This submission presents a portfolio of 50 outputs (3 books, 7 book chapters and 40 journal articles) that were
published between 2000 - 2020. This accompanying narrative offers a frame for these outputs to place them in the
context of the wider literature and to highlight connections and developments in the underpinning thought
processes. Here I exploit the Deleuzian figuration of the rhizome to present the portfolio to emphasise the non
linear nature of this body of work and provide a novel conceptual framework for analysis.
This corpus emerged from my initial exploration of Novakian concept mapping as a tool to support and document
learning. From my early studies that built on the dominant discourse of the field, I examined concept mapping as
a study aid. From this my interests diverged into the visualisation of expertise and the implications of variation in
the structure of knowledge as depicted by students and as promoted in the curriculum.
I started to use concept mapping to explore educational theory and have combined the tool that is strongly linked
to its origins in educational psychology (particularly the work of David Ausubel) with other theoretical positions
that might inform teaching in higher education. These have included ideas from the sociology of education
(particularly the work of Basil Bernstein and Karl Maton); ideas from evolutionary Biology (Stephen Jay Gould’s
concept of exaptation); ideas from health sciences (particularly the work on Salutogenesis by Anton Antonovsky),
and the post-structuralist ideas of Gilles Deleuze (especially the concept of the rhizome). These ideas offer an
opportunity to revise and refresh the assumptions that underpinned Joe Novak’s work on concept mapping – that
might increase the level of criticality in continuing research.
This work raises questions about the methodological conservatism of the field of concept mapping (and perhaps
of higher education research more broadly). The observed methodological and conceptual conservatism of the
concept mapping literature is seen as a consequence of its linear (arborescent) development from science
education. Through this work, the reader can trace the development of the researcher from his roots in Biological
Sciences towards a greater appreciation of post-structuralist perspectives – challenging the conservatism
The purpose of this paper is to evaluate the impact on stress and work-related outcomes of an app-delivered mindfulness-based program (MBP; Headspace®) offered to employees in a UK higher education (HE) institution.
Using a randomized waitlist control trial design, participants were randomly allocated to be offered a mindfulness-based program (MBP) immediately for 2 months or after a waiting list period of 2 months (WLC). Data were analyzed using Intention to Treat (ITT; MBP n = 62; WLC n = 63); with supplementary analysis restricting to those who completed all measures; (MBP n = 45; WLC n = 56) and then further restricting the MBP group to those who completed at least foundation level 1 of the app; (MBP n = 31; WLC n = 56).
The ITT analysis showed significant increases in several aspects of mindfulness and a significant reduction in perceived stress but no significant effects for work-related outcomes. Analysis restricted to MBP participants who completed the app foundation course showed a similar pattern but in addition showed significant increases in work-life balance and the emotional aspect of job engagement.
The offer of the Headspace® app in the HE sector may result in reduced perceived stress. If improvements in work-related outcomes are also to be seen, then users need to be encouraged to complete a minimum level of practice.
Effect size estimates for stress and work-related outcomes of an app-delivered MBP contribute to the evolving picture of MBPs in the workplace.
Women with a family history of breast or ovarian cancers may be eligible for genetic testing to see if they have a genetic mutation that increases their risk of either disease. Two prevalent mutations increasing breast and ovarian cancer risks are BRCA1 and BRCA2. Women carrying a BRCA mutation may consider risk-reducing breast and or ovarian surgeries to reduce their risk of future disease. When faced with these decisions, women often turn to health professionals for support, but they also access their wider support network that includes partners, family and friends. Most previous research of these decisions has focused on the patient-doctor relationship. Understanding how social influences impact women’s decisions is integral to the effective support of those accessing genetic services. With four empirical studies using both qualitative and quantitative methods this thesis aimed to develop a greater understanding of the distal and proximal social influences on women’s decisions to have genetic testing and risk-reducing surgery. In Study 1, a content analysis was used to examine UK broadsheet and tabloid newspapers’ coverage of genetic testing and risk-reducing surgery. Four newspapers were coded, and the results showed that newspapers supported testing but were nuanced in their coverage of the value of surgery, with this discussion played out through coverage of celebrity experiences. The newspapers presented the decisions as primarily medical decisions taken by rational decision makers. Studies 2 and 3 then used a qualitative approach to examine the influence non-health professionals on decision makers’ testing and surgical decisions. Study 2 involved interviews with sixteen women and showed that familial influences, appealing to both rational and emotional decision-making processes, were common in women’s testing decision which many women saw as a minor decision compared to the decision to have surgery. Study 3 involved interviews with ten female BRCA carriers and showed that firstly, carriers valued peer experiences, and secondly, carriers’ self-concept influenced dual decision-making processes. In particular, the results from these studies found, firstly, that participants used both rational and emotional decision making but were more inclined to emotional decision making when they adopted a relational identity, such as sister, which anchored them to emotive familial cancer experiences. Secondly, participants valued the support of women who had experienced like surgery, support they perceived of as neutral and of having added value. This was often epitomised in a ‘show and tell’ event whereby women meet with other women who have been through similar experiences. This qualitative work therefore highlighted the role of both rational and emotional decision-making processes. It also emphasised the impact of peer support, specifically the ‘show and tell’ experience. To further examine the role of ‘show and tell’ in the decision-making process study 4, used a quantitative design to explore differences from before to after a ‘show and tell’ intervention. Due to recruitment problems this study used a retrospective quantitative design, and an online survey with 29 women. The results showed increases in participants’ intentions to have mastectomy after their show and tell experience and a reduction in decisional conflict. Overall, this thesis demonstrates that genetic testing and risk-reducing surgical decision making occurs, at the distal level, in a social environment generally positive to towards testing, where women are encouraged to be rational decision-makers. At the proximal level, decision makers are influenced by family and peers with shared cancer or decision-making experiences. The dual processes of rational and emotional decision-making are influenced by the decision makers’ individual and relational identities and this relationship between self-concept and dual process decision making is illustrated in the concluding model of this thesis.
Purpose: Prisons offer a public health opportunity to access a group with multiple and complex needs and return them to the community with improved health. However, prisons are not conducive to optimal health and there are few frameworks to guide efforts. This study aims to generate insights into health literacy across a young adult prison population, specifically examining the level of limitations, barriers and characteristics associated with these limitations.
Design/methodology/approach: The study took place in a single prison in England for young adult men aged 18–21 years old. A mixed-methods design was adopted with 104 young men completing a quantitative survey and qualitative semi-structured interviews with 37 young men.Findings72% (n = 75) of young men scored as limited in their health literacy. Barriers included structural restrictions, limited access to formal support and social and natural disruptions. No demographic characteristics or smoking intentions/behaviours predicted limited health literacy, but characteristics of the prison were predictive. Physical problems (sleep, nausea, tiredness and headaches), mental health and well-being (anxiety, depression and affect) and somatisation problems were also predictive of limitations.
Practical implications: Prison healthcare services and commissioners should undertake regular health literacy needs assessments to support developments in reducing barriers to healthcare and increasing health improvement efforts. Action also requires greater political will and investment to consider broader action on the wider determinants of (prison) health.
Originality/value:The study provides a framework to understand and guide prison health efforts and highlights attention needed at the level of governments, prison leaders and their health systems.
The recent rise in body dissatisfaction and weight bias has led to a call to the media to increase the diversity of their imagery, in efforts to challenge the thin-ideal. Therefore, this study aimed to evaluate the effects of both body diversity and thin-ideal interventions on health outcomes. Female participants (n = 160) were randomly allocated into an intervention group: body diversity; thin-ideal; control. They completed measures of body satisfaction, body compassion, internalisation of the thin-ideal, weight bias and behavioural intentions at baseline and post-intervention. The results showed significant differences between groups for weight bias and intentions to eat healthily. Specifically, those in the body diversity intervention group reported a greater reduction in weight bias compared to the other conditions. Further, those in the thin-ideal intervention group reported a greater increase in intentions to eat healthily compared to the other conditions. There were no differences between groups for body satisfaction, body compassion, internalisation of the thin-ideal and behavioural intentions to exercise and manage weight. In conclusion, exposure to body diversity images reduced weight bias whereas exposure to the thin-ideal promoted intentions towards healthy eating. These findings therefore offer empirical evidence for the impact of using different types of imagery to change different health outcomes.
Despite efforts, attempts to induce successful long term weight loss remain a problem in obesity research, with the majority of those who lose weight unable to control or sustain the loss. It is accepted that in order to bring about more successful approaches to weight management, it is vital to determine the psychosocial factors that underpin weight control capability. Previous research has demonstrated that successful weight maintainers and less successful overweight individuals display different patterns of weight control behaviours (1). The present study aims to explore weight control practices and help-seeking behaviours in an overweight sample from 8 European countries. Data were collected as part of the EU project DiOGenes – a pan-European project which aims to refine understanding of the individual genetic, dietary and behavioural factors influencing weight control, and how these factors interact. Participants of a pan-European dietary intervention trial (n ~ 700) completed a set of online questionnaires relating to their weight control practices and help-seeking behaviours before entering the trial such as use of antiobesity medication, commercial products and help from health professionals. Objective weight measurements were recorded at baseline as well as self-reported weight control history. The results of this investigation will be presented, focussing on inter country differences in weight control behaviours. Differences in weight control behaviours and baseline weight status and previous weight history will be explored.
Poor work privacy represents a frequently reported issue in open office environments,yet relatively little is known about its consequences. In addition, prior research has limitations including weak operationalisations and measures of privacy. Therefore, this thesis developed a new work privacy measure and examined the adverse effects of poor work privacy on workers’ well-being. The roles of coping appraisal and contextual factors in this relationship were explored to inform future preventative steps. Study 1 (n = 30) qualitatively explored different scenarios of poor work privacy in an open-plan office context for the development of a new measure of privacy fit. Three dimensions of poor work privacy have been identified: acoustical and visual stimulation,interruptions, and confidentiality. Study 2 quantitatively tested (2.A n = 195) and confirmed (2.B n = 109) the factor structure of the new privacy fit measure in two open-plan office worker samples. Four dimensions were identified: conversation confidentiality, task confidentiality, visual/acoustical stimulation, and interruptions. The measure concluded with 12 items, good model fit, reliability, and construct validity. Study 3 (n = 220) employed the newly developed measure and quantitatively examined stress-related consequences of poor privacy fit in an open-plan office worker sample. Poor privacy fit was associated with dissatisfaction, stress, and fatigue. Coping appraisal was found to mediate these relationships. Study 4 (n = 61) quantitatively demonstrated in a longitudinal study that a move to an activity-based office influenced workers’ privacy fit, coping appraisal, and stress-related outcomes (satisfaction, stress, and fatigue). Study 5 (n = 22) qualitatively explored contextual factors in the activity-based Office that support or hinder privacy fit. Four factors were identified: the physical environment (e.g. variety of settings) and the social environment (e.g. social norms), the job (e.g. role conflict), and the self (e.g. self-awareness). This thesis developed a new measure of work privacy and confirmed that privacy fit has an impact on workers’ well-being. The thesis demonstrated the methodological benefit of considering individuals’ appraisal, and the importance of contextual factors in privacy regulation.
Research indicates a role for attention in the perception of hunger and food intake. The present experimental study aimed to explore the impact of attention to food cues through either active or passive food preparation, versus attention away from food cues through a non-food distraction task on eating behaviour using a preload / taste test design. Female participants (n=80) were randomly allocated to one of four conditions: active food preparation (making a wrap); passive video preparation (watching video of researcher making a wrap); distraction (a non-food colouring task); no time control. Measures of desire to eat (hunger, fullness, motivation) were taken before and after the interventions. Food intake was measured in terms of mass of wrap consumed and snacks consumed at a subsequent taste test. The results showed greater wrap consumption for active and passive food preparation and the control groups compared to the distraction intervention. Further, the results showed that active food preparation resulted in increased hunger and motivation to eat and that passive food preparation resulted in increased motivation to eat. No changes were found following distraction. To conclude, attention to food cues through both active and passive food preparation can increase both food intake and the desire to eat. The implications for promoting changes in eating behaviour are discussed.
Two naturalistic experiments are reported exploring the impact of parental restriction on children's diets. For study 1, 53 parents gave 75. g of chocolate coins to their child over a weekend. For study 2, 86 parents were recruited prior to the 2. week Easter break when their children would be receiving chocolate Easter eggs. For both studies, parents were randomly allocated to either the non-restriction or restriction conditions and rated their child's preoccupation with the target food and other sweet foods (demanding and eating) at the start and end of the interventions. Perceived and actual food intake was assessed. Children in the restriction conditions consumed fewer chocolate coins and Easter eggs. All children showed decreased preoccupation with chocolate coins or Easter eggs over the course of the studies yet by the end the restriction group were more preoccupied with the target food. In contrast, all children showed an increased preoccupation with other sweet foods as the studies progressed which was greater in the non-restriction group for the chocolate coins study. Overall, restriction resulted in reduced intake but relative increased preoccupation with the food being restricted. Non-restriction resulted in a greater preoccupation with other sweet foods once the target foods had been consumed. © 2012.
Media images of stereotypically attractive women are often cited as contributory factors in body size distortion and body dissatisfaction. In fact, recent research suggests that acute exposure to such images may exacerbate body distortion in women with eating disorders. The present study examined the effects of acute exposure to images of stereotypical attraction (thin pictures) compared to images of overweight individuals (fat pictures) in both men and women. Twenty men and 20 women completed measures of body satisfaction before and after viewing images of either thin or overweight individuals matched for the subject's gender. The results suggested that subjects of both gender reported feeling less satisfied with their bodies as measured by rating scales (e.g. feeling fat, feeling attractive), body silhouettes and body size estimation, after viewing the thin pictures and showed improved body satisfaction after viewing the overweight pictures. The results also suggested that this response was greater in the female than in the male subjects for some of the measures (e.g. feeling fat, feeling toned) and was unrelated to levels of restrained eating. The results are discussed in terms of the role of the media in determining body image and the possible use of such images in clinical practice.
Examination marking is a cognitively demanding task. In England, examiners of formal, high stakes assessments are tasked with marking hundreds of scripts accurately and consistently within a short, intensive period of time. Despite assessment and marking practices having been the focus of research for many years, there is comparatively little research into the judgement and decision making processes used by examiners when marking high stakes examinations. This thesis adopted a cognitive psychological perspective to investigate the cognitive marking strategies used when marking A-level Psychology responses, with a focus on the marking of extended written responses which have been consistently shown to be the least reliably marked. The thesis consists of five empirical studies. In Study 1, a hybrid thematic analysis of interviews with senior A-level Psychology examiners (n = 5) identified that the cognitive marking strategies used when marking extended written responses were qualitatively different to those previously identified in the marking of GCSE responses. Study 2, a multi-methods study confirmed these findings in a larger sample comprised of novice (n = 30) and experienced (n = 13) markers. The participants completed a marking activity whilst ‘thinking aloud’ followed by an online questionnaire which asked them about their marking practices. Qualitative and quantitative analyses identified that there were few differences in the marking strategies used by novice and experienced markers and that marking accuracy was not associated with marking strategy usage. A model of marking was developed which was investigated further in the subsequent studies. The next two studies investigated marking processes across a three week operational examining period. In Study 3, A-level Psychology examiners (n = 53) completed online surveys which asked them about their marking at four times points across the marking period. Statistical analysis identified that whilst there was an increase in marking speed, this was not the result of a reduction in how thoroughly responses were read, but rather the result of a decreased reliance on the physical mark scheme and less re-reading of material. Interestingly few differences were identified in the marking strategies of accurate and inaccurate examiners, although marking accuracy was found to be associated with the use of an internalised marking schema. Further insight into the model of marking was gained from Study 4, in which a small sample (n = 5) of the Study 3 examiners completed a marking activity whilst having their eye-movements tracked, once at the start of the examining period and again at the end. A semi-structured interview followed the marking activity and included a cued retrospective think aloud (RTA) generated from the examiners watching a replay of their eye movements. Qualitative analysis of the data led to a revised model of marking. In Study 5, aspects of the model were validated using secondary marking accuracy data obtained from the examiners used in Study 3 (n = 53) and the associated population of A-level Psychology examiners (N = 284). The thesis concludes that marking takes place within an individual mental marking paradigm (MeMaP), the values of which are resistant to change. This suggests that ensuring examiners develop and embed a shared understanding of the mark scheme is crucial to marking accuracy.
This thesis aimed to investigate the role of minority stress (MS) and autistic community connectedness (ACC) on mental health (MH) and wellbeing in the autistic community. Multiple methods were used, across four studies. Study one consisted of a qualitative study using grounded theory tools to create a measure of ACC, as none existed. The findings indicated that ACC compromises of three sub-domains – belongingness, social, and political connectedness. Stigma and identity both informed the level of ACC experienced by participants. In study two, a measure of ACC was created and validated in a new sample of autistic individuals (N = 133) using confirmatory factor analysis to test factor-structure and for item purification. Results indicated factorial, convergent and discriminant validity, for a 10-item scale. Studies three and four consisted of a cross-sectional and longitudinal survey where 195 autistic and 181 non-autistic people completed questionnaires at baseline and 99 autistic participants completed measures nine months later at follow-up. Resilience resources, ACC, MH and wellbeing, and MS were measured both times. Study three showed that the differences in MH, wellbeing, and resilience resources between the autistic and non-autistic sample persisted beyond demographics and general stress. Higher MS predicted lower MH and wellbeing, while ACC moderated the relationship between MS and MH, ameliorating the effects of MS. The longitudinal study (study four) showed that higher MS scores at baseline were associated with worse MH and wellbeing nine-months later, while higher ACC was associated with better MH and wellbeing. The results suggest a model of ACC and MS whereby autistic people may experience differing levels of ACC depending on experiences of stigma and autistic identity. This ACC in turn moderates the impact of MS on MH.These findings and implications of the research are further integrated into autism, MS, MH, and community literature.
Lockdown policies brought on by the COVID-19 pandemic pose a threat to well-being. This study examined the effectiveness of three positive psychology interventions, with different time-orientations, on well-being as well as predictors of well-being during lockdown. Participants (n=216) completed measures of lockdown characteristics, attachment orientation, and emotion regulation, were then randomly allocated to one of four interventions; nostalgia (past), gratitude (present), best possible self (BPS; future) or control (recalling a TV show), and completed outcome measures of well-being and affect. Results showed that BPS resulted in higher positive affect and that both BPS and gratitude resulted in higher social connectedness than the nostalgia intervention. Further, greater well-being during lockdown was predicted by greater attachment security, greater emotion regulation, and more social interactions. In sum, focusing on the present or future during lockdown is more effective for well-being than focusing on the past, which alongside trait characteristics predict well-being under lockdown.
Abstract Objective: To identify whether racial differences between mother and child in interracial families produce a perceived lack of resemblance, and whether this affects the claiming and relationship formation processes. Design: Data was collected through semi structured interviews and analysed using thematic analysis. Participants: Nine white European women, in an interracial relationship with at least one child under the age of four. Results: Four themes were generated: 1) anticipated lack of resemblance 2) the reality of having a mixed-race baby 3) challenges faced by the family 4) creating a multifaceted identity. Conclusions: The women anticipated a lack of resemblance between themselves and their baby. This could have served to affect the claiming and relationship formation processes. However, the women actively searched for similarities between themselves and their baby which aided the claiming process. This, in combination with other factors, helped the women begin to form a relationship with their baby. Keywords: Interracial families, claiming, relationship formation, physical similarities, multifaceted identity
This study explored how women made sense of their recovery from Anorexia Nervosa (AN). Semi-structured telephone interviews were carried out with fifteen women who had received a diagnosis of AN and defined themselves as either recovered or in recovery. Data were analysed using interpretative phenomenological analysis (IPA). The women described their experiences in terms of three broad areas; being anorexic; the process of change; and being recovered. Transcending these themes was a series of dichotomies involving splits between their mind and body, AN behaviour and cognitions and their rational and irrational side. Further, they indicated that recovery reflects the time when these many different components of their selves are no longer divided and that this was often facilitated through therapy and close relationships which enabled them to find non bodily means to express their distress. Therapy should therefore aim to facilitate a sense of becoming 'whole' again. © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.
Leg ulcers are a chronic wound of the lower leg, prone to high levels of recurrence and associated with poor quality of life (QOL). Whilst a substantial body of literature has investigated the comparative efficacy of various treatments, little research has explored patient’s qualitative experiences of these treatments or their impact on psychological outcomes. This thesis aimed to address this gap in the literature through a systematic review and four empirical studies. Firstly, a systematic review found evidence for a relationship between wound status and QOL in leg ulceration, and revealed that surgical management may be associated with greater improvements in QOL than compression therapy alone. Next, study 1 used a cross-sectional design (n = 159) to explore predictors and mediators of quality of life in individuals with leg ulcers and reinforced this relationship between clinical severity and quality of life, suggesting that negative mood may mediate the relationship between these two elements. Study 2 then employed a longitudinal design (n = 6) to investigate the QOL of individuals undergoing minimally invasive surgical management, observing a significant improvement in emotional elements of disease specific QOL at 6-months post-surgery, but no significant improvements in other aspects of QOL. Study 3 used a qualitative design (n = 11) to explore the experiences of individuals undergoing minimally-invasive surgery,. The results highlighted the importance of finding a sense of hope and empowerment not associated with other treatment approaches, and the importance of beliefs surrounding chronicity. Finally, Study 4 also used a qualitative design (n = 21) to explore patients experiences of non-surgical treatment, finding overwhelming feelings of powerlessness and frustration, whilst stressing the redemptive power of good relationships. Overall, the findings of these studies suggest that patient’s experiences of treatment for leg ulcers can be conceptualised in terms of three key themes: ‘notions of chronicity’, ‘impact of relationships’, and ‘hope and agency’. Transcending these themes is the proposal that leg ulcers and their treatment, whether surgical or not, exist in a dynamic system and that that their treatment should therefore be approached holistically.
Within any discipline there is always a degree of variability. For medicine it takes the form of Health Professional’s behaviour, for education it’s the style and content of the classroom and for health psychology it can be found in patient’s behaviour, our theories and our practice. Over recent years attempts have been made to reduce this variability through the use of the Behaviour Change Technique Taxonomy, the COM-B and the Behaviour Change Wheel. This paper argues that although the call for better descriptions of what we do are useful for clarity and replication this systematisation may be neither feasible nor desirable. In particular, it is suggested that the gaps inherent in the translational process from protocol to behaviour will limit the effectiveness of reducing patient variability, that theory variability is necessary for the health and well being of a discipline and that practice variability is central to the professional status of our practitioners. It is therefore argued that we should celebrate rather than remove this variability in order for our discipline to thrive and for us to remain as professionals rather than technicians.
