Phenomenology and Critical Social Psychology: Directions and Debates in Theory and Research

Community health action and COVID-19 in Barcelona neighbourhoods: responses and challenges

The COVID-19 pandemic exacerbated pre-existing social, economic and political inequalities. The evidence describes the use of community engagement approaches to support appropriate COVID-19 prevention and control measures. We aimed to delve deeper into the community response to COVID-19 in Barcelona neighbourhoods with different pre-existing levels of development of community health action (CHA). A qualitative phenomenological study was conducted in six Barcelona neighbourhoods with different types of CHAs. The sample included 37 in-depth interviews with community agents with good knowledge of the territory. The content analysis focused on three dimensions: symbolic (conceptions motivating action), substantive (the content and resources of the action) and operational (interactions between agents). Regardless of their CHA typology, all neighbourhoods responded to the needs generated by the pandemic. Symbolic: strong-CHA development, characterized by well-established participatory structures, facilitated responses to the crisis. In medium-CHA neighbourhoods, the emergency exacerbated previous tensions. In emerging-CHA neighbourhoods, previous participatory structures, although not health-specific, favoured the coordination of responses. Substantive: technology influenced the way CHA activities were conducted. Operative: in the strong-CHA neighbourhood, new participants were able to join previous participatory structures. In medium-CHA neighbourhoods, power dynamics hindered coordination. In conclusion, strong CHA can play a key role in addressing the adverse consequences of social and health crisis. Empowering citizens and communities should be a primary objective of public policy that integrates the 'health-in-all-policies' approach. This approach entails allocating public resources to strengthen the role of community action and power.

Use of poppers (nitrite inhalants) among young men who have sex with men with HIV: A clinic-based qualitative study

Nitrite inhalants (poppers) are associated with HIV transmission and commonly used among young men who have sex with men (YMSM), a group at increased risk for HIV. Significant research gaps exist in understanding the context in which YMSM use poppers. Qualitative interviews were conducted with 15 YMSM (22-31 years) with HIV to better understand the context in which poppers are used and their impacts on HIV care outcomes, such as care retention and antiretroviral adherence. The Social Ecological Model was applied to understand intrapersonal, interpersonal, community, and system level influences on popper use. Factors influencing popper use included: ubiquity of popper use in sexual settings, introduction to poppers by casual sexual partners, patient-HIV provider communication surrounding poppers, neighborhood, substance use and HIV care systems, and the legal status of poppers. Implications for clinical care, public health, policy, and future research are discussed.

Financial medicine: A multi-dimensional concept moving towards contextually specific working definitions for use in the South African prehospital setting

Introduction

The phenomenon that has been described as Financial Medicine has been occurring within the South African Healthcare sector for at least the last decade. Despite the ongoing effect of this phenomenon, there is no organised body of knowledge or formulated working definitions to guide knowledge sharing and theorisation within this research focus area. The practice of Financial Medicine exerts a deleterious effect on the South African prehospital healthcare system, and represents an area in dire need of focused research efforts. Establishing appropriate working definitions and associated taxonomy is an important first step in supporting further research efforts into this aspect of South African prehospital healthcare systems.

Methods

A qualitative research methodology following a constructivist grounded theory design was used. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity.

Results

A working definition for Financial Medicine is provided. Six new terms are introduced, with associated working definitions, namely Financial Medicine Practices, Treatment-based profiteering, Cost-of-care-aversion, Personal-gain-at-patient-expense, Money-racketeering-in-healthcare, and Impoverishing-healthcare-earning.

Conclusion

The working definitions and suggested taxonomy presented in this article are the first step in formally conceptualising and theorising the phenomenon of Financial Medicine, in order to support further research and collaboration in this space.

Impact of the COVID-19 pandemic on the mental health and well-being of adults with mental health conditions in the UK: a qualitative interview study

BACKGROUND

People with mental health conditions have been identified as particularly vulnerable to poor mental health during the coronavirus disease 2019 (COVID-19) pandemic. However, why this population have faced these adverse effects, how they have experienced them and how they have coped remains under-explored.

AIMS

To explore how the COVID-19 pandemic affected the mental health of people with existing mental health conditions, and to identify coping strategies for positive mental health.

METHODS

Semi-structured qualitative interviews with 22 people with mental health conditions. Participants were purposively recruited via social media, study newsletters and third sector mental health organisations. Data were analysed using reflexive thematic analysis.

RESULTS

Participants were aged 23-70 (mean age 43), predominantly female (59.1%) and of white ethnicity (68.2%). Fifty percent were unable to work due to illness and the most frequently reported mental health condition was depression. Five pandemic-related factors contributed to deteriorating mental health: (i) feeling safe but isolated at home; (ii) disruption to mental health services; (iii) cancelled plans and changed routines; (iv) uncertainty and lack of control; (v) rolling media coverage. Five coping strategies were identified for maintaining mental health: (i) previous experience of adversity; (ii) social comparison and accountability; (iii) engaging in hobbies and activities; (iv) staying connected with others; (v) perceived social support.

