Therapeutic landscapes and living with breast cancer: The lived experiences of Thai women

Effective and ineffective psychological adjustment in breast cancer patients before receiving neoadjuvant chemotherapy: insights from a cohort study

BACKGROUND

The timing of a breast cancer (BC) diagnosis has a significant psychological impact on patients. However, it reported that those eligible for treatment regimens based on neoadjuvant chemotherapy may experience high levels of depression, anxiety and distress. To cope with this situation, patients deploy psychological coping strategies. The aim of this study is to explore effective and ineffective psychological adjustment mobilized by Moroccan patients newly diagnosed with BC and before receiving neoadjuvant chemotherapy, as well as to identify their associations to socio-demographic and clinical determinants.

MATERIALS AND METHODS

A total of 209 patients were recruited in outpatient in oncology department in the public oncology hospital of Fez city, between 2021 and 2023. Ethics approval was obtained for this study and patients has signed an informed consent form. The questionnaire interview included socio-economic and clinical variables and the Arabic version of Mini-Mental Adjustment to Cancer (Mini-MAC) scale, which measures the strategies of mental adjustment to disease, as fighting spirit (FS), hopelessness/helplessness (HH), anxious preoccupations (AP), cognitive avoidance (CA), fatalism (FA), "maladaptive coping" and "adaptive coping". Bivariate analysis of psychological adjustment strategies and sociodemographic and clinical variables was carried out using statistical tests according to the nature of the variables, to their normality and the homogeneity of their variances. Univariate and multivariate linear regression modelling was carried out using a forward "enter" regression procedure.

RESULTS

A mean age of 47.43 ± 9.45 was found among participants. Assessment of mental adjustment to cancer using Mini-MAC scores revealed that psychological adjustment strategies with a higher mean score were FA, FS and "adaptive coping" strategies. Based mainly on multiple linear Regression, monthly family income was negatively associated with HH, and FS and positively linked to FA and "adaptive coping" strategies. Moreover, the left side as BC laterality was negatively associated with AP and "maladaptive coping" strategies. Furthermore, positive ER status was negatively associated with HH and "maladaptive coping" strategies and high Ki-67 levels were positively linked to AP.

CONCLUSION

Programs to strengthen psychological adjustment in patients with BC candidates for NACT, taking into consideration the determinants found associated in this study, are of great importance since the first oncology consultation.

"We Need to Go Back Home (to) the Philippines Healthy": An Interpretive Phenomenological Analysis of Migrant Domestic Workers' Experiences of Having Breast Cancer in Hong Kong

Diagnoses of breast cancer are continuing to increase in the Philippines, but little is known about incidence rates among the significant number of Filipino women working abroad as migrant domestic workers (MDWs). These women are often the main income providers for their families, and their ability to work depends upon their physical health and strength. In this article, we use interpretive phenomenological analysis to explore the experiences of 10 MDWs from the Philippines who were diagnosed with breast cancer during a period of employment in Hong Kong. Analysis of these narratives revealed numerous points at which their status as temporary, transnational migrant workers intersected with their experiences of breast cancer detection, diagnosis, and treatment. We argue that these women's experiences of breast cancer were shaped by the structures of migration that link the Philippines with host destinations like Hong Kong. These structures create a unique context in which these women had to constantly renegotiate their identities as migrants, financial providers, and breast cancer patients.

Women's experiences with breast cancer during diagnosis and therapy, Wolaita, Ethiopia: a qualitative study

BACKGROUND

Breast cancer is the most common cancer in women and the most frequent cancer worldwide. After being diagnosed with breast cancer, women experience unexpected and stressful events. In Ethiopia, specifically in the study area, the experiences of women with breast cancer, the challenges they face during treatment and follow-up have not been thoroughly investigated.

OBJECTIVE

This qualitative study explores the experiences of women diagnosed with breast cancer and undergoing therapy at a University-based hospital in Ethiopia.

METHODS

A qualitative research design was used, to explore the experiences of women diagnosed with breast cancer and undergoing therapy. A purposively selected sample of ten women who had been diagnosed with breast cancer and were receiving therapy was recruited. Recruitment was conducted from August 1 to September 30, 2022. Semi-structured face-to-face interviews were conducted to collect data on their experiences. The interviews were transcribed verbatim, and a thematic analysis approach was employed utilizing open coding. The coded data were then analysed to reveal important insights and understandings about the participants' experiences with breast cancer during the diagnosis and therapy journey.

