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Subhani M, Talat U, Knight H, Morling JR, Jones KA, Aithal GP, Ryder SD, Rennick-Egglestone S. Application and Extension of the Alcohol Recovery Narratives Conceptual Framework. QUALITATIVE HEALTH RESEARCH 2023; 33:1203-1217. [PMID: 37683106 PMCID: PMC10626984 DOI: 10.1177/10497323231197384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Recovery narratives are personal stories of health problems and recovery. A systematic review proposed a conceptual framework characterising alcohol misuse recovery narratives, consisting of eight principal dimensions, each with types and subtypes. The current study aims to apply and extend this preliminary conceptual framework. Semi-structured interviews were conducted to collect alcohol misuse recovery narratives from adult participants. A two-stage inductive and deductive thematic analysis approach was used to assess the relevance of the dimensions and types included in the preliminary conceptual framework and identify new components. The sample consisted of 11 participants from diverse socioeconomic backgrounds who had previously displayed varying degrees of alcohol misuse. All conceptual framework dimensions (genre, identity, recovery setting, drinking trajectories, drinking behaviours and traits, stages, spirituality and religion, and recovery experience) were present in the collected narratives. Three dimensions were extended by adding types and subtypes. Whilst the existing conceptual framework fitted the collected narratives, a new dimension describing the alcohol environment was required to fully characterise narratives. Types included in the alcohol environment dimension were policy and practice and social dynamics. The extended framework could guide the production of resources enabling clinicians to engage with narratives shared by their clients.
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Affiliation(s)
- Mohsan Subhani
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Usman Talat
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Holly Knight
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Joanne R. Morling
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Katy A. Jones
- School of Medicine, Applied Psychology, University of Nottingham, Nottingham, UK
| | - Guruprasad P. Aithal
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Stephen D. Ryder
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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Subhani M, Enki DG, Knight H, Jones KA, Sprange K, Rennick-Egglestone S, Morling JR, Wragg A, Hutton C, Ryder SD. Does knowledge of liver fibrosis affect high-risk drinking behaviour (KLIFAD): an open-label pragmatic feasibility randomised controlled trial. EClinicalMedicine 2023; 61:102069. [PMID: 37448808 PMCID: PMC10336239 DOI: 10.1016/j.eclinm.2023.102069] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Background Early identification followed by effective behaviour interventions is pivotal to changing the natural history of alcohol-related liver disease. We examined the feasibility of using transient elastography based advice and alcohol recovery video stories (ARVS) to change drinking behaviour in community alcohol services. Methods A feasibility randomised control trial (RCT) was conducted in three community alcohol services. Adults 18+ years presenting with a primary alcohol problem were randomised (1:1) to receive either usual care (control group) or usual care and the KLIFAD Intervention, consisting of advice tailored to liver stiffness measure and access to ARVS (intervention group). Data were collected at baseline and six months. To establish definitive trial feasibility, recruitment and retention rates, study procedure safety and extent of effectiveness were measured (Start date: 02.10.2019, End date: 30.11.2022, ISRCTN.com: 16922410). Findings 382 service users were screened, 184 were randomised (intervention: 93, control: 91), and baseline data were collected for 128 (intervention: 71, control: 59). Six months follow-up data were available in 87 (intervention: 53, control: 34). Intervention compared to the control group had a longer duration of engagement with services (mean difference 8.6 days SD = 18.4), was more likely to complete the allocated treatment program and reduced or stop drinking (54.9% vs 43.9%) and reduce AUDIT category (71.7% vs 61.8%). There were no reported serious adverse reactions, one intervention group participant reported an increase in AUDIT category. Interpretation Integration of transient elastography in community alcohol services is feasible. It may improve engagement with services, retention in clinical trials and supplement the reduction in self-reported alcohol consumption. A definitive RCT is supported. Funding National Institute for Health and Care Research (NIHR201146).
