An English lecturer, a palliative care practitioner, and an absent poet have a confabulation

The possibilities for developing the poet Douglas Dunn’s archive (which includes the drafts and manuscripts for his collection Elegies, dealing with the terminal illness and death of the poet’s wife from cancer) for therapeutic benefit are explored by an English lecturer (C.J.) and a palliative care practitioner (C.M.). This has led us to explore the potential benefit of this resource for health practitioners working with those affected by cancer and other life-limiting conditions. This article offers a “written conversation” (an acknowledged oxymoron of genre) about working with the themes of death and loss: a conversation which includes Douglas Dunn, who was not actually there. We reflect on the value of this “confabulation” as methodological inquiry, and its potential influence on practice. Thus, an example of “creative writing” (the confabulation) becomes a piece of research into methodology regarding the use of “creative writing” resources (the poetry archive) in palliative health care.PostprintPeer reviewe

The impact of antenatal psychological group interventions on psychological well-being : a systematic review of the qualitative and quantitative evidence

Depression, anxiety and stress in the perinatal period can have serious, long-term consequences for women, their babies and their families. Over the last two decades, an increasing number of group interventions with a psychological approach have been developed to improve the psychological well-being of pregnant women. This systematic review examines interventions targeting women with elevated symptoms of, or at risk of developing, perinatal mental health problems, with the aim of understanding the successful and unsuccessful features of these interventions. We systematically searched online databases to retrieve qualitative and quantitative studies on psychological antenatal group interventions. A total number of 19 papers describing 15 studies were identified; these included interventions based on cognitive behavioural therapy, interpersonal therapy and mindfulness. Quantitative findings suggested beneficial effects in some studies, particularly for women with high baseline symptoms. However, overall there is insufficient quantitative evidence to make a general recommendation for antenatal group interventions. Qualitative findings suggest that women and their partners experience these interventions positively in terms of psychological wellbeing and providing reassurance of their ‘normality’. This review suggests that there are some benefits to attending group interventions, but further research is required to fully understand their successful and unsuccessful features

Transcending sexualisation : a constructivist grounded theory study of asexual self-identity