RESULT

The thematic analysis of the data revealed four prominent themes: women's mixed emotions, characterized by a sense of high threat and hope upon receiving breast cancer diagnosis results; dealing with the changes, both physical and psychological, that the cancer and its treatment bring about in women's bodies and emotional well-being; dealing with the challenges associated with accessing therapy, including unfavourable hospital conditions and financial hardship; and experiencing care and supports from health care providers, family and friends, and faith-based communities.

CONCLUSION

These findings underscore the importance of providing comprehensive support and care for women with breast cancer. Enhancing the hospital environment, addressing resource shortages, and prioritising patient well-being are crucial steps towards improving the experiences of breast cancer patients in the study area.

"This family and the Games are my world": Conceptualizing the British and European Transplant Games as therapeutic landscapes

The first Transplant Games took place in 1978 in Portsmouth, England. Since then, numerous Olympic-style sporting 'Games' have been established, each aiming to increase public awareness of organ donation, demonstrate the benefits of transplantation, and encourage patient fitness. Despite this, there is limited research exploring the psycho-social and health impacts of the Games. Drawing on qualitative research conducted at the 2022 British Transplant Games and the 2022 European Transplant and Dialysis Games, this paper explores the Games through a therapeutic landscapes framework, a concept that examines the ways in which environments contribute to health and wellbeing. Building upon work that acknowledges the relational and contingent nature of health-in-place, I argue that the Games are a therapeutic landscape of social relations for transplant recipients in three ways: providing a landscape of belonging, a landscape of hope, and a landscape of motivation. Through this therapeutic landscapes perspective, the Transplant Games are presented as a peer-to-peer clinic - a care space where individuals are more actively involved in their health on a reciprocal level than in the traditional hospital clinic. In turn, this paper emphasises the crucial role of affective peer support in producing health-promoting environments. This research seeks to make a practical contribution to the wider transplant community by promoting the Games as an environment which may positively contribute to both physical and mental wellbeing.

Concerns and coping mechanisms of breast cancer survivor women from Asia: a scoping review

PURPOSE

The incidence of breast cancer has increased significantly in Asia due to epidemiological transition and changes in human development indices. Advancement in medical technology has improved prognosis with a resultant increase in survivorship issues. The effects of breast cancer diagnosis and treatment are influenced by the patient's cultural beliefs and social systems. This scoping review aims to summarise concerns and coping mechanisms of women with breast cancer in Asia and understand gaps in the existing literature.

METHODS

We performed a scoping review using the population-concept-context strategy. A systematic search of MEDLINE (PubMed, Web of Science), CINAHL, SCOPUS, and Embase was conducted for studies conducted in Asia on women diagnosed with breast cancer, identifying their concerns and coping mechanisms, published between January 2011 and January 2021. Data from included studies were reported using frequencies and percentages.

RESULTS

We included 163 studies, of which most (81%) were conducted in hospital settings. Emotional and psychological concerns were reported in 80% of studies, followed by physical appearance and body-image concerns in 46%. Social support (59%), emotion-based coping (46%), spirituality, and problem-based coping (37%) were the major coping systems documented.

CONCLUSION

The mapped literature documented that anxiety, depression, and fear of cancer recurrence dominated women's emotional concerns. Women coped with the help of social support, positive reappraisal, and faith in God and religion. Sensitization of caregivers, including healthcare professionals and family members, to context-specific concerns and inquiry into the patients' available support systems is essential in strengthening breast cancer women's recovery and coping.

Benefits of nature-based walking for breast cancer survivors

INTRODUCTION

Physical activity (PA) promotes significant physical and psychosocial benefits for breast cancer survivors. While evidence exists regarding recommendations for the frequency, duration and intensity of exercise that optimise PA benefits for cancer survivors, the role of the environment in achieving optimal outcomes has yet to be determined. This paper presents a protocol for a clinical trial to evaluate the feasibility of a 3-month nature-based walking programme for breast cancer survivors. Secondary outcomes assessed include the impact of the intervention on fitness, quality of life outcomes, and biomarkers of ageing and inflammation.

METHODS AND ANALYSIS

The trial is a 12-week single-arm pilot study. Twenty female breast cancer survivors will engage in a supervised moderate intensity walking intervention in small groups in a nature reserve for 50 minutes three times per week. Data will be collected at baseline and end of study, and include assessment of inflammatory cytokines and anti-inflammatory myokines (TNF-α, IL-1ß, IL-6, CRP, TGF-ß, IL-10, IL-13), as well as ageing (DNA methylation, ageing genes) biomarkers; surveys (Patient-Reported Outcomes Measurement Information System-29, Functional Assessment of Cancer Therapy-General, Post-Traumatic Growth Inventory); and fitness assessments (6 min Walk Test, Grip-Strength, One Repetition-Maximum Leg Press). Participants will also complete weekly surveys assessing social support and participate in an exit interview. This is an important first step for future research on the influence of exercise environment on cancer survivor PA outcomes.