Abstract Kuwait has changed dramatically over the last 50 years and simultaneously the world has changed in terms of economic and financial factors, globalization, technology, and religion. These changes have implications for the lives of women in terms of a range of factors such as clothing, relationships, sexuality, childhood, and parenting. This thesis aimed to explore how women make sense of themselves in the context of this changing world taking three different perspectives. In line with this, three inductive empirical studies were carried out in Kuwait using open-ended in-depth interviews as the methodological tool and thematic analysis as the analytic approach. Reported meaning making experiences were shared on culturally sensitive topics providing new insights to contribute academically in this under-researched field. Study one explored taboo issues related to the women’s sexuality and relationships (aged 19-27). The aim was to examine reasons as to why young Muslim Kuwaiti women engage in pre-marital sexual relationships and how much their modernized thoughts influence their personal desires even if they are aware of the consequences in societal norms and rigid restrictions. Results indicated that women engage in romantic relationships and continuously feel the need to “balance” between their secretive personal sexual desires and the Islamic Sharia law of Kuwait. Having relationships in this changing world creates issues around sexual guilt. This creates tensions and implications for women including “a clash” of their two selves when managing two identities. Study two involved a sample of unmarried Muslim Kuwaiti women (aged between 22-55). The aim was to understand the causes of the increased rates of divorce and spinsterhood in an Islamic context that stigmatizes single women. Results indicated that women demand to remain single for reasons such as the demand for independence in their patriarchal context and the desire for new marital expectations. Being unmarried in this changing world creates cultural rebound effects explained in women’s senses of social and family pressures, clothing, sexual liberation, and the Kuwaiti feminist roles in today’s changing world when transgressing taboo. Conflict is created when choosing between being socially invisible because their desires for “women’s independency” is neglected in Kuwait, or being socially visible in a “negative light” for choosing to remain unmarried within their Islamic context. Yet still, they are not willing to give up their independent identities in order to fit in with traditional or marital expectations. Study three looks at the views of religious, traditional, and modern Muslim Kuwaiti mothers today and their relations with their children, specifically in raising daughters (aged between 5-13). The aim was to explore socio-cultural patterns of change allowing a richer understanding of Muslim Kuwaiti mothers in current generations in comparison to the past. Results indicated that mothers are continuously normalizing cultural taboos and social stigmas in terms of emotional and intellectual aspects. Tension was apparent when reflecting on the veil, education, and social life in a changing world. The mothers did face some challenges by living in an “old” traditional space, yet in a “new” modern time. With that, they desired stronger daughters (with a future that does not mirror theirs). Overall, this thesis shows that living in a changing world in Kuwait challenges women’s identities when reflecting upon social identity approach and self-categorization theory. This creates tension of self and identity. Women when describing their sexual relationships, being unmarried, or bringing up their daughters experienced a sense of clash of self and identity when balancing between desired selves and social identities.
The existing literature on parental control and children's diets is confusing. The present paper reports two studies to explore an expanded conceptualisation of parental control with a focus on overt control which 'can be detected by the child' and covert control which 'cannot be detected by the child'. In study 1, 297 parents of children aged between 4 and 11 completed a measure of overt control and covert control alongside ratings of their child's snacking behaviour as a means to assess who uses either overt or covert control and how these aspects of parental control relate to a child's snacking behaviour. The results showed that lighter parents and those with children perceived as heavier were more likely to use covert control and those from a higher social class were more likely to use overt control. Further, whilst greater covert control predicted a decreased intake of unhealthy snacks, greater overt control predicted an increased intake of healthy snacks. In study 2, 61 parents completed the same measure of overt and covert control alongside the three control subscales of the Child Feeding Questionnaire [Birch, L.L., Fisher, J.O., Grimm-Thomas, Markey, C.N., Sawyer, R. (2001). Confirmatory factor analysis of the Child Feeding Questionnaire: A measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite, 36, 201-210] to assess degrees of overlap between these measures. The results showed that although these five measures of control were all positively correlated, the correlations between the new and existing measures indicated a maximum of 21% shared variance suggesting that covert and overt control are conceptually and statistically separate from existing measures of control. To conclude, overt and covert control may be a useful expansion of existing ways to measure and conceptualise parental control. Further, these constructs may differentially relate to snacking behaviour which may help to explain some of the confusion in the literature.
Processing fluency has been shown to be flexible metacognitive cue for a range of judgements including truth, familiarity, and trust. Amongst these, affect judgements are of particular interest as 1) affect can be genuinely evoked by fluency, and 2) affect can be used as a cue for other judgements. However, there is disagreement towards the pattern of affective responses arising from fluency. The hedonic marking hypothesis (Winkielman, Schwarz, Fazendeiro, & Reber, 2003) suggests that fluency is fundamentally positive, whilst the fluency amplification account (Albrecht & Carbon, 2014) suggests that the affective response can be positive or negative, depending on (and congruent with) the valence of stimuli being exposed to. Whilst these accounts have been used as competing explanations, this thesis argues that they both contribute to overall affective responses in a novel multi-source account. This thesis developed a novel set of business scenarios to manipulate fluency (using coherence) and valence (using risk). Evidence from three approaches is presented: 1) Meta-Analysis examining affective responses to fluency, with a sample of 108 publications (k = 591 effect sizes), 2) Five behavioural experiments, and 3) Facial electromyography (fEMG). Across these approaches, neither hedonic marking nor fluency amplification in isolation could account for the full pattern of results. Instead, results were explained by the combined contribution of the two models, as predicted by the multi-source account. The unique findings were uncovered by manipulating stimuli valence, as well as separately measuring positive and negative affect, an approach not previously investigated in the literature, thereby adding methodological, as well as theoretical, contributions to the literature on fluency effects. Implications for future research are to adopt a separate measurement approach to investigate wider judgement domains, whilst practical implications for business assessment and agenda setting are also discussed.
Children with autism face many social challenges and these have been associated with vulnerability to social exclusion and higher levels of bullying compared to the general population. This can lead to long-term negative outcomes including damaged self-esteem and mental health difficulties. Since the majority of autistic children in the UK attend mainstream schools, the studies conducted for this thesis aimed to explore under-researched areas such as the impact of inclusion, and in particular the attitudes of neurotypical children towards their autistic peers. In Study 1, interviews with autistic girls and their parents (n=22) revealed that girls experienced high levels of bullying, school absenteeism and a tendency to mask their autism and that this was more apparent in mainstream compared to special schools. In Study 2, interviews with teachers (n=12) highlighted many challenges supporting autistic children, but also identified some creative solutions and factors that control the extent to which these were implemented. The next three studies explored attitudes of neurotypical children and whether these could be changed through exposure and contact. Studies 3 and 4 (n=775) investigated attitudes of children in schools with high versus low exposure to autism. Findings revealed that educational exposure led to an increase in prosocial emotional responses to bullying and increased personal exposure facilitated an increase in positive attitudes towards people with autism. Study 5 evaluated the influence of contact with autistic peers through group music-making (n=49) on the attitudes of their neurotypical peers. The intervention led to increased prosocial emotional responses to a vignette depicting social exclusion of a child with autism. In summary, autistic children face many challenges, which are not always addressed by teachers in mainstream schools. Furthermore, the physical and social environment of the school affects attitudes towards autistic children. Combining educational exposure within inclusive school climates, and personal exposure through structured intergroup opportunities, can improve responses to bullying and attitudes towards autism, and may ultimately increase quality of life for autistic children in mainstream schools.
Due to resource limitations, psychological support for bariatric patients needs to be targeted to those most in need. This study aimed to evaluate the resource implications of a brief triage tool to identify and support those most at risk from poorer outcomes Materials and methods
A four stage process was used involving: Expert consensus; the selection of appropriate measures; A patient cohort over two years; A resource analysis Results
Three key psychological contra-indications for bariatric surgery were identified by expert psychologists (n=45) as alcohol and drug dependency and suicidality. Next, existing validated measures were selected based upon the literature to form the Bariatric Triage Tool (BTT) consisting of the AUDIT, DAST-10 and SBQ-R. Consecutive patients at one UK bariatric clinic then completed the BTT for 2 years (n=484). Of these under a fifth were identified as at risk (n=85; 17.6%) and referred for an in depth one to one assessment with a bariatric psychologist. Of these 7 (1.4%) were referred to their GP for further psychological support and removed from the surgical pathway. Finally, resource implications were evaluated and indicated that the BTT saved both money (between £15 and £105 per patient depending on the metric) and time (just under one hour per patient) which could be used to target those patients most in need of psychological support Conclusion
The BTT is a brief, easy to self-administer tool that could be used to identify those most at risk and ensure that psychological support is targeted to those most in need
It is estimated that 50% of the UK leisure horse population are overweight/obese, which leads to laminitis, disability and premature death. In human contexts, practitioners ‘make every contact count’ (MECC) to support overweight/obesity management. However, there was no research into whether farriers, who regularly shoe horses’ hooves, MECC when working with owners.
The aim of this research was to explore whether and how farriers MECC to support owners in managing horse overweight/obesity to prevent and manage laminitis.
A classical grounded theory methodology framed multi-methods research. Study 1 involved a classical grounded theory method (GTM) to analyse semi-structured interviews with farriers (n=12) and horse owners (n=11). Study 2 used a case study method to collect and analyse evidence of farrier-owner interaction in a MECC consultation. Study 3 adopted a quantitative method to operationalise the grounded theory from Study 1 using a cross-sectional farrier (n=59) and horse owner (n=140) survey design. Study 4 used a GTM to analyse additional semi-structured interviews with farriers (n=2), horse owners (n=5) and equine veterinary practitioners (EVPs) (n=10).
The research identified typologies for farrier role construction (technically- and holistically-focused) and owner engagement (task- and welfare-focused), and how a contracting process led to four contexts of care which involved concordance or discordance. When holistically-focused farriers work with welfare-focused owners, farriers are more likely to MECC in supporting owners to prevent and manage laminitis. However, this depends upon their role being legitimised through interaction with owners and EVPs, and the mutual recognition of expectations, rights, obligations, standards of practice and behaviour. When farriers do not work in this way, and owners lack the knowledge to manage horse weight/obesity and recognise laminitis risks, important opportunities for its prevention and horse welfare are missed.
The research highlights the importance of supporting farrier and EVP professional development, and owner education in understanding the potential of the farrier’s role in MECC to support owners to manage horse overweight/obesity and the laminitis risk associated with it.
The overall aim of this research is to identify the impact of a brief, low-cost mindfulness meditation training program for employees in a workplace setting, specifically in the UK higher education sector. Although there has been extensive research on the efficacy of mindfulness training for perceived stress of employees, to date, there has been limited research exploring the following: (a) impact of mindfulness-based training interventions on work-related outcomes (b) long-term impact of those interventions, and (c) use of self-help training interventions (low-cost) without supplementary guidance. This thesis aimed to address the research gaps through three empirical studies. Firstly, Study 1 used a randomised waitlist control trial design (N = 125) to assess the impact of offering a mindfulness-based intervention to employees. Intention-to-treat analysis showed improvements in mindfulness and perceived stress after the offer of the Headspace® app. With higher levels of participation, results showed progressively greater improvements in mindfulness, perceived stress and two work-related outcomes, work-life-balance and emotional job engagement. Study 2 then used a longitudinal (12 months) repeated-measures design (N = 60) to investigate the extent to which the amount of Headspace app usage predicted mindfulness, perceived stress and work-related outcomes. Simple regression analysis showed that higher Headspace usage led to greater improvements in work-life-balance and emotional job engagement, however other outcomes were not significant. Study 3 used a qualitative design (N = 13) to explore participants’ 12-months experiences of practicing mindfulness, and the perceived impact on their workplace issues. From a thematic analysis of phone interview transcripts, three themes evolved: challenges (workplace related), selective focus (experience of mindfulness), and work impact (from more mindful approach to workplace). Overall, the findings from this thesis provide support for the effectiveness of brief mindfulness-based training in improving mindfulness and perceived stress. The findings demonstrate that those who use a mindfulness training app can improve their work-life balance and emotional job engagement within two months and both work-related outcomes can be improved with increased usage over one year, although improvements do not increase in mindfulness and perceived stress, and other work-related outcomes. Finally, this thesis contributes to research on the use of digital smart-phone apps as an effective delivery method of mindfulness-based training.
There is some evidence for a positive relationship between affective responses to exercise and future physical activity behaviour, however previous research has been laboratory-based. This thesis aimed to contribute to the current theoretical understanding of affective responses to outdoor physical activity (walking and running), and the relationship of these affective responses to physical activity behaviour change, via three separate empirical studies and a synthesis of the qualitative data across studies. This research makes a number of contributions towards our understanding of the relationships between affective responses to exercise and future physical activity behaviour. Firstly, there was no reliable evidence to indicate that affective responses during everyday outdoor walking at baseline predicted future physical activity behavior (Study 1), though social factors were found to be important in both quantitative and qualitative analyses. Qualitative results suggested that the meanings of everyday walking might be one potential reason for this. Using a run-walking session as an exercise stimulus, affective responses mid-session, end-session and post-session did predict changes in physical activity six months later, whereas early-session affective responses were not significantly related to future physical activity (Study 2). Using results from the first two studies, a beginner run-walking intervention based on affect-regulated exercise intensity in was developed and optimised (Study 3), which was shown to be acceptable, enjoyable and feasible for a future randomised trial testing adherence. Qualitative results from the empirical studies were synthesised, and commonalities, differences and new insights into affective responses to walking and running were found. Results included themes of sources of affective responses (environment, social factors, dis/comfort, comparison with previous self and stages of exercise) and psychological outcomes of exercise (achievement, emotional and mental outcomes). The affective measure used in all empirical studies was analysed, with results showing the most promise for the measure in social situations.
Patients’ expectations pre-treatment for cancer can impact on subsequent treatment experiences. The existing literature is conflicted about whether expectations should be positive or realistic, with some studies reporting expectations as predictors of experiences and some studies highlighting the expectations-experiences gap as more important. Research has been narrow in focus and there exists no broad measure of expectations. Clinical Nurse Specialists (CNSs) manage expectations, therefore their perspectives are important but are currently under-researched. This thesis aimed to explore patients’ expectations of cancer treatment more broadly, develop and validate new measures, and better understand CNSs’ perceptions. The thesis consists of six empirical studies. Study 1 qualitatively explored patients’ (n=16) expectations of cancer treatment. It highlighted a broader range of expectations than in the literature and suggested a role for the expectations-experiences gap. Study 2 designed two measures, validating them in a cross-sectional sample of cancer patients (n= 200). This produced a 39-item measure of expectations and a matched 36-item measure of experiences. Study 3 used the above sample to explore the expectations-experiences relationship and found that the expectations-experiences gap may be particularly important in a wide range of experiences. Study 4 measured expectations and experiences longitudinally but recruitment difficulties resulted in a case study of one cancer patient, which showed support for the findings from Study 3. Study 5 qualitatively explored CNSs’ (n=8) beliefs about patient expectations and found that CNSs believe balancing hope and honesty is the best approach to their management. Study 6 qualitatively explored CNSs’ (n=8) experiences of providing care and found that it was challenging but rewarding. This thesis contributes a broader understanding of patient expectations, facilitates their measurement and suggests that setting more realistic pre-treatment expectations is preferable. It shows that CNSs believe in balancing hope and honesty and that their roles are challenging but rewarding.
Antimicrobial resistance (AMR) poses a profound threat to human and animal health. More research has focused on drivers of inappropriate antimicrobial prescribing and usage in human medicine than in veterinary medicine. This thesis helps address this gap by exploring antimicrobial stewardship in UK livestock farming. It consists of six empirical studies and uses a mixed-method approach. Three qualitative studies explored farm vets’ and farmers’ beliefs about AMR and about antimicrobial prescribing, usage, and stewardship. Study One used qualitative interviews with farm vets (n = 13); results indicated vets understand their stewardship responsibilities but feel they cannot always prescribe in line with stewardship ideals due to contextual factors. Study Two used qualitative interviews with farmers (n = 12); results indicated farmers want to be antimicrobial stewards, but they feel constrained from making changes by external forces. Study Three used a secondary analysis of the combined datasets from Studies One and Two (n = 25) and identified that vets and farmers share a sense of ambivalence towards stewardship; they take some ownership for stewardship, but also engage in other-blaming for AMR. Three quantitative studies further explored the qualitative findings. Study Four used vignettes with farm vets (n = 16) to compare ‘ideal’ and ‘real-world’ prescribing and identify a clinical scenario for use in Study Five. Results showed antimicrobial prescribing was higher in ‘real-world’ than ‘ideal’ situations. Study Five used an experimental vignette and cross-sectional design with farm vets (n = 97) to assess the effects of context, values, and beliefs on vets’ prescribing. Results indicated context (vet-farmer relationship under pressure) and beliefs about responsibility for preventing AMR were associated with vets’ prescribing, but values and beliefs about causing AMR were not. Vets believed other groups had greater responsibility for causing and preventing AMR. Study Six used a cross-sectional survey to explore antimicrobial usage behaviours, knowledge, and beliefs about responsibility for AMR in vet students (n = 573). Results indicated vet students’ behaviours were responsible, knowledge about AMR was moderate to good, and they believed vets have less responsibility than other groups for causing or preventing AMR. Findings are discussed in terms of two key themes; ‘Psychological distancing: a barrier to stewardship’ and ‘Positive interactions: facilitating stewardship’. Findings are considered from a social ecological perspective, highlighting the need for stewardship interventions at multiple levels, and from a social identity perspective, highlighting the importance of emphasising a common goal of stewardship, to reduce psychological distancing and increase positive interactions between individuals and groups.
In an era of secular (post)modernity, when increasing numbers of people no longer identify with traditional religious groups, this thesis explores, from both subjective and objective perspectives, how atheists and other non-religious people understand, explain and find meaning in the phenomenon of atheists claiming to have had a mystical-type experience. Overall the project consists of three studies, one using directed content analysis and two using constructivist grounded theory. For the first study, 29 self-identifying atheists wrote accounts of personal experiences that could be described as “spontaneous, transformative, enlightening and/or of a mystical-type”. Codes relating to the content, context, impact and processes involved in such experiences were created, drawn from published psychological studies on the topic. The written accounts were checked against the codes to see if the atheist accounts were recognisable in terms of existing literature. It was found that the atheists’ accounts were similar to those in the literature in terms of their descriptions of content, context and impact. There was insufficient data in the accounts to ascertain whether they described the holistic process similar to those in the literature. The second study used data from the first study supplemented by data from ten semi-structured interviews with selected atheist participants. Data from both the written accounts and interviews were analyzed using constructivist grounded theory to explore how participants made sense of their experiences and how, if at all, it impacted their sense of atheist identity. The participant’s experiences were located within the meaning and identity literature to explore how people who profess not to believe in supernatural agency considered the event meaningful. From the study, an emergent theory proposes that atheists’ experiences can be characterised as an intuitive leaps of meaning which bypass the rational mind. The resulting meaning-made appears to resolve earlier dissonance between the individual’s normal global meaning system and a prior atypical circumstance in participants’ lives. After the event, participants assessed the value of their mystical-type experience in a more rational way. Some dismissed it as a temporary brain malfunction, while others valued it and modified their global meaning orientation accordingly. In some cases, where the apparent meaning of the experience conflicted with the participant’s atheist identity, those who valued their experience also modified their atheist identity through processes of assimilation and accommodation. The above study gave an insider perspective on the topic. In order to pursue alternative outsider perspectives, and to confirm or extend the emergent theory, a third study, also using grounded theory, was carried out utilising a focus group format. In order to gain insight into how the non-religious people, but not necessarily atheists, who may or may not have had such experience themselves, make sense of the idea of atheists having such experiences. Participants were asked to discuss vignettes taken from the account of a participant in the earlier study. It was found that through their discussions, the focus group participants mobilized resources to negotiate a meaning for such experiences that reduced possible tension between an atheist identity and an experience that could be described as religious or spiritual. Discursively they did this both through relating to the euphoric aspect described in the account and relating anecdotes about people they knew who also had strange experiences. They did not distinguish between explicitly religious and other anomalous experiences, categorising them all under an umbrella category of human experiences, and they saw no reason why religious people would be more likely than the non-religious to have them. Conceptualising them in this way left their own non-religious status unthreatened by the possibility of such an experience. Consistent with attribution theory, while the atheists, relating their subjective experiences, emphasized context as the most relevant contributory factor, focus group participants, relating experiences of others, gave less importance to context and also considered the personal qualities of the individual concerned. A small number of individuals in both studies, however, left open the possibility of supernatural causality. The thesis sheds light on how atheists and other non-religious people create meaning to explain the anomaly of atheists having mystical-type experiences. Consistent with the aims of grounded theory work, it is hoped the findings can contribute towards the development of an overarching theory of mysticism; add to faith/nonfaith dialogue around the role of such experiences, and possibly be helpful in existential therapy settings where the focus is on finding meaning in life.
This thesis explores the experience of the working relationships for clients and their non-therapist workers who are marginalised from main stream health and social care in the third sector. Addressing psychological and emotional problems is traditionally the domain of trained psychotherapists, psychologists and counsellors - professions that draw upon clinical and practice based evidence. Third sector workers are often less qualified yet still provide psychosocial support to others, particularly the more vulnerable in society. Little research has explored the subjective experience of client and worker using brief therapy approaches in non-clinical third sector settings which support those who do not have access to mainstream health and social care services. This thesis explores the subjective experience of clients and their workers within the charity sector in three studies. Study 1 and 2 used thematic analysis and continued into study 3, using grounded theory methodology. Study 1 (n=8) explored the experiences of young people who were marginalised from mainstream education and mental health services and were accessing a workshop and manualised programme utilising brief therapy tools. Study 2 (n=5) explored the experiences of workers who had used the manualised workbook and programme to help these young people to manage their behaviour, with a view to returning to mainstream education. The findings of study 1 and 2 informed the development of a grounded theory exploration with an adult age population in study 3. This population were being supported by workers in a veterans Post Traumatic Stress Disorder (PTSD) charity. In addition, study 3 (n=11) also explored workers experiences in a veterans’ homeless charity and two addictions charities. The workers were using a range of brief therapy interventions from a range of approaches: Brief Solution Focussed Therapy, Cognitive Behavioural Therapy, Motivational Interviewing and Neurolinguistic Programming. The data from all 3 studies in this thesis were then synthesised to develop a middle range grounded theory. The findings of the thesis suggest that a therapeutic working relationship based on self-maturational models develops between worker and client. Both the workers and their clients have had disrupted attachment histories and see similarities in each other as part of their own healing journey. The relationship is sometimes uncontained with the workers lacking aspects of self-reflective functioning that would normally be supported through training, personal therapy and supervision of the qualified worker. The charity sector is an increasingly important economic contributor to the health and social care system. This thesis recommends a quality commissioning process that enables education and supervision of non-clinically trained workers to help develop and support their reflexive functioning.
