Stigma and Stigma Resilience: Role of the Undergraduate and the Campus Environment

RATIONALE

Stigma permeates disability experiences and compounds disability-related challenges.

OBJECTIVE

Identify individual and environmental factors of stigmatizing experiences of college students with learning disabilities (LDs) and attention-deficit/hyperactivity disorder (ADHD).

METHODOLOGY

A qualitative descriptive design was used with a thematic analysis of 30 transcripts from group discussions among four cohorts of undergraduates with LD/ADHD (N = 52). The Person-Environment-Occupation-Performance Model was used in interpreting the stigmatizing experiences.

FINDINGS

The themes Perceived Misconceptions and Stigmatizing Actions describe key social-environmental factors. The theme Overcoming Stigmatizing Experiences elucidates key skills and processes for developing stigma resilience. These skills and processes were anchored in self-awareness and personally contextualized understanding of disability-related challenges and strengths, which were fostered during positive interactions with supportive others, such as instructors and mentors.

IMPLICATIONS

Findings illustrate the biopsychosocial nature of stigma and highlight the role of individual and social-environmental factors in building stigma resilience among young adults with LD/ADHD.

Psychosocial factors contributing to value creation in value-based healthcare: a scoping review

Background

Healthcare systems constantly evolve to improve care quality and resource utilization. One way is implementing Value-Based Healthcare (VBHC) an economic approach. This scoping review aims to identify and describe the literature on VBHC, particularly its psychosocial aspects, to uncover research gaps.

Method

The review followed the PRISMA guidelines for Scoping Reviews. We took the following 14 steps: (a) defining the research question; (b) identifying relevant studies; (c) selecting studies; (d) 15 mapping data; (e) collecting, synthesizing and reporting results. A detailed Boolean search was conducted from January 2021 to August 31, 2021, across APA PsycINFO and PubMed databases using keywords such as "Value-Based Healthcare" and "psychosocial perspective." Initially, three reviewers screened 70 e-records independently, assessing titles, abstracts, and full-text against the inclusion criteria. Discrepancies regarding the evaluation of the articles were resolved through consensus sessions between the reviewers.

Results

The final review included 14 relevant e-records in English from peer-reviewed sources, focusing on quantitative and qualitative research. From the analysis, four areas emerged: (1) Value chains in Healthcare; (2) Styles, activities, and practices of value co-creation in Healthcare; (3) Value co-creation in the encounter process; (4) Value co-creation in preventive health services.

Conclusion

The scoping review findings suggest several potential key aspects, including the interdependence between patients and healthcare organizations, organizational culture in healthcare, and the role of patient-centered approaches that focus on relationships, communication, and social support in healthcare. This can be achieved through patient engagement, patient-centered care and communication, health literacy, psychosocial support services, comprehensive psychosocial assessments, care coordination, and continuity of care. Integrating psychosocial elements in VHBC enhances quality and optimizes resource use. Findings highlight the need to develop practical guidance on how to implement a culture of value in care that takes into account the psychosocial aspects that have emerged, but not fully addressed. The pandemic teaches that the workforce poorly receives sudden and unsystematic changes. This review could provide an initial basis for the redesign of value in healthcare and a paradigm shift that has already begun with patient-centered medicine and patient engagement.

Value of Care: An Exploratory Qualitative Study with Doctors and Patients

The concept of value in healthcare is mainly based on economic and financial aspects. However, the literature has emphasised the need to investigate value from other perspectives. The present study aimed to explore the views of physicians and patients on the value of healthcare, and to examine in depth the psychosocial and organisational elements that have emerged but that need to be investigated more. Therefore, two qualitative studies were performed, in which 69 physicians and 111 patients participated. The data were analysed using content analysis and text mining using t-lab software. The results revealed common elements between the two healthcare actors that constitute value in healthcare, including competence, professionalism, and soft skills like communication and empathy. Furthermore, the importance of functioning health services and effective organisational culture in local healthcare and investment emerged. These findings can guide healthcare organisations to consider the potential psychosocial factors related to value in healthcare, which affect organisation in terms of costs and healthcare relationships. In addition, these findings are a first step in filling the gap found in the literature regarding the consideration of value from a non-economic perspective and the difficulty of defining and measuring it.

