Women's use of online health and social media resources to make sense of their polycystic ovary syndrome (PCOS) diagnosis: a qualitative study

BACKGROUND

With the growing availability of online health resources and the widespread use of social media to better understand health conditions, people are increasingly making sense of and managing their health conditions using resources beyond their health professionals and personal networks. However, where the condition is complex and poorly understood, this can involve extensive "patient work" to locate, interpret and test the information available. The overall purpose of this study was to investigate how women with polycystic ovary syndrome (PCOS) across two healthcare systems engage with online health resources and social media to better understand this complex and poorly understood lifelong endocrine disorder.

METHODS

A semi-structured interview study was conducted with women from the US ( N = 8 ) and UK ( N = 7 ) who had been diagnosed with PCOS within the previous five years. Transcribed data was analysed using a reflexive thematic analysis method.

RESULTS

We highlight the information needs and information-seeking strategies women use to make sense of how PCOS affects them, to gain emotional support, and to help them find an effective treatment. We also show how women with PCOS use online health and social media resources to compare themselves to women they view as "normal" and other women with PCOS, to find their sense of "normal for me" along a spectrum of this disorder.

CONCLUSION

We draw on previous models of sense-making and finding normal for other complex and sensitive health conditions to capture the nuances of making sense of PCOS. We also discuss implications for the design and use of social media to support people managing PCOS.

Family caregivers' sense-making of the results of functional neurodiagnostics for patients with Prolonged Disorders of Consciousness

Functional neuroimaging and electrophysiological assessments can identify evidence of residual consciousness and cognition in patients with prolonged disorders of consciousness (PDOC) who are otherwise behaviourally unresponsive. These functional neurodiagnostics are increasingly available in clinical settings and are recommended by international clinical guidelines to reduce diagnostic and prognostic uncertainty, and thereby assist family caregivers in their best-interests decision-making. Nevertheless, little is known about how family caregivers make sense of the results of these state-of-the-art functional neurodiagnostics. By applying Interpretative Phenomenological Analysis (IPA) to interviews with family caregivers of patients with diagnoses of PDOC who had received a functional neurodiagnostic assessment, we identify three primary themes of sense-making: The special significance of "brain scans"; A dynamic sense-making process; Holding on to hope and holding on to the person. These themes highlight the challenges of helping family caregivers to balance the relative importance of functional neurodiagnostic results with other clinical assessments and identify an ability of family caregivers to hold a contradiction in which they hope for recovery but simultaneously express a rational understanding of evidence to the contrary. We offer several recommendations for the ways in which family caregivers can be better supported to make sense of the results of functional neurodiagnostics.

Diaries as Technologies for Sense-making and Self-transformation in Times of Vulnerability

Diaries have been generally understood as "windows" on sense-making processes when studying life ruptures. In this article, we draw on Michel Foucault's conceptualization of self-writing as a "technology of the self" and on sociocultural psychology to propose that diaries are not "windows" but technologies that aid in the sense-making. Concretely, we analyzed three non-exhaustive and non-exclusive uses of diary writing in times of vulnerability: (1) imagination of the future and preparation to encounter difficulties; (2) distancing from one's own experience; and (3) creating personal commitments. Our longitudinal data comprised three public online diaries written over more than twenty years, belonging to three anonymous individuals selected from a database of more than 400 diaries. We analyzed these three diaries by iterating between qualitative and quantitative analysis. We conclude that: (1) beyond their expressive dimension, diaries are technologies that support the sense-making process, but not without difficulties; (2) diaries form a self-generated space for dialogue with oneself in which the diarist also becomes aware of the social nature of her life story; (3) diaries are not only technologies for the Socratic "know thyself" but also technologies to work on oneself, especially in terms of the personal perspective on the past or the future; and (4) the practice of diary writing goes beyond sense-making towards personal development and the desire to transform one's life trajectory.

