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Alderson J, Thornton M, Skae M, Jones J, Nicoll N, Harcourt D, Woodward M, Crowne EC. Parental concerns about genital differences in children with congenital adrenal hyperplasia persist regardless of the selected intervention. J Sex Med 2024; 21:361-366. [PMID: 38481013 DOI: 10.1093/jsxmed/qdae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Congenital Adrenal Hyperplasia (CAH) due to 21-hydroxylase deficiency (21HD) can affect the in utero development of the genital anatomy of people with the 46XX karyotype. Health professionals engage parents in decision-making regarding managing genitals with this difference, including genital surgery options and patient communication. AIM We sought to investigate parental communication with their daughters regarding clitoral size variation related to neonatal CAH. METHODS Semistructured in-person interviews of 24 parents of chromosomal XX children with clitoral size variation attributable to a neonatal CAH diagnosis comprised 3 management categories: (1) clitoral reduction surgery (RS) (7 parents, 9 children), (2) clitoral concealment surgery (CS) (8 parents, 8 children), and no surgery on or around the clitoris (NS) (9 parents, 7 children). OUTCOMES Four representative themes, Obvious Choice, Still Different, Parental Burden, and Ignorance Is Bliss, were common across all 3 treatment groups. RESULTS For most parents, none of the 3 options of genital appearance alteration via clitoral reduction, clitoral concealment surgery, or avoidance of clitoral surgery ameliorated concerns, with most parents expressing an aversion to educating their child on the topic of genital differences, past treatment, or future function. CLINICAL IMPLICATIONS Reliance on surgical treatment pathways to manage this psychosocial concern is ineffective in alleviating parental uncertainty without the application of psychosocial interventions. STRENGTHS AND LIMITATIONS This was a qualitative study but was limited to parents of children with a specific genital difference, without direct exploration of parental values regarding the clitoris or the application of adequate psychosocial care. CONCLUSION Healthcare services must have an impact on parental ability to engage in essential communication with their children in cases such as clitoral size variation related to neonatal CAH. Improved communication skills allow parents to engage in more genuine decision-making and adapt to enduring genital reality, including possible future sexual challenges for their adult child, without resorting to burdensome strategies focused on attempts to perpetuate a benevolent ignorance.
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Affiliation(s)
- Julie Alderson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| | - Maia Thornton
- University of the West of England, Stoke Gifford, Bristol BS16 1QY, United Kingdom
| | - Mars Skae
- Manchester University NHS Foundation Trust, Cobbett House Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Julie Jones
- Manchester University NHS Foundation Trust, Cobbett House Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Nicky Nicoll
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| | - Diana Harcourt
- University of the West of England, Stoke Gifford, Bristol BS16 1QY, United Kingdom
| | - Mark Woodward
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| | - Elizabeth C Crowne
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
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Guest E, Williamson H, Harcourt D. Congenital melanocytic naevus (CMN) through the lens: Using photo-elicitation interviews to explore adjustment in adolescents with a rare birthmark condition. Body Image 2024; 48:101656. [PMID: 38091858 DOI: 10.1016/j.bodyim.2023.101656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 03/05/2024]
Abstract
Adolescents with the rare birthmarks congenital melanocytic naevi (CMN) experience physical and psychosocial challenges, many of which stem from looking different from the 'norm'. However, some adjust and have positive experiences. Understanding the lived experiences of adolescents who have adjusted to CMN can provide a holistic picture of adjustment and inform the development of support and interventions for others with the condition. Open, participant-driven photo-elicitation interviews were conducted with four White females (15-17 years) who self-identified as having adjusted to CMN. Participants chose five photographs which were used to guide the interviews (47-80 min). Interpretative phenomenological analysis (IPA) was used to analyse the transcribed interview data. Three superordinate themes were identified: 'Accepting My 'True' Self' (1), 'I am Not Alone in This' (2), and 'Developing as a Person' (3). The themes related to accepting CMN as part of their identity, developing a positive body image (e.g., body appreciation, broad conceptualisations of beauty, body image flexibility), feeling supported and accepted by family, friends, and others with CMN, and developing adaptive coping skills. Findings suggest positive body image may be important for adjustment and can be determined by an individual. The benefits of using photo-elicitation within appearance research are discussed.
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Affiliation(s)
- Ella Guest
- Centre for Appearance Research, University of the West of England, Bristol BS16 1QY, United Kingdom.
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol BS16 1QY, United Kingdom
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol BS16 1QY, United Kingdom
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3
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Tollow P, Ogden J, McCabe CS, Harcourt D. Physical appearance and well-being in adults with incurable cancer: a thematic analysis. BMJ Support Palliat Care 2023; 13:e163-e169. [PMID: 33246936 DOI: 10.1136/bmjspcare-2020-002632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/16/2020] [Accepted: 11/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Existing research has established the importance of appearance concerns for individuals with cancer and identified appearance as an important factor in dying with dignity. No research, however, has explored in depth the role of appearance in the experiences of individuals who have incurable cancer. This research aims to explore patients' experiences and perspectives in relation to the role of appearance issues in adults with incurable cancer. METHODS Semi-structured interviews were conducted with 24 adults with incurable cancer (20 women, 4 men; mean age 54.5, SD 11.32). RESULTS Thematic analysis generated three themes: 'Identity: Embodying Cancer', 'Communication: Wearing your illness' and 'Support: Holistic Care'. Appearance was felt to be an important element of identity, which was often dominated by cancer, leading to feelings of separation from the participant's previous self. Appearance changes also influenced the way in which individuals communicated with their external world, forcing discussion of their diagnosis, and increasing focus on their cancer, with participants having to manage the emotional impact of this on loved ones, as well as the impact on their legacy. Finally, participants highlighted the positive impact of appearance-related support in their well-being and identified peer connections and refocusing on the self as key elements of such support. CONCLUSIONS Appearance changes play an important role in the experiences of individuals with incurable cancer with regards to both identity and communication and challenged participants' ability to maintain normalcy. Further psychosocial support relating to appearance concerns was considered necessary to promote dignity and provide truly holistic patient care.
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Affiliation(s)
- Philippa Tollow
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, UK
| | - Candida S McCabe
- Dorothy House Hospice, Winsley, UK
- University of the West of England, Bristol, UK
- Florence Nightingale Foundation, London, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
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4
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Armoogum J, Foster C, Llewellyn A, Harcourt D, McCabe C. 'I think it affects every aspect of my life, really': Cancer survivors' experience of living with chronic pain after curative cancer treatment in England, UK. PLoS One 2023; 18:e0290967. [PMID: 37656690 PMCID: PMC10473538 DOI: 10.1371/journal.pone.0290967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/19/2023] [Indexed: 09/03/2023] Open
Abstract
AIM To explore cancer survivors' experiences of living with chronic pain after curative cancer treatment in England, UK. METHODS A qualitative study using telephone interviews with adult cancer survivors experiencing chronic pain after curative cancer treatment. Interview data was analysed using a reflexive thematic approach [1-3]. FINDINGS Nineteen participants: 14 female, 5 male, mean age 62.4 years, 1.5-48 years since cancer diagnosis, eight tumour groups represented. Six participants (31.6%) developed chronic pain more than ten years after completing cancer treatment (range 0-25 years). Five themes were generated which highlighted the experience of chronic pain after cancer treatment for cancer survivors: 1) 'Hear me… believe me…. Please'. Survivors felt that they had not been listened to when they tried to talk about their chronic pain after cancer treatment, nor at times, believed. 2) 'Expectation versus reality'. Survivors had anticipated returning to pre cancer quality of life yet living in chronic pain prevented them from doing so. 3) 'They don't understand…. We don't understand'. Cancer survivors did not feel informed or prepared for the risk or reality of chronic pain after cancer treatment and this compounded the difficulties of coping with and managing their pain. They felt health care professionals lacked knowledge and understanding of chronic pain after cancer. 4) 'Negotiating the maze'. Cancer survivors encountered unclear and limited pathways for support, often bouncing from one support team to another. Identifying and accessing services was a challenge, and the responsibility of this was often left to the survivor. 5) 'Validate my pain, validate me'. Palpable relief and benefit was felt when health care professionals diagnosed and acknowledged their chronic pain after cancer treatment. CONCLUSIONS Cancer survivors can feel ill prepared for the risk of chronic pain after cancer treatment and can experience challenges accessing support from healthcare professionals and clinical services.
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Affiliation(s)
- Julie Armoogum
- College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Alison Llewellyn
- College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
- Dorothy House Hospice, Winsley, United Kingdom
| | - Diana Harcourt
- College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Candida McCabe
- College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
- Dorothy House Hospice, Winsley, United Kingdom
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Bogart KR, Bryson BA, Harcourt D. Disclosing the obvious: Psychosocial implications of (not) explaining facial differences. Body Image 2023; 46:91-102. [PMID: 37247489 DOI: 10.1016/j.bodyim.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023]
Abstract
Although the disclosure of invisible stigmatized identities has been frequently researched, little work has examined disclosure of facial differences (FD), in which stigma is often highly visible. People with FD are frequently expected by others to disclose or explain their condition. Qualitative work indicates that people with FD have a range of disclosure approaches from agentic disclosure (feeling obliged to disclose), autonomous nondisclosure (choosing not to disclose or to disclose only to certain people), and autonomous disclosure (choosing to openly disclose). The purpose of the present study was to validate these disclosure approaches in a large international sample, examine their frequency of use, and test their relationship to psychosocial outcomes using validated measures. English-speaking participants (n = 288) with 33 different types of FD completed an online survey of disclosure approaches and psychosocial outcomes (i.e. anxiety, depression, self-esteem, stigma, job satisfaction, and relationship self-concept). Participants disclosed to 59 % of the people they knew. Selective and indiscriminate disclosure were the most frequently used and recommended approaches. As predicted, autonomous disclosure was associated with more positive psychosocial outcomes than agentic (non)disclosure and autonomous nondisclosure. Findings from this study can support disclosure autonomy, and thus positive psychosocial outcomes, among people with FD.