CONCLUSIONS

Challenges were identified as a direct result of the pandemic and people with severe mental illnesses were particularly negatively affected. However, some found this period a time of respite, drew upon reserves of resilience and adapted their coping strategies to maintain positive well-being.

Paradigms unfolded - developing, validating, and evaluating the Medical Education e-Professionalism framework from a philosophical perspective

In order to ensure a strong research design, literature stresses the adoption of a research paradigm that is consistent with the researcher's beliefs about the nature of reality. In this article we provide an overview of research paradigm choices in relation to the creation of a Medical Education e-Professionalism (MEeP) framework discussing the research design, research methods, data collection and analysis to enhance the transparency of our previously published research. The MEeP framework was conceived to help Health Care Professionals (HCPs) safeguard the construct of professionalism in the digital context. This entire process was heavily informed by wider readings and deliberations of published literature on e-professionalism. Although the MEeP framework research journey has been published, the paradigms approach was not discussed in any detail. Considering that one of the duties of medical educator is to balance the service and science by bringing the theoretical underpinnings of one's research to public attention and scrutiny so as to nullify the notion of 'weak' research. We were compelled to unfold this paradigm story of the MEeP framework in a detailed manner. In an effort to make our research both robust and effective, this study portrays a philosophical approach to guide future research designs and methodological choices by detailing our rationale for pragmatism as a choice of paradigm.

Women's voices: the lived experience of HIV-positive women in the postpartum period at the University of Gondar comprehensive specialized referral hospital, Ethiopia: a phenomenological study

BACKGROUND

Pregnancy and the postpartum period are incredibly challenging for women living with the Human Immune Deficiency Virus (HIV) due to the multidimensional influence of HIV infection. These women experience the challenges of navigating pregnancy and motherhood while living with HIV. It is poorly understood how women living with HIV (WLWH) experience pregnancy and postpartum. Therefore, the current study aimed to explore the lived experience of pregnancy and postpartum among women living with HIV.

METHODS

A phenomenological qualitative study design was employed. A semi-structured, interview guide was used to conduct in-depth interviews with HIV-positive postpartum women from April to May 2022. All interviews were recorded using a voice recorder and note was taken. The collected data were transcribed and translated into English for analysis. Inductive thematic analysis was applied to analyze the data.

RESULTS

Six main themes about the lived experience of women living with HIV were identified: (1) Fear and distress related to maternal and child Health, (2) HIV status self-disclosure dilemma, (3) Courage and commitment of HIV-positive women to prevent HIV, (4) Challenges faced and coping mechanisms used by HIV-positive women, (5) Health care providers and HIV-positive women interaction, and (6) Solution from their voices.

CONCLUSION

HIV infection also has a multidimensional impact on women's life during pregnancy and postpartum. The findings of this study improve our understanding of the lived experience of HIV-positive women while pregnant and in the postpartum period. These women's descriptions showed that they have been experiencing various challenges that are not often addressed in antenatal clinics, such as distress and uncertainties related to vertical transmission of HIV. These women need specialized support and all-encompassing care to have a healthy pregnancy and postpartum period. Moreover, it is essential to understand the circumstances of women's lives, their relationships with others, and their decision-making processes. Healthcare professionals and other responsible bodies working with women living with HIV should encourage and support these mothers to appraise and maintain their commitment to protecting their children from acquiring HIV infection and maintaining their Health to the maximum to raise their children.

Influence of grandmothers on breastfeeding practices in a rural community in Papua New Guinea: A critical discourse analysis of first-time mothers' perspectives

BACKGROUND

Almost all babies are breastfed in Papua New Guinea (PNG); yet appropriate breastfeeding practices are not always followed.

AIM

To explore the perspectives of first-time mothers in rural PNG on how the language and discourse of grandmothers about infant feeding influence their breastfeeding practices.

METHODS

A critical discourse analysis (CDA) approach was used to theoretically frame the analysis of twenty first-time mothers' narratives.

FINDINGS

Analysis revealed three themes: (i) prescribed knowledge repository, (ii) social control and dominance, and (iii) disapproval and role conflict, which provides an understanding of grandmothers' differing views and positions on infant feeding practices and their influence on breastfeeding.

CONCLUSION

This study shows that grandmothers remain influential in infant feeding practices in rural PNG. There appears to be a societal expectation that empowers grandmothers in the maternal decision-making processes regarding breastfeeding practice. Grandmothers' influence includes the early introduction of complementary foods to infants less than six months old. Interventions aimed at promoting, protecting, and supporting breastfeeding need to include grandmothers.

