1
|
Wang X, Chen D, Zou P, Zhang H, Qiu X, Xu L, Lee G. Understanding adaptive tasks in cardiac rehabilitation among patients with acute myocardial infarction: a qualitative study. Ann Med 2024; 56:2311227. [PMID: 38306095 PMCID: PMC10840589 DOI: 10.1080/07853890.2024.2311227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake. OBJECTIVES To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing. PATIENTS AND METHODS This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist. RESULTS Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role's responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making. CONCLUSION Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients' daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.
Collapse
Affiliation(s)
- Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Dandan Chen
- School of Nursing, Zhejiang University School of Medicine, Zhejiang, China
| | - Ping Zou
- School of Nursing, Nipissing University, Toronto, Ontario, Canada
| | - Hui Zhang
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Xunhan Qiu
- Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Xu
- Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Geraldine Lee
- Catherine McAuley School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| |
Collapse
|
2
|
Gregory SK, Kemp AM. Experiences of Acquired Brain Injury as Expressed Through Mask-Making: A Qualitative Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-16. [PMID: 39151113 DOI: 10.1044/2024_ajslp-23-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE Acquired brain injury (ABI) extends beyond the immediate aftermath, and understanding individual experience of ABI is paramount to providing effective support mechanisms. This study examined how people with ABI used mask-making to engage in self-expression. METHOD Publicly available data from the Unmasking Brain Injury Project website, an advocacy group for people with ABI, were analyzed. A qualitative approach with hybrid inductive/deductive analysis was used to explore how people with ABI use art to express their emotional experiences of ABI. RESULTS In total, 1,049 masks had narratives describing the visual components and meaning in the associated masks. Three major themes emerged: the multiplicity of experiences after ABI, including positive, negative, and mixed outcomes; the expression of emotional pain and living with loss through art; and the importance of positivity, purpose, and faith in the experience with ABI. Multiplicity was the central expression represented in the masks. The most commonly represented emotional experiences were: emotional pain and living with loss and positivity, purpose, and faith. The masks incorporated literal depictions of the ABI, visual metaphors, and intentional use of colors and shapes for self-expression. CONCLUSIONS These results support previous findings that emotional experiences after ABI are complex and often interlaced with several emotions. The most prominent feelings include emotional pain and living with loss, and positivity, purpose, and faith. Mask-making may be a particularly appropriate method for people with ABI to process or express emotional experiences, as well as to provide clinicians with visual records of sense of self, coping, or progress.
Collapse
Affiliation(s)
- Sarah Kaytlyn Gregory
- Department of Communication Sciences and Special Education, University of Georgia, Athens, GA
| | - Amy M Kemp
- Department of Physical Medicine and Rehabilitation and Department of Veterans Affairs, Northwestern University, Chicago, IL
| |
Collapse
|
3
|
Gepshtein YD, Lee JA, Bounds DT, Burton CW. Understanding Refugees Health Experiences in Host Countries: Three Theoretical Perspectives. Clin Nurs Res 2024; 33:292-300. [PMID: 38817093 DOI: 10.1177/10547738241253655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Healthcare providers working with forcefully displaced populations often have limited knowledge and skills regarding the care of this population. The reasons are twofold. First, most of the research on refugee health does not consider refugees' adaptive skills, diversity of experiences, and daily life context. Second, healthcare providers' knowledge of how the sociopolitical environment shapes health research and practice in the context of refugee care is often limited. This work aims to specify gaps in refugee healthcare and research by applying a relational approach to three theoretical frameworks. The relational approach supports a pragmatic, in-depth understanding of healthcare practices by shifting the focus of the inquiry from description of social structures toward exploration of processes and relations that propagate and sustain such structures. The focus is on the threefold interaction between refugees, healthcare providers, and healthcare institutions. The three theoretical frameworks are as follows: First, using concepts from the Theory of Practice by Bourdieu, we examine how gaps in care can result from a mismatch between the dispositions and skills that refugees develop through life experience and the cultural-professional practices of healthcare providers in host countries. Second, the Cultural Determinants of Help Seeking by Saint Arnault is applied to posit that gaps in care can result from differences in the meanings that healthcare providers and refugees assign to their interactions. Finally, we use the concept of Othering as described in nursing by Canales to explain how power dynamics inherent in the interaction between refugees and healthcare systems can affect refugee healthcare and research. This relational approach helps to elucidate some of the culture-bound mechanisms of health maintenance and help-seeking and brings attention to the sociopolitical context that shapes the way we care to refugees.
Collapse
|
4
|
Nizza IE, Smith JA, Kirkham JA. Picturing oneself over time: a multi-modal interpretative phenomenological analysis of pain management trajectories. Eur J Pain 2024; 28:741-753. [PMID: 38102753 DOI: 10.1002/ejp.2214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Chronic pain (CP) can be a disabling condition with impacts that affect the sense of identity of those who live with it. This article idiographically describes the longitudinal evolution of the sense of self of participants following their referral to a pain management service and participation in a pain management programme (PMP). METHODS Participants were interviewed three times: before they attended a PMP, and 1 and 6 months after the PMP. Data included the drawings of themselves that participants created at each interview and the transcripts of the interviews guided by the drawings, analysed longitudinally using interpretative phenomenological analysis. RESULTS This paper describes in detail the cases of four participants: two who experienced a positive albeit troubled trajectory following their PMP and two who did not experience any positive change. The results provide a nuanced account of how the impacts of CP on identity can evolve, with different people engaging with different aspects of a PMP and some people not engaging at all, and how pain self-management strategies enable those that do engage to cope in times of difficulty. CONCLUSIONS Participant responses to PMP participation are idiosyncratic and interviews with drawings of self analysed longitudinally can help illustrate processes of change. SIGNIFICANCE Not enough is understood about why some people get limited benefits from pain services. This idiographic longitudinal study illustrates how the impact of CP on identity can evolve when people are introduced to pain self-management, with some embracing change and others resisting it. For clinicians, this study describes four detailed CP individual paths, showing the interaction between contextual and idiosyncratic aspects. This is also the first study to use multiple drawings of self to explore the impacts of illness on identity longitudinally. In a person-centred approach to treatment, the drawings of self could also be adopted as a tool in clinician-patient conversations to gain a deeper understanding of the impacts of living with CP.
