Ethnographic methods for process evaluations of complex health behaviour interventions.

This is the final version of the article. Available from BioMed Central via the DOI in this record.This article outlines the contribution that ethnography could make to process evaluations for trials of complex health-behaviour interventions. Process evaluations are increasingly used to examine how health-behaviour interventions operate to produce outcomes and often employ qualitative methods to do this. Ethnography shares commonalities with the qualitative methods currently used in health-behaviour evaluations but has a distinctive approach over and above these methods. It is an overlooked methodology in trials of complex health-behaviour interventions that has much to contribute to the understanding of how interventions work. These benefits are discussed here with respect to three strengths of ethnographic methodology: (1) producing valid data, (2) understanding data within social contexts, and (3) building theory productively. The limitations of ethnography within the context of process evaluations are also discussed

Navigating the maze: Qualitative research methodologies and their philosophical foundations

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordObjectives: One of the three objectives of the Society and College of Radiographers is the promotion and dissemination of research in radiography and radiotherapy. This article aims to assist in the production of high standard research by explaining how transparency in reporting the underpinning philosophical basis of a qualitative study can be achieved in addition to the more customary descriptions of how data were collected and analysed. Key findings: Unlike their quantitative equivalent, qualitative research methodologies are less well understood and reported in radiography research, in particular the philosophical and epistemological assumptions which underpin the methods used. Conclusion: Demonstrating consistency between the philosophical position taken and the methods used within a study is an important aspect of research quality. Implications for practice: Qualitative research can offer valuable insights into the social, organisational, behavioural and interpersonal aspects of medical imaging practice. These may include wellbeing, attitudes, perceptions and beliefs, leadership, management practices, education, professionalism and a wide range of issues around patients' experiences during medical imaging. Patient care and outcomes can be positively impacted as a result of acquiring these insights

“It's what's behind the mask”: Psychological diversity in compassionate patient care

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record Introduction: The Francis Report recommended an increased focus on compassion in healthcare, and recognition and non-judgmental acceptance of diversity is fundamental in compassionate patient care. The aim of this study was to achieve a wider understanding of diversity that includes individual patient needs, expectations, perceptions and feelings during diagnostic imaging. Methods: Using thirty-four semi-structured interviews with individual patients, this qualitative study explored their experiences of undergoing diagnostic radiography examinations and asked what compassionate care meant to them and how it is perceived and manifested in the brief, task-focussed and highly technical diagnostic projection imaging encounter. Data were analysed using Thematic Analysis. Results: Four key themes were identified from the analysis; these were: feelings and vulnerability; hidden emotions; professionalism and valued qualities and communication. Conclusion: Diversity is defined not only in terms of socio-cultural differences but also psychological ones, i.e. individual emotional and attitudinal characteristics, some of which may be consciously or unconsciously concealed. In order that patients are treated equitably and all of their care needs met, recommendations include a broader focus in education and training to include adapting communication skills and techniques in perception and expression of non-verbal cues. Further research into the pressures specific to the time-pressured, task-focussed, highly technical and rapid turnover environment of projection imaging radiography and how this impacts upon compassionate patient care would make a useful contribution to the field

Family preferences for home or hospital care at diagnosis for children with diabetes in the DECIDE study.

This is the final version of the article. Available from Wiley via the DOI in this record.AIMS: A diagnosis of Type 1 diabetes in childhood can be a difficult life event for children and families. For children who are not severely ill, initial home rather than hospital-based care at diagnosis is an option although there is little research on which is preferable. Practice varies widely, with long hospital stays in some countries and predominantly home-based care in others. This article reports on the comparative acceptability and experience of children with Type 1 diabetes and their parents taking part in the DECIDE study evaluating outcomes of home or hospital-based treatment from diagnosis in the UK. METHODS: Semi-structured interviews with 11 (pairs of) parents and seven children were conducted between 15 and 20 months post diagnosis. Interviewees were asked about adaptation to, management and impact of the diabetes diagnosis, and their experience of initial post-diagnosis treatment. RESULTS: There were no differences between trial arms in adaptation to, management of or impact of diabetes. Most interviewees wanted to be randomized to the 'home' arm initially but expressed a retrospective preference for whichever trial arm they had been in, and cited benefits relating to learning about diabetes management. CONCLUSIONS: The setting for early treatment did not appear to have a differential impact on families in the long term. However, the data presented here describe different experiences of early treatment settings from the perspective of children and their families, and factors that influenced how families felt initially about treatment setting. Further research could investigate the short-term benefits of both settings.National Institute for Social Care and Health Research Clinical Research Centr