ETHICS AND DISSEMINATION

This study was approved by the Cedars Sinai Medical Center Institutional Review Board (IIT2020-20). Findings will be disseminated through academic manuscripts, conferences, and community presentations.

TRIAL REGISTRATION NUMBER

NCT04896580.

The lived experience of surviving from the Islamic State attack and capture in Iraq and Syria: An arts-based qualitative study with Yazidi young women

BACKGROUND

In August 2014, the Islamic State in Iraq and Syria (ISIS) attacked the Sinjar district and destroyed several villages and towns and killed several individuals.

AIM

In this study, the Yazidi young women who survived the ISIS attack were encouraged to express their lived experiences through paintings following participation in a 6-month art-based intervention program.

METHODS

A total of 13 Yazidi Kurdish females aged 18 to 25 years (Mean: 21.7 years) were invited to participate in an art-based (drawing and painting) course for 6 months in 2018. They were invited to draw or paint images that portrayed their lived experiences of attack and capture by the ISIS. Qualitative research situated within feminist methodology was used with the young women in this study. The interviews were analyzed using the descriptive content analysis method.

RESULTS

The paintings and narratives of the participants were constructed into three main themes: fear and traumatic experiences; feeling of hopelessness; and freedom and hope. During the attack and capture, due to the escape, rape, and horrific treatments by the ISIS fighters, the young women were traumatized severely. They were sold as a sex slave by the ISIS fighters. The participants still had severe anxiety and psychological challenges after being free from the capture. However, despite their traumatic experiences and feeling of hopelessness, most of them were hoping for freedom and a better future.

CONCLUSIONS

This study showed that the Yazidi young females still experienced psychological challenges burdens even 3 years after the traumatic day. However, the participants showed their resilience through feeling hopeful for freedom and a better future.

Enabling care: Maggie's centres and the affordance of hope

This study explores the role of architecture in the affordance of hope for people with cancer. Specifically, it revisits 'enabling places' debates to understand the influence of spatial design in the experience of cancer care. Combining interviews and focus group data from two separate studies of visitors, volunteers, and staff members of Maggie's Centres, an organisation providing cancer support in the UK and internationally, the study investigates the emotional power of their buildings. In particular, we explore how Maggie's Centre buildings provide material, social, and affective resources for their users. We argue that Maggie's Centres help its visitors to orient themselves to their changing lives and uncertain futures in thoughtful ways and, thus, their buildings offer examples of the 'taking place' of hope.

Landscape Perception and the Importance of Recreation Areas for Students during the Pandemic Time

The landscape and its perception influence the quality of life of a local community. Recreation areas bring a lot of benefits to society, also in terms of mental health. Open space and contact with nature, particularly during a crisis such as the pandemic, help alleviate the effects of the lockdown and social isolation. The study objective was to determine whether and to what extent the COVID-19 pandemic influenced the importance of recreation areas and the perception of landscape among students-a social group that experiences mood disorders increasingly often and has been severely affected by the lockdown. A survey was conducted in two stages, using a Google Forms online survey. A total of 381 students from universities in Lublin participated in the survey. The survey showed that the significance of recreation areas increased during the pandemic. The perception of landscape changed as well: the value of nature, scenic views, and the therapeutic effect of the landscape began to be appreciated to a greater extent. The survey results indicate the need to ensure the diversity of green areas and improve their accessibility. Designing these areas should also consider quiet areas as well as ensuring green mobility and places of recreation.

Processes underpinning survival in gay men living with HIV and a history of suicidality

Gay men living with HIV represent a particularly high risk group for suicide; however, little is known about suicidality, specifically, resiliencies in the context of suicidality among this particular group of men. The current study draws on photovoice and grounded theory methods to examine the processes that underpin survival for gay men living with HIV who have experienced suicidality. Twenty-two Canadian-based gay men participated, taking photographs to depict and discuss their perspectives on resiliencies. Analyses revealed three processes that supported men's survival: (1) connecting to key supports, (2) finding sanctity in the outdoors, and (3) giving help as purposeful value-adding. Connecting to key supports highlighted the utility of connection and therapeutic communication, listening and support provided by friends, family and professionals. Finding sanctity in the outdoors emphasised the healing capacity of outdoor green spaces, and giving help as purposeful value-adding illustrated the meaning and purpose men derived from supporting others. These findings can inform public health and primary care interventions to foster gay men's resilience and coping, and ultimately suicide prevention efforts.