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Affiliation(s)
- Kathleen R Bogart
- School of Psychological Science, Oregon State University, Corvallis, OR 97331, USA.
| | - Brooke A Bryson
- Department of Psychology, Texas State University, San Marcos, TX 78666, USA
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK
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Zucchelli F, Dalen MV, Bhatia R, White P, Hamlet C, Harcourt D. Do congenital and acquired causes of visible difference predict distinct appearance-related psychosocial outcomes? Body Image 2023; 45:355-361. [PMID: 37062227 DOI: 10.1016/j.bodyim.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/18/2023]
Abstract
Having a visible difference caused by an appearance-altering condition or injury can impact psychosocial wellbeing. It remains unestablished whether the time at which a visible difference manifests, namely pre-memory (congenital) or later (acquired), predicts psychosocial outcomes associated with adjustment. In this survey study of 331 adults with visible differences, we tested whether their type, congenital (n = 161) or acquired (n = 170), would predict four key psychosocial outcomes: Appearance satisfaction, social appearance anxiety, life disengagement and intimacy distress. To account for other potential predictors and to test whether other variables would moderate any predictive effect found from the type of visible difference, the analyses also included demographic variables, visible difference characteristics and history, and interpersonal and intrapersonal factors. Four regression models were tested. With all variables entered, we found no evidence of type of visible difference as a significant predictor of any psychosocial outcome. Instead, the only consistent predictors of outcomes were optimism, social support and the extent to which participants felt able to disguise their difference. Overall, findings do not support the idea that there is a psychosocial advantage to having a congenital nor acquired visible difference, and broadly reinforce commonalities in adjusting to any cause.
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Affiliation(s)
- Fabio Zucchelli
- Centre for Appearance Research, University West of the England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.
| | - Marije van Dalen
- Centre for Appearance Research, University West of the England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Radhika Bhatia
- Centre for Appearance Research, University West of the England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Paul White
- Department of Engineering, Design and Mathematics, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Claire Hamlet
- Centre for Appearance Research, University West of the England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Diana Harcourt
- Centre for Appearance Research, University West of the England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
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Ivanova A, Rodríguez-Cano R, Kvalem IL, Harcourt D, Kiserud CE, Amdal CD. Body image concerns in long-term head and neck cancer survivors: prevalence and role of clinical factors and patient-reported late effects. J Cancer Surviv 2023; 17:526-534. [PMID: 36509859 PMCID: PMC10036408 DOI: 10.1007/s11764-022-01311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Head and neck cancer (HNC) patients are at risk of long-term body image distress (BID). We aimed to investigate the severity of BID in long-term HNC survivors and to explore the associations between sociodemographic and clinical factors, patient-reported late effects, and cancer-related body image (BI) concerns. METHODS This cross-sectional study included quality of life and BI assessment in an 8-year (SD = 1.58) follow-up after treatment among 258 HNC survivors. Multinomial logistic regression analysis was used to investigate the relationship between three groups of BI concerns (no concerns, mild to moderate concerns, and BID) and patient-reported late effects. Sociodemographic and clinical variables were included in the model as covariates. RESULTS A total of 51.2% of participants had mild to moderate BI concerns, and 9.5% reported BID. Compared to those with no BI concerns, participants with BID were more likely to live without a partner, to have had radiotherapy and surgery, and to report worse emotional functioning and higher oral and throat pain. Compared to participants with no BI concerns, those with mild to moderate concerns reported higher oral and throat pain and speech problems. CONCLUSIONS Some level of cancer-related BI concerns persisted in the majority of HNC survivors many years after treatment, while a small proportion of survivors experienced BID. BI concerns were associated with treatment modality and patients' daily functioning and symptoms. IMPLICATIONS FOR CANCER SURVIVORS Insight into factors associated with BI problems may help to identify survivors at risk and may facilitate closer follow-up of survivors in need.
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Affiliation(s)
- Anna Ivanova
- Department of Psychology, University of Oslo, Blindern, PB 1094, 0317, Oslo, Norway.
| | - Rubén Rodríguez-Cano
- Department of Psychology, University of Oslo, Blindern, PB 1094, 0317, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, University of Oslo, Blindern, PB 1094, 0317, Oslo, Norway
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | | | - Cecilie D Amdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Research support services, Oslo University Hospital, Oslo, Norway
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Tollow P, Hamlet C, Zucchelli F, Williamson H, Harcourt D. Experiences and impact of the UK lockdown amongst adults who have a facial visible difference. Curr Psychol 2023; 42:1-10. [PMID: 36718390 PMCID: PMC9878478 DOI: 10.1007/s12144-022-04089-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/27/2023]
Abstract
Globally, COVID-19 has been shown to have had a wide ranging and significant impact on individuals' daily living, and physical and mental health. However, there are some groups of individuals who may encounter unique challenges with regards to COVID-19 and whose experiences have not been investigated thus far. Therefore, this study aimed to understand the experiences of adults with a facial visible difference in relation to COVID-19 and lockdown. Semi-structured interviews were conducted with 21 adults with a variety of facial visible differences (e.g., cleft lip/palate, facial scars, skin conditions) and analyzed using inductive reflexive thematic analysis. This analysis generated three themes (Escaping the external gaze; Existing feelings manifesting in new challenges; COVID-19 taking priority). The results of this study suggest that the first U.K. lockdown from the COVID-19 pandemic created significant challenges for some individuals with a facial visible difference, and ongoing restrictions and social distancing measures might be particularly challenging for those who experience anxiety around social encounters. These findings highlight the importance of providing appropriate and accessible support for people with facial differences during lockdown and as restrictions ease.
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Affiliation(s)
- Philippa Tollow
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Claire Hamlet
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Fabio Zucchelli
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
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9
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Mathews A, Costa B, Mikkola A, Harcourt D. ' Scars: How Our Wounds Make Us Who We Are': Improving appearance-based stigma, conceptualisation of beauty and body esteem through a documentary. Scars Burn Heal 2023; 9:20595131231205398. [PMID: 38022894 PMCID: PMC10656807 DOI: 10.1177/20595131231205398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Introduction Those with an altered appearance as a result of injury, health condition or treatment can face stigma, which may contribute to adverse psychosocial outcomes. However, current research tends to focus on supporting individuals themselves to cope, rather than targeting societal stigma. This study aimed to reduce societal stigma towards this group, through the use of a documentary about people with scars. Methods 146 adults completed questionnaires before and after viewing the documentary. Results After viewing, participants had reduced self-reported intentions to behave in a stigmatising way towards those with visible differences, broader conceptualisation of beauty, and more positive body-esteem. Qualitative data also suggested further positive impacts. Conclusion Those with visible differences (for example scars) are subject to societal stigmatisation which perpetuates psychological and social problems. Therefore, alleviating social stigma through the media, as demonstrated through the documentary in this study, may improve the lives of those living with visible differences. Lay Summary People with an altered appearance or scars as a result of injury, health condition or treatment can face stigma, which may contribute to harmful psychological and social outcomes. However, current research tends to focus on supporting affected individuals themselves to cope, rather than targeting societal stigma. This study aimed to find out whether a documentary about people with scars was successful at reducing viewers' stigma towards this group. A group of 146 adults completed questionnaires before and after viewing the documentary. After viewing, questionnaires indicated that participants had reduced intentions to behave in a stigmatising way towards those with visible differences. Furthermore, they also viewed a broader range of appearances as beautiful and felt more positive about their own bodies. Comments and feedback from participants also suggested further positive impacts. Those with visible differences (for example scars) are subject to societal stigmatisation which can cause and worsen mental health problems. Therefore, alleviating social stigma through the media, as demonstrated through the documentary in this study, may improve the lives of those living with visible differences.
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Affiliation(s)
- Abigail Mathews
- The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Bruna Costa
- The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Aida Mikkola
- The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Diana Harcourt
- The Centre for Appearance Research, University of the West of England, Bristol, UK
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Keeling M, Williamson H, Williams VS, Kiff J, Evans S, Murphy D, Harcourt D. Body image and psychosocial well-being among UK military personnel and veterans who sustained appearance-altering conflict injuries. Mil Psychol 2023; 35:12-26. [PMID: 37130559 PMCID: PMC10013218 DOI: 10.1080/08995605.2022.2058302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
A modest but significant number of military personnel sustained injuries during deployments resulting in an altered-appearance (e.g., limb loss and/or scarring). Civilian research indicates that appearance-altering injuries can affect psychosocial wellbeing, yet little is known about the impact of such injuries among injured personnel. This study aimed to understand the psychosocial impact of appearance-altering injuries and possible support needs among UK military personnel and veterans. Semi-structured interviews with 23 military participants who sustained appearance-altering injuries during deployments or training since 1969 were conducted. The interviews were analyzed using reflexive thematic analysis, identifying six master themes. These themes indicate that in the context of broader recovery experiences, military personnel and veterans experience a variety of psychosocial difficulties related to their changed appearance. While some of these are consistent with evidence from civilians, military-related nuances in the challenges, protective experiences, coping approaches, and preferences for support are evident. Personnel and veterans with appearance-altering injuries may require specific support for adjusting to their changed appearance and related difficulties. However, barriers to acknowledging appearance concerns were identified. Implications for support provision and future research are discussed.
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Affiliation(s)
- Mary Keeling
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - Heidi Williamson
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - Victoria S. Williams
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - James Kiff
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - Sarah Evans
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - Dominic Murphy
- Combat Stress & King’s Centre for Military Health Research, King’s College London, London, UK
| | - Diana Harcourt
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
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Falconer L, Hendricks E, Harcourt D. What is the evidence of effectiveness of non-pharmaceutical, non-surgical, biopsychosocial interventions for body image and pain management in individuals with endometriosis? A systematic review. Journal of Endometriosis and Pelvic Pain Disorders 2022. [DOI: 10.1177/22840265221139909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Aim: To identify and review the success of non-pharmaceutical, non-surgical biopsychosocial interventions in individuals with endometriosis, in managing pain and improving body image. Methods: Cochrane, EBSCO, IBSS, NICE, Open Grey, OVID, Proquest, Scopus and Science Direct were searched in April 2021, using inclusion and exclusion criteria. Data collection and analysis: Five randomised control trials, and one controlled clinical trial resulted from the search. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Studies were synthesised by intervention type, into physical only, and physical and psychological. Results: Across the six papers, 323 participants were recruited, through medical records or self-referral, and treatments largely administered by specialist practitioners. From the EPHPP quality assessment,2 weak quality papers, and four moderate quality papers found improvements to pain, with large effect sizes in four papers. No studies used established body image measures to examine intervention effects on body image, and all lacked health psychology theoretical basis. There were common issues in selection bias, confounders and blinding. Conclusion: Without gold-standard methodology, evidence of effectiveness cannot be concluded. However, there is promising rationale if these issues are addressed.