Self-Efficacy for Managing Injury After Distal Radius Fracture: A Mixed Methods Exploration

Self-efficacy for managing injury may contribute to variation in clients' support needs after distal radius fracture (DRF). This study aimed to (a) explore associations between self-efficacy for managing injury and self-reported health and (b) compare qualitative descriptions of the self-management process and outcome between high and low self-efficacy groups. In this cross-sectional convergent mixed methods study, 31 adults aged 45 to 72 with a unilateral DRF completed patient-reported outcome measures and a semi-structured interview 2 to 4 weeks after discontinuing full-time wrist immobilization. Higher self-efficacy was moderately associated with better physical, mental, and social health. The High-Self-Efficacy group described self-directed behaviors to manage injury sequelae and more confidence in their ability to use their injured hand. They also described less disruptive physical and emotional symptoms and fewer participation restrictions compared with the Low-Self-Efficacy group. Findings suggest that occupational therapy practitioners should assess and address self-efficacy for managing DRF sequelae to support recovery.

Preferred Content in Occupational Therapy-Based Weight Loss Interventions: A Survey

Despite decades of attempts from doctors and dietitians to break the obesity curve, obesity rates are increasing in Denmark. To counteract this, municipal occupational therapy-based interventions are in development as part of the Danish Obesity Intervention Trial (DO: IT). The objective was to survey Danish adults on preferred content in an occupational therapy municipal weight loss intervention and determine if preferences differed by gender and age. A 21-item questionnaire was developed to explore preferences related to diet, physical activity, occupational balance, habits, and social relations. In all, 429 respondents were included. Chi-square statistics were performed to determine if preferences differed by gender and age. A total of 15 of the 21 items indicated gender-based differences in preferences. Two items indicated age-based differences. Notably, compared to men, women indicated significantly more interest in content relating to habit formation and occupational balance. Gender-based differences should be considered when developing a weight loss intervention.

Mass Media Beauty Standards, Body Surveillance, and Relationship Satisfaction within Romantic Couples

As part of objectification processes, individuals engage in body surveillance, whereby they constantly assess the extent to which their external appearance conforms to culturally valued ideals. Mass media play a key role in fostering the objectification and internalization of media beauty standards and increases body surveillance. At the individual level, the literature has largely demonstrated that body surveillance leads to a variety of negative psychological outcomes, but little research has focused on the consequences of body surveillance in the context of romantic relationships. Using dyadic data from couples who identified as heterosexual, the present study examined relations among internalization of media standards, body surveillance, surveillance of the partner’s body, surveillance from the partner, and relationship satisfaction. There were 438 participants (219 couples) recruited using snowball sampling. They were surveyed with an anonymous online questionnaire. Results showed that internalization of media standards was related to body surveillance in both men and women, and to surveillance of the partner’s body and relationship satisfaction in men only. For both sexes, surveillance of the partner’s body was negatively associated with relationship satisfaction. For women only, surveillance from the partner was also negatively related to relationship satisfaction. Implications are discussed.

Are stress-related pathways of social status differentiation more important determinants of health inequities in countries with higher levels of income inequality?

We explored socioeconomic gradients in self-rated overall health (SROH) using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial perspectives (subjective social status (SSS)) among adults living in countries with varying levels of income inequality, and the importance of psychosocial stress in mediating these associations. If psychosocial processes at the individual and societal levels correspond, associations between SSS and SROH should be higher among adults in countries with higher income inequality, and psychosocial stress should be a more important mediator of these associations. We used multigroup structural equation models to analyse cross-sectional data from the International Food Policy Study of adults (n = 22,824) in Australia, Canada, Mexico, the UK and the United States. Associations between SSS and SROH were not higher in more unequal countries, nor was psychosocial stress a more important mediator of these associations. Inequities in SROH in more unequal countries may not predominantly reflect stress-related pathways of social status differentiation.

What children and young people learn about ADHD from youth information books: A text analysis of nine books on ADHD available in Dutch

Attention Deficit Hyperactivity Disorder (ADHD) is not a singular concept. For the purposes of this study, understandings of ADHD are assumed also to spread along a conceptual dimension that includes some combination of biomedical and psychosocial knowledge. Biomedically, ADHD may be considered a somatic affliction causing inattention and hyperactivity, amenable to pharmaceutical treatment. Psychosocially, ADHD ranks among adverse behaviour patterns that are amenable to psychosocial and pedagogical intervention. Considering both biomedical and psychosocial factors are associated with the ADHD construct, it seems self-evident that young people should be offered information that gives equal consideration to both ways of addressing ADHD, but the question is just how balanced the information available to young people is. This study investigated nine information books on ADHD available in the Netherlands in Dutch, aimed at children and young people up to age 17. Thirteen perspective-dependent text elements were identified in qualitative content analysis. Eight attributes associate with a biomedical view: ADHD as cause, biological factors, clinical diagnosis, brain abnormality, medication, neurofeedback, heritability and persistence. Five text elements associate with a psychosocial view: ADHD as perceived behaviour, environmental factors, descriptive diagnosis, behavioural intervention and normalisation. The most frequent text passages encountered describe ADHD as a brain abnormality, along with medical and behavioural treatment. Providing the main focus for information in eight out of nine books, biomedical information about ADHD predominates in the available youth information books, while psychosocial information about ADHD is far less well covered.