Enhancing the Health and Well-Being of People with Chronic Diseases: Assessment and Sustainable Development Planning for Therapeutic Landscapes after Urban Expansion

Under the influence of economic, environmental, and social structural changes, urban space expands and contracts to varying degrees and the everyday urban landscape changes in response. Over the past 20 years, a large number of cities in China have undergone a brief but rapid urban expansion and are moving toward shrinking cities. Most of these cities are now facing social problems such as an aging population and a high prevalence of chronic diseases. Therefore, the “therapeutic” role and impact of everyday landscapes in these cities need to be examined in the context of urban development processes through appropriate assessment methods. Therefore, this study applies the ANP-mV model to examine the therapeutic nature of everyday urban landscapes in different development periods, with the aim of enhancing the health and well-being of people with chronic diseases. Firstly, this study uses the city of Jinzhou in Northeast China as an example to develop a framework for assessing the therapeutic nature of everyday urban landscapes based on the health care needs of people with chronic diseases; secondly, it examines the therapeutic nature of the former Jinzhou Suburban Riverfront Forest Park as it has developed and evolved over the past 16 years; finally, it explores place-making and regeneration strategies for therapeutic landscapes from the perspectives of dynamic impact and sustainable development to enhance chronic illness patients' well-being. At the theoretical level, this study contributes by providing a methodology and research ideas for examining the “therapeutic” nature of everyday urban landscapes and proposing further development plans for renewal, constructing a framework for assessing therapeutic landscapes, and elucidating the relationship between networks of influence and the relative importance of various assessment dimensions/elements. At the practical application level, the contribution of this study is to provide local policymakers with a key decision basis for the future development planning of the East Lake Forest Park. The aim is to explore landscape creation and regeneration strategies for the East Lake Forest Park in the context of Jinzhou's progressive move toward a shrinking city, in order to sustain the well-being of the chronically ill.

Psychological response of children to home confinement during COVID-19: A qualitative arts-based research

BACKGROUND

The evidence has shown that children are more susceptible to the emotional effects of traumatic events such as outbreaks with the possible disruption in their daily lives.

AIM

In this paper, we discussed the psychological wellbeing of children during the COVID-19 outbreak through the art-based qualitative study using the drawing method among children in Iraqi Kurdistan.

METHODS

In this qualitative arts-based research study, 15 children aged 6 to 13 years old who were confined at home during the COVID-19 outbreak for at least 1 month were included following obtaining the consent from their parents. The children were asked to draw his/her feelings, reflections, and responses during the COVID-19 on a paper. The children were guided to paint their reflections during the COVID-19 based on the following criteria: if they experienced loneliness, tiredness, insomnia, depression, worry or anxiety, or have behavior changes and their relationship with their parents and other siblings.

RESULTS

This study showed that children have a high level of stress at home during the COVID-19 outbreak. The children had great fear about the coronavirus. They experienced loneliness and stress, and felt sad, depressed due to home confinement and social distancing. The possibility of infection by coronavirus has occupied their entire mind. Mental health care providers must take the experiences of children who are caught in this global pandemic seriously and ensure that appropriate care is offered to the children and their parents.

CONCLUSIONS

The children exhibited a strong feeling of distress, loneliness, and fear during the COVID-19 outbreak. This has implications for mental health care.

A review of psychological impact of breast cancer in women below 50 years old

A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.

Therapeutic landscape experiences of everyday geographies within the wider community: A scoping review

As community dwelling populations of older people and those living with chronic and life limiting conditions continue to grow, the role of everyday geographies, particularly of community based settings and activities, in supporting health and wellbeing has become a focus in both research and policy development. The therapeutic landscape scholarship provides a holistic view of how place promotes health and wellbeing, and has in recent years expanded its focus from reputable places of healing to everyday geographies. Based on a scoping review of 45 studies on everyday community based therapeutic landscapes, this paper identifies and critically examines the settings, populations and mechanisms of therapeutic experiences. It presents critical summaries of the scales and boundaries of landscapes; the diverse and dichotomous characteristics of places; the therapeutic benefits of proximal and distal socio-spatial interactions; the role of everyday settings and activities as sources of refuge, anchor and resonance and finally the broader social, cultural, political and economic contexts in which everyday therapeutic landscapes are embedded. In so doing the paper highlights the complex nature of everyday therapeutic landscape experiences and how this research can further inform the development of community based settings and activities that promote health and wellbeing. It also identifies areas for future research on everyday therapeutic landscapes.

