What is the Evidence of the Experience of Having a Fall across the Life Course? A Qualitative Synthesis

Background: Alleviating the economic and human impacts of falls and fear of falling are critical health and social care issues. Despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low and attrition high. There is a need for greater understanding of social, cultural and individual, life course positioning of falling, actual or perceived. Objective: To address the question: what is the evidence of the experience of having a fall across the life course? Method: A qualitative evidence synthesis with key electronic databases searched from 1990-2011 using terms related to the experience of falls and falling. Selected papers presented data from the perspective of the person who had fallen. Synthesis included collaborative coding of ‘incidents’ related to falling, theoretical sampling of studies to challenge emerging theories, and constant comparison of categories to generate explanations. Results: The initial focus was to access and assess the evidence for the experiences of a fall across the life course but the authors’ systematic search revealed that the vast majority of the published literature focuses on the experience of a fall in later life. Only 2 of the 16 studies included, provided perspectives of falling from a life stage other than that of older adults. However older adults’ perceptions of their falls experiences are likely to be influenced by lifelong attitudes and beliefs about falling and older age. Synthesis identified that a falls incident or fear of falling induces explicit or implicit ‘Fear’. Consequences are related to notions of ‘Control’ and ‘Social standing’. Recovery work involves ‘Adaptation’, ‘Implications’ ‘Social standing’ and ‘Control’. ‘Explanation’ is sought. Conclusions: How and why people make sense of falling across the life course should have positive impacts on developing falls intervention programmes that people will want to engage with and adhere to

Everything should be as simple as possible, but no simpler : towards a protocol for accumulating evidence regarding the active content of health behaviour change interventions

Supplemental data for this article can be accessed here: 10.1080/17437199.2013.848409Peer reviewedPublisher PD

A Multimodal Approach for the Assessment of Alexithymia: An Evaluation of Physiological, Behavioral, and Self-Reported Reactivity to a Traumatic Event-Relevant Video

Evidence suggests alexithymia is often relatively elevated among people suffering from posttraumatic stress symptoms (PTSS). Despite a growing body of research supporting this relation between alexithymia and PTSS, it is unclear whether alexithymia is a unique predictor of emotional reactivity relative to posttraumatic stress symptoms. Furthermore, existing literature is largely limited to retrospective, self-reported symptoms. Therefore, the current study employed a multimodal assessment strategy for measuring emotional reactivity in the context of posttraumatic stress. More specifically, self-report, behavioral, and physiological measures were used to measure emotional responding to a traumatic event-related stimulus among motor vehicle accident victims. It was hypothesized that behavioral and self-reported responding would evidence a negative relation to level of alexithymia, while physiological responding was not expected to relate to levels of alexithymia. Results replicated previous research demonstrating a strong correlation between self-reported PTSS and alexithymia. Also as expected, alexithymia did not predict physiological responding to the stimulus. However, alexithymia was not found to uniquely predict self-reported or behavioral responding above and beyond the influence of PTSS. These findings do not conclusively support alexithymia as a unique predictor of emotional responding relative to PTSS

Analysing Qualitative Data Using Facial Expressions in an Educational Scenario

In communication, both verbal and non-verbal means ensure that a message is conveyed, and facial expressions are acknowledged as one of the most influential factors in non-verbal communication. Facial Analysis Coding System (FACS) is a tool to analyse data other than the spoken language to improve a researcher's reading of an interviewee's emotions, and proposes a methodology to support the annotation process of facial expressions in a piece of communication. This study investigates an applied framework for FACS in an educational scenario. The study combines both the computerised and manual entries in the applied method. The study addresses the challenges, findings and recommendations of this applied method

