Negotiating parental accountability in the face of uncertainty for Attention-Deficit Hyperactivity Disorder.

Despite extensive research into attention-deficit hyperactivity disorder (ADHD), parents’ constructions of theirchildren’s behaviors have received limited attention. This is particularly true outside North American contexts, whereADHD is less established historically. Our research demonstrates how United Kingdom parents made sense of ADHDand their own identities postdiagnosis. Using discourse analysis from interviews with 12 parents, we show that theydrew from biological and social environmental repertoires when talking about their child’s condition, parallelingrepertoires found circulating in the United Kingdom media. However, in the context of parental narratives, both theserepertoires were difficult for parents to support and involved problematic subject positions for parental accountabilityin the child’s behavior. In this article we focus on the strategies parents used to negotiate these troublesome identitiesand construct accounts of moral and legitimate parenting in a context in which uncertainties surrounding ADHD existed and parenting was scrutinzed

Life Interrupted: Experiences of adolescents, young adults and their family living with malignant melanoma

AimMelanoma is one of the most common human malignancies; yet, it is often thought of as a disease of adulthood rather than one affecting adolescents and young adults. This study sought to understand the experiences of adolescents, young adults and their family living with malignant melanoma.DesignA qualitative study using Interpretive Phenomenological Analysis, through a multi-perspective design.MethodsData collection was conducted between January and August 2018 in each participant's Primary Care Centre when they were attending for an outpatient appointment. Each young person and a nominated family member were interviewed (n = 10) either individually (n = 4) or as a dyad (n = 6) according to their personal choice. In-depth semi-structured interviews were conducted and audio-recorded with the participant's consent. Interview data were transcribed verbatim and analysed.FindingsThe metanarrative ‘Life Interrupted’ was the core conceptual thread woven throughout the findings. It represents the interconnections and interrelationships between the adolescent or young adult and their family. Being able to recognize the disease and seek support was challenging with often limited physical, emotional or social support resulting in feelings of fear and isolation. Four super-ordinate themes were identified: (a) ‘Is it Serious’, (b) ‘Too Much too Young’, (c) ‘Not the Same’ and (d) ‘Time to Live’.ConclusionsWith the rising incidence of MM in the adolescents and young adults population globally, there are demands to improve healthcare professionals and nurse's knowledge and understanding of MM. As young people with MM experience their journey outside specialist cancer services, the care delivery for this patient group and their families require stronger links between services.ImpactThis study will inform the improvement of care delivery for MM in order that this patient group is provided with the same access to service delivery as other adolescents and young adults with cancer

Using Foucauldian Discourse Analysis to Analyze Young Women’s Constructions of the Human Papillomavirus Vaccine

This case study introduces the reader to Foucauldian discourse analysis (FDA) as applied to a cross-cultural project around young women’s constructions of the Human Papillomavirus (HPV) vaccine. We introduce common qualitative research approaches in psychology. We discuss two main types of Discourse Analysis in psychology and why a Foucauldian discourse analysis was adopted here. In this case we examine examples of our data according to Carla Willig’s (2008) approach to Foucauldian discourse analysis using six stages: discursive constructions, discourses, action orientation, positionings, practice and subjectivity. Finally, we consider the main limits and strengths with a Foucauldian discourse analysis

A profiling exercise of childhood immunisation services in Edinburgh: A qualitative report.

BACKGROUND:Childhood immunisation is a complex area in the research literature with a number of contributing influences. Within Edinburgh Community Health Partnership (CHP), recent figures indicated that there was great geographical variety for immunisations and uptake rates. While initial primary immunisations were high, uptake of measles, mumps and rubella (MMR) did not always meet expected targets (e.g. Health Protection Newsletter, April, 2008).AIMS OF EXERCISE:- To review the current literature on childhood immunisations.- To explore the views and experiences of relevant stakeholders (parents, health staff and key management) for current childhood immunisation services across Edinburgh.- To identify potential facilitators and barriers towards childhood immunisations that may affect uptake rates.KEY MESSAGES AND RECOMMENDATIONS:- Lay beliefs about immunisation could be addressed- Communication and rapport for immunisation is important- There is conflict between public health issues versus the financial model in current services- Increased parental choice about immunisation services delivery is needed- Developing confidence and skills in health staff is necessary for the delivery of childhood immunisations after informed consent- Greater public health campaigns are needed concerning the value of vaccinations- Greater support was requested by health staff for complex schedules- Government policies and vaccine shortages were held to be unsatisfactory amongst health staff- From a local Edinburgh context, this work has wider relevance for the national immunisation campaigns

The views of young women on HPV vaccine communication in four European countries.