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12
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Gentili C, McClean S, McGeagh L, Bahl A, Persad R, Harcourt D. The impact of hegemonic masculine ideals on self-esteem in prostate cancer patients undergoing androgen deprivation therapy (ADT) compared to ADT-naïve patients. Psychooncology 2022; 31:1958-1971. [PMID: 35833603 DOI: 10.1002/pon.6001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Androgen deprivation therapy (ADT) for Prostate Cancer (PCa) is associated with side effects that could lead to negative body image and low masculine self-esteem of survivors. We compared a group of PCa survivors following ADT with ADT-naïve patients, expecting the ADT group to show lower masculine self-esteem. We also expected patients with hegemonic masculinity ideals to show poorer masculine self-esteem and we hypothesized that ADT would moderate this relationship, expecting PCa patients on ADT with stronger hegemonic ideals to show the worst masculine self-esteem scores among study participants. METHODS We compared 57 PCa survivors on ADT (Mage = 64.16 (7.11)) to 59 ADT-naïve patients (Mage = 65.25 (5.50)), on the Masculine Self-Esteem Scale (MSES), Body Image Scale (BIS), and Hegemonic Masculinity Ideals Scale (HMIS). RESULTS While the two groups did not significantly differ on masculine self-esteem (F [1, 115] = 3.46, p = 0.065, ηp 2 = 0.029) and body image (F [1, 115] = 3.46, p = 0.065, ηp 2 = 0.029), younger age was significantly associated with higher body image issues (F [1, 115] = 8.63, p < 0.01, ηp 2 = 0.071, β = -0.30). Hegemonic masculinity significantly predicted more masculine self-esteem related issues (t (2, 114) = 2.31, β = 0.375, p < 0.05). ADT did not moderate this relationship. CONCLUSIONS The results suggest that endorsing hegemonic masculinity could represent a risk factor for low masculine self-esteem regardless of ADT status and that younger age is associated with negative body image among PCa survivors. IMPLICATIONS These results suggest the importance of inclusion of topics related to hegemonic masculinity when providing support to PCa survivors, both when discussing treatment side effects, as well as in the later phases of survivorship. This pilot also suggests that younger PCa survivors might benefit from body-image focused support regardless of treatment plan.
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Affiliation(s)
- Caterina Gentili
- Faculty of Health and Applied Sciences, Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Stuart McClean
- Faculty of Health and Applied Sciences, Centre for Public Health & Wellbeing, University of the West of England, Bristol, UK
| | - Lucy McGeagh
- Supportive Cancer Care Research Group, Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Amit Bahl
- University Hospitals Bristol NHS Trust, Bristol, UK
| | | | - Diana Harcourt
- Faculty of Health and Applied Sciences, Centre for Appearance Research, University of the West of England, Bristol, UK
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13
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Guest E, Zucchelli F, Costa B, Bhatia R, Halliwell E, Harcourt D. A systematic review of interventions aiming to promote positive body image in children and adolescents. Body Image 2022; 42:58-74. [PMID: 35679652 DOI: 10.1016/j.bodyim.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
Evidence shows interventions can improve positive body image in adult women. This systematic review examined the evidence of efficacy of interventions that aimed to increase positive body image in children and young people aged under 18 years. The authors followed PRISMA guidelines for the review. Searches of CINAHL Plus, Medline, PsychINFO, Wiley Online Library, SCOPUS and grey literature were conducted up to February 2021 and identified 4171 papers. Thirteen studies evaluating 12 interventions, designed for children/adolescents aged 9-18 years, were eligible and evaluated using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. The studies evaluated body appreciation, body-esteem, and embodiment. Studies using cognitive dissonance, peer support, and psychoeducation had evidence of improving body appreciation and body-esteem in adolescent girls. However, evidence of efficacy for younger children and boys was lacking and the studies ranged in methodological quality. Further research should rigorously evaluate positive body image interventions using second-generation measures that assess specific components of positive body image and consider how to promote positive body image in young children and boys.
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Affiliation(s)
- Ella Guest
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK.
| | - Fabio Zucchelli
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
| | - Radhika Bhatia
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
| | - Emma Halliwell
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
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14
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Herring B, Lewis-Smith H, Paraskeva N, Harcourt D. Exploring the experiences and psychosocial support needs of informal carers of men with breast cancer: a qualitative study. Support Care Cancer 2022; 30:6669-6676. [PMID: 35508668 PMCID: PMC9067554 DOI: 10.1007/s00520-022-07095-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/25/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The provision of practical and emotional support for men who have been diagnosed with breast cancer in the UK falls primarily on their partners, close family members or friends. However, informal carers' experiences are omitted from the research literature. Therefore, the present study aimed to explore the care-giving experiences of informal carers (ICs) of men with breast cancer in the UK and identify psychosocial support needs and preferences. METHODS Semi-structured interviews, conducted on the telephone or via online video calls, explored ICs' experiences of providing support, the psychosocial issues they faced and the impact of the illness on themselves and their relationship with the patient. They were also asked about any support previously offered to them, in addition to their support preferences. Twelve ICs participated (11 females, 1 male), and 9 were spouses. Interview transcripts were analysed with reflexive thematic analysis using NVIVO software. RESULTS Four key themes were identified: "The impact of caring", "Lack of awareness", "Isolated and alone" and "Making a difference". CONCLUSIONS The physical, emotional, financial and social impact of providing emotional and practical care and support for a man diagnosed with breast cancer can be considerable. ICs may experience significant levels of distress and often feel isolated. Greater awareness and more research is needed to better understand the psychosocial impact and support needs for ICs of men with breast cancer. There is an evident necessity to address their information needs and offer sources of support throughout the cancer journey.
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Affiliation(s)
- Beth Herring
- Centre for Appearance Research, Faculty of Health & Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - Helena Lewis-Smith
- Centre for Appearance Research, Faculty of Health & Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Nicole Paraskeva
- Centre for Appearance Research, Faculty of Health & Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health & Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
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15
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Tollow P, Marie Stock N, Harcourt D. Exploring parents' attitudes towards a multicentre cohort study of children with burns injuries: A qualitative interview study. Scars Burn Heal 2022; 8:20595131221098526. [PMID: 35800295 PMCID: PMC9253984 DOI: 10.1177/20595131221098526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Burn injuries affect more than 60,000 children every year in the UK, with
many experiencing scarring as a result. Scarring can be highly variable, and
research is required to explore the factors that may influence variability,
as well as the psychosocial impact of these injuries on children and their
caregivers. A multicentre burns cohort study is being planned to investigate
genetic determinants of scarring and long-term psychosocial outcomes. Public
involvement (PI) is an essential element of the design and feasibility
stages of this planning. As part of this work, this study aimed to gain an
in-depth understanding of parents’ attitudes towards participation in burns
research, specifically a longitudinal cohort study of children with small
burns (<10% total body surface area [TBSA]). Methods In total, 16 parents of children with burns took part in semi-structured
interviews regarding their experiences of taking part in research and their
attitudes towards the potential future cohort study. Interviews were
audio-recorded, transcribed verbatim and analysed using Reflexive Thematic
Analysis. Results Four themes were identified: ‘Acknowledging trauma’; ‘Aligning research with
experience’; ‘Research as a reciprocal relationship’; and ‘Contributing to
change’. Discussion These four themes represent factors that parents suggested were important for
acceptability, relevance, recruitment and retention of participants into a
longitudinal multicentre cohort study of children with a burn injury and
their caregivers. Conclusion The findings of this study will be incorporated into the design of such a
study, as well as having wide reaching relevance for research in the field
of paediatric burn injuries. Lay Summary Background to this subject More than 60,000 children experience a burn injury every year in the UK and
many of these injuries lead to scarring. We know that the extent of this
scarring can vary, and we know that some children and their
parents/caregivers manage well but others struggle with the challenges they
face after having a burn. Researchers would like to carry out research on
these topics, including asking participants to take part in research over
several years to find out how genetics might influence scarring, as well as
their psychological experiences over this time. Before they conduct this
study, it is very important that researchers understand parents' attitudes
towards this kind of research. The current study aimed to find out parents'
opinions and ask what issues were important to them when taking part in
burns research. Details of how the work was conducted Parents of children who had experienced a scald (a type of burn injury) were
asked to take part in a research interview. In total, 16 parents took part
in this study. We recorded these interviews and analysed them, looking for
patterns and shared experiences in participants' interviews. What we did and did not learn from this study We found four themes in the interview data: ‘Acknowledging trauma', ‘Aligning
research with experience', ‘Research as a reciprocal relationship', and
‘Contributing to change'. Overall, these themes suggest that parents were
mostly supportive of a ‘burns cohort study’, but they have also highlighted
some important considerations for this research and other future burns
research studies.