Online teaching during COVID-19 pandemic: A phenomenological study of university educators’ experiences and challenges

To further understand how online teaching and learning can be improved during the COVID-19 pandemic, a phenomenological study was conducted on 15 educators’ experiences of online teaching in Malaysian Universities. The Community of Inquiry framework is used as a guide, as well as a data interpretation tool, to understand the educators’ experiences in terms of planning and implementing teaching and learning in using online tools, technologies, and platforms. Findings indicate that in the current situation, with all the intricacies, deficiencies and challenges, the educators’ teaching presence is clearly discernible. Nevertheless, there appears to be efforts by the educators to ensure that teaching presence, cognitive presence and social presence are integrated, albeit in an unstructured manner. Based on the data, a flexible, fluid and dynamic model of Community of Inquiry, which is suitable to crisis situations, is suggested and a supporting guideline is provided to understand the framework.

Phenomenological Qualitative Methods Applied to the Analysis of Cross-Cultural Experience in Novel Educational Social Contexts

The qualitative method of phenomenology provides a theoretical tool for educational research as it allows researchers to engage in flexible activities that can describe and help to understand complex phenomena, such as various aspects of human social experience. This article explains how to apply the framework of phenomenological qualitative analysis to educational research. The discussion within this article is relevant to those researchers interested in doing cross-cultural qualitative research and in adapting phenomenological investigations to understand students’ cross-cultural lived experiences in different social educational contexts.

Social Isolation in Older Adults: A Qualitative Study on the Social Dimensions of Group Outdoor Health Walks

Physical distancing practices during the COVID-19 global pandemic contributed to a high degree of social isolation among older adults. To reduce loneliness and other ill effects of social isolation, public health experts recommended outdoor social gathering, with physical distancing. Adopting a case study approach, we explored how social aspects of group outdoor health walks (GOHWs) mitigate social isolation for older adults and improve individual social wellbeing. We used semi-structured interviews to understand the experiences of social isolation and social relationships in nine older (50-80 s) adults participating in a GOHW in Scotland, United Kingdom (UK). Verbatim transcripts were analysed through an iterative process of thematic analysis carried out by an interdisciplinary team of qualitative researchers from environmental psychology, medicine, and geography. Themes provide insight into the social dimensions of GOHWs, the mediating effects of social experiences, and the contribution these make to individual social wellbeing. GOHWs provide opportunities to be part of a group and attend to the needs of inexperienced or physically challenged individuals. Being part of the group walk fosters casual interpersonal interactions through spontaneous mixing during and after the walk. This programmatic structure counters loneliness, engenders pleasurable anticipation of regular contact with others, supports physical activity, and fosters group cohesion. These in turn contribute to individual social wellbeing, including expanding social networks, meaningful relationships, a sense of belonging, and acting on empathy for others. GOWHs may be beneficial for mitigation of social isolation as we emerge from the COVID-19 pandemic. Findings were used to propose a conceptual model to parse social constructs and inform selection or development of quantitative social measures for future studies of nature-based interventions such as GOHWs.

Understanding Barriers and Facilitators to Compliance with UK Social Distancing Guidelines During the COVID-19 Pandemic: A Qualitative Interview Study

When followed, there is evidence that social distancing measures play a major role in reducing the transmission of viruses such as COVID-19. However, not all individuals follow the guidance. We explored barriers and facilitators to compliance with UK social distancing guidelines during the COVID-19 pandemic through semi-structured interviews with 116 adults. Data were analysed using reflexive thematic analysis and themes mapped to the Capability, Opportunity and Motivation Model of Behaviour (COM-B). Barriers to compliance included inconsistent rules, caring responsibilities, fatigue, unintended consequences of control measures, and the need for emotional support. Facilitators were informational support and social responsibility. Six themes were both a barrier and a facilitator: lived environment, beliefs about consequences of non-compliance, influence of others, practical support, and trust in government. Reflective motivation, psychological capability, and social opportunity were important drivers for compliance. Measures that enable social support alongside strategies to maintain motivation to comply, provide clear guidance and optimise social cohesion should be promoted.

Community and cultural engagement for people with lived experience of mental health conditions: what are the barriers and enablers?

Background

Community and cultural engagement can support recovery, help symptom management and increase social connections for people with lived experience of mental health conditions. However, research suggests that people with mental health conditions experience significant barriers to participation. The aim of this study was to explore barriers and enablers of participation in community and cultural activities among people with mental health conditions.

Methods

A qualitative interview study with 23 people with mild-to-moderate mental health conditions was undertaken. Data were analysed thematically, and themes were mapped to domains of the Capability, Opportunity and Motivation Model of Behaviour (COM-B).