Health-related quality of life and its correlates in Japanese patients with myotonic dystrophy type 1

PURPOSE

Myotonic dystrophy type 1 (DM1) is a common form of muscular dystrophy that presents with a variety of symptoms that can affect patients' quality of life (QoL). Despite the importance of clarifying patients' subjective experience in both physical and psychosocial aspects for improved symptom management, there is lack of evidence concerning QoL of patients with DM1 in Japan.

PATIENTS AND METHODS

A cross-sectional study was performed with 51 DM1 patients who completed questionnaires that measured health-related QoL (HRQoL), depression, and daytime sleepiness. Activities of daily living, body mass index (BMI), and genetic information were also collected, together with general demographic information. Correlation analyses using these variables were performed. Furthermore, regression analysis was utilized to assess the relationship that HRQoL, depression, and daytime sleepiness scores have with other variables.

RESULTS

Physical component summary (PCS) score was affected by the disease more than the mental component summary (MCS) score among study participants. Moderate correlation was observed between PCS and depression, PCS and Barthel index, and depression and daytime sleepiness. Regression analysis revealed that age, sex, cytosine-thymine-guanine repeats, and BMI did not predict the aforementioned dependent variables.

CONCLUSION

DM1 symptoms influenced physical component scores more than mental component scores, although the state of physical wellness seemed to affect patients' mood. Explaining the QoL of these patients only using biologic and genetic characteristics was not sufficient. We conclude that social and psychological aspects of these patients' lives and the nature of adjustments made by patients due to DM1 to require further examination in order to improve the standard of care.

Lived experience of Silver-Russell syndrome: implications for management during childhood and into adulthood

OBJECTIVE

There is limited information on the psychosocial impact of growing up with Silver-Russell syndrome (SRS), characterised by slow growth in utero leading to short stature in adulthood. Such information could aid families in making difficult treatment decisions and guide management strategies for health professionals. We aimed to explore the lived experience of people with SRS across the lifespan.

DESIGN/SETTING/PATIENTS

In-depth, semi-structured interviews were conducted between January 2015 and October 2016 with a sample of 15 adults (six women) with genetically confirmed SRS from the UK. Qualitative interviews were transcribed and coded to identify similarities and differences: codes were then grouped to form overarching themes.

RESULTS

Four themes were identified from participant accounts: (1) appearance-related concerns extending beyond height; (2) strategies to deal with real and perceived threats; (3) women's experiences of pain, disability and feeling older than their years; and (4) feeling overlooked in romantic relationships. These themes show that other factors, beyond short stature, affect patient well-being and indicate a mismatch between patient need and healthcare provision.

CONCLUSIONS

Challenges in SRS during childhood and adolescence were central to the psychosocial impact of SRS, and were not limited to height. These challenges, as well as symptoms such as pain and fatigue for women, have not previously been documented. To help individuals with SRS develop strategies to manage psychosocial issues, we recommend clinicians incorporate psychological services as an integral part of multidisciplinary teams managing individuals with SRS during childhood, adolescence and adulthood.

Giving less importance to pain and focusing on achieving objectives

Giving less importance to pain and focusing on achieving objectives in accordance with values can help people to live their lives in spite of the pain. We present a rationale for this orientation and several techniques that can help people achieve this. Specifically, we present the importance of starting the intervention by educating people about pain and setting objectives in line with each person's personal values. After that, we present some techniques that can help people deal with triggers and barriers that can make it difficult to stay on track when it comes to giving less importance to pain and more to achieving objectives.

"The margin for error": Ritual coping with cultural pressures

Meritocratic sport cultures, media attention, coaches' ambitions, and "enthused" parents create stress and make coping pivotal for athletes' performance. A transdisciplinary dialogue between a sports-sociologist and a sport-psychologist manifests ritual practices in athletes' lived sport experiences as coping strategies. Based on two empirical strands, field observations of boy's handball and interviews with elite male wrestlers', analysis of pregame routines scrutinize psychosocial dimensions of athletes' ritual practice. The implications of ritual meaning making are investigated as a means to cope with sport specific sociocultural anxieties. Rituals are interpreted as psychosocial processes applied to construct perceived order and comfort in stressful sport milieus. We contend that it is reasonable to believe that successful coping is not solely because of athletes' psychological competencies and experiences, but also their ability to ritually use culture in meaningful ways. To manifest important contextual aspects of athletes' lived sport experiences, to nurture task-oriented sport milieus, and to create change in sport and physical cultural contexts, we consequently suggest that the cultural meanings applied in ritual should be an important aspect to address.