Evaluating the literature of therapeutic landscapes with an emphasis on the search for the dimensions of health: A systematic review

Health geography emphasizes landscape capacity as a perspective for examining health dimensions. Much of this emphasis is on the concept of therapeutic landscapes. In the last two decades, changes in the therapeutic landscapes concerning health, as well as why and how the development of the emphasis on the dimensions of the health in the landscape in proportion to the temporal-spatial course of literature in this field can be considered. The framework of the present study is based on a systematic review of therapeutic landscapes in the geography of health in the last two decades. This systematic literature review followed the PRISMA guidelines. Searching for "Therapeutic Landscapes" term at Science Direct and PubMed, screening, 56 eligible articles were selected in the journal Social Science and Medicine, and Health and Place. The results of the systematic review, aiming to search for the health dimensions of the therapeutic landscape, and recognize main gaps, identified three main issues: scale and range of users of therapeutic landscapes, the position importance of experiences in therapeutic landscapes, therapeutic landscapes as the holistic paradigm. The results of the research show that in recent years, attention to multiple dimensions of health, especially non-physical relationships of therapeutic landscapes and multiple dimensions of health, has been considered more and more by researchers. Personal-social perceptions and experiences are also continually evolving, so the concept of therapeutic landscapes and its relationship to health is considered living and dynamic.

Health, Wellness, and Place Attachment During and Post Health Pandemics

Therapeutic landscapes encapsulate healing and recovery notions in natural and built environmental settings. Tourists’ perceptions determine their decision making of health and wellness tourism consumption. Researchers struggle with the conceptualization of the term ‘therapeutic landscapes’ across disciplines. Drawing on extant literature searched in nine databases, this scoping review identifies different dimensions of therapeutic landscapes. Out of identified 178 literature sources, 124 met the inclusion criteria of identified keywords. We review the contribution and the potential of environmental psychology in understanding tourist behavior to promote health and wellness tourism destinations in a post COVID-19 context. We develop and propose a conceptual framework comprising: (1) perceived goodness of therapeutic landscapes, (2) health and wellness consumption, (3) COVID-19 pandemic perceived health and wellness risk, (4) place attachment, and (5) re-visitation. We propose measurement scales and discuss implications and major issues in the immediate and post the COVID-19 pandemic to inform future research.

Symptom Burden and Unmet Support Needs of Patients With Parkinson's Disease: A Cross-Sectional Study in Asia-Pacific Regions

OBJECTIVES

Support care is rarely assessed and offered to people with long-term neurologic conditions, particularly Parkinson's disease. This study aimed to assess the symptom burden and unmet support care needs in people with mild to severe Parkinson's disease.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Patients with Parkinson's disease were recruited from neurologic outpatient clinics from 3 East and Southeast Asian regions, including Hong Kong, Taiwan, and Thailand.

METHODS

A standardized set of questionnaires assessing unmet care needs [Palliative care Outcome Scale (POS)], disease-specific symptom burden (POS-Symptoms-Parkinson's Disease), generic health-related quality of life (HRQOL) (EQ-5D-3L), and sociodemographic and clinical background.

RESULTS

Completed questionnaires (n = 186) were collected from 64 Hong Kong Chinese, 64 Taiwanese, and 58 Thai patients. Their mean age was 67.23 ± 8.07, 54% were female, and 80% had mild-to-moderate disease. Their mean POS score was 10.48 ± 6.38, indicating moderate unmet support needs. Two-thirds of the participants rated constipation, fatigue, leg problem, and daytime somnolence as the most prevalent and burdensome symptoms. Patients from Hong Kong and Taiwan prioritized psychosocial and spiritual support, whereas Thai patients prioritized physical needs and emotional concerns. Multivariate adjustment for demographics and clinical characteristics showed that high psychological, spiritual, and practical burdens are associated with young age, male gender, and advanced disease stages.

CONCLUSIONS AND IMPLICATIONS

Patients experience significant symptom burden and moderate unmet support needs at the early to middle stage of Parkinson's disease. Routine assessment of changes in symptom burden should start early. The timely referral of support care services should provide appropriate psychospiritual and practical support in addition to motor training. Planning for support care services should consider cultural and health service contexts.

Self-Efficacy for Coping with Breast Cancer in North-Eastern State of Peninsular Malaysia

OBJECTIVE

To determine the level of self-efficacy for coping with breast cancer among Malaysian women and its association with socio-demographic and clinical variables.

