Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples’ experiences

Background Coronary heart disease is an incurable condition. The only approach known to slow its progression is healthy lifestyle change and concordance with cardio-protective medicines. Few people fully succeed in these daily activities so potential health improvements are not fully realised. Little is known about peoples’ experiences of managing lifestyle change. The aim of this study was to synthesise qualitative research to explain how participants make lifestyle change after a cardiac event and explore this within the wider illness experience. Methods A qualitative synthesis was conducted drawing upon the principles of meta-ethnography. Qualitative studies were identified through a systematic search of 7 databases using explicit criteria. Key concepts were identified and translated across studies. Findings were discussed and diagrammed during a series of audiotaped meetings. Results The final synthesis is grounded in findings from 27 studies, with over 500 participants (56% male) across 8 countries. All participants experienced a change in their self-identity from what was ‘familiar’ to ‘unfamiliar’. The transition process involved ‘finding new limits and a life worth living’ , ‘finding support for self’ and ‘finding a new normal’. Analyses of these concepts led to the generation of a third order construct, namely an ongoing process of ‘reassessing past, present and future lives’ as participants considered their changed identity. Participants experienced a strong urge to get back to ‘normal’. Support from family and friends could enable or constrain life change and lifestyle changes. Lifestyle change was but one small part of a wider ‘life’ change that occurred. Conclusions The final synthesis presents an interpretation, not evident in the primary studies, of a person-centred model to explain how lifestyle change is situated within ‘wider’ life changes. The magnitude of individual responses to a changed health status varied. Participants experienced distress as their notion of self identity shifted and emotions that reflected the various stages of the grief process were evident in participants’ accounts. The process of self-managing lifestyle took place through experiential learning; the level of engagement with lifestyle change reflected an individual’s unique view of the balance needed to manage ‘realistic change’ whilst leading to a life that was perceived as ‘worth living’. Findings highlight the importance of providing person centred care that aligns with both psychological and physical dimensions of recovery which are inextricably linked

Theorising variation in engagement in professional and curriculum development: performativity, capital, systems and purpose

Increasingly, policymakers seek to improve the quality of teaching through curriculum innovations and continuing professional development (CPD) programmes. However, engagement by schools and teachers varies due to mediating influences of neoliberal policies. In this article, we contribute to understanding how these tendencies affect participation. Problematising the notion of context, we examine ways in which systemic influences interacted with participation in a government-funded mathematics professional and curriculum development programme and also with participants’ purposes. A 3-level clustered Randomised Controlled Trial (RCT) and an implementation and process evaluation were augmented by in-depth case studies, cross-case analysis and the application of theoretical constructs to interpret findings. Theories of capital, figured worlds and systemic coupling are utilised to theorise context. Different levels of engagement are partly explainable by: the interaction of schools' relative systemic advantage and disadvantage; their orientation and coupling to performativity regimes; and the alignment or dissonance between continuing professional development or change programmes and the pedagogical and CPD cultures and purposes of the ‘actors’ (schools, departments and teachers). Performativity concerns restricted what were considered legitimate outcomes in some case study schools. This depended on teachers and schools' positioning in terms of relative degrees of systemic privilege or disadvantage - understood as economic, cultural, social and symbolic capital - and also in terms of figured worlds and system coupling. The case studies provide insights into how collaborative professional learning can be fostered more productively. Methodologically, we demonstrate the power of combining methodologies and applying explanatory social theory to augment quasi-experimental paradigms

What young people report about the personal characteristics needed for social science research after carrying out their own investigations in an after-school club

Several arguments have been put forward about the benefits of young people carrying out their own social science research in terms of empowering their voices and their participation. Much less attention has been paid to investigating the understandings young people develop about the research process itself. Seven twelve-year-olds carried out self-directed social science research into a topic of their choice. Towards the end of their six months experience we used a questionnaire and follow-up semi-structured interviews to investigate, from a socio-cultural perspective, what the young people thought about being a researcher. Thematic analysis of the interviews identified three themes and eight subthemes suggesting that they were aware of: the need to demonstrate researcher/research integrity (be thorough, truthful, orderly, and have a good understanding of research process); the need for good interpersonal skills and standards; and good self-management skills (be resilient, agentic, committed, and good at time management). We discuss how first-hand social science research experience might: be relevant to several areas of schooling; give young people experience of the personal characteristics important for success; help young people to realise that they can be social science researchers, and offer advanced and novel learning experiences outside the constraints of the school curriculum

“Charity Begins at Home”: Informal Caring Barriers to Formal Volunteering Among Older People

Formal volunteering is an important economic and social activity. In many countries, prevalence of volunteering is decreasing overall, including among older people who constitute a major volunteering resource. This qualitative study explored reasons for non-volunteering among seniors, with a focus on those who attribute their non-volunteering to their existing helping commitments. Forty-nine Australian interviewees aged 60 + years described a range of social, psychological, and temporal factors that resulted in their prioritization of informal rather than formal volunteering activities. These factors are mapped onto a theoretical framework matrix, with social identity and social capital theories appearing to possess the most explanatory power. The findings suggest that programs designed to encourage formal volunteering among older people need to be implemented in a manner that recognizes that members of this group can hold many other responsibilities that limit their ability to participate, especially those assisting in the care of multiple generations

Studying neuroanatomy using MRI

The study of neuroanatomy using imaging enables key insights into how our brains function, are shaped by genes and environment, and change with development, aging, and disease. Developments in MRI acquisition, image processing, and data modelling have been key to these advances. However, MRI provides an indirect measurement of the biological signals we aim to investigate. Thus, artifacts and key questions of correct interpretation can confound the readouts provided by anatomical MRI. In this review we provide an overview of the methods for measuring macro- and mesoscopic structure and inferring microstructural properties; we also describe key artefacts and confounds that can lead to incorrect conclusions. Ultimately, we believe that, though methods need to improve and caution is required in its interpretation, structural MRI continues to have great promise in furthering our understanding of how the brain works