Collapse
Affiliation(s)
- I E Nizza
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - J A Smith
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - J A Kirkham
- Kent Community Health NHS Trust, Ashford, UK
| |
Collapse
|
5
|
Gu X, Shen X, Zhou JR, Chu JH, Jiang L. The effects of common-sense model interventions on cancer patients: A systematic review. Medicine (Baltimore) 2024; 103:e37777. [PMID: 38669411 PMCID: PMC11049692 DOI: 10.1097/md.0000000000037777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND From the time of new diagnosis to treatment, cancer patients experience a variety of health problems that can affect the patient's health outcomes. Individuals with cancer are being given increasing responsibility for the self-management of their health and illness. The self-regulating common-sense model (CSM) is effective in patients' disease management. This article briefly introduces the common-sense model intervention, in which patients with cancer are affected by these interventions, what they are about, and what effects they have. METHODS The authors systematically review evidence for the common-sense model of self-regulation for cancer using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Based on a comprehensive literature search, we searched the Cochrane Library, PsycINFO, Embase, PubMed, Medline, CINAHL, CNKI, and WanFang databases. The included studies underwent a quality assessment using the Effective Public Health Practice Project (EPHPP). RESULTS Eleven empirical studies illustrated the aspects of common-sense model interventions for cancer patients. It is concluded that common-sense model intervention has an effect on symptoms in cancer treatment, behavior, and quality of life, but more studies are needed to verify the use of common-sense model intervention to explore in patients with different cancers. The systematic review summarized a four-point paradigm about intervention content, including assessing the current situation, setting goals, having a disease education and psychological adjustment, and getting feedback for further response. However, the application of intervention requires specific analysis of patient behavior and outcomes. CONCLUSION Common-sense model interventions are beneficial for the self-management of cancer patients; however, more intervention studies are needed to specify the cognitive, emotional, and coping styles of people with a particular cancer.
Collapse
Affiliation(s)
- Xue Gu
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Xia Shen
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jun-Rui Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jiang-Hui Chu
- Department of Cardiothoracic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Lei Jiang
- Department of Radiology, Huadong Sanatorium, Wuxi, China
| |
Collapse
|
6
|
Douglas M, Yielder R, Kleinstäuber M, Borgmann A, Karu LT, Dalbeth N, Petrie KJ. The Big Picture: Patient Drawings of Gout and Their Relationship to Illness Perceptions and Stigma. J Rheumatol 2024; 51:203-205. [PMID: 37839819 DOI: 10.3899/jrheum.2023-0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Affiliation(s)
- Meihana Douglas
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael Yielder
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Anna Borgmann
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Leanne Te Karu
- Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
7
|
Cao H, Zhang X, Zhang X, Yan W. The effects of emotion and COVID-19 context priming on the size and color of drawings: based on human figure drawings and tree drawings. Front Psychol 2023; 14:1278577. [PMID: 38111865 PMCID: PMC10726032 DOI: 10.3389/fpsyg.2023.1278577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/16/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction This study aimed to investigate the effects of emotional themes and the COVID-19 pandemic context priming on the size and color of drawings. Methods A 3 (emotion: peacefulness, gratitude, loneliness) × 2 (context: pandemic, regular) mixed design was used and 113 university students in Shanghai were recruited to draw human figures and trees using 10 marker colors. Results The size of the drawings depicting loneliness was smaller than that of the those depicting peacefulness and gratitude. Drawings depicting loneliness used more cool and non-preferred colors; drawings depicting gratitude used more warm and preferred colors. Drawings in the pandemic context were larger, which may reflect the more significant threat perceived by individuals. Drawings in the pandemic context used more red colors, showing symbolic meanings such as danger. Discussion The drawing size and drawing color are influenced by emotional themes and the pandemic context priming.
Collapse
Affiliation(s)
- Huijing Cao
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Xiaohan Zhang
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Xinlei Zhang
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Wenhua Yan
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, East China Normal University, Shanghai, China
| |
Collapse
|
8
|
Florijn BW, Kloppenborg R, Kaptein AA, Bloem BR. Narrative medicine pinpoints loss of autonomy and stigma in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:152. [PMID: 37914740 PMCID: PMC10620172 DOI: 10.1038/s41531-023-00593-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
Parkinson's disease characteristics can create a self-perceived sense of stigmatization and disapproval by others, thereby affecting self-perceived autonomy. This study investigated the metaphors related to the loss of autonomy and stigma in stories and drawings of Parkinson's disease. We compare a contemporary first-person illness narrative and -drawing from a person with Parkinson's disease, with two novels (Jonathan Franzen's The Corrections and Claudia Piñeiro's Elena Knows), a graphic novel (Peter Dunlap-Shohl's My Degeneration: A Journey Through Parkinson's), a non-fiction book (Oliver Sacks' Awakenings) and a first-person illness narrative (John Palfreman's The Bright Side of Parkinson's). Metaphors in the patient narrative, novels, and non-fiction work were reviewed and a list of themes or categorizations common to 2 of the metaphors was generated. Parkinson's disease metaphors indicate a 'Parkinson's prism' thereby depicting extreme experiences (24.4%) like a 'fall by mischance', a 'tantrum of selfish misery' or a 'bottomless darkness and unreality' (Table 1). Both novels signify a sense of 'betrayal and disconnection' in the Parkinson's disease experience while non-fiction of Parkinsonism depicts a space in which one feels 'caged and deprived'. This makes the Parkinson's disease narrative a chaos story that could influence the decision to initiate treatment and treatment adherence. We conclude that narrative medicine can help to focus the medical consultations with affected individuals on issues that matter most to them, thereby improving self-perceived autonomy and stigma. As such, it is a critical component of the much-needed move towards personalized medicine in Parkinson's disease, achieved through the reciprocity of thinking with stories.
Collapse
Affiliation(s)
- Barend W Florijn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
- Department of Neurology, Hague Medical Center Westeinde, The Hague, the Netherlands.
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands.
| | - Raoul Kloppenborg
- Department of Neurology, Hague Medical Center Westeinde, The Hague, the Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| |
Collapse
|
9
|
Kaptein AA. Torn between two lovers - on being a psychologist in a university medical centre. Health Psychol Behav Med 2023; 11:2170379. [PMID: 36733298 PMCID: PMC9888463 DOI: 10.1080/21642850.2023.2170379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Psychology as applied to health and illness has a relatively short history. Nevertheless, that history shows a rapid development of the theoretical models that guide the field over the past 60 years. Core theoretical approaches are concisely reviewed, in the context of Kaplan's paper 'Behavior as the central outcome in health care' (1990), which is used as a model to examine the extent to which these approaches embrace Kaplan's notions. Advances Empirical studies from the health psychology domain are used, which demonstrate the gains in terms of quality of life and behavioural outcomes in patients with (chronic) somatic diseases. Over a period of some 60 years, theoretical models and core concepts in psychology as applied to health and illness have evolved from psychosomatic views to neuropsychology, quality of life, patient education, self-management, illness perceptions, patient-reported outcome measures (PROMs), shared decision-making (SDM) and health humanities (HH). The more recent models (SDM, HH) appear to align to a considerable degree with adopting 'behavior as the central outcome an outcome in health care'; shared decision-making and health humanities focus on encouraging patients to make sense of and give meaning to their illness in order to attain optimal psychosocial adjustment. Conclusions In addition to 'behavior as the central outcome in health care', a new definition of the concept of health (i.e. 'the ability to adapt and to self-manage' - Huber et al., 2011) seems to favour patients, healthcare providers, society, and health psychology. Incorporating this concept into medical care may be viewed as a challenge for health psychologists - and as a source of continual struggle with strong biomedical forces.