This study aimed to explore experiences of learning, friendships and bullying of boys with autism attending specialist and mainstream schools, and those of their parents. Semi-structured interviews were conducted with 11 boys with autism, aged 11 – 17 years, and 9 of their mothers. Thematic analysis identified four key themes relating to experiences of friendships and bullying, risk factors, protective factors and outcomes. Overall, the findings indicated that five of the 11 participants had been subjected to bullying, particularly those in mainstream schools (four out of six). Further, if risk factors relating to autism or the school culture were not mediated by protective factors such as self-esteem or supportive friends, various negative outcomes were identified as more likely including mental health issues and effects on learning and relationships. Therefore, although not inevitable, mainstream settings may increase the likelihood of negative experiences as they have fewer resources to protect children against the risk of bullying.
BACKGROUND: The purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service (BRS) on patient weight loss following bariatric surgery at 1 year. METHODS: A single-site open-randomised parallel group control trial based at St. Richard's Hospital in Chichester in the UK. Patients (n = 162) were recruited immediately prior to Roux-en-Y gastric bypass and randomly allocated to receive either treatment as usual (n = 80) or the BRS (n = 82). The BRS involved three 50-min one-to-one sessions with a health psychologist and provided information, support and mentoring pre and post surgery addressing psychological issues such as dietary control, self esteem, coping and emotional eating. Weight loss was assessed at 1 year. The key outcome variable was BMI and change in BMI. RESULTS: Follow-up weight was available for 145 patients. Intention-to-treat analysis (n = 162) using last measured weights showed that mean change in BMI by 1 year post surgery was -16.49. There was no significant difference between the two groups (control group = -16.37, 95 % CI = 15.15-17.57; intervention = -16.6, 95 % CI = 15.42-17.81; η p (2) = 0.001). Similarly, explanatory analysis (n = 145) showed a mean change in BMI of -17.17. The difference between the two groups was not significant (control group = -16.9, 95 % CI = 15.78-18.18; intervention = -17.35, 95 % CI = 18.5-16.16; η p (2) = 0.001). CONCLUSIONS: Psychological support pre and post bariatric surgery had no impact on weight loss as measured by BMI and change in BMI by 1 year. It is argued that psychological support should be targeted to patients who start to demonstrate weight regain at a later stage. TRIAL REGISTRATION: ClinicalTrials.gov NCT01264120.
BACKGROUND: Although obesity surgery is currently the most effective method for achieving weight loss, not all patients lose the desired amount of weight and some show weight regain. Previous research shows that successful weight loss may be associated with the amount of investment the patient feels that they have made in their operation. For example, those who feel that it has taken more time and effort to organise, has cost more money, has been more disruptive to their lives and has caused pain are more likely to lose weight after their operation. Therefore, it seems as if the greater the sense of investment, the greater the motivation to make the operation a success. The present study aims to build on these findings by encouraging weight loss surgery patients to focus on the investment they have made, thus making their investment more salient to them and a means to improve weight loss outcomes. METHODS: The study involves an open randomised parallel group control trial with patients allocated either to the control or investment intervention group. Using third party blinded randomization, half the patients will be asked to rate and describe the investment they have made in their operation just before surgery then 3 and 6 months after surgery. All patients will record their weight, beliefs about food, intentions to change and actual eating and exercise behaviour at baseline then 3, 6 and 12 months follow up. Patients will be recruited from the bariatric surgery pre-assessment clinic at University College Hospital, London. The primary outcome is to explore the impact of the investment based intervention on patient's weight and BMI, with secondary outcomes of patients' beliefs about foods, behavioural intentions and diet and exercise behaviours. DISCUSSION: It is predicted that the investment intervention will improve excess weight loss post-surgery, together with beliefs about food, intentions to change and actual change in diet and exercise behaviour. This has cost implications for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term and this simple, easy to administer and low cost intervention could become routine practice for bariatric patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02045628; December 2, 2013.
Research indicates that an unhealthy diet is a risk factor for the development of a range of chronic conditions, including obesity, cancer, diabetes and coronary heart disease. Dietary habits formed in childhood persist into adulthood. Previous research on dietary habits has focused on families with young children. This qualitative study extends the literature by exploring how mothers manage their teenage children's diets. Semi-structured interviews were carried out with l5 British mothers who had at least one child aged 13–16 years. The data were analysed using interpretative phenomenological analysis. Five themes emerged: achieving gold standard, coping with obstacles, using strategies, resolving conflict and support. The participants were determined to achieve the gold standard (of nutrition) for their children and used a range of strategies to implement it. Mothers developed ways to cope with obstacles that undermined the gold standard. They were keen to resolve conflicts that were generated in the process. Some mothers received a degree of support in achieving the gold standard. The mothers felt that the strong presence of fast food and confectionary in the external environment was the biggest threat to the maintenance of their children's healthy eating. Participants were highly motivated to achieve the gold standard, as it was central to the notion of being a good mother. Being a good mother was a vital component of their self-identity.
Children with autism are more likely to be socially excluded than their neurotypical peers. Since the majority of children with autism attend mainstream schools, interventions are needed to improve the attitudes and behaviours of their peers. Many studies highlight the influence of contact on positive attitudes and reduced discrimination. Group music-making provides an ideal opportunity for positive contact to occur in the classroom. This study evaluated the impact of music-based contact with autistic peers on the attitudes, emotions and behaviours of neurotypical children. Changes in those with autism were also assessed. Neurotypical participants (n=55) aged 10-11 years took part in an eleven-week music programme designed to increase social interaction, which either did or did not include contact with autistic children (n=10). Measures of attitudes, emotions and behaviours were assessed at baseline and follow up. In response to a hypothetical scenario depicting social exclusion of a child with autism, neurotypical participants in the contact group showed a greater increase in prosocial emotions and a greater decrease in tendency to be a victim than those in the no-contact group. Participants with autism also showed a 19.7% decrease in victimisation. Implications of group music-making for tackling social exclusion of children with autism are discussed.
Samaritan listening volunteers provide emotional support to people in distress or suicidal. Samaritans’ has high volunteer turnover, which may be due to burnout. This study evaluated the role of demographic and psychosocial factors in predicting Samaritans listening volunteers’ burnout and health status. Samaritans’ listening volunteers (n=216) from seven branches across UK completed an online survey to assess their levels of burnout (emotional exhaustion, depersonalisation, personal accomplishment), subjective health status, coping, empathy and social support. Overall, listeners showed low levels of burnout and good health. Regression analysis revealed that higher emotional exhaustion was predicted by younger age and avoidant coping style; higher depersonalisation was predicted by lower empathy fantasy and higher avoidant coping style; lower personal accomplishment scores were predicted by higher empathy personal distress and worse health status was predicted by more hours per week spent on listening duties, lower social support and higher avoidant coping style. Overall, different factors influenced different facets of burnout. However, higher use of avoidant coping style consistently predicted higher burnout and worse health status, suggesting avoidant coping is an important target for intervention.
To assess the impact of distraction on subsequent eating, 60 females consumed a cereal bar while watching TV, walking or talking, and their subsequent desire to eat and food intake were assessed. No effects were found for desire to eat. But while those higher in restrained eating consumed less overall and fewer calories after watching TV or talking, they consumed more overall and more calories (specifically five times more chocolate) if the cereal bar was eaten while walking. 'Eating on the go' may disinhibit restrained eaters either as a form of distraction or by offering a justification to overeat.
The present qualitative study aims to explore the experiences of dieters who successfully maintain their weight loss with a focus on the transition in perception of self from their heaviest to their current reduced weight. Ten successful women from a slimming club who had lost at least 10 per cent of their weight for a minimum of one year participated in the study. The results showed an identity shift from a previous restrained self towards a liberated individual, regarding their social interactions, dietary habits, emotional regulation and self-appraisal. The results are discussed in terms of the process of reinvention and the impact of stigma on an obese person’s self-identity.
Objective: To evaluate the effectiveness of a print-based intervention supported by Internet tools at improving physical activity in cancer survivors compared to a standard letter recommendation. Pre-diagnosis physical activity and self-efficacy were hypothesised to predict physical activity improvement.
Study design: Waiting list randomised control trial and cost-consequence analysis.
Methods: Adult cancer survivors who could become physically active without prior medical approval were randomised to receive either a print-based intervention supported by Internet tools (intervention, n=104) or a standard letter recommendation (control, n=103). Physical activity was assessed at 12-weeks with maintenance assessed at 24-weeks in the intervention arm. A number-needed-to-treat was calculated and a cost-consequence analysis completed.
Results: Participants in receipt of a print-based intervention supported by Internet tools improved their physical activity by 36.9% over 12-weeks compared to 9.1% in the control arm. Physical activity was maintained at 24-weeks in the intervention arm. Six-point-two-nine cancer survivors needed to receive the intervention for one to improve physical activity over a standard letter recommendation. Intervention delivery cost £8.19 per person. Pre-diagnosis physical activity and self-efficacy did not predict physical activity improvement.
Conclusion: A print-based intervention supported by Internet tools offers a promising low-cost means to intervene to improve physical activity in cancer survivors.
Research suggests a link between being in care and eating problems. The present study compared the eating behaviour of looked after young people and their non-looked after peers with a focus on the role of their perceived early childhood attachments. Looked-after young people completed questionnaires about their perceived and unresolved attachment to their main caregiver during early childhood (aged 0 to 5), their level of picky eating and food disgust and the meanings they ascribed to food. They then nominated a non-looked after friend to complete the same measures. The results showed that looked-after young people reported poorer scores on all aspects of early childhood attachments and were more like to be ‘picky eaters’ and to find food disgusting. Further, they rated food as less embedded with meanings relating to sexuality, family life, a treat and social interaction. In addition, although care status independently predicted picky eating, food disgust and a belief that food was central to family life and social interaction, unresolved attachment was a better predictor of these variables. Further, unresolved attachment also significantly predicted a belief that food was a means to take control over one’s life. Being brought up in care is associated with eating problems and a less engaged approach to food. Poor attachment is a powerful explanation of this association. Carers and other professionals are key to the development of trusting relationships with looked after young people. Such secure attachments with carers and other professionals may enable looked after young people to foster a more positive relationship with food.
Symptom perception is complex and influenced by a number of psychological factors. Further, a number of problems relating to symptom perception have been identified including poor interoception and a reduced ability to recognise bodily signals and alexithymia reflecting an impaired ability to identify and describe emotional symptoms. In addition, research indicates that some individuals may have difficulty distinguishing between internal signals and demonstrate an ‘Interoceptive Crossover’ of emotions and physical symptoms. To date, research in this area is sparse. The current study therefore aimed to explore the incidence and nature of Interoceptive Crossover. 239 individuals completed an online survey and reported their experiences of perceived similarity between a range of emotions (e.g., Sad, Happy, Afraid and Calm) and physical symptoms (e.g., Stomach Pain, Fatigue/Tiredness, Headache and Abnormal Heartbeat) to assess the incidence and nature of Interoceptive Crossover. Some individuals demonstrated crossover between emotions and physical symptoms. Some crossovers were more unsurprising and reported by greater proportion of the sample, such as Afraid and Abnormal Heartbeat (74.5%); Sad and Fatigue (29.4%) and Afraid and Shortness of Breath (58.5%). Other crossovers were less prevalent in the sample and more unexpected such as Satisfied with Headache (1.2%); Bored with Back Pain (5.95%) and Happy and Back Pain (0.4%). Some individuals demonstrate Interoceptive Crossover of emotions and physical symptoms. Some crossovers are more prevalent whilst others are rare and unexpected. This phenomena needs to be explored in more depth and with relation to other constructs such as alexithymia and interoception.
J Ogden, J Boden, R Caird, C Chor, M Flynn, M Hunt, K Khan, K MacLurg, S Swade, V Thapar (1999)'You're depressed'; 'No I'm not': GPs' and patients' different models of depression, In: BRITISH JOURNAL OF GENERAL PRACTICE49(439)pp. 123-124
ROYAL COLL GENERAL PRACTITIONERS
This study explored long-term consequences of obesity surgery. Interpretative phenomenological analysis was used to analyse transcripts of 10 interviews with patients who underwent surgery 8 or more years ago. Experiences were described under three broad themes: eating behaviours, relationship with food and quality of life. Although patients described variability within these themes, describing different patterns of change, analysis revealed associations between themes and outcomes. In particular, those who reported successful weight loss also described the functionalization of food, the development of new coping strategies and a process of positive reinvention creating a new sense of self.
With its primary focus on the psychology of eating from a social, health, and clinical perspective, the second edition of The Psychology of Eating: From Healthy to Disordered Behavior presents an overview of the latest research into a wide range of eating-related behaviors •Features the most up-to-date research relating to eating behavior •Integrates psychological knowledge with several other disciplines •Written in a lively, accessible style •Supplemented with illustrations and maps to make literature more approachable
There is an evidence-base in human and small animal veterinary healthcare contexts which understands how practitioners engage in partnership working with patients and owners to support adherence to treatment/care plans. However, as yet, it is believed there is no similar evidence-base for how practitioners in equine healthcare contexts work with equine owners. It is argued that this is essential for understanding complex equine practitioner-owner interaction involving the prevention and management of laminitis. The aim of this study was to explore farrier-client interaction where risk management for an equine recovering from laminitis was being undertaken. A case report method involved a microlevel analysis of farrier-client consultation. The consultation was video-recorded and analysed using a conversation analysis approach to identify the linguistic and paralinguistic features of the interaction. These were compared with conversation analyses in other healthcare contexts to identify the actions being accomplished within the consultation. The analysis identified a number of joint actions, including managing epistemic stance (or knowledge rights) and deploying the animal’s presence to navigate problem sequences which supported progression of the consultation through a three-stage model involving ‘team-’, ‘option-’ and ‘decision-‘ talk, known to be associated with partnership working in human healthcare contexts. The study highlights the importance of developing an empirical evidence-base in equine practice for how practitioners engage with owners based on a microlevel analysis of real-world interactions. It is argued this evidence-base is necessary in supporting effective practitioner training in partnership working with clients to promote their adherence to treatment/care plans.
L Ridsdale, D Robins, A Fitzgerald, S Jeffery, L McGee, J Close, A Free, C Hughes, Y Hart, J Ogden, A OrmeSmith, N Stoy, P Stott (1996)Epilepsy in general practice: Patients' psychological symptoms and their perception of stigma, In: BRITISH JOURNAL OF GENERAL PRACTICE46(407)pp. 365-366
ROYAL COL GEN PRACTITIONERS
A minority of patients show sub-optimal outcomes after weight loss surgery. Research has identified predictors of poor outcomes focusing on the patients’ perspective. No research has explored surgeons’ accounts. Design:
Ten bariatric surgeons were interviewed using a critical incident approach to explore their explanations for sub-optimal outcomes in the context of a real-life case. Data were analysed using thematic analysis. Results:
Three main themes were developed: ‘Challenges to success’ highlighting the role of psychosocial issues, poor adherence and patient non-disclosure; ‘Ideal world solutions’ describing who should identify and address psychosocial issues and ‘Real world compromise’ reflecting the impact of limited resources and weighing up risk between carrying out versus not carrying out surgery. Transcending these themes was the notion of ‘responsibility’ with surgeons balancing the role of the patient, themselves and the health care system. Conclusion:
Some surgeons concluded that if they had known before surgery what they know now, they may not have operated. All emphasised that they could only know what was disclosed by the patient, that they were not convinced that not operating would have resulted in better outcomes in the longer term and many felt that they were ‘damned one way or the other’.
Most current approaches to obesity management involve dietary interventions designed to change and reduce the amount of food consumed. Research indicates, however, that although such interventions can induce weight loss in the short term longer term changes in weight, which are required if the individual’s health is to improve, are much more difficult to sustain. This paper will explore the complex reasons behind why we eat and the many roles that food plays in our lives. It will then explore current dietary and alternative interventions for obesity and assess what we can learn from them to improve obesity management.
Background Stress has become an increasingly common presentation in general practice. This may relate to an increase in stress in people's lives or a change in the meaning of stress and its conceptualisation as a legitimate problem for the GP. Aim, To explore patients' beliefs about stress, their association with help-seeking behaviour, and to examine differences by ethnic group. Design of study Gross-sectional survey of general practice patients attending to see their GP. Setting An inner-city London practice. Method Consecutive general practice patients completed a questionnaire, which involved rating a series of symptoms for the extent to which they were associated with stress and describing their help-seeking behaviour. In total, 548 patients completed the questionnaire. Most patients described themselves as black Caribbean (n = 163), black African (n = 48), or white British In = 187). Results The symptoms most frequently associated with stress were sleeping problems, feeling depressed, feeling panicky, having high blood pressure and feeling anxious; feeling ashamed, experiencing indigestion, having diarrhoea, feeling hot or cold, and suffering from constipation were least commonly associated to stress. This model of stress did not vary by ethnic group. Ethnic group differences were found for the association between the model of stress and help-seeking behaviour. Although white British patients consistently reported that the more a symptom was seen as indicative of stress, the more likely they would be to visit the doctor for that symptom, this association was not found for either black Caribbean or black African patients. Conclusions The belief that stress-related symptoms are a legitimate problem for the GP is not universal and varies according to ethnic group. Stress is used by different patients in different ways and offers a variable pathway to the doctor.
Objective: A waiting list randomised control trial has shown the Move More Pack, a print-based intervention supported by Internet tools, to improve physical activity levels in cancer survivors; however, one-third do not improve from the intervention. The objective of this process evaluation is to understand intervention use, the mechanisms of impact, the perceived benefits, and the contextual factors influencing these, identifying for whom it is a useful resource.
Methods: A mixed methods process evaluation, based on guidance from the UK Medical Research Council, including 181 questionnaire responses on intervention use and physical activity improvement over 12-weeks, 56 open text responses and 17 semi-structured interviews.
Results: The Move More Pack was suggested to be most useful when delivered towards the start of the cancer journey to those with a positive attitude to fighting cancer but with a low level of physical activity, capitalising on a teachable moment. It was suggested that healthcare professionals could support the effective distribution of the Move More Pack. The intervention’s printed components were more popular and well used than the Internet tools. The printed intervention components were positively correlated with physical activity improvement but the Internet tools were not. Females were more likely to use the intervention’s printed components than males. Cancer survivors using the intervention reflected that they had increased confidence and motivation for physical activity and other lifestyle behaviours.
Conclusion: The Move More Pack should be offered by healthcare professionals, during cancer treatment, when health is salient, to those with a positive attitude to fighting cancer but with low levels of physical activity. Use of the intervention’s printed components are more likely to improve physical activity than the Internet tools and are more likely to be used by females. The use of Internet tools to support physical activity improvement in cancer survivors requires further investigation.
Interviews were carried out with 10 men and women who had undergone weight-loss surgery (WLS) up to 10 years ago and felt that it had failed. Seven had had a further successful procedure. Data were analysed using Interpretative Phenomenological Analysis. Weight regain following surgery was explained in terms of either the mechanics of the operation or with participants describing ways to ‘cheat’ as food continued to be used for emotional regulation. Everyone spoke of how surgery neglected their mind. Following the second successful surgery, participants described changes in both their eating behaviour and cognitions emphasising how their mind had been brought ‘in gear’ through the investment of two invasive procedures. Transcending all accounts was the mind/body relationship and the issue of control with attributions for both failed and successful surgery shifting from the self to the surgical mechanism as the participants negotiated the pathway between self-blame and responsibility and utilised conflicting frameworks in which the mind and body were either divided or united. Whereas failed surgery is characterised by a battle for control, successful surgery involves handing control over to their restricted stomachs or considering WLS as a tool to be worked with.
Interviews with 11 participants who had suffered a range of traumas five or more years ago were analysed using thematic analysis to explore the impact of a negative event and the mechanisms involved in subsequent changes and adjustment. Participants described a sense of mortality reflected in a feeling that life was fragile as though the intellectual knowledge of their future death had been turned into an emotional reality, which had offered them opportunity to make changes across a number of life domains. For some, however, these changes were hindered through ongoing issues such as physical and psychological symptoms and legal action. The final theme reflected a process of recalibration and many described achieving a state of relative contentment. Transcending these themes were a series of mechanisms facilitating change including downward comparisons to friends and abstract others, active remembering involving forced reflection, self-talk and reading diaries, shifting priorities and a focus on the positives and lowered expectations. Overall, it is suggested that growth following trauma is achieved through a shift in the object of comparison whether it be others or themselves as either in an alternative life trajectory or even death. This may result in a greater appreciation of life, but rather than being achieved through growth in one's sense of self per se it reflects a generalised lowering of expectations and growth in comparison to a new lowered set of points of comparison.
Background The introduction of patient screens for outpatient procedures is becoming increasingly common. To date, the impact on the patient of viewing the screen remains unknown. Objectives To explore how viewing the screen during a hysteroscopy procedure affects the patient’s experience. Setting The outpatient clinics at the Royal Surrey Hospital in Guildford and the Royal Infirmary in Bradford. Design A randomised control trial. Sample Women undergoing a hysteroscopy procedure were randomly allocated to see the screen (n = 81) or not to see the screen (n = 76). Methods A quantitative study with measures taken before and after the intervention. Main outcome measures Pain perception, mood, illness cognitions, communication. Results Seeing the screen or not had no impact on several measures of pain perception, mood, illness cognitions or communication. However, women who did not see the screen were more optimistic about the effectiveness of their treatment and felt that the health professional was more receptive to them during the consultation compared with those who saw the screen. After controlling for the use of a local anaesthetic, those who did not see the screen also reported a greater decrease in anxiety after the procedure. However, those who saw the screen described pain more positively (i.e. in terms of comfort, reassurance or encouragement) compared with those who did not see the screen. Conclusion Viewing the screen does not benefit the patient and may interfere with the patient–physician interaction.
