The Life-World and Its Multiple Realities: Alfred Schütz's Contribution to the Understanding of the Experience of Illness

Alfred Schütz original contribution to the social sciences refers to his analysis of the structure of the "life-world". This article aims to invigorate interest in the work of this author, little known in the field of health psychology. Key concepts of Schütz' approach will be presented in relation to their potential interest to the understanding of the experience of illness. In particular, we develop the main characteristics of the everyday life and its cognitive style, that is, its finite province of meaning. We propose to adopt this notion to define the experience of chronic or serious illness when the individual is confronted to the medical world. By articulating this analysis with literature in health psychology, we argue that Schütz's perspective brings useful insight to the field, namely because of its ability to study meaning constructions by overcoming the trap of solipsism by embracing intersubjectivity. The article concludes by outlining both, the limitations and research perspectives brought by this phenomenological analysis of the experiences of health and illness

The Experience of Skilled Migrant Women in Switzerland: Challenges for Social and Professional Integration

Recent studies on migrants’ social and professional integration in Switzerland indicate that migrant women are the most vulnerable group. Researches highlight the “deskilling power” of migration but tend to focus on a descriptive level, without considering the influence of context and the heterogeneity of migrants’ experiences. This qualitative study aims to investigate the meaning of migration and integration process from participants’ point of view: their challenges, strategies and the impact of the migration experience on self-image. Semi-structured interviews (n = 30) were conducted with two groups of skilled migrant women: group one are skilled women who migrated through the invitation of an international company (Expats) and group two are skilled women who migrated and had to find a job by themselves (Indep). Data is analysed by thematic content analysis (assisted by Nvivo). First results indicate that there are similarities between participants’ experiences concerning the importance of their first encounters when arriving in Switzerland. Their migratory project and expectations seem to be key elements for motivating integration strategies. Professional and social integration imply dealing with shifting boundaries of belonging and a dynamic negotiation of self-image between diverse groups, which they consider as a resource but may also lead to different perceptions of deskilling

General Practitioners' Perceptions of the Use of Wearable Electronic Health Monitoring Devices: Qualitative Analysis of Risks and Benefits.

The rapid diffusion of wearable electronic health monitoring devices (wearable devices or wearables) among lay populations shows that self-tracking and self-monitoring are pervasively expanding, while influencing health-related practices. General practitioners are confronted with this phenomenon, since they often are the expert-voice that patients will seek. This article aims to explore general practitioners' perceptions of the role of wearable devices in family medicine and of their benefits, risks, and challenges associated with their use. It also explores their perceptions of the future development of these devices. Data were collected during a medical conference among 19 Swiss general practitioners through mind maps. Maps were first sketched at the conference and their content was later compared with notes and reports written during the conference, which allowed for further integration of information. This tool represents an innovative methodology in qualitative research that allows for time-efficient data collection and data analysis. Data analysis highlighted that wearable devices were described as user-friendly, adaptable devices that could enable performance monitoring and support medical research. Benefits included support for patients' empowerment and education, behavior change facilitation, better awareness of personal medical history and body functioning, efficient information transmission, and connection with the patient's medical network; however, general practitioners were concerned by a lack of scientific validation, lack of clarity over data protection, and the risk of stakeholder-associated financial interests. Other perceived risks included the promotion of an overly medicalized health culture and the risk of supporting patients' self-diagnosis and self-medication. General practitioners also feared increased pressure on their workload and a compromised doctor-patient relationship. Finally, they raised important questions that can guide wearables' future design and development, highlighting a need for general practitioners and medical professionals to be involved in the process. Wearables play an increasingly central role in daily health-related practices, and general practitioners expressed a desire to become more involved in the development of such technologies. Described as useful information providers, wearables were generally positively perceived and did not seem to pose a threat to the doctor-patient relationship. However, general practitioners expressed their concern that wearables may fuel a self-monitoring logic, to the detriment of patients' autonomy and overall well-being. While wearables can contribute to health promotion, it is crucial to clarify the logic underpinning the design of such devices. Through the analysis of group discussions, this study contributes to the existing literature by presenting general practitioners' perceptions of wearable devices. This paper provides insight on general practitioners' perception to be considered in the context of product development and marketing

Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study

Although home-dwelling older adults are frequently assisted with polypharmacy management by their informal caregivers, they can still face medication-related problems. Identifying older adults’ and their informal caregivers’ beliefs about medication is a gateway to understanding and improving medication adherence. This study aimed to analyse beliefs about polypharmacy among home-dwelling older adults with multiple chronic conditions and their informal caregivers, focusing on their daily medication practices. Semi-structured interviews were conducted with 28 older adults, 17 informal caregivers, but also 13 healthcare professionals. Based on an inductive methodological approach, data were analysed using thematic content analysis. Interviews revealed the different attitudes adopted by older adults and their informal caregivers in relation to the treatment information provided by healthcare professionals. A variety of beliefs were identified and linked to medication adherence by examining daily medication practices. Polypharmacy was experienced as a habit but also an obligation, highlighting some of the strategies and negotiations underlying medication use at home. Collecting viewpoints from multiple stakeholders is an innovative way of accessing and analysing beliefs about polypharmacy. Daily medication practices provided information about medication beliefs and may contribute to developing targeted professional interventions that improve medication adherence

Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol.

Optimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes. A mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles-made up of patient-related, medication-related and environment-related factors-of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky's quadruple aim. Ethical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers' and patients' associations

Migratory project and structural barriers: A comparative study of psychosocial issues for the two most vulnerable regular migrant populations in Switzerland.

Despite Switzerland’s tradition of migration, most foreigners are still considered a threat to Swiss values and identity, especially those from outside the European Union (EU) and the European Free Trade Association (EFTA) whose permit conditions are more restrictive. In this context, different migratory groups face similar structural challenges. Based on this assumption, this paper compares the results of two qualitative studies conducted with the two most vulnerable regular migrant groups in Switzerland, according to their migratory project: women from third countries with university diplomas and asylum seekers. Both projects were conducted using semi-structured interviews and the data were analyzed with thematic content analysis. Results demonstrate how these two groups might face similar difficulties for social and economical insertion, impacting their wellbeing, despite the different conditions of arrival. Our comparative perspective contributes to the understanding of current migration issues and to possible strategies to avoid the victimization of politically disadvantaged groups in Europe

A birational mapping with a strange attractor: Post critical set and covariant curves

We consider some two-dimensional birational transformations. One of them is a birational deformation of the H\'enon map. For some of these birational mappings, the post critical set (i.e. the iterates of the critical set) is infinite and we show that this gives straightforwardly the algebraic covariant curves of the transformation when they exist. These covariant curves are used to build the preserved meromorphic two-form. One may have also an infinite post critical set yielding a covariant curve which is not algebraic (transcendent). For two of the birational mappings considered, the post critical set is not infinite and we claim that there is no algebraic covariant curve and no preserved meromorphic two-form. For these two mappings with non infinite post critical sets, attracting sets occur and we show that they pass the usual tests (Lyapunov exponents and the fractal dimension) for being strange attractors. The strange attractor of one of these two mappings is unbounded.Comment: 26 pages, 11 figure