Focus groups in health research: exploring the meanings of health and illness

External breast prostheses in post-mastectomy care: women's qualitative accounts

A good-quality external breast prosthesis and prosthesis-fitting service is an integral part of the recovery process post-mastectomy. However, this is an area of care that has minimal information or research available. The aim of this research was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. To ascertain women's own personal and subjective experiences, five focus groups with 47 women recruited through national cancer advocacy/support organizations and four Follow-up Breast Clinics throughout Ireland were conducted. As a result, five main themes emerged: (1) The fitting experience--Fitting? (2) Post-mastectomy products--Having? (3) Cost--Affording? (4) Information--Knowing? and (5) Adaptation--Accepting? The emerging themes pinpointed the impact of the fitting experience, fitting environment and the qualities of a prosthesis fitter on a woman's experience in obtaining a first or replacement breast prosthesis; the importance of the physical characteristics of the prosthesis and mastectomy bras; cost, affordability and entitlements; a lack of and perceived difficulty in getting information; and the myriad of personal and social impacts of a breast prosthesis for the woman. These findings are integral for the development of standards of practice in the fitting and supply of external breast prostheses in post-mastectomy care.

Chronic low back pain: Patients' experiences, opinions and expectations for clinical management

PURPOSE

To explore the experiences, opinions and treatment expectations of chronic low back pain (LBP) patients in order to identify what components of treatment they consider as being of most value.

METHOD

Three stand-alone focus groups were convened. All participants were experiencing chronic non-specific LBP (>3 months). Each group was facilitated by an independent moderator, and guided by a series of pre-determined questions. Participants were encouraged to freely air their personal opinions during the discussion. Transcribed data were organized into a series of 'categories' using the Qualitative Solutions for Researchers Nudist 6 package from which five common themes emerged.

RESULTS

Each participant had typically experienced a variety of failed treatment approaches. Whilst the value of advice and exercise was recognized, participants typically questioned the appropriateness of such treatment given the fact that a precise diagnosis was rarely given, and symptoms often recurred. As a result, poor adherence with advice and exercise appeared to be a key factor limiting the potential effectiveness of long-term self-management strategies.

CONCLUSIONS

Participants considered appropriate exercise (despite pain) and activity modification as important components for effective long-term self-management of symptoms. To enhance treatment effectiveness, participants welcomed the introduction of individually tailored advice and exercise programmes, with supervision and follow-up support, along with a better understanding of the physical and emotional impact of chronic LBP by practitioners.

The palliative care link nurse role in nursing homes: barriers and facilitators

AIM

This paper is a report of a study to explore link nurses' views and experiences regarding the development, barriers and facilitators to the implementation of the role in palliative care in the nursing home.

BACKGROUND

The delivery of palliative care in nursing homes is widely advocated; one approach is to develop the link nurse role to cascade good practice and training to nurses and other care staff to enhance patient care.

METHOD

A descriptive qualitative study was conducted with a purposive sample of 14 link nurses from 10 nursing homes in Northern Ireland during 2006. Three focus groups, composed of all Registered Nurses currently acting as link nurses in their nursing homes participated, and the data were audio recorded, fully transcribed and content analysed.

FINDINGS

The link nurse system shows potential to enhance palliative care within nursing homes. However, link nurses experienced a number of difficulties in implementing education programmes. Facilitators of the role included external support, monthly meetings, access to a resource file and peer support among link nurses themselves. Lack of management support, a transient workforce and lack of adequate preparation for link nurses were barriers to fulfilling this role.

CONCLUSION

Whilst palliative care link nurses can improve care for residents in nursing homes, consideration must be given to overcome the types of barriers identified in order to enable the link nurse system to function effectively.