J Ogden, R Branson, A Bryett, A Campbell, A Febles, I Ferguson, H Lavender, J Mizan, R Simpson, M Tayler (2003)What's in a name? An experimental study of patients' views of the impact and function of a diagnosis, In: Family Practice20(3)pp. 248-253
Objective. The aim of the present study was to examine patients' views about the relative impact and function of lay and medical diagnoses for stomach and throat problems. Methods. A questionnaire survey was carried out among 900 consecutive patients attending nine general practices across England. A total of 740 questionnaires were completed (response rate: 82.2%). Each participant rated a series of statements describing the impact upon the patient and the function for the doctor following both a stomach and a throat problem case scenario involving either a lay (stomach upset/sore throat) or medical (gastroenteritis/tonsillitis) label. Results. The results showed consistent differences between the lay and medical labels for both stomach and throat problems in terms of their impact upon the patient and their function for the doctor. In particular, the medical labels were rated as beneficial for the patient in terms of validating the sick role and improving their confidence in the doctor. In contrast, the lay labels resulted in a greater sense of ownership of the problem which could be associated with unwanted responsibility and blame. In addition, the medical labels were seen to provide the doctor with a greater sense of professionalism, as giving them a clearer role in the consultation and to imply less blame on the part of the patient. 'Stomach upset' was also seen as a more pragmatic label than 'gastroenteritis'. Conclusion. Although much current prescriptive literature in general practice advocates the use of lay language in the consultation as a means to promote better doctor-patient partnerships, the issue of diagnosis is more complex than this. Patients attribute greater benefits to the use of medical labels for themselves and state that such medical labels are of greater benefit to the doctor.
Food intolerance is one of medicine's modern enigmas. Its etiology and mechanism are unclear and the subject of constant debate, while estimates of its prevalence vary widely from 2% to over 20% of the population. Using interpretive phenomenonological analysis, this study explored the phenomenon of food intolerance in primary care from the general practitioner's (GP) perspective. Semi-structured interviews were carried out with 17 GPs from around the UK. Food intolerance was primarily conceptualised as a spectrum of clinical importance with medical conditions arranged in three hierarchies; the certainty that the GP would have in making a diagnosis, the authenticity of the patients' experience, and the threat posed to physical health. Since some conditions within the spectrum had a medical name that was used in preference to the term ‘food intolerance’, food intolerance essentially became a ‘dustbin diagnosis’, focused at just one end of the spectrum and viewed with scepticism. The scepticism about food intolerance as a specific condition influenced the GPs' perceptions of patients and of the patients' underlying problems. This was, however, tempered by an element of awareness of the limitations of modern medicine. Rather than risk damaging the doctor–patient relationship, the GPs chose, despite their scepticism, to negotiate mutually acceptable ground with patients and with patients' beliefs. As a result, whether due to a placebo effect, secondary benefit, or as a biophysical result of excluding a food from the diet, the GPs acknowledged both personal and therapeutic benefit in working with the patients' belief in food intolerance and with behaviours associated with the beliefs.
Nineteen heterosexual couples completed questionnaires concerning their own and their partner's body size. Although women reported higher levels of body dissatisfaction, both men and women reported being dissatisfied with their body parts. Further, the results showed comparability within couples for ratings of the male partner's body size but consistent differences for ratings of the female partner's body size. In addition, both partners reported most dissatisfaction with the female partner's body size. It is suggested that a sexual partner's beliefs may play a greater role in the development of men's body dissatisfaction and that the female body may have become a legitimate source of criticism for both men and women. The implications for the social context on self-perception are discussed.
Media images of unrealistic beauty have been identified as a determinant of women's body dissatisfaction. This experimental study aims to explore whether the negative impact of such images could be reduced by a one-time educational intervention consisting of a presentation and discussion, teaching women to be critical of media images. Design/methodology/approach
Female psychology students (n=176) from a university in the UK were randomly assigned to the control or intervention group and completed measures of body dissatisfaction after being challenged by images of the perfect female body. Follow up data were collected four weeks later. Findings
The results suggested that the intervention had no immediate buffering effect on body dissatisfaction but participants in the intervention group showed a long-term improvement for confidence, attractiveness and body-parts dissatisfaction. Practical implications
This one-time intervention could be used to protect young women against the detrimental impact of media images in the longer term. Originality/value
This study provides an evidence base for the use of an educational intervention for young people in schools and colleges.
For centuries health professionals have recognised that psychology can be a consequence of being ill and we know that a diagnosis of cancer or diabetes can make people anxious or depressed. This course, however, will draw upon health psychology, public health and community psychology to emphasise how psychology can also contribute to the cause, progression, experience and outcomes of any physical illness. This course will highlight the many roles that psychology plays in physical illness from i) being and staying well and the role of health behaviours and behaviour change; ii) becoming ill with a focus on illness beliefs, symptom perception, help seeking and communication with health professionals; iii) being ill in terms of stress, pain and chronic illnesses such as obesity, coronary heart disease and cancer; iv) the role of gender on health; and v) health outcomes in terms of quality of life and longevity.
Objective To explore general practitioners (GPs’) beliefs about the causes and solutions to obesity, to compare them to those held by a lay sample and to assess the role of beliefs about causes in explaining beliefs about solutions. Methods Questionnaires regarding the causes and solutions to obesity were completed by GPs (n = 73) and a lay sample (n = 311). Results GPs generally believe that obesity is caused by psychological and behavioural factors and are ambivalent about the effectiveness of the majority of available solutions. When compared to a lay population, GPs show a greater endorsement of behavioural, structural, social and psychological causes of obesity whereas the lay population prefer a more biological model of causality. The present study also provides some evidence for the origins of such beliefs about solutions and indicates consistency between GPs’ beliefs about solutions and causes. For example, GPs endorse a medical solution if they believe obesity is caused by biological factors and endorse policy change as a solution if they believe it is caused by social factors. The lay sample did not show such consistency in their beliefs. Conclusions GPs believe that obesity does not belong within the medical domain. They hold a coherent model in terms of beliefs about causes and solutions which may limit their perspective on what constitutes a suitable solution to this ever common problem. Practice implications If GPs are to take responsibility for the management of obesity they should be encouraged either to change their beliefs or to consider whether solutions need always address causality.
This study explored the predictors of weight loss following orlistat with a focus on both baseline variables and changes in beliefs and behaviours occurring over the course of taking the drug. Patients (n = 566) prescribed orlistat completed a questionnaire at baseline and after 6 months concerning their weight, beliefs and behaviours. By 6 months the majority had lost some weight and showed improvements in diet. Many had also stopped taking the drug and a large minority reported using it flexibly as a lifestyle drug. Those who lost most weight showed a decrease in beliefs in a medical solution, a decrease in unhealthy eating, an increased belief in treatment control and an increased belief that the unpleasant consequences are both due to their eating behaviour and just part of the drug. When taken with fatty food orlistat causes symptoms such as anal leakage and oily stools. These may encourage some patients to focus on the behavioural aspects of their weight problem thus promoting the dietary changes needed for both short and longer term weight loss. When prescribing orlistat, clinicians should encourage patients to see the consequences as an education as a means to promote the effectiveness of this form of medical management.
Eight homeless people were interviewed about their experiences of health and social services. Three themes emerged: responsibility, identity, and feeling trapped. Although some felt they were responsible for their own situation and avoided help, most turned to formal channels for help, but professionals were often seen as offering unwanted labels and as being rule bound. In contrast, peers were considered more understanding but colluded with their problems. Participants also expressed feeling trapped within the homeless system. Therefore, by locating responsibility for change with others, they were left feeling stigmatized, but by turning to their peers, their situation remained the same.
Background. Previous studies have suggested that the attitudes of health professionals towards people with disability may be as negative as those of society. Further, even positive attitudes may not always be reflected in the health professional's behaviour. Objective. The aim of this study was to examine GPs' (registrars and trainers) consultations with people who have congenital disabilities and to explore incidents when their attitudes were either matched or not matched with their behaviour. Methods. A purposeful sample of 19 registrars and trainers participated in a semi-structured interview using the critical incident technique. Subjects were asked to describe encounters from their professional life with a person with a congenital disability, when they either had or had not been able to behave as they wished. Results. The results indicated that matching or non-matching between attitudes and behaviour was related to three main themes: aspects of the patient such as their appearance, ease of communication and autonomy; aspects of the GP including their management of personal, expert and professional boundaries and the historical context of the consultation including the GP's personal and professional experience, the familiarity between the GP and the patient and the patient's previous experiences of care. Conclusion. The critical incident technique was found to be a useful tool to gain access into this complex and problematic area and the results raise many issues pertinent to the planning of learning opportunities for both undergraduates and postgraduates.
Background Providing choice in health care is part of an ongoing policy initiative. Aim To explore how people understand choice in healthcare provision. Design of study A qualitative study using semi-structured interviews. Setting South East England. Method Twenty-two people were interviewed about the issue of choice in general, and choice in healthcare in particular. Data were analysed using template analysis. Results Participants discussed choice in the NHS within the context of the GP consultation. Four main themes about choice were identified: positive aspects of choice; the appearance of choice; unwanted choice; and the role of information in choice. Participants valued choice in principle, and having choice was seen as positive. However, the provision of choice options was not always associated with the possibility of meaningful choice. Participants expressed that in some instances they were given the appearance rather than the substance of choice. Making - as opposed to having - choice was often unwanted and considered as indicative of erosion in trust in the GP. Information was seen as a necessary, but not sufficient, prerequisite of informed choice. Conclusion People value having choices rather than making choices but are concerned about choice provision for its own sake rather than choice that is available in a meaningful way. Health care policy that recommends an increase in choice per se may be met with scepticism which could ultimately undermine, rather than promote, the doctor-patient relationship.
Objective To develop a clinic for patients who believe they have a food intolerance that could be administered by practice nurses with minimal experience of dietary change or food intolerance. Methods The clinic consisted of 1 week baseline, 2 weeks healthy eating plan (HE), 2 weeks wheat and dairy free plan (WD). Patients were discharged after the HE plan if their symptoms had improved, otherwise they continued onto the WD plan. Following training 4 nurses ran 4 clinics across the UK. Results 281 patients with perceived food intolerance were recruited. The most common symptoms were bowel symptoms, tiredness, stomach symptoms, and headaches. Of those who completed the programme (n=150), the majority were discharged after the HE plan as their symptoms had improved (n=106, 70.6%). A third also completed the WD plan (n=44, 29%). Symptoms, mood and quality of life improved significantly by the end of the intervention. WD showed added value as symptoms showed further improvement. Conclusion There was a need for the clinic although not on a full time basis. Symptoms improved following both the HE and WD plans. Practice implications A simple dietary based intervention may help relieve symptoms in those who believe they have a food intolerance.
L Ridsdale, D Robins, C Cryer, H Williams, J Close, A Free, C Hughes, Y Hart, J Ogden, A OrmeSmith, N Stoy, P Stott (1997)Feasibility and effects of nurse run clinics for patients with epilepsy in general practice: Randomised controlled trial, In: BRITISH MEDICAL JOURNAL314(7074)pp. 120-122
BRITISH MED JOURNAL PUBL GROUP
Background Due to the increased prevalence of obesity GPs now have a key role in managing obese patients. Aim To explore GPs' views about treating patients with obesity. Setting An inner London primary care trust Design of study A qualitative study using semi-structured interviews. Method Twenty-one GPs working in an inner London primary care trust were interviewed about recent obese patients and obesity in general. An interpretative phenomenological approach was used for data analysis. Results GPs primarily believed that obesity was the responsibility of the patient, rather than a medical problem requiring a medical solution. They also believed that in contrast to this, obese patients wanted to hand responsibility over to their doctor. This contradiction created conflict for the GPs, which was exacerbated by a sense that existing treatment options were ineffective. Further, this conflict was perceived as potentially detrimental to the doctor-patient relationship. GPs described a range of strategies that they used to maintain a good relationship including offering anti-obesity drugs, in which they had little faith, as a means of meeting patients' expectations; listening to the patients' problems, despite not having a solution to them; and offering an understanding of the problems associated with being overweight. Conclusion GPs believe that although patients want them to take responsibility for their weight problems, obesity is not within the GP's professional domain. Until more effective interventions have been developed GPs may remain unconvinced that obesity is a problem requiring their clinical expertise and may continue to resist any government pressure to accept obesity as part of their workload.
This study explored the role of life events in triggering both weight loss and weight gain and assessed whether a number of variables differentiated between these two types of weight change. Members of a slimming club (n = 538) completed an online questionnaire concerning two events, which had caused either weight loss or weight gain. They then described the event and its impact in terms of a number of variables. The majority of participants could describe a time when a life event had resulted in both weight loss and weight gain including relationship problems, pregnancy, illness and death of someone close. Compared with the weight gain event, the weight loss event was perceived as more positive, less negative, more controllable and more predictable than the weight gain event. Further, in terms of sustaining conditions, the weight loss event was perceived as reducing the choice over food and the function of eating and as increasing the choice over exercise and the function of this behaviour. To conclude, life events are related to weight change and the direction of this change can be explained both by the perceived nature of the event and its impact upon choice and function of eating and exercise.
Our original paper (Ward & Ogden, 1994 ) explored women's experiences of vaginismus and argued that it should be conceptualised as a psychosocial rather than just a psychosexual problem. This commentary describes the background to the study and highlights what contribution we feel it made to the literature in the context of recent developments.
Objective: Established risk factors for jet lag are mostly physiological including circadian preference, age, gender, the number of flight zones crossed and to some extent direction of travel. Some research has also highlighted a role for psychosocial factors including sleep, diet and ‘circadian’ health behaviours and illness cognitions although this remains relatively untested. The aim of this study was to evaluate the role of sleep, diet and illness cognitions in predicting perceived jet lag amongst long-haul crew. Design: 60 long-haul crew took part in a longitudinal study. Profile characteristics (including chronotype), preparation strategies (sleep, eating and ‘circadian’ behaviours) and illness cognitions were measured at baseline (before a trip). Main outcome measures: Subjective jet lag (unidimensional and multidimensional) was measured on the crews’ second day off (post-trip). Results: Hierarchical regression analyses showed that unidimensional jet lag was predicted by the belief in a cyclical timeline whereas multidimensional jet lag was predicted by multidimensional jet lag at baseline and to a lesser extent by identity. No role was found for profile characteristics and preparation strategies. Conclusion: Illness cognitions partly explain the experience of perceived jet lag in long-haul cabin crew indicating that jet lag is in part a psycho-social construct, not just a biological one.
This study explored whether breast scarring following a lumpectomy generated negative judgements using an experimental between subjects factorial design. Eight images of women varying in terms of breast scarring (present vs. absent), beauty (average vs. high) and celebrity (as a proxy for familiarity; present vs. absent) were rated by 232 participants. The results showed that scarring resulted in lower ratings of attractiveness and self esteem and higher ratings of femininity. Scarred celebrities were judged as particularly unattractive. Women's assumption that they will be judged more harshly following breast cancer surgery maybe reflected in the actual ratings of others.
Background Current policy advocates individual choice across a number of domains, including healthcare provision. Aim To develop a new tool for measuring people's beliefs about the value of choice in the context of healthcare provision. Design of study Cross-sectional survey. Setting Four general practices in South East England. Method Nine items relating to health and general domains, derived from in-depth interviews with 22 participants, were collated into a questionnaire. This formed the measurement tool called the Choice Questionnaire (ChQ), which was completed by 823 consecutive patients (response rate = 81.2%). Results Principal components analysis resulted in two factors: having choices (for example, `I like to know all the possible ways in which I could be treated') and making choices (for example, `I am happy for the doctor to make decisions for me'). These two constructs showed good internal consistency. One item was deleted, resulting in the 8-item ChQ. Beliefs about choice in health and general domains were not discrete. The vast majority of participants endorsed having choices as positive. In contrast, beliefs about the value of making choice were more mixed. A greater endorsement of both these aspects of choice was related to higher educational status. Conclusion Results from this study indicate that choice can be usefully conceptualised as consisting of two separate constructs: having choices and making choices. The 8-item ChQ has an interpretable factor structure and has been shown to be reliable. It could be used in research to assess beliefs about the value of choice or in the clinical setting to establish whether a patient would prefer to be provided with options or to be managed in a more paternalistic way.
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Objective: A quasi-longitudinal design was used to explore how changes in the home environment reflect body weight and eating behavours in three generations of women across two non-Mediterranean (UK and Australia) and two Mediterranean countries (Greece and Malta). Method: A within- and between-subjects design was used. The within-subjects factor was generation (daughters, mothers and grandmothers). The between-subjects factor was nationality (Mediterranean (Malta, n=135 and Greece, n=106) vs non-Mediterranean (UK, n=120 and Australia, n=96). Body Mass Index (BMI), eating behaviour and aspects of the home environment were assessed using questionnaires for family triads. Results: There were consistent differences by generation in terms of BMI, eating behaviour and most aspects of the home environment, with daughters being lighter but reporting less healthy diets in terms of drinks, snacks, meals and food preparation than either their mothers or grandmothers and a lower endorsement of parental control over food, a lower belief in controlling forms of parenting and a lower belief in the mothers’ autonomy over their daughter. Further, those from Mediterranean countries were heavier and reported poorer diets and a stricter approach to the home environment. The results also indicate that a shift between the generations was more marked in Mediterranean countries with more pronounced differences occurring between daughters, their mothers and grandmothers. Conclusion: Increased weight may be associated with a less managed home environment and poorer eating behaviours which are particularly apparent in those from Mediterranean countries where daughters may be reacting against their more controlling family culture.
Purpose: Ex-service personnel face numerous and significant problems upon discharge from the forces. The purpose of this paper is to explore experiences of the transition from military to civilian life and to identify some of the barriers and facilitators to re-employment. Design/methodology/approach: In-depth interviews were carried out with 11 ex-servicemen who had previously served in the UK armed forces and analysed using interpretative phenomenological analysis (IPA). Findings: Participants described their experiences in terms of three broad themes: characteristics of a military life; loss as experienced upon return to civilian life; and the attempt to bridge the gap between these two lives. Transcending these themes was the notion of identity, illustrating that the transition from military to civilian life can be viewed as a shift in sense of self from soldier to civilian. Research limitations/implications: The current study only recruited male ex-service personnel and therefore the findings may not accurately represent the experiences of female service leavers. Practical implications: The military needs to ensure that not only is support provided for all service personnel, but that it goes beyond basic vocational advice. Although the needs of ex-service personnel are defined by factors other than unemployment, such as trauma or the sudden loss of security, they do relate back to unemployment in some capacity. Methodological changes to the discharge process could help this population to achieve a more continuous trajectory rather than a fragmented one. Originality/value: The present study has provided further insight into the identity experiences of ex-service personnel along their journey from soldier to civilian. Breakwell's Identity Process Theory provided a valuable framework for understanding the experiences of ex-service personnel. © Emerald Group Publishing Limited.
Research indicates that eating related problems, body weight and eating habits often start in childhood and track through to adulthood. To date, however, little is known about how children conceptualise food and the factors involved in their decision making processes. This qualitative study aimed to explore children's understanding of food and how this influences their food related decisions. Children (n = 27) aged 9–10 took part in a think-aloud study and voiced their thoughts whilst making different meals and snacks using pictures of food. Data were analysed using thematic analysis which described 3 core themes: i) drivers of food decisions (hunger, health, liking, emotions, availability) ii) sources of these drivers (parents, peers, routine); iii) polarised reasoning whereby food was often dichotomised as good or bad. Transcending these themes was the degree of deliberation whereby children showed decision making as automatic, considered or sanctioned. Finally, overarching their accounts was the notion of the transitioning child with children illustrating the shift between being a passive child whose decisions were made for them and an active child with autonomy and agency. The results illustrate the ways in which children begin to internalise the messages of others as they grow older which they incorporate into their own schema. These messages in turn form part of their heuristic system which enable less sanctioned decisions as children take ownership of their own eating behaviour. The results are discussed in terms of the implications for decision making and a framework for developing interventions.
J Ogden, A Amirova, H Brunger, Y Hirst, B Jones, A Pringle, K Wood, V Senior (2014)The impact of the London Olympics on physical activity, general health status, wellbeing and national identity: a quantitative survey based in Stratford, 2011 and 2012, In: Health Psychology Update23(Autumn)pp. 17-26
The British Psychological Society
Having become an academic 30 years ago due to the love of ideas and debate, and having spent most of those 30 years not doing this, I have welcomed the chance to think again and before I respond want to thank my commentators for engaging in this process so fully! My call to celebrate variability and critique of the Behaviour Change Technique Taxonomy (BCTT) and the Behaviour Change Wheel (BCW)has not gone without criticism and within these commentaries authors have argued for the benefits of systematisation and consensual frameworks (Johnston, 2016), the feasibility of being innovative within a process of description and prescription (Albarracin & Glassman, 2016), the usefulness of coding and mapping (Abraham, 2016; Peters and Kok, 2016), and the absence of any clear alternative approach to improving behaviour change interventions (Teixeira, 2016). Yet across these very disparate viewpoints three tensions within health psychology have been highlighted which I think remain central to the debate about systematisation. In this response I will briefly discuss these tensions and their implications.
Objective: Jet lag is common place amongst long haul cabin crew. Timed food has been shown to reset the circadian rhythm in rodents. Implementation intentions have been used to change eating behaviour. Meal times could therefore be used as a countermeasure to reduce jet lag and improve alertness in long-haul cabin crew through forming an implementation intention to improve the regularity of meals on days off. Design: 60 long-haul crew took part in a randomized controlled trial, with two conditions: forming an implementation intention to eat regular meals on days off versus no implementation intention. Pre-intervention measurements were taken at baseline (before a long-haul trip) and post-intervention measures were taken on the first and second days off post-trip. Main outcome measures: Subjective jet lag (unidimensional and multidimensional) and objective alertness (Psychomotor Vigilance Task (PVT)). Results: Mixed ANOVA showed a significant condition x time interaction for unidimensional jet lag but not for multidimensional jet lag and objective alertness. In particular, the formation of an implementation intention to alter meal times resulted in a reduction of unidimensional jet lag. Conclusion: Implementation intentions can be used to alleviate jet lag in long-haul crew through promoting a change in meal times.
