The effect of appearance and functionality concerns, and weight status, on negative body image mental health literacy in women

Few studies have investigated community knowledge and beliefs about negative body image. Yet, low rates of recognition and help-seeking for body image concerns have been reported. Given the prevalence of body image problems and associated mental health risks in women, the current online study investigated negative body image mental health literacy in 260 women aged 18 to 64 years recruited via Prolific. The mental health literacy paradigm was employed in a 2 × 2 experimental design in which the effect of a target's domain of body image concern (appearance versus body functionality) and weight status ("normal weight" versus "overweight") was assessed on problem recognition, beliefs, and help-seeking recommendations. Overall, low symptom recognition was observed, and ratings for beliefs and help-seeking suggested low levels of stigma. However, significantly greater sympathy and lifestyle support recommendations were observed in the overweight compared to normal weight condition, and a domain × weight interaction suggested significantly fewer negative emotional reactions in the appearance overweight condition compared to appearance normal weight, and functionality overweight, conditions. The findings suggest a need for education about body image independent of weight status in women. Future research would benefit from examining diverse samples, broader functionality concerns, and stigma.

Clinician-Spoken Plain Language in Health Care Encounters: A Qualitative Analysis to Assess Measurable Elements

PURPOSE

Good communication and use of plain language in health care encounters improve outcomes, including emotional health, symptom resolution, and functional status. Yet there is limited research on how to measure and report spoken plain language, which is the use of familiar, clear language. The authors aimed to describe key, measurable elements of spoken plain language that can be assessed and reported back to clinicians for self-reflection.

METHOD

The authors conducted secondary analysis of transcripts from recorded encounters between breast cancer surgeons and patients with early-stage breast cancer. Two coders used a hybrid qualitative analysis with a framework based on U.S. Federal Plain Language Guidelines. To develop major themes, they examined (1) alignment with the Guidelines and (2) code frequencies within and across transcripts. They also noted minor themes.

RESULTS

From 74 transcripts featuring 13 surgeons, the authors identified 2 major themes representing measurable elements of spoken plain language: (1) clinicians had a propensity to use both explained and unexplained medical terms, and (2) clinicians delivered information using either short turns (one unit of someone speaking) with 1 topic or long turns with multiple topics. There were 3 minor themes that were not indicative of whether or not clinicians used spoken plain language. First, clinicians regularly used absolute risk communication techniques. Second, question-asking techniques varied and included open-ended, close-ended, and comprehension checks. Third, some clinicians used imagery to describe complex topics.

CONCLUSIONS

Clinicians' propensity to use medical terms with and without explanation and parse encounters into shorter or longer turns are measurable elements of spoken plain language. These findings will support further research on the development of a tool that can be used in medical education and other settings. This tool could provide direct and specific feedback to improve the plain language practices of clinicians in training and beyond.

Negative body image mental health literacy in women: Exploring aesthetic and functional concerns and the role of self-objectification

Despite its high prevalence in women, few studies have examined lay knowledge and beliefs about negative body image. Yet, studies applying mental health literacy to body image problems suggest recognition of appearance concerns is poor, which could impede help-seeking. The present study extended previous work by investigating problem recognition, beliefs and help-seeking for aesthetic and functional (physical ability focused) body image concerns in women, and the role of self-objectification in help-seeking. A within-subjects online survey design employing the mental health literacy paradigm was undertaken in a sample of 210 female-identifying adults residing in Australia (Mage = 31.25, SD = 12.76). Overall, results indicated that recognition of body image problems depicted via fictional text vignettes was limited. Moreover, recognition, as well as ratings of perceived prevalence, distress, sympathy, affective reactions, and help-seeking recommendations and intentions, were significantly greater for aesthetic compared to functional body image concerns. Self-objectification displayed significant negative associations with help-seeking recommendations for aesthetic (but not functional) concerns, and was not associated with help-seeking intentions. Findings suggest that negative body image mental health literacy is poor in women, particularly in relation to body functionality. More research is needed to facilitate help-seeking and reduce the impact of body image concerns in women.

Framing a New Nutrition Policy: Changes on Key Stakeholder's Discourses throughout the Implementation of the Chilean Food Labelling Law

The global implementation of structural policies to tackle obesity has been slow, likely because of the competing interests of governments and the food industry. We used the discussion of the Chilean Food Labeling Law to identify influential stakeholders in the media and their frames during different periods of the law's implementation. This involved a content analysis of the food regulation media coverage in five key periods from 2007, when the food bill was first introduced in Congress, to 2018, when the second phase of the law was implemented (N = 1295). We found that most of the law coverage was through elite press. Half of the sources were from the food industry (26.7%) and government (26.2%), while other stakeholders, were less prevalent. Frames were mostly competing, except for cooperation with the law. The main food industry frame used during the discussion of the law was the "economic threat" (41.9%), whose prevalence decreased at the post-implementation period (13%, p < 0.01). No other relevant stakeholders changed their framing. Our results highlight that there are several aspects of public health communication, such as the type of media used, the involvement of scholars and civil society, and the framing, that could be improved to advance food environment policies.

Paternal pregnancy-related anxiety: Systematic review of men's concerns and experiences during their partners' pregnancies

BACKGROUND

Up to 25 % of expectant parents experience anxiety symptoms. Pregnancy-related anxiety is characterised by concerns and worries specific to pregnancy, childbirth, and the transition to parenthood. While pregnancy-related anxiety is well-researched in women, the exact nature of this construct in men is unclear. The purpose of the current review was to examine men's concerns, worries, and fears during pregnancy and gain an understanding of their experiences during pregnancy.

METHODS

An integrative review design was adopted, using thematic content analysis to synthesise findings from quantitative and qualitative studies. Quality appraisal of the quantitative studies used the AXIS appraisal tool. The Critical Appraisal Skills Program (CASP) checklist was used for the qualitative studies.