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Affiliation(s)
- Philippa Tollow
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
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16
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Jones B, Ndosi M, Hunt A, Harcourt D, Dures E. Factors associated with patient activation in inflammatory arthritis: a multisite cross-sectional study. Rheumatol Adv Pract 2021; 5:ii35-ii44. [PMID: 34755027 PMCID: PMC8570153 DOI: 10.1093/rap/rkab053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/05/2021] [Indexed: 01/28/2023] Open
Abstract
Objectives Patient activation covers the skills, abilities and behaviour that impact how able and willing someone is to take an active role in self-managing their health. This study explored clinical and psychosocial factors associated with patient activation in rheumatology patients. Methods This was a cross-sectional study using postal survey methods. Participants with inflammatory rheumatic conditions were from six rheumatology centres in England. Patient activation was captured using the Patient Activation Measure (PAM). Twenty-nine explanatory factors were tested for potential association with patient activation in univariable and multivariable analyses. In preliminary multivariable analyses, factors found to have an association with patient activation at a P < 0.1 level were entered into the final multivariable model. Those that remained significant at a P < 0.05 level were considered associated with patient activation. Results The sample comprised 251 participants (74% female) with a mean age of 59.31 years (s.d. 12.69), disease duration of 14.48 years (s.d. 12.52) and a PAM score of 58.3 (s.d. 11.46). Of the 29 candidate factors, 25 were entered into a preliminary multivariable analysis. In the final multivariable analysis, four factors (self-efficacy, the illness belief that treatment will control participants’ condition and two dimensions of health literacy) were significantly associated with patient activation. This final model accounted for 40.4% of the variance in PAM scores [F(4, 246) = 41.66, P < 0.001]. Conclusions Patient activation is important in managing rheumatic conditions. Our data confirm that self-efficacy and health literacy are particular targets for patient activation interventions.
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Affiliation(s)
- Bethan Jones
- School of Healthcare Sciences, Cardiff University, Cardiff
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, Faculty of Health and Applied Sciences, University of the West of England.,Academic Rheumatology, Bristol Royal Infirmary
| | - Andrew Hunt
- Academic Rheumatology, Bristol Royal Infirmary
| | - Diana Harcourt
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Emma Dures
- School of Health and Social Wellbeing, Faculty of Health and Applied Sciences, University of the West of England.,Academic Rheumatology, Bristol Royal Infirmary
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17
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Thornton M, Harcourt D, Deave T, Kiff J, Williamson H. "Have We Done Enough?" A Cross-condition Exploration of the Experiences of Parents Caring for A Child with an Appearance-affecting Condition or Injury. Dev Neurorehabil 2021; 24:418-428. [PMID: 33852812 DOI: 10.1080/17518423.2021.1901150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children and young people (CYP) with appearance-affecting conditions/injuries report common pervasive psychosocial difficulties, regardless of cause, nature or extent of their visible differences. Parents or carers can also experience psychosocial difficulties and challenges specific to having CYP with a visible difference. Current literature is confined to exploring condition-specific concerns of parents, typically in more prevalent appearance-affecting conditions/injuries, whilst the experiences of parents of CYP with other visible differences are unknown. Thirty-one interviews (parents n = 20, health and support professionals n = 11) and 4 parent focus groups (n = 25) were conducted. Three overarching themes were constructed: "Appearance does(n't) matter" describes the impact of having a child with a socially undesirable appearance; "Being 'battle' ready" reflects parents' desire to arm their child with resources to manage challenges, whilst "Walking the tightrope" reflects parents' lack of clarity about how best to approach this. Findings highlight shared and common cross-condition psychosocial difficulties among parents and carers.
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Affiliation(s)
- Maia Thornton
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Toity Deave
- Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - James Kiff
- Outlook Service, Southmead Hospital, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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18
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Clarke A, Paraskeva N, White P, Tollow P, Hansen E, Harcourt D. PEGASUS: the Design of an Intervention to Facilitate Shared Decision-making in Breast Reconstruction. J Cancer Educ 2021; 36:508-518. [PMID: 31994007 PMCID: PMC8099795 DOI: 10.1007/s13187-019-01656-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Studies have found varying levels of satisfaction after breast reconstruction surgery with a substantial group of patients reporting some level of regret about their decision. The variable outcomes reported by women undergoing breast reconstruction surgery suggest a role for improved pre-operative communication and shared decision-making (SDM) between patient and health professional. Pragmatic approaches such as decision aids have been evaluated, but the aim of the Patient Expectations and Goals Assisting Shared Understanding of Surgery (PEGASUS) intervention is to facilitate closer interaction between the patient and clinical team. PEGASUS is a standardised two-stage process, in which patients' goals are first elicited, ranked in importance and recorded before being used to frame discussion and decision-making with the surgeon managing care. Following the Medical Research Council (MRC) model, feasibility and acceptability studies have already been reported and a 4-year multicentre randomised controlled trial of 180 participants is underway, (completion 2020). This paper therefore focuses on the design of the intervention itself, in line with recent advice that interventions, in comparison with evaluations, commonly lack a theoretical base and are often under reported. We report a retrospective application of the Capability, Opportunity, Motivation-Behaviour (COM-B) model to provide explicit detail of each step in the intervention design. This is intended to facilitate replication by other clinicians and to provide systematic guidance for others wishing to develop PEGASUS as a strategy for implementing SDM in other clinical populations. Trial Registration: ISRCTN 18000391 (DOI 10.1186/ISRCTN18000391) 27/01/2016.
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Affiliation(s)
- A. Clarke
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - N. Paraskeva
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - P. White
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - P. Tollow
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - E. Hansen
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG UK
| | - D. Harcourt
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
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19
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Tollow P, Paraskeva N, Clarke A, White P, Powell J, Cox D, Harcourt D. 'They were aware of who I was as a person': Patients' and health professionals' experiences of using the PEGASUS intervention to facilitate decision-making around breast reconstruction. Eur J Cancer Care (Engl) 2021; 30:e13464. [PMID: 34028913 DOI: 10.1111/ecc.13464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/02/2020] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Many women choose to have breast reconstruction after mastectomy; however, decision-making can be difficult and expectations are often unmet. The PEGASUS intervention (Patient Expectations and Goals: Assisting Shared Understanding of Surgery) was developed to support shared decision-making by helping women and healthcare professionals to clarify and discuss their individual expectations around surgery. This study aimed to explore patients' and health professionals' experiences of using the intervention and its implementation. METHODS Forty interviews were conducted with participants in a large scale, multi-site trial of the effectiveness of PEGASUS, from 'intervention' (n=16) and 'usual care' groups (n=11), and healthcare professionals (n=13). Data were analysed using thematic analysis. RESULTS 'Usual care' participants described feeling overwhelmed in decision-making ('bombarded'), often using their own research to break down information ('process of elimination'). In contrast, intervention group participants described PEGASUS providing focus ('focus amongst the frenetic'), and increased connection with clinicians ('more than a number'). Healthcare professionals described increased focus on patient priorities ('shifting focus'), but stressed the need for whole team buy-in ('collective commitment'). CONCLUSIONS The PEGASUS intervention offered a qualitatively different experience to individuals considering breast reconstruction, with potential to enhance patients' and healthcare professionals' feelings of shared decision-making and patient-centred care. TRIAL REGISTRATION ISRCTN 18000391 (https://doi.org/10.1186/ISRCTN18000391) 27/01/2016.
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Affiliation(s)
- Philippa Tollow
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Nicole Paraskeva
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Alex Clarke
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, UK
| | - Jane Powell
- Centre for Public Health and Wellbeing, University of the West of England, Bristol, UK
| | - Danielle Cox
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
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20
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Gilmour A, Cutress R, Gandhi A, Harcourt D, Little K, Mansell J, Murphy J, Pennery E, Tillett R, Vidya R, Martin L. Oncoplastic breast surgery: A guide to good practice. Eur J Surg Oncol 2021; 47:2272-2285. [PMID: 34001384 DOI: 10.1016/j.ejso.2021.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/18/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023] Open
Abstract
Oncoplastic Breast Surgery has become standard of care in the management of Breast Cancer patients. These guidelines written by an Expert Advisory Group; convened by the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), are designed to provide all members of the breast cancer multidisciplinary team (MDT) with guidance on the best breast surgical oncoplastic and reconstructive practice at each stage of a patient's journey, based on current evidence. It is hoped they will also be of benefit to the wide range of professionals and service commissioners who are involved in this area of clinical practice.
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Affiliation(s)
- A Gilmour
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, United Kingdom
| | - R Cutress
- University of Southampton and University Hospital Southampton, United Kingdom
| | - A Gandhi
- Manchester Academic Health Sciences Centre & Manchester University Hospitals NHS Trust, Manchester, United Kingdom
| | - D Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - K Little
- Liverpool Breast Unit, Liverpool University Foundation Trust, United Kingdom
| | - J Mansell
- Gartnavel General Hospital, Glasgow, United Kingdom
| | - J Murphy
- Manchester University Hospitals NHS Trust, United Kingdom
| | | | - R Tillett
- Royal Devon and Exeter NHS Trust, Exeter, United Kingdom
| | - R Vidya
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - L Martin
- Liverpool Breast Unit, Liverpool University Foundation Trust, United Kingdom.
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21
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Jones B, Hunt A, Hewlett S, Harcourt D, Dures E. Rheumatology patients' perceptions of patient activation and the Patient Activation Measure: A qualitative interview study. Musculoskeletal Care 2021; 20:74-85. [PMID: 33826238 DOI: 10.1002/msc.1555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION An important aspect of self-management is patient activation (the skills, abilities and confidence someone uses to actively manage their health). The dominant method of capturing patient activation is the Patient Activation Measure (PAM) which has been integrated into many aspects of clinical practice in musculoskeletal care. However, limited research has investigated how rheumatology patients understand and perform patient activation, and how closely their perceptions align with the PAM. METHODS Seventeen patients from two rheumatology departments in South West England participated in semi-structured interviews at two timepoints. They discussed how they actively managed their health and their views on the PAM. Data on activation were analysed using framework analysis and data on the PAM were analysed using content analysis. RESULTS Participants self-managed with determination, finding ways to make small, sustainable behaviour changes and effectively navigate the healthcare system. They reported the value of knowing what self-management techniques suited them individually and reported benefitting from positive perceptions of their own health and good social support. Participants noted that the PAM did not always capture the fluctuating nature of their inflammatory arthritis and the collaborative nature of healthcare. CONCLUSIONS Patients' perceptions and experiences of patient activation covered a wide range of skills, behaviours and beliefs. However, these are not always captured by the PAM. Therefore, its use as a clinical tool is best accompanied by dialogue with patients to understand their self-management.