Background: Weight management interventions involving behaviour change often utilise face to face interventions which include evidence based behaviour change strategies yet are costly and time intensive. In contrast, digital interventions cost less and have a wider reach yet tend to lack an evidence base and are less effective.
Aims: The present study therefore aimed to develop an evidence based behaviour change low cost app for weight management and to provide a preliminary analysis of its effectiveness.
Methods: The Ladle app was developed through evidence review and feedback from health care professionals and patients and consists of a 12 week course focusing on 6 habits and weight loss facilitated through 36 audio psychological lessons and 12 lessons specifically on the 6 habits. Each lesson was between 2-5 minutes (approx. 168 minutes of lessons). It was evaluated in terms of completion rate, weight loss, adoption of the 6 habits and participant feedback.
Results: The results showed a completion rate of 44%, that 52% of Completers showed weight loss of at least 5%, 79% showed weight loss of at least 3%, the median % weight lost was -5% and the median weight loss was -3.8kg. Further, by the end of 12 weeks the majority (>80%) of participants had adopted 4 of the 6 habits for at least 5 days a week and nearly half (45%) had adopted the remaining 2 habits for at least 4 days out of 7. Feedback comments were mainly positive (n=80) focusing mostly on the content of the lessons. Some comments were neutral (n=56) and involved a statement of commitment or a description of a challenge and a minority were negative (n=23) describing some technical issues which were addressed as the evaluation progressed.
Conclusion: The new Ladle app offers an evidenced based alternative to more intensive face to face interventions. On preliminary analysis it would seem to have lower completion rates than some more intensive interventions but comparable effectiveness for weight loss. It can also improve habits and is less time-intensive and costly to deliver. Participant feedback was generally positive.
This study investigated how intensivists make decisions regarding withholding and withdrawing treatment for patients at the end of their lives. This involved completing in-depth interviews from two sites of the South of England, United Kingdom by twelve intensivists. The data collected by these intensivists were analysed using thematic analysis. This resulted in the identification of three themes: intensivists’ role, treatment effectiveness, and patients’ best interest. Transcending these were two overarching themes relating to the balance between quantity and quality of life, and the intensivists’ sense of responsibility versus burden. The results are considered in terms of making sense of death and the role of beliefs in the decision-making process.
Much research has addressed behavior change but has tended to focus on short term changes. This study aimed to explore the mechanisms behind sustained changes in behavior and involved qualitative interviews with 34 `success stories' who had either lost weight through changes in diet and exercise (n = 24) or stopped smoking (n = 10) and had maintained this change for at least 3 years. The results showed that the majority described how their sustained behavior change had been triggered by a significant life crisis relating to their health, relationships or salient milestones. This initial change was then translated into sustained change if three sustaining conditions were met: the function of the unhealthy behavior was disrupted, the individual perceived that their choice over carrying out the unhealthy behavior had been reduced and they adhered to a behavioral model of their problem. Further, these conditions functioned by enabling a process of reinvention with participants showing a shift in identity toward a new healthier self. The results are discussed in terms of self-regulation and the establishment of a new post-crisis healthier equilibrium.
Objectives: Research illustrates that people hold beliefs about the causes and solutions to illness. This study aimed to assess the consistency in these beliefs in terms of their variation according to type of problem and whether they are consistent with each other. Further, the study aimed to assess whether they are open to change and whether changing beliefs about cause resulted in a subsequent shift in beliefs about solutions. Design: Experimental factorial 3 (problem) × 2 (manipulated cause) design using vignettes. Methods: Two hundred seventy-nine participants rated their beliefs about the cause and solution of one of three problems (depression, obesity and sleep problems) following a vignette which described the causes as either psychological or biomedical. Results: Beliefs about causes and solutions varied according to type of problem indicating that beliefs are illness specific. The results also showed that people hold beliefs about causes and solutions which are consistent with each other as an endorsement of a psychological cause was consistently reflected in a belief that a psychological solution was most appropriate and effective. A similar pattern was seen for beliefs about biomedical causes and solutions. Finally, the results showed that beliefs were open to manipulation and that a shift in beliefs about causes resulted in a parallel shift in beliefs about solutions.Conclusions: People hold beliefs about causes and solution which vary according to type of problem. However, they are always consistent with each other and a shift in one set of beliefs results in a significant shift in the other set.
Objective: As weight loss in primary care remains minimal, Health Professionals are advised to medically manage obesity-related risk factors including blood pressure and cholesterol. This experimental study evaluated the impact of medically managing risk factors on obese patients’ motivation to change their behaviour. Methods: A vignette study with two arms: successful medical management (ie risk factors have improved) vs failed medical management (ie no change) set in three General Practices in the South of England. Overweight and obese patients (n=170) patients rated their behavioural intentions and beliefs after reading a vignette describing an overweight patient who had received either successful or failed medical management of their risk factors (blood pressure and cholesterol). Results: Following successful medical management overweight and obese patients reported increased intentions to lose weight and a greater understanding of their condition. Conclusion: Medical management may change patient’s understanding of their weight problem and motivate them to lose weight. Practice implications: Successful management relating to improvements in blood pressure and cholesterol may offer renewed hope and motivate obese patients to change their behaviour. This could be used as a teachable moment to encourage patients to see that obesity need not be an inevitable part of their lives.
This study investigates the lived experience of inflammatory bowel disease with the aim of examining the process of adapting to life with inflammatory bowel disease. Adaptation is often referred to as the desirable outcome in chronic illnesses such as inflammatory bowel disease; yet little is known as to how this is achieved. A total of 10 Crohn's and 12 ulcerative colitis patients recruited from online support networks participated in individual, semi-structured interviews. The study has identified the notion of a 'new normal' as central to adaptation, whereby patients seek to recover a sense of normality by finding an equilibrium between their lives before and after diagnosis.
In the prison context, the Illicit Economy (IE) refers to trade that is forbidden by law or by prison rules which mostly includes either goods ranging from canteen items to classified drugs, New Psychoactive Substances (NPS), prescribed medications, alcohol and mobile phones or services such as money lending and gambling. Although the IE may have some positive impact on prison life by engaging prisoners in an activity that rewards the seller and meets a buyer’s need, or by filling idle hours and keeping prisoners calm, reports suggest that the IE can lead to debt, intimidation, violence and disruptive behaviour. 1,2,3,4,5 This study explored prisoners’ experiences of the illicit economy (IE) and developed a new measure of biddability to predict involvement in the IE; the BIDSCALE.
The aim of this study is to explore the role of attachment styles in obesity. Material and Methods
The present study explored differences in insecure attachment styles between an obese sample waiting for bariatric surgery (n = 195) and an age, sex and height matched normal weight control group (n = 195). It then explored the role of attachment styles in predicting change in BMI 1 year post bariatric surgery (n = 143). Results
The bariatric group reported significantly higher levels of anxious attachment and lower levels of avoidant attachment than the control non-obese group. Baseline attachment styles did not, however, predict change in BMI post surgery. Conclusion
Attachment style is different in those that are already obese from those who are not. Attachment was not related to weight loss post surgery.
Sexual contact between psychological therapists and their clients is regarded as highly damaging, both to the clients and to the professions, and regulatory bodies impose increasingly severe sanctions upon those practitioners who are disciplined. The present study captured therapists' accounts of sexual boundary violations through interpretative phenomenological analysis of interviews with three disciplined practitioners about their relationships with clients and former clients. The results highlighted two key themes relating to (i) therapists' efforts to neutralize the power imbalances between themselves and the clients by minimizing the clients' mental health problems, stressing the conventionality of the relationships and not testing the appropriateness of the relationship with their supervisors, and (ii) a shifting identity of the therapist between hero, victim, perpetrator, which permeated their accounts as the relationship moved from success to failure. In order for a sexual boundary violation to occur, the therapist needed to generate a sense of equivalent status between themselves and the client. As the relationships failed, the therapists' accounts of the clients shifted and the inequality of the relationship re-emerged. The results are discussed in terms of implicit theories and the implications for both training and supervision in the prevention of sexual boundary violations. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message: In accounting for their sexual boundary violations, this small sample of therapists minimized the power imbalances between themselves and their clients. Minimizing the client's mental health problems; stressing the conventionality of the relationship; stressing the therapist's own needs-all contributed to the neutralization of the client's patient status. A relationship with a client that we are not willing to discuss with our supervisor should be a cause for concern. © 2011 John Wiley & Sons, Ltd.
Anecdotal evidence indicates a difference between doctors' health seeking behaviours for their patients and for themselves. This difference remains untested. This study aimed to assess any differences between the first-line treatment options GPs would accept for themselves and those they would advise their patients. A postal questionnaire was completed by 286 GPs based in two west London Health Authorities (response rate 51.4%) asking them to score the treatment options of 6 common symptoms for both themselves and their patients in terms of over the counter (OTC) remedies, prescriptions, referrals and complementary therapies. The results showed that GPs differentiated between themselves and their patients in terms of OTC remedies for indigestion and depression, prescriptions for indigestion, hypertension, depression and 'tired all the time' (TATT); referrals for indigestion, hypertension, low back pain and TATT; and complementary therapy for depression. GPs may be prepared to cross the boundary be treated the same as their patients if the symptoms are relatively uncontroversial. Stigmatised problems and those with clinical guidelines, however, seem to result in a 'do as I say not as I do' approach to health care. (C) 2004 Elsevier Ireland Ltd. All rights reserved.
This article analyses research exploring medication adherence, help-seeking behaviour, screening and behaviour change to argue that all interventions have the potential for both benefit and harm. Accordingly, health psychology may have inadvertently contributed to psychological harms (e.g. lead times, anxiety, risk compensation and rebound effects); medical harms (e.g. medication side effects, unnecessary procedures) and social harms (e.g. financial costs, increased consultations rates). Such harms may result from medicalisation or pharmaceuticalisation. Or, they may reflect the ways in which we manage probabilities and an optimistic bias that emphasises benefit over cost.
Emerging research highlights how, due to demographic changes in horse owner populations in Western soci eties, complex owner -horse relationships are leading to inappropriate horse care, including over -nutrition, which in turn can lead to laminitis. Farriers, due to their regular visits, may be in a position to support owners in dealing with this problem. Objectives:
This study explored whether UK farriers have a role in working with horse owners to support horse welfare and prevent laminitis. Study design :
Grounded theory analysis, a qualitative methodology. Methods:
Semi -structured interviews were conducted with 12 farriers and 11 horse owners. The interviews were transcribed verbatim and systematically analysed using an inductive coding approach. Results:
The analysis of the farrier and horse owner interview data revealed farriers and horse owners undertake a contracting process leading to either a task -focussed or holistic - care -focussed approach. Either approach can be satisfactory, but the evidence from this study suggests that when horses are at risk of laminitis, a task -focussed approach misses important opportunities to prevent it. Main limitations :
This analysis , based on a small sample of participants, was not able to identify the frequency of farriers or horse owners orientating towards different approaches in a way that can be generalised to a wider population. However, the power of grounded theory lies in its inductive design to develop new theory, which can be subsequently tested. Conclusions:
Farriers are in a perfect position to support horse owners to prevent laminitis through providing feedback, guidance and advice. However, not all farriers adopt this role and it is not necessary in all contexts. The evidence presented in this study has implications for equine veterinarians and welfare officers in educating horse owners about the value of holistic -care -focussed farriery .
This qualitative Think Aloud study explored how Black women (n=32) processed information from a White or Black fashion magazine. Comments to the ‘White’ magazine were characterised by rejection, being critical of the media and ambivalence, whereas they responded to the ‘Black’ magazine with celebration, identification and a search for depth. Transcending these themes was their self identity of being a Black woman which was brought to the fore either by a sense of exclusion (White magazine) or engagement (Black magazine). Such an identity provides resilience against media thin ideals by minimising the processes of social comparison and internalisation.
Empirical articles published between 1997 and 2001 from 4 health psychology journals that tested or applied 1 or more social cognition models (theory of reasoned action, theory of planned behavior, health belief model, and protection motivation theory; N = 47) were scrutinized for their pragmatic and conceptual basis. In terms of their pragmatic basis, these 4 models were useful for guiding research. The analysis of their conceptual basis was less positive. First, these models do not enable the generation of hypotheses because their constructs are unspecific; they therefore cannot be tested. Second, they focus on analytic truths rather than synthetic ones, and the conclusions resulting from their application are often true by definition rather than by observation. Finally, they may create and change both cognitions and behavior rather than describe them.
Objective: To examine the effect of questionnaire context on self-reported illness cognition. Design: A single-item measure of the perceived impact of lower urinary tract symptoms (LUTS) was embedded twice in a questionnaire battery completed by community-dwelling middle-aged males (N = 1,790). The impact measure was placed in two distinct questionnaire contexts; at the end of a general somatic symptoms questionnaire, and following an illness-specific symptoms questionnaire. The order of the two questionnaire contexts was counter-balanced in a random sub-sample. Main Outcome Measures: An established single-item measure of the perceived impact of LUTS. Results: Concordance between the two single-item measures was moderate. Scores on a single-item measure of impact were significantly lower when assessed immediately following the completion of a LUTS-specific questionnaire than when assessed following the completion of a general symptoms questionnaire. There was no evidence of order effects. The observed effect was moderated by the severity of LUTS such that the difference in perceived impact scores between contexts (where general symptoms context > illness-specific context) increased as urinary symptoms increased. Conclusion: Questionnaire context systematically influenced responses on self-report measures of illness impact. The magnitude of the context effect was largest in the highest quintile of LUTS severity, a difference of >0.5 on a scale with a range of 3. These findings may have implications for situations where patient reported outcome measures are used to evaluate healthcare interventions or inform treatment decisions.
Two promising strategies to manage eating behaviour are Intuitive Eating (IE; following hunger) and Pinned Eating (PE; ignoring hunger / eating at specific times of the day). This study compared IE and PE on behavioural markers. Participants (n=56) were randomly assigned to IE (n=28) or PE (n=28) and given instructions to follow for one week. Drive to eat, behaviour, behavioural intentions and self-efficacy were measured at baseline and follow up. Participants also evaluated their specific intervention. Comparable changes over time were found for both conditions for many measures. Significant condition by time interactions were found for healthy snacking, total self efficacy and self efficacy for weight loss: those following IE showed an increase in each of these outcomes compared to those following PE who showed no change. The IE group found their intervention more useful than those following PE. Further research is needed to build on these preliminary findings.
Background. Research in general practice emphasizes the importance of matched models, beliefs and vocabulary in the consultation. Objective. The present study aimed to explore the impact of matched and unmatched vocabulary on patient satisfaction with consultations. Methods. The study took place in one inner city general practice. Patients (n = 62) were randomized to either matched or unmatched vocabulary consultations when consulting for problems relating to sexual or bodily function or anatomy. Matched consultations required the doctor to use the same vocabulary as the patient. Unmatched consultations required the doctor to use medical vocabulary. Completed questionnaires were received from 60 patients. The main outcome measure was patient satisfaction (using the Medical Interview Satisfaction Scale). This assesses total satisfaction and has four subscales: distress relief; communication comfort; rapport; and compliance intent. Doctor satisfaction with the consultation was also assessed. Results. The results showed that the two groups were comparable for demographic variables and doctor satisfaction. However, patients in the matched consultation group had significantly higher total satisfaction scores and higher ratings of rapport, communication comfort, distress relief and compliance intent than those in the unmatched group. Conclusion. The results indicate that a doctor's choice of vocabulary affects patient satisfaction immediately after a general practice consultation and that using the same vocabulary as the patient can improve patient outcomes.
Objectives To describe contraceptive risk and compensatory behaviour, using condoms or emergency contraception (EC), in young people in education aged 16-24 years. Design Cross-sectional study. Subjects A total of 1135 students aged 16-24 years. Setting Educational establishments in and around London, UK. Results Seventy-six percent of women and 55% of men reported having experienced sex either without contraception or when a condom split or came off. Most participants (or their sexual partners) who reported such risks had compensated by using EC at least once (72% women, 55% men) but only a minority had compensated on each occasion of risk (37% women and 22% men). Of the oral contraceptives users the majority (83%) had experienced a pill 'problem' and the majority of these participants had compensated for such problems by using condoms (79%). Fewer than half of the women who experienced pill problems (45%) compensated by using condoms on each occasion. Less than a quarter (23%) of those who experienced pill problems but did not compensate by using condoms ever compensated by using EC. Conclusions This study demonstrates high levels of primary contraceptive risk and low levels of consistent compensatory condom or EC use. The findings suggest that there would be large increases in EC use and repeated use if all primary contraceptive risks were followed by compensatory action. Interventions to increase contraceptive use should focus not only on initiation of contraception use but acknowledge that risks do happen and promote both continuing use and compensatory behaviour.
Objectives: Leg ulcers are known to have a profound effect on patient quality of life; however, the influence of different treatment approaches is unclear. This review aims to evaluate the comparative impact of conservative treatments and superficial venous surgery, for venous leg ulcers, on patient Quality of Life. Data sources: Three electronic databases (PsycInfo, Medline, and CINAHL), and reference lists of relevant articles, were searched. Two-hundred and nine articles were initially identified, and sixteen articles were included in the review. Results: The results lend cautious support to the suggestion that all treatment has a positive effect on quality of life, regardless of type, whilst wound status also appears to be an important factor. Conclusions: Some evidence suggests that surgical treatment methods may lead to greater improvements in patient quality of life than compression bandaging alone; however, future research may focus on the psychological mechanisms underlying such changes.
J Ogden, I Bandara, H Cohen, D Farmer, J Hardie, H Minas, J Moore, S Qureshi, F Walter, MA Whitehead (2001)General practitioners' and patients' models of obesity: whose problem is it?, In: Patient Education and Counseling44(3)pp. 227-233
Primary care literature emphasises the importance of agreement and shared models in the consultation. This study compared general practitioners' (GPs') and patients' models of obesity. Questionnaires concerning beliefs about the causes, consequences and solutions to obesity were completed by 89 general practitioners (GPs) and 599 patients from practices across UK. In terms of causes, the results showed that the patients were more likely to attribute obesity to a gland/hormone problem, slow metabolism and stress than the GPs, whereas the GPs were more likely to blame eating too much. In terms of consequences, the patients rated difficulty getting to work more highly whereas the GPs regarded diabetes as more important. For the solutions to obesity. the two groups reported similar beliefs for a range of methods, but whereas the patients rated the GP and a counsellor as more helpful. the GPs rated the obese person themselves more highly. It is argued that patients show a self serving model of obesity by blaming internal uncontrollable factors for causing obesity yet expecting external factors to solve it. In contrast, GPs show a victim blaming model by attributing both cause and the solution to internal controllable factors. Such differing models have implications regarding the form of intervention likely to be used in primary care and indicate that whereas patients would prefer a more professional based approach. GPs would prefer a more patient-led one. Further. the results suggest that even if an intervention could be negotiated, success rates would be low as either the patient or the GP would be acting in contradiction to their beliefs about the nature of obesity. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.
This study explored the predictors of weight loss following orlistat with a focus on both baseline variables and changes in beliefs and behaviours occurring over the course of taking the drug. Patients ( = 5 6 6 ) prescribed orlistat completed a questionnaire at baseline and after 6 months concerning their weight, beliefs and behaviours. By 6 months the majority had lost some weight and showed improvements in diet. Many had also stopped taking the drug and a large minority reported using it flexibly as a lifestyle drug. Those who lost most weight showed a decrease in beliefs in a medical solution, a decrease in unhealthy eating, an increased belief in treatment control and an increased belief that the unpleasant consequences are both due to their eating behaviour and just part of the drug. When taken with fatty food orlistat causes symptoms such as anal leakage and oily stools. These may encourage some patients to focus on the behavioural aspects of their weight problem thus promoting the dietary changes needed for both short and longer term weight loss. When prescribing orlistat, clinicians should encourage patients to see the consequences as an education as a means to promote the effectiveness of this form of medical management.
Most quantitative research considers miscarriage a trigger to grief, anxiety and depression. The present qualitative study involved in depth interviews with a heterogeneous sample of 13 women who had experienced a miscarriage up to five weeks previously. The women described their experiences using a range of themes which were conceptualised into three stages: turmoil, adjustment and resolution. For the majority, the turmoil stage was characterised. by feelings of being unprepared and negative emotions. Some women who had had an unwanted pregnancy described their shock at the physical trauma of miscarriage but described the experience as a relief. The women then described a period of adjustment involving social comparisons, sharing and a search for meaning. The latter included a focus on causality which left a minority, particularly those who had had previous miscarriages, feeling frustrated with the absence of a satisfactory medical explanation. The final resolution stage was characterised by a decline in negative emotions, a belief by some that the miscarriage was a learning experience and the integration of the experience into their lives. This resolution seemed more positive for those with children and more negative if the miscarriage was not their first. Rather than being a trigger to psychological morbidity a miscarriage should be conceptualised as a process involving the stages of turmoil, adjustment and resolution. Miscarriage could also be considered a pivotal point in the lives of many women resulting in the reassessment of both their past and future experiences.
Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 (or 35 with co morbidities). A minority of patients, however, either do not show the desired loss of excess weight or show weight regain by follow up. Research highlights some of the reasons for this variability, most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body, psychological issues relating to dietary control, self esteem, coping and emotional eating remain neglected.The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service (BRS) on patient health outcomes. The bariatric rehabilitation service will provide information, support and mentoring pre and post surgery and will address psychological issues such as dietary control, self esteem, coping and emotional eating. The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes.
This study explored the experiences of newly arrived and settled Eritrean immigrants currently in the UK. Semi-structured interviews were carried out with 10 newly arrived (< 1 year) and 10 settled (> 7 years) participants, recruited through an Eritrean café and using snowball sampling. Thematic analysis identified three themes: 1) Wanting freedom, expectations of the UK and the desire for safety, 2) Integration and becoming part of the British community, 3) Personal development, which involved growth and aspirations. Transcending these themes was the notion of balance, and the co-existence of past and present. It is argued that Eritreans in the UK wish to become part of British community whilst at the same time remembering and celebrating their Eritrean culture. This is explained within the context of a dual identity and it is argued that rather than being a hindrance, a dual rather than single identity facilitates the process of integration.