'I know it is only exercise, but to me it is something that keeps me going': a qualitative approach to understanding mental health service users' experiences of sports therapy

The relationship between exercise and mental health is well documented and has led to the inclusion of exercise into the treatment of people with mental health problems. A qualitative (grounded theory) methodology, using focus groups, investigated the experiences of people with mental health problems, who had successfully participated in exercise as part of their treatment. The aim of this study was to investigate the experiences of service users who had successfully participated in sports therapy as part of their treatment. One of the researchers is also a service user who has participated in sports therapy and these experiences provided an insight into the research, especially in the design of the interview schedule, data collection (empathy with participants), and in the interpretation of the data. The dual role of service user and researcher is commended in contemporary mental health research and as such makes this study unique. A conceptual model is presented that explains the participants' subjective experiences, opinions, and perceptions of the role exercise has in their treatment, and their perceived outcomes from participation. The findings support sports therapy as an acceptable and beneficial adjunct to usual treatment for some people with mental health problems within the community, but that problems exist regarding knowledge and understanding of the theory underpinning its use.

Using photographs to capture women's experiences of chemotherapy: reflecting on the method

This article examines the value of using the photo-elicitation method for generating health-related narratives. Drawing on research in which women kept a photographic record of their experiences of chemotherapy treatment for breast cancer, this research explored how this method (a) produced elaborate accounts of illness experiences through an exploration of the process of representing experiences and through an interrogation of the images themselves; (b) allowed an opportunity to capture experiences over time and a way of capturing the past, which can then be reexplored from the present; (c) enabled patients to retain control over their images of themselves and how they choose to represent their experiences; and (d) provided a window into the private, everyday experiences of patients away from a health care setting.

Applying a feminist approach to health and human rights research in Malawi: a study of violence in the lives of female domestic workers

In this study, we responded to the human rights challenges posed in Malawi by burgeoning poverty, rapid urbanization, lack of employment opportunity for women, and AIDS-related morbidity and mortality as they affect young women in domestic service. Through focus groups and individual interviews with 48 female domestic workers, we examined violence from a postcolonial feminist perspective. In this article, we tell the story of how we operationalized our feminist science and forged relationships with Malawian women to identify the jeopardy they face and make steps toward an emancipatory change. We highlight substantive findings, but direct our focus to methodology, theoretical grounding, and implications for nursing research undertaken with vulnerable populations in the Third World.

Adolescents' psychosocial experiences living with asthma: a focus group study

INTRODUCTION

Asthma is influenced by and influences psychosocial experiences in adolescents. Therefore, the purpose of this study was to explore psychosocial experiences and coping strategies of a sample of adolescents with asthma based on their own accounts.

METHODS

Six focus group interviews were conducted in Central Virginia with 19 adolescents with asthma ages 12 to 18 years.

RESULTS

Three general descriptions of experiences with asthma were found in the data: "Doing less with more effort," "Missing out," and "Not all bad." Adolescents' negative emotions were compounded by perceptions of others' responses. Three coping strategies, "Toughening," "Guardedness," and "Modifying" also were identified.

DISCUSSION

Findings enhance understanding of particular patterns of psychosocial experiences in adolescents and lay a foundation for developmentally appropriate asthma interventions.

Irish nurses? and midwives? understanding and experiences of empowerment

AIM

This study explored conceptualizations of empowerment among Irish nurses and midwives.

BACKGROUND

Current literature on the meaning of empowerment lacks consensus. As a result there is a likelihood that empowerment will be conceptualized differently between managers and subordinates.

METHOD

In order to get a sense of how Irish practitioners viewed empowerment, 10 focus groups were held in locations throughout Ireland (n = 93). A national distribution of participants was obtained.

RESULTS

Twenty-one different responses emerged representing what nurses and midwives understood by the term empowerment. In relation to experiences of empowerment, six themes were found to impact on empowerment experiences. Three themes emerged as central to empowerment. One theme (education for practice) was identified as an antecedent to empowerment.

CONCLUSION

Empowerment is a complex concept and its meaning is contextually determined. Managers play a key role in impacting on the empowerment perceptions of Irish nurses and midwives.

