Apprentice to Graduate: A narrative study into the progression experience of Advanced Apprentice

This thesis explores the biographical journey into and through HE of a small group of former Advanced Apprentices. It explores how early educational experiences relate to pathways into and through the Apprenticeship system and how former Apprentices experiencing HE to develop an understanding of how HE impacts on their lives, experiences, and identities. The changing landscape of both Apprenticeships and higher education means we need to capture these accounts becoming a HE student to understand better the lived, biographical experience of individuals in increasingly credentialised learning and work settings. This study utilises a narrative, longitudinal approach to explore the experiences of Apprentices who have embarked on higher education, drawing upon data from several semi-structured narrative interviews with sixteen former Apprentices as they progress through their higher education programme. The final phase of the study engaged with the broader social network of six participants, illuminating how education and career decision-making and experiences are deeply embedded within family, friendship and peer networks. Analysing learning experiences, educational transitions, and learner identity highlight the process of becoming a higher education student is relational, situational, and part of a web of complex interactions. The study has drawn on communities of practice (Lave and Wenger, 1991; Wenger, 1998) and modes of reflexivity (Archer, 2003, 2007, 2012) as useful frameworks to understand the learning experiences of former Apprentices and how reflexivity guides how people navigate constellations of education and career possibilities. Insights from the social networks suggest that individuals adapt their approach to reflexivity according to the social situation, aspects of and stages in their lives

An interview study exploring clients' experiences of receiving therapeutic support for family estrangement in the UK

Many people experience estrangement from a family member, which is broadly understood to refer to negative relationships that are characterised by little or no contact. However, little is known about how people cope with family estrangement. To address this gap, interviews were conducted with 46 participants who identified as being estranged from a parent/sibling and/or child and having sought therapeutic support for this experience. The participants were recruited from a UK‐based charity that supports individuals experiencing family estrangement. The participants had a range of experiences of therapeutic support, with most (N = 31, 67%) having paid for private therapy. The data were analysed using thematic analysis, and three themes were generated: (1) finding the missing qualities in estranged family relationships: warmth, validation and safety; (2) speaking the unspoken: addressing the causes and consequences of estrangement; and (3) learning relational skills: improving the relationship with oneself and with others. When the causes of estrangement were addressed in the context of a safe therapeutic relationship, participants learned strategies to improve the relationships they had both with themselves and with others. When participants experienced a cold or unresponsive therapeutic relationship, and the causes and consequences of estrangement were not adequately addressed or understood, counselling was experienced as unhelpful. Individuals who seek therapeutic support for family estrangement have specific needs. Training around these needs and the causes and consequences of estrangement could be beneficial to helping professionals and the clients with whom they work

Parents’/caregivers’ fears and concerns about their child’s epilepsy: A scoping review

Background: Childhood epilepsy is a serious and common neurological condition and can have life-long consequences and its impact can pervade all aspects of family life. Whilst the medical management of seizures is important, much of the day-to-day home management of epilepsy is invisible to people external to the family, including health care professionals, and parents’/caregivers’ fears and concerns can go unacknowledged and unaddressed by health care professionals. Objective: This objective of this review was to examine parents’/caregivers’ fears and concerns regarding their child’s epilepsy, the impact of these fears and concerns on family life, the social and emotional well-being of parents/caregivers and any factors which mitigate these fears and concerns. Design: Scoping review using a modified version of Arksey and O’Malley’s framework. Data sources: Relevant studies were identified using key search terms in Scopus, Medline, CINAHL and PsychInfo databases in March 2021 with hand checking of reference lists. Search terms were developed using population (parents/caregivers of children aged ≤ 18 years with epilepsy, families); concept (parents’/caregivers’ fears, concerns, anxiety about their child’s epilepsy); and context (any setting). A further search was run in April 2022. Other inclusion criteria: English language empirical studies, 2010–2021. Study appraisal methods: A minimum of two reviewers independently screened articles and undertook data extraction and decisions were consensually made. Methodological quality appraisal was undertaken using the Mixed Methods Appraisal Tool v2018. A data extraction table was created to chart all studies. The conduct and reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (S1 Table). There is no published copy of the review protocol. Main findings: The search identified a total of 4077 papers (after duplicates were removed) of which 110 were assessed for eligibility. Twenty-four papers published between 2010–2021 were included in the review and each paper was treated as a separate study. The review findings indicate that parents’/caregivers’ fears and concerns stem from more than their child’s seizures and relate to many wider aspects of family life. These fears and concerns had far-reaching influences on their parenting/caregiving, and on the lifestyle and activities of their child and their family. What was less evident was what parents/caregivers wanted in terms of support or how they thought health professionals could acknowledge and/or allay their fears and concerns. The discussion is framed within the compassion-focused therapy model as a basis for generating new thinking about the impact of these fears and concerns and the need for a new agenda for clinical consultations in childhood epilepsy. Conclusions: The review concludes with a proposal that a more compassionate agenda underpins the dialogue between parents/caregivers and clinicians to encompass and mitigate the wider emotional, psychosocial, and societal threats that impact on the parent/caregivers of children with epilepsy