Results

Eleven themes were identified from the analysis. Three themes involved participant Capability: physical skills, psychological traits and physical health limitations and three themes related to Opportunity: affordability and accessibility, structure and nature of the group, and support from others to attend. Five themes mapped to Motivation: creative identity, recovery and coping, enjoyment and fun, connecting with others, and information and planning. Participants were motivated to engage with community and cultural activities through “a creative identity”, belief that engagement would help recovery from mental illness, and a desire to connect with others and make friends. Motivation to participate was sustained by the enjoyable nature of activities. However, participants’ ability to engage was hampered by the expense, inaccessibility and sometimes unstructured nature of activities, and social anxiety associated with attending. Some participants had physical limitations such as fatigue or physical health problems to overcome. Interventions that could address these barriers include peer support, training for social prescribers to account for identity and previous experiences of participation, training for community organisations in providing a welcoming and structured environment, and provision of long-term sustainable funding to community organisations to subsidise attendance, transport or equipment costs.

Conclusion

People with mental health conditions may be at risk of experiencing barriers to community and cultural engagement due to existing social inequalities and social anxiety, however believing that involvement will support mental health was an enabler to participation. Future studies are needed to test the effectiveness of potential interventions to address the barriers and harness the facilitators identified here, to enable a more socially inclusive community and voluntary sector, and a potentially more responsive and effective social prescribing service in the UK for people experiencing mental health problems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00775-y.

Client experiences with holistic neuropsychological rehabilitation: "It is an ongoing process"

The effectiveness of holistic neuropsychological rehabilitation for people with acquired brain injury has previously been demonstrated by means of standardized and routinely administered outcome measures. However, the most important outcomes from the perspective of former clients are largely unknown. This study explored the experience of participating in a holistic neuropsychological rehabilitation programme by conducting three focus groups with twelve former clients who had sustained a brain injury. Data were transcribed verbatim and analysed using thematic analysis. "It is an ongoing process" emerged as the overarching theme for the experience of recovery from brain injury. Four subthemes, or phases, were identified. Participants went through (1) a phase of confrontation, after which they (2) trained their skills and strategies, and (3) experimented with these in daily life. In the end, clients reached a phase of (4) coming to terms with their injury. Participants described increased levels of self-esteem, sense of competence, and adaptation as the most important outcomes of the programme, as these factors helped them regain a sense of identity. The results indicate that including these factors in outcome evaluations of complex interventions after brain injury may be important as they appear essential for capturing the client's perspective on change.

'She come like a sister to me': a qualitative study of volunteer social support for disadvantaged women in the transition to motherhood in England

This qualitative study explores the ways in which disadvantaged women benefit from social support from a trained volunteer during pregnancy and the postnatal period, using the theoretical frameworks of stress and coping and a multi-dimensional model of social support. Forty-seven mothers took part in semi-structured interviews. The mothers, who had received social support through nine volunteer projects in England, faced many potentially stressful challenges besides having a baby (such as poverty, poor housing, histories of abuse, motherhood at a young age, living with physical or mental health difficulties, migration and insecure immigration status). Analysis was in two distinct stages: first, an inductive thematic analysis of mothers' experiences, and second, mapping of the results onto the theoretical frameworks chosen. Volunteers built relationships of trust with mothers and gave skilled emotional support, positive appraisal support, informational support and practical support according to mothers' individual needs, thereby assisting mothers exposed to multiple stressors with problem-focused, emotion-focused and perception-focused coping. This helped to reduce social isolation, increase effective access to services and community resources, and build mothers' confidence, self-esteem and self-efficacy. Volunteer social support may have particular salience for mothers who lack structural support and need skilled functional support. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Exploring Nurses' Perceptions of Safety: A Phenomenological Study

The purpose of the study is to explore the lived experiences of nurses with regard to their personal safety and to identify the fundamental structures underlying nurse safety. A qualitative descriptive phenomenological design, using the data analysis method proposed by Colaizzi, was used. Eleven nurses participated in the study between March and July 2019. The research findings indicated the fundamental structure of nurse safety encompasses 3 categories: "nurses' personal protection systems," "safety support systems," and "risk factors." The fundamental structure identified in this study can contribute to better understanding and insight regarding the safety of nurses.

Experiences of barriers to trans-sectoral treatment of patients with severe mental illness. A qualitative study

Background

Patients with severe mental illness (SMI) have shorter life expectancy than people without SMI, mainly due to overmortality from physical diseases. They are treated by professionals in three different health and social care sectors with sparse collaboration between them, hampering coherent treatment. Previous studies have shown difficulties involved in establishing such collaboration. As the preparatory phase of an intervention to improve physical health of people with SMI and increase collaboration across sector borders, we explored different actors’ experiences of barriers for collaboration.

Method

We collected qualitative data from patients, professionals in general practice, psychiatry and social psychiatry involved in the treatment of these patients. Data consisted of notes from meetings and observations, interviews, focus groups and workshops. Analysis was by Interpretative Phenomenological Analysis.