What medical imaging professionals talk about when they talk about compassion

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordBackground Compassion is a poorly understood concept in Medical Imaging research, but an increase in its focus was recommended in the Francis Report (2013). Little research has been conducted in this area to date. Methods The project was conducted from within a constructivist paradigm with appropriate ethical approval. As part of a wider doctoral study, data were harvested from a Twitter journal club discussion between medical imaging professionals of the author's published literature review and one focus group of post-graduate radiographers. Data were transcribed and analysed thematically. Results Compassion in DI is conceptualised according to three themes constructed from the data: 1) Perceptible elements of the procedure; 2) Underlying qualities, skills and abilities of radiographers; 3) Moral and ethical foundations. When medical imaging professionals talk about compassion they talk about its importance in professional practice, the challenges faced in giving compassionate care and the strategies they employ to cope with the emotional as well as physical demands they face. Contradictory organisational values and an over-emphasis on individuals’ responsibility for providing compassionate care were also highlighted. Ethical professional practice need not necessarily include in every interaction expressions of compassion, or feelings in a medical imaging professional of caring about their patient. Conclusion The concept of compassion has depth, with surface appearances underpinned by moral values and behaviour-motivating drivers. These findings offer a clearer understanding of compassion that could inform radiographic practice and education

The dynamics of decision-making in weight loss and maintenance: a qualitative enquiry

This is the final version. Available on open access from BMC via the DOI in this recordBackground . Behavioural approaches to weight loss are often initially successful but less so in the longer term, as some people maintain the necessary behaviour changes while others do not. This study aimed to derive possible explanations for this using a qualitative approach with a view to improving intervention effectiveness. Methods . Thirty-six participants in a development and feasibility study for a weight loss and maintenance intervention (called SkiM) were interviewed three times over 18 months regarding their experiences before, during and after the intervention. Data were analysed thematically. The accounts of those who were more and less successful in terms of longer term weight loss were compared, and a conceptual model linking the main analytic themes was developed. Results. Five interpretative themes were generated: encountering and managing key situations; the impact of emotion; the source of control; personal values; and acquiring knowledge and skills. These themes were linked through a model of decision-making during key situations. In this model, behavioural decisions emerge from a dynamic interplay between several drivers: emotional state and needs, perceived control, personal values, the individual’s knowledge and skills, and their existing habits. The individual’s response in key situations generates experiential learning that caninfluence decisional dynamics in similar situations in future. These dynamics appeared to differ between participants, and between those who were more and less successful in weight management. Conclusions. Our analysis and model of decision-making during weight-management have implications for the development and delivery of behavioural weight management interventions. By helping individuals to identify the drivers of their decision-making in key situations, and equipping them to manage these drivers, programmes may enhance their capacity to sustain the behaviour changes needed for long-term weight loss.National Institute for Health Research (NIHR

“It's a lot more complicated than it seems”: physiotherapists' experiences of using compensation strategies in people with Parkinson's