Sustaining, forming, and letting go of friendships for young people with Inflammatory Bowel Disease (IBD): A qualitative interview-based study

Inflammatory bowel disease (IBD) is an incurable, chronic, gastrointestinal condition that can constrain young people's social relationships. Few studies have specifically explored friendships of people with IBD. This qualitative, participatory study used interviews, photographs, and friendship maps to explore friendships and friendship networks of young people with IBD. An online Young Person's Advisory Group was actively engaged throughout the study. Thirty-one young people participated (n = 16 males, n = 15 female; n = 24 Crohn's disease, n = 6 ulcerative colitis, n = 1 IBD-unclassified; the mean age at study was 18.7 years; range 14-25 years). Findings present a metatheme "The importance and meaning of friendships" and three interwoven subthemes of "Sustaining friendships," "Forming new friendships," and "Letting go of friendships." Friendship was important to the young people with IBD, providing support, but associated with challenges such as disclosure. Such challenges could be mitigated by clearer conversations with clinicians about friendships and more extensive conversations about friendships and long-term conditions in education settings

Depression, anxiety, and loneliness among adolescents and young adults with IBD in the UK: the role of disease severity, age of onset, and embarrassment of the condition

From Springer Nature via Jisc Publications RouterHistory: registration 2020-09-24, accepted 2020-09-24, online 2020-09-30, pub-electronic 2020-09-30, pub-print 2021-02Publication status: PublishedFunder: Crohn's and Colitis UK; doi: http://dx.doi.org/10.13039/501100003522; Grant(s): SP2017-2Funder: University of ManchesterAbstract: Purpose: Adolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) report higher depressive symptoms and anxiety compared to healthy controls, with disease severity and abdominal pain being important factors. In the current study, building on what young people had told us in our previous work, we examined whether embarrassment of the condition, social self-efficacy, and friendship quality mediated the relationship between abdominal pain and disease severity, and mental health/well-being. We also included loneliness as a component of well-being. Methods: Data on depression, anxiety, loneliness, friendship quality, social self-efficacy, and disease embarrassment were collected from 130 AYA with IBD ages 14–25 years; data on disease severity and abdominal pain were taken from their medical records. Structural Equation Modeling (SEM) was used to test the relationships between the variables. Results: Using SEM, we established that higher IBD disease activity negatively impacted how AYA felt about their friendships and how embarrassed they were about their condition; embarrassment then influenced reports of mental health, including loneliness. Abdominal pain, disease onset, and social self-efficacy directly predicted internalising problems. Conclusion: In this sample of 14–25-year-old patients with IBD, specifics about the disease (severity and pain) predicted poorer mental health, suggesting discussion of mental health should be part of the clinical dialogue between patient and consultant. In addition, embarrassment about their condition increased depression, anxiety, and loneliness, mediating the relationship between disease severity and well-being. Thus, it is important to consider how perceived stigma affects those with chronic illness, and those issues should be explored in clinic

“I don’t like to make a big thing out of It”: A qualitative interview-based study exploring factors affecting whether young people tell or do not tell their friends about their IBD