The paradoxical reliance on allopathic medicine and positivist science among skeptical audiences

A number of studies have found an association between what people see, hear and read in the mass media and their corresponding actions and beliefs. This link has been demonstrated both at the micro and at the macro levels of analysis. However, when people are asked directly about the impact of mass media they tend to deny that they are personally affected. In fact, they tend to describe themselves as critical and skeptical media consumers. The purpose of this paper is to explore this contradiction through 12 in-depth focus group discussions undertaken in Ontario, Canada in 2004. Findings from the focus group interviews confirm earlier research in that people claimed that they were not susceptible to media influence. At the same time as they said that they took information from the mass media "with a grain of salt", they articulated sophisticated and nuanced accounts of how and why they evaluated some information as good and some as bad. In general they evaluated media stories on the basis of the values of allopathic medicine and positivistic science. Moreover, in the context of the focus groups and their explicit comments on their skepticism, they discussed health information from the magazine articles that they were given to read (on either HIV/AIDS, Alzheimer's disease, or a heart disease). Possible explanations for these paradoxical findings are discussed.

Developing a parenting skills-and-support intervention for mothers with eating disorders and pre-school children part 1: qualitative investigation of issues to include

OBJECTIVE

This study aimed to (i) identify themes and issues that might usefully be addressed in a skills-and-support intervention for mothers with eating disorders who have children less than 5 years of age, and (ii) determine the most appropriate format for such an intervention.

METHOD

Focus groups and individual interviews were conducted with seven mothers with eating disorders and pre-school children, and four local health professionals working with mothers of pre-school children.

RESULTS

Thematic analysis of interview transcripts revealed 10 themes: 'Passing on Traits', 'Food Preparation and Provision', 'Interactions Around Food and Mealtimes', 'Mother's Intake', 'Self Care', 'Self Identity and Parental Expectations', 'Impact on General Parent-Child Relationship', 'Need for Control', 'The Group Experience' and 'Practicalities and Format'.

DISCUSSION

Findings highlight a number of difficulties and concerns experienced by mothers with eating disorders who have pre-school age children. An intervention incorporating the identified themes could provide important support to this patient group and potential benefit to their offspring.

Using focus group results to inform preschool childhood obesity prevention programming

OBJECTIVE

This study about maternal feeding practices and beliefs was conducted as background for the development of a childhood obesity prevention program for multi-ethnic parents in the USA receiving services from a federal government supplemental nutrition program for low-income mothers.

DESIGN

Using a grounded theory approach, focus groups were conducted with low-income African American, white non-Hispanic (i.e. the majority Caucasian American population), Hispanic and Vietnamese parents to collect cross-cultural perspectives on: (a) infant and child feeding practices, (b) childhood overweight, (c) healthy dietary intake, (d) physical activity and inactivity, and (e) infant feeding information sources.

RESULTS

A content analysis of the data yielded three main themes common to all four groups: (a) lack of awareness of the relationship between increased physical activity and health, (b) the use of food to influence behavior, and (c) the loss of parental control over feeding when a child starts child care or school, and revealed perspectives on age-appropriate food, infant satiety, overweight and information sources that were specific to each group.

CONCLUSION

Interventions that enhance parent self-efficacy that build on themes that are specific to ethnic groups toward preventing childhood obesity are needed. There is also a need for culturally appropriate information for governmental nutrition programs that is in the client's own language and takes into account ethnic differences in beliefs and traditions.

Cross-cultural validation of expressed emotion in caregivers of Chinese patients with first episode psychosis in Singapore: a qualitative study

BACKGROUND

The concept of Expressed Emotion (EE; Brown et al., 1972), a measure of criticism, over-involvement and hostility in families, has been shown to be a robust predictor of relapse in schizophrenia (Parker & Hadzi-Pavlovic, 1990). Recent criticism of using Western instruments in Asian countries has led to more stringent procedures for validation of scales.

