‘It’s been a long haul, a big haul, but we’ve made it’: hepatitis C virus treatment in post-transplant patients with virus recurrence: An interpretative phenomenological analysis

The lived experience of both interferon-based and new interferon-free treatments in patients with hepatitis C virus remains understudied. To explore their journey through hepatitis C virus treatment, we interviewed seven post-transplant patients with recurrent hepatitis C virus. Three themes were identified using interpretative phenomenological analysis. Participants reported an ongoing sense of ontological uncertainty characterized by lack of control over their condition and treatment. Furthermore, an apposition of scepticism and hope accompanying each stage of hepatitis C virus treatment was described. A staged approach to psychological intervention tailored to the needs of the patient and their associated ‘stage’ of hepatitis C virus treatment was recommended

Pet owner and vet interactions: exploring the drivers of AMR

Background: Antimicrobial resistance (AMR) is a growing public health problem across the world. As the negative consequences of AMR become apparent at local, national and international levels, more attention is being focussed on the variety of mechanisms by which AMR is potentiated. We explore how interactions between pet owners and veterinarians represent a key arena in which AMR-related behaviours can be shaped. Methods: In depth semi-structured interviews were carried out with pet owners (n = 23) and vets (n = 16) across the UK in 2017. A thematic analysis approach was taken, with inductively gathered data analysed deductively using a behavioural framework to identified key behaviours emerging from participant accounts which were amenable to change. Results: Interactions between vets and pet owners were characterised by misunderstandings and misconceptions around antibiotics by pet owners, and a lack of clarity about the positions and intentions of the other party. Vets and pet owners had differing perceptions of where pressure to prescribe antibiotics inappropriately originated. Vets perceived it was mostly pet owners who pushed for inappropriate antibiotics, whereas pet owners reported they felt it was vets that overprescribed. Low levels of understanding of AMR in general were apparent amongst pet owners and understandings with regard to AMR in pets specifically were almost non-existent in the sample. Conclusions: Improved use of antibiotics could be assisted by educating the pet owning public and by guideline development for companion animal vets, concurrent development of mandatory legislation, increased consultation time to facilitate better communication, development of vet training on antimicrobial therapy and stewardship led interactions with pet owners, and increased levels of knowledge of pet-related AMR amongst pet owners

Associations between experiences of disrupted attachments and suicidal thoughts and behaviours: an interpretative phenomenological analysis

Suicide is a major public health concern and itsaetiology is complex. Evidence suggests that experiences of early disrupted attachment relationships with parents and family members are associated with later experiences of suicidal thoughts and behaviours (STB). However, no study has investigated this relationship from an inductive, interpretative and idiographic perspective. Objective: This paper explores the role of interpersonal relationships in STB among nine individuals who have attempted suicide. Method: Semi-structured face-to-face interviews were analysed using an interpretative phenomenological analysis approach. Results and conclusion: Two inter-related master themes were identified: 1) ‘challenging relationships as catalysts for STB’; and 2) ‘positive relationships as buffers against STB’. Findings indicate that experiences of early disrupted parent-child attachments may contribute to vulnerability for STB by shaping participants' perceptions of intimate others and themselves (internal working models). These working models, along with other environmental factors and life events, may increase the risk of STB through perceptions of defeat, entrapment, perceived burdensomeness and thwarted belongingness. Results also suggest that being exposed to respectful, caring, unconditionally accepting, reciprocal, trusting, and non-judgemental intimate adult relationships increase resilience and is associated with recovery from past STB and a reduction of current suicide risk. The theoretical and clinical implications are discussed

Experiences of diagnosis, stigma, culpability, and disclosure in male patients with hepatitis C virus: an interpretative phenomenological analysis