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Affiliation(s)
- Mohsan Subhani
- Nottingham Digestive Diseases Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Doyo G. Enki
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Holly Knight
- Nottingham Centre for Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | - Katy A. Jones
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Joanne R. Morling
- Nottingham Digestive Diseases Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Centre for Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | - Andrew Wragg
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Clare Hutton
- Patient and Public Involvement (PPI) Co-applicant, Nottingham, UK
| | - Stephen D. Ryder
- Nottingham Digestive Diseases Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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Schnabel S, van Wijck F, Kidd L. Supporting stroke survivors to meet their personal rehabilitation needs in community-based arm rehabilitation: development of initial programme theories to explore what may work for whom, how and under what circumstances. Front Neurol 2023; 14:1089547. [PMID: 37332992 PMCID: PMC10272837 DOI: 10.3389/fneur.2023.1089547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/20/2023] [Indexed: 06/20/2023] Open
Abstract
Objective This study explored what worked for whom, how and under what circumstances in a community-based augmented arm rehabilitation programme that was designed to enable stroke survivors to meet their personal rehabilitation needs. Design A mixed methods realist-informed study of data from a randomised controlled feasibility trial, comparing augmented arm rehabilitation after stroke with usual care. The analysis was designed to develop initial programme theories and refine these through triangulation of qualitative and quantitative trial data. Participants with a confirmed stroke diagnosis and stroke-related arm impairment were recruited from five health boards in Scotland. Only data from participants in the augmented group were analysed. The augmented intervention comprised evidence-based arm rehabilitation (27 additional hours over 6 weeks) including self-managed practice, and focused on individual rehabilitation needs identified through the Canadian Occupational Performance Measure (COPM). The COPM indicated to which extent rehabilitation needs were met following the intervention, the Action Research Arm Test provided data on changes in arm function, and qualitative interviews provided information about the context and potential mechanisms of action. Findings Seventeen stroke survivors (11 males, age range 40-84 years, NIHSS median (IQR) 6 (8)) were included. Median (IQR) COPM Performance and Satisfaction scores (min.1-max.10) improved from pre-intervention 2 (5) to post-intervention 5 (7). Findings suggested that meeting rehabilitation needs was facilitated by strengthening participants' sense of intrinsic motivation (through grounding exercises in everyday activities linked to valued life roles, and enabling them to overcome barriers to self-managed practice), and via therapeutic relationships (through trust and expertise, shared decision-making, encouragement and emotional support). Collectively, these mechanisms enabled stroke survivors to build confidence and gain mastery experience necessary to engage in new self-managed practice routines. Conclusion This realist-informed study enabled the development of initial programme theories to explain how and in what circumstances the augmented arm rehabilitation intervention may have enabled participants to meet their personal rehabilitation needs. Encouraging participants' sense of intrinsic motivation and building therapeutic relationships appeared instrumental. These initial programme theories require further testing, refinement, and integration with the wider literature.
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Affiliation(s)
- Stefanie Schnabel
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
- Alice Salomon University of Applied Sciences Berlin, Alice-Salomon-Platz, Berlin, Germany
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lisa Kidd
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
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Leverenz A, Hernandez RA. Uncertainty Management Strategies in Communication About Urinary Tract Infections. QUALITATIVE HEALTH RESEARCH 2023; 33:321-333. [PMID: 36760161 DOI: 10.1177/10497323231156370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Urinary tract infections (UTIs) are the most common bacterial infection, and yet the etiology, treatment, and prevention of UTIs are often clouded by uncertainty. UTIs can cause severe pain and may lead to serious infection, but communication about UTIs can help individuals manage this condition and avoid recurring UTIs. Grounded in uncertainty management theory (UMT), this study explored how individuals with female anatomy manage uncertainty surrounding UTIs. Iterative analysis was employed using UMT to analyze 21 qualitative interviews. Participants used uncertainty management strategies of talking to health care providers, eliciting social support, and using the internet to gather information. Results indicated that talking to heath care providers was a dominant strategy intended to reduce uncertainty about the diagnosis and treatment of their symptoms. However, these interactions inadvertently increased uncertainty as well, as providers did not provide information about the causes and prevention of UTIs. Some participants also engaged in deception to reduce uncertainty about how their providers would respond to their pain and their illness. Finally, participants employed metaphors to interpret and neutralize uncertainty related to their experiences. Implications for these findings include guidelines and support for patient and provider communication, communication in social networks, as well as deeper nuances and development for UMT.