RESULTS

A comprehensive search of nine databases led to inclusion of 14 quantitative and 41 qualitative studies. Ten dimensions of paternal pregnancy-related anxiety were identified: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards health care professionals, and practical and financial concerns. The pregnancy transition was characterised by mixed emotions and conflicted experiences for fathers.

LIMITATIONS

Generalizability of review findings was limited by poor reporting of demographic information by many included studies, exclusion of studies not published in English, and focus on heterosexual relationships.

CONCLUSIONS

Expectant fathers may experience anxiety symptoms characterised by excessive worry across multiple domains of pregnancy-related concerns. Clinicians play an important role in identifying and supporting fathers with pregnancy-related anxiety and addressing the sense of exclusion often experienced by them.

Transgender community resilience on YouTube: Constructing an informational, emotional, and sociorelational support exchange

This strength-based, mixed-methods study explored how trans individuals utilize transvlogs as a community building and resilience resource. Eighty-six transvlog viewers explained their motivation for viewing transvlogs and additionally rated their self-efficacy and well-being. Narrative analyses indicate that participants viewed transvlogs to gain informational, emotional, and sociorelational resources. Twelve percent of participants additionally shared those resources with others and contributed to a relational resilience exchange. In addition, transvlog viewers' self-efficacy and well-being scores were higher than previously reported means. While prior research has noted the benefits of transvlog creation, the present study furthers this study by suggesting that transvlog viewers interactionally benefit as well. Participants in this study were not passive viewers, but rather active, agentive contributors to a trans community resilience exchange. Building on this study, we conclude with a discussion of how therapists can incorporate extant trans-created resources to foster trans community resilience.

Crowd Models for Last Mile Delivery in an Emerging Economy

The dramatic rise in online shopping means that the last mile delivery (LMD) task is becoming extremely important. However, last mile delivery faces many economic, social, and environmental challenges. A fast-growing innovative solution is Crowd Logistics Delivery (CLD). This study investigates how CLD is meeting these challenges in a rapidly emerging economy (Saudi Arabia). It uses semi-structured interviews to analyse CLD from the perspectives of multiple stakeholders, focusing on its implementation, benefits to different stakeholders, and its limitations. While the findings of this study broadly support the work of other studies in this area, it provides several new insights. It observed three different business models being used for CLD: B2B, B2C, and C2C. It identified the internal success factors of each business model, including registration, assigning orders, compensation, and the payment model. It revealed the motivations for stakeholders to use CLD as a last mile delivery solution, such as LMD-related benefits and the social impact on society. In addition, the study highlighted the four main challenges these CLD implementations face that impede their success: legislation, availability of supply/drivers, trust, and culture. These results add to the rapidly expanding field of CLD.

Understanding Symptoms in RYR1-Related Myopathies: A Mixed-Methods Analysis Based on Participants' Experience

BACKGROUND

In rare diseases such as ryanodine receptor 1-related myopathies (RYR1-RM), health-related quality of life (HRQoL) measures are critically important so clinicians and researchers can better understand what symptoms are most important to participants, with the ultimate goal of finding tangible solutions for them.

OBJECTIVES

The main objective of this study was to characterize symptoms in individuals with RYR1-RM to inform future research. A secondary objective of this study was to analyze positive and negative sentiments regarding symptoms and treatment effects post N-acetylcysteine (NAC) administration in individuals with RYR1-RM.

METHODS

The study used a mixed-methods design applying methodological triangulation. Qualitative data were collected via semi-structured interviews at three visits to characterize symptoms in individuals with RYR1-RM and to analyze treatment effects. Qualitative data were then transformed into quantitative results to measure the frequency with which each symptom was mentioned by participants.

RESULTS

A total of 12 symptoms were identified as areas of interest to participants with RYR1-RM, highlighting fatigue and weakness as key symptoms. Data transformation categorized more than 1000 citations, reporting a greater number of positive comments for postintervention interviews than for baseline and preintervention visits and that NAC group participants stated more positive comments regarding treatment effect than did the placebo group.

CONCLUSIONS

We present a comprehensive characterization of symptoms in RYR1-RM and how those symptoms influence HRQoL. Furthermore, the introduction of mixed methods may be a valuable way to better understand patient-centered data in rare diseases to support affected individuals in coping with their symptoms.

Intentions to see a psychologist for weight management: A cross-sectional study investigating beliefs about psychologists, psychological services and obesity

OBJECTIVES

The current study investigated beliefs about psychologists, psychological services and obesity, and their association with intentions to see a psychologist for weight management.

METHODS

A cross-sectional online survey design was employed in a sample of 136 adults with overweight or obesity (n = 121 females, M_age  = 37.58, SD = 9.85).

RESULTS

Psychologists and psychological services were viewed favourably by participants, with little evidence of role knowledge deficits or significant treatment barriers. Behavioural and social causal beliefs about obesity were indirectly associated with intentions to see a psychologist for weight management through positive associations with psychologists' perceived helpfulness in lifestyle intervention. Indirect effects were not observed for psychological and medical causal beliefs.

CONCLUSION

Promotion of psychological services in obesity could highlight their utility in addressing behavioural and social factors. However, there is a need for more research into avoidance of all sources of professional support in this context.