MATERIALS AND METHODS

This cross-sectional study involved 168 women diagnosed with breast cancer. The inclusion criteria were age >18 years old, having histologically confirmed breast cancer, and being diagnosed between January 1, 2009 to December 31, 2012. The exclusion criteria were being illiterate and having cognitive impairment. For data collection patients' medical records and the Cancer Behaviour Inventory-Brief (CBI-B) Malay version questionnaire were used. Simple and multiple logistic regression methods were used to analyse the data.

RESULTS

Patients' mean (SD) age was 51.4 (10.8) years old. Most of the patients were Malays, married, diagnosed at stage 2 breast cancer (41%), and completed their breast cancer treatment. The mean score for self-efficacy for coping with breast cancer was 83.67 (95% CI: 81.87, 85.47). The significant factors positively correlated with self-efficacy for coping with breast cancer were higher educational background and a higher family income. However, factors such as a family history of breast cancer and breast surgery reduced the mean score of self-efficacy for coping with breast cancer.

CONCLUSION

The mean score of self-efficacy for coping with breast cancer in this study was moderate. Self-efficacy for coping with breast cancer in Hospital Universiti Sains Malaysia was not adequate among sufferers and improvement is needed probably by providing education to these patients.

From Liminality to Vitality: Infant Feeding Beliefs Among Refugee Mothers From Vietnam and Myanmar

Infant feeding in traditional (non-White societies) is imbued within beliefs surrounding the human body and food. This article, framed within the liminality theory, demonstrates perspectives of 38 Vietnamese and Myanmarese refugee mothers. Situated within the postmodern methodological framework, innovative methods of in-depth interviewing and drawing were used to gather participant's subjectivities. As birthing renders the new mother and infant weak, the findings mirror a "liminality to vitality" nurturing continuum, acknowledging the (a) essentialism of bodily breast milk, (b) rituals that strengthen mothers for lactation, (c) lactation-inducing food, and (d) culturally symbolic non-milk food that promote an independence for nourishment other than from the maternal body. Health care professionals are called to value the importance of bodily vitality in birthing and clinical maternal-child health/nutrition spheres so that culturally specific services and consultations are rendered. Our findings also offer a platform to developing models of care for families from Vietnamese and four ethnic Myanmarese communities.

"I'm a foreigner there": Landscape, wellbeing and the geographies of home

The experience of migration brings particular challenges for wellbeing, especially as an individual's sense of disconnection from previous homes can persist over many years. This paper reports on how visitors to a Chinese community centre in NW England reflected upon their experiences of being uprooted from their homelands, even in cases where they had lived for more than half of their lives in the UK. Memories of their previous homelands were persistently called upon in understanding their sense of belonging and cultural identities in the present. We use their accounts in dialogue with recent theories of landscape, especially those that argue for an understanding of place as embodied, ambivalent and in a continual process of making and re-making, in order to trace memories of home in contemporary cultures of wellbeing.

Experiences of young mastectomised Colombian women: An ethnographic study

OBJECTIVE

To explore the experiences of a group of young women in relation to the reconstruction of their breasts after mastectomy.

METHOD

Focused ethnography, performed in the League against Cancer- Huila Section (Colombia). Through casual sampling oriented by criteria, semi-structured interviews were conducted with eight young women (diagnosed at 45 years or earlier) with breast cancer (reconstructed or not reconstructed after mastectomy) until saturation of discourse. Data collection was carried out between August-November 2017, after the endorsement of the Ethics Committee and the consent of the participants. Data was analysed using the thematic analysis technique after being anonymised.

RESULTS

Three issues emerged in the women's discourses: The social stigma of being a young woman with breast cancer; learning to live with a body transformed by disease and treatment, and surviving, which is the most important thing.

CONCLUSIONS

Being a young woman, and suffering from breast cancer implies a diversity of changes that permanently alter the lives of women and their bodies. Women prioritise survival in order to take care of others over breast reconstruction. At a healthcare level, the cultural and gender perspective must be incorporated to design individualised nursing interventions that contribute to better care.

Putting the "where" in HIV care: Unpacking narratives of antiretroviral therapy adherence among HIV-Positive men who have sex with men

This study explores the spatial constitution of adherence to antiretroviral therapy (ART) by recasting therapeutic landscapes (Gesler, 1992) and how it structures the exercise of expressive agency (Bowden, 2014). Engagement in antiretroviral therapy among HIV-positive men who have sex with men (MSM) is contextualized within the discursive-materiality of emplaced assemblages for HIV Care in the Philippines. Combining qualitative data from field visits and semi-structured interviews, three key spatial narratives were derived illustrating how adherence to ART unfolds in place: (a) an unwelcoming treatment hub, (b) an unsafe and safe home, and (c) a constraining workplace. The results illustrate the spatial, multilayered barriers to ART adherence proposing insights for the theorization of adherence as an emplaced process and the implications of using of place-based interventions in resource-limited countries beyond the discourse of free service and availability.