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Affiliation(s)
- Alaina Leverenz
- Department of Communication, 14716University of Missouri, Columbia, MO, USA
| | - Rachael A Hernandez
- Department of Communication, Department of Public Health, 14716University of Missouri, Columbia, MO, USA
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Alawafi R, Rosewilliam S, Soundy A. A qualitative study of illness narratives: ‘overcoming the monster’ master plot for patients with stroke. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background/Aims Research that considers illness narrative ‘master plots’ (common and recognisable story plots related to the experience of illness), as expressed by individuals who have had a stroke, is needed Thus far, the literature has focused on identifying pre-established illness narrative master plots: the restitution, the chaos and the quest narrative. However, these narrative plots represent extreme psychological responses to the experience of illness; other narratives need to be understood in order to most effectively support individuals with stroke. Further research must identify if other master plots exist, and consider the implication of such plots. Methods A narrative methodology was undertaken, contextualised within a social constructivist worldview. A purposive sample of individuals with stroke undertook a single online semi-structured interview. A categorical-form narrative analysis was undertaken in five stages. Results A total of eight individuals were interviewed. Following analysis, six individuals were identified as illustrating experiences related to a master plot termed ‘overcoming the monster’. The ‘monster’ was represented in several ways, which included: a mental health problem or an expression relating to internal feelings; a sense of being isolated from others; a threat to the individual's independence; and a negative interaction or experience related to health care. Individuals identified clear strategies for ‘overcoming the monster’. These included: adopting a different way of viewing life; identifying and attaining both big and small goals; persistence and determination in the face of adversity; and giving support to others through activities and receiving support. Conclusions Allied health professionals need to understand the importance of this narrativisation of stroke because research has shown that allied health professionals can stereotype interactions by plots and seek to correct them. Implications of these findings ilustate the importance of understanding the individuals experience, not immediately reacting to a narrative type that may seem to fit, understanding the plot of overcoming the monster varies and may need time to be observed.
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Affiliation(s)
- Rana Alawafi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sheeba Rosewilliam
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Subhani M, Talat U, Knight H, Morling JR, Jones KA, Aithal GP, Ryder SD, Llewellyn-Beardsley J, Rennick-Egglestone S. Characteristics of alcohol recovery narratives: Systematic review and narrative synthesis. PLoS One 2022; 17:e0268034. [PMID: 35511789 PMCID: PMC9070949 DOI: 10.1371/journal.pone.0268034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Narratives of recovery from alcohol misuse have been analysed in a range of research studies. This paper aims to produce a conceptual framework describing the characteristics of alcohol misuse recovery narratives that are in the research literature, to inform the development of research, policy, and practice. METHODS Systematic review was conducted following PRISMA guidelines. Electronic searches of databases (Ovid MEDLINE, EMBASE, CINHAL, PsychInfo, AMED and SCOPUS), grey literature, and citation searches for included studies were conducted. Alcohol recovery narratives were defined as "first-person lived experience accounts, which includes elements of adversity, struggle, strength, success, and survival related to alcohol misuse, and refer to events or actions over a period of time". Frameworks were synthesised using a three-stage process. Sub-group analyses were conducted on studies presenting analyses of narratives with specific genders, ages, sexualities, ethnicities, and dual diagnosis. The review was prospectively registered (PROSPERO CRD42021235176). RESULTS 32 studies were included (29 qualitative, 3 mixed-methods, 1055 participants, age range 17-82years, 52.6% male, 46.4% female). Most were conducted in the United States (n = 15) and Europe (n = 11). No included studies analysed recovery narratives from lower income countries. Treatment settings included Alcoholic Anonymous (n = 12 studies), other formal treatment, and 'natural recovery'. Eight principle narrative dimensions were identified (genre, identity, recovery setting, drinking trajectory, drinking behaviours, stages, spirituality and religion, and recovery experience) each with types and subtypes. All dimensions were present in most subgroups. Shame was a prominent theme for female narrators, lack of sense of belonging and spirituality were prominent for LGBTQ+ narrators, and alienation and inequality were prominent for indigenous narrators. CONCLUSIONS Review provides characteristics of alcohol recovery narratives, with implications for both research and healthcare practice. It demonstrated knowledge gaps in relation to alcohol recovery narratives of people living in lower income countries, or those who recovered outside of mainstream services. PROTOCOL REGISTRATION Prospero registration number: CRD42020164185.
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Affiliation(s)
- Mohsan Subhani
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Usman Talat
- Alliant Manchester Business School, University of Manchester, Manchester, England
| | - Holly Knight
- Population and Lifespan Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Joanne R. Morling
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
- Population and Lifespan Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Katy A. Jones
- School of Medicine, Applied Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Guruprasad P. Aithal
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Stephen D. Ryder
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Ulberg R, Evensen J. Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy. BMC Psychiatry 2021; 21:533. [PMID: 34706691 PMCID: PMC8555134 DOI: 10.1186/s12888-021-03551-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression. METHODS Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. RESULTS Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent. CONCLUSIONS Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. TRIAL REGISTRATION Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.