Enhancing Self-Esteem and Body Image of Breast Cancer Women through Interventions: A Systematic Review

Breast Cancer (BC) is the most common neoplasm in women worldwide, considered a global public health problem. Among BC women, some of the most common psychological symptoms in the adaptation to the disease are reduction in self-esteem and distorted body image (BI). Although there are numerous studies with the goal of promoting different psychological variables, BI and self-esteem are often separately observed despite their relationship and their importance in the process of the illness. Moreover, there have been no reviews that have synthesized the findings related to interventions aimed at enhancing both self-esteem and BI in BC women. Therefore, the objective of this review was to identify and examine the implemented interventions aimed at boosting both variables in this population. For this purpose, a systematic review was implemented following the PRISMA statement. A thorough search was performed on the following databases: Web of Science, PubMed, PsychInfo, PsychArticles, and Scopus. Among 287 records, only eight articles met the eligibility criteria. Interventions were grouped into three types according to their characteristics: Group therapies, Physical activity therapies, and Cosmetic and beauty treatments. The levels of effectiveness of the different interventions varied between them, and within each, in their impact on self-esteem and BI. More interventions focused on developing BI and self-esteem in this population are needed due to their ability to predict psychological functioning and quality of life of women with breast cancer.

Interactive Clinical Avatar Use in Pharmacist Preregistration Training: Design and Review

BACKGROUND

Virtual patients are interactive computer-based simulations that are being increasingly used in modern health care education. They have been identified as tools that can provide experiential learning and assessment in a standardized and safe environment. However, the study of high-fidelity virtual patients such as interactive clinical avatars within pharmacy is limited.

OBJECTIVE

The aim of this paper is to describe the design and review of three interactive clinical avatar simulations as part of pharmacist preregistration training.

METHODS

A multistep design approach was taken to create interactive clinical avatar simulations on the topics of emergency hormonal contraception (EHC), calculation of renal function, and childhood illnesses. All case studies were reviewed by registered pharmacists to establish content and face validity. The EHC case study and data collection questionnaire were also reviewed by a purposive sample of preregistration trainees and newly qualified pharmacists. The questionnaire used Likert ranking statements and open-ended questions to obtain users' feedback on the design, usability, and usefulness of the interactive clinical avatars as learning tools. Descriptive statistics and content analysis were undertaken on the data.

RESULTS

Ten preregistration trainees and newly qualified pharmacists reviewed the EHC interactive clinical avatars and data collection questionnaire. The data collection questionnaire was associated with a Cronbach alpha=.95, demonstrating good reliability. All three interactive clinical avatar simulations were reported as usable and appropriately designed for preregistration training. Users perceived they were developing skills and knowledge from the simulations. The high-fidelity nature of the avatars and relevance of the simulations to real-life practice were reported as aspects that encouraged the application of theory to practice. Improvements were suggested to ensure the simulations were more user-friendly.

CONCLUSIONS

The design and creation of the interactive clinical avatar simulations was successful. The multistep review process ensured validity and reliability of the simulations and data collection questionnaire. The in-depth explanation of the design process and provision of a questionnaire may help widen the use and evaluation of interactive clinical avatars or other simulation tools in pharmacy education. The interactive clinical avatars were reported as novel learning tools that promoted experiential learning and allowed users to feel like they were engaging in real-life scenarios, thus developing transferable knowledge and skills. This may be potentially beneficial for many health care training courses as a way to provide standardized experiences promoting active learning and reflection.

Actual vs. Perceived Competency Development-How Can Virtual Patients Impact Pharmacist Pre-Registration Training?

Virtual patients are an active learning pedagogical tool that simulate clinical scenarios. There is an established disparity in pre-registration examination pass rates depending on whether individuals complete their training in a community or hospital pharmacy. This study aimed to evaluate virtual patient (VP) and non-interactive (NI) case studies, concerning knowledge, skill and confidence development of pre-registration pharmacist trainees. A quasi-experimental evaluation was conducted. Pre-registration pharmacists completed three VP or NI case studies. Each case study was associated with a pre-and post-knowledge quiz. Pre-registration trainees were invited to complete a questionnaire consisting of Likert ranking statements and open-ended questions on the case study features, usability and individual development. Both learning tools significantly improved trainees' knowledge on the topic areas (except for the NI group in case study 3). Although no significant differences in knowledge improvement were identified between the learning tools, trainees who used the VP reported the development of a wider knowledge base and skill set, an increase in confidence for practice and an opportunity to apply their learning. The sector in which pre-registration pharmacists were completing their training (community or hospital) had a significant impact on knowledge improvement in the three case studies. Future research evaluating VPs with pre-registration and qualified pharmacists should be conducted to explore their benefits and establish their effectiveness as learning tools.

Fighting the Battle of Recovery Together: A Content Analysis of Anonymous Posts in an Online Substance Use Forum

Background: The rates of use of substance have increased dramatically worldwide in the past several years. Approximately 10% of people who use illicit substances will develop a substance use disorder (SUD), which is a major health problem internationally. Recovery is a period of time when someone with an SUD is in remission or is not using substances. Little research has been done to examine views of patients with SUDs on recovery, particularly when that information is being shared anonymously.Objective: The purpose of the study is to gain an understanding of the experience of recovery from anonymous online postings in recovery support forums.Design: The study was conducted using a qualitative, descriptive, thematic content analysis approach to analyze 1,230 anonymous posts made to an International online recovery forum.Results: Themes identified from the online postings were that the experience of recovery included (a) the agony of withdrawal and screaming cravings, (b) a psychological roller coaster during withdrawal and recovery, and (c) use of coping skills and other strategies that help in recovery.Conclusions: These findings support current recommendations being given by healthcare providers on the use of coping skills and other recovery strategies. They also suggest that people with SUDs endure physical and psychological suffering and show a level of sophistication in managing their symptoms during recovery. Findings reveal that hope and feelings of self-satisfaction exist as a positive experience of recovery. Finally, we can interpret that there are clear benefits to online recovery communities and that healthcare providers have an important role to play as allies in the recovery experience.

