An Interpretative Phenomenological Analysis of Participation in a Pro-anorexia Internet Site and Its Relationship with Disordered Eating

Coping with multiple sclerosis as a couple: 'peaks and troughs' - an interpretative phenomenological exploration

PURPOSE

Multiple Sclerosis (MS) is a chronic degenerative condition where illness uncertainty is a key difficulty that people with MS and their significant others have to cope with. Clinicians acknowledge that people with MS need to be seen in the context of their families, however there is little knowledge on what to expect about how people cope as a couple, which this study set out to explore.

METHOD

Interpretative Phenomenological Analysis (IPA) exploring, through semi-structured interviews, how seven couples, where one had MS, experienced coping with their situation.

RESULTS

Two overarching themes pertaining to coping as a couple emerged from the data: Coping Together: "Peaks and Troughs" and Coping Over the Long Haul, with each overarching theme relating to sub-themes. Two integrative themes emerged also, which were called Faith in Self and Faith in Each Other.

CONCLUSIONS

These results will assist clinicians better comprehend how those with MS and their spouses cope in an interconnected way and this in turn affects their experience of rehabilitation. Results from this research indicated that clinicians need to be sensitive to the individual coping strategies of both members of a couple where one has MS, and address the changing needs of their relationship.

Exploring Mental Health Service Users' Experiences of Social Inclusion in their Community Occupations

Introduction:

Social inclusion is a recent policy driver, which aims to develop fair access to opportunity for marginalised groups: a major goal in keeping with the values of occupational therapists. Evaluation of progress towards social inclusion includes listening to individuals' experiences of inclusion or exclusion in their local communities. This research aimed to explore the experiences of social inclusion for mental health service users when engaged in everyday community occupations and to identify possible factors that influenced the service user experience.

Method:

Eight in-depth interviews with mental health service users were carried out, using interpretative phenomenological analysis to recount participants' life world perspectives.

Findings:

The findings revealed three themes: the outside experience, which described features of the social, physical and economic environment that influenced inclusion; the internal disability, which described features within participants themselves that influenced inclusion; and an active lifestyle, which described how features of occupation influenced inclusion. Feelings of inclusion or exclusion were predominantly linked to the response received from others, which was at times stigmatising and hostile.

Conclusion:

Given the negative impact of the reactions of society, occupational therapists need to prioritise working with local communities to facilitate their capacity to support social inclusion, as well as focusing on individual skill acquisition.

Review of extracting information from the Social Web for health personalization

In recent years the Web has come into its own as a social platform where health consumers are actively creating and consuming Web content. Moreover, as the Web matures, consumers are gaining access to personalized applications adapted to their health needs and interests. The creation of personalized Web applications relies on extracted information about the users and the content to personalize. The Social Web itself provides many sources of information that can be used to extract information for personalization apart from traditional Web forms and questionnaires. This paper provides a review of different approaches for extracting information from the Social Web for health personalization. We reviewed research literature across different fields addressing the disclosure of health information in the Social Web, techniques to extract that information, and examples of personalized health applications. In addition, the paper includes a discussion of technical and socioethical challenges related to the extraction of information for health personalization.

Quand le poker cesse d’être un jeu

Cet article fait état d’une enquête portant sur une communauté électronique de joueurs de poker, qui échangent ensemble en ligne au sujet de leurs pratiques et habitudes de jeu. L’analyse du contenu des échanges qui prennent place dans le forum vise à éclairer le rapport particulier qu’entretiennent ces aspirants joueurs professionnels de poker avec le jeu ainsi que le rôle que joue la fréquentation d’un espace électronique de joueurs en regard du rapport qu’ils entretiennent avec le jeu. L’article montre que la pratique de ces joueurs est pensée comme un parcours, dans lequel on joue maintenant dans le but de s’améliorer pour devenir un jour un joueur gagnant. L’article trace les contours du cadre disciplinaire dans lequel les joueurs envisagent le jeu et se penche sur les principes qui fondent les règles auxquelles ceux-ci disent vouloir s’astreindre en vue de devenir des « joueurs gagnants ». L’analyse révèle en outre la caractère structurant de l’opposition entre « poissons » et « bons joueurs » dans les représentations et discours des joueurs qui fréquentent le forum et montre enfin que la participation à ces échanges permet aux joueurs de se retrouver entre eux, autour d’une même conception marginale du jeu, alors même que leur entourage semble plutôt susceptible de s’inquiéter de leurs habitudes de jeu et du rapport qu’ils entretiennent avec le poker.