Postpartum breastfeeding experiences in the traditional-biomedical crossroads: A qualitative study using drawing with Vietnamese and Myanmarese refugee women in Australia

AIMS

To explore how postpartum support networks, hospital stay and healthcare services had an impact on breastfeeding experiences of refugee women from Vietnam and Myanmar in Brisbane, Australia.

DESIGN

A qualitative study guided by feminist methodological inquiry.

METHODS

Semi-structured interviews and drawing exercises were conducted with recent (<10 years) and established (≥10 years) refugee women between July 2015 - June 2016. Verbal data were analysed thematically, whereas drawings were analysed with the critical visual analytical framework.

RESULTS

The findings reflect how 36 mothers negotiated their breastfeeding experiences in the "traditional-biomedical" intersection (major theme) in face of changing support networks, social structures, hospital policies and postpartum services postresettlement (sub-themes). Tensions of cultural unfamiliarity in the western setting generally contributed to early breastfeeding cessation among recent arrivals, whereas social (extended families, tertiary education) and cultural (English literacy) capitals and a longer stay in Australia enabled established arrivals to integrate the traditional and western biomedical beliefs.

CONCLUSION

The ability of established arrivals to integrate both traditional and western worldviews may assist in addressing breastfeeding uncertainties that affect recent arrivals. Perspectives of midwives from the western postnatal spheres merit future exploration.

IMPACT

Positive early breastfeeding experiences lead to its long-term success. By identifying the impact that conflicting beliefs have on breastfeeding experiences of refugees in the western biomedical environment, this study suggests how interventions that focus on reinforcing maternal cultural and social capital could benefit community empowerment, healthcare and policy sectors nationally and globally.

Walking groups for women with breast cancer: Mobilising therapeutic assemblages of walk, talk and place

Walking is widely accepted as a safe and effective method of promoting rehabilitation and a return to physical activity after a cancer diagnosis. Little research has considered the therapeutic qualities of landscape in relation to understanding women's recovery from breast cancer, and no study has considered the supportive and therapeutic benefits that walking groups might contribute to their wellbeing. Through a study of a volunteer-led walking group intervention for women living with and beyond breast cancer (Best Foot Forward) we address this gap. A mixed-methods design was used including questionnaires with walkers (n = 35) and walk leaders (n = 13); telephone interviews with walkers (n = 4) and walk leaders (n = 9); and walking interviews conducted outdoors and on the move with walkers (n = 15) and walk leaders (n = 4). Questionnaires were analysed descriptively. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Our study found that the combination of walking and talking enabled conversations to roam freely between topics and individuals, encouraging everyday and cancer-related conversation that created a form of 'shoulder-to-shoulder support' that might not occur in sedentary supportive care settings. Walking interviews pointed to three facets of the outdoor landscape - as un/natural, dis/placed and im/mobile - that walkers felt imbued it with therapeutic qualities. 'Shoulder-to-shoulder support' was therefore found to be contingent on the therapeutic assemblage of place, walk and talk. Thus, beyond the physical benefits that walking brings, it is the complex assemblage of walking and talking in combination with the fluid navigation between multiple spaces that mobilises a therapeutic assemblage that promotes wellbeing in people living with and beyond breast cancer.

Longitudinal effect of emotional processing on psychological symptoms in women under 50 with breast cancer

Breast cancer is a potential traumatic event associated with psychological symptoms, but few studies have analysed its impact in under-50 women. Emotional processing is a successful function in integrating traumatic experiences. This work analysed the relationship between emotional processing and psychological symptoms during three phases of treatment (before hospitalization, counselling after surgery and adjuvant therapy) in 50 women under the age of 50 with breast cancer. Mixed-effects models tested statistical differences among phases. There were significant differences in symptoms during the treatments: the levels of anxiety decrease from T1 to T3 (0.046), while those of hostility increase (<0.001). Emotional processing is a strong predictor of all symptoms. Clinical implications are discussed.

[Heroine, but no Superwoman. Evaluation of a peer-training activity for women with breast cancer]

OBJECTIVE

To evaluate a peer-training intervention for women with breast cancer, from a gender perspective: to discover the results of the intervention and examine in-depth the personal experiences of patients and health professionals participating in the training activity.