Motive on the mind: Explanatory preferences at multiple stages of the legal-investigative process

Much work has investigated explanatory preferences for things like animals and artifacts, but how do explanation preferences manifest in everyday life? Here, we focus on the criminal justice system as a case study. In this domain, outcomes critically depend on how actors in the system (e.g., lawyers, jurors) generate and interpret explanations. We investigate lay preferences for two difference classes of information: information that appeals to opportunistic aspects of a crime (i.e., how the culprit could have committed the crime) vs. motivational aspects of that crime (i.e., the purpose for committing the crime). In two studies, we demonstrate that people prefer 'motive' accounts of crimes (analogous to a teleology preference) at different stages of the investigative process. In an additional two studies we demonstrate that these preferences are context-sensitive: namely, we find that 'motive' information tends to be more incriminating and less exculpatory. We discuss these findings in light of a broad literature on the cognitive basis of explanatory preferences; specifically, we draw analogy to preferences for teleological vs. mechanistic explanations. We also discuss implications for the criminal justice system.

Question Design Affects Students' Sense-Making on Mathematics Word Problems

Mathematics word problems provide students with an opportunity to apply what they are learning in their mathematics classes to the world around them. However, students often neglect their knowledge of the world and provide nonsensical responses (e.g., they may answer that a school needs 12.5 buses for a field trip). This study examined if the question design of word problems affects students' mindset in ways that affect subsequent sense-making. The hypothesis was that rewriting standard word problems to introduce inherent uncertainty about the result would be beneficial to student performance and sense-making because it requires students to reason explicitly about the context described in the problem. Middle school students (N = 229) were randomly assigned to one of three conditions. In the standard textbook condition, students solved a set of six word problems taken from current textbooks. In the modified yes/no condition, students solved the same six problems rewritten so the solution helped answer a "yes" or "no" question. In the disfluency control condition, students solved the standard problems each rewritten in a variety of fonts to make them look unusual. After solving the six problems in their assigned condition, all students solved the same three "problematic" problems designed to assess sense-making. Contrary to predictions, results showed that students in the modified yes/no condition solved the fewest problems correctly in their assigned condition problem set. However, consistent with predictions, they subsequently demonstrated more sense-making on the three problematic problems. Results suggest that standard textbook word problems may be able to be rewritten in ways that mitigate a "senseless" mindset.

Response to a sexual risk reduction intervention provided in combination with hepatitis C treatment by HIV/HCV co-infected men who have sex with men: a reflexive thematic analysis

BACKGROUND

Hepatitis C virus reinfections in HIV-positive men-who-have-sex-with-men (MSM) challenge the effectiveness of antiviral treatment. To fight this problem, an adapted sexual risk reduction intervention was implemented within a hepatitis C treatment trial. Following this, the current study had two aims and describes 1) how the program was received by participants; and 2) their responses to the program regarding sexual risk taking. Based on the participants' input, we hoped to judge the intervention's potential for scale-up.

METHODS

Seventeen participants who received the sexual risk reduction intervention in addition to hepatitis C treatment were recruited for semi-structured interviews six to 12 months post-intervention. We evaluated the responses via reflexive thematic analysis and applied the concept of sense-making.

RESULTS

Giving hepatitis C a place and living without it again illustrates how participants received the program and how their experiences were altered by the impact of sense-making. Based on their responses, we allocated participants to three groups: 1. Avoid risks: get rid of hepatitis C for life. For these men, hepatitis C remained a life-threatening disease: they actively modified their risk behavior and felt supported by the intervention in maintaining their behavioral changes. 2. Minimize risks: live as long as possible without hepatitis C. In contrast to group 1, these men saw hepatitis C as a manageable disease. The intervention facilitated reflection on risks and how to develop behavioral changes that suited them individually. 3. Accept risks; live with the risk of hepatitis C. These men perceived behavioral changes as much more difficult than "easy" medical treatment. They expected to either undergo repeated rounds of treatment or stay HCV re-infected.