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Affiliation(s)
- Bethan Jones
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Andrew Hunt
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Sarah Hewlett
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Emma Dures
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
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22
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Lahdenperä NI, Repo JP, Aartolahti E, Tollow P, Griffiths C, Harcourt D, Vuola J, Lindford A. The CARe Burn Scale-Adult Form: Translation and linguistic validation into Finnish. Burns 2021; 47:1922-1928. [PMID: 33814216 DOI: 10.1016/j.burns.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Burn injury can dramatically deteriorate health-related quality of life. Effective burn care may minimize the impact of the burn injury and ensure optimal functional outcome. This requires continuous improvement in burn care and assessment of treatment results. The aim of this study was to translate, culturally adapt and linguistically validate the CARe Burn Scale-Adult Form, a burn-specific patient-reported outcome measure, into Finnish. METHODS The translation process followed the International Society for Pharmacoeconomics and Outcomes Research guidelines consisting of forward and backward translations, pilot-testing and cognitive debriefing interviews of five burn patients, and proofreading before finalizing. The process involved expert panel meetings and continuous discussion between the developers of the Scale and the research group. RESULTS In the forward translation 10 amendments were required. After the backward translation, 12 items were reworded. Cognitive debriefing interviews led to three alterations enhancing the comprehensiveness and accuracy of the translation. The translation was reviewed by burn occupational therapists for practicality, resulting in 12 modifications. Minor grammatical changes were made after proofreading. CONCLUSION The Finnish version is the first foreign translation of the CARe Burn Scale. It is equivalent to the original Scale and ready for psychometric validation with burn patients in Finland.
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Affiliation(s)
- Noora-Ilona Lahdenperä
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland.
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Eeva Aartolahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Finland
| | - Philippa Tollow
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Catrin Griffiths
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Diana Harcourt
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Jyrki Vuola
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland
| | - Andrew Lindford
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland
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Stock NM, Sharratt ND, Treneman-Evans G, Montgomery K, Denman R, Harcourt D, At The Centre For Appearance Research TVTCTFRT. 'My face in someone else's hands': a qualitative study of medical tattooing in women with hair loss. PSYCHOL HEALTH MED 2021; 27:1431-1442. [PMID: 33559487 DOI: 10.1080/13548506.2021.1883688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The psychological and social impact of hair loss and its ongoing treatment can be considerable. Medical treatments are not always successful, and alternative treatments, such as medical tattooing, are growing in popularity. The aims of this study were to explore adults' motivations, experiences, and self-perceived outcomes in relation to medical tattooing. Individual telephone interviews were conducted with 22 women from the United Kingdom aged 26-67 years who had undergone medical tattooing in the past 5 years related to hair loss. Interviews were transcribed and inductive thematic analysis was performed. Appearance concerns, loss of self-confidence/identity, and the practicalities of daily upkeep were cited as reasons for seeking a semi-permanent solution. Trust in the practitioner and the ongoing costs of tattoo maintenance were important considerations in participants' decision-making process and their overall satisfaction with treatment outcomes. Participants felt the emotional impact of hair loss and the subsequent need for appearance-restoring treatment remains unrecognised. This study provides insight into participants' perceptions of an under-researched and unregulated but widely accessible treatment. Implications for the decision-making process are discussed, and suggestions for health professionals are offered.
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Affiliation(s)
- Nicola Marie Stock
- Department of Health and Social Sciences, The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Nicholas David Sharratt
- Department of Health and Social Sciences, The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Georgia Treneman-Evans
- Department of Health and Social Sciences, The Centre for Appearance Research, University of the West of England, Bristol, UK
| | | | - Rae Denman
- Rae Denman Medical Tattooing, London, UK
| | - Diana Harcourt
- Department of Health and Social Sciences, The Centre for Appearance Research, University of the West of England, Bristol, UK
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Jones LF, Williamson H, Downing P, Lecky DM, Harcourt D, McNulty C. A Qualitative Investigation of the Acceptability and Feasibility of a Urinary Tract Infection Patient Information Leaflet for Older Adults and Their Carers. Antibiotics (Basel) 2021; 10:antibiotics10010083. [PMID: 33467185 PMCID: PMC7830400 DOI: 10.3390/antibiotics10010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 12/03/2022] Open
Abstract
Urinary tract infections (UTIs) can be life threatening in older adults. The aim of this study was to primarily understand the acceptability and feasibility of using a UTI leaflet for older adults in care homes and the community. Qualitative interviews and focus groups informed by the Theoretical Domains Framework were conducted in 2019 with 93 participants from two English areas where a UTI leaflet for older adults had been introduced to improve self-care advice. Discussions were conducted with care staff (carers and nurses), older adults, general practice staff (GPs, nurses and health care assistants), and other relevant stakeholders and covered experiences of using the leaflet; its implementation; and barriers and facilitators to use. Participants deemed the leaflet an acceptable tool. Clinicians and care staff believed that having information in writing would reinforce their messages to older adults. Care staff reported that some older adults may find the information overwhelming. Where implemented, care staff used the leaflet as an educational guide. Clinicians requested the leaflet in electronic and paper formats to suit preferences. Implementation barriers included lack of awareness of the leaflet, lack of staffing and resource, and weak working relationships between care homes and general practices. It is recommended that regional strategies must include plans for dissemination to care homes, training, promotion and easy access to the leaflet. Improvements to the leaflet consisted of inclusion of antibiotic course length, D-mannose, atrophic vaginitis and replacement of less alarmist terminology such as ‘life threatening’.
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Affiliation(s)
- Leah F. Jones
- Public Health England, Gloucester GL1 1DQ, UK; (L.F.J.); (P.D.); (D.M.L.)
| | - Heidi Williamson
- Health and Social Sciences, Frenchay Campus, University of the West of England, Bristol BS16 1QY, UK; (H.W.); (D.H.)
| | - Petronella Downing
- Public Health England, Gloucester GL1 1DQ, UK; (L.F.J.); (P.D.); (D.M.L.)
| | - Donna M. Lecky
- Public Health England, Gloucester GL1 1DQ, UK; (L.F.J.); (P.D.); (D.M.L.)
| | - Diana Harcourt
- Health and Social Sciences, Frenchay Campus, University of the West of England, Bristol BS16 1QY, UK; (H.W.); (D.H.)
| | - Cliodna McNulty
- Public Health England, Gloucester GL1 1DQ, UK; (L.F.J.); (P.D.); (D.M.L.)
- Correspondence:
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25
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Guest E, Paraskeva N, Griffiths C, Hansen E, Clarke A, Baker E, Harcourt D. The nature and importance of women's goals for immediate and delayed breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 74:2169-2175. [PMID: 33495140 DOI: 10.1016/j.bjps.2020.12.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/11/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Increasingly, women undergo breast reconstruction (BR) surgery to restore health-related and psychosocial quality of life after mastectomy. Most research focuses on BR outcomes rather than women's pre-surgical expectations of, and goals for, immediate (IBR) or delayed (DBR) procedures, yet such information could support women's decision-making. This study aimed to investigate women's BR goals, whether they differed according surgery timing (IBR or DBR), and the importance women placed on them. METHODS Seventy-six women considering DBR (n = 50) or IBR (n = 26) at a UK hospital were encouraged to clarify their BR goals and rate the importance of achieving each one. Content analysis categorised and counted the frequency of the goals they reported. RESULTS Fifteen goal categories (7 surgical, e.g. scarring; 8 psychosocial/lifestyle, e.g. feeling feminine) were identified. Many (e.g. scarring, intimacy) were reported by a similar percentage of women in each surgical group, however, differences were identified (e.g. breast sensation was not mentioned by women considering IBR). Women reported more psychosocial (n = 206) than surgical goals (n = 160). Further, an independent t-tests revealed that women in both groups placed significantly more importance on the psychosocial (M = 9.4) than surgical goals (M = 8.5). CONCLUSIONS This study highlights the variety of goals women have for BR, the importance they attach to them, and differences and similarities between those seeking IBR and DBR. Future research should consider whether BR goals are met, how goal achievement influences satisfaction with outcome over time and how best to incorporate goals into pre-surgical treatment decision-making.
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Affiliation(s)
- E Guest
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom.
| | - N Paraskeva
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom
| | - C Griffiths
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom
| | - E Hansen
- Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, United Kingdom
| | - A Clarke
- Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, United Kingdom
| | - E Baker
- Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, United Kingdom
| | - D Harcourt
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom
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Tollow P, Paraskeva N, Clarke A, White P, Powell J, Cox D, Harcourt D. Challenges and reflections from a multi-centre trial of a psycho-oncology intervention to support shared decision-making in breast reconstruction. Eur J Cancer Care (Engl) 2020; 30:e13384. [PMID: 33274523 DOI: 10.1111/ecc.13384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/13/2020] [Accepted: 11/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Philippa Tollow
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Nicole Paraskeva
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Alex Clarke
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Paul White
- Applied Statistics Group, Department of Engineering, Design and Mathematics, University of the West of England, Bristol, UK
| | - Jane Powell
- Centre for Public Health and Wellbeing, University of the West of England, Bristol, UK
| | - Danielle Cox
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Lewis-Smith H, Diedrichs PC, Bond R, Harcourt D. Psychological and sociocultural influences on body image among midlife women with and without a history of breast cancer: Testing the Tripartite Influence Model of Body Image. Body Image 2020; 35:114-125. [PMID: 33010788 DOI: 10.1016/j.bodyim.2020.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 12/25/2022]
Abstract
Body image concerns are common among breast cancer survivors and women in midlife. However, effective interventions are lacking for breast cancer survivors. This may be related to prior research having examined non-modifiable and medicalised influences on body image, instead of modifiable sociocultural and psychological influences. An adaptation of the 'Tripartite Influence Model of Body Image' was tested among women with (n = 169; mean age = 49.9) and without (n = 323; mean age = 47.6) a history of breast cancer, to investigate whether psychological and sociocultural influences on body image were similar between groups. Structural equation modelling revealed the model fit was satisfactory. Media pressure had an indirect effect on body image among both groups, and a direct effect among women treated for breast cancer. An additional influence of relevance only to women without breast cancer was pressure from friends. Overall, findings indicate common influences of media pressure and appearance comparisons on body image among both groups of women. This suggests that with some tailoring, existing evidence-based body image interventions designed for midlife women targeting these factors may also be relevant and beneficial for breast cancer survivors.