Depressive and Anxiety Symptoms among Pediatric In-Patients with Dengue Fever: A Case-Control Study

BACKGROUND

Psychiatric symptoms have been reported in adult patients with dengue fever (DF); however, information on pediatric patients remains inadequate. We sought to identify the prevalence and predictors of depressive and anxiety symptoms and identify other psychiatric symptoms among pediatric patients with DF. This case-control study involved pediatric in-patients (n = 225) who had clinical or serologic-confirmed DF and healthy school-based controls (n = 260). Participants completed the Revised Child Anxiety and Depression Scale (RCADS).

RESULTS

The prevalence of depressive (13.3%) and anxiety (34.2%) symptoms among pediatric patients with DF was significantly (p < 0.001) higher than that among controls (3.5% and 16.2%, respectively). Multiple linear regression analysis found that age, family history of DF, ≤2 days of hospitalization, myalgia, and arthralgia were predictors of increased depressive and anxiety symptoms among the patients. Further, 26.7% of pediatric patients reported irritability, agitation, visual hallucinations, and aggressiveness.

CONCLUSION

Pediatric patients present depressive and anxiety symptoms whose levels were associated with social and clinical factors. However, whether these symptoms are present only during the infection or may still persist after recovery or are brought by children's adverse reactions to hospitalization are unknown, and thus, further studies are needed.

Generalised Versus Specific Internet Use-Related Addiction Problems: A Mixed Methods Study on Internet, Gaming, and Social Networking Behaviours

The field of technological behavioural addictions is moving towards specific problems (i.e., gaming disorder). However, more evidence of generalised versus specific Internet use-related addiction problems (generalised pathological Internet use (GPIU) vs. specific pathological Internet use (SPIU)) is still needed. This mixed methods study aimed to disentangle GPIU from SPIU. A partially mixed sequential equal status study design (QUAN→QUAL) was undertaken. First, through an online survey, which adapted the compulsive Internet use scale (CIUS) for three types of problems (i.e., generalised Internet use, and specific online gaming and social networking). Second, potential problem users’ perceptions of the evolution of these problems (aetiology, development, consequences, and factors) were ascertained, through semi-structured interviews, together with their opinion on present Internet gaming disorder (IGD) criteria adapted to each problem studied. Findings showed the CIUS remains valid and reliable for GPIU and SPIUs examined; a prevalence between 10.8% and 37.4% was estimated for potential at-risk problem gamers and Internet users, respectively, who reported their preference for maintaining their virtual lives. Half of the sample had a risk of a unique or mixed profile of these problems. Moreover, device patterns, gender, and age issues emerged, such as problem gamers being proportionally equal male and female young or middle-aged adults. GPIU was highly associated with problem social networking use, and weakly with problematic gaming, but both SPIUs were independent. Concerning addictive symptoms, salience, deception, and tolerance required redefinition, especially for SPIUs, while better-valued IGD criteria applied to GPIU and SPIUs were: Risk relationships or opportunities, give up other activities, withdrawal, and continue despite problems. Thus, although problems studied are present as risk behaviours, SPIUs seem to cover the addictive symptomatology in those categorised as potential problem users, online gaming being the most severe behavioural addiction problem.

Integrating the Neurobiology of Minority Stress with an Intersectionality Framework for LGBTQ-Latinx Populations

The comprehensive lived experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals of color remain invisible in neurobiological studies of LGBTQ populations. Models of minority stress posit that LGBTQ and Latinx individuals experience and internalize sexual, ethnic, racial, and gender discrimination, which may adversely impact mental and physical health. However, the current minority stress models predominantly focus on single categorical social identities and do not account for interlocking systems and processes of oppression based on features of sexuality, race, ethnicity, sex, and gender, as explained by an intersectionality framework in feminist theory. Thus, it remains unclear how LGBTQ people of color internalize and navigate multiple cultural, institutional, and societal stressors, and, furthermore, how these sources of stress may affect health and well-being. A potential mechanism for this adverse internalization process is through the effects of stress on neurobiological regulation. This review will apply an intersectionality framework to the examination of how heterosexism, racism, and cissexism, as systems of oppression, create LGBTQ and Latinx lived experiences, and the differential impacts of these inequalities on neurobiological stress regulation. The overarching goal of this manuscript is to advocate for the application of intersectionality theory to advance the ecological validity of biopsychosocial models of multiple-minority stress.

Identifying Hallmark Symptoms of Developmental Prosopagnosia for Non-Experts

Developmental prosopagnosia (DP) is characterised by a severe and relatively selective deficit in face recognition, in the absence of neurological injury. Because public and professional awareness of DP is low, many adults and children are not identified for formal testing. This may partly result from the lack of appropriate screening tools that can be used by non-experts in either professional or personal settings. To address this issue, the current study sought to (a) explore when DP can first be detected in oneself and another, and (b) identify a list of the condition’s everyday behavioural manifestations. Questionnaires and interviews were administered to large samples of adult DPs, their unaffected significant others, and parents of children with the condition; and data were analysed using inductive content analysis. It was found that DPs have limited insight into their difficulties, with most only achieving realisation in adulthood. Nevertheless, the DPs’ reflections on their childhood experiences, together with the parental responses, revealed specific indicators that can potentially be used to spot the condition in early childhood. These everyday hallmark symptoms may aid the detection of individuals who would benefit from objective testing, in oneself (in adults) or another person (for both adults and children).

An investigation into discharge, visual perception, and appearance concerns of prosthetic eye wearers

We investigate prosthetic eye wearers' initial and current concerns about mucoid discharge, visual perception, and appearance, and the reasons for their concerns. A retrospective, cross-sectional study of private practice patients was designed. Participants were 217 experienced prosthetic eye wearers, aged at least 16 years. An anonymous questionnaire was e-mailed or mailed to participants. Descriptive and inferential statistics were used to investigate differences or correlations between variables. Content analysis was used to analyze participants' open responses. Participants were equally concerned about discharge, visual perception, and appearance during the first three months following eye loss and at least 2 years later, even though their concerns decreased. Older participants were less concerned about appearance, while females were more concerned about current discharge and appearance. The greater the frequency and volume of discharge, the greater was the concern. Participants' initial discharge concern was due to a negative interpretation of what it meant, but later, it was due to discomfort from wiping, and how discharge looked to others. Loss of depth perception and reduced visual range were equally concerning. Initial appearance concerns related to disguisability of the prosthesis, but over time, changes to the socket and eyelids became more important. Loss of self-image is commonly considered to be the major concern of anophthalmic patients, but discharge and visual perception concerns are of equal importance. Reasons given for these concerns provide greater insight into patients' personal experience of eye loss.