CONCLUSION

These results illustrate the diversity of men's responses and their decisions regarding sexual risk behavior after participating in a combination of antiviral treatment and a sexual risk reduction intervention. Two major aspects were identified: 1) Teachable moments, particularly at the time of diagnosis/treatment, could offer an opportunity to develop openness for behavioral change; 2) adapting sexual risk reduction interventions to sense-making patterns could help to improve its effectiveness. Support for reducing infection risk and raising awareness of preventative measures are additional benefits.

TRIAL REGISTRATION

Clinical Trial Number: NCT02785666 , 30.05.2016.

The relevance of a sociocultural perspective for understanding learning and development in older age

This paper proposes a sociocultural psychology approach to ageing in the lifecourse. It proposes to consider sociogenetic, microgenetic and ontogenetic transformations when studying older age. On this basis, it considers that older people's lives have two specificities: a longer life experience, and a unique view of historical transformation. The paper calls for a closer understanding of the specific and evolving conditions of ageing, and for more inclusion of older citizens in public debate and policy making.

Beyond the Meaning Given. The Meaning as Explanandum

The paper starts from the recognition of Bruner's contribution to the development of psychological science. It is claimed here that to proceed in that direction requires the building of an analytical notion of meaning. This analytical notion should distinguish between meaning-making and sensemaking, namely between the processes of elaboration and use of meaning (meaning-making) and the processes that makes the meaning emerge to be lived as psychological reality (sense-making). In order to discuss this distinction, two main issues are addressed - the limit of the hypostatized view of meaning and the dynamics of presentification through which meaning is endowed with value of life. These two issues are complementary - together they push psychology to search for a theoretical and methodological framework where meaning can be investigated as an emergent psychological phenomenon, and not only taken for granted as a premise.

A conceptual model of urgent care sense-making and help-seeking: a qualitative interview study of urgent care users in England

Background

Theoretical models have sought to comprehend and conceptualise how people seek help from health professionals but it is unclear if such models apply to urgent care. Much previous research does not explain the complex interactions that influence how people make sense of urgent care and how this shapes service use. This paper aims to conceptualise the complexity of sense-making and help-seeking behaviour in peoples’ everyday evaluations of when and how to access modern urgent care provision.

Methods

This study comprised longitudinal semi-structured interviews undertaken in the South of England. We purposively sampled participants 75+, 18–26 years, and from East/Central Europe (sub-sample of 41 received a second interview at + 6–12 months). Framework analysis was thematic and comparative.

Results

The amount and nature of the effort (work) undertaken to make sense of urgent care was an overarching theme of the analysis. We distinguished three distinct types of work: illness work, moral work and navigation work. These take place at an individual level but are also shared or delegated across social networks and shaped by social context and time. We have developed a conceptual model that shows how people make sense of urgent care through work which then influences help-seeking decisions and action.

Conclusions

There are important intersections between individual work and their social networks, further shaped by social context and time, to influence help-seeking. Recognising different, hidden or additional work for some groups may help design and configure services to support patient work in understanding and navigating urgent care.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4332-6) contains supplementary material, which is available to authorized users.

Conceptual frameworks for the workplace change adoption process: elements integration from decision making and learning cycle process

Sound workplace ergonomics and safety-related interventions may be resisted by employees, and this may be detrimental to multiple stakeholders. Understanding fundamental aspects of decision-making, behavioural change, and learning cycles may provide insights into pathways influencing employees' acceptance of interventions. This manuscript reviews published literature on thinking processes and other topics relevant to decision making and incorporates the findings into two new conceptual frameworks of the workplace change adoption process. Such frameworks are useful for thinking about adoption in different ways and testing changes to traditional intervention implementation processes. Moving forward, it is recommended that future research focuses on systematic exploration of implementation process activities that integrate principles from the research literature on sense-making, decision-making, and learning processes. Such exploration may provide the groundwork for development of specific implementation strategies that are theoretically grounded and provide a revised understanding of how successful intervention adoption processes work. Practitioner summary: Adoption and acceptance of workplace changes may be facilitated through sound implementation strategies. This manuscript explores several principles of sense-making and decision-making processes that can potentially be used by industrial practitioners to inform the design and development of implementation strategies for interventions that improve workplace ergonomics and safety.