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Affiliation(s)
- Helena Lewis-Smith
- Centre for Appearance Research, University of the West of England, United Kingdom.
| | | | - Rod Bond
- University of Sussex, United Kingdom
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, United Kingdom
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Abstract
OBJECTIVE Microtia is a medically complex condition, with the option of surgery to address hearing and reconstruct the ear. The current study explored adults' experiences of microtia, with a particular focus on the psychosocial impact and experiences of ear reconstruction. The ultimate aim was to identify areas for support and future research that could improve patient care. DESIGN Fifteen adults (12 females) aged between 20 and 62 years took part in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. RESULTS Three main themes were identified in the data: microtia as an invisible difference, surgery as a welcome opportunity, and living well with microtia. Participants had incorporated microtia into their self-concept and did not report a lasting negative impact on their lives. However, some psychosocial challenges were reported, including anxiety about showing their ears (even after reconstruction), disclosing their diagnosis to romantic partners, surgical decision-making, and feeling unsupported in the work environment. CONCLUSION Individuals with microtia may benefit from psychosocial interventions to increase confidence, access to support for treatment decision-making, and guidance around disclosing microtia to employers.
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Affiliation(s)
- Claire Hamlet
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Sharma N, Harcourt D, Jenkinson E, Pearce A. WS02.6 Living with cystic fibrosis: patients’ experiences of diagnosis in adulthood. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jones B, Hunt A, Hewlett S, Harcourt D, Dures E. SAT0615-HPR FACTORS ASSOCIATED WITH PATIENT ACTIVATION IN PEOPLE WITH RHEUMATIC CONDITIONS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patient activation describes the skills, abilities and confidence someone uses to actively manage their health. Patient activation abilities in rheumatology are unclear, and there is little knowledge about factors that explain variation in patient activation. Therefore, understanding these factors can contribute to the development of appropriate, rheumatology-specific interventions targeting activation. The Patient Activation Measure (PAM) captures patient activation and provides people with both a score and a level to describe how able they are to actively manage their health.Objectives:To explore longitudinal changes to patient activation (measured using the PAM) (Hibbardet al., 2005), and the PAM’s associations with related constructs (including self-efficacy, health literacy and health beliefs) in a sample of participants with inflammatory arthritis.Methods:A postal survey was administered at two time points that were nine months apart. This survey captured the PAM and a range of clinical, demographic and psychosocial variables in a sample of rheumatology patients from 6 NHS sites in England. The measures included in the survey had been selected based on both theory and prior qualitative research and the survey pack was designed in collaboration with a patient partner. Following data collection, candidate variables for a multiple regression analysis were initially identified using univariable analysis. These variables were included in a forced entry multiple regression at each time point, and the variables that were statistically significant contributors at a 0.1 level were included in the final models. Changes to PAM scores over time were investigated using a Wilcoxon matched-pair signed rank test.Results:251 participants completed the first survey and 154 participants completed both full surveys. Self-efficacy, illness beliefs, health literacy and health locus of control were consistently associated with variance in PAM scores. The first three factors were also predictive of variance in PAM levels. With the 154 participants who fully completed both surveys, there was a statistically significant difference in participants’ PAM scores between the two surveys.Conclusion:The findings suggest factors that may be targets for interventions that aim to increase patient activation. The changes to PAM scores across the data collection period also suggest that when using the PAM as a clinical tool, healthcare professionals would benefit from incorporating regular reviews and preparations for any increases or reductions in patient activation.References:[1]Hibbard, J.H., Mahoney, E.R., Stockard, J. and Tusler, M. (2005) Development and testing of a short form of the patient activation measure.Health Services Research. 40 (6 I), pp. 1918–1930.Disclosure of Interests:Bethan Jones Speakers bureau: Honorarium for Lilly in their work with the British Society of Rheumatology for the delivery of 2 webinars due to be held on 30th January 2020., Andrew Hunt: None declared, Sarah Hewlett Grant/research support from: Received independent learning grant from Pfizer for the STRIDE project. However, the work has been completed and the grant closed, Diana Harcourt: None declared, Emma Dures Grant/research support from: Independent Learning Grant from Pfizer, combined funding for a research fellow from Celgene, Abbvie and Novartis, Paid instructor for: A fee from Novartis to deliver training to nurses.
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31
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Heath J, Williamson H, Williams L, Harcourt D. www.SupportingChildrenWithBurns.co.uk: A website developed with parents and professionals for the psychosocial support of parents of burn-injured children. Burns 2020; 46:1232-1233. [PMID: 32446741 DOI: 10.1016/j.burns.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jennifer Heath
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK
| | - Lisa Williams
- Chelsea and Westminster Burns Service, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK
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32
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Armoogum J, Harcourt D, Foster C, Llewellyn A, McCabe CS. The experience of persistent pain in adult cancer survivors: A qualitative evidence synthesis. Eur J Cancer Care (Engl) 2019; 29:e13192. [PMID: 31762169 DOI: 10.1111/ecc.13192] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 02/02/2023]
Affiliation(s)
| | | | | | - Alison Llewellyn
- University of the West of England Bristol UK
- Royal United Hospitals Bath NHS Foundation Trust Bath UK
| | - Candida S. McCabe
- University of the West of England Bristol UK
- Royal United Hospitals Bath NHS Foundation Trust Bath UK
- Florence Nightingale Foundation London UK
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Williamson H, Hamlet C, White P, Marques EMR, Paling T, Cadogan J, Perera R, Rumsey N, Hayward L, Harcourt D. A Web-Based Self-Help Psychosocial Intervention for Adolescents Distressed by Appearance-Affecting Conditions and Injuries (Young Persons' Face IT): Feasibility Study for a Parallel Randomized Controlled Trial. JMIR Ment Health 2019; 6:e14776. [PMID: 31755870 PMCID: PMC6898888 DOI: 10.2196/14776] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Disfigurement (visible difference) from wide-ranging congenital or acquired conditions, injuries, or treatments can negatively impact adolescents' psychological well-being, education and health behaviours. Alongside medical interventions, appearance-specific cognitive behavioural and social skills training to manage stigma and appearance anxiety may improve psychosocial outcomes. YP Face IT (YPF), is a Web-based seven session self-help program plus booster quiz, utilising cognitive behavioural and social skills training for young people (YP) struggling with a visible difference. Co-designed by adolescents and psychologists, it includes interactive multimedia and automated reminders to complete sessions/homework. Adolescents access YPF via a health professional who determines its suitability and remotely monitors clients' usage. OBJECTIVE To establish the feasibility of evaluating YPF for 12-17 year olds self-reporting appearance-related distress and/or bullying associated with a visible difference. METHODS Randomized controlled trial with nested qualitative and economic study evaluating YPF compared with usual care (UC). Feasibility outcomes included: viability of recruiting via general practitioner (GP) practices (face to face and via patient databases) and charity advertisements; intervention acceptability and adherence; feasibility of study and data collection methods; and health professionals' ability to monitor users' online data for safeguarding issues. Primary psychosocial self-reported outcomes collected online at baseline, 13, 26, and 52 weeks were as follows: appearance satisfaction (Appearance Subscale from Mendleson et al's (2001) Body Esteem Scale); social anxiety (La Greca's (1999) Social Anxiety Scale for Adolescents). Secondary outcomes were; self-esteem; romantic concerns; perceived stigmatization; social skills and healthcare usage. Participants were randomised using remote Web-based allocation. RESULTS Thirteen charities advertised the study yielding 11 recruits, 13 primary care practices sent 687 invitations to patients on their databases with a known visible difference yielding 17 recruits (2.5% response rate), 4 recruits came from GP consultations. Recruitment was challenging, therefore four additional practices mass-mailed 3,306 generic invitations to all 12-17 year old patients yielding a further 15 participants (0.5% response rate). Forty-seven YP with a range of socioeconomic backgrounds and conditions were randomised (26% male, 91% white, mean age 14 years (SD 1.7)); 23 to YPF, 24 to UC). At 52 weeks, 16 (70%) in the intervention and 20 (83%) in UC groups completed assessments. There were no intervention-related adverse events; most found YPF acceptable with three withdrawing because they judged it was for higher-level concerns; 12 (52%) completed seven sessions. The study design was acceptable and feasible, with multiple recruitment strategies. Preliminary findings indicate no changes from baseline in outcome measures among the UC group and positive changes in appearance satisfaction and fear of negative evaluation among the YPF group when factoring in baseline scores and intervention adherence. CONCLUSIONS YPF is novel, safe and potentially helpful. Its full psychosocial benefits should be evaluated in a large-scale RCT, which would be feasible with wide-ranging recruitment strategies. TRIAL REGISTRATION ISRCTN registry ISRCTN40650639; http://www.isrctn.com/ISRCTN40650639.
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Affiliation(s)
- Heidi Williamson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Claire Hamlet
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Paul White
- Faculty of Environment and Technology, University of the West of England, Bristol, United Kingdom
| | - Elsa M R Marques
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Thomas Paling
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Julia Cadogan
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Rohan Perera
- Bristol Clinical Commissioning Group, Bristol, United Kingdom
| | - Nichola Rumsey
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | | | - Diana Harcourt
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
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Carrard I, Argyrides M, Ioannou X, Kvalem IL, Waldherr K, Harcourt D, McArdle S. Associations between body dissatisfaction, importance of appearance, and aging anxiety with depression, and appearance-related behaviors in women in mid-life. J Women Aging 2019; 33:70-83. [PMID: 31635544 DOI: 10.1080/08952841.2019.1681882] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The impacts of body dissatisfaction have been widely studied among adolescent girls, but much less in women in mid-life. In this study, we evaluated the associations between body dissatisfaction, psychological health and behaviors used to manage age-related changes, in an online survey of 331 women aged 45-65. Body dissatisfaction, importance of appearance and aging anxiety were associated with higher depression scores. Moreover, importance of appearance and aging anxiety were associated with the probability of using "anti-aging" behaviors. It seems that with age, for a subgroup of women, the pressure to stay young may be added to that of staying thin.