AbstractIntroduction and backgroundThere is an expectation that everyone feels sexual attraction and sexual desire and that these feelings begin in adolescence. This is called the sexual assumption (Carrigan, 2011). Sexual attraction and desire are perceived to be the norm. These universally felt experiences are thought to be a precursor to engaging in sexual behaviour and they form an intrinsic part of a person’s sexuality. There is, however, an emerging movement that challenges the sexual assumption based on the recognition of a lifelong experience of the absence of sexual desire. This is driven by a community of people who self-identify as asexual.Research suggests that individuals who embrace an asexual identity do so because of a number of factors relating to their absent or lowered levels of sexual desire and/or attraction (Bogaert, 2004; Prause & Graham, 2007; Scherrer, 2008; Brotto, et al., 2010; Scherrer, 2010; Poston & Baumle, 2010; Carrigan, 2011; DeLuzio, 2011). The asexual community is reportedly amongst the most poorly understood sexual minority populations (Pinto, 2013). This study aims to fill a gap in the literature on the overall construction of asexual identity, which is captured, by interview through the perspectives of people who self-identify as asexual. It will unpack asexuality and propose new ways of understanding how asexuality is negotiated and self-interpreted.Aims and objectives/research questionsThere are six areas of interest based on gaps in the existing literature. In order to address these, an overarching research question of ‘What are the social processes involved in constructing an asexual identity’ has been identified. Social processes represent the ways in which individuals and groups, interact, adjust, readjust and establish relationships and patterns of behaviour. This research question can be broken down into a number of specific objectives, which are detailed below: To establish how people who identify as asexual define their asexual identity. To understand the processes that inform the (development) construction of the identity. To understand how the asexual identity impacts upon relationships with others. To understand how embracing (or just the asexual) identity impacts upon health and wellbeing.Data collectionSemi-structured interviews were considered to be the most appropriate method of collecting data for this study.SampleThe data for this study was is based on interview data from 21 participants who self-identified as asexual. Participants were recruited through a number of asexuality forums: AVEN (The Asexuality Visibility and Education Network), asexuality.livejournal.com, asexuality.org, asexuality Facebook and Twitter pages, Craigslist UK, and Craigslist US community pages. This study was also advertised through existing contacts, including: The Hull and East Riding LGBT Forum, the LGBT Foundation in Manchester, Stonewall, the University of Hull’s LGBT society, and the University of Hull e-Bulletin.Data analysisIn order to gain an understanding of the social processes that inform asexual self-identity and to derive a theory of asexual self-identity, constructivist grounded theory (CGT) was used to analyse and interpret the data.FindingsThe process of self-identifying as asexual was informed by a central premise of transcending the sexualised world, represented by a core category of transcending sexualisation to fulfil a need to belong. Three conceptual categories were identified: (1) Becoming, (2) Resolution, and (3) Consolidation. These conceptual categories underpin the core category. Data indicates that individuals enter the becoming stage having already encountered the term asexuality, but having limited understanding of what it means to be asexual. The stage of becoming continues in a straightforward way for many, for some, however, an event, or a number of events occur resulting in the individual finding themselves in a situational bind: this is a critical juncture in their sexual and social lives where there is a level of risk to their ability to form meaningful relationships: their sense of belonging is potentially compromised. These situations, or events constitute a crisis of internal conflict, and something has to be done to rectify it. Those who decide to rectify it move on to the resolution stage. Some individuals reframe their experience of the situational bind, and by doing so, they by-pass the opportunity to contemplate their identity as anything other than sexual. When a stage of resolution follows a stage of becoming, individuals make a stand by disengaging from the cultural norms of sexuality/heterosexuality and begin consolidating their asexual identity. Ten subcategories represent the three conceptual categories: assimilating, connecting, experiencing situational binds, reframing, disengaging, searching for explanations, embracing the nuances, critiquing sexuality, and identifying as essentially asexual. The basic social process reflects a pattern of progression that may or may not be linear. Bourdieusian social theory, namely doxa, habitus, field, and capital offer a lens through which the collective action of participants and their interactions, adjustments, readjustments and patterns of behaviour during asexual self-identity formation can be appreciated in more detail. Whilst the core, conceptual, and the subcategories represent important aspects of progression towards self-identity, the application of Bourdieusian social theory has provided a framework to illustrate the social processes in action, by illuminating the structures of sexuality, gender, medicalisation, patriarchy and religion and demonstrating how their process dimensions become enmeshed within the progressive stages, and thus inform the process of asexual self-identity.Implications for practice and researchRelationship education, as well as relationship and sex education, should be directed towards encouraging a culture that values lasting positive and significant interpersonal relationships with or without sexual behaviour. Alternative models of relationship formation that are not intrinsically bound to sexual attraction do exist and relationship education should encourage individuals to think more broadly about relationships and how they could be constructed in more meaningful ways.The findings from this study have significance to the field of mental health. A significant percentage of the sample (38%) engaged with psychology, counselling, and/or antidepressant medication. The emotional wellbeing of people who identify with an asexual narrative should be a matter of concern for health and social care professionals and researchers.There are significant gaps in the literature about individuals who reject a centralised model of sexuality and do not fall into a white middle-class category. Research is required in relation to this group, particularly, regarding their experiences of relationship formation and belonging, and how they navigate the sexualised environment.Finally, this work has implications in relation to the education of society. Given that asexuality is largely shrouded in misunderstanding and negativity, as well as being met with doubt and questioning (Conger, 2012), how non-asexual members of society consider asexuality is important. This study makes a significant contribute to our understanding of contemporary sexual norms. It challenges existing ideas which associate asexuality with an absence or lack of sexuality and presents an alternative framework for considering the decisions made by self-identified asexuals to adopt the identity. In relation to healthcare, anecdotal evidence, taken from one of the largest asexual online forums, suggests that a number of self-identified asexuals choose not to disclose their identity to healthcare professionals through fear of their asexual status being pathologised, problematises or judged. Given that asexuality has been identified through studies as a poorly understood concept, this may be due to lack of understanding on behalf of healthcare providers. The work provides health professionals and practitioners working in clinical settings with some insights of the social processes which inform the identity as well as the features of an asexual identity to facilitate culturally competent care