AIMS

The first aim was to establish that the concept of Expressed Emotion exists in Singapore. The second aim was to examine the Level of Expressed Emotion (LEE; Cole & Kazarian, 1988, Gerlsma & Hale, 1997) scale to ascertain the conceptual and construct operationalisation of this instrument in this culture.

METHODS

This was a qualitative study. The concept of EE was examined using a Singaporean population; 10 patient-caregiver pairs were recruited and interviewed using a semi-structured interview format. Regarding the LEE, small focus-group interviews were conducted with a cross-section of Singaporeans to gain their views on the concepts in the scale and the relevance of the items in this culture.

RESULTS

The interviews were analysed in light of attitudes found to discriminate between high and low EE families (Leff & Vaughn, 1985). A clear distinction between high and low EE groups was found. With regard to the LEE, the data from the focus groups, for the most part, supported the cross-cultural conceptual and operational equivalence of the scale and suggestions for additional items were made.

CONCLUSION

There is support for the existence of EE among families in Singapore, and the LEE was found, for the most part, to be applicable in Singapore, with the addition of several emic items.

Follow-up care for childhood cancer survivors: A focus group analysis

Follow-up of survivors of childhood cancer is recommended to improve detection of late-effects, and provide individuals with information and advice. This study aimed to follow-up survivors of childhood cancer and report on their attitudes to current follow-up methods. Twenty-six survivors (13-25 years) of childhood cancer and their parent(s) attended focus groups (n = 7) to discuss views about follow-up care. Transcripts were analysed using interpretative phenomenological analysis (IPA). Three themes were identified: strategies to achieve a normal life (through playing down possibility of late-effects or careful monitoring of health); expectations about follow-up (facts and information, advice about self-care, everyday living, and psychosocial consequences) and preferences for different models of care. Given that some families had reservations about the benefits of follow-up, it is important that services address survivors' interests and meet their expectations. Changes to service delivery must take account of individual needs and expectations. Possible limitations of focus group methods (recruitment, bias reduction, methods of analysis and influence of other participants' views) are discussed.

Breast cancer detection among older Latinas: is it worth the risk?

Fifty-eight Latinas participated in focus group interviews to assess their perceptions about screening to detect breast cancer (BC). Grounded theory methods helped uncover a cultural explanatory model that explained how cultural and psychosocial dynamics influence BC screening decisions. According to this model, Latinas generally perceived BC screening as a risky behavior. Three themes emerged that influenced the amount and type of perceived risks: feeling healthy (i.e., perceptions about the etiology of the illness and its nature), feeling indecent (i.e., the behaviors involved in screening), and feeling threatened (i.e., the anticipated consequences of BC detection). Screening was perceived as risky because of many personal and interpersonal consequences associated with detecting BC. Latinas' subjective assessment that detecting BC is too risky might influence their participation in screening procedures. Health education programs should aim at helping Latinas perceive that the early detection of BC is a life-saving benefit that outweighs its perceived risks.

One size fits all? Promoting condom use for sexually transmitted infection prevention among heterosexual young adults

The aims of this exploratory qualitative study were to increase our understanding of heterosexual young adults' knowledge and beliefs about sexually transmitted infections (STIs) other than HIV, to explore their beliefs about the factors that influence condom use for STI prevention, and to explore their ideas about how best to promote condom use for STI prevention. Data came from a qualitative study that used 11 group discussions with 53 heterosexual men and women aged 18-25. Respondents thought that STI infection and unplanned pregnancy were equally likely, but were less concerned about STIs than unplanned pregnancy. Respondents gave several reasons for their low levels of concern about STIs. They also suggested several means to promote condom use for STI prevention. They supported multi-faceted condom promotion campaigns, using multiple styles of communication and a variety of media. The range of suggestions given by participants suggests that rather than employing a 'one size fits all' strategy, a variety of different approaches are needed to promote condom use for STI prevention.

What about focus group interaction data?

The purpose of this article is to discuss issues related to group interaction data in focus groups. How should it be analyzed and reported? The author addresses these questions using qualitative research approaches with examples from her research to foster further discussion regarding focus group research.