‘I’ve got a very dichotomous difference in the way that I perceive myself’: Positive and negative constructions of body image following cancer treatment

This study investigated how women constructed body image following cancer. Four women, aged 32–67 years, who had experienced breast or bowel cancer took part in a 2-hour, in-depth focus group. Discourse analysis revealed that women orientated to positive aspects of the post-treatment body (silhouette, trust, acceptance) while acknowledging that their experiences were also traumatic (hair loss, scarring, sickness, swelling). Bodies and illness were concealed from public judgment, and women developed new trust in their bodies due to overcoming cancer; post-cancer bodies were accepted despite opportunities for normalisation. Implications for those wanting to support women during and after cancer are discussed.

Hosting the others’ child? Relational work and embodied responsibility in altruistic surrogate motherhood

Studies on surrogate motherhood have mostly explored paid arrangements through the lens of a contract model, as clinical work or as a maternal identity-building project. Turning to the under-examined case of unpaid, so-called altruistic surrogate motherhood and based on an analysis of interviews with women who had been unpaid surrogate mothers in a full gestational surrogacy with a friend or relative in Canada, the United States or Australia, this article explores altruistic surrogate motherhood as relational work. It argues that this form of surrogate motherhood within close interpersonal relations can be conceptualised through the relational work involved in hosting a child for the intended parents. The article explores how relational work in this context implies an embodied, asymmetrical and far-reaching sense of responsibility that surrogate mothers describe as characteristic of their surrogacy experience. In this way, the article sheds light on feminist concerns about surrogacy as an embodied and objectifying work of women while at the same time illuminating how surrogate mothers respond to the intended parents in light of their pre-surrogacy relationship, how meanings are negotiated by them and how relationships are managed during the pregnancy.

"And Now I'm Just Different, but There's Nothing Actually Wrong With Me": Asexual Marginalization and Resistance

This article explores the relationship between contemporary asexual lives and compulsory sexuality, or the privileging of sexuality and the marginalizing of nonsexuality. Drawing on 30 in-depth interviews, I identify four ways the asexually identified individuals in this study saw themselves as affected by compulsory sexuality: pathologization, isolation, unwanted sex and relationship conflict, and the denial of epistemic authority. I also identify five ways these asexually identified individuals disrupted compulsory sexuality: adopting a language of difference and a capacity to describe asexuality; deemphasizing the importance of sexuality in human life; developing new types of nonsexual relationships; constituting asexuality as a sexual orientation or identity; and engaging in community building and outreach. I argue that some of these practices offer only a limited disruption of compulsory sexuality, but some of these practices pose a radical challenge to sexual norms by calling into question the widespread assumption that sexuality is a necessary part of human flourishing.

Views of Health in the Lay Sector: A Compilation and Review of How Individuals Think about Health

The way lay people think about health and wellness influences their health and wellness-related behaviors. This article integrates and synthesizes the research conducted to understand lay health worldviews. We identify 18 themes that capture the findings about lay health worldviews. The themes fall into four categories: definitions of health, explanations for health, external and/or uncontrollable factors impinging on health, and the place health occupies in people’s lives. The results lead to the observation that lay health worldviews - or health styles - are not understood in depth, particularly in US populations. Variation across the themes underscores the need for further descriptive research designed to understand consumers’ ways of thinking about health and how the many changes in the professional and folk sectors affect lay worldviews. This has implications with respect to understanding consumers’ health care behaviors and developing more effective communication strategies.

Breast Cancer: Feminism, Representations and Resistance – a Commentary on Dorothy Broom’s ‘Reading Breast Cancer’

In this commentary, I identify two sets of coercive ‘discourses and practices’ which typically oppress women with breast cancer: the imperative of concealment and the notion of personal blame and responsibility for their illness. I examine how a feminist analysis can support and encourage resistance to such coercive ‘discourses and practices’, and I argue for a thoroughgoing feminist approach to breast cancer more generally.

Taking the Biscuit? A Discursive Approach to Managing Diet in Type 2 Diabetes

Adopting and maintaining a healthy diet is pivotal to diabetic regimens. Behavioural research has focused on strategies to modify/maintain healthy behaviours; thus ‘compliance’ and ‘ noncompliance’ are operationalized by researchers. In contrast, discursive psychology focuses on the actions different accounts accomplish—in this case regarding diets. Using thematic discourse analysis, we examine dietary management talk in repeat-interviews with 40 newly diagnosed type 2 diabetes patients. Women in our study tended to construct dietary practices as an individual concern, while men presented food consumption as a family matter. Participants accounted for ‘cheating’ in complex ways that aim to accomplish, for instance, a compliant identity. Discursive psychology may facilitate fluidity in our understandings of dietary management, and challenge fixed notions of ‘compliant’ and ‘non-compliant’ diabetes patients.

Feminist Research Traditions in Health Psychology: Breast Cancer Research

This article discusses three key traditions of feminist research: positivist empiricist, experiential and discursive. It explores the ways in which each is used in developing understandings of women’s health and improving health care services, focusing in particular on breast cancer research and activism, including my own work in this area. It is argued that all three research traditions are important for advancing feminist political goals: positivist empiricism enables us to expose the biases of mainstream health research and to develop better (i.e. more objective) research; experiential approaches enable us to engage with the diversity of women’s subjective experiences of health and health care; and discursive research enables us to explore issues related to identity management, accountability of conduct and the moral order of social life surrounding health and illness.

