Thou Shalt Not Covet Another Man? Exploring Constructions of Same-Sex and Different-Sex Infidelity Using Story Completion

'Do I cry or just carry on?' A story completion study of healthcare professionals' anticipated responses to experiencing chest pain

Healthcare professionals may experience barriers to seeking healthcare that differ from the general population. We explored healthcare professionals' anticipated responses to experiencing chest pain following a period of stress using qualitative story completion method with healthcare professionals (n = 44). Data were analysed using reflexive thematic analysis, which identified three themes: '"Do I cry or just carry on?": A Culture of Suffering in Silence' identified worries that expressing health concerns would be perceived as weakness, with potential impact on career opportunities. Participants also described self-diagnosis and self-medication rather than help-seeking. '"Me? Have a panic attack?": Psychosomatic Shame' suggested mental health issues may be ignored due to stigma. '"We definitely don't take care of ourselves": Prioritising Pressures of Multiple Responsibilities over Self-care' identified real or perceived pressures to de-prioritise their health. Future research should explore the design of confidential, time efficient support for healthcare professionals that tackle cultural norms and barriers to self-care.

Compassionate Othering: the construction of refugee patients in medical students' narratives - a qualitative study using story completion

BACKGROUND

Refugees remain a marginalized population and are exposed to a variety of discriminatory processes, among them Othering which categorizes people as belonging or not-belonging according to certain ascribed characteristics. We explored how the narrative construction of refugee patients by medical students constitutes a form of Othering.

METHODS

Using story completion, 124 5th year medical students at the Martin- Luther- University Halle-Wittenberg in October 2019 wrote a fictional story in response to a story stem situated in a medical practice. In a comparative approach, one patient presenting with abdominal pain lacks further characterization (version A) and the other is a refugee (version B). The stories were coded using qualitative content analysis by Mayring with a focus on content and narrative strategies (plot structure and perspective).

RESULTS

We identified four themes: characters, medical condition, access to care and provision of substandard care. The stories were predominantly framed with a medical or an interaction-based plot structure and written from a process-oriented perspective. The themes in version B, supported by their use of narrative strategies, were largely contextualized within the patients' history of migration. An empathic depiction of patient B and the students' compassion for the patients facing substandard care were key motifs as well.

CONCLUSION

The perception of the version B patients predominantly as refugees establishes their construction as an Other. The students' compassion acts as a representation of societal inequalities and remains an inept response without the tools to counter underlying discriminatory structures. Based on a discourse of deservingness, compassion alone therefore perpetuates Othering and highlights the need for structural competency training in medical school.

Perpetrator Perceptions on the Emotions and Motivations Driving Technology-Facilitated Abuse in Relationships: A Story Completion Study

Technology-facilitated abuse in relationships (TAR) is a widespread social problem that has a significant impact on victim-survivors. Most contemporary evidence on TAR focuses on victim-survivor and practitioner perspectives rather than those of perpetrators who choose to enact this form of harm. Addressing this deficit, this study explored perpetrators' discourses on emotions and motivations associated with engaging in TAR. Using story completion method, 35 self-identified perpetrators of TAR completed story stems describing scenarios that may precede the use of abusive online behaviors. Reflexive thematic analysis generated three themes. Abusive behaviors and negative emotions speaks to maladaptive experiences of anger and/or sadness that can precede a decision to use TAR. A loss of trust, a desire for control describes potential motives for using TAR. Finally, inhibitors of abusive behavior investigates rationales perpetrators use for avoidance of TAR behaviors, suggesting avenues for working with perpetrators to refrain from using TAR. We conclude by discussing policy, practice, and research recommendations including strategies for technology designers and suggestions for primary prevention and response to TAR.

Qualitative Story Completion: Opportunities and Considerations for Health Research

Qualitative story completion (QSC) is an innovative research method that offers researchers a range of unique opportunities for generating and analysing data. Participants are asked to write a 'story' in response to a hypothetical 'story stem', often in the third-person and involving fictional characters, rather than reporting on their direct experiences. QSC is being developed and increasingly taken up by researchers working across a range of fields; but it has been little used in health research, especially in the fields of nursing, health services research, medicine, and allied health. This means that health researchers have few examples to draw on when considering what QSC can offer them and how to rigorously design, conduct, and report a QSC study within health-related fields. We aim to address this gap and contribute to existing QSC literature by promoting increased use of QSC by health researchers and supporting them to produce rigorous QSC research. We outline three case examples illustrating how we have used QSC to conduct multidisciplinary health research relevant to nursing, medicine and nutrition. Drawing on these case examples, we reflect on challenges that we encountered, describe decision-making processes, and offer recommendations for conducting rigorous health research using QSC.