Collapse
Affiliation(s)
- Ad A. Kaptein
- Medical Psychology, Leiden University Medical Centre, Leiden, The Netherlands, Ad A. Kaptein Medical Psychology, Leiden University Medical Centre, PO Box 9600, Leiden2300, The Netherlands
| |
Collapse
|
10
|
Richards HL, Wormald A, O'Dwyer A, Najt P, Eustace J, O'Connor K, McKiernan M, O'Dea E, Burke P, Fortune DG. Healthcare Workers Beliefs about COVID-19; a Longitudinal, Mixed Methods Analysis. PSYCHOL HEALTH MED 2023; 28:110-123. [PMID: 35089104 DOI: 10.1080/13548506.2022.2032773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The psychological impact of COVID-19 on Health Care Workers (HCWs) has been widely reported. Few studies have sought to examine HCWs personal models of COVID-19 utilising an established theoretical framework. We undertook a mixed methods study of beliefs about COVID-19 held by HCWs in the Mid-West and South of Ireland during the first and third waves of COVID-19. Template analysis was undertaken on the free text responses of 408 HCWs about their perceptions of the Cause of COVID-19 as assessed by the Brief Illness Perception Questionnaire (B-IPQ). Responses were re-examined in the same cohort for stability at 3 months follow-up (n = 100). This analytic template was subsequently examined in a new cohort (n = 253) of HCWs in the third wave. Female HCWs perceived greater emotional impact of COVID-19 than men (t = -4.31, df405, p < 0.01). Differences between occupational groups were evident in relation to Timeline (F4,401 = 3.47, p < 0.01), Treatment Control (F4,401 = 5.64, p < 0.001) and Concerns about COVID-19 (F4,401 = 3.68, p < 0.01). Administration staff believed that treatment would be significantly more helpful and that COVID-19 would last a shorter amount of time than medical/nursing staff and HSCP. However, administration staff were significantly more concerned than HSCP about COVID-19. Template analysis on 1059 responses to the Cause items of the B-IPQ identified ten higher order categories of perceived Cause of COVID-19. The top two Causes identified at both Waves were 'individual behavioural factors' and 'overseas travel'. This study has progressed our understanding of the models HCWs hold about COVID-19 over time, and has highlighted the utility of the template analysis approach in analysing free-text questionnaire data. We suggest that group and individual occupational identities of HCWs may be of importance in shaping HCWs responses to working through COVID-19.
Collapse
Affiliation(s)
- H L Richards
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - A Wormald
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - A O'Dwyer
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - P Najt
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - J Eustace
- Department of Nephrology, Cork University Hospital and HRB Clinical Research Facility at University College Cork, Cork, Ireland
| | - K O'Connor
- Department of Geriatrics, Mercy University Hospital, Cork, Ireland
| | - M McKiernan
- Department of Nursing, Mercy University Hospital, Cork, Ireland
| | - E O'Dea
- Psychology Department, Mid West Community Healthcare Organisation 3, Limerick, Ireland
| | - P Burke
- Clinical Education & Research Centre, University Hospital Limerick, Limerick, Ireland
| | - D G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
| |
Collapse
|
11
|
Bierbauer W, Lüscher J, Scholz U. Illness perceptions in long-COVID: A cross-sectional analysis in adults. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2105007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- W. Bierbauer
- Applied Social and Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Switzerland
| | - J. Lüscher
- Applied Social and Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - U. Scholz
- Applied Social and Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Switzerland
| |
Collapse
|
12
|
Liaw FY, Chang YW, Chang YD, Shih LW, Tsai PF. Using drawing and situated learning to teach transitional care to post-graduate residents. BMC MEDICAL EDUCATION 2022; 22:687. [PMID: 36131340 PMCID: PMC9494879 DOI: 10.1186/s12909-022-03738-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The "draw-and-talk" technique has become popular in medical training, as it can help healthcare practitioners develop empathic understanding of patients and contribute to personal transformation. We adopted this method to make the teaching of transitional care planning more relevant to post-graduate residents undergoing their internal medicine training at a medical center in Taiwan. METHODS Before the conventional lecture on discharge planning, trainees were invited to draw their "home" and "life as older adults" and share their drawings with others. Subsequently, they were guided to consider whether their home would be livable if they either had a disability or were old. The drawings and narratives were analyzed thematically, and feedback on the session was collected. RESULTS Trainees were initially of the opinion that they did not have any role in discharge planning. However, the emphasis on the self-experience of drawing and the thematic use of "home" and "elderly life" led to reflective discussions about post-discharge care. The session provoked constructive self-reflection and meta-cognitive awareness and encouraged residents to actively participate in transition care plans. Response to the draw-and-talk session was overwhelmingly favorable. CONCLUSIONS Post-graduate residents in Taiwan conventionally do not have much interest or autonomy regarding their patients' lives outside the hospital. The use of drawing and reflection is a simple and inexpensive method to contextualize discharge planning in participants' real lives, engage them in actively visualizing the healthcare needs of older adults and patients with disability, and initiate thinking about the impact of discharge preparations, follow-up care, and barriers to care at home. Draw-and-talk might be helpful in improving residents' knowledge and empathy toward patients preparing for discharge, which is crucial for the quality of transitional care.