Worry, problem elaboration and suppression of imagery: the role of concreteness

Both lay concept and scientific theory claim that worry may be helpful for defining and analyzing problems. Recent studies, however, indicate that worrisome problem elaborations are less concrete than worry-free problem elaborations. This challenges the problem solving view of worry because abstract problem analyses are unlikely to lead to concrete problem solutions. Instead the findings support the avoidance theory of worry which claims that worry suppresses aversive imagery. Following research findings in the dual-coding framework [Paivio, A. (1971). Imagery and verbal processes. New York: Holt, Rhinehart and Winston; Paivio, A. (1986). Mental representations: a dual coding approach. New York: Oxford University Press.], the present article proposes that reduced concreteness may play a central role in the understanding of worry. First, reduced concreteness can explain how worry reduces imagery. Second, it offers an explanation why worrisome problem analyses are unlikely to arrive at solutions. Third, it provides a key for the understanding of worry maintenance

Coming in Warm: Qualitative Study and Concept Map to Cultivate Patient‐Centered Empathy in Emergency Care

Background Increased empathy may improve patient perceptions and outcomes. No training tool has been derived to teach empathy to emergency care providers. Accordingly, we engaged patients to assist in creating a concept map to teach empathy to emergency care providers. Methods We recruited patients, patient caretakers and patient advocates with emergency department experience to participate in three separate focus groups (n = 18 participants). Facilitators guided discussion about behaviors that physicians should demonstrate in order to rapidly create trust, enhance patient perception that the physician understood the patient's point of view, needs, concerns, fears, and optimize patient/caregiver understanding of their experience. Verbatim transcripts from the three focus groups were read by the authors and by consensus, 5 major themes with 10 minor themes were identified. After creating a codebook with thematic definitions, one author reviewed all transcripts to a library of verbatim excerpts coded by theme. To test for inter‐rater reliability, two other authors similarly coded a random sample of 40% of the transcripts. Authors independently chose excerpts that represented consensus and strong emotional responses from participants. Results Approximately 90% of opinions and preferences fell within 15 themes, with five central themes: Provider transparency, Acknowledgement of patient's emotions, Provider disposition, Trust in physician, and Listening. Participants also highlighted the need for authenticity, context and individuality to enhance empathic communication. For empathy map content, patients offered example behaviors that promote perceptions of physician warmth, respect, physical touch, knowledge of medical history, explanation of tests, transparency, and treating patients as partners. The resulting concept map was named the “Empathy Circle”. Conclusions Focus group participants emphasized themes and tangible behaviors to improve empathy in emergency care. These were incorporated into the “Empathy Circle”, a novel concept map that can serve as the framework to teach empathy to emergency care providers

Characteristics of outdoor falls among older people: A qualitative study

Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people

Maintaining places of social inclusion : Ebola and the emergency department

We introduce the concept of places of social inclusion—institutions endowed by a society or a community with material resources, meaning, and values at geographic sites where citizens can access services for specific needs—as taken-for-granted, essential, and inherently precarious. Based on our study of an emergency department that was disrupted by the threat of the Ebola virus in 2014, we develop a process model to explain how a place of social inclusion can be maintained by custodians. We show how these custodians—in our fieldsite, doctors and nurses—experience and engage in institutional work to manage different levels of tension between the value of inclusion and the reality of finite resources, as well as tension between inclusion and the desire for safety. We also demonstrate how the interplay of custodians’ emotions is integral to maintaining the place of social inclusion. The primary contribution of our study is to shine light on places of social inclusion as important institutions in democratic society. We also reveal the theoretical and practical importance of places as institutions, deepen understanding of custodians and custodianship as a form of institutional work, and offer new insight into the dynamic processes that connect emotions and institutional work

Coding Scheme for Negative Utterances

This document contains an abbreviated version of a coding scheme employed for the pragmatic 2-coder analysis of negation types and their felicity. It was used for the coding of negative utterances originating from human-robot dialogues gathered in the experiments described in articles contained in the reference list. Some theoretical parts as well as sections on future work have been removed for space reasons. The complete scheme is contained in the author's thesis. The scheme was devised by the author who also acted as first coder. Additionally a second coder was employed, and those parts of the coding scheme handed to the latter as coding manual are marked as such.Downloa