Background. Recent qualitative research indicates that life events can enhance behaviour change maintenance. if a number of sustaining conditions are met. This study aimed to quantitatively test this theory in the context of weight loss maintenance. Method. Based upon their weight histories participants were classified as either successful (n = 431) or unsuccessful (n = 592) dieters and all completed questionnaires relating to life events, choice, the function of eating and exercise and the model of their weight problem. Findings. Successful dieters reported a higher number of life events than unsuccessful dieters particularly for events such as "clothes did not fit me", "doctor's recommendation" and "reached my heaviest weight". Successful participants also indicated reduced choice over their previous unhealthy diet, more choice over their exercise behaviours and more benefits from the new healthy behaviours. They were also less likely to attribute their previous increased weight to any medical and psychological factors. This was accompanied by a belief about the effectiveness of behavioural solutions to their weight problem. Discussion. Life events can promote behaviour change for some individuals. This change is facilitated by a reduction in choice and disruption of function over the unhealthy behaviours, and a belief that behavioural solutions will be effective.
The notion of nudge effects was investigated in two field experiments which focused on influencing customers’ purchases by manipulating the location and availability of food in a University canteen setting. Study 1 manipulated the location of fruit and confectionary. Study 2 restricted the types of bread (i.e. brown only not white) that customers could choose for their sandwiches. The results of the Study1 showed that the fruit sales increased when positioned away from the checkouts. The majority of interviewed customers bought fruit intentionally but those who bought confectionary did it on impulse. In the Study 2, a restricted choice of baguettes did not reduce sales, with customers simply buying more brown baguettes. This increase did not persist after the intervention. Simple changes in the location and availability of food items can nudge the customers’ purchases towards the choice of healthier options. There may be different processes that guide the purchase of fruit (intention/deliberation) and confectionary (impulse/reflex).
Qualitative studies have highlighted the complexity of patient models of health. The present quantitative study aimed to compare general practitioners' (GPs) and patients' models of health. A questionnaire consisting of 27 'markers of health' was completed by 472 patients (response rate 78.8%) and 64 GPs (response rate 71 %). The results showed that GPs and patients were comparable in their ratings of those markers relating to arousal, such as sleep, sex drive and energy and infections, such as neck glands and having lots of colds. However, in the main GPs and patients were consistently different. In particular, the patients showed a higher rating for those markers relating to digestion (e.g. appetite, bloatedness), bodily fluids (e.g. the colour and smell of urine, regularity of bowels), the condition of the tongue, hair and complexion and for more traditional medical markers (e.g. heart beat, body weight). In contrast, GPs reported higher ratings for mood and emotions. To conclude, patients appeared to hold much more diverse models of health than GPs and reported greater endorsement for markers consistent with both a humoral and medical approach to health. These results suggest that GPs and patients do not have a shared understanding of health, which has implications for the effectiveness of primary care consultations. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.
Medically unexplained symptoms such as headache, tiredness and stomach problems are common amongst children and research highlights the potential importance of the family environment in their development and maintenance. The present qualitative study aimed to explore how mothers make sense and manage their child's unexplained recurrent somatic symptoms. Mothers (n=13) with children with headaches, tiredness or stomach problems were interviewed. Transcripts were analysed using thematic analysis. Three main areas emerged relating to "making sense of the symptom", "impact of the symptom" and "strategies for coping". Transcending these areas were three core issues relating to managing ambiguity, authenticity and responsibility. In particular, more ambiguous symptoms were associated with making uncontrollable causal attributions that removed responsibility away from the family. Further, even though the mothers reported coping strategies that may have exacerbated their child's symptoms these were defended in ways to minimise their own potential influence on the symptom and to emphasise its authenticity. In conclusion, mothers perceptions and behaviours may be counterproductive in the longer term but function in the more immediate term by facilitating a protective relationship with their child. © 2012 Copyright Taylor and Francis Group, LLC.
A number of models of behaviour have been applied to contraception use including subjective expected utility theory and social cognition models. Whilst correlates of contraception use have been identified, the limitations of these models include their failure to consider either contextual factors or changes in contraception use over time. Researchers have called for integrated and dynamic models of contraception use, which can be related to the changing contraception use of individual women and can also be readily operationalised to explore within and between subject differences in contraception use. The present study therefore used a qualitative methodology to explore women's contraceptive histories and to enable women to define the issues from their perspectives, resulting in a model of contraception use that is firmly located within the context of their own lives and allows an investigation of the factors and processes involved in changes in contraception use/ non-use over time. This model conceptualises the predictors of contraception use in terms of the meaning and importance of a range of social goals, perceptions of vulnerability and constraints on or facilitators of contraception. Further the dynamic nature of these factors is described and it is illustrated how these core components vary over time according to situation, experience, and new information. The paper outlines the relevance of the findings for different models of decision-making processes and highlights the way that the model addresses the limitations of previous approaches.
The current study aimed to examine the role of binge eating (BE) in explaining weight loss in patients undergoing laparoscopic adjustable gastric banding (LAGB) for severe obesity. Participants were 49 patients (13 males and 36 females) who completed questionnaires two weeks prior and three and six months after their operation. Predictor measures of weight loss included pre and postoperative BE and changes in BE following surgery. A decrease in BE as a consequence of having surgery was able to significantly predict postoperative weight loss. Many surgical services currently screen patients for BE at baseline to identify those most suitable for surgery. This study suggests that this process may be redundant as the results indicate that it is not the presence of BE pre- or post-operatively which are predictive of treatment-induced weight loss, but whether patients' BE behaviours decrease or persist in response to surgery. Future research therefore should seek to identify predictors of decreased BE following surgery in order to enhance candidate selection and improve the efficacy of this form of obesity management. © 2012 Elsevier Ltd.
This study aimed to explore the impact of the size of a post-operative dressing and the subsequent visibility of the wound on recovery from laparoscopic cholecystectomy (LC). A randomised controlled trial was conducted. Fourty-one patients (8 men and 33 women, mean age = 44 years) scheduled for LC were included. Participants were randomly assigned to receive either small gauze dressings (n = 19) or large gauze dressings (n = 22) which were directly applied on post-operative incisions. Patients' mood, psychological well-being, illness cognitions, and pain and recovery were assessed at three time points: baseline, immediately after the procedure and then two weeks later. The findings suggest that the management of post-surgical incisions influences patients' interpretation of their illness which in turn has an impact upon the process of recovery from LC. This implies that visual information available to patients after the procedure through the cognitive and emotional mechanisms involved in their processing can alter the process of convalescence from LC.
Although recent work has encouraged doctors to express their uncertainty to patients as a means to improve communication the potential impact of this on patients remains unclear. The present study first explored the impact of the way in which uncertainty was expressed (behaviourally versus verbally) on doctor's and patient's beliefs about patient confidence. Second the study examined the role of the patient's personal characteristics and knowledge of their doctor as a means to address the broader context. Matched questionnaires were completed by GPs (n = 66, response rate = 92%) and patients (n = 550, response rate = 88%) from practices in the south-east of England. The results showed that the majority of GPs and patients viewed verbal expressions of uncertainty such as 'Let's see what happens' as the most potentially damaging to patient confidence and both GPs and patients believed that asking a nurse for advice would have a detrimental effect. In contrast, behaviours such as using a book or computer were seen as benign or even beneficial activities. When compared directly, GPs and patients agreed about behavioural expressions of uncertainty, but the patients rated the verbal expressions as more detrimental to their confidence than anticipated by the doctors. In terms of the context, patients who indicated that both verbal and behavioural expressions of uncertainty would have the most detrimental impact upon their confidence were younger, lower class and had known their GP for less time. To conclude, patients' reactions to uncertainty occur within the context of the patient's own background and experience, however, some consistent responses can be found. In particular, whilst behavioural expressions of uncertainty may have a positive impact upon patient confidence, verbal expressions have a consistently detrimental effect which is underestimated by GPs. (C) 2002 Published by Elsevier Science Ireland Ltd.
Evidence relating to dietary change is contradictory, as some studies document a lack of dietary change while other studies report a degree of success in the implementation and maintenance of long-term dietary change. The present cross-sectional survey aimed to establish the prevalence of dietary change in a community sample, with a focus on four mechanisms of dietary change: two mechanisms within an active path (accumulation of evidence and trigger to action) and two mechanisms within a passive path (imposed change and seamless change) across participants' lifespan (N = 404). The results indicated that minor dietary change occurred frequently in the lives of 99% of participants. Those described as involving the active path illustrated a reliance on different, self-regulatory styles. In contrast, passive path changes reflected participants' flexible adaptation to the external environment and evolving personal health needs. Both, the changes within active and passive paths, occurred with almost equal frequency across participants' lifespan. Further, while weight loss in the past year tended to be attributed to conscious effort, weight gains were blamed on the obesogenic environment.
This audit was based in general practice and examined 49 consecutive referrals to a UK trained traditional Chinese acupuncturist. It aimed to assess the type of patients referred to an acupuncturist, subsequent changes in health status, whether the effectiveness of acupuncture was related to the type of presenting problem and to examine which factors were predictive of the success of acupuncture. The referred patients had a wide variety of conditions which were categorised as to whether or not there was empirical evidence from trials of responsiveness to acupuncture (evidence based vs non evidence based). Patients completed measures of their health status prior to treatment and at two and six month follow ups. In addition, the referring GP’s beliefs about the prognosis of the problem and the therapist’s and patient’s expectations of success were measured at baseline. The results showed that referred patients reported poorer health status than a historical sample of general practice patients and that they showed significant improvements in all aspects of health status following acupuncture. In particular, patients showed improved energy, pain, emotional reactions, sleep and reduced social isolation at two months which were maintained at six months. Physical mobility was improved at six months. In addition, the results indicated that the best predictors of effectiveness were the therapist’s and patient’s expectations of success at baseline. Effectiveness was not related to the category of condition (evidence based or not) nor to the GP’s expectations about the prognosis of the condition. The results are discussed in terms of implications for the role of acupuncture in General Practice and selectively targeting patients who would be responsive to such an approach.
Antimicrobial resistance (AMR) is a global health burden. Although a complex and multi-faceted problem, inappropriate antibiotic use has repeatedly been identified as one of the main drivers of the acceleration and spread of AMR. Behaviours associated with antibiotic prescription and use have been extensively investigated in human medicine, and in the livestock sector of veterinary medicine. There is now a growing interest in the factors that drive inappropriate antibiotic use in companion animal medicine, as the significance of antimicrobial use in this sector is being recognised. Additionally, the possibility of an alternative antimicrobial, phage therapy, being implemented into companion animal medicine is explored in this study. Interviews revealed complexities in the vet-owner relationship including conflicting perceptions of responsibility regarding antibiotic prescription and use, distrust of vets’ intentions and misconception of clients’ needs. A need for alternative antimicrobials was evident, as all vets were able to report difficulties finding antibiotics to treat infections as a common occurrence. Questionnaire results indicated that vets and pet owners are open to the use of phage therapy in companion animals. This study shows that an alternative antimicrobial such as phage therapy could be accepted into companion animal medicine in the UK, however, effective communication between vets and pet owners is vital if antibiotic use is to be reduced and new antimicrobials successfully implemented.
Background: This paper reports the findings from an interview study conducted with people who had attended a specialist food intolerance clinic running in four general practices in the UK. The aims of the interviews were to investigate the experiential accounts and meaning-making of people who had reported symptom improvement whilst attending the clinic. Methods: Semi-structured interviews were conducted with 10 participants following clinic attendance. Interviews were analysed using Interpretative Phenomenological Analysis. Findings: Analyses revealed five key themes: ‘reported expectations of clinic intervention’, ‘reported symptom changes’, ‘reported implications of symptom change for personal social and emotional life’, ‘accounts of processes of change’ and ‘adherence and non-adherence to dietary regime’. Discussion: Participants reported attending the food intolerance clinic to search for an explanation for the cause of their symptoms. The clinic seemed to work by helping participants to identify food related culprits thus bringing into line their beliefs about causes and solutions to their problem.
Likert scales relating to quality of life were completed by the homeless (N = 75); first year students (N = 301) and a town population (N = 72). Participants also completed free text questions. The scale and free text data were often contradictory and the results highlighted three processes to account for these disparities: i) frame of reference: current salient issues influenced how questions were interpreted; ii) within-subject comparisons: ratings were based on expectations given past experiences; iii) time frame: those with more stable circumstances showed habituation to their level of deprivation. Likert scale data should be understood within the context of how ratings are made.
Many organisations avoid disease-based labels such as 'diabetic' or 'epileptic' as they are believed to be detrimental to a patient's beliefs about their condition and may generate stigma. The aim of this study was to examine the impact of the term 'a diabetic' compared with the term 'a person with diabetes' on the beliefs of participants who either did or did not have the condition. The study used an experimental design and was in two parts, with study cohorts derived from Diabetes UK websites and the University of Surrey website. Part 1 evaluated the impact of the two terms - 'a diabetic' and 'a person with diabetes' - on participants who had diabetes, in relation to their beliefs about the condition, using the Revised Illness Perception Questionnaire. Part 2 measured the impact of these two terms on participants without diabetes in relation to their positive and negative stereotypes of the condition. Data were gathered for 92 participants with diabetes (Part 1) and for 99 participants without diabetes (Part 2). The results showed no significant differences between the term 'a diabetic' compared with the term 'a person with diabetes' on either the beliefs of people with diabetes or the stereotypical attitudes of people without diabetes. In conclusion, the results suggest that the two terms are not as different as has been sometimes assumed. © 2013 FEND. Published by John Wiley & Sons, Ltd.
This experimental study investigated the role of BMI on the impact of weight bias versus body positivity terminology on behavioural intentions and beliefs about obesity. Participants (n=332) were randomly allocated to two conditions to receive a vignette depicting an image of a person with obesity using either weight bias (n=164) or body positivity (n=168) terminology. Participants were divided into 3 groups based upon their BMI category (normal weight n=173; overweight n=92; obese n=64). They then completed measures of behavioural intentions, obesity illness beliefs and fat phobia. Although there were several differences in beliefs by BMI group, the results showed no differences between weight bias or body positivity terminology on any measures. There were, however, significant BMI group by condition interactions for beliefs about obesity relating to personal control and treatment control. Post hoc tests showed that weight bias resulted in reduced personal control in the obese BMI group compared to other participants. Weight bias also resulted in higher personal control over obesity in normal weight individuals compared to body positivity. People with obesity reported higher treatment control when exposed to weight bias compared to overweight participants, whereas normal weight participants reported greater treatment control when exposed to body positivity compared to both other groups. To conclude, the impact of weight bias and body positivity information is not universal and varies according to the BMI of the audience and the outcome being measured; whereas people of normal weight may benefit from weight bias there is no evidence that obese people benefit from body positivity. Implications for the prevention and treatment of obesity are discussed.
Research shows that the attitudes of children and adolescents towards bullying are influenced by the school environment and their peer groups. Given the increased vulnerability to bullying for autistic children, this study explored whether neurotypical children’s attitudes towards bullying and autism varied according to school exposure and personal contact with autistic people. Survey data were collected at the beginning and end of the school year from 775 children aged 11-12, from six schools: three with specialist centres for autism and three without. Participants read vignettes depicting bullying scenarios then completed measures of their attitudes in relation to the vignette and towards autism. Children from centre schools showed a greater increase in prosocial emotions towards bullying. For children from non-centre schools, an interaction showed a decrease in prosocial emotions except in response to social exclusion of an autistic child. Increases in personal contact showed a greater increase in positive attitudes towards autistic people. Explanations draw on theories of inter-group contact and social-moral reasoning. Results highlight the need for contact both at a personal level and through attending a school with an inclusive autism provision to increase understanding, improve attitudes towards autism and reduce tolerance for bullying.
This is an accessible and comprehensive guide to all the major topics of health psychology, including a new chapter on women's health.
Objectives To explore young women's accounts of their use and non-use of emergency contraception. Design Qualitative study using in-depth interviews. Participants 30 women aged 16-25; participants from socially deprived inner city areas were specifically included. Setting Community, service, and educational settings in the London area. Results Young women's accounts of their non-use of emergency contraception principally concerned evaluations of the risk conferred by different contraceptive behaviours, their evaluations of themselves in needing emergency contraception, and personal difficulties in asking for emergency contraception. Conclusions The attitudes and concerns of young women, especially those from disadvantaged backgrounds, may make them less able or willing than others to take advantage of recent increases in access to emergency contraception. Interventions that aim to increase the use of emergency contraception need to address the factors that influence young women's non-use of emergency contraception.
Social media, and particularly posting ‘selfies’ have become fully incorporated into young people’s lives. Research indicates that posting selfies may impact upon self esteem and that feedback in the form of ‘likes’ may change how young people feel about themselves. To date, however, most research has been cross sectional or qualitative limiting conclusions about causality. Further, it has taken place in non naturalistic environments, with no longer term follow up and limited outcome variables. This experimental study explored the impact of posting selfies and receiving feedback (‘likes’) on Instagram on broader aspects of the psychological well-being of young people. Participants (n = 59) aged 16-25 were randomly allocated to one of three conditions for a 7-day intervention (no selfie-posting; posting selfies without feedback; posting selfies with feedback) and completed measures at baseline, after the intervention and at one week follow up. ‘Likes’ were delivered through an app. The intervention had no impact on self-esteem or mood. Posting no selfies resulted in a greater improvement in appearance satisfaction over the study compared to posting selfies (regardless of feedback). In contrast, posting selfies with feedback resulted in a greater improvement in face satisfaction during the intervention although this dropped back to baseline by follow up. To conclude the impact of selfies may vary depending upon which outcome variable is measured and when.
Malignant melanoma (MM) is mainly attributable to UV exposure and research indicates that maladaptive sun safe beliefs and behaviour need to be changed in order to help reduce MM prevalence in the most at risk subset of the UK population; fair skinned young women. Sun safety interventions which are personalised and appearance-based have been found effective at improving sun safe beliefs and behaviour. To date, no research has explored whether the effectiveness of these interventions can be improved by varying both their format of presentation and temporal framing. In this experimental study UK fair skinned young women (n=65) aged between 16 and 25 rated their sun safe beliefs and behavioural cognitions after being exposed to personalised appearance-based information which varied in terms of format (text vs visual) and temporal framing (immediate vs future). Their sun safe behaviour was also observed. The visual format used the Aprilage® digital sun aging programme. The results showed that following the visual format intervention participants had significantly lower perceptions of the skin’s ability to heal, and higher levels of observed sun safe behaviour in the form of taking a sunscreen sample and a sun safety educational leaflet compared to those who received the text intervention. No significant effect of temporal framing was found. The results suggest that a visual, personalised, appearance-based intervention may be an effective form of sun safety promotion for young women in the UK.
Objective GPs sometimes use euphemisms rather than medical terms. The present study aimed to explore the relative impact of using the term ‘obese’ compared to GPs’ preferred euphemism on patients’ beliefs about the problem. Methods A cross sectional survey followed by an experimental study was used with two conditions: the term ‘obese’ versus the GPs’ preferred euphemism. In the cross sectional survey, GPs’ (n = 19) described their preferred use of term. In the experimental study, patients (n = 449) from one General Practice in West London then completed a set of ratings about their beliefs following a vignette using either the term ‘obese’ or the GPs’ preferred euphemism. Results The first stage of the study showed that GPs avoided using the term ‘obese’ and preferred to use a euphemism. The most commonly used euphemism was ‘your weight may be damaging your health’. The second stage showed that the term ‘obese’ made patients believe that the problem had more serious consequences and made them feel more anxious and upset than when the same symptoms were labelled using the euphemism. When analysed according to the patient's own BMI, however, the results showed that the term ‘obese’ had a greater emotional impact than the euphemism only on patients who were not obese; obese patients found the euphemism more upsetting. Conclusion GPs avoid using the term ‘obese’ for fear of upsetting patients. This term, whilst making the problem appear more serious is only more upsetting for non-obese patients. Practice implications GPs choice of term therefore needs to reflect whether they want the patients to be upset or whether they want them to accept the seriousness of their problem.
Whilst overeating is often influenced by others in an implicit way, people may also explicitly encourage others to overeat. This has been labelled being “a Feeder” but to date, this more deliberate trait remains neglected. This study aimed to conceptualize being “a Feeder” in terms of motivations and behaviour and to operationalize this construct with a new measurement tool through five stages with three discrete samples. Using the definition of a Feeder as “someone who offers others food even when they are not hungry” a preliminary qualitative study (n = 5) clarified the behaviour of a Feeder and revealed six motivations for such feeder behaviour. These six motivational dimensions and the feeder behaviours were operationalized with individual items and the psychometric properties of the scale were assessed using two independent samples (n = 116; n = 113). The final 27‐item measure consisted of six motivational factors (affection; waste avoidance; status; hunger avoidance; offloading; manners) and one behaviour factor, all with good internal consistency (α ≥ .7). The two samples were then merged (n = 229) to describe motivations and behaviour and to assess the association between them. The best predictors of feeder behaviour were love, offloading, manners and status. This new Feeder questionnaire has a strong factor structure and good internal consistency and could be used for further research or clinical practice.
It is well established that exercise and lifestyle behaviours improve men's health outcomes from prostate cancer. With 3.8 million men living with the disease worldwide, the challenge is creating accessible intervention approaches that lead to sustainable lifestyle changes. We carried out a phase II feasibility study of a lifestyle intervention delivered by nine community pharmacies in the United Kingdom to inform a larger efficacy study. Qualitative interviews explored how men experienced the intervention, and these data are presented here.
Community pharmacies delivered a multicomponent lifestyle intervention to 116 men with prostate cancer. The intervention included a health, strength, and fitness assessment, immediate feedback, lifestyle prescription with telephone support, and reassessment 12 weeks later. Three months after receiving the intervention, 33 participants took part in semistructured telephone interviews.
Our framework analysis identified how a teachable moment can be created by a community pharmacy intervention. There was evidence of this when men's self‐perception was challenged and coupled to a positive interaction with a pharmacist. Our findings highlight the social context of behaviour change with men identifying how their lifestyle choices were negotiated within their household. There was a ripple effect as lifestyle behaviours made a positive impact on friends and family.
The teachable moment is not a serendipitous opportunity but can be created by an intervention. Our study adds insight into how community pharmacists can support cancer survivors to make positive lifestyle behaviour changes and suggests a role for doing rather than just telling.