Preventing HIV transmission in adolescents: an analysis of the Portuguese data from the Health Behaviour School-aged Children study and focus groups

BACKGROUND

There is recognition of the need to examine psychosocial and ecological determinants contributing to both risk and protective factors related to adolescents' sexual behaviour and HIV/AIDS.

METHODS

The study utilized mixed quantitative and qualitative methods. Data were collected from the Portuguese sample of the Health Behaviour in School-aged Children (HBSC) 2002. Based on these results, 14 focus group discussions were conducted.

RESULTS

A substantial minority of young people continue to engage in high-risk practices. Thus, female gender, older age, reporting easy to talk with father, not getting drunk and not getting involved in fights are significantly associated with protected sexual behaviour (using condom during last sexual intercourse). According to these results, being female and a comprehensive grade student are both related to a significantly more positive attitude towards infected people. It was concluded that these adolescents view sexual behaviour, sexual partners and condom use as elements within a complex script that governs heterosexual interactions. Several themes related to condom used emerged. Despite HIV/AIDS knowledge, young people underestimate their own risk of becoming infected with HIV. The majority of adolescents believe that HIV-infected people experience discrimination and social exclusion. Adolescents' opinions of HIV-infected people were mostly positive. Although most participants knew that HIV cannot be transmitted through social contact, undefined fears concerning the infection exist.

CONCLUSIONS

These findings have important implications for the implementation of a comprehensive programme on HIV/AIDS education in secondary schools.

The stresses of volunteering in a hospice: a qualitative study

OBJECTIVES

This study examined the stresses associated with hospice volunteering, ways of coping and perception of available support.

METHODS

Two focus groups were conducted comprising 17 volunteers. The data obtained were transcribed and analysed using thematic analysis.

RESULTS

Reported stressors included losing patients and dealing with disfigurement. However, informants generally reported the work as satisfying and generally stress-free. Coping strategies ranged from keeping a distance from clients, religious faith, to the realization that death was a merciful end and was not necessarily painful. Informants generally perceived support to be adequate.

CONCLUSIONS

The implications of these findings for training volunteers are discussed, especially the need to educate volunteers about the symptoms and signs of cancer.

Individualisation and inequalities in health: a qualitative study of class identity and health

It has been argued that social class, if not dead, is at least a 'zombie category' in contemporary Western society. However, epidemiological evidence shows that class-based inequalities have either persisted or widened, despite overall improvements in the health of Western populations. This article presents an exploratory qualitative study of the individualization of class identity and health conducted in a southern English city. Findings are presented in consideration of two competing argumentative positions around which participants worked to negotiate class identity and health. The first of these positions denied the significance of class for identity and health and was associated with the individualised heroic and stoic narratives of working class identity. The second position acknowledged the reality of class relations and their implications for health and identity, being associated with structurally and politically orientated narratives of middle class identity. In sum, resistance to class was associated with talk about individual, private experience whereas the acceptance of class was linked to discussion of health as a wider social or political phenomenon. This evidence lends qualified support to the individualization thesis: inequalities in health existing on structural or material levels are not simply reproduced, and indeed in some contexts may even juxtapose, accounts of social identity in interview and focus group contexts. Class identity and health are negotiated in lay talk as participants shift argumentatively back and forth between competing positions, and public and private realms, in the attempt to make sense of health and illness. The promotion of greater awareness and interest in health inequalities within wider public discourse may well help support attempts to tackle these injustices.

Focus groups in the design of prostate cancer screening information for Hispanic farmworkers and African American men

PURPOSE/OBJECTIVES

To gain a better understanding of men's everyday concerns as part of formative research for creating relevant prostate cancer screening education; to describe methods and processes used to conduct community-based focus groups.

SETTING

Community-based settings in catchment areas surrounding Tampa, FL.

SAMPLE

8 community-based focus groups: a total of 71 Hispanic farmworkers and African American men.