Inflammatory Bowel Disease (IBD) describes a group of conditions that includes Crohn’s disease and ulcerative colitis. Unlike some chronic conditions, to a greater or lesser extent, IBD is hidden from or invisible to others which enables concealment of the condition, especially when stigma is associated with the condition. Concealment or nondisclosure allows a means of identity management. Disclosure of a chronic condition is not a single event, and it is dependent on many factors. There is little literature that specifically addresses stigma and/or disclosure in relation to children and young people with IBD. An in-depth qualitative study was undertaken, framed by Interpretive Description and using interviews, friendship maps, and photographs within a participatory framework. Public and patient involvement and engagement (PPIE) was undertaken throughout (inception to dissemination) the study. Young people aged 14-25 years with IBD who had participated in the survey phase of the larger study self-selected to participate in interviews that focused broadly on friendship and feelings of social connectedness. Data were analysed using an iterative, interpretive approach. Preliminary themes were developed and these were explored further, and then tentative theoretical connections about friendship were developed. One superordinate theme focused on disclosure. Thirty-one young people (16 males, 15 females, mean age 18.7 years; 24 Crohn’s, 7 colitis) participated in the interviews (of these, five created friendship maps and six utilised photographs). Three discrete, but interlinked, themes were generated, revealing young people’s experiences of disclosure: to tell or not to tell; controlling the flow: the who, when, what, and how of telling; and reactions and responses to telling: anticipated and actual. Decisions about telling friends about having IBD are challenging for many young people. Having control over disclosure is not always possible, and the potential consequences can feel risky. However, most young people had positive experiences of disclosure and gained support from friends and romantic partners. Most young people downplayed the seriousness of their IBD, revealing some facets of their condition, aiming to sustain their self-identity. Only one young person had been given professional support to disclose. Provision of support and opportunities to discuss whether, when, who, and how to tell friends and what the risks and benefits may be is something that could be woven into an ongoing and wider person-centred dialogue between young people and health professionals within routine clinic visits

Depression, anxiety, and loneliness among adolescents and young adults with IBD in the UK: The role of disease severity, age of onset, and embarrassment of the condition

Purpose: Adolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) report higher depressive symptoms and anxiety compared to healthy controls, with disease severity and abdominal pain being important factors. In the current study, building on what young people had told us in our previous work, we examined whether embarrassment of the condition, social self-efficacy, and friendship quality mediated the relationship between abdominal pain and disease severity, and mental health/well-being. We also included loneliness as a component of well-being. Methods: Data on depression, anxiety, loneliness, friendship quality, social self-efficacy, and disease embarrassment were collected from 130 AYA with IBD ages 14–25years; data on disease severity and abdominal pain were taken from their medical records. Structural Equation Modeling (SEM) was used to test the relationships between the variables. Results: Using SEM, we established that higher IBD disease activity negatively impacted how AYA felt about their friendships and how embarrassed they were about their condition; embarrassment then influenced reports of mental health, including loneliness. Abdominal pain, disease onset, and social self-efficacy directly predicted internalising problems. Conclusion: In this sample of 14–25-year-old patients with IBD, specifics about the disease (severity and pain) predicted poorer mental health, suggesting discussion of mental health should be part of the clinical dialogue between patient and consultant. In addition, embarrassment about their condition increased depression, anxiety, and loneliness, mediating the relationship between disease severity and well-being. Thus, it is important to consider how perceived stigma affects those with chronic illness, and those issues should be explored in clinic

Estrangement between siblings in adulthood: A qualitative exploration

Relationships between siblings have been described as the longest lasting an individual can have, yet siblings both can and do become estranged from one another in adulthood. An online survey was disseminated to individuals who had sought support from the charity Stand Alone, which supports individuals who are experiencing family estrangement. Individuals estranged from one full genetic sister and/or brother were asked to describe the relationship in their own words. Open-text responses were thematically analysed from 291 respondents. Family systems were described as being characterised by estrangements, alliances and conflicts; there was variation in the participant’s preferences regarding reconciliation; and most respondents focused on describing their sibling’s challenging or disappointing characteristics and behaviour. The fact that siblings both can and do become estranged challenges commonly held assumptions about family relationships, confirming that they are not necessarily or always life-long, significant or supportive