A Home-Start peer support scheme for women with low mood following childbirth

Perinatal mental health problems vary in impact and severity, and can have long-lasting effects on maternal health and child psychological health and development. The evidence to support the effectiveness of postnatal peer and volunteer support schemes to improve the long-term health of women is mixed, with some studies highlighting positive effects in terms of reducing symptoms of depression. Using data from a peer support scheme designed to support women with low mood following childbirth, this paper provides insight into the initial support needs of women, alongside the challenges of using volunteer and peer support services. This paper provides health visitors and others working in community settings with an understanding of how volunteer befriending services may, or may not work in community settings. The data suggests that Home-Start does have a positive impact on the lives of some women, however more work is required in order to understand which aspects of the Home-Start intervention women find effective and why

A qualitative evaluation of home based contraceptive and sexual health care for teenage mothers

This paper reports on the findings from a qualitative study exploring the experiences of teenage mothers using a nurse-led, home-based contraceptive service designed to prevent repeat unplanned pregnancies. The aim was to understand if, and how the service was effective in equipping teenage mothers to make informed choices about contraception, thus preventing a second pregnancy. Unplanned teenage pregnancy remains a significant focus of health and social policy in the United Kingdom (UK). Despite the long-term pattern of declining conception rates, the UK continues to report higher rates than comparable countries elsewhere in Europe. Current estimates suggest that approximately one fifth of births amongst under 18’s are repeat pregnancies (Teenage Pregnancy Independent Advisory Group, 2009). Services that are designed to reduce second unplanned pregnancies are an important element in promoting teenage sexual health. However, there has been no UK research that explores this kind of service and the experiences of service users. We conducted a qualitative interview study. From 2013–2014 we interviewed 40 teenage mothers who had engaged with the nurse-led, home-based contraceptive service. The data demonstrates that the service was effective in preventing repeat pregnancies in a number of cases. Among the aspects of the service which were found to contribute to its effectiveness were privacy, convenience, flexibility, appropriately timed access, the non-judgemental attitude of staff and ongoing support

Women with a BMI ≥ 30 kg/m² and their experience of maternity care : a meta ethnographic synthesis

Objective: This paper is a report of a systematic review and meta-ethnography of the experiences of women with body mass index (BMI) ≥ 30 kg/m² and their experience of maternity care. Method: Systematic review methods identified 12 qualitative studies about women’s experiences of maternity care when their BMI ≥ 30 kg/m². Findings from the identified studies were synthesised into themes, using meta-ethnography. Synthesis and Findings: The meta-ethnography produced four key concepts; Initial encounters, Negotiating risk, Missing out and The positive intervention, which represent the experiences of maternity care for women with BMI ≥ 30 kg/m². Key Conclusion: Many women with BMI ≥ 30 kg/m² appear to be dissatisfied with the approaches taken to discuss weight status during maternity encounters. When weight is not addressed during these encounters women appear to be equally dissatisfied. The absence of open and honest discussions about weight, the feeling of being denied of a normal experience, and an over emphasis on the risks imposed upon pregnancy and childbirth by obesity, leave women feeling dissatisfied and disenfranchised. Sensitive care and practical advice about diet and exercise can help women move towards feeling more in control of their weight management

Second pregnancy prevention among teenagers

Practitioners’ perspectives were used to evaluate a sexual health service designed to prevent second unplanned teenage pregnancy. The service is called Preventing Second Pregnancy (P2P).According to the Family Planning Association (FPA), the UK has the highest teenage pregnancy rates in Western Europe (FPA, 2016). One fifth of births among under 18 year olds are repeat pregnancies (Teenage Pregnancy Independent Advisory Group (TPIAG), 2010; Aslam et al, 2015). The use of outreach contraception and sexual health services aimed at adolescents is one way in which easier access to support and advice on sex, relationships, contraception and sexually transmitted infections is facilitated (Hadley and Evans, 2013). The responsibility for the design and implementation of such programmes rests with local authorities, but little is known about what makes them a success or failure in preventing secondary pregnancies in teenagers (Hayter et al, 2016).Qualitative evaluation was conducted using three focus groups with nurses, midwives and health visitors involved in the referral to, and delivery of, the P2P sexual health service. Analysis was guided by Ritchie and Spencer (1994). This paper presents four characteristics emerging from the analysis that were perceived by health professionals to be important for the effectiveness of P2P.Key findings from previous research indicates that for some young mothers, outreach contraception and sexual health services have a role in the prevention of an unplanned second pregnancy (Hayter et al, 2016). Findings from this study indicate that aspects of the P2P service that practitioners felt contributed to its effectiveness were: flexibility and responsiveness, a commitment to breaking down barriers to accessing contraception, maintaining the initial impetus, and timely service provision