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Affiliation(s)
- Isabelle Carrard
- Nutrition and dietetics department, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO) , Geneva, Switzerland
| | | | - Xaris Ioannou
- Department of Psychology, Neapolis University Pafos , Cyprus
| | | | - Karin Waldherr
- Research & quality management department, FernFH Distance-Learning University of Applied Sciences , Wiener Neustadt, Austria
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England , Bristol, England
| | - Siobhan McArdle
- School of Health and Human Performance, Dublin City University , Dublin, Ireland
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35
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Guest E, Costa B, Williamson H, Meyrick J, Halliwell E, Harcourt D. The effectiveness of interventions aiming to promote positive body image in adults: A systematic review. Body Image 2019; 30:10-25. [PMID: 31077956 DOI: 10.1016/j.bodyim.2019.04.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 01/25/2023]
Abstract
Theory suggests promoting positive body image (PBI) through interventions would have a significant impact on health and well-being. However, little is known about the effectiveness of existing interventions. This review aimed to identify and assess the evidence of effectiveness of interventions to increase PBI in adults. Database searches were conducted using CINAHL Plus, Medline, PsychINFO, Wiley Online Library, and SCOPUS. Application of inclusion criteria and data extraction were conducted by two reviewers. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and narrative synthesis was conducted. Fifteen studies, evaluating 13 interventions, were included. Three studies, evaluating one online writing-based functionality intervention, were judged to have strong methodological quality and had evidence of improving body appreciation, body esteem, and functionality satisfaction. Six moderate quality studies found interventions using intuitive eating, CBT, self-compassion, and exercise improved PBI. There was limited evidence of effectiveness of interventions for men, suggesting future research is needed to better understand PBI mechanisms in men. Lack of heterogeneity of outcome measures is discussed as a limitation. Findings suggest existing interventions are effective at increasing aspects of PBI among women and support the development of interventions that target multiple components of PBI.
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Affiliation(s)
- Ella Guest
- Centre for Appearance Research, University of the West of England, Bristol, UK.
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK.
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, UK.
| | | | - Emma Halliwell
- Centre for Appearance Research, University of the West of England, Bristol, UK.
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK.
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36
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Heath J, Williamson H, Williams L, Harcourt D. Supporting children with burns: Developing a UK parent-focused peer-informed website to support families of burn-injured children. Patient Educ Couns 2019; 102:1730-1735. [PMID: 30962077 DOI: 10.1016/j.pec.2019.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Children's burn injuries can have a significant psychosocial impact on parents. However, the stress involved in caring for a child following a burn can often go unrecognized and does not necessarily prompt help seeking by parents. OBJECTIVE It is common for adults to seek health-related support and information via the Internet. Many benefit from immediate and easy access to online psychological interventions. A prototype burn-specific, parent-focused, peer-informed, supportive website, designed to provide easy access to information and psychoeducation, was created and tested for acceptability. PATIENT INVOLVEMENT Using a partnership-based method of website development, parents and professionals (clinical, academic and support organizations) were recruited and their particular expertise was acknowledged and valued. A participatory action approach was adopted to determine the acceptability of the website for parents/carers. METHODS 31 participants (9 parents, 22 professionals) tested a prototype version of the website. Data was collected using the eHealth Impact Questionnaire and the concurrent think-aloud protocol. RESULTS Parents and professionals had favorable opinions of the website. Parents' ratings tended to be more favorable than professionals', which was significant for the information and presentation. Participants' thoughts were categorized into seven topics: need, structure/navigation, trust/relevance, language/comprehension, therapeutic content, mode of delivery, and suggested improvements. DISCUSSION Many practical and psychological barriers can prevent parents of burn-injured children accessing psychosocial support and contribute to a feeling of isolation. Participants felt that the website would be a valuable addition to UK pediatric burn care. The existence of an accessible resource could help to normalize parents' experience of their child's injury and reduce their perceived isolation, although peer interaction is not provided by the website. PRACTICAL VALUE This online resource, hosting information and peers' personal experiences, offers promising and exciting opportunities to empower parents whilst providing accessible supportive advice to encourage self-care and formal/informal support seeking when necessary.
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Affiliation(s)
- Jennifer Heath
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Lisa Williams
- Chelsea and Westminster Burns Service, Chelsea and Westminster Hospital, London, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Herring B, Paraskeva N, Tollow P, Harcourt D. Women's initial experiences of their appearance after mastectomy and/or breast reconstruction: A qualitative study. Psychooncology 2019; 28:2076-2082. [PMID: 31386237 DOI: 10.1002/pon.5196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/03/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Beth Herring
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Nicole Paraskeva
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Philippa Tollow
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
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Gentili C, McClean S, Hackshaw-McGeagh L, Bahl A, Persad R, Harcourt D. Body image issues and attitudes towards exercise amongst men undergoing androgen deprivation therapy (ADT) following diagnosis of prostate cancer. Psychooncology 2019; 28:1647-1653. [PMID: 31141623 DOI: 10.1002/pon.5134] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is an established treatment for prostate cancer (PCa), but its side-effects can affect body appearance and functioning. However, research into the impact of ADT on body image is limited. Exercise can help patients to counterbalance some side-effects, potentially improving body image too. However, adherence to exercise recommendations is low. Therefore, we explored body image after ADT and attitudes towards exercise. METHODS Twenty two semi-structured interviews were conducted with PCa patients receiving ADT (Mage = 67.9 years old, SD = 9.99). RESULTS Participants expressed appearance dissatisfaction focusing on body feminization. Participants exercised to counterbalance ADT side-effects and improve mood. Exercise also helped them to re-establish a sense of control over their body and experience a sense of achievement. However, some men described being worried that their appearance and physical performance would be judged by others, so they often exercised alone or gave up exercise. Time management and fatigue were also identified as exercise barriers. CONCLUSION These findings highlight the need to further investigate body image concerns and exercise barriers in PCa patients undergoing ADT. These results could also inform support groups and health care professionals on the topic. However, further research should explore the most effective and acceptable ways to provide support to PCa patients on body image issues.
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Affiliation(s)
- Caterina Gentili
- Centre for Appearance Research, Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Stuart McClean
- Centre for Public Health and Wellbeing Research, Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Amit Bahl
- University Hospitals Bristol NHS Trust, Bristol, UK
| | | | - Diana Harcourt
- Centre for Appearance Research, Health and Applied Sciences, University of the West of England, Bristol, UK
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Tollow P, Williams VS, Harcourt D, Paraskeva N. “It felt like unfinished business, it feels like that's finished now”: Women's experiences of decision making around contralateral prophylactic mastectomy (CPM). Psychooncology 2019; 28:1328-1334. [PMID: 30963646 DOI: 10.1002/pon.5086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Philippa Tollow
- Centre for Appearance ResearchUniversity of the West of England Bristol UK
| | | | - Diana Harcourt
- Centre for Appearance ResearchUniversity of the West of England Bristol UK
| | - Nicole Paraskeva
- Centre for Appearance ResearchUniversity of the West of England Bristol UK
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Paraskeva N, Herring B, Tollow P, Harcourt D. First look: A mixed-methods study exploring women's initial experiences of their appearance after mastectomy and/or breast reconstruction✰. J Plast Reconstr Aesthet Surg 2019; 72:539-547. [DOI: 10.1016/j.bjps.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/30/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
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Jones BE, Hunt A, Harcourt D, Hewlett S, Dures E. 148 Rheumatology patient perceptions of the Patient Activation Measure (PAM): how well does it capture their experiences of patient activation? Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez108.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bethan E Jones
- Nursing & Midwifery, University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UNITED KINGDOM
| | - Andrew Hunt
- Academic Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UNITED KINGDOM
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UNITED KINGDOM
| | - Sarah Hewlett
- Nursing & Midwifery, University of the West of England, Bristol, UNITED KINGDOM
| | - Emma Dures
- Nursing & Midwifery, University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UNITED KINGDOM
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Griffiths C, Guest E, Pickles T, Hollén L, Grzeda M, White P, Tollow P, Harcourt D. The Development and Validation of the CARe Burn Scale—Adult Form: A Patient-Reported Outcome Measure (PROM) to Assess Quality of Life for Adults Living with a Burn Injury. J Burn Care Res 2019; 40:312-326. [PMID: 30820556 DOI: 10.1093/jbcr/irz021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Catrin Griffiths
- Centre for Appearance Research (CAR), University of the West of England, Bristol, UK
| | - Ella Guest
- Centre for Appearance Research (CAR), University of the West of England, Bristol, UK
| | | | - Linda Hollén
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - Mariusz Grzeda
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - Paul White
- Department of Engineering, Design and Mathematics, University of the West of England, Bristol, UK
| | - Philippa Tollow
- Centre for Appearance Research (CAR), University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research (CAR), University of the West of England, Bristol, UK
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Abstract
A qualitative study using photo-elicitation was conducted to investigate the experiences of family members attending a residential burn camp. Six families were provided with cameras and asked to take photographs of their time at camp. They were subsequently interviewed about their experiences of camp, using their photographs as prompts. Thematic analysis of interview transcripts identified three main themes: benefits for the family as a whole (new activities and experiences and lasting impacts), benefits for the child (having fun without feeling different), and benefits for the parent/carer (support from those who understand). This is the first study to specifically investigate the experience of the whole family at a burn camp and suggests that attendance may offer a number of benefits for parents/carers and children. Photo-elicitation was an effective method for encouraging participants to recall and discuss their time at camp, and should be considered in future burns research.
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Lewis-Smith H, Diedrichs PC, Harcourt D. A pilot study of a body image intervention for breast cancer survivors. Body Image 2018; 27:21-31. [PMID: 30121489 DOI: 10.1016/j.bodyim.2018.08.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 01/26/2023]
Abstract
Body image interventions for breast cancer survivors are lacking in empirical support. Examining existing research on effective body image interventions for women in midlife more broadly may provide useful insights. This pilot study assessed the acceptability, feasibility, and preliminary effects of a Cognitive Behavioural Therapy-based intervention adapted from women in midlife to promote positive body image among breast cancer survivors. Twenty-two breast cancer survivors received the 7-week group intervention, co-facilitated by a clinical psychologist and peer. Participant evaluations suggested the intervention was both acceptable (e.g., 94% would recommend it) and feasible (e.g., 91% completed the intervention). Improvements were identified at either post-test or 1-month follow-up in nearly all body image measures. Maintained improvements were found in body appreciation, weight and shape concern, acceptance of aging-related appearance changes, and self-esteem. This study suggests that the adapted intervention is acceptable, feasible, and demonstrates preliminary efficacy in improving body image and secondary outcomes among breast cancer survivors.