Collapse
Affiliation(s)
- Fang-Yih Liaw
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, No. 250, Wu Shin Street, Taipei City, 110, Taiwan
| | - Yaw-Wen Chang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yan-Di Chang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Li-Wen Shih
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, No. 250, Wu Shin Street, Taipei City, 110, Taiwan
| | - Po-Fang Tsai
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, No. 250, Wu Shin Street, Taipei City, 110, Taiwan.
| |
Collapse
|
13
|
Shen Z, Xu J, Yin W, Liu Q, Fan M, Luo C. Common Sense Model program on illness perceptions in patients with impaired awareness of hypoglycemia. Contemp Nurse 2022; 58:171-191. [PMID: 35477371 DOI: 10.1080/10376178.2022.2071311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Illness perceptions are important for patients with insulin-treated type 2 diabetes mellitus (T2DM) and impaired awareness of hypoglycemia (IAH), as they determine health-related behaviors and motivations. Patients with IAH in many countries have poor illness perception, and there is a paucity of research exploring the effectiveness of Common Sense Model (CSM)-based interventions in this population. OBJECTIVE To investigate the effects of a CSM-based intervention program on perceptions of illness in patients with insulin-treated T2DM and IAH. DESIGN Quasi-randomized controlled trialMethods: 78 patients with IAH receiving routine care were included. The intervention group (n = 39) participated in a CSM-based program, whereas the control group (n = 39) did not. Illness perceptions, coping styles, hypoglycemia fear, and awareness of hypoglycemia at baseline, 1 month, and 3 months were analyzed and compared between the two groups. RESULTS The intervention group exhibited significant improvements in consequences (β = -1.615, P = 0.032); personal control (β = -1.897, P = 0.006); treatment control (β = -1.274, P = 0.046); and positive coping style (β = 4.872, P = 0.002) at the 3-month follow-up, and timeline (β = 2.769, P = 0.004) at the 1-month follow-up. Hypoglycemia fear and awareness were not significantly improved in the intervention group compared with the control group. No intervention-related adverse events were observed. CONCLUSIONS A CSM-based intervention program can modify illness perceptions to an extent and improve the positive coping style in patients with IAH.Impact statement: Nurses should conduct a CSM-based intervention program to help patients with IAH improve illness perceptions.
Collapse
Affiliation(s)
- Zhijia Shen
- Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Jianou Xu
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Wei Yin
- Affiliated hospital of Jiangsu University, Jiangsu, China
| | - Qiaoyan Liu
- Affiliated hospital of Jiangsu University, Jiangsu, China
| | - Minyu Fan
- Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Caifeng Luo
- School of Medicine, Jiangsu University, Jiangsu, People's Republic of China
| |
Collapse
|
14
|
Peev A, Brandt O, Navarini A, Mueller SM. More than words: Itch perception visualised by patients´ drawings. J Eur Acad Dermatol Venereol 2022; 36:e638-e640. [PMID: 35305045 DOI: 10.1111/jdv.18095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/16/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- A Peev
- Department of Dermatology, University Hospital Basel, Switzerland.,Faculty of Medicine, Saarland University, Homburg, Germany
| | - O Brandt
- Department of Dermatology, University Hospital Basel, Switzerland
| | - A Navarini
- Department of Dermatology, University Hospital Basel, Switzerland
| | - S M Mueller
- Department of Dermatology, University Hospital Basel, Switzerland
| |
Collapse
|
15
|
Versluis A, Alphen KV, Dercksen W, Haas HD, Kaptein AA, Hurk CVD. Looking bad: Female patients drawing their representation of chemotherapy-induced alopecia. J Health Psychol 2022; 27:3013-3027. [PMID: 35212563 DOI: 10.1177/13591053221075503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study explored the experienced impact of alopecia using patient's drawings. Forty patients made drawings of their feelings about appearance of their head and hair before and during chemotherapy. Patients also reported illness perceptions (B-IPQ). Twenty-four patients (60%) reported ⩾50% alopecia at enrollment. Most patients (70%) drew a negative change of feelings over time and physical changes. Many experiences related to alopecia emerged from the written texts underneath the drawings and the B-IPQ. Drawings depicted deteriorated feelings of appearance, affecting many activities throughout the day. Healthcare providers are advised to use patient-tailored questioning about alopecia.
Collapse
Affiliation(s)
- Anne Versluis
- Netherlands Comprehensive Cancer Organisation (IKNL), The Netherlands
| | | | | | | | - Ad A Kaptein
- Leiden University Medical Centre, The Netherlands
| | | |
Collapse
|
16
|
Szyfer Lipinsky A, Goldner L. The Experience of Mothers from the Israeli Jewish Ultra-Orthodox Sector after Disclosure of Their Child's Sexual Abuse as Manifested in Drawings and Narratives. JOURNAL OF CHILD SEXUAL ABUSE 2022; 31:86-104. [PMID: 33947316 DOI: 10.1080/10538712.2021.1918307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
Child sexual abuse is present in all strata of Israeli society. However, there is scant research on the emotional experiences of non-abusing mothers after disclosure. In particular, no studies have examined the experiences of these mothers from the Jewish Ultra-Orthodox community in Israel. The current study analyzed the drawings and short narratives of 21 Israeli Ultra-Orthodox mothers to explore the effects of the disclosure of their child's sexual abuse. A phenomenological approach was used to analyze the drawings and yielded four different phenomena: (1) squiggles that represented distress, (2) the mother-child relationship, (3) pseudo-sweet houses, and (4) split drawings. The drawings were either colorful, sweet or shallow, or alternatively were in black and white. As confirmed by the narratives, these drawings primarily expressed the negative emotions of shock, sadness, distress, guilt, and failure as mothers. While some mothers reported breaking down and that pain had permeated their daily lives others coped by dissociating the painful experience, putting up a façade of normalcy, or splitting their lives into two parts corresponding to before and after the disclosure.
Collapse
Affiliation(s)
- Aiala Szyfer Lipinsky
- School of Creative Arts Therapies, Emili Sagol CAT Research Center & Sagol Lab for Children at Risk, Faculty of Welfare and Health Sciences, University of Haifa, Israel
| | - Limor Goldner
- School of Creative Arts Therapies, Emili Sagol CAT Research Center & Sagol Lab for Children at Risk, Faculty of Welfare and Health Sciences, University of Haifa, Israel
| |
Collapse
|
17
|
Visual Communication and Creative Processes Within the Primary Care Consultation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1356:223-244. [PMID: 35146624 DOI: 10.1007/978-3-030-87779-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Discussion of the value of image, metaphor and creative principles to good consulting skill and patient education within the Primary Care setting is important in enhancing improved patient-physician interactions. A broad-based view of the techniques used in undergraduate and postgraduate teaching within Medical Education in the UK and US are canvassed to establish the best practices and efficacy of using drawings and images as communication tools between physicians and patients. A descriptive analysis of the author's use of image and metaphor is analysed to assess how such convey medical information and help in the improvement of consultation and patient understanding.