'This bloody rona!': using the digital story completion method and thematic analysis to explore the mental health impacts of COVID-19 in Australia

OBJECTIVE

To use the digital story completion method to prompt participants to describe thoughts, fears and mental health experiences in response to a story stem about COVID-19, to capture a specific sociohistoric moment.

DESIGN

We used digital story completion, a qualitative research method, to gather narratives from Australians coping with physical distancing and social restriction measures. Our reflexive thematic analysis of the data was underpinned by a constructionist approach to reflect the importance of social context in understanding health experiences.

SETTING

Australia.

PARTICIPANTS

52 people living in Australia (aged 18 years and over).

RESULTS

Four meta-themes were prevalent across 52 stories submitted: (1) expressions of mental distress linked to COVID-19; (2) various coping strategies offered by characters in stories; (3) narratives outlining social support offered to alleviate distress; and (4) specialised COVID-19 vocabulary.

CONCLUSION

We cautiously propose that points of convergence across stories indicate a level of shared experience among participants relating to COVID-19 in Australia. We suggest this is due to intensive media coverage of the pandemic, persistent public health messaging, engagement with social media and instant messaging technologies, and extended lockdowns that impacted the mental health of vast numbers of Australians.

'The Internet Both Reassures and Terrifies': exploring the more-than-human worlds of health information using the story completion method

Lay people are now encouraged to be active in seeking health and medical information and acting on it to engage in self-care and preventive health practices. Over the past three decades, digital media offering ready access to health information resources have rapidly expanded. In this article, I discuss findings from my study that sought to investigate health information practices by bringing together the social research method of story completion with more-than-human theory and postqualitative inquiry. Narratives of health, illness and embodiment are powerful ways to portray people's experiences and identify the shared cultural norms and discourses that give meaning and context to these experiences. The research method of story completion is a novel approach to eliciting narratives that involve participants' responses to hypothetical situations. Participants were asked to use an online questionnaire format to complete three stories involving characters faced with a different health problem. This approach sought to identify the human and non-human enabling resources with which the characters engaged as they tried to address and resolve their problem, with a particular interest in how both digital technologies and non-digital resources were used. This analysis highlighted the affective and relational dimensions of humans' enactments of health, illness and embodiment. The stories surfaced the relations of sense-making, embodiment and care and how they are distributed between humans and non-humans. Agential capacities were closed off by elements such as too much information online creating confusion or anxiety, self-consciousness about the appearance of one's body, feelings of embarrassment and shame, or not wanting to appear to be too weak or vulnerable. Capacities for change, wellness and recovery were opened by finding helpful information, making connections with others and finding therapeutic spaces and places.

A linguistic analysis of future narratives in adolescents with Complex Regional Pain Syndrome and their pain-free peers

BACKGROUND

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that often develops after injury, with a typical onset in adolescence. The impact of chronic pain is far-reaching, with many adolescents reporting atypical developmental trajectories compared with peers. Social Comparison Theory offers a framework for understanding how such comparisons influence well-being, whereby a heightened sense of disparity places adolescents at risk of poor cognitive, affective and social outcomes. Using a novel linguistic analysis programme, this study aims to investigate cognitive, affective and social language used by adolescents with CRPS in comparison to their peers during a task reflecting on their futures.

METHODS

A story completion task was completed by adolescents with CPRS (n = 49) and adolescents without pain (n = 48). This task involved asking adolescents to describe their imagined future. Narratives were analysed using a novel linguistic analysis programme, focusing on the cognitive, affective and social dimensions.

RESULTS

Findings revealed significant group differences in how adolescents with CRPS described their imagined futures. Adolescents with CRPS used significantly fewer positive affect and more negative affect, anger and sadness words, and greater insight and discrepancy words. No significant groups differences were found for social words.