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Affiliation(s)
- Helena Lewis-Smith
- Centre for Appearance Research, University of the West of England, United Kingdom.
| | | | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, United Kingdom
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Lewis-Smith H, Diedrichs PC, Rumsey N, Harcourt D. Efficacy of psychosocial and physical activity-based interventions to improve body image among women treated for breast cancer: A systematic review. Psychooncology 2018; 27:2687-2699. [PMID: 30161285 DOI: 10.1002/pon.4870] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/01/2018] [Accepted: 08/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Helena Lewis-Smith
- Centre for Appearance Research; University of the West of England; Bristol UK
| | | | - Nichola Rumsey
- Centre for Appearance Research; University of the West of England; Bristol UK
| | - Diana Harcourt
- Centre for Appearance Research; University of the West of England; Bristol UK
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Harcourt D, Hamlet C, Feragen KB, Garcia-Lopez LJ, Masnari O, Mendes J, Nobile F, Okkerse J, Pittermann A, Spillekom-van Koulil S, Stock NM, Williamson H. The provision of specialist psychosocial support for people with visible differences: A European survey. Body Image 2018; 25:35-39. [PMID: 29454284 DOI: 10.1016/j.bodyim.2018.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
A substantial body of research has demonstrated the challenges commonly facing people with visible differences (disfigurements) and explored the potential benefits offered by specialist psychosocial support and intervention for those who are negatively affected. However, little is known about the availability of such support in Europe for people whose appearance is in any way different to 'the norm'. This survey of 116 psychosocial specialists from 15 European countries, working with a range of patient groups, has shown a tendency for specialists to prioritise Cognitive-behavioural-based approaches, amongst a wide range of other approaches and interventional techniques. It indicates variations in the availability of support, and a perceived need for improved access to interventions, additional training, and greater awareness of the psychosocial issues associated with visible differences.
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Affiliation(s)
- Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK.
| | - Claire Hamlet
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK
| | | | - Luis-Joaquin Garcia-Lopez
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Building C5, 23071, Jaen, Spain
| | - Ornella Masnari
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Jose Mendes
- INTELECTO - Psychology & Research, Rua do Monte, 52B, R/C Esquerdo Nascente, 9500-451, Ponta Delgada, Açores, Portugal
| | | | - Jolanda Okkerse
- Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Anna Pittermann
- General Hospital of Vienna, Medical University, Department of Plastic and Reconstructive Surgery, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | | | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK; Cleft Collective, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK
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Jones B, Hewlett S, Harcourt D, Hunt A, Dures E. 278 How effective are interventions targeting patient activation in people with long-term physical conditions? A systematic review. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bethan Jones
- Nursing & Midwifery, University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Sarah Hewlett
- Nursing & Midwifery, University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UNITED KINGDOM
| | - Andrew Hunt
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Emma Dures
- Nursing & Midwifery, University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
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Merz EL, Kwakkenbos L, Carrier ME, Gholizadeh S, Mills SD, Fox RS, Jewett LR, Williamson H, Harcourt D, Assassi S, Furst DE, Gottesman K, Mayes MD, Moss TP, Thombs BD, Malcarne VL. Factor structure and convergent validity of the Derriford Appearance Scale-24 using standard scoring versus treating 'not applicable' responses as missing data: a Scleroderma Patient-centered Intervention Network (SPIN) cohort study. BMJ Open 2018; 8:e018641. [PMID: 29511009 PMCID: PMC5855329 DOI: 10.1136/bmjopen-2017-018641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Valid measures of appearance concern are needed in systemic sclerosis (SSc), a rare, disfiguring autoimmune disease. The Derriford Appearance Scale-24 (DAS-24) assesses appearance-related distress related to visible differences. There is uncertainty regarding its factor structure, possibly due to its scoring method. DESIGN Cross-sectional survey. SETTING Participants with SSc were recruited from 27 centres in Canada, the USA and the UK. Participants who self-identified as having visible differences were recruited from community and clinical settings in the UK. PARTICIPANTS Two samples were analysed (n=950 participants with SSc; n=1265 participants with visible differences). PRIMARY AND SECONDARY OUTCOME MEASURES The DAS-24 factor structure was evaluated using two scoring methods. Convergent validity was evaluated with measures of social interaction anxiety, depression, fear of negative evaluation, social discomfort and dissatisfaction with appearance. RESULTS When items marked by respondents as 'not applicable' were scored as 0, per standard DAS-24 scoring, a one-factor model fit poorly; when treated as missing data, the one-factor model fit well. Convergent validity analyses revealed strong correlations that were similar across scoring methods. CONCLUSIONS Treating 'not applicable' responses as missing improved the measurement model, but did not substantively influence practical inferences that can be drawn from DAS-24 scores. Indications of item redundancy and poorly performing items suggest that the DAS-24 could be improved and potentially shortened.
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Affiliation(s)
- Erin L Merz
- Department of Psychology, California State University, Dominguez Hills, Carson, California, USA
| | - Linda Kwakkenbos
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Behavioral Science Institute, Clinical Psychology, Radboud University, Nijmegen, The Netherlands
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Shadi Gholizadeh
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Sarah D Mills
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Rina S Fox
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa R Jewett
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Educational and Counseling Psychology, McGill University, Montreal, Quebec, Canada
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health and Life Science, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Life Science, University of the West of England, Bristol, UK
| | - Shervin Assassi
- Department of Internal Medicine, Division of Rheumatology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Daniel E Furst
- Division of Rheumatology, Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | | | - Maureen D Mayes
- Department of Internal Medicine, Division of Rheumatology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Tim P Moss
- Centre for Appearance Research, Faculty of Health and Life Science, University of the West of England, Bristol, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Educational and Counseling Psychology, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Vanessa L Malcarne
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- Department of Psychology, San Diego State University, San Diego, California, USA
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Armstrong-James L, Cadogan J, Williamson H, Rumsey N, Harcourt D. An evaluation of the impact of a burn camp on children and young people's concerns about social situations, satisfaction with appearance and behaviour. Scars Burn Heal 2018; 4:2059513118816219. [PMID: 30574405 PMCID: PMC6295691 DOI: 10.1177/2059513118816219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This evaluation aimed to assess the impact of a burn camp on children and young people's concerns about social situations, satisfaction with appearance and behaviour. METHODS Young people completed the Perceived Stigmatisation Questionnaire (PSQ), Social Comfort Questionnaire (SCQ) and Satisfaction with Appearance Scale (SWAP) one month before camp (n=23), on the last day of camp (n=21) and at a three-month follow-up (n=13). Parents completed the Strengths and Difficulties Questionnaire (SDQ) one month before camp (n = 22) and at follow-up (n=12). Parents and young people also completed open-ended questions before camp and at the follow-up. RESULTS Results in this evaluation were mixed. While parents' reported scores on the SDQ were poorer after camp, young people's reported outcomes on all three measures improved at the end of camp. PSQ and SWAP scores were maintained and improved, respectively, at the follow-up. Qualitative responses were generally consistent with these scores. Significant improvements were found between the scores before camp and at the three-month follow-up for both the SWAP and PSQ. These results indicate that the burn camp may help to improve young people's satisfaction with their appearance and concerns about social situations. However, there was no comparison group and there was a significant loss of participants at follow-up. CONCLUSION Burn camps may therefore offer a range of psychosocial benefits to young people with burn injuries. This was the first evaluation to demonstrate a positive impact of a burn camp on satisfaction with appearance and concerns about social situations using outcome measures validated with the burns population.
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Affiliation(s)
- Laura Armstrong-James
- Centre for Appearance Research, Faculty of Health & Applied Science, University of the West of England, Coldharbour Lane, Bristol, UK
| | - Julia Cadogan
- Children’s Burns Research Centre, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health & Applied Science, University of the West of England, Coldharbour Lane, Bristol, UK
| | - Nichola Rumsey
- Centre for Appearance Research, Faculty of Health & Applied Science, University of the West of England, Coldharbour Lane, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health & Applied Science, University of the West of England, Coldharbour Lane, Bristol, UK
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Green E, Cadogan J, Harcourt D. A qualitative study of health professionals' views on using iPads to facilitate distraction during paediatric burn dressing changes. Scars Burn Heal 2018; 4:2059513118764878. [PMID: 30627440 PMCID: PMC6305946 DOI: 10.1177/2059513118764878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Distraction is a non-pharmacologic pain management technique commonly used to avert a person's attention from procedural pain and distress during stressful procedures such as treatment after a burn injury. In recent years, computer tablets (such as iPads) have been used within paediatric burns services to facilitate distraction by way of apps, games, cartoons and videos during dressing changes. However, we know very little about health professionals' experiences of using them in this context. METHODS The current study explored health professionals' experiences of using iPads to facilitate distraction during paediatric burn dressing changes. Fifteen health professionals from a single paediatric burns unit were interviewed. Thematic analysis revealed two key themes: (1) the iPad is a universal panacea for distraction; and (2) trials and tribulations. DISCUSSION Participants considered iPads to be potentially useful and effective distraction tools, suitable for use with a wide range of patients with burn injuries including young children, adolescents and young adults. However, issues including health professionals' understandings of one another's roles, the challenge of working in a busy burns service, and lack of experience and confidence were identified as possible barriers to their use within routine burn care. Training for staff on the use of iPads as a means of facilitating distraction, development of guidelines and a review of how they are incorporated into routine burn care are recommended.
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Affiliation(s)
- Elizabeth Green
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Julia Cadogan
- Bristol Royal Hospital for Children, Bristol, UK
- The Scar Free Foundation Centre for Children’s Burns Research, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
- The Scar Free Foundation Centre for Children’s Burns Research, Bristol, UK
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