2001 Carolyn Sherif Award Address: the Presence of an Absence

Awarded for your spectacular contributions to feminist psychology, Division 35 presents to you the Carolyn Wood Sherif Award. A prodigious researcher and theorist, you break down the artificial distinctions between basic and applied work and between erudition and accessibility. In your scholarship you have raised to the forefront neglected variables such as ethnicity, social class, and disability. Your creativity, courage, warmth, and generosity of spirit make you an inspiration to scholars across a spectrum of disciplines, many of whom you have mentored, nurtured, and helped. Nor does your indefatigable advocacy stop at the campus gates. With humor, wisdom, and abundant determination, you have used the tools of our discipline to create community and to advance the cause of social justice. It is with gratitude that we honor you and your work, Michelle Fine.

Assessing subjective memory complaints: a comparison of spontaneous reports and structured questionnaire methods

BACKGROUND

Subjective memory complaints (SMCs) are a common occurrence for adults, which increase with age, and cause considerable distress. Traditionally SMCs have been assessed by either questionnaires, which ask whether a person has experienced given examples of SMCs, or open-ended questions which elicit spontaneous reports of SMCs. However, little is known about how these methods of assessment might influence reporting of SMCs.

METHODS

Four hundred and twenty one adults aged 40 years and above were surveyed about SMCs using spontaneous report and questionnaire methods.

RESULTS

As expected, spontaneously reported SMCs were fewer in number and rated more distressing overall than SMCs endorsed on a questionnaire. However, comparison of individual SMCs revealed that distress ratings tended to be higher when assessed in a questionnaire than spontaneously reported, which may be due to the context of a questionnaire causing inflated ratings. Participants also reported SMCs which were not well assessed by the questionnaire, including some which were among the most distressing SMCs overall. Conversely, other SMCs were over-sampled by the questionnaire and did not feature in spontaneous reports.

CONCLUSIONS

Implications for clinical assessment of SMCs are that open-ended questioning might be preferable to initial use of prescriptive questionnaires, in order to elicit SMCs that are most distressing. While use of questionnaires may reveal endorsement of a wider range of SMCs than are spontaneously reported, they can take focus away from, or even fail to assess, those SMCs which cause most subjective distress (and therefore should be the target of interventions).

Bridging the divide: HIV prevention research and Black men who have sex with men

OBJECTIVES

We obtained contextual information regarding documented barriers to HIV clinical trial participation among Black men who have sex with men (MSM), and explored current preventive HIV clinical trial attitudes, beliefs, and perceptions among Black MSM leaders in the United States.

METHODS

We conducted 2 focus groups with Black MSM leaders attending an annual African American MSM Leadership Conference on HIV/AIDS. Focus group questions explored biomedical research perceptions and attitudes, barriers to participation in biomedical prevention research, and steps that need to be taken to address these barriers. A feedback and member checking (participants presented with final themes to provide feedback and guidance) session was also held at the 2012 conference.

RESULTS

Three distinct themes emerged regarding Black MSM engagement and participation in HIV vaccine research: (1) community-based organizations as true partners, (2) investment in the Black gay community, and (3) true efforts to inform and educate the community.

CONCLUSIONS

A key focus for improving efforts to engage the Black MSM community in preventive HIV clinical trials is building and maintaining equitable and reciprocal partnerships among research institutions, Black-led AIDS service organizations and community-based organizations, and community members.

The potential of alcohol "heat-of-the-moment" scenarios in HIV prevention: A qualitative study exploring intervention implications

Scenarios simulating real-world risk situations have proven effective for substance use intervention methods and could potentially prove useful as an HIV-prevention method. This study explored qualitatively the development and use of such "in-the-moment" methods. We interviewed 97 moderate-drinking women (50 % Caucasian) after participation in an experiment requiring that they project themselves into a risky-sex scenario. Most participants (58 %) reported experiencing the scenario as a reflective tool characterized by two primary themes: (1) increased awareness of risk and (2) contemplation of behavior change. Findings suggest that "in-the-moment" methods depicting real-world risk situations and providing opportunities to reflect about behavioral choices and subsequent outcomes could prove a useful adjunct to HIV/AIDS-prevention interventions. Such methods could potentially augment existing prevention protocols.

A qualitative study of heterosexual women's attempts to renegotiate sexual relationships in the context of severe sexual problems

Previous qualitative research on women's sexual problems has documented the ways in which they can impact psychological well-being as well as women's close interpersonal relationships. However, little attention has been paid to the ways that women with sexual problems negotiate sexual contact in the context of a relationship where sexual activity has a central role. This article draws on qualitative data from in-depth interviews with 23 heterosexual women who experienced sexual desire loss or vulvar pain. The data were analyzed within a material-discursive framework and this identified the centrality of relational and broader social factors in women's sexual negotiation. Key findings included: avoiding potentially intimate situations; engaging in intercourse when it was painful or the women had no desire to; and mentally planning and preparing themselves for sex. Other sexual activities were almost always regarded as a prelude to intercourse, yet around half of the sample had adapted their sexual repertoire to compensate for an absence of intercourse. The implications for future research and treatment in the area of women's sexual problems are discussed.

How do adolescents adjust to their parent's multiple sclerosis? An interview study

OBJECTIVES

The aim of this study was to explore how adolescents with a parent with multiple sclerosis (MS) adjust to their parents' illness.

DESIGN

We used an inductive qualitative approach with open ended questions as this was appropriate to facilitate the development of a broad and child-centred understanding of how adolescents adjust and which resources they use to cope with the challenges that are associated with parental MS.