CONCLUSIONS

Substantial differences in cognitive and affective words were found between adolescents with and without CRPS. Findings provide novel insights into current understandings of cognitive, affective and social processes in adolescents living with chronic pain, particularly with regard to adolescent developmental trajectories, and may in turn highlight potential targets in psychosocial interventions for adolescents living with chronic pain.

SIGNIFICANCE

Social comparisons are commonly undertaken by adolescents with CRPS in relation to peers, increasing risk for poor cognitive, affective and social outcomes. Findings promote the potential importance of targeting psychosocial factors in treatments for paediatric chronic pain.

Loss-adjusting: Young People's Constructions of a Future Living With Complex Regional Pain Syndrome

OBJECTIVES

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that can present specific difficulties when occurring in adolescence. There is limited work exploring future narratives of healthy adolescents, and how these may differ for those who have chronic health conditions, but there is no research on the future narratives of adolescents who have CRPS.

MATERIALS AND METHODS

In this study, 50 adolescents (44 females, 5 males, 1 preferred not to say) aged 14 to 25 years (mean=19.8, SD=3.68), completed an online story completion task, with a further sample of 10 completing a follow-up telephone interview.

RESULTS

Story completion data were initially analyzed deductively based on the work of Morley and colleagues using hoped-for and feared-for future codes, revealing higher instances of hope (291 over 48 stories) than fear (99 over 27 stories). These codes were subsequently analyzed alongside the in-depth interview data using inductive thematic analysis, generating 2 themes that represent distinct, yet related, approaches of how adolescents incorporate CRPS into their future narratives: (1) the centrality of loss theme identifies the ways some adolescents described how CRPS brings loss, with narratives focused on how these adolescents imagine such losses continuing into the future, and (2) the adjusting to loss theme illustrates the ways other adolescents were able to imagine a future in which they were able to adjust to the losses which CRPS may bring.

DISCUSSION

CRPS may damage the future plans of adolescents. However, being or learning how to be flexible about these goals, may help them to build more positive future narratives.

Comprehensive sexuality education is 'not for us': Rethinking 'cultural relevance' through Young Tanzanians' identifications with/against intervention knowledge

The need for comprehensive sexuality education (CSE) to be culturally relevant and inclusive is increasingly recognised as a fundamental aspect of supporting young people to live healthy sexual lives. Nevertheless questions remain about how to represent cultures and difference without subtly reinforcing inequalities. This paper makes a case for the need to explore this issue through analyses of how different gendered and demographic groups of young Tanzanian attendees of culturally relevant CSE, identify with (or against) intervention knowledge[s]. Grounded in dialogical social psychological theorising, we present a methodological approach for exploring how processes of belonging and Othering structure young people's negotiations of culturally relevant CSE amongst other knowledges. An adapted version of the 'story completion' method was used with university students and urban-poor young people (aged 18-34) to instigate dialogues about how a fictional protagonist might think, feel, and act in their relationship, looking to see if, and how, young people incorporated CSE knowledge. Twelve single-gendered focus-group discussions were held in September 2014 with 48 young people, and then findings from these were discussed further with 27 returning young people through three mixed-gendered workshops in August 2015. The analyses highlight how young Tanzanians explicitly Other CSE interventions, positioning their knowledge as 'not for us'. More implicitly, difference is also constructed around ideas about change and gendered development, along with trust and support in relationships. The devices used to Other shifted and differed across demographic groups, ranging from complete denials of intervention knowledge to viewing it as unrealistic, dangerous, or self-stigmatised for not being able to use it. We propose that these findings highlight the need to rethink how both 'culture' and 'relevance' are conceptualised in CSE, most specifically necessitating greater recognitions of poverty, transnationality, and the lasting legacies of colonialism and behaviour change interventions that communicated through fear and morality.

Therapists' and non-therapists' constructions of heterosex: A qualitative story completion study

OBJECTIVES

Little research has examined the discourses that shape therapists' sense-making around heterosex. This paper explores the discourses of sexuality and gender underpinning therapists' and non-therapists' responses to a sexual experimentation scenario in a heterosexual relationship. It also considers the value of the novel technique of story completion (SC), in which participants are asked to write a story in response to a hypothetical scenario, for qualitative psychology and psychotherapy research.

