems, or both. Thus saliency analysis can expose what is non-recurrent but potentially important to the aims of a study.

"My lung disease won't go away, it's there to stay": profiles of adaptation to functional limitations in workers with asthma and COPD

PURPOSE

Earlier research has shown that adaptation (i.e., the way in which employees cope with limitations resulting from their disease) is associated with sick leave. Our aim was to investigate signs of adequate or inadequate adaptation in employees with asthma and COPD.

METHODS

A Q-methodological study was carried out among 34 workers with asthma or COPD.

RESULTS

Four adaptation profiles were distinguished: the eager, the adjusted, the cautious, and the worried workers. The adaptation profiles provide insight into the different ways in which workers with asthma and COPD cope with their illness at work.

CONCLUSIONS

The adaptation profiles serve as a starting point for the design of appropriate (occupational) care. The eager workers experience little difficulties at work; the cautious workers may need assistance in learning how to accept their disease; the worried workers need reassurance, and may need reactivation; the adjusted workers deserve extra attention, and, when necessary, advice on how to live with their asthma or COPD.

Difficult incidents and tutor interventions in problem-based learning tutorials

CONTEXT

Tutors report difficult incidents and distressing conflicts that adversely affect learning in their problem-based learning (PBL) groups. Faculty development (training) and peer support should help them to manage this. Yet our understanding of these problems and how to deal with them often seems inadequate to help tutors.

OBJECTIVES

The aim of this study was to categorise difficult incidents and the interventions that skilled tutors used in response, and to determine the effectiveness of those responses.

METHODS

Thirty experienced and highly rated tutors in our Year 1 and 2 medical curriculum took part in semi-structured interviews to: identify and describe difficult incidents; describe how they responded, and assess the success of each response. Recorded and transcribed data were analysed thematically to develop typologies of difficult incidents and interventions and compare reported success or failure.

RESULTS

The 94 reported difficult incidents belonged to the broad categories 'individual student' or 'group dynamics'. Tutors described 142 interventions in response to these difficult incidents, categorised as: (i) tutor intervenes during tutorial; (ii) tutor gives feedback outside tutorial, or (iii) student or group intervenes. Incidents in the 'individual student' category were addressed relatively unsuccessfully (effective < 50% of the time) by response (i), but with moderate success by response (ii) and successfully (> 75% of the time) by response (iii). None of the interventions worked well when used in response to problems related to 'group dynamics'. Overall, 59% of the difficult incidents were dealt with successfully.

CONCLUSIONS

Dysfunctional PBL groups can be highly challenging, even for experienced and skilled tutors. Within-tutorial feedback, the treatment that tutors are most frequently advised to apply, was often not effective. Our study suggests that the collective responsibility of the group, rather than of the tutor, to deal with these difficulties should be emphasised.

A Qualitative Study of the Multiple Impacts of External Workplace Violence in Two Western Cape Communities

We explore the individual, organisational, familial, and community impacts of external workplace violence in a South African telecommunications company, as perceived and experienced by victims of such violence and the members of management mandated to manage and prevent it. Exposure to violence while working dramatically and directly affected the lives of the individual victims. Moreover, its impacts were felt across and within the organisational, familial, and community settings in which these individuals are located daily. The use of conventional crisis management strategies that are traditionally directed at addressing the individual impacts of trauma through specialised psychological interventions were perceived to be ineffective by all of the research participants. Our findings therefore call into question current understandings of the psychologist's role in managing violence in the workplace. Accordingly, ways of re-conceptualising the role and requisite skill set of psychologists working with or in organisations, where violence while working is an everyday reality, are suggested.

Diaries from cannabis users: an interpretative phenomenological analysis

This article is based on research, which aimed to uncover the meanings behind the experience of cannabis use. Six participants were recruited and asked to keep a diary for 15 days. Data were analysed using Interpretative Phenomenological Analysis (IPA). Four master themes emerged and were explored in detail. These were: 'Withdrawing from everyday life', 'Indulging in the here-and-now of the emotional body', 'The containment of the sacred space' and 'Living the addiction'. The author draws on the theoretical insights of Analytical Psychology in an attempt to capture and explain the dynamics emerging from participants' experiences. Throughout the narratives the use of cannabis, commonly regarded as a risky practice, appears to incarnate an attempt to reconnect with the here-and-now of the emotional body, as a way to escape from a convulsive consumeristic society. However, as the author argues, the lack of a conscious integration of the same convulsive consumeristic aspects within the psyche, leads participants into being ;possessed' by these same forces, ultimately leading to a repetitive and compulsive addictive behaviour.