METHOD

Mixed method multicentre design completed in 2017 in Andalusia (Spain), with a pre and post evaluation questionnaire with 102 patients, measuring life style, limitations, use of health services, communication with professionals and self-management; and content analysis of semi-structured interviews and focus groups with 21 patient-trainers and 5 health professionals, looking at experiences, needs and suggestions for improvement.

RESULTS

The patients described a good general health status, with improvements of: diet quality (7 in pre-test to 7.7 in post-test), limitations for daily life (from 1.93 to 1.64 points), self-efficacy (from 6.46 to 7.42 points). Age, civil status and level of education generated statistically significant differences, with more improvement in more vulnerable social profiles. Participants revealed the benefits of the peer-training at a personal, relational, psycho-emotional and socio-cultural level and expressed how the training changed their experiences around identity-construction and gender roles. The improvement dimensions related to organization, evaluation and continuity.

CONCLUSIONS

The peer-training intervention is a positive experience for women's physical, relational and emotional health and, from a gender perspective, it represents an opportunity, at both individual and group level, to negotiate and deconstruct gender roles when living with breast cancer.

From therapeutic landscapes to healthy spaces, places and practices: A scoping review

The term 'therapeutic landscapes' was first coined by health geographer, Wilbert Gesler, in 1992 to explore why certain environments seem to contribute to a healing sense of place. Since then, the concept and its applications have evolved and expanded as researchers have examined the dynamic material, affective and socio-cultural roots and routes to experiences of health and wellbeing in specific places. Drawing on a scoping review of studies of these wider therapeutic landscapes published between 2007 and 2016, this paper explores how, where, and to what benefit the 'therapeutic landscapes' concept has been applied to date, and how such applications have contributed to its critical evolution as a relevant and useful concept in health geography. Building on themes included in two earlier (1999, 2007) edited volumes on Therapeutic Landscapes, we summarise the key themes identified in the review, broadly in keeping with the core material, social, spiritual and symbolic dimensions of the concept initially posited by Gesler. Through this process, we identify strengths and limitations of the concept and its applications, as well as knowledge gaps and promising future directions for work in this field, reflecting critically on its value within health geography and its potential contribution to wider interdisciplinary discussions and debates around 'healthy' spaces, places, and related practices.

Exploring Meaning in the Life of Chinese Breast Cancer Survivors

BACKGROUND

Breast cancer is the most common cancer among women worldwide, and spiritual fulfillment such as experiencing meaning in life plays an important role in coping with the disease.

OBJECTIVE

The objectives of this study were to explore and understand Chinese breast cancer survivors' perspective on meaning in life.

METHODS

This study used Grounded Theory; 23 participants were recruited using convenience sampling, purposive sampling, and theoretical sampling. Semistructured interviews were conducted, and the data were analyzed using open coding, axial coding, and selective coding.

RESULTS

A core category emerged as "satisfaction with my life" to explain Chinese breast cancer survivors' perspective of meaning in life, and 4 subcategories described the core category including (1) living a healthy and peaceful life, (2) having a good relationship with others, (3) achieving purpose in life, and (4) fulfilling responsibility.

CONCLUSION

Chinese breast cancer survivors value physical health as well as spiritual fulfillment. The experience of adapting to life with cancer, having a good relationship with others, pursuing life goals, and fulfilling responsibility consists of a satisfying life, which makes life more meaningful.

IMPLICATIONS FOR PRACTICE

Health providers should pay more attention to survivors' experience of meaning in life and help them enhance meaning in life and improve their quality of life through building good relationship with others, achieving purpose in life, and fulfilling responsibility for family and society.

Meaning-Making Process Related to Temporality During Breast Cancer Traumatic Experience: The Clinical Use of Narrative to Promote a New Continuity of Life

Previous research has agreed that meaning-making is a key element in the promotion of patients' well-being during and after a traumatic event such as cancer. In this paper, we focus on an underestimated key element related to the crisis/rupture of this meaning-making process with respect to the time perspective. We consider 40 narratives of breast cancer patients at different times of treatment, undergoing chemotherapy and biological therapy. We collected data through writing technique. We performed an interpretative thematic analysis of the data and highlighted specific ways to signify time during the different treatment phases. Our central aspect "the time of illness, the illness of time" demonstrates that the time consumed by illness has the risk of becoming an illness of time, which transcends the end of the illness and absorbs a patient's past, present, and future, thus saturating all space for thought and meaning. The study suggests that narrative can become a therapeutic and preventive tool for women with breast cancer in a crisis of temporality, and enable the promotion of new semiotic connections and a specific functional resynchronization with the continuity/discontinuity of life. This is useful during the illness and medical treatment and also after the treatment.