This is the final version. Available from Frontiers Media via the DOI in this record. Data availability statement: The datasets presented in this article are not readily available to protect confidentiality. Requests to access the datasets should be directed to [email protected]: Gait disturbances often result in functional limitations in daily activities and negatively impact the quality of life in people with Parkinson’s disease. Physiotherapists often employ compensation strategies in an attempt to improve patients’ walking. However, little is known about physiotherapists’ experiences in this regard. We evaluated how physiotherapists adopt compensation strategies and what they draw on to inform their clinical decision-making. Methods: We carried out semi-structured online interviews with 13 physiotherapists with current or recent experience working with people with Parkinson’s disease in the United Kingdom. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was utilized. Results: Two main themes were developed from the data. The first theme, optimizing compensation strategies through personalized care, shows how physiotherapists accounted for the individual needs and characteristics of people with Parkinson’s, which resulted in them individually tailoring compensation strategies. The second theme, delivering compensation strategies effectively, considers the available support and perceived challenges with work settings and experience that impact physiotherapists’ ability to deliver compensation strategies. Discussion: Although physiotherapists strived to optimize compensation strategies, there was a lack of formal training in this area, and their knowledge was primarily acquired from peers. Furthermore, a lack of specific knowledge on Parkinson’s can impact physiotherapists’ confidence in maintaining person-centered rehabilitation. However, the question that remains to be answered is what accessible training could address the knowledge–practice gap to contribute to the delivery of better personalized care for people with Parkinson’s.National Institute for Health and Care Research Applied Research Collaboration South West PeninsulaMinistry of Education, Saudi Arabi

The economic impact of cancer diagnosis to individuals and their families: a systematic review

This is the final version. Available on open access from Springer via the DOI in this recordBackground: The effect of a cancer diagnosis is wide ranging with the potential to affect income, employment and risk of poverty. The aim of this systematic review is to identify the economic impact of a cancer diagnosis for patients and their families/caregivers. Methods: The search covered peer-reviewed journals using MEDLINE, EMBASE, CINAHL, Cochrane Library, Epistemonikos and PsycINFO databases. Quality appraisal was undertaken using CASP tools. Monetary values were converted to US Dollars/2019 using a purchasing power parities (PPP) conversion factor. The review included articles up to and including January 2020, written in English language, for patients with cancer aged ≥18 years and focused on the costs up to five years following a cancer diagnosis. Results: The search was run in January 2020 and updated in November 2021. Of 7973 articles identified, 18 met the inclusion criteria. Studies were undertaken in the USA, Ireland, Canada, Australia, France, UK, Malaysia, Pakistan, China and Sri Lanka. The majority were cohort studies. Twelve reported out-of-pocket costs (range US$16–US$2,523/month per patient/caregiver) consisting of medical expenses (e.g. surgery, radiotherapy and chemotherapy) and non-medical expenses (e.g. travel, food and childcare). Fourteen studies reported patient/caregiver loss of income and lost productivity (range 14–57.8%). Conclusions: A high percentage of cancer patients and their families/caregivers experience out-of-pocket expenditure, loss of income and lost productivity. Future research is needed to observe the effects of continuing changes to healthcare policies and social protections on the economic burden among cancer patients and their families/caregivers.Saudi Arabia Cultural Burea

Nature as a 'Lifeline': The Power of Photography when Exploring the Experiences of Older Adults living with Memory Loss and Memory Concerns.

The visual is an underutilised modality through which to investigate experiences of memory loss in older people. We describe a visual ethnography with older adults experiencing subjective or objective memory loss, receiving a cognitive wellbeing group intervention designed to prevent cognitive decline and dementia (APPLE-Tree programme). We aimed to explore lived experiences of people with memory concerns, how participants engaged with this photography and co-design project, and how collaboration with an artist/photographer enhanced this process. Nineteen participants shared photographs reflecting what they valued in their daily lives, their experiences of memory concerns, and the intervention. Fourteen participated in qualitative photo-elicitation interviews, and thirteen collaborated with a professional artist/photographer to co-create an exhibition, in individual meetings and workshops, during which a researcher took ethnographic field notes. Eight participants were re-interviewed after the exhibition launch. We contextualise images produced by participants in relation to discourses around the visual and ageing and highlight their relationship with themes developed through thematic analysis that interconnects photographic, observational and interview data. We present themes around the use of photographs to: (1) celebrate connections to nature as a lifeline; (2) anchor lives within the context of relationships with family; (3) reflect on self and identity, enduring through ageing, memory concerns, pandemic, and ageing stereotypes. We explore visual research as a powerful tool for eliciting meaningful accounts from older adults experiencing cognitive change and to connect the arts and social sciences within ageing studies