A qualitative study of the acceptability of an intensive format for the delivery of cognitive-behavioural therapy for obsessive-compulsive disorder

OBJECTIVES

An intensive format may be both useful and effective for the delivery of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD). However, the acceptability of an intensive treatment format from the perspective of service users is unknown. This study examines service user perspectives on the acceptability of an intensive versus a standard weekly treatment format.

DESIGN

The study comprises a detailed comparative qualitative analysis of the perspectives of service users who have completed either intensive or weekly CBT for OCD.

METHODS

Six treatment completers in each format (matched for age, gender, and symptom changeover the course of treatment) were asked to reflect on helpful and problematic aspects of their treatment format, and to consider the differences between treatment formats. The interviews were transcribed and analysed in detail using thematic analysis.

RESULTS

Individual differences were apparent in preference for treatment format. Weekly treatment completers were concerned that intensive treatment could be overwhelming or too brief for real change to take place. However, intensive treatment completers valued the high pressure and pace and felt that it improved motivation, engagement, and eventual outcome.

CONCLUSION

An intensive treatment format for the delivery of CBT for OCD can be highly motivating and acceptable to service users who have chosen to undertake it. Good quality follow-up and crisis support may be particularly important following intensive treatment.

Adults with intellectual disabilities affected by cancer: critical challenges for the involvement agenda

Cancer incidence and prevalence in people with intellectual disabilities are poorly documented. Changing demographic patterns, however, mirror those in the general population with increased longevity leading to higher numbers of people developing cancer in the future. Little is known about the service and support needs of this group, but there is a precedent to understand their experiences to inform research and service development if appropriately tailored approaches are to be adopted. This article outlines a project that sought to develop an advisory forum of adults with intellectual disabilities affected by cancer, to inform the development of a research agenda. The process of this work is described alongside a critical appraisal of the tensions in involving people with intellectual disabilities as advisors on cancer research and practice. We discuss and challenge the underlying ideologies, which lie in the path of fully engaging with marginalized patients.

What do people with psychosis think caused their psychosis? A Q methodology study

BACKGROUND

A key component of cognitive therapy for psychosis is the development of a meaningful and shared formulation of the onset of the psychosis. Therapists bring an understanding of the development of psychotic symptoms based on theoretical models and try to marry these with the person's own experience and explanations. However, an important question is whether this understanding is compatible with the explanations held by the client.

AIMS

This study investigated what factors people believed led to the onset of their psychosis.

METHOD

A Q set of potential causes for psychosis was identified from a literature search and interviews with people with differing experiences of psychosis. From this, 58 potential causes of psychosis were identified. Twenty-one people who had experienced a psychotic breakdown then ranked these explanations as possible causes.

RESULTS

Using Principle Components Analysis four main factors were identified as perceived causal factors for the onset of psychosis. These factors were described as: a) drug usage; b) traumatic experiences in adulthood; c) personal sensitivity; and d) developmental vulnerabilities.

CONCLUSIONS

This study revealed that people with psychosis have different explanatory frameworks for the onset of their difficulties. This work is helpful as this effort to understand the person's own understanding of their problems is a first stepping stone towards a collaboratively generated formulation that may be helpful in building a therapeutic alliance, engagement in treatment, and ultimately in improved outcome. It is likely that these different explanatory frameworks could lend themselves to different treatment approaches.

A method for studying decision-making by guideline development groups

Background

Multidisciplinary guideline development groups (GDGs) have considerable influence on UK healthcare policy and practice, but previous research suggests that research evidence is a variable influence on GDG recommendations. The Evidence into Recommendations (EiR) study has been set up to document social-psychological influences on GDG decision-making. In this paper we aim to evaluate the relevance of existing qualitative methodologies to the EiR study, and to develop a method best-suited to capturing influences on GDG decision-making.

Methods

A research team comprised of three postdoctoral research fellows and a multidisciplinary steering group assessed the utility of extant qualitative methodologies for coding verbatim GDG meeting transcripts and semi-structured interviews with GDG members. A unique configuration of techniques was developed to permit data reduction and analysis.

Results

Our method incorporates techniques from thematic analysis, grounded theory analysis, content analysis, and framework analysis. Thematic analysis of individual interviews conducted with group members at the start and end of the GDG process defines discrete problem areas to guide data extraction from GDG meeting transcripts. Data excerpts are coded both inductively and deductively, using concepts taken from theories of decision-making, social influence and group processes. These codes inform a framework analysis to describe and explain incidents within GDG meetings. We illustrate the application of the method by discussing some preliminary findings of a study of a National Institute for Health and Clinical Excellence (NICE) acute physical health GDG.

Conclusion

This method is currently being applied to study the meetings of three of NICE GDGs. These cover topics in acute physical health, mental health and public health, and comprise a total of 45 full-day meetings. The method offers potential for application to other health care and decision-making groups.