Collapse
|
18
|
Alyami M, Serlachius A, Mokhtar I, Broadbent E. Longitudinal Associations Between Illness Perceptions and Glycemic Control in Type 2 Diabetes. Int J Behav Med 2021; 29:398-407. [PMID: 34523073 PMCID: PMC8439369 DOI: 10.1007/s12529-021-10024-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/24/2022]
Abstract
Background Cross-sectional research demonstrates associations between illness perceptions and glycemic control in people with type 2 diabetes (T2D). Prospective studies are limited and show mixed findings. This study aimed to investigate (1) whether baseline illness perceptions predicted glycemic control (HbA1c levels) at 6–12-month follow-up and (2) possible differences in baseline illness perceptions between individuals who completed at least one HbA1c blood test during the 12-month follow-up and those who did not. Methods A total of 115 individuals with T2D were recruited from an outpatient clinic. Demographic and clinical information and illness perceptions were assessed at baseline. HbA1c was assessed at baseline and 12 months later from clinical records. Hierarchical multiple linear regression examined associations between baseline illness perceptions and HbA1c levels at 6–12-month follow-up, controlling for age, sex, education, types of diabetes medication, and baseline HbA1c. Results Univariate analysis showed perceived weight management effectiveness at baseline was associated with lower HbA1c at follow-up (rho = −.25, p = .04, n = 67). Adjusted multiple regression showed that HbA1c at baseline was the only significant predictor of HbA1c at 6–12-month follow-up (β = 0.51, p < .001). There were no significant differences in baseline illness perceptions between individuals who completed HbA1c blood tests during follow-up (n = 78) and those who did not (n = 34), p > .05. Conclusion Illness perceptions at baseline did not predict longitudinal HbA1c in adjusted analyses, nor completion of HbA1c tests. Results may be due to temporal variability in HbA1c and barriers to accessing blood tests. Supplementary Information The online version contains supplementary material available at 10.1007/s12529-021-10024-y.
Collapse
Affiliation(s)
- Mohsen Alyami
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Ibrahim Mokhtar
- Diabetes and Endocrine Centre, King Khaled Hospital, Najran, Saudi Arabia
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| |
Collapse
|
19
|
Bood ZM, Scherer-Rath M, Sprangers MAG, Timmermans L, van Wolde E, Cristancho SM, Heyning F, Russel S, van Laarhoven HWM, Helmich E. Repeated use of rich pictures to explore changes in subjective experiences over time of patients with advanced cancer. Cancer Rep (Hoboken) 2021; 5:e1428. [PMID: 34313027 PMCID: PMC8789615 DOI: 10.1002/cnr2.1428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/09/2021] [Accepted: 05/05/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The combination of verbal and visual tools may help unravel the experiences of advanced cancer patients. However, most previous studies have focused on a specific symptom, at only one moment in time. We recently found that a specific visual tool, originating from systems thinking, that is, rich pictures (RPs), could provide a more comprehensive view of the experiences of patients with advanced cancer. AIMS To examine whether the repeated use of RPs can make changes in subjective experiences of patients living with advanced cancer visible over time. METHODS AND RESULTS We performed a prospective study with a generic qualitative approach that was mostly informed by the process of grounded theory. We invited patients to make an RP twice, at the start of the study, and again after 2 months. Both RP drawing sessions were directly followed by a semi-structured interview. Patients with all types of solid tumors, above the age of 18, and with a diagnosis of advanced, incurable cancer, were eligible. Eighteen patients participated and 15 patients were able to draw an RP twice. In eight RP-sets, considerable differences between the first and second RP were noticeable. Two patterns were distinguished: (1) a change (decline or improvement) in physical health (five patients), and/or (2) a change in the way patients related to cancer (three patients). CONCLUSION RPs are a valuable qualitative research method that can be used to explore the experiences of patients with advanced cancer, not only at a single point in time but also over time.
Collapse
Affiliation(s)
- Zarah M Bood
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Scherer-Rath
- Faculty of Philosophy, Theology, and Religious Studies, Radboud University-Nijmegen, Nijmegen, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Liesbeth Timmermans
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ellen van Wolde
- Faculty of Philosophy, Theology, and Religious Studies, Radboud University-Nijmegen, Nijmegen, The Netherlands
| | - Sayra M Cristancho
- Centre for Education Research & Innovation and Department of Surgery, Health Sciences Addition, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Fenna Heyning
- Association of Topclinical hospitals STZ, Utrecht, The Netherlands
| | | | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther Helmich
- Center for Education Development and Research in Health Professions, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
20
|
Richards HL, Sweeney P, Corscadden R, Carr C, Rukundo A, Fitzgerald J, O'Connor C, Fortune DG. "Picture this"- Patients' Drawings of Non-Muscle Invasive Bladder Cancer: A Novel Method to Help Understand How Patients Perceive Their Condition. Bladder Cancer 2021; 7:149-159. [PMID: 38994531 PMCID: PMC11181761 DOI: 10.3233/blc-201528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a paucity of data regarding patient experiences of living with non-muscle-invasive bladder cancer (NMIBC). OBJECTIVES To investigate patients' beliefs about NMIBC utilising both a well-established verbal/linguistic method, the Brief Illness Perception Questionnaire (B-IPQ) in addition to a novel visual/perceptual method, that is, asking patients to draw their bladder as it is now and as they perceive it will be in the future. METHODS Cross-sectional study of patients with NMIBC. Patients completed: (i) the B-IPQ, and (ii) 2 drawings of their bladder: as they perceived it currently and as they perceived it would look in 5 years' time. RESULTS A total of 118 patients completed the B-IPQ, of which 96 produced 2 bladder drawings. Forty-seven per cent of patients depicted no change in their bladder across time, 35% depicted improvements, while 18% drew their NMIBC as deteriorating between the two time points. Patients who drew their NMIBC worsening over time reported significantly stronger beliefs in the severity of current consequences from their NMIBC (F(2,94) = 9.07, p < 0.001, m = 5.68, 95% CI 4.38-6.88) and greater current concerns about their NMIBC (F(2,94) = 6.17, p < 0.01, m = 7.06, 95% CI 5.47-8.66). This was unrelated to cancer grade, cancer stage, treatment or demographic variables. CONCLUSION This is the first study to explore beliefs about NMIBC in a sample of patients with NMIBC attending routine clinics using both a well-established and a novel method of assessing patients' perceptions. Results highlight the usefulness of a simple non-verbal technique, in identifying patients' concerns about the condition. Almost one fifth of patients with NMIBC may experience significant concerns about the worsening of their condition, which appear to be independent of demographic, histopathological, and treatment related variables. Further exploration of the psychological concerns of individuals with NMIBC is required in order to appropriately plan for needs led multidisciplinary approach in their care.