Understanding the experience of ambivalence in anorexia nervosa: the maintainer's perspective

People with anorexia often feel ambivalent about whether they wish to maintain it or recover from it. One place where individuals can communicate their experiences of wanting to maintain their anorexia is through pro-anorexia websites. This study investigated the experiences and understandings of those who wish to maintain their anorexia and looked at how these understandings may affect their treatment experiences. Data were collected online and analysed using interpretative phenomenological analysis (IPA). Anorexia denoted meanings of a 'tool', an 'entity' and a 'disease'. Participants felt ambivalent about whether their anorexia gave them control or controlled them, whether it played a positive or negative role and whether they wished to maintain their behaviours or recover. Participants also discussed barriers to recovery. Theoretical and treatment implications are discussed.

e-Ana and e-Mia: A content analysis of pro-eating disorder Web sites

OBJECTIVES

The Internet offers Web sites that describe, endorse, and support eating disorders. We examined the features of pro-eating disorder Web sites and the messages to which users may be exposed.

METHODS

We conducted a systematic content analysis of 180 active Web sites, noting site logistics, site accessories, "thinspiration" material (images and prose intended to inspire weight loss), tips and tricks, recovery, themes, and perceived harm.

RESULTS

Practically all (91%) of the Web sites were open to the public, and most (79%) had interactive features. A large majority (84%) offered pro-anorexia content, and 64% provided pro-bulimia content. Few sites focused on eating disorders as a lifestyle choice. Thinspiration material appeared on 85% of the sites, and 83% provided overt suggestions on how to engage in eating-disordered behaviors. Thirty-eight percent of the sites included recovery-oriented information or links. Common themes were success, control, perfection, and solidarity.

CONCLUSIONS

Pro-eating disorder Web sites present graphic material to encourage, support, and motivate site users to continue their efforts with anorexia and bulimia. Continued monitoring will offer a valuable foundation to build a better understanding of the effects of these sites on their users.

Seeking support: An interpretative phenomenological analysis of an Internet message board for people with Complex Regional Pain Syndrome

In this article, we report on the findings of a qualitative inquiry into how an online message board for people who have Complex Regional Pain Syndrome (CRPS) was used by its members. All messages (and responses) posted on the CRPS message board over a 4-month period were collected retrospectively. The data were analysed using the method of Interpretative Phenomenological Analysis. Members used the message board to seek (and provide) support to those with CRPS, and also to express their emotions, feelings and experiences linked to their condition. The message board provided an important source of support for a patient group that can otherwise become isolated as a result of their mobility problems. Furthermore, the analysis revealed the unrealistic hopes that patients can hold concerning the anticipated outcomes of their treatment. This is an important issue for healthcare professionals to explicitly address when interacting with the patient group.

Interpersonal interactions on online forums addressing eating concerns

OBJECTIVE

Although some research suggests that online eating disorder forums promote "pro-eating-disorder" lifestyles and discourage recovery, other research suggests that such forums are an important source of interpersonal support. The current study extends this research by exploring the positive and negative behaviors encouraged on these forums and by comparing forum members' perceptions of support received from online and offline relationships to support received in relationships of age-matched controls.

METHOD

In a survey of 60 forum members, we assessed information exchanged and support provided on eating disorder forums. Further, we assessed perceptions of social support for general and specific life concerns in this group of forum members as well as 64 age-matched university controls.

RESULTS

Results show that both adaptive and maladaptive behaviors are encouraged on the forums, and that this encouragement has some influence on forum members trying out these behaviors. Overall, forum members reported receiving less support for their eating concerns as compared to their general life stressors, and they perceived less support for both their general concerns and eating concerns in their offline relationships as compared to their online forum relationships. Moreover, forum members reported receiving less support from their offline relationships as compared to support received in relationships by age-matched controls.

DISCUSSION

Forum members perceive less support in their important relationships than other peers do, and they seek out and participate in forums as a means of attaining greater social support. However, our research suggests that these forums also encourage dysregulated eating behaviors. Implications of online forum support and its impact on recovery are discussed further.

Viewership of pro-anorexia websites in seventh, ninth and eleventh graders

OBJECTIVE

To examine the prevalence of visiting pro-anorexia websites by 13-, 15- and 17-year old adolescents and to explore correlates of visiting such websites and predictors of anorexia nervosa (AN).

METHOD

Questionnaire in a sample of 711 secondary school children from the 7th, 9th and 11th grade in Flanders, Belgium.

RESULTS

12.6% of the girls and 5.9% of the boys had visited such websites. In girls, visiting pro-anorexia websites was associated with a higher drive for thinness, worse perception of appearance and more perfectionism.

CONCLUSION

The prevalence of visiting pro-anorexia sites is non-trivial and the significant correlations between viewership of pro-ana sites and predictors of AN suggest a potential for negative impact of exposure to pro-ana sites. We conclude with some speculative remarks on the potential threat of the existence of pro-ana sites to organized health care.

Pro-anorexia websites: what a clinician should know

OBJECTIVE

The purpose of this study was to conduct a content analysis of the "Tips and Tricks" section of pro-ana websites to better understand information shared on these sites, and aide clinicians in identification, treatment, and prevention of anorexia.