Abstract Purpose - To evaluate an online ‘teachable moment’ intervention to promote healthy eating for overweight and food intolerance symptoms. Design/methodology/approach – The study involves a 2 x 2 factorial design with two conditions: group (weight loss vs food intolerance) and condition (intervention vs control). The intervention aimed to generate a ‘teachable moment’ by providing knowledge regarding the relationship between food and the problem (overweight or food intolerance), focusing on the negative aspects of the problem, creating a behavioural model, and encouraging hope and reinvention. Participants receiving the intervention (n = 22) completed measures of dietary behaviour and either weight or food intolerance symptoms before receiving the intervention and again one month later. Control participants (n = 20) provided measures but did not receive the intervention. Findings - There were no significant reductions in weight or food intolerance symptoms. However, compared to control participants, participants in the intervention conditions reported greater intentions to eat healthily (p = .01) and improved healthy eating behaviour over time, following both an intention-to-treat (p = .046) and explanatory analysis (p = .042). Practical implications - Encouraging individuals to perceive their everyday situation as a time for change and adopt healthier behaviour early on, may prevent future diet-related medical events. This has benefits for both the individual and for health care costs. Originality/value - A quick and easy to administer online ‘teachable moment’ intervention improves dietary behaviour and can be minimally adapted to suit individuals with differing health needs.
Background: Research has shown that doctor's make judgements about patients on the basis of their demographic characteristics. Little is known about how patients judge their doctors. Aim: The present study aimed to explore the impact of a doctor's ethnicity, age and gender on patients' judgements in the setting of a general practice consultation. Methods: The study involved an experimental factorial design using vignettes with patients receiving one of eight photos of a doctor who varied in terms of ethnic group (Asian versus White), age (older versus younger) and gender (male versus female). Six general practices in South West London took part and 309 patients (response rate = 77%) rated the doctor in terms of the expected behaviour of the doctor, the expected behaviour of the patient and the patient ease with the doctor. Results: The results showed that in terms of the impact of ethnic group, the Asian doctor and White doctor received comparable ratings for most questions; however, the Asian doctor was rated as being more likely to explore emotional aspects of health than the White doctor. Differences for age and gender were more profound. In particular, both the younger doctor and the female doctor were judged to have a better personal manner, better technical skills, better explanation skills, to be more likely to explore emotional aspects of health and empower the patient. Patients also stated that they were more likely to have faith in their diagnoses, advice and to comply with treatment and preferred both the younger and female doctors for a physical examination. In addition, younger doctors were deemed to be more likely to refer a patient to see a hospital specialist and female doctors were seen to be more likely to suggest complementary therapy. Conclusion: A doctor's age and gender have a stronger impact on a patient's judgements than their ethnicity.
There has recently been an increased call for the use of more diverse images by the media as a means to promote body satisfaction. The present experimental study evaluated the impact of body diversity images and whether these could act as a buffer against thin-ideal norms. Female participants (n=106, aged 16-30 years) completed measures of body compassion, body and face satisfaction before and after random allocation to images reflecting one of three interventions: control, body diversity and thin-ideal. Attitudes towards thin-ideal images were also assessed. The results showed significant differences between groups for overall body compassion, the body compassion subtype of body kindness, body satisfaction and face satisfaction with those viewing the body diversity images reporting higher scores after exposure compared to the other two groups. Those in the body diversity group also displayed more negative attitudes towards thin-ideal images compared to controls. There were no differences between the groups for body compassion subtypes relating to common humanity, motivated action and body criticism or positive attitudes to the thin-ideal images. In sum, exposure to body diversity images had a positive impact on body kindness and overall body compassion and body satisfaction providing experimental support for the use of diversity images as a buffer against thin-deals.
A repeated measures cohort study was conducted to investigate the impact of attending a day treatment programme on physical and psychological state, and to assess which baseline factors predicted level of recovery. Physical and psychological outcomes of treatment were analysed for 116 patients admitted to the treatment programme between 1996 and 2006 and were found to be in line with previous day care evaluations, with the majority of patients showing improvements on all measures. A multiple regression analysis revealed several factors to be predictive of treatment outcomes including patient demographics, comorbidities and traumatic life events. In particular, those patients who benefited most from the treatment had a lower body mass index at admission, stayed longer at the unit, were older, less likely to have other physical and psychiatric comorbidities, particularly obsessive compulsive disorder or a history of sexual abuse, and whose most predominant eating disorder problem was characterised by low weight.
Research indicates that parental control and parental modelling are key factors in shaping a child's eating behaviour. To date, however, little is known about how these factors influence a child's diet once they have left home. This prospective study evaluated the extent to which a parent's own behaviour and their use of control over food whilst their child was still living at home predicted their child's relationship with food once they had begun to live independently. Parent/child dyads (n=93) took part in the study. Parents completed baseline measures of parental control practices (overt control, covert control and pressure to eat), their own diet (unhealthy snacks, unhealthy meals, healthy foods) and eating behaviours (emotional, uncontrolled and restrained eating). At one year follow up, once their child had left home, the child completed measures of their own diet and eating behaviours. The results showed a clear role for modelling with concordance between a child's intake of unhealthy snacks and emotional eating and their parents' own reports of these behaviours. Furthermore, the child's intake of healthy foods was also predicted by their parent's behaviour although there was both concordance and discordance between parents and their children. No role for parental control was found for any measure of diet or eating behaviour. It is concluded that a parent's own behaviour rather than parental control has a stronger longer lasting influence once a child has left home and that although this mostly involves a child copying their parent's behaviour (action) at times it also involves the opposite (reaction).
Eating behaviour is influenced by both cognitions and triggers in the environment. The potential difference between a ‘snack’ and a ‘meal’ illustrates these factors and the way in which they interact, particularly in terms of the label used to describe food and the way it is presented. To date no research has specifically explored the independent and combined impact of label and presentation on eating behaviour. Using a preload / taste test design this experimental study evaluated the impact of label (‘snack’ vs. ‘meal’) and place (‘snack’ vs. ‘meal’) of a preload on changes in desire to eat and subsequent food intake. Eighty female participants consumed a pasta preload which labelled as either a ‘snack’ or a ‘meal’ and presented as either a ‘snack’ (standing and eating from a container) or a ‘meal’ (eating at a table from a plate), generating four conditions. The results showed main effects of label and place with participants consuming significantly more sweet mass at the taste test when the preload had been labelled a ‘snack’ and more total mass and calories when the preload had been presented as a ‘snack’. No label by place interactions were found. The results also showed a combined effect of both label and place with those who had eaten the preload both labelled and presented as a ‘snack’ consuming significantly more in terms of nearly all measures of food intake than those in the other conditions. To conclude, label and presentation influence subsequent food intake both independently and combined which is pertinent given the increase in ‘snacking’ in contemporary culture
Much research has explored the interaction between doctor and patient in the consultation and patient centredness has generally emerged as the preferred mode of consultation style. The present study aimed to examine and compare general practitioners' (GPs) and patients' beliefs about the importance of the different aspects of patient centred behaviour in a consultation. Matched questionnaires were completed by 410 patients (response rate = 76.5%) and 64 GPs (response rate = 85.3%) from practices around London concerning aspects of patient centredness operationalised in terms of doctor receptiveness, patient involvement, the affective content of the relationship and information giving. The results showed that GPs and patients showed similar beliefs about involving the patient in decision making, aspects of doctor receptiveness and the importance of the patient's own feelings in the consultation. However, GPs believed that it was less important to focus only on the patient's main problem, and more important to acknowledge their own feelings and avoid medical language. Further, GPs rated doctor receptiveness and the affective content of the relationship overall as more important for a good consultation than the patients. The patients also consistently rated information giving as more important than the GPs. To conclude, GPs rated the doctor receptiveness and affective components of patient centredness as more important than patients whereas patients showed greater endorsement of information indicating that although patient centredness may currently be the preferred style of consultation, doctors and patients prefer different aspects of this behaviour. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.
This study compared the impact of different forms of distraction on eating behaviour with a focus on the mechanisms behind this association and the link between the amount consumed and changes in the desire to eat. Participants (n=81) were randomly allocated to four conditions: driving, television viewing, social interaction or being alone in which they took part in a taste test. Measures of the desire to eat (i.e. Hunger, fullness, motivation to eat) were assessed before and after the intervention. The results showed that those watching television consumed more than the social or driving conditions. Food intake was associated with a decreased desire to eat for those eating alone, but was unrelated to changes in the desire to eat for those driving. Watching television also created a decrease in the desire to eat commensurate with food intake whereas social eating resulted in the reverse relationship. The results are discussed in terms an expanded model of mindless eating and it is argued that eating more requires not only distraction away from the symptom of hunger but also sufficient cognitive capacity left to attend to the process of eating.
This experimental study seeks to explore the impact of media images on women's body dissatisfaction and to assess whether this impact could be reduced by an educational intervention describing the power of air-brushing. Design/methodology/approach
The study involved a 2×2 factorial design with two conditions: picture (thin vs fatter) and air-brushing intervention (present vs absent). A total of 200 women completed measures of body dissatisfaction before and after viewing the experimental information. Findings
The results showed that women felt consistently more dissatisfied with their bodies after viewing thin pictures and more satisfied after viewing fatter pictures. In addition, the air-brushing intervention reduced the detrimental effect of viewing the thinner pictures but had no effect on the benefits of viewing the fatter pictures. Originality/value
Media images may have a role to play in body dissatisfaction in women. But a simple intervention focusing on air-brushing can facilitate a more critical perspective and thus provide a buffer against the influence of media images.
Although weight loss surgery (WLS) is currently the most effective management approach for those with a Body Mass Index greater than 40, many patients are left with excess skin and a sense that they are aesthetically worse than they were before. This in-depth qualitative study explored patients' (n = 7) experiences of having plastic surgery post WLS. Thematic analysis revealed three broad themes; (i) a journey which involved investing time, energy and money; (ii) goals such as health, improved body esteem, choice and a desire to feel normal; (iii) barriers to achieving these goals including shame, guilt and self-criticism. Transcending these themes was a gradual recognition that their problems should not be treated with a surgical approach alone but were more psychological in nature, which emerged through shifting expectations that could never be met and an acknowledgement that their physical shape was not the key cause of a negative sense of self. Accordingly, by the end of their surgical journey they began to question whether they had set out on the wrong journey with the wrong goals in mind which is discussed in the context of social comparisons and the need for coherence between beliefs about causes and solutions. © 2014 © 2014 Taylor & Francis.
This paper aimed to develop a reliable measurement tool to evaluate the meanings of food that could be used in both practice and research and to examine possible gender differences. A new meaning of food questionnaire (MOF) was refined across two studies (study 1, n = 451 and study 2, n = 170). The final questionnaire consisted of 25 items and 8 reliable subscales: food and sex, emotional regulation, treat, guilt, social interaction, control over life, control over food, family. The new Meaning of Food (MOF) questionnaire could be used in both research and clinical practice to profile patients and explore predictors of eating behaviour. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.
This paper aimed to investigate which parents use which types of parenting control practices to manage their children's diets and to assess the impact of these practices on children's dietary patterns and their BMI. A cross-sectional survey of 518 parents with children aged 4–7 years was carried out in 18 primary schools across the South of England. Measures included aspects of parental control practices and the child's diet. Results showed that older parents with a lower BMI and who were stay at home parents used more “snack overt control”, “snack covert control” and “meal covert control” and those with more education used more covert control strategies. In contrast, male, non-white parents with younger children used more “pressure to eat”. In terms of the children's diet, the results showed links between parental and child demographics and aspects of unhealthy and healthy food intake. In addition, links were also found for parental control practices. For example, eating more unhealthy snacks was related to less covert control and more pressure to eat, eating fruit and vegetables was related to higher levels of both overt and covert control over meals and less pressure to eat and being neophobic was related to less covert control over meals and more pressure to eat. The children's BMIs were unrelated to any variables measured in the study
Doctors often use a range of euphemisms as a means to facilitate communication in the consultation. The present experimental study aimed to assess whether GPS use or avoid the term 'heart failure' and to evaluate the relative impact of the term 'heart failure' Versus their preferred euphemism on patients' belief's about the illness. This two part study involved a cross sectional Survey of GPs and all experimental Study of patients' beliefs and was based oil one General Practice in a semi-rural area of the UK. For the first part, 42 GPs completed a questionnaire about their preferred terms to describe symptoms of heart failure. The results showed that GPs rated the majority of euphemisms as preferable to the term 'heart failure'. Their preferred euphemism was 'fluid oil your lungs as your heart is not pumping hard enough'. For the second part, 447 patients completed ratings of their beliefs about a condition, which was described its either 'heart failure' or the GPs' preferred euphemism. Patients who received the condition described as 'heart failure' believed that the illness would have more serious consequences for their life. that the problem would be more variable over time and that it would last for longer and reported feeling more anxious and depressed than those who received the condition described using the euphemism. GPs are encouraged to be open with their patients and to respect their experience. The choice of language, therefore, presents a dilemma for doctors. The term 'heart failure' may be in line with the Current climate of openness but may evoke a more negative response from the patient. In contrast, a euphemism may be less open but more protective of the patients experience. This study suggests that the area of heart failure may be one where GPs may chose to compromise openness for the sake of the patient's experience and that this fear of upsetting the patient is well founded. (c) 2004 Elsevier Ireland Ltd. All rights reserved.
Our objective was to examine patients' experiences of taking orlistat as a means to explore adherence and behavior change.
Health education highlights the role of fear and knowledge as a means to improve women's use of contraception. This paper explores the ways in which contraception use is more complex than this and argues for a central role of beliefs, aspects of the situation and negotiation in determining whether or not a woman decides to use contraception and which form of contraception is best for her. In terms of beliefs, research highlights the role of a range of beliefs about the costs and benefits of each form of contraception, the risk of pregnancy and STDs and people's feelings of competency at using contraception. Contraception use however, arises out of the sexual situation, which involves an interaction between people. This situation can result in emotions such as anxiety and embarrassment and is often associated with high levels of arousal, which may be exacerbated by drugs or alcohol. At such times using contraception may not always be high priority. Finally, contraception use involves communication and negotiation both between sexual partners and with health professionals. Research indicates that whilst people are prepared to become intimate with each other physically, discussing contraception can be embarrassing, leading to non-use if either partner is less than determined. Furthermore, contact with health professionals such as the GP, pharmacist or nurse may also feel uncomfortable and be a barrier to seeking help. Contraception use is therefore the result of a complex set of cognitions and emotions, which are not sufficiently addressed by knowledge and education. It is suggested that such factors should be given more attention within health education if contraception use is to increase. Further it is argued that whilst health professionals may aim to encourage 'best case' contraception use, a compromise approach such as the use of emergency contraception is always worth pursuing. © 2005 Elsevier Ltd. All rights reserved.
Although texts recommend the generation of rich data from interviews, no empirical evidence base exists for achieving this. This study aimed to operationalise richness and to assess which components of the interview (for example, topic, interviewee, question) were predictive. A total of 400 interview questions and their corresponding responses were selected from 10 qualitative studies in the area of health identified from university colleagues and the UK Data Archive database. The analysis used the text analysis program, Linguistic Inquiry and Word Count, and additional rating scales. Richness was operationalised along five dimensions. ‘Length of response’ was predicted by a personal, less specific or positive topic, not being a layperson, later questions, open or double questions; ‘personal richness’ was predicted by being a healthy participant and questions about the past and future; ‘analytical responses’ were predicted by a personal or less specific topic, not being a layperson, later questions, questions relating to insight and causation; ‘action responses’ were predicted by a less specific topic, not being a layperson, being healthy, later and open questions. The model for ‘descriptive richness’ was not significant. Overall, open questions, located later on and framed in the present or past tense, tended to be most predictive of richness. This could inform improvements in interview technique.
Aims: To study tobacco advertising in the United Kingdom between 1950-2003 and to evaluate the role of the cigarette box in advertising. Method: Tobacco company advertisements (n=204) were coded for content and meanings used to promote the product. Results: There was a significant shift over time from cigarettes being displayed to the cigarette box only. Changes in advertising and the meanings evoked were unrelated to changes in smoking behaviour. Conclusions: It is argued that the cigarette box has absorbed the meanings associated with smoking and has become an effective vehicle for advertising. It is also argued that this can only be minimised with plain packaging.
The present study evaluated community nurses’attributions for a case patient's heart attack and their recommendations for treatment Eighty-nine district nurses and health visitors completed a set of rating scales following a case vignette describing a patient who had suffered a heart attack and prior to which had either adopted a healthy lifestyle (n=47) or had maintained unhealthy behaviours (n= 42) The results suggest that subjects in the unhealthy-behaviour condition rated the case patient as less likely to follow advice, more responsible for his/her condition and rated the heart attack as more preventable In addition, the results suggest that subjects were more likely to offer recommendations for behavioural change to the unhealthy case patient and that these recommendations were significantly related to internal attributions of patient responsibility The results are discussed in terms of theories of health professionals’beliefs and behaviours
This experimental study explored whether the physical symptoms of cold, pain and itchiness could be generated by visual cues, whether they varied in the ease with which they could be generated and whether they were related to negative affect. Participants were randomly allocated by group to watch one of three videos relating to cold (e.g. ice, snow, wind), pain (e.g. sporting injuries, tattoos) or itchiness (e.g. head lice, scratching). They then rated their self-reported symptoms of cold, pain and itchiness as well as their negative affect (depression and anxiety). The researcher recorded their observed behaviour relating to these symptoms. The results showed that the interventions were successful and that all three symptoms could be generated by the visual cues in terms of both self-report and observed behaviour. In addition, the pain video generated higher levels of anxiety and depression than the other two videos. Further, the degree of itchiness was related to the degree of anxiety. This symptom onset process also showed variability between symptoms with self-reported cold symptoms being greater than either pain or itchy symptoms. The results show that physical symptoms can be generated by visual cues indicating that psychological factors are not only involved in symptom perception but also in symptom onset.
Although much research has investigated the drivers of inappropriate antimicrobial prescribing in human medicine, equivalent research in veterinary medicine is in its infancy. This qualitative study used a critical incident approach to explore farm veterinarians' (vets) and farmers' beliefs about antimicrobial use and antimicrobial stewardship. Semi-structured interviews were conducted with 13 vets and 12 farmers in the UK, who worked mostly with beef cattle, dairy cattle and sheep, but a minority also worked with pigs or poultry. An inductive thematic analysis was conducted to explore how vets and farmers understood their responsibilities toward stewardship and antimicrobial resistance (AMR) and to identify key similarities and differences between the professions. The analysis generated four themes: “A shared conflict between ideals and behaviour,” “Barriers to stewardship: the vets' perspective,” “Barriers to stewardship: the farmers' perspective,” and “A shared ambivalence: ownership vs. other-blaming.” Vets and farmers demonstrated good understanding of stewardship but their treatment decisions are not always aligned to stewardship principles. Various barriers to improving antimicrobial stewardship were discussed by vets and farmers, but they placed differing emphasis on specific barriers. Faced with these barriers and an awareness that antimicrobial usage is not always aligned to stewardship principles, vets and farmers expressed frustration and a sense of ambivalence toward stewardship, and also engaged in other-blaming for the problem of AMR. In conclusion, vets and farmers in this study seem motivated to be antimicrobial stewards but feel challenged by the day-to-day reality of their jobs; they experience ambivalence toward their responsibilities for AMR, which may negatively impact their motivation to always act as antimicrobial stewards. Successfully tackling AMR will require change at the individual-, group-, and societal-level. Future interventions to improve antimicrobial usage in livestock farming could be situated within a social ecological framework, where other-blaming between professions is seen as a result of the interplay between psychological and contextual factors. Other-blaming could be reduced using a social identity approach; a common ingroup identity could be created by encouraging vets and farmers to focus on their common goal, namely a shared desire to promote animal welfare through optimal antimicrobial stewardship.
Prisons provide an important public health opportunity to improve the health of a hard-to-reach population. However, the prison as a place for health promotion requires greater attention. Using De Certeau’s concept of tactics, semi-structured interviews with 35 young men who had screened as low on an anxiety and depression scale, illustrate how they stitch together discrete tactics to navigate the prison system and mitigate the risks to their health and wellbeing. These involve a process of being vigilant to the cracks in the system whilst appropriating objects and seeking out spaces of comfort. Understanding imprisonment in this nuanced approach provides greater insights into the interplay of health and place with the potential to inform context-relevant practice and policy.
Background. Although consultations have increased in length, patients still express dissatisfaction with how much time they spend with their doctor. Objectives. This study aimed to explore aspects of consultation time and to examine the correlates of patients' desire for more time. Methods. A quantitative cross-sectional design was used. General practice patients from eight UK practices (n = 294) completed a questionnaire following a consultation regarding their satisfaction with the consultation, their beliefs about how long the consultation lasted (perceived time) and how long they would have preferred it to last (preferred time). The actual consultation length (real time) was recorded by the doctor. Results. The majority of patients underestimated how long the consultation took, and a large minority stated that they would have preferred more time. When controlling for both real time and perceived time, a preference for more time was correlated with a dissatisfaction with the emotional aspects of the consultation and a lower intention to comply with the doctors recommendations. It was unrelated to satisfaction with the information giving and examination components of the consultation. Conclusion. Patients' dissatisfaction with consultation length could be managed by making consultations longer. Alternatively, it could also be managed by changing how a given time is spent. In particular, a doctor who listens and tries to understand their patient may make the patient feel more satisfied with the consultation length and subsequently more motivated to follow any recommendations for change.
The present qualitative study aimed to explore how people experience their obesity and to explore the impact of this on their motivations to lose weight. Participants (n = 46) were either currently obese or had been obese and were interviewed about their experiences. Participants described the impact of obesity on aspects of their self-identity and used language such as "ugly", "freak", "hate", "blob", and "disgust" which reflected the pervasively negative impact of their weight. They highlighted a complex and often contradictory relationship with food and described how such negative experiences were created out of the dynamic between their obesity and a stigmatising social context. Some, however, suggested that such stigma could also have positive consequences by promoting and encouraging behaviour change. Many obese people, therefore, experience their weight in profoundly negative ways as a result of existing within a social context which stigmatises their condition. The results are discussed in terms of the costs and benefits of stigma and a balance between support, tolerance, and collusion in promoting weight loss.