ABBREVIATIONS

 Musculoskeletal Disorders (MSDs); National Institute for Occupational Safety and Health (NIOSH); National Occupational Research Agenda (NORA); Health and Safety Executive (HSE).

Exploring reasoning mechanisms in ward rounds: a critical realist multiple case study

BACKGROUND

Ward rounds are an important and ubiquitous element of hospital care with a history extending well over a century. Although originally intended as a means of educating medical trainees and junior doctors, over time they have become focused on supporting clinical practice. Surprisingly, given their ubiquity and importance, they are under-researched and inadequately understood. This study aims to contribute knowledge in human reasoning within medical teams, meeting a pressing need for research concerning the reasoning occurring in rounds.

METHODS

The research reported here aimed to improve the understanding of ward round reasoning by conducting a critical realist case study exploring the collaborative group reasoning mechanisms in the ward rounds of two hospitals in Victoria, Australia. The data collection involved observing rounds, interviewing medical practitioners and holding focus group meetings.

RESULTS

Nine group reasoning mechanisms concerning sharing, agreeing and recording information in the categories of information accumulation, sense-making and decision-making were identified, together forming a program theory of ward round reasoning. In addition, themes spanning across mechanisms were identified, further explaining ward round reasoning and suggesting avenues for future exploration. Themes included the use of various criteria, tensions involving mechanisms, time factors, medical roles and hierarchies.

CONCLUSIONS

This paper contributes to the literature by representing rounds in a manner that strengthens understanding of the form of the group reasoning occurring within, thus supporting theory-based evaluation strategies, redesigned practices and training enhancements.

The role of pedagogical tools in active learning: a case for sense-making

BACKGROUND

Evidence from the research literature indicates that both audience response systems (ARS) and guided inquiry worksheets (GIW) can lead to greater student engagement, learning, and equity in the STEM classroom. We compare the use of these two tools in large enrollment STEM courses delivered in different contexts, one in biology and one in engineering. Typically, the research literature contains studies that compare student performance for a group where the given active learning tool is used to a control group where it is not used. While such studies are valuable, they do not necessarily provide thick descriptions that allow instructors to understand how to effectively use the tool in their instructional practice. Investigations on the intended student thinking processes using these tools are largely missing. In the present article, we fill this gap by foregrounding the intended student thinking and sense-making processes of such active learning tools by comparing their enactment in two large-enrollment courses in different contexts.

RESULTS

The instructors studied utilized each of the active learning tools differently. In the biology course, ARS questions were used mainly to "check in" with students and assess if they were correctly interpreting and understanding worksheet questions. The engineering course presented ARS questions that afforded students the opportunity to apply learned concepts to new scenarios towards improving students' conceptual understanding. In the biology course, the GIWs were primarily used in stand-alone activities, and most of the information necessary for students to answer the questions was contained within the worksheet in a context that aligned with a disciplinary model. In the engineering course, the instructor intended for students to reference their lecture notes and rely on their conceptual knowledge of fundamental principles from the previous ARS class session in order to successfully answer the GIW questions. However, while their specific implementation structures and practices differed, both instructors used these tools to build towards the same basic disciplinary thinking and sense-making processes of conceptual reasoning, quantitative reasoning, and metacognitive thinking.

CONCLUSIONS

This study led to four specific recommendations for post-secondary instructors seeking to integrate active learning tools into STEM courses.

How Families Make Sense of Their Child's Behaviour When on an Autism Assessment and Diagnosis Waiting List

Families waiting for an Autism Spectrum Condition assessment often experience difficulties explaining, or making sense of, the referred young person's behaviour. Little is known about this sense making, or how clinicians might support this ambiguity. This paper explored finite details of how five families do 'sense-making' in conversations with each other, while on the waiting list for an ASC assessment. A Discursive Psychology analysis of these conversations found that sense making was affected by (1) an interactional pattern of interruptions impeding the progress of sense making narratives; (2) face saving to maintain positive identities and shared understanding; and (3) difficulties in word finding within sense making narratives. These practices challenged the production of a coherent family sense making narrative.