Exploring changes in health visitors' knowledge, confidence and decision-making for women with perinatal mental health difficulties following a brief training package

Rationale and objective: Perinatal Mental Health (PMH) is an issue that spans the spectrum of pregnancy and childbirth and is now acknowledged to be significant on a global level. Health visitors (HVs) are increasingly expected to extend their knowledge and to understand and identify PMH in the antenatal period and across the spectrum from mild/moderate to severe. While training has been shown to enable HVs to identify post-natal depression (PND) effectively and reduce the proportion of women at risk, the mechanisms underpinning this success are unclear. This paper reports on the findings of a mixed methods study aimed at examining the impact of a single half day training session on perinatal mental health problems (PMHP) on HVs knowledge, confidence and empowerment in relation to managing PMH. Methods: Findings from data gathered by Likert Scales and focus group discussions are presented. Results: Training can empower HVs to identify PMHP beyond PND and plays a vital role in promoting confidence. Conclusions: This research highlights the potential that training of this type has on service provision and delivery. In a resource-limited service, the feasibility of a brief training package has demonstrated positive results for health visitors, childbearing women and their families

Understanding asexual identity as a means to facilitate culturally competent care: a systematic literature review

Aims and Objectives This paper aims to provide a contemporary overview of asexuality and the implications this has for health care practice. Background Individuals belonging to sexual minority groups face many barriers in accessing appropriate health care. The term ‘sexual minority group’ is usually used to refer to Lesbian Gay Bisexual and Transgender (LGBT) individuals. Anecdotal and research evidence suggests that those who identify as asexual have similar poor experiences. Methods This work uses a systematic review and qualitative analysis of the existing interview data from self-identified asexuals, to construct features of the asexual identity. The findings will help practitioners and health professionals develop an understanding of this poorly understood construct. Ultimately this work is aimed at facilitating culturally competent care in the context of asexuality. Results Qualitative analysis produced 3 themes, which can be used, not only to frame asexuality in a positive and normalising way, but also to provide greater understanding of asexuality, ‘romantic differences coupled with sexual indifference’, ‘validation through engagement with asexual communities’ and ‘a diversity of sub-asexual identities’. Conclusions Having some understanding of what it means to identify as asexual, respecting the choices made by asexuals and can markedly improve the experiences of those who embrace an asexual identity when engaging with healthcare. Relevance to clinical practice Anecdotal evidence, taken from one of the largest asexual online forums, suggests that a number of self-identified asexuals choose not to disclose their identity to health care professionals through fear of their asexual status being pathologised, problematised, or judged. Given that asexuality is a poorly understood concept, this may be due to lack of understanding on behalf of healthcare providers. The review provides health professionals and practitioners working in clinical settings with some insights of the features of an asexual identity to facilitate culturally competent care

‘Welcome to the World’: parents' experiences of an antenatal nurturing programme

Background The transition to parenthood lays the foundations for the parent-infant relationship, but can also be a time of increased vulnerability. It can therefore be a suitable time for interventions to increase parents’ emotional wellbeing and support couple relationships as well as the relationship with the baby. Aims This study aimed to explore the experiences of attendees at an antenatal nurturing programme and its effect on their experiences of the early postnatal period. Methods A total of 36 attendees took part in six focus groups across the UK. Findings Participants’ experiences of the programme were very positive; it provided knowledge and skills and gave participants a safe space in which to explore feelings and concerns.The programme encouraged participants to nurture themselves, as well as their babies and their relationships. Some groups formed strong support networks, while others did not. Conclusion Participants felt they had benefitted from the programme, particularly in terms of their emotional wellbeing and couple relationships