METHODS

Focus group discussions were tape-recorded, transcribed, and analyzed for identification of emergent themes.

MAIN RESEARCH VARIABLES

General life and health priorities, prostate cancer knowledge, screening attitudes, cancer beliefs, and learning preferences.

FINDINGS

Major themes among African American men were importance of work, family, and faith. Major themes among Hispanic farmworkers were importance of family, employment, education of children, and faith. A common issue that surfaced among most men was that a cancer diagnosis was considered to be a death sentence. Preferred learning methods included use of cancer survivors as spokespeople, interactive group education, and the provision of easy-to-understand information. Issues of trust, respect, and community involvement were key to the successful conduct of focus groups among ethnically diverse groups.

CONCLUSIONS

Study findings have important implications for the content of information developed for prostate cancer education materials and media.

IMPLICATIONS FOR NURSING

Insights gained from focus group methodology can help nurses and other healthcare professionals design and develop appropriate prostate cancer education tools for use in community-based prostate cancer screening programs.

Narrativity and the mediation of health reform agendas

Over the last two decades the repositioning of state-funded health systems and the increased use of private services have been the focus of extensive public debate. This paper explores the ways in which media coverage of healthcare reform is made sense of by lower socio-economic status (SES) audiences. We presented television documentaries to participants and analysed their accounts from focus group discussions following the viewing. We explore these discussions as shared social spaces within which participants work through the dilemmas posed by the reforms. In exploring reception as a storytelling process, we link audience and lay beliefs research and investigate how aspects of television coverage are appropriated by viewers to make sense of the causes and implications of healthcare reform.

Incorporating patients' views and experiences of life with IBS in the development of an evidence based self-help guidebook

To become active partners in chronic illness management, patients need relevant information which clearly explains treatment choices. This paper describes a method of producing information to feed into production of a guidebook for people with irritable bowel syndrome (IBS). Users were involved throughout the development process. Five focus groups were held involving 23 people with IBS out of 147 who responded to a newspaper article asking for help with a study of self-care in IBS. Qualitative analysis of transcripts from these meetings formed the basis of guidebook development. Patients described their experiences, coping strategies, experiences of the healthcare system, treatments and social consequences of the condition. Medical literature searches were made to find answers to identified areas of information need. The book includes direct quotes from patients describing their own experiences. Guided and practical ways of support are required for people with IBS who want to self-manage their condition.

Mental health support for youth offending teams: a qualitative study

The objective of the present study was to examine the views of professionals working in youth offending teams (YOTs) on a new model for providing mental health service support within the context of an interagency setting. Focus groups were used and data were analysed according to the constant comparative method. The setting consisted of two YOTs, one in an inner-city area and the other in a rural/semi-urban area, where primary mental health workers operate at the interface between YOTs and the specialist child and adolescent mental health services. Seventeen YOT professionals participated in four focus groups. Four themes were identified: previous experiences of specialist mental health services; issues of interagency working; the role of the primary mental health worker within the YOT; and recommendations for the future. Overall, the clinical component of the role (assessment and intervention), and the accessibility and responsiveness of the mental health staff were consistently valued, while there were mixed responses on role definitions within the team, consultation and training. It is concluded that mental health service provision through primary mental health workers is a useful model for interagency partnerships for high-risk client groups with multiple and complex mental health needs.

Young women's health concerns: revealing paradox

Because of the numerous physical, psychological, and social changes that take place for adolescents, the risk of engaging in life-threatening behavior is greater than at any other time in their life-span. Community workers identified the invisibility of adolescent women (ages 16-24) in their health-related programs and sought to rectify this. To discover the unmet health concerns of adolescent women, eight focus groups were held with a diverse group of adolescent women. Forty-two adolescent women, including adolescent mothers, women of color, attendees at a drop-in youth center, high school and university students, and employed persons participated. While most women attended one focus group, some participants attended two. Using Spradley's ethnographic method, we identified two overarching themes shared by the adolescent women. These themes included feeling invisible and struggling with independence. Our findings underscore the invisibility of adolescent women's lived experiences and concerns within most research agendas.