METHOD

Nine pro-ana websites were evaluated to identify categories of information in "Tips and Tricks." A content analysis was performed using emergent coding methods and 16 categories were determined. Reliability was acceptable (Cohen's Kappa = 0.702). Discrepancies were corrected by consensus. Frequencies of individual categories were computed.

RESULTS

Most "Tips and Tricks" are directed at dieting/restricting calories (28.6%) and distraction (14.0%). Most disturbing, 11% of comments were directed at lying and concealing symptoms.

DISCUSSION

Clinicians aware of "Tips and Tricks" might be better equipped to recognize the symptoms of anorexia early in treatment. Knowledge of "Tips and Tricks" can also facilitate better education, making it difficult for clients to conceal their illness.

Asperger's syndrome: differences between parents' understanding and those diagnosed

This paper reports on a content analysis of blogs written by people with Asperger's syndrome (AS), as well as people who are parents and caretakers of people with AS. The paper documents that the views of the two groups, based on 30 blogs from each perspective, are frequently oppositional to one another. Whereas the parents and caretakers usually accept the medical definition of the situation and seek assistance and a cure for their children, the Aspies argue against this pathologizing and medicalizing perspective. Those diagnosed with AS say they are happy with who they are and that any suffering they may have undergone has been the result of society and not inherent in their condition. The paper concludes with a discussion of the theoretical, methodological, substantive, and practical implications of these findings.

What does viewing a pro-anorexia website do? An experimental examination of website exposure and moderating effects

OBJECTIVE

This study experimentally examined the effects of viewing a pro-anorexia website.

METHOD

Following construction of a prototypic pro-anorexia website, 235 female undergraduates were randomly assigned to view either the pro-anorexia website or one of two comparison websites related to female fashion (using average-sized models) or home décor. Post-website affect, cognitions, and behavioral expectations were examined along with moderator effects.

RESULTS

Study participants exposed to the pro-anorexia website had greater negative affect, lower social self-esteem, and lower appearance self-efficacy post-website than those who viewed a comparison website. Additionally, they perceived themselves as heavier, reported a greater likelihood of exercising and thinking about their weight in the near future, and engaged in more image comparison. Minimal support was found for moderator effects.

CONCLUSION

Results provide an empirical basis for concern (expressed by clinicians, researchers, the media) that pro-anorexia websites are a troubling new form of thin-ideal exposure that warrants further examination.

Inside the "pro-ana" community: a covert online participant observation

A covert participant observation was conducted into the meanings of interaction in the "pro-ana" online community. Specifically, the researchers were interested in the kind of psychological support offered by such websites and by the beliefs of community members towards eating disorders and the processes of treatment and recovery. One of the authors joined a number of pro-ana sites in the guise of a plausible persona and experienced a variety of responses from community members, some extremely hostile, others very supportive, yet without ever being exposed as an interloper. These starkly different responses challenge the notion of a broad "pro-ana" philosophy, suggesting that the sites are best understood as local cliques offering temporary relief from offline hostility, but it is doubtful whether they can be said to possess any therapeutic value beyond the immediate online context.

Surfing for thinness: a pilot study of pro-eating disorder Web site usage in adolescents with eating disorders

OBJECTIVE

Pro-eating disorder Web sites are communities of individuals who engage in disordered eating and use the Internet to discuss their activities. Pro-recovery sites, which are less numerous, express a recovery-oriented perspective. This pilot study investigated the awareness and usage of pro-eating disorder Web sites among adolescents with eating disorders and their parents and explored associations with health and quality of life.

PATIENTS AND METHODS

This was a cross-sectional study of 698 families of patients (aged 10-22 years) diagnosed with an eating disorder at Stanford between 1997 and 2004. Anonymous surveys were mailed and offered in clinic. Survey content included questions about disease severity, health outcomes, Web site usage, and parental knowledge of eating disorder Web site usage.

RESULTS

Surveys were returned by 182 individuals: 76 patients and 106 parents. Parents frequently (52.8%) were aware of pro-eating disorder sites, but an equal number did not know whether their child visited these sites, and only 27.6% had discussed them with their child. Most (62.5%) parents, however, did not know about pro-recovery sites. Forty-one percent of patients visited pro-recovery sites, 35.5% visited pro-eating disorder sites, 25.0% visited both, and 48.7% visited neither. While visiting pro-eating disorder sites, 96.0% reported learning new weight loss or purging techniques. However, 46.4% of pro-recovery site visitors also learned new techniques. Pro-eating disorder site users did not differ from nonusers in health outcomes but reported spending less time on school or schoolwork and had a longer duration of illness. Users of both pro-eating disorder and pro-recovery sites were hospitalized more than users of neither site.

CONCLUSIONS

Pro-eating disorder site usage was prevalent among adolescents with eating disorders, yet parents had little knowledge of this. Although use of these sites was not associated with other health outcomes, usage may have a negative impact on quality of life and result in adolescents' learning about and adopting disordered eating behaviors.