Collapse
Affiliation(s)
- Helen L Richards
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Paul Sweeney
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Rebekah Corscadden
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Chelsea Carr
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Aphie Rukundo
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Jill Fitzgerald
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Charles O'Connor
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Dónal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
| |
Collapse
|
21
|
Alyami M, Serlachius A, O'Donovan CE, van der Werf B, Broadbent E. A systematic review of illness perception interventions in type 2 diabetes: Effects on glycaemic control and illness perceptions. Diabet Med 2021; 38:e14495. [PMID: 33306203 DOI: 10.1111/dme.14495] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/08/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022]
Abstract
AIMS This systematic review sought to synthesize the evidence regarding the effectiveness of illness perception interventions compared with control conditions at changing illness perceptions and improving glycaemic control in individuals with type 2 diabetes. METHODS Seven electronic databases were searched between October 2018 and May 2020. Randomized controlled trials that tested interventions informed by the Common-Sense Model in adults with type 2 diabetes, and measured illness perceptions and glycaemic control at pre- and post-intervention were included. The Cochrane risk of bias tool was used to assess risk of bias. RESULTS A total of 4095 articles were identified, of which nine randomized control trials (2561 participants) across 12 publications were included in this review. Findings showed that all the illness perception domains were modified in at least one trial, with the exception of cyclical timeline perceptions. Coherence, personal control, treatment control and chronic timeline perceptions were the most frequently modified perceptions. Glycaemic control demonstrated an improvement in the intervention group compared to the control group at 3 and 6 months post-intervention in two trials. Risk of bias assessment showed high risk of bias especially for the blinding of participants and the personnel domain. CONCLUSIONS There is limited evidence that interventions informed by the Common-Sense Model can improve glycaemic control in individuals with type 2 diabetes through changing inaccurate illness perceptions. Recommendations for future research are to tailor intervention content based on baseline perceptions, measure the emotional and causal domains, and involve family members in the intervention. (PROSPERO registration: CRD42019114532).
Collapse
Affiliation(s)
- Mohsen Alyami
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Claire E O'Donovan
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Bert van der Werf
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
22
|
Goldner L, Lev-Wiesel R, Binson B. Perceptions of Child Abuse as Manifested in Drawings and Narratives by Children and Adolescents. Front Psychol 2021; 11:562972. [PMID: 33519578 PMCID: PMC7840510 DOI: 10.3389/fpsyg.2020.562972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022] Open
Abstract
Child abuse is an underreported phenomenon despite its high global prevalence. This study investigated how child abuse is perceived by children and adolescents as manifested in their drawings and narratives, based on the well-established notion that drawings serve as a window into children's mental states. A sample of 97 Israeli children and adolescents aged 6-17 were asked to draw and narrate what child abuse meant to them. The drawings and narratives were coded quantitatively. The results indicated that participants did not perceive a distinction between abuse and violence and referred to them interchangeably. Almost half of the participants focused on emotional abuse. The most frequent type of abuse within the family was between parents and children, and the most frequent abuse outside the family was peer victimization. Most of the drawings were figurative and realistic and half of the drawings included words suggestive of the participants' attempts to be heard and fully understood. The vast majority of drawings did not include the figure of the artist, about a third of the drawings employed dissociative techniques (i.e., included positive objects, were unrelated to abuse, used words alone, or did not follow the instructions), and almost half of the narratives were dissociative or characterized by negative resolution, describing feelings such as sadness, humiliation, and loneliness. These findings suggest the emotional pain associated with the abuse or violence and the use of dissociative mechanisms to bypass the pain. The findings are discussed in light of the literature on children's disclosure.
Collapse
Affiliation(s)
- Limor Goldner
- Sagol Lab for Children at Risk, The Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Rachel Lev-Wiesel
- Sagol Lab for Children at Risk, The Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Bussakorn Binson
- FAA-Emili Sagol Creative Arts Research and Innovation for Well-Being Center, Faculty of Fine and Applied Arts, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
23
|
Murray J, Williams B. The Role of Images on Illness Behaviour: Interdisciplinary Theory, Evidence, and Ideas. Psychol Rep 2020; 124:2453-2475. [PMID: 32757718 PMCID: PMC8647478 DOI: 10.1177/0033294120945602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
If illness behaviour is to be fully understood, the social and behavioural sciences must
work together to understand the wider forms in which illness is experienced and
communicated with individuals and society. The current paper synthesised literature across
social and behavioural sciences exploring illness experience and communication through
physical and mental images. It argues that images may have the capacity to embody and
influence beliefs, emotions, and health outcomes. While four commonalities exist,
facilitating understandings of illness behaviour across the fields (i.e., understanding
the importance of the patient perspective; perception of the cause, sense of identity with
the illness, consequences, and level of control; health beliefs influencing illness
experience, behaviours, and outcomes; and understanding illness beliefs and experiences
through an almost exclusive focus on the written or spoken word), we will focus on
exploring the fourth commonality. The choice to focus on the role of images on illness
behaviour is due to the proliferation of interventions using image-based approaches. While
these novel approaches show merit, there is a scarcity of theoretical underpinnings and
explorations into the ways in which these are developed and into how people perceive and
understand their own illnesses using image representations. The current paper identified
that the use of images can elucidate patient and practitioner understandings of illness,
facilitate communication, and potentially influence illness behaviours. It further
identified commonalities across the social and behavioural sciences to facilitate theory
informed understandings of illness behaviour which could be applied to visual intervention
development to improve health outcomes.
Collapse
Affiliation(s)
- Jennifer Murray
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| |
Collapse
|
24
|
van Alphen K, Versluis A, Dercksen W, de Haas H, Lugtenberg R, Tiemensma J, Kroep J, Broadbent E, Kaptein AA, van den Hurk C. Giving A Face to Chemotherapy-Induced Alopecia: A Feasibility Study on Drawings by Patients. Asia Pac J Oncol Nurs 2020; 7:218-224. [PMID: 32478141 PMCID: PMC7233558 DOI: 10.4103/apjon.apjon_8_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/03/2020] [Indexed: 11/10/2022] Open
Abstract
Objective: Individuals with cancer experience the impact of chemotherapy on hair loss in different ways. The aim of this pilot study was to explore patients' experiences of alopecia through patients' drawings. Methods: Fifteen female patients diagnosed with cancer and treated with chemotherapy were recruited at the oncological day-care unit of a teaching hospital in the Netherlands. Participants completed a semi-structured interview about alopecia. They drew their head and hair before and during chemotherapy and completed the Brief Illness Perception Questionnaire (B-IPQ). Results: The drawings revealed predominantly physical effects, rather than emotions. Emotions were evident in the text that patients wrote under the drawings and in the B-IPQ open question about the perceived consequences of alopecia. The overall impact of alopecia that emerged from the drawings and the B-IPQ corresponded to the information retrieved from the interviews, namely disappointment, insecurity, sadness, and confrontation. Conclusions: Drawings expose cognitive and emotional responses to alopecia that may be relatively unexplored when using traditional assessment methods such as questionnaires or interviews. In future research, the drawing instructions need to be more specifically focused on feelings in order to better capture emotional reactions to hair loss.