Patient perspectives on spirituality and the patient-physician relationship

OBJECTIVE

To identify the preferences and concerns of seriously ill patients about discussing religious and spiritual beliefs with physicians.

DESIGN

Three focus group discussions with patients who had experienced a recent life-threatening illness. Discussions were audiotaped, transcribed verbatim, and reviewed independently by two investigators to identify discrete comments for grouping into domains. A third investigator adjudicated differences in opinion. Comments were then independently reviewed for relevance and consistency by a health services researcher and a pastoral counselor.

SETTING

Academic medical center.

PARTICIPANTS

Referred sample of 22 patients hospitalized with a recent life-threatening illness.

MEASUREMENTS AND MAIN RESULTS

Almost all of the 562 comments could be grouped into one of five broad domains: 1) religiosity/spirituality, 2) prayer, 3) patient-physician relationship, 4) religious/spiritual conversations, and 5) recommendations to physicians. God, prayer, and spiritual beliefs were often mentioned as sources of comfort, support, and healing. All participants stressed the importance of physician empathy. Willingness to participate in spiritual discussions with doctors was closely tied to the patient-physician relationship. Although divided on the proper context, patients agreed that physicians must have strong interpersonal skills for discussions to be fruitful. Physician-initiated conversation without a strong patient-physician relationship was viewed as inappropriate and as implying a poor prognosis.

CONCLUSION

Religion and spirituality are a source of comfort for many patients. Although not necessarily expecting physicians to discuss spirituality, patients want physicians to ask about coping and support mechanisms. This exploratory study suggests that if patients then disclose the importance of spiritual beliefs in their lives, they would like physicians to respect these values.

"I would rather be size 10 than have straight A's": a focus group study of adolescent girls' wish to be thinner

The study aimed to investigate the body concerns of adolescent girls, together with the underlying motivations for the wish to be thinner. Focus group methodology was employed in order to access participants' experience in their own language. Altogether 67 girls of Year 11 (aged approximately 16 years) took part in five groups. Audiotaped and transcribed discussions were systematically coded for themes and rated on frequency, extensiveness, intensity, specificity and level of agreement. As expected, sociocultural influences, in particular the media, were reported as exerting the strongest pressures to be thin. More importantly, however, the girls displayed an unexpected sophistication in their conceptualization of the role of both media effects and body image in the construction of their self-image. Contrary to assumptions made in quantitative research, despite clearly articulating a desire to be thinner, the girls also described how this did not necessarily mean they were dissatisfied with their bodies. The findings suggest that the girls' meta-awareness and sophisticated understanding of the media and other pressures, may serve to moderate against these forces which would otherwise seem overwhelming.

Thinking differently about thinking positive: a discursive approach to cancer patients' talk

There is an extensive social science and psycho-oncology literature on coping with cancer which claims that "thinking positive" is correlated with--and, by extension, causally implicated in--individuals' morbidity and mortality rates, and their overall level of mental health. Drawing on our own data, in which groups of women with breast cancer talk about "thinking positive", this paper interrogates the basis of such claims from a discursive perspective, by challenging the data analyses upon which they are based. We show that previous literature overwhelmingly relies on self-report data, which are taken as offering more or less accurate depictions of speakers' psychological states (i.e. their mental adjustment or coping style). A discursive approach, by contrast, explores talk as a form of action designed for its local interactional context, and pays detailed attention to what statements about "thinking positive" actually mean for speakers in the contexts in which they occur. We show that "thinking positive" functions not as an accurate report of a internal cognitive state, but rather as a conversational idiom, characterised by vagueness and generality, and summarising a socially normative moral requirement; we also show that even those breast cancer patients who report "thinking positive" can also actively resist its moral prescriptions. Finally, we sketch out the implications of our analysis for analyses of cancer patients' talk more generally and for future research on coping with cancer.