DESIGN

This research used a comparative SC design (Kitzinger & Powell, 1995). Participants were sequentially presented with and invited to complete two story stems: one in which a male character suggested 'trying something new' to his female partner and one in which the female character made the suggestion. The stems were otherwise identical.

METHODS

A total of 100 SCs were written by 49 (28 female; 21 male) therapists and 51 (29 female; 22 male) non-therapists. Participants were recruited mainly via UK-based email lists and Facebook groups, and therapeutic training organizations, and the data were analysed using a feminist post-structuralist thematic analysis (Braun & Clarke, 2006).

RESULTS

Both groups of participants drew on heteronormative discourses of sexuality and gender to make sense of the stem. Engaging in sexual experimentation was often depicted as a demonstration of being normal. In some stories written by women, sex was framed as a site for negotiating 'equality' and reciprocity in relationships. Therapists were more likely than non-therapists to frame 'difficulties' within relationships as opportunities for personal growth and increased emotional depth, and their stories included greater emotional complexity.

CONCLUSION

These findings raise questions about practitioner training and whether it results in therapists drawing on narrow and restrictive discourses of heterosex in clinical practice.

PRACTITIONER POINTS

Training on sexual issues is largely absent from non-specialist practitioner training courses, which potentially means therapists are ill-equipped to respond to clients' anxiety about sexual issues. Evidence from this and other research indicates that therapists' sense-making around heterosexual sexual relationships is underpinned by narrow and restrictive discourses that entrench traditional gender relations and limit sexual agency. Psychologists are increasingly taking up positions of clinical leadership and are looked to for models of best practice. Drawing on theorizations of sexual difficulties, and of anxieties about sexual practice, that challenge traditional gender and heteronorms, and the commodification and medicalization of sex, is important for effective psychological leadership relating to the treatment of sexual issues and the furthering of social justice agendas.

Forgive and Forget?: Examining the Influence of Blame and Intentionality on Forgiveness Following Hypothetical Same-Sex Infidelity in the Context of Heterosexual Romantic Relationships

The present study investigated responses to imagined same-sex infidelity committed by a partner in a heterosexual relationship. The motivational theory of infidelity and research on communicative infidelity were used as guiding frameworks for exploring differences in perceptions of blame and intentionality as a result of varying motivations for engaging in same-sex infidelity (i.e., cheating due to attraction, experimentation, sexual preoccupation, sexual depression, sociosexuality, jealousy, vengefulness, or not viewing the infidelity as cheating). It was predicted that greater perceptions of blame and intent would be associated with more negative transgression-related interpersonal motivations (i.e., more revenge and avoidance; less benevolence) and an increased expectation of terminating the relationship due to the partner's same-sex infidelity. Whether these relationships would replicate or differ according to the partner's motive for committing the hypothetical same-sex infidelity was also tested. Results revealed that, in general and across motives, attributions of blame were positively associated with revenge, avoidance, and relationship termination; perceived intentionality was positively associated with avoidance; and blame was negatively associated with benevolence. Furthermore, across most motives, blame was indirectly associated with relationship termination through avoidance and benevolence, and these associations were not moderated by biological sex. These findings and their implications for research on infidelity specifically, and relational functioning more broadly, are discussed.

Accounting for Men's Refusal of Heterosex: A Story-Completion Study With Young Adults

In the present study we bring together theory regarding the construction of heterosexuality and masculinities to understand the shifting and changing terrain of heterosexual sex (heterosex). We use inductive qualitative content analysis of story completion data to discover the different ways that heterosex is constructed by the male and female respondents in scenarios where women initiate sex and men, at first, refuse. The stories represented a spectrum of responses that reify and subvert dominant understandings of heterosex. Five major themes were generated from the current data (1) men should initiate sex, (2) he wants to take it slowly, (3) it is natural for men to want sex, (4) it is men's job to look after women, and (5) coercion. We discuss in detail the dominant narratives described by women and men and how they may be shifting. The study thus provides a rich, experience-based representation of heterosexual sexual activity and suggests subtle shifts in how masculinity is managed within heterosexual relationships.