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Affiliation(s)
- A Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway.
| | - J I Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, Blindern, 0318, Oslo, Norway
| | - T Dammen
- Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, Blindern, 0318, Oslo, Norway
| | - A Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway
| | - R Ulberg
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, Blindern, 0318, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Box 85 Vinderen, 0319, Oslo, Norway
| | - J Evensen
- Nydalen Outpatient Clinic, P.O. box 4959 Nydalen, N-0424, Oslo, Norway
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Hartog I, Scherer-Rath M, Kruizinga R, Netjes J, Henriques J, Nieuwkerk P, Sprangers M, van Laarhoven H. Narrative meaning making and integration: Toward a better understanding of the way falling ill influences quality of life. J Health Psychol 2017; 25:738-754. [PMID: 28948830 PMCID: PMC7221864 DOI: 10.1177/1359105317731823] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Falling seriously ill is often experienced as a life event that causes conflict
with people’s personal goals and expectations in life and evokes existential
questions. This article presents a new humanities approach to the way people
make meaning of such events and how this influences their quality of life.
Incorporating theories on contingency, narrative identity, and quality of life,
we developed a theoretical model entailing the concepts life event, worldview,
ultimate life goals, experience of contingency, narrative meaning making,
narrative integration, and quality of life. We formulate testable hypotheses and
describe the self-report questionnaire that was developed based on the
model.
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Affiliation(s)
- Iris Hartog
- University of Amsterdam, The Netherlands.,Radboud University Nijmegen, The Netherlands
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Greenfield B. Phenomenology as a Philosophical Orientation for Understanding the Transformative Experience of Disabling Illness. Top Stroke Rehabil 2015; 18:35-9. [DOI: 10.1310/tsr1801-35] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Gray J, Lie MLS, Murtagh MJ, Ford GA, McMeekin P, Thomson RG. Health state descriptions to elicit stroke values: do they reflect patient experience of stroke? BMC Health Serv Res 2014; 14:573. [PMID: 25413030 PMCID: PMC4254212 DOI: 10.1186/s12913-014-0573-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
Background To explore whether stroke health state descriptions used in preference elicitation studies reflect patients’ experiences by comparing published descriptions with qualitative studies exploring patients’ lived experience. Methods Two literature reviews were conducted: on stroke health state descriptions used in direct preference elicitation studies and the qualitative literature on patients’ stroke experience. Content and comparative thematic analysis was used to identify characteristics of stroke experience in both types of study which were further mapped onto health related quality of life (HRQOL) domains relevant to stroke. Two authors reviewed the coded text, categories and domains. Results We included 35 studies: seven direct preference elicitation studies and 28 qualitative studies on patients’ experience. Fifteen coded categories were identified in the published health state descriptions and 29 in the qualitative studies. When mapped onto domains related to HRQOL, qualitative studies included a wider range of categories in every domain that were relevant to the patients’ experience than health state descriptions. Conclusions Variation exists in the content of health state descriptions for all levels of stroke severity, most critically with a major disjuncture between the content of descriptions and how stroke is experienced by patients. There is no systematic method for constructing the content/scope of health state descriptions for stroke, and the patient perspective is not incorporated, producing descriptions with major deficits in reflecting the lived experience of stroke, and raising serious questions about the values derived from such descriptions and conclusions based on these values.
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Chow EOW. Narrative therapy an evaluated intervention to improve stroke survivors’ social and emotional adaptation. Clin Rehabil 2014; 29:315-26. [DOI: 10.1177/0269215514544039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To describe a theoretical and practical framework of using a train metaphor in narrative therapy for stroke rehabilitation in group practice. Background: There is a paucity of literature on the application of narrative therapy in meeting the psycho-social-spiritual needs of stroke survivors in rehabilitation. In the current article, the use of narrative therapy being evaluated in a formal randomized study in stroke survivors is described in detail. The metaphor may be of practical interest to those working with populations confronted with unpredictable life challenges. Method: Narrative practice using the metaphor of ‘Train of life’ is an alternative practice to psychopathology, which provides a means for the participants to deconstruct from the illness experience, re-author their lives, and reconstruct their identity with hopes and dreams. This therapeutic conversations, primarily using questions, can be divided into six steps: (1) engaging participants to a Concord station; (2) unfolding the experience with Stroke: where each of the participants are coming from; (3) dialoging directly with Stroke; (4) co-constructing the train carriage; (5) planning for a future life journey with Stroke; and (6) celebrating the unlocking of a new journey. Along with the train of life metaphor, therapeutic documents and outsider witness conversations are used to strengthen the preferred identity, as opposed to the problem-saturated identity of the participants. Discussion: This metaphor poses an alternative methodology in stroke rehabilitation by reconnecting the survivors’ inner resources, skills, and competencies. Eventually, it could re-author the survivors’ identity developed from previous life challenges and reconstruct their purpose in life.