The Human Papilloma Virus (HPV) is the most common sexually transmitted infection (STI) and can cause cervical cancer. Two vaccines are available to protect against the most common strands of the virus. Vaccination programs differ across Europe but most neglect young adults, who are the group with the highest risk of contracting STIs. Our aim was to explore the views of young women from four European countries-Scotland, Spain, Serbia, and Bulgaria - about the HPV vaccine communication strategy. These countries are characterized by different cervical cancer prevalence and vaccine implementation policies. We conducted focus group discussions with young women (aged 18-26) with various vaccination histories in a purposive sample. We subjected the data to thematic analysis with the purpose of identifying themes related to communication about the HPV vaccine. We recorded the information sources mentioned by participants. Participants discussed numerous sources of vaccine-related information. They approached information critically rather than naively and questioned the sources’ trustworthiness and motives. Participants desired transparent information about the risks of the virus and the risks and benefits of the vaccine. These risks and benefits were individualized in view of personal and external factors. Particular aspects of the vaccine and the way information was communicated resulted in feelings of uncertainty. There were notable cross-cultural differences in experiences with HPV vaccine communication. Our results suggest that transparent risk communication about the HPV vaccine is valued by young women. In addition, both individual and culturally-dependent factors influenced experiences with, and preference for information

The views of young women on HPV vaccine communication in four European countries.

The Human Papilloma Virus (HPV) is the most common sexually transmitted infection (STI) and can cause cervical cancer. Two vaccines are available to protect against the most common strands of the virus. Vaccination programs differ across Europe but most neglect young adults, who are the group with the highest risk of contracting STIs. Our aim was to explore the views of young women from four European countries-Scotland, Spain, Serbia, and Bulgaria - about the HPV vaccine communication strategy. These countries are characterized by different cervical cancer prevalence and vaccine implementation policies. We conducted focus group discussions with young women (aged 18-26) with various vaccination histories in a purposive sample. We subjected the data to thematic analysis with the purpose of identifying themes related to communication about the HPV vaccine. We recorded the information sources mentioned by participants. Participants discussed numerous sources of vaccine-related information. They approached information critically rather than naively and questioned the sources’ trustworthiness and motives. Participants desired transparent information about the risks of the virus and the risks and benefits of the vaccine. These risks and benefits were individualized in view of personal and external factors. Particular aspects of the vaccine and the way information was communicated resulted in feelings of uncertainty. There were notable cross-cultural differences in experiences with HPV vaccine communication. Our results suggest that transparent risk communication about the HPV vaccine is valued by young women. In addition, both individual and culturally-dependent factors influenced experiences with, and preference for information

Development of a cross-cultural HPV community engagement model within Scotland

Objective To examine cultural barriers and participant solutions regarding acceptance and uptake of the Human Papillomavirus (HPV) vaccine from the perspective of Black African, White-Caribbean, Arab, Indian, Bangladeshi and Pakistani young people.Methods Forty young people from minority ethnic communities in Scotland took part in a qualitative study, involving seven focus groups and four paired interviews, to explore their views and experiences of the HPV vaccine. Using critical discursive psychology, the analysis focussed on young people’s accounts of the barriers and enablers to information, access and uptake of the HPV vaccination programme.Results Participants suggested innovative strategies to tackle intergenerational concerns, information design and accessibility, and public health communications across diverse contexts. A cross-cultural community engagement model was developed, embracing diversity and contradiction across different ethnic groups. This included four inter-related strategies: providing targeted and flexible information for young people; vaccine provision across the life-course; intergenerational information and; specific cross-cultural communications.Conclusion This is the first HPV cross-cultural model inductively derived from accounts of young people from different ethnic communities. We recommend public health practitioners and policymakers consider utilising the processes and strategies illustrated within this model in order to increase dialogue around public engagement, awareness and receptivity towards the HPV vaccination

Diagnosing dying: an integrative literature review

Background To ensure patients and familiesreceive appropriate end-of-life care pathways andguidelines aim to inform clinical decision making.Ensuring appropriate outcomes through the useof these decision aids is dependent on timelyuse. Diagnosing dying is a complex clinicaldecision, and most of the available practicechecklists relate to cancer. There is a need toreview evidence to establish diagnostic indicatorsthat death is imminent on the basis of needrather than a cancer diagnosis.Aim To examine the evidence as to howpatients are judged by clinicians as being in thefinal hours or days of life.Design Integrative literature review.Data sources Five electronic databases(2001–2011): Cochrane Central Register ofControlled Trials (CENTRAL) on The CochraneLibrary, MEDLINE, EMBASE, PsycINFO andCINAHL. The search yielded a total of 576 hits,331 titles and abstracts were screened, 42papers were retrieved and reviewed and 23articles were included.Results Analysis reveals an overarching theme ofuncertainty in diagnosing dying and twosubthemes: (1) ‘characteristics of dying’ involvedying trajectories that incorporate physical,social, spiritual and psychological decline towardsdeath; (2) ‘treatment orientation’ where decisionmaking related to diagnosing dying may remainfocused towards biomedical interventions ratherthan systematic planning for end-of-life care.Conclusions The findings of this review supportthe explicit recognition of ‘uncertainty indiagnosing dying’ and the need to work withand within this concept. Clinical decision makingneeds to allow for recovery where that potentialexists, but equally there is the need to avoid futile intervention