Collapse
Affiliation(s)
- Kirsten van Alphen
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Anne Versluis
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Wouter Dercksen
- Department of Medical Oncology, Máxima Medical Centre, Eindhoven, Netherlands
| | - Henk de Haas
- Department of Medical Oncology, Máxima Medical Centre, Eindhoven, Netherlands
| | - Rieneke Lugtenberg
- Departments of Medical Oncology, Leiden University Medical Centre, Leiden, The, Netherlands
| | - Jitske Tiemensma
- Department of Psychological Science University of California, Merced, CA, USA
| | - Judith Kroep
- Departments of Medical Oncology, Leiden University Medical Centre, Leiden, The, Netherlands
| | - Elizabeth Broadbent
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Ad A Kaptein
- Medical Psychology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Corina van den Hurk
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| |
Collapse
|
25
|
Leeuwen NM, Boonstra M, Huizinga TW, Kaptein AA, Vries‐Bouwstra JK. Illness perceptions, risk perceptions and worries in patients with early systemic sclerosis: A focus group study. Musculoskeletal Care 2020; 18:177-186. [PMID: 31984643 PMCID: PMC7318332 DOI: 10.1002/msc.1453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022]
Abstract
Objectives This study explores illness perceptions, risk perceptions and degree of worry in patients with recently diagnosed systemic sclerosis (SSc). Specifically, it aims to answer whether and how early diagnosis in a stage that disease is relatively mild can impact patients' lives, and if and how disease severity associates with illness perceptions and risk perception. Methods Patients with a diagnosis of SSc <2 years were invited to participate in a focus group discussion for in‐depth exploration of illness perceptions, risk perceptions and worry. In addition, illness perceptions, risk perceptions and worries were evaluated with the use of questionnaires. To explore how patients perceive SSc, we asked them to draw their disease. Physician global assessment of disease severity was used to measure disease severity. Associations between disease severity, illness/risk perceptions, drawings and elements of the focus group were assessed. Results We observed three dimensions of illness perception as most relevant for patients: personal control, concern and consequences. Patients with SSc experienced many symptoms and felt low personal control. Concerns about the future were often mentioned, and the majority of patients scored high on the worry questionnaire. None of the patients was preoccupied with prognosis or death. All drawings illustrate the impact of SSc on daily life and psychological well‐being. Illness perceptions were highly variable between patients and did not associate with disease severity. Conclusion This study showed that a diagnosis of early SSc had a significant impact on patients' lives, also in the absence of severe disease complications.
Collapse
Affiliation(s)
- Nina M. Leeuwen
- Department of RheumatologyLeiden University Medical Centre Leiden The Netherlands
| | - Maaike Boonstra
- Department of RheumatologyAmsterdam University Medical Centre Amsterdam The Netherlands
| | - Tom W.J. Huizinga
- Department of RheumatologyLeiden University Medical Centre Leiden The Netherlands
| | - Ad A. Kaptein
- Department of Medical PsychologyLeiden University Medical Centre Leiden The Netherlands
| | | |
Collapse
|
26
|
Dalbeth N, Douglas M, MacKrill K, Te Karu L, Kleinstäuber M, Petrie KJ. The impact of the illness label 'gout' on illness and treatment perceptions in Māori (Indigenous New Zealanders). BMC Rheumatol 2020; 4:23. [PMID: 32313870 PMCID: PMC7158036 DOI: 10.1186/s41927-020-00120-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 02/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background Despite contemporary advances in understanding pathogenesis and effective management of gout, beliefs about the disease continue to be focused on gout as a self-inflicted illness. The illness label itself may contribute to inaccurate perceptions of the disease and its management. In Aotearoa/New Zealand, Māori (Indigenous New Zealanders) have high prevalence of severe gout. The aim of this study was to examine the impact of the illness label ‘gout’ on perceptions of the disease and its management for Māori. Methods Māori supermarket shoppers (n = 172) in rural and urban locations were recruited into a study examining the perceptions about arthritis. Participants were randomised 1:1 to complete a questionnaire examining the perceptions of the same illness description labelled as either ‘gout’ or ‘urate crystal arthritis’. Differences between the two illness labels were tested using independent sample t-tests. Results ‘Gout’ was most likely to be viewed as caused by diet, whereas ‘urate crystal arthritis’ was most likely to be viewed as caused by aging. ‘Urate crystal arthritis’ was seen as having a wider range of factors responsible for the illness, including stress or worry, hereditary factors and chance. ‘Gout’ was less likely to be viewed as having a chronic timeline, and was perceived as being better understood. Dietary management strategies were seen as more helpful for management of the gout-labelled illness. Conclusions This study has demonstrated that for Māori, Indigenous New Zealanders who are disproportionately affected by gout, the illness label influences perceptions about gout and beliefs about management.
Collapse
Affiliation(s)
- Nicola Dalbeth
- 1Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand
| | - Meihana Douglas
- 2Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Kate MacKrill
- 2Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Leanne Te Karu
- Ngā Kaitiaki o te Puna Rongoā o Aotearoa, Taupō, New Zealand
| | - Maria Kleinstäuber
- 2Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.,4Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Keith J Petrie
- 2Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
27
|
Plourde V, Kung JY, Gates A, Jun S, Brooks BL, Sebastianski M. How Perceptions Impact Recovery from Concussion in Childhood and Adolescence: a Systematic Review. Neuropsychol Rev 2020; 30:142-163. [PMID: 32124152 DOI: 10.1007/s11065-020-09430-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 02/16/2020] [Indexed: 12/24/2022]
Abstract
Perceptions about the causes and consequences of concussion, and individual representations and interpretations of these factors, can influence the post-concussive recovery process. The goal of this project was to synthesize evidence on perceptions related to concussions as experienced by children, adolescents, and parents, and to evaluate how these perceptions impact post-concussive recovery in physical, behavioural, cognitive, and psychological domains. We undertook a systematic review based on the Cochrane Handbook, conducting a comprehensive search of six databases and Google Scholar. Duplicate, independent screening was employed and the quality of studies was assessed using the Mixed Methods Appraisal Tool (MMAT). A total of 1552 unique records were identified, and six records (5 scientific articles and 1 thesis, published between 1990 and 2018; N = 26 to 412, age range from 2 to 18 years) were included. Perceptions about concussions were assessed differently between studies, with a range in types of measures and respondents. Some evidence suggested that perceptions could negatively impact concussion recovery, mostly post-concussive symptoms. However, results were not consistent between studies and the methodological quality was variable (and often low). There is limited evidence of the impact of perceptions of children, adolescents, and their parents on concussion recovery. Priorities for future research investigating concussion recovery should include recruiting representative samples, accounting for potential confounders, and measuring perceptions in children, adolescents and parents using validated measures. Higher quality studies are needed to better understand the role of perceptions in concussion recovery and to inform clinical care.