METHODS

Fifteen semi-structured face-to-face interviews were conducted. Interviews were audiotaped, transcribed, and analysed using inductive thematic analysis.

RESULTS

Adolescents described both positive and negative experiences related to having a parent with MS. Benefits to having a parent with MS included reports of feeling more empathetic to others and more grown-up. Negative impacts included family tension, less time to spend with friends, and worries about the future. The support from the well parent, siblings, and friends were found to facilitate adolescents' adjustment. Adolescents assuming a parenting role and illness characteristics, such as illness deterioration, relapses and fatigue, challenged adolescents' adjustment to having a parent with MS.

CONCLUSIONS

Some adolescents described adjusting well to having a parent with MS, while others appeared to have more difficulty. Whilst the severity of the parent's deterioration and symptoms appeared to play a role in adjustment, other potentially modifiable factors such as the lack of well parent's support, adolescents' increased parenting responsibilities, and family tension also posed barriers to adolescents' adjustment. Support interventions may be helpful for vulnerable adolescents, which consider both family and individual factors.

"I need to lead my own life in any case"--a study of patients in dialysis with or without a partner

OBJECTIVE

To elicit psychological and psychosocial problems existing in patients in dialysis and their partners, its being felt that the diversity involved has important implications for how service in dialysis units is delivered to patients and their partners.

METHODS

The results of a series of interviews of 39 patients in dialysis and 21 partners of theirs, each interview individual, concerning their ways of thinking and their feelings and the behaviour, were analyzed in qualitative and content-oriented terms.

RESULTS

Five basic themes could be identified: importance of treatment being individualized, dependency on an apparatus, consequences of the disease and its treatment, hopes for the future, and thoughts concerning life and death. Diversities relating to age, civil status, cultural and gender matters were disclosed.

CONCLUSION

The interview approach illustrated the importance of extended professional and individualized support in handling psychological and psychosocial disparities and needs in order to make treatment regimes more acceptable to the persons involved.

PRACTICE IMPLICATIONS

Suggestions are made concerning efforts to improve the care of patients receiving dialysis, and the importance of working with the patients and those closest to them in multidisciplinary teams.

Sex, Menopause and Social Context

Most research on sex and menopause has been conducted within a biomedical framework describing how, for example, declining hormone levels result in reduced sexual desire. Little research has examined women’s own perspectives. In this article we present an analysis of interview data from 12 British women experiencing natural menopause. Analysis identified the key role of interpersonal factors in sexual pleasure, alongside heterogeneity with regard to changes in sexual desire and orgasm. The findings complement existing psychological literature on the topic of women’s sexual and reproductive health which foregrounds social context and emphasizes diversity of experience.

Overcoming barriers to engaging socio-economically disadvantaged populations in CHD primary prevention: a qualitative study

Background

Preventative medicine has become increasingly important in efforts to reduce the burden of chronic disease in industrialised countries. However, interventions that fail to recruit socio-economically representative samples may widen existing health inequalities. This paper explores the barriers and facilitators to engaging a socio-economically disadvantaged (SED) population in primary prevention for coronary heart disease (CHD).

Methods

The primary prevention element of Have a Heart Paisley (HaHP) offered risk screening to all eligible individuals. The programme employed two approaches to engaging with the community: a) a social marketing campaign and b) a community development project adopting primarily face-to-face canvassing. Individuals living in areas of SED were under-recruited via the social marketing approach, but successfully recruited via face-to-face canvassing. This paper reports on focus group discussions with participants, exploring their perceptions about and experiences of both approaches.

Results

Various reasons were identified for low uptake of risk screening amongst individuals living in areas of high SED in response to the social marketing campaign and a number of ways in which the face-to-face canvassing approach overcame these barriers were identified. These have been categorised into four main themes: (1) processes of engagement; (2) issues of understanding; (3) design of the screening service and (4) the priority accorded to screening. The most immediate barriers to recruitment were the invitation letter, which often failed to reach its target, and the general distrust of postal correspondence. In contrast, participants were positive about the face-to-face canvassing approach. Participants expressed a lack of knowledge and understanding about CHD and their risk of developing it and felt there was a lack of clarity in the information provided in the mailing in terms of the process and value of screening. In contrast, direct face-to-face contact meant that outreach workers could explain what to expect. Participants felt that the procedure for uptake of screening was demanding and inflexible, but that the drop-in sessions employed by the community development project had a major impact on recruitment and retention.

Conclusion

Socio-economically disadvantaged individuals can be hard-to-reach; engagement requires strategies tailored to the needs of the target population rather than a population-wide approach.

Revisiting biographical disruption: exploring individual embodied illness experience in people with terminal cancer

Biographical accounts of illness offer useful insights into the social and adaptive processes of living with chronic illness. Yet there are concerns that the underlying theoretical assumptions of a reflexive self seeking to maintain meaning may not reflect the lived experience of individuals. A narrative emphasis may neglect the importance of emotional/felt experiences; while an analytical focus on disruptive processes may not adequately reflect the totality of actual events. In this study, we explored how well biographical theory supports understanding of individual lived experience. Narratives from 19 individuals identified from General Practice lists with a terminal diagnosis of cancer were analysed using the holistic-form approach described by Lieblich. Participants described an ongoing process of living their life, 'managing' disruptive events and maintaining an overall sense of well-being (narrative form = biographical flow). For a minority, continuity was lost when people's capacity to continue living their everyday lives was overwhelmed (narrative form = fracture). The identified emphasis was on individual creative capacity in the face of terminal illness, highlighting the importance of embodied experience in understanding outcome and need. Maintaining continuity was draining: exhaustion precipitated fracture and thus need for external help to restore continuity. By focusing on feelings associated with overall narrative form, rather than individual disruptive events, we highlight the context in which disruptive events are experienced, and individual perceptions of their relative importance. We conclude that combining narrative and emotion offers new insights into the value of understanding of biographical accounts of illness in the context of individual creative capacity. We discuss the possibilities for new approaches to clinical assessment and management of need.