The aim of this study is to explore the experiences of young women undergoing weight loss surgery in relation to quality of life and health behaviour issues with a focus on reproductive health. This is in light of the increasing numbers of women who have unsuccessfully tried conventional weight loss approaches and are now opting for surgical interventions in order to gain control of their weight and better assimilate into society. Weight loss operations refer to a collection of permanent and reversible surgical techniques collectively known as Bariatric Surgery (“BS”), which have been demonstrated to be an effective and viable treatment to sustain weight-loss in the severely obese. These operations are unique in that they also have a positive influence on other medical conditions and aid long-term health, including resolving menstrual irregularities leading to improved female fertility. In recent years there has been an increase in women aged 18-25 years who have undergone BS. This age bracket correlates with the natural ‘peak’ in fertility and inevitably leads to some early post-surgery pregnancies with an increase in the risk of adverse health issues for both mother and (foetal development) child. Seven women (aged 18-25 years) responded via an on-line tool to share their experiences of undergoing BS, in one to one recorded interviews conducted via Skype. All had undergone surgery within the private sector and were 6-24 months post-surgery at the time of the interview. Thematic framework was used to analysis and understand the personal narratives and identify semantic themes. The participants described their experiences in terms of three broad themes i) identifying a problem, ii) seeking help and iii) reality check. Transcending these themes was the ‘cost’ which linked with the Subjective Expected Utility (SEU) Theory being the theoretical framework underpinning this study, based on the decision making model of behaviour (Edward 1954). The majority of the participants described feeling optimistic after-surgery, however this was balanced against various costs (trade-offs) of positive/negative experiences and outcomes with a realisation for some that psychological issues still needed to be addressed. These findings provide an insight to the physical and psychological experiences of young women who have undergone BS and offer awareness for health care professional and prospective participants considering/preparing to undergo BS.
Obesity is a leading cause of death globally and is an increasing public health concern. To provide effective treatment and prevention interventions it is essential to understand the mechanisms underpinning obesity. One area receiving increased attention in this field is attachment. This thesis aimed to determine the role attachment styles have in the obese population. Part one of this portfolio presents a review of research investigating the relationship between attachment styles and obesity. The findings of the review suggest that insecure attachment styles are implicated in the development of obesity, weight loss and well-being in the obese population. It was found that the relationship between attachment styles and obesity was mediated by factors including coping styles, trauma, psychopathology, emotional awareness and emotional eating. Part two presents an empirical paper that investigated the link between attachment styles, emotional eating and obesity using an experimental design. The findings indicate that mood drives food preferences and desire to eat, with BMI and attachment moderating the relationship.
South Asians have been neglected from studies exploring help-seeking related to sexual problems. This experimental case vignette study aimed to explore the role of ethnic group and gender on the beliefs held about the causes, consequences and possible solutions to sexual problems. The study examined the impact of ethnic group (South Asian versus White British), gender of the person in a fictitious case vignette (male versus female), and participant gender (male versus female) on beliefs about sexual problems and coherence between beliefs. 291 participants randomly received a single sentence case vignette depicting either a male or female with a sexual problem and completed measures online concerning their beliefs about causes, consequences and solutions to sexual problems. South Asian and White British participants equally endorsed a psychological causal model, however South Asians showed greater endorsement for biological and social factors for the causes, consequences and solutions to sexual problems. Participants considering the male case vignette perceived greater psychological consequences and biological solutions compared to those who received the female case vignette. Female participants showed greater endorsement for biological, psychological and social causes, and biological and social consequences. Both ethnic groups showed a coherent model between beliefs about the causes and the solutions to sexual problems. The findings provide theoretical support to cognitive models of help-seeking and offer clinical implications to improve help-seeking behaviour and management of sexual problems.
Transcranial direct current stimulation (tDCS) as a means for enhancing learning and memory has received a lot of attention in recent times. However, its applicability in a wider context has been limited due to lack of replicability across the literature. This may likely stem from inter-individual differences such as age, gender, nutrition, stress, brain morphology and sleep. Sleep in particular may be a source of inter-individual differences in tDCS-effect because of its link to brain plasticity mechanism such as long-term potentiation (LTP). The extent to which sleep may account for inter-individual differences in tDCS outcomes has not been assessed in the literature. Therefore, the central aim of this thesis is to investigate 1) the effect of sleep quality 2) circadian mis- /alignment 3) prior sleep compared to wake on tDCS-enhanced learning. Findings from this thesis suggests that sleep quality does not affect variability in tDCS-effect on cognitive performance, while circadian mis/-alignment and prior wakefulness before task may modulate tDCS-efficacy. In conclusion, data suggests that tDCS-effect is greater in a brain which is in a non-optimal state in terms of circadian misalignment and prolonged wake, and in this context, sleep may be responsible for variabilities in tDCS studies. These findings have implications for researchers and clinicians using tDCS. Further studies are required to fully characterise the findings from this thesis.
Abstract This thesis contains three related studies in the general field of educational psychology and in the specific area of behaviour, educational achievement and educational needs in mainstream schooling. The work investigated relationships between behaviour and achievement in the educational context of Kuwait, where poor behaviour has been argued to be a primary cause of low education achievement levels. Using a systemic approach, the first study sought to establish patterns of behaviour and educational achievement among Kuwaiti pupils in grades 4 and 5 of primary schools. The results indicated associations between some behavioural traits (particularly hyperactivity) and measures of literacy and numeracy. The second study took advantage of an inclusion project undertaken in Kuwait to improve classroom management practices and increase awareness of, and support for, students with learning problems. Using the same methods as in Study 1, the second study investigated levels of behaviour and educational achievement among pupils in grades 4 and 5 taught by teachers who had been inclusion trained in comparison with non-inclusion trained teachers in an adjacent educational district. Results suggested that the hypothesised associations between behaviour and academic attainment existed but there were no significant differences in the measures between schools where teachers had been inclusion trained and those where they had not. Thus, relations between behaviour and academic achievement are important and may be impervious to change. The third study explored the comparative attitudes, practices and beliefs of inclusion and non-inclusion trained teachers and identified one significant difference, which was in terms of the educational structures of Kuwait. The thesis has the potential to make contributions to knowledge in several areas, both theoretical and practical. One is that there is a relative lack of similar studies that are set within a Middle Eastern context generally and within a Kuwaiti context specifically. Others include a systemic approach (something that differentiates it from a majority of work in this area of educational psychology) and the potential to inform future policies and interventions in Kuwaiti primary schools that are focused on behaviour and its associations with academic attainment.
Primary objective : This study assessed the degree of insecure attachment style in a sample of patients undergoing bariatric surgery compared to a normal weight control group. It also investigated the association between attachment style and eating behaviour within the bariatric group pre-surgery and the impact of attachment on weight loss 6 months post-surgery. Design and method: A cross sectional and cohort quantitative design was used. The bariatric group consisted of 195 patients recruited from a bariatric clinic who were compared with 195 normal weight controls recruited through social media. All participants completed the ECR-R and provided demographic information. The bariatric group also completed measures of control over eating, diet and exercise behaviour, behavioural intentions, and the Power of Food Scale. T-tests and correlations were used for analysis. Outcome and results: The bariatric group demonstrated significantly higher levels of attachment avoidance and lower levels of attachment anxiety than controls. Significant correlations were found between insecure attachment and hedonic wanting of food, and attachment anxiety was significantly correlated with control over eating. No significant correlations were found between attachment and weight loss at 6 months follow up. Conclusion: A potentially causal relationship between attachment and obesity is discussed, as well as the implications for clinical psychology in bariatric services.
Moral identity, which is based on moral concerns, is one of the many types of identities that an individual may have. In recent literature, spanning the period from the 1980s to the present - including the work of the prominent researcher into moral identity, Blasi, and Aquino and Reed, who developed their widely used moral identity scale in 2000 - there has been a persistent assumption that fairness and caring, or the individualising moral foundations, comprise the entire contents of moral identity. However, it is well documented that broader cultural differences are considered to have a clear effect on individuals, as cultures vary in the degree to which their norms, values and beliefs influence individual identities. Despite this, no published studies have explored moral identity with respect to culture. Thus, in this thesis, I argued that culture influences people’s moral identity, and that we need to consider and expect more moral variation between people across different cultures. I aimed here to develop an understanding of the importance of culture influence on moral identity in two cultural contexts, those of Britain and Saudi Arabia. In Study 1 (n=160), I employed the prototype approach, and my results show that traits related to fairness/reciprocity and care/harm were prototypical of the concept of a moral person among both the British and Saudi participants. Meanwhile, respect, as well as traits related to religiousness, were prototypical of the concept of a moral person in only the Saudi sample. In Study 2, (n = 539), participants from each culture were randomly assigned one of six conditions where they completed moral identity measures. In each condition, participants were presented either with a person characterised by the exact moral traits listed in Aquino and Reed’s (2002) moral identity scale, or with a person characterised by moral traits represent one of the five moral foundations. Also, for each condition, the moral traits important in the participants’ own culture were examined. The results showed large differences between the British and Saudi samples with regard to three moral foundations: in-group/loyalty; authority/respect and purity/sanctity, all three of which relate to binding concerns. These differences were mediated by the perceived cultural importance of these traits in each sample, particularly the binding traits. In Study 3 (n=938), I developed a novel moral identity scale and tested it for its reliability and validity in overcoming the shortcomings of previous scales used to measure moral identity, particularly the overlooked element of cultural variations in morality. Finally, in Study 4 (n=496), and given that there is an assumption in the literature that moral identity which is based on the individualising moral foundations (particularly caring and fairness) has always pro-social implications. I argued in this study that when we expand our understanding of moral identity to include the long-overlooked binding moral approach (e.g., authority, purity, in-group loyalty), moral identity may relate to negative attitudes toward out-groups. The results supported the idea that we need not take for granted that moral identity contributes to a reduction in prejudice. The results also indicated that the new moral identity scale is better than Aquino and Reed’s (2002) moral identity scale in its ability to predict prejudice attitudes. Overall, this thesis demonstrates that the contents of moral identity are more diverse than has been assumed in the moral identity research. In addition, the results indicate that there is a need to be mindful of a dark side to moral identity that is often neglected, specifically when we, as researchers, recognise and include various moral concerns in the conceptualisation and measurements of moral identity.
This thesis presents a literature review and two qualitative research papers that explore the under-researched and under-reported topic of iatrogenesis (unintended harm). There seems no clear theory within Counselling Psychology which encompasses the notion of iatrogenesis. Therefore, this research draws upon relevant theories from other domains. The research in this thesis is underpinned by Merton’s (1936, 1968, 1972, 2016) sociological theory of unintended consequences, which supports a detailed exploration of what happens when two people meet in the social context of the consultation room. Each of the three studies which form this research will explore a different aspect of iatrogenesis. This is intended to support an exploration of unintended harm from various epistemological and methodological positions, and different analytical perspectives. For a conceptual consistency across the research, harm is defined as, “a negative effect [that] must be relatively lasting, which excludes from consideration transient effects ... [such as in-session anxiety or between session sadness, and] must be directly attributable to, or a function of, the character or quality of the therapeutic experience or intervention” (Strupp, Hadley, & Gomes-Schwartz, 1977, pp. 91-92). The theoretical grounding of the Literature Review is Merton’s (1936) theory of the Unanticipated consequences of purposive social action, which I have used to explore the dilemmas involved when the unintended consequences of actions expected to engender helpful change, can result in an unexpected or unexpected outcome. The research begins with a review of the literature that reports the prevalence of iatrogenesis as 10% of the public attending therapy. Therapists in the role of client report the greatest level of harmful experiences, at up to 40%. In the review, the process of iatrogenesis is explored from the perspectives of quantitative, qualitative and mixed methods research. Each method reveals the strengths and weaknesses of the research approach when exploring the complex topic of iatrogenesis. The Literature Review concludes by suggesting there is a gap in the literature and indicates the relevance of qualitative studies as a means towards filling it. The second study will present an Interpretative Phenomenological Analysis (IPA: Smith, Flowers, & Larkin, 2009), of the experiences of psychotherapists in the role of client. Merton’s (1972) distinction between ‘insiders-outsiders’ is applied, which in this study translates as ‘insider’ (client) and ‘outsider’ (therapist) roles, or positions. These positions help explicate potential mechanisms of change that are deemed to engender harmful experiences in psychotherapy sessions. A phenomenological approach was applied by interviewing counselling psychologists about their ‘insider’ experiences in their personal psychotherapy sessions. As their philosophical training is rooted in phenomenological, reflexive and humanistic training, counselling psychologists were assumed to be able to speak from the dual focus of being an informed client, as well as being an informed practitioner. Therefore, counselling psychologists were considered the most suitable group who would be best placed to help me explore the research question. Semi-structured interviews were conducted with four participants, all qualified psychotherapists. The data was analysed using IPA’s methodology. The findings yielded three master themes: Competing world views: clashing epistemologies; How and by whom is therapy constructed?; and Making sense of an experience. The third study builds upon the Literature Review and broadens the findings of the IPA, by applying a qualitative method of Thematic Analysis (Braun & Clarke, 2006). The Thematic Analysis utilises Merton’s (2016) distinction of the ‘manifest’ and ‘latent’ functions of purposive social actions. The notion of ‘manifest’ and ‘latent’ functions serves to explicate the experience of iatrogenesis from the perspective of psychotherapists delivering psychotherapy, who perceived their delivery of psychotherapy to have engendered unintended harm. The notion of functions serves also to explicate potential latent processes that can be obscured, and also the more subtle influences within and beyond the therapeutic space that impact upon what happens within the consultation room. The Thematic Analysis is framed by the increasing number of clients who are complaining to professional registration bodies regarding perceived harmful experiences during their psychotherapy. One response has been to introduce new codes of ethics. Applying Thematic Analysis, I conducted interviews with 20 practitioners from various modalities about their experiences of providing psychotherapy sessions. They reported their day-to-day experiences of ‘do no harm’. The Thematic Analysis indicated three themes; ‘Preparation for practice’; ‘Boundaries’; and ‘Issues of safety’. An overarching fourth theme was Professionalism. Transcending all the comments was the notion of tensions, which questioned: ‘Is therapy an art or a science’? Implications are drawn for training, supervision, practice and the future. Across the three studies, I practice and research from a stance which is critical realist, which is to say we each edit the reality we perceive to accord it with our beliefs. My research position is that of a reflective scientist-practitioner, and I identity strongly with counselling psychology’s philosophy and ethical value-base. The research stance is critical-realist.
Extant caregiving research indicates family caring as being a female gendered task and the family caregiver as a related, heterosexual, female. On the other hand, research examining caregiving by the LGBT population is focused on partner caregiving or parenting. Taken together, the experiences of lesbian family caregivers remain unexamined by both caregiving research and LGBT psychological research. To redress this omission four empirical studies were undertaken. Study One was a Foucauldian genealogy, which aimed to establish how the current construction of the informal carer concept came into being. The analysis highlighted how the current carer concept influences research leading to some carers being considered more valid than others. Study Two examined the elder caregiving experiences of lesbian women (n = 10) using grounded theory methodology. Issues pertaining to lesbian identity, privacy and living as an “out” lesbian were raised. Study Three explored the anticipated future caregiving involvement with aging families of young lesbian women (n = 20) using thematic analysis. The young women anticipated future, unproblematic, connectedness with their families, as well as future lesbian created families of their own. Study Four examined how a general population (n = 324) perceived lesbian family caregiving using a vignette questionnaire with 8 conditions. Overall an effect of modern homonegativity was found. In sum, the lesbian caregiver experience is elided due to the dominant heteronormative family discourse that dictates the focus of caregiver research. Examining the lesbian caregiver experience indicates unique issues for lesbian carers around the loss of lesbian identity, loss of lesbian social networks, and difficulties in lesbian identity performance within the home. Younger women anticipated providing family elder care, but did not envisage sexual orientation related problems. While general perceptions of lesbian caregiving are mediated by modern homonegativity that work to deny the lesbian carer agency.
Background. Research has shown spontaneous imagery to be a common form of cognition in a chronic pain population. Imagery rescripting was found to be an easy and effective intervention in improving the pain experience, but similar to the immediate effects of distraction. The current study aimed to test the effects of imagery rescripting against an imagery distraction task through an online questionnaire. Method. Adults (n=126) were recruited through Internet pain support forums. An experimental design compared the immediate effects of intervention (imagery rescripting) vs. control (imagining a dream house) using Visual Analogue Scales of pain intensity, distress, physical threat and emotional threat (pain experience variables). A 4-6 week follow-up questionnaire used a repeated measures design to compare changes against baseline for pain experience variables and a measure of fear-avoidance beliefs. 106 participants met criteria for statistical analysis. Results. Both imagery rescripting and imagery distraction resulted in immediate and statistically significant improvements across all pain experience variables, to a clinically significant level. Further significant reductions were observed at follow up in fear-avoidance beliefs and levels of pain, distress and emotional threat (n=40). Conclusions. Imagery techniques are an effective way to improve the experience of chronic pain in the short term. The reductions observed at follow-up were small and may not have been due to the effects of imagery rescripting, as some participants also performed the imagery-distraction task. However, wider theoretical considerations point towards imagery rescripting as a useful therapeutic tool in chronic pain management.
Inflammatory bowel disease (IBD) is a term used to describe two chronic diseases of the gastrointestinal tract: Ulcerative Colitis (UC) and Crohn's Disease (CD). Although the efficacy of treatment is continuously improving, Quality of Life (QoL) in this illness population remains low with many patients suffering from psychological and psychiatric comorbidities. Psychological interventions aimed at improving outcomes in these patients have largely demonstrated little improvement. This thesis argues that this may be the result of poor understanding of the experience of living with this condition with too little focus on the adaptation of the patient to their illness. This thesis aimed to address this gap in the literature through four empirical studies. Firstly, Study 1 used a qualitative design to (n = 22) to explore the lived experiences of patients with IBD and to conceptualise adaptation to IBD. The results highlighted the importance of making sense of the illness and the impact and feelings associated with the illness. This was transcended by a notion of uncertainty which was resolved by employing coping mechanisms to restore equilibrium between their identity before and after diagnosis, resulting in a 'new normal'. Study 2 then employed a cross-sectional design (n = 307) to develop a new measure of adaptation to IBD (the A-IBD) which after psychometric analysis revealed four subscales including person identity, patient identity, acceptance and expectations. This study also explored the degree of association of the A-IBD with existing measures of sense making (BIPQ) and QoL (IBDQ), to assess the ability of the A-IBD in predicting QoL and ascertain whether it could predict QoL over and above sense making. The results suggested the A-IBD was not synonymous with these constructs and had utility as a predictor of QoL even when accounting for the predictive ability of the BIPQ. Finally, Study 3 used a combination of qualitative and quantitative design (n = 16). Patients scoring in the top and bottom 25% of the A-IBD from Study 2 completed the measure again to assess the dynamic nature of adaptation and were interviewed about the factors that either encouraged or inhibited their degree of adaptation. This analysis revealed that adaptation is indeed dynamic, and that antecedents of adaptation include 'engagement', 'resilience' and certain 'contingencies' including disease and social factors. Overall, the findings from this thesis indicate that the treatment of IBD must be approached in a biopsychosocial manner, that adaptation can be measured effectively with the new tool and that adaptation, with an emphasis on the notion of person, not patient, predicts quality of life.
Long-haul crew experience regular misalignment of the circadian rhythm causing several jet lag symptoms. However, it is unclear whether melatonin acrophase shifts post-trip relate to perceived jet lag. In addition, the role of psycho-behavioural variables on the relationship between subjective and objectively measured jet lag and fatigue are largely ignored. Further, recent research indicates that the timing of meals may help reduce jet lag symptoms on days off. The overall aim of the thesis was to give a comprehensive account of jet lag in long-haul cabin crew in terms of the relationship between bio measures and symptom perception. Four studies were undertaken. In Study 1 (longitudinal), 35 long-haul crew completed measures of circadian preference, coping, stress arousal, objective sleep parameters and subjective jet lag. The results found that i) symptoms of jet lag were worse on the day crew returned home and ii) perceived lower appetite than normal and restless sleep (objective) predicted subjective jet lag. In Study 2 (longitudinal, N = 28), circadian phase [melatonin acrophase (peak time)] was also measured. The results found a discrepancy between subjective jet lag change scores and circadian phase change post-flight predicted by perceived lower appetite than normal. In Study 3 (cross-sectional), 95 crew completed measures of illness cognitions, coping, social support, pre-work strategies, subjective jet lag and fatigue. Timeline predicted subjective jet lag, consequences predicted subjective fatigue whereas a reduction in multidimensional jet lag was predicted by increased social support. In Study 4 (randomized controlled trial, N = 60), half the participants formed an implementation intention to eat regular meals on days off (intervention) and half did not (control). Pre-intervention measurements were taken at baseline and post-intervention measures on the second recovery day. Formation of an implementation intention to eat regularly resulted in a reduction of jet lag (unidimensional) but not multidimensional jet lag and objective alertness (PVT). These findings demonstrate that jet lag is in part a psycho-social construct, not just a biological one, which is influenced by sense making and can be moderated through diet. The results have important practical and theoretical implications.
Objective : The aim of the research was to investigate the effect of an airbrushing and self-affirmation interventions which were theorised to inhibit social comparison and internalisation processes in order to reduce body dissatisfaction in women. Changes were also anticipated in eye movement data after either intervention when participants viewed normal, underweight and overweight media images. Participants: Fifty-eight women (74.1% white) completed self-report measures of body dissatisfaction, social comparison and internalisation of the thin-ideal at three time points. Design: Participants were randomly assigned to the airbrushing, self-affirmation interventions or control condition. Eye movement data assessed the extent to which participants viewed the media images of normal, underweight and overweight images pre and post-intervention and 4-6 weeks later. Findings: Results indicated that body dissatisfaction and internalisation were significantly reduced as an immediate effect of the airbrushing and self-affirmation intervention however this effect was not maintained at follow-up. Receiving either the airbrushing or self-affirmation intervention had no impact on social comparison scores, and glance duration towards underweight media images compared to the control group. Implications: Together, these findings suggest that the airbrushing and self-affirmation interventions were successful at immediately blocking the effects of the media which provides an evidence base for using a brief intervention to reduce body dissatisfaction in women. However, more exploration needs to be addressed in future research to ascertain how the benefits of utilising eye movement data can be reliably incorporated into a design and how the benefits of these interventions can be maintained beyond follow-up. Keywords: Eye tracking, body dissatisfaction, internalisation, social comparison, airbrushing intervention, self-affirmation intervention