Collapse
Affiliation(s)
- Vickie Plourde
- School of Psychology, Université de Moncton, 18 Av Antonine-Maillet, Moncton, NB, E1A 3E6, Canada.
| | - Janice Y Kung
- John W. Scott Health Sciences Library, University of Alberta, 2K3.28 Walter C. Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2R7, Canada
| | - Allison Gates
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, 4-482C, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Shelly Jun
- Department of Surgery, University of Alberta, 3E1.14 Walter Mackenzie Centre, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
| | - Brian L Brooks
- Neurosciences program, Alberta Children's Hospital, Calgary, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Pediatrics, University of Calgary, Calgary, Canada
- Alberta Children's Research Institute, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, 4-486D, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada
| |
Collapse
|
28
|
Sándor Z, Látos M, Pócza-Véger P, Havancsák R, Csabai M. The drawing version of the pictorial representation of illness and self measure. Psychol Health 2020; 35:1033-1048. [DOI: 10.1080/08870446.2019.1707825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Zita Sándor
- Faculty of Health and Social Sciences, Gál Ferenc College, Gyula, Hungary
- Faculty of Medicine Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Melinda Látos
- Faculty of Medicine, Department of Surgery, University of Szeged, Szeged, Hungary
| | - Petra Pócza-Véger
- Faculty of Medicine Department of Neurosurgery, University of Szeged, Szeged, Hungary
| | - Rózsa Havancsák
- Student Counselling Centre, University of Szeged, Szeged, Hungary
| | - Márta Csabai
- Institute of Psychology, University of Szeged, Szeged, Hungary
| |
Collapse
|
29
|
Hagger MS, Hamilton K, Hardcastle SJ, Hu M, Kwok S, Lin J, Nawawi HM, Pang J, Santos RD, Soran H, Su TC, Tomlinson B, Watts GF. Predicting intention to participate in self-management behaviors in patients with Familial Hypercholesterolemia: A cross-national study. Soc Sci Med 2019; 242:112591. [PMID: 31630009 DOI: 10.1016/j.socscimed.2019.112591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Martin S Hagger
- Psychological Sciences, University of California, Merced, USA; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; School of Applied Psychology, Griffith University, Brisbane, Australia.
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Sarah J Hardcastle
- School of Health and Human Performance, Dublin City University, Ireland; Institute for Health Research, University of Notre Dame, Fremantle, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Miao Hu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,Special Administrative Region
| | - See Kwok
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, UK; Lipoprotein Research Group, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Jie Lin
- Department of Atherosclerosis, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hapizah M Nawawi
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Jing Pang
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, and Preventive Medicine Centre and Cardiology Program Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Handrean Soran
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ta-Chen Su
- Department of Internal Medicine and Cardiovascular Centre and College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,Special Administrative Region
| | - Gerald F Watts
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Australia
| |
Collapse
|
30
|
DeLongis A, Morstead T. Bringing the social context into research using the common sense model. Health Psychol Rev 2019; 13:481-483. [PMID: 31412727 DOI: 10.1080/17437199.2019.1652107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Anita DeLongis
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Talia Morstead
- Department of Psychology, University of British Columbia, Vancouver, Canada
| |
Collapse
|
31
|
Benyamini Y, Karademas EC. Introduction to the special issue on the common sense model of self-regulation. Health Psychol Rev 2019; 13:373-377. [PMID: 31339455 DOI: 10.1080/17437199.2019.1644189] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
32
|
Johnston M. Representing health threat representations. Health Psychol Rev 2019; 13:477-480. [PMID: 31286823 DOI: 10.1080/17437199.2019.1641426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
33
|
Thorpe C, Arbeau KJ, Budlong B. 'I drew the parts of my body in proportion to how much PCOS ruined them': Experiences of polycystic ovary syndrome through drawings. Health Psychol Open 2019; 6:2055102919896238. [PMID: 31903221 PMCID: PMC6928539 DOI: 10.1177/2055102919896238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Polycystic ovary syndrome is a chronic endocrine disorder associated with persistent physical symptoms and psychological and lifestyle repercussions. Eighty-nine participants (83 females, 6 non-binary) aged 19-43 years described their experiences of polycystic ovary syndrome through drawings and personal accounts. Four descriptive themes were identified: awareness of visible and invisible symptoms, misshapen self and body, limitations and barriers and resignation. Taken together, participants described a condition with all-encompassing effects: much more than symptom management alone. Findings support the use of drawings as an appropriate method with this population and suggest continuing need for supports for individuals with polycystic ovary syndrome.
Collapse
|
34
|
Brogan A, Hevey D, Wilson C, Brinkley A, O'Malley G, Murphy S. A network analysis of the causal attributions for obesity in children and adolescents and their parents. PSYCHOL HEALTH MED 2019; 24:1063-1074. [PMID: 31131625 DOI: 10.1080/13548506.2019.1620298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Illness attributions inform how people understand illness and relate to psychological outcomes. Parental attributions may impact children's adjustment to illness. This study investigated child, adolescent and parental causal attributions in paediatric obesity and illustrates the relationships between these attributions using network analysis. A cross-sectional design using the diagram network analytic method. Thirty children and 25 parents generated individual causal attribution maps. Network theory was used to analyse causal effects and results were visualised using network models. The results indicated large individual variation in the networks. Activity and eating-related variables featured strongly in child and parent networks. Children viewed their activity while parents regarded their child's eating behaviours as the main drivers of obesity. The characterisation of some children along an internalising dimension was supported in both networks. Habitual cluster behaviours and difficulties in regulation were identified in the child network. Parents ascribed significance to the future impact of obesity on body image and mood. Challenges in parent management were also indicated. Obesity is a heterogeneous condition, requiring a tailored treatment approach. Therapeutic directions were identified in the areas of activity, food intake, sleep hygiene and parent management. Attributional processes represent a potential mechanism to tailor obesity treatment. Further research is needed to establish the relationship between attributions, treatment engagement and outcome.
Collapse
Affiliation(s)
- Amy Brogan
- a School of psychology , Trinity College Dublin , Dublin , Ireland
| | - David Hevey
- a School of psychology , Trinity College Dublin , Dublin , Ireland
| | - Charlotte Wilson
- a School of psychology , Trinity College Dublin , Dublin , Ireland
| | - Aoife Brinkley
- b W82GO programme , Children's University Hospital , Temple Street , Ireland
| | - Grace O'Malley
- b W82GO programme , Children's University Hospital , Temple Street , Ireland
| | - Sinéad Murphy
- b W82GO programme , Children's University Hospital , Temple Street , Ireland
| |
Collapse
|