Results

The study revealed many obstacles to collaboration and coherent treatment, including the consultation structures in general practice, sectors being subject to different legislation, and incompatible IT systems. Professionals in general practice and social psychiatry felt that they were left with the responsibility for actions taken by hospital psychiatry without opportunity to discuss their concerns with psychiatrists. There were also cultural differences between health care and social psychiatry, expressed in ideology and language. Social psychiatry had an existential approach to recovery, whereas the views of health professionals were linked to symptom control and based on outcomes. Meanwhile, patients were left in limbo between these separate ideologies with no leadership in place to promote dialogue and integrate treatments between the sectors.

Conclusion

Many obstacles to integrated trans-sectoral treatment of patients with SMI seem related to a lack of an overriding leadership and organizational support to establish collaboration and remove barriers related to legislation and IT. However, professional and ideological barriers also contribute. Psychiatry does not consider general practice to be part of the treatment team although general practitioners are left with responsibility for decisions taken in psychiatry; and different ideologies and treatment principles in psychiatry and municipal social psychiatry hamper the dialogue between them. There is a need to rethink the organization to avoid that the three sectors live autonomous lives with different cultures and lack of collaboration.

A qualitative study of first time mothers' experiences of postnatal social support from health professionals in England

PROBLEM

Many women experience the transition to motherhood as stressful and find it challenging to cope, contributing to poor emotional wellbeing.

BACKGROUND

Postnatal social support from health professionals can support new mothers in coping with this transition, but their social support role during the postnatal period is poorly defined.

AIM

To explore how first time mothers in England experienced social support from health professionals involved in their postnatal care.

METHODS

A qualitative descriptive study, theoretically informed by phenomenological social psychology, based on semi-structured, in-depth interviews with 32 mothers from diverse backgrounds. These were analysed using inductive thematic analysis, with themes subsequently mapped on to the four dimensional model of social support (emotional, appraisal, informational, practical).

FINDINGS

There were nine themes connected to social support, with the strongest mapping to appraisal and informational support: for appraisal support, 'Praise and validation', 'Criticism and undermining', and 'Made to feel powerless'; for informational support, 'Is this normal?', 'Need for proactive information', and 'Confusion about postnatal care'; for emotional support, 'Treated as an individual and heard' and 'Impersonal care and being ignored'; for practical support, 'Enabling partners to provide practical support'.

CONCLUSIONS

Health professionals can play an important role postnatally in helping first time mothers to cope, develop confidence and to thrive, by taking every opportunity to give appropriate and personalised appraisal, informational and emotional social support alongside clinical care. Training and professional leadership may help to ensure that all health professionals are able and expected to offer the positive social support already offered by some.

Young adults' transition to a plant-based diet as a psychosomatic process: A psychoanalytically informed perspective

This study examined transition to a plant-based diet by young adults and the challenges and conflicts this brings. Interviews were conducted with nine young adults in Sweden and the answers were analysed guided by a psychological method from descriptive phenomenology. The results indicate that the transition to a plant-based diet is a process comprising five dimensions: 1) Exploring new ways of living based on health anxieties, 2) regulating conflicting emotions through differentiation, 3) transforming traditional models into new alternatives, 4) confirming new skills and abilities and 5) integrating experiences and emotions into a whole. These five dimensions reflect how transition to a plant-based diet is experienced physically and emotionally. The results also indicate that plant-based meals and ingredients used in the new diet are loaded with symbols and conflicting emotions. Psychoanalytically informed theory, especially object relation theory, was used in discussing what can happen to the mind during the transition. In a wider perspective, this study provides insights into how a dietary transition can bring stability to the life of young adults and help them endure and master their situation. More research is needed to assess the role of mental health in transitioning to a plant-based diet and to draw more general conclusions, an area where psychodynamic theory can provide insights.

The MOVE Framework: Meanings, Observations, Viewpoints, and Experiences in processes of Social Change

Social psychologists are often criticized for failing to capture the dynamic nature of psychological processes. We present a novel framework to address this problem. The MOVE framework contends that to comprehend complex, contradictory, and divergent patterns of thought, affect, and behavior within changing, real-world contexts, it is necessary to undertake ecologically valid research that is attentive to the lived experiences and meaning-making processes of culturally embedded individuals over time. A focus on meanings, observations, viewpoints, and experiences is essential for social psychological research that holistically captures how people construct, understand, respond, position, and act over time within changing social, economic, and political contexts. To illustrate the utility of our proposition, we draw on classic social psychological studies and multimethod fieldwork during a period of rapid social and political change in Colombia during the peace process (2012–2017). We argue the MOVE framework has the potential to advance psychological understandings of, and contributions to, individuals embedded in real, dynamic social and political contexts. We discuss the implications of this extended social psychological paradigm for advancing psychological science.