The current study aimed to explore the lived experience of patients with hepatitis C virus infection. Semi-structured interviews were conducted with seven male participants living with hepatitis C virus and were analysed using interpretative phenomenological analysis. Two master themes were identified: (1) diagnosis and the search for meaning and (2) impact of stigma on disclosure. Participants reported fears of contaminating others, feelings of stigma and concerns of disclosing the condition to others. Response to diagnosis, stigma and disclosure among the participants appeared to be interrelated and directly related to locus of blame for virus contraction. More specifically, hepatitis C virus transmission via medical routes led to an externalisation of culpability and an openness to disclosure. Transmission of hepatitis C virus as a direct result of intravenous drug use led to internalised blame and a fear of disclosure. The inter- and intra-personal consequences of hepatitis C virus explored in the current study have potential implications for tailoring future psychological therapy and psychoeducation to the specific needs of the hepatitis C virus population

An exploratory Interpretative Phenomenological Analysis (IPA) of childbearing women's perceptions of risk associated with having a high Body Mass Index (BMI)

Background: In 2016, the World Health Organization (WHO) labelled 13% of the world's adult population as obese. This increase in obesity is accompanied by mortality and morbidity problems, with maternal obesity and its accompanying risk for mother and infant requiring to be carefully managed.Aim: To explore childbearing women with a high BMI (>35kg/m2) perceptions of risk and its potential impacts upon pregnancy and outcome.Method: Qualitative Interpretative Phenomenological Analysis (IPA) was used to gain deeper understanding of the lived experiences of childbearing women with a BMI>35kg/m2 and perceptions of their risk and potential pregnancy outcome.Findings: One of the superordinate themes that emerged was (1) Risk or no risk, and its associated three subthemes of (1a) Emotional consequences of her risky position, (1b) Recognition of high-risk complications finally sinking in, and (1c) Accepting the risk body.Recommendations for practice: In general, health care professionals are uncomfortable about discussing obesity-associated risks with pregnant women. The participants in this study did not classify themselves as obese, with this absence of acknowledgement and 'risky talk' leaving participants' unaware of their obesity-associated risk. This downplaying of obesity related talk requires to be corrected, simply because women in denial will perceive no need to engage with health promotion messages. In response, directives are required to be embedded into policy and practice.Conclusion: Specific training is required to teach maternity care professionals how to have difficult, sensitive conversations about obesity related risks with childbearing women with high BMI's. In addition, this risk information needs to be accompanied by relevant advice and support

Suicidal histories in adults experiencing psychological trauma: exploring vulnerability and protective factors

Objective: This study aimed to identify vulnerability and protective factors for suicidal histories among adults experiencing psychological trauma.Method: Adults seeking treatment for psychological trauma (N=113) completed self-report questionnaires measuring childhood trauma history, self-concept, relational functioning, emotion regulation, living arrangements, employment status, marital status, and suicidal history. Independent samples t-tests were used to determine variables on which those with and without suicidal histories differed significantly. These variables were then entered into a binary logistic regression model to identify factors which independently distinguished between those with and without a suicidal history.Results: Univariate differences were found for childhood emotional abuse (CEA), childhood emotional neglect (CEN), emotion deactivation, and employment status, with those in the suicidal history group scoring higher on all of these. CEA (OR=1.13, 95% CI=1.01-1.27) and employment status (OR=4.12, 95% CI=1.23-13.73) remained significant predictors of suicidal status in the multivariable logistic regression.Conclusions: CEA was an independent vulnerability factor for suicidal risk, highlighting the need for clinicians to assess exposure to such trauma in those presenting with proximal traumatic experiences. Being in employment was an independent protective factor against suicidal risk, highlighting the importance of social buffers or networks when faced with traumatic situations

Positive changes and appreciation of life among economic immigrants in Scotland.