Interpersonal Issues in Expressing Lay Knowledge

This article examines lay knowledge about causes of infertility. We use discursive psychology to analyse semi-structured interviews with purposively sampled Malawians with a fertility problem. We observe that respondents deny knowledge of causes, sometimes emphatically, but this co-occurs with descriptions of potential causes. We show that these respondents thereby address problematic interpersonal issues: namely that one is not entitled to medical knowledge and that negative inferences that may be drawn about someone who knows particular causes of infertility. These findings shed new light on previous observations, and have implications for the study of lay knowledge.

Qualitative methodologies in health-care priority setting research

Priority setting research in health economics has traditionally employed quantitative methodologies and been informed by post-positivist philosophical assumptions about the world and the nature of knowledge. These approaches have been rewarded with well-developed and validated tools. However, it is now commonly noted that there has been limited uptake of economic analysis into actual priority setting and resource allocation decisions made by health-care systems. There seem to be substantial organizational and political barriers. The authors argue in this paper that understanding and addressing these barriers will depend upon the application of qualitative research methodologies. Some efforts in this direction have been attempted; however these are theoretically under-developed and seldom rooted in any of the established qualitative research traditions. Two such approaches - narrative inquiry and discourse analysis - are highlighted here. These are illustrated with examples drawn from a real-world priority setting study. The examples demonstrate how such conceptually powerful qualitative traditions produce distinctive findings that offer unique insight into organizational contexts and decision-maker behavior. We argue that such investigations offer untapped benefits for the study of organizational priority setting and thus should be pursued more frequently by the health economics research community.

Holding onto womanhood: a qualitative study of heterosexual women with sexual desire loss

This article explores heterosexual women's accounts of sexual, desire loss, particularly the ways in which it can affect their sense of themselves, as women. In-depth interviews were conducted with 17 participants recruited, through a psychosexual clinic in England, and the data analysed using a, material-discursive approach. The findings showed that having sexual desire, loss often challenged participants' perceptions of themselves as women. Specific challenges related to dealing with isolation and otherness, addressing their own feelings of not being 'proper wives' because they did not sexually satisfy their partners and maintaining a sense of sexual attractiveness in the absence of sexual desire. Participants responded to these challenges in various ways, often renegotiating their identities as women. The findings are discussed in relation to theorizing women's sexuality and their implications for health care.

Weaving meaning? An exploration of the interplay between lay and professional understandings of cervical cancer risk

In line with the increasing emphasis on informed choice, women invited for cervical cancer screening in England receive a leaflet containing information on the risk factors and causation of the condition. However, data from a qualitative interview study with 35 women suggest that the ways in which women make sense of this information can vary and frequently do not correspond to the causal pathways and explanations which characterise contemporary professional medical explanations. This paper examines the complex interplay between lay and professional understandings that takes place as women attempt to weave the information they receive, their prior understandings and contextual factors together into some kind of coherent framework, in which each piece of information makes sense in relation to everything else. We conclude by arguing that, while presenting full and accurate information about orthodox medical understandings of cervical cancer causation in an accessible way maybe challenging, partial presentation of 'the facts' is likely to be ineffective.

Barriers to cervical cancer screening: a qualitative study with women in Serbia

Serbia employs opportunistic approaches to cervical cancer screening, leading to inequitable health care access. To better understand the health care needs of women, we investigated their knowledge of and perceived barriers to cervical cancer screening. Data reported in the paper arise from nine focus group discussions with 62 women from diverse socio-economic backgrounds. They were recruited in two cities with contrasting social settings, Belgrade, the Serbian capital, and a regional town, Smederevo. Thematic analysis identified that the interplay of social and personal barriers influenced women's poor presentation for screening. Inadequate public health education, lack of patient-friendly health services, socio-cultural health beliefs, gender roles, and personal difficulties were the most salient barriers to screening. We suggest how within the context of opportunistic screening patient education may be employed. The introduction of compulsory cervical cancer screening, suggested by some participants, is also discussed.

Language use as Social Strategy: A Review and an Analytic Framework for the Social Sciences

Language use as a social strategy is reviewed and a new interdisciplinary taxonomy developed. Four categories are suggested for using language: to get people to do things, to get people to say things, to keep people's attention, and to maintain social relationships. Within these categories, all of the discourse and conversational analysis literatures are reviewed, allowing a common framework within which to make more systematic analyses. Reinterpretations of psychological theories are suggested, and fresh avenues for interdisciplinary research are created. A major imperative from the review is that some form of ethnographic data collection is needed for all analyses of conversations and texts to incorporate more of the social, economic, historical, and cultural contexts into both our observations and theorizing.

'The thief of womanhood': women's experience of polycystic ovarian syndrome

Previous research on polycystic ovarian syndrome (PCOS) has overwhelmingly been conducted within a medical or psychiatric framework, and has failed to explore women's own experience of the syndrome. Interviews were conducted with 30 women with PCOS recruited through a national self-help organisation. Thematic analysis of the interviews revealed pervasive reports of feeling 'freakish', 'abnormal', and not 'proper' women. These feelings were related to three symptoms commonly experienced by women with PCOS: 'excess' hair growth; irregular, absent or disrupted periods; and infertility. Smooth hairless bodies and faces, regular menstruation and the capacity to bear children were associated with femininity, and as a result of their symptoms women expressed feeling 'different' from other women and less 'feminine'. The results are discussed within a feminist framework and suggest that polycystic ovarian syndrome is a deeply stigmatising condition, 'a theft of womanhood', with far reaching implications for all women, whether or not they conform to 'feminine' norms.