Sexual stigma and symbolic violence experienced, enacted, and counteracted in young Africans' writing about same-sex attraction

There is growing recognition of the health disparities faced by sexual minority populations and the critical role played by sexual stigma in increasing their vulnerability. Experienced, anticipated, and internalized, stigma based on sexual orientation reduces access to HIV/STI prevention and treatment services among African men who have sex with men and has been linked to compromised mental health, risk-taking, and HIV status. It is likely that similar processes undermine the health of sexual minority African women and transgender and non-binary people. There is a need for increased understanding of both the contextual factors and the cultural meanings, or symbolic violence, that inform sexual stigma and harmful stigma management strategies in contexts that are culturally and socio-politically oppressive for sexual and gender minorities. Using thematic data analysis and narrative-based methodologies, we analyzed narratives and essays on same-sex attraction contributed by young people aged 13-24 from ten African countries to a Spring 2013 scriptwriting competition on HIV, sexuality, and related themes. Submitted by 27 male and 29 female authors, the texts were written in response to a prompt inviting participants to "Tell a story about someone who is attracted to people of the same sex". We analyzed the ways in which sexual stigma and its effects are described, enacted, and counteracted in the texts. The data provide insights into the social and symbolic processes that create and sustain sexual stigma in the context of broader transnational discourses. The data shed light on psychosocial challenges faced by sexual minority youth and identify both rhetoric, stereotypes, and discourse that devalue them and representations that counteract this symbolic violence. We share our findings in the hope they may inform education and communication programming as part of multi-level efforts to improve the health and human rights of sexual minority populations in sub-Saharan Africa.

Something Blossoms in Between: Silence-Phenomena as a Bordering Notions in Psychology

Mysterious yet unavoidable, silence-phenomena appear to us in inherent ambiguity. In its plurality of meanings, phenomena related to silence are often perceived as overwhelming because they transcend the communicative capacity of language making it a challenge for cultural psychology to understand its involvement in our processes of making sense of experience and existence. Human growth and development involve processes where presence, void and content, voice, sound and noise, motion, transition and stillness, have dialectic interactions. In this article I discuss silence-phenomena as a bordering notion in terms of its discursive quality, the silent quality of speech, and the awareness of the ineffable. In addition, I highlight the possible implications of such notion in the understanding of affect from the perspective of Semiotic Cultural Psychology. I also emphasize the importance of considering psychological borders as multi-dimensional, taking the phenomenological experience of temporality as an illustration, which is also related to high emotional involvement of attention.

Changing policy and practice: making sense of national guidelines for osteoarthritis

Understanding uptake of complex interventions is an increasingly prominent area of research. The interplay of macro (such as changing health policy), meso (re-organisation of professional work) and micro (rationalisation of clinical care) factors upon uptake of complex interventions has rarely been explored. This study focuses on how English General Practitioners and practice nurses make sense of a complex intervention for the management of osteoarthritis, using the macro-meso-micro contextual approach and Normalisation Process Theory (NPT), specifically the construct of coherence. It is embedded in a cluster RCT comprising four control practices and four intervention practices. In order to study sense-making by professionals introduction and planning meetings (N = 14) between researchers and the practices were observed. Three group interviews were carried out with 10 GPs and 5 practice nurses after they had received training in the intervention. Transcripts were thematically analysed before comparison with NPT constructs. We found that: first, most GPs and all nurses distinguished the intervention from current ways of working. Second, from the introduction meeting to the completion of the training the purpose of the intervention increased in clarity. Third, GPs varied in their understanding of their remit, while the practice nurses felt that the intervention builds on their holistic care approach. Fourth, the intervention was valued by practice nurses as it strengthened their expert status. GPs saw its value as work substitution, but felt that a positive conceptualisation of OA enhanced the consultation. When introducing new interventions in healthcare settings the interaction between macro, meso and micro factors, as well as the means of engaging new clinical practices and their sense-making by clinicians needs to be considered.