Objectives: Existing qualitative studies focussed predominantly on exploring immigrants’ stress, distress and coping aimed at reducing stress. Little attention has been paid to immigrants’ psychological growth or positive life changes. In the present study the impact of post-migration experiences on well-being among economic immigrants has been explored. Design: Semi-structured interviews were conducted with a sample of 17 immigrants. Transcripts were analysed by a deductive and inductive thematic analysis. Results: All immigrants reported positive life changes as a result of migration. Experiences related to migration helped immigrants rebuild their sense of self-worth and find ‘mental peace’ after living a demanding and burdensome life in Poland. Immigrants’ accounts also suggested that their thinking and behaviour patterns may be shaped by their cultural values and socio-economic background. Conclusion: Overall, the study indicates that migration is not merely a stressful life event but can have a positive impact on many aspects of immigrants’ lives and may provide opportunities for personal growt

The impact of assuming the primary caregiver role following traumatic spinal cord injury: an interpretative phenomenological analysis of the spouse's experience.

This study aimed to explore the lived experience of assuming the primary caregiver role in a group of spouses of individuals living with a traumatic spinal cord injury (SCI) (injuries ranged from paraplegia to quadriplegia). Individual in-depth interviews were conducted with 11 participants who were both the spouse and primary caregiver of an individual with a SCI; of these, 10 were female and 1 was male. All interviews were transcribed verbatim and were subjected to interpretative phenomenological analysis (IPA). Here we present three inter-related master themes: 'The emotional impact of SCI'; 'Post-injury shift in relationship dynamics' and 'Impact of caregiving on identity'. Regarding the emotional impact of spinal injury, participants reported an almost instantaneous sense of loss, emptiness and grief during the injured person's rehabilitative period and feelings of anxiety were reported in anticipation of their return to the family home. A distinct change in role from spouse and lover to care provider was reported and this ultimately contributed to relationship change and a loss of former identity. The findings are discussed in relation to extant caregiver literature and recommendations for future caregiver support are highlighte

A feasibility study of a cross-diagnostic, CBT-based psychological intervention for acute mental health inpatients: Results, challenges, and methodological implications

ObjectivesAcute psychiatric inpatient wards are characterised by minimal provision of therapeutic activities and high readmission rates. Implementation of a comprehensive inpatient psychological intervention service has been recommended to overcome these problems, however whether this is feasible or effective remains unclear.MethodsThis non-randomised parallel cluster feasibility trial examined the feasibility of delivering and evaluating cross-diagnostic psychologically informed acute psychiatric care (the E-Acute Psychological Inpatient Therapy Service; EDAPTS), and gathered preliminary clinical outcome data. Patients able to consent and complete questionnaires were recruited from two adult acute wards (i.e. clusters) and received either EDAPTS plus TAU or TAU.ResultsBetween October 2015 and 2016, 96 inpatients were recruited. Findings suggested there were good data completion rates for several clinical outcomes, that several EDAPTS components were successfully delivered and that some initial effects appeared to favour the intervention, depending on outcome. However difficulties relating to the recruitment process were also identified, as well as problems relating to adequate delivery of group therapies, participant engagement in some intervention components, and data-completion at follow-up.ConclusionThese issues, and the feasibility of randomisation and rater-blinding, have important implications for the design of future trials. Overall, this study provides an important insight into the challenges and complexities of developing and evaluating a comprehensive psychological intervention service in an acute psychiatric setting

An evaluation of mainstream type 2 diabetes educational programmes in relation to the needs of people with intellectual disabilities: A systematic review of the literature

BackgroundRisk reduction and self?management programs for type 2 diabetes (T2D) are commonplace. However, little is known about their appropriateness for people with intellectual disabilities (ID). This review evaluates successful components and theoretical basis of interventions and preventions in relation to the needs of people with ID with or at risk of T2D.MethodCharacteristics of 23 randomised controlled trialled T2D educational programs were systematically assessed alongside the needs of people with ID, and evaluated in terms of study design and theoretical application.ResultsSuccessful components of programs align to the needs of people with ID. Further adaptations are required to ensure accessibility of materials and social support to enable reflection on illness perceptions and self?efficacy, as underpinned by Self?regulation and Social?cognitive theories.ConclusionsSupport is provided for further trials of self?management and preventative adaptations under development. Impact may be enhanced through preventions aimed at younger groups in educational setting