A Therapist’s Vicarious Posttraumatic Growth and Transformation of Self

The South Korean Sewol ferry sank off the Jindo Island in April 2014, with the loss of 304 lives. Of those who died, 250 were students from Danwon High School. Our study examined the tragedy and detailed experiences of the therapist who helped the bereaved families. It employed an idiographic approach that allowed the therapist to speak the language of her consciousness, personal growth, and meaning making. We conducted a critical narrative analysis to integrate individual dialogues and institutional discourses. The results revealed the therapist’s motives for commencing therapy post the Sewol tragedy, her projective identification with adolescent siblings of victims, ambivalence toward their parents, and an awakening that trauma and loss can be framed within a larger sociocultural context. The process transformed the self-of-the-therapist and helped her redefine the role of trauma therapists. The therapist’s critical reflection on macro–micro interconnection and vicarious posttraumatic growth were also discussed. The results suggest therapeutic implications for trauma professionals at both the individual and system levels.

"Being the best person that they can be and the best mum": a qualitative study of community volunteer doula support for disadvantaged mothers before and after birth in England

BACKGROUND

Disadvantaged pregnant women and new mothers are at increased risk of psychosocial stress, anxiety and depression. As well as affecting birth outcomes and child development, poor maternal emotional wellbeing can inhibit the development of parenting self-efficacy and successful adjustment to the maternal role. Social support is a protective factor against antenatal and postnatal depression, anxiety and stress, and improves mothers' confidence in infant care. Community doula programmes have been developed to meet the social support and information needs of disadvantaged women. In these programmes trained volunteer doulas support mothers during pregnancy, at birth and for a short period postnatally.

METHODS

This was a descriptive qualitative study, informed by phenomenological social psychology, exploring mothers' and doulas' experiences of antenatal and postnatal community doula support. Semi-structured qualitative interviews were undertaken with 13 disadvantaged mothers and 19 doulas at three community volunteer doula projects in England. Interviews were audio-recorded and transcripts were analysed using inductive thematic analysis.

RESULTS

The overarching theme emerging from the analysis was "Supporting the mother to succeed and flourish". There were five subthemes: "Overcoming stress, anxiety and unhappiness", "Becoming knowledgeable and skilful", "Developing self-esteem and self-efficacy", "Using services effectively", and "Becoming locally connected". Doulas believed that their community role was at least as important as their role at births. Their support was highly valued by vulnerable mothers and helped to improve their parenting confidence and skills.

CONCLUSIONS

Volunteer doula support before and after birth can have a positive impact on maternal emotional wellbeing, by reducing anxiety, unhappiness and stress, and increasing self-esteem and self-efficacy. Doulas help mothers feel more knowledgeable and skilful, support them to make effective use of maternity services, and enable them to build social ties in their community. To facilitate the best service for vulnerable mothers at the end of doula support, doula projects should consider formalising their relationship with other community organisations that can offer ongoing one-to-one or group support. They might also alleviate some of the potential distress caused by the ending of the doula relationship by increasing the flexibility of the ending, or by organising or permitting informal low level contact.

Maternity experiences of mothers with multiple disadvantages in England: A qualitative study

Background

Disadvantaged mothers and their babies are at increased risk of poor perinatal outcomes and have less positive experiences of maternity care.

Aim

To explore the maternity care experiences of mothers with multiple disadvantages.

Methods

A qualitative descriptive study based on semi-structured interviews with 40 mothers with multiple disadvantages, using thematic analysis.

Findings

Four themes emerged: ‘A confusing and frightening time’, ‘Longing to be respected as an individual’, ‘The importance of choice and control’, and ‘Needing trust to feel safe’. Mothers brought feelings of powerlessness and low self-esteem to their encounters with maternity professionals, which could be significantly worsened by disrespectful care. They needed support to navigate the complex maternity system. Positive experiences were much more likely where the mother had received continuity of care from a specialist midwife or small team.

Discussion and conclusion

Mothers with multiple disadvantages value being treated as an individual, making informed choices, and feeling safe, but they may lack the confidence to ask questions or challenge disrespectful treatment. Training and supervision should enable maternity professionals to understand how confusing maternity care can be to very disadvantaged mothers. It should emphasise the need to provide accessible and empowering information and guidance to enable all mothers to make choices and understand the system. Leaders of maternity services need to do more to challenge negative staff attitudes and ensure that that all mothers are treated at all times with kindness, respect and dignity. Specialist midwives can deliver a high quality service to mothers experiencing multiple disadvantages.

A qualitative study of volunteer doulas working alongside midwives at births in England: Mothers' and doulas' experiences

OBJECTIVE

to explore trained volunteer doulas' and mothers' experiences of doula support at birth and their perceptions of how this related to the midwife's role.

DESIGN

a qualitative descriptive study, informed by phenomenological social psychology.

METHODS

semi-structured interviews were carried out between June 2015 and March 2016. Interview transcripts were analysed using inductive thematic analysis.

SETTING

three community volunteer doula projects run by third sector organisations in England.

PARTICIPANTS

19 volunteer doulas and 16 mothers who had received doula support during labour.