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Affiliation(s)
- Esther OW Chow
- Department of Applied Social Sciences, City University of Hong Kong, Hong Kong SAR, China
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McClelland M, Wenz C, Sood K, Yono A. Perceptions of pediatric asthma in African American underserved families using metaphorical analysis. J SPEC PEDIATR NURS 2013; 18:342-53. [PMID: 24094129 DOI: 10.1111/jspn.12045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 06/13/2013] [Accepted: 06/20/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose was to understand how African American children with asthma and their families living in underserved urban areas experience and perceive asthma. DESIGN AND METHODS A narrative inquiry design with metaphorical analysis was used in this study with 20 African American children and their 10 families. RESULTS Participants metaphorically viewed the family system as a functioning healthcare facility. Children didn't find their asthma abnormal but did use asthma symptoms to their advantage. Caregivers were viewed as first-line medical responders but often made errors in delivering medical treatment. Lack of knowledge relating to appropriate asthma interventions led to insufficient asthma care. PRACTICE IMPLICATIONS Results provide evidence to improve patient-nurse interactions for this vulnerable patient group.
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Affiliation(s)
- Molly McClelland
- University of Detroit Mercy, College of Health Professions, Detroit, Michigan, USA
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Kitzmüller G, Häggström T, Asplund K, Gilje FL. The Existential Meaning of Couples' Long-Term Experience of Living with Stroke. ACTA ACUST UNITED AC 2012. [DOI: 10.2190/il.20.4.c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study employs Heideggerian hermeneutic phenomenology to uncover the existential meaning of couples' long-term experiences of living with stroke. Transcripts of 23 interviews with stroke survivors and 17 interviews with spouses focusing on the couple perspective were analyzed. The five emerging themes and the constitutive pattern illuminate the existential meaning of stroke and include fear, hope, unfamiliarity, temporality, and reinterpretation of the life-world. The constitutive pattern indicates that life after stroke is characterized by the struggle to adapt to an abruptly twisted and unfamiliar being-in-the-world. Changes in couples' interpretations of their life-world seem to be connected with different interpretations of time and an increased view of life as limited. Health professionals with an empathic understanding of the existential meaning of stroke may better facilitate the reinterpretation of couples' actual life-world. Stroke couples' life-restricting fears of living, dying, and caregiving should be explored further.
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Affiliation(s)
| | | | - Kenneth Asplund
- University of Mid-Sweden, Sundsvall and University of Tromsø, Norway
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14
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Chow EO, Nelson-Becker H. Spiritual distress to spiritual transformation: Stroke survivor narratives from Hong Kong. J Aging Stud 2010. [DOI: 10.1016/j.jaging.2010.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Understanding the lived experiences of patients: application of a phenomenological approach to ethics. Phys Ther 2010; 90:1185-97. [PMID: 20539020 DOI: 10.2522/ptj.20090348] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
This perspective article provides a justification, with an overview, of the use of phenomenological inquiry and the interpretation into the everyday ethical concerns of patients with disabilities. Disability is explored as a transformative process that involves physical, cognitive, and moral changes. This perspective article discusses the advantages of phenomenology to supplement and enhance the principlist process of ethical decision making that guides much of contemporary medical practice, including physical therapy. A phenomenological approach provides a more contextual approach to ethical decision making through probing, uncovering, and interpreting the meanings of "stories" of patients. This approach, in turn, provides for a more coherent and genuine application of ethical principles within the "textured life-world" of patients and their evolving values as they grapple with disability to make ethical and clinical decisions. The article begins with an in-depth discussion of the current literature about the phenomenology of people with disability. This literature review is followed by a discussion of the traditional principlist approach to making ethical decisions, which, in turn, is followed by a discussion of phenomenology and its tools for use in clinical inquiry and interpretation of the experiences of patients with disabilities. A specific case is presented that illustrates specific tools of phenomenology to uncover the moral context of disability from the perspective of patients. The article concludes with a discussion of clinical, educational, and research implications of a phenomenological approach to ethics and clinical decision making.
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Greenfield B, Jensen GM. Beyond a code of ethics: phenomenological ethics for everyday practice. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 15:88-95. [DOI: 10.1002/pri.481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mould TJ, Oades LG, Crowe TP. The use of metaphor for understanding and managing psychotic experiences: A systematic review. J Ment Health 2010; 19:282-93. [DOI: 10.3109/09638231003728091] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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