Blending Behavioural Theory and Narrative Analysis to Explore the Lived Experience of Obesity and Assess Potential Engagement in a UK Weight Management Service: Theory and Narrative Approaches in Weight Management

BACKGROUND

Current treatments for people with obesity emphasise the need for person-centred approaches that consider complex biopsychosocial factors and value the lived experience of people when attempting to lose weight.

METHODS

Narrative interviews (n = 20) were conducted with people living with obesity to explore the causes of their weight gain and their expectations and engagement with treatment at a Weight Management Clinic. A mixed inductive and deductive qualitative analysis identified utterances that represented psychological constructs used to understand self-appraisal and health behaviour. A narrative analysis was used to situate these findings in the context of a participant's life story.

RESULTS

Locus of control was a dominant construct evidenced through a person's attributional style and self-efficacy. Transcripts represented a heightened sense of self-understanding and shifts in control, and styles of attribution and efficacy resulted in either stasis or self-actualisation. The Stages of Change model could be applied to narratives to ascertain a patient's motivation to access treatment. Importantly, narrative interviews also allowed for the consideration of how a person's systemic context influenced their weight.

CONCLUSION

Narrative interaction supports both self- and shared understandings of the causes and consequences of obesity for individuals, in a non-blaming or shaming manner. It provides an opportunity to enhance engagement through tailored, person-centred treatments.

Narrative Elicitation as Ethnography: Methodological Insights From the Examination of Children's Perspective Marking in Amdo Tibetan

This paper employs a case study with Amdo Tibetan children to demonstrate the benefits of narrative elicitation for ethnographic language socialization research in under-studied languages. Primarily by examining spontaneous verbal interaction, existing language socialization research has demonstrated how salient grammatical resources shape children's understanding of cultural belief systems pertaining to sociality and the appropriate display of emotion. However, spontaneous data do not always capture children's full linguistic repertoires and competencies, and may therefore present a partial picture of their mastery over particular grammatical systems. One such area that remains to be studied is how children use interactional cues to build their emerging knowledge of grammatical perspective marking in Tibetan languages. This paper integrates narrative elicitation with ethnographic methods from language socialization to examine how Amdo Tibetan children mark perspective using evidentiality, the grammatically-obligatory encoding of knowledge source, an area not frequently documented in language socialization studies. Language socialization research involved 15-months of participant observation, audio-video recording, and analysis of spontaneous interactions with children aged 1–4. This ethnographic research found that adults' narratives highlighted local theories about the importance of compassion (Tib. snying rje) by using grammatical evidentiality to emphasize characters' direct experiences in the story-world. However, grammatical evidentiality was under-represented in children's spontaneous talk. To provide further insight into children's mastery of evidentiality in this culturally salient communicative genre, I conducted narrative elicitation tasks with seven Amdo Tibetan children, aged 2–7. By framing narrative elicitation tasks as forums for social interaction in family homes, I adapted a method traditionally used in experimentation to complement the study of naturalistic interaction. Interaction analysis of the elicited narratives found that family members positioned young children as novice narrators, leading to dialogic rather than monologic narratives. Young children co-constructed shared perspectives on narrated events, and used evidentiality in conventionalized ways by mirroring the grammatical forms of adults' previous utterances. By adapting narrative elicitation tasks to language socialization's ethnographic methods, this paper models how qualitative researchers can locate patterns in children's experiences of language across complementary settings of data collection, an endeavor that is particularly important to research with child speakers of under-documented languages.

Epistemic injustices in clinical communication: the example of narrative elicitation in person-centred care

The increasing popularity of the term 'person-centred' in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person-centred care. Initiating clinical communication by inviting people to tell their stories makes persistent yet often subtle problems in clinical communication visible. By drawing upon an observational study on narrative elicitation and vignette-based focus group interviews with nurses, our aim is to trace 'credibility deficits' (Fricker 2007. Epistemic Injustice. Power and the Ethics of Knowing. Oxford: Oxford University Press) and 'credibility excesses' (Medina 2011, Social Epistemology, 25, 1, 15-35, 2013, The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and the Social Imagination. Oxford: Oxford University Press) in narrative elicitation. We argue that narrative elicitation may be one way to tackle epistemic injustices by giving voice to previously silenced groups, yet it is not enough to erase the effects of 'credibility deficits' in clinical communication. Rather than judging individual professionals' success or failure in eliciting narratives, we underline some extrinsic problems of narrative elicitation, namely structural and positional inequalities reflecting on narrative elicitation and the credibility of patients. 'Credibility excesses' can be useful and indicative to better understand where they are missing.

The potential and pitfalls of narrative elicitation in person-centred care

BACKGROUND

Revitalized interest in narrative has informed some recent models of patient and person-centred care. Yet, scarce attention has been paid to how narrative elicitation is actually used in person-centred care practice and in which ways it is incorporated into clinical routine.

AIM

We aimed to identify facilitators and barriers for narrative elicitation and setting goals in a particular example of person-centred care practice (University of Gothenburg Centre for Person-centred Care, GPCC) where narrative elicitation is considered as a method of setting goals for the patient.

METHODS

Observation of 14 admission interviews including narrative elicitation on an internal medicine ward in Sweden where person-centred care was implemented. Five focus group vignette-based interviews with nurses (n = 53) were conducted to assess confirmation of the emerging themes.

RESULTS

The inductive analysis resulted in three themes about the strategies to elicit patients' narratives: (a) Preparing for narrative elicitation, (b) Lingering in the patient's narrative, and (c) Co-creating, that is, the practitioner's and third parties' engagement in the patient's narration. Even though there were obstacles to eliciting narratives and setting lifeworld goals in a medical setting, narrative elicitation was often useful to turn general and medical goals into more specific and personal goals.

CONCLUSIONS

Narrative elicitation is neither a simple transition from traditional medical history taking nor a type of structured interview. It entails skills and strategies to be practiced. On the one hand, it revitalizes ethical considerations about clinical relationship building. On the other hand, it can help patients articulate lifeworld goals that are meaningful and important for themselves.