FINDINGS

three overarching themes emerged: (1) 'the doula as complementary to midwives', containing subthemes 'skilled physical and emotional support', 'continuous presence', 'woman-centred support', 'ensuring mothers understand and are understood' and 'creating a team for the mother'; (2)'the doula as a colleague to midwives', containing subthemes 'welcomed as a partner', 'co-opted to help the midwives', and 'doulas identify with the midwives'; and (3) 'the doula as challenge to midwives', containing subthemes 'confusion about the doula's role', 'defending informed choice', and 'counterbalancing disempowering treatment'. KEY CONCLUSIONS&IMPLICATIONS FOR PRACTICE: volunteer doulas can play an important role in improving women's birth experiences by offering continuous, empowering, woman-focused support that complements the role of midwives, particularly where the mothers are disadvantaged. Greater clarity is needed about the scope of legitimate volunteer doula advocacy on behalf of their clients, to maximise effective working relationships between midwives and doulas.

Mothers' accounts of the impact on emotional wellbeing of organised peer support in pregnancy and early parenthood: a qualitative study

BACKGROUND

The transition to parenthood is a potentially vulnerable time for mothers' mental health and approximately 9-21% of women experience depression and/or anxiety at this time. Many more experience sub-clinical symptoms of depression and anxiety, as well as stress, low self-esteem and a loss of confidence. Women's emotional wellbeing is more at risk if they have little social support, a low income, are single parents or have a poor relationship with their partner. Peer support can comprise emotional, affirmational, informational and practical support; evidence of its impact on emotional wellbeing during pregnancy and afterwards is mixed.

METHODS

This was a descriptive qualitative study, informed by phenomenological social psychology, exploring women's experiences of the impact of organised peer support on their emotional wellbeing during pregnancy and in early parenthood. Semi-structured qualitative interviews were undertaken with women who had received peer support provided by ten projects in different parts of England, including both projects offering 'mental health' peer support and others offering more broadly-based peer support. The majority of participants were disadvantaged Black and ethnic minority women, including recent migrants. Interviews were audio-recorded and transcripts were analysed using inductive thematic analysis.

RESULTS

47 mothers were interviewed. Two key themes emerged: (1) 'mothers' self-identified emotional needs', containing the subthemes 'emotional distress', 'stressful circumstances', 'lack of social support', and 'unwilling to be open with professionals'; and (2) 'how peer support affects mothers', containing the subthemes 'social connection', 'being heard', 'building confidence', 'empowerment', 'feeling valued', 'reducing stress through practical support' and 'the significance of "mental health" peer experiences'. Women described how peer support contributed to reducing their low mood and anxiety by overcoming feelings of isolation, disempowerment and stress, and increasing feelings of self-esteem, self-efficacy and parenting competence.

CONCLUSION

One-to-one peer support during pregnancy and after birth can have a number of interrelated positive impacts on the emotional wellbeing of mothers. Peer support is a promising and valued intervention, and may have particular salience for ethnic minority women, those who are recent migrants and women experiencing multiple disadvantages.

A framework for negotiating positionality in phenomenological research. MEDICAL TEACHER 2017;39:20-25. [PMID: 27832716 DOI: 10.1080/0142159x.2017.1245854]

This Guide was written as an aid to those who are considering phenomenology as a methodology in their education research. Phenomenology allows us to understand and appreciate educational issues by exploring the unique experiences and perspectives of individuals involved in the process. There are certain core tenets to all phenomenological research, such as a focus on exploring experience and adopting a phenomenological stance. However, because phenomenology has emerged from the work of a number of related but distinct philosophers, phenomenologists do not adhere to a single approach. To help phenomenological researchers position themselves and their work with regard to the various approaches, we offer the "3 + 1" framework. This framework articulates three dimensions on which phenomenological researchers vary: (1) focusing primarily on the general or the particular; (2) managing "pre-understandings" using primarily reduction or reflexivity; and (3) engaging with participants' stories using primarily description or interpretation. We suggest that a researcher need not adhere to a single position with regard to these dimensions, but rather should intentionally and reflectively shift across the various positions depending on purpose and context. The fourth aspect of the framework, writing, overlays these three dimensions, and is central to the reflective enactment of the phenomenological process.

"I didn't think we'd be dealing with stuff like this": A qualitative study of volunteer support for very disadvantaged pregnant women and new mothers

OBJECTIVE

to identify the particular issues associated with volunteer support for very disadvantaged mothers (who were young, had insecure immigration status, were recent migrants whose English was poor,misused drugs or alcohol, or were involved in crime), from the perspective of the volunteers.

DESIGN

a qualitative descriptive study, informed by phenomenological social psychology. Semi-structured qualitative interviews were carried out between July 2013 and March 2015. Interview transcripts were analysed using inductive thematic analysis.

SETTING

nine volunteer support projects for pregnant women and new mothers, run by third sector organisations in England.

PARTICIPANTS

38 volunteer supporters.

MEASUREMENTS AND FINDINGS

three key themes were identified: 'Meeting challenges', 'Needing support' and 'Identifying successes'. 'Meeting challenges' contained the subthemes 'making the relationship of trust','remaining non-judgemental', 'maintaining boundaries' and 'dealing with child protection'. 'Needing support' contained the subthemes 'feeling prepared', 'feeling supported' and 'staying safe'. 'Identifying successes' contained the subthemes 'celebrating the small wins', 'validation as a mother', and 'supporting access to services'.

KEY CONCLUSIONS

volunteers were able to build strong, empowering relationships with some very disadvantaged women during pregnancy and afterwards, including where the mothers did not readily engage with professionals. However, supporting women with complex needs is emotionally challenging and volunteers need to be carefully selected, realistically trained and robustly supervised and supported during their volunteering.

IMPLICATIONS FOR PRACTICE

third sector organisations offering volunteer support for pregnant women and new mothers can be valuable partners in reaching very disadvantaged women who may find it difficult to engage with services. Volunteers can build up a relationship of trust with vulnerable mothers over time, but need to be well supported to do this safely and effectively.

Arqueologia fenomenológica, fenomenologia genética e psicologia: rumo à gênese das manifestações culturais

Resumo Neste artigo é realizada uma investigação teórica de fundamentos e princípios da fenomenologia clássica enquanto orientação metodológica para o estudo de fenômenos culturais. Tal investigação se inscreve no domínio qualitativo de pesquisa em psicologia e, portanto, no domínio da psicologia da cultura. Porém, ao considerar o domínio geral dos estudos fenomenológicos em psicologia, constata-se a regularidade de críticas à fenomenologia clássica, pondo em questão alguns pressupostos metodológicos adotados por Husserl, tendo por referência, sobretudo, seus trabalhos publicados em vida. Com base em autores contemporâneos que têm se dedicado ao estudo de suas últimas obras e manuscritos ainda não publicados, o debate em torno dessas críticas é atualizado de modo a inovar as reflexões sobre a aplicação empírica de sua fenomenologia. Verificam-se então equivalências entre a arqueologia fenomenológica das culturas e a fenomenologia genética que delineiam as primeiras orientações metodológicas para o estudo de fenômenos culturais.

Peer support during pregnancy and early parenthood: a qualitative study of models and perceptions

BACKGROUND

Peer support is a flexible concept used in healthcare across diverse areas to describe the activities of individuals acting in a non-professional capacity offering support to others with whom they have some experience in common. There is little research on peer supporters and women supported in the context of the transition to parenthood and disadvantage. This study particularly focuses on peer support for women experiencing a range of vulnerabilities during pregnancy and the postnatal period, in projects which assigned trained volunteers to individual pregnant women. There were three core elements to the volunteers' support in these projects: active listening, providing information, and signposting to local services in the area. Many also offered practical support.

METHODS

This was an descriptive qualitative study, informed by phenomenological social psychology, exploring experiences and perceptions of giving and receiving voluntary peer support during pregnancy and early parenthood in England, with a particular focus on disadvantaged women. Participants took part in semi-structured, audio-recorded interviews, the transcripts of which were analysed using thematic analysis.

RESULTS

Forty-seven volunteers and 42 mothers were interviewed, from nine peer support projects. The overarching themes identified were (1) 'What is peer support?', containing two themes: 'befriending or mentoring', and 'responding to the individual'; (2) 'Who is a peer supporter?', containing two themes: 'someone like me', and 'valuing difference'; (3) 'The peer support relationship', containing five themes: 'a friend or a 'professional friend', 'building relationships of trust', 'avoiding dependency', 'managing endings', and 'how peer supporters differ from professionals'.

CONCLUSION

A variety of models of volunteer peer support have been offered to pregnant women and new mothers in England. All create a structure for meaningful relationships of trust to occur between volunteers and vulnerable women. In the absence of agreed definitions for the nature and boundaries of peer support during pregnancy and early parenthood, it is important that projects provide clear information to referrers and service users about what they offer, without losing the valued flexibility and individuality of their service.

Phenomenological Approaches in Psychology and Health Sciences

A whole family of qualitative methods is informed by phenomenological philosophy. When applying these methods, the material is analyzed using concepts from this philosophy to interrogate the findings and to enable greater theoretical analysis. However, the phenomenological approach represents different approaches, from pure description to those more informed by interpretation. Phenomenological philosophy developed from a discipline focusing on thorough descriptions, and only descriptions, toward a greater emphasis on interpretation being inherent in experience. An analogous development toward a broader acknowledgment of the need for interpretation, the influence of the relationship and the researcher, and the co-construction of the narrative is mirrored in qualitative analytic theory and the description of newer analytic methods as, for example, Interpretative Phenomenological Analysis and Critical Narrative Analysis, methods which are theoretically founded in phenomenology. This methodological development and the inevitable contribution of interpretation are illustrated by a case from my own research about psychological interventions and the process of understanding in general practice.