Investigating how young people learn to live with inflammatory bowel disease

Inflammatory Bowel Disease (IBD) is the medical term for two chronic conditions; ulcerative colitis and Crohn's disease. It affects approximately 180,000 people in the UK, and the incidence of Crohn's disease in children and young people has increased during the last 10 years. Research into IBD mainly concentrates on treatments and causes, with a smaller proportion of studies addressing psychosocial issues. Much of the existing research is disease focussed, and neglects to inform us of how young people live their daily lives with IBD. This research fills this gap, and takes the step of following a group of young people with IBD over an extended time. The first part of data collection was an interview study with adults aged between 20 and 25 years. All had a minimum of five years experience of IBD, and were diagnosed before age 18. The interviews used a life story format, and addressed concerns of the public and private nature of illness experience, perceptions of the body, relationships with family and friends, changing living space, and problems with disclosing illness. These outcomes raised questions about what it means to live "beyond" illness. The interview study informed the next part of data collection, an audio diary intervention study with a cohort of young people. This comprised six participants aged between 11 and 16 years at the time of recruitment into the study. All were diagnosed with IBD up to a maximum of 18 months prior to being approached to take part. They were each given a digital recorder and encouraged to record aspects of their lives that were of importance to them. These did not have to be disease related. The total period of the diary production lasted 48 weeks, Each participant was interviewed first, and then had a follow-up interview every six weeks in diary sets. This exercise was called an "unclosed diary", to reflect the emergent, flexible nature of documenting information usually disclosed in a private, autobiographical journal. Data was analysed in terms of how much IBD featured in individual lives and how participants positioned themselves in their accounts. The data from both studies revealed that IBD was not a catalyst for all decisions and events that shaped the lives of young participants. There are aspects of IBD experience that are aligned to existing literature, in terms of bodily perception and restricted living space through fear of faecal incontinence. However there are other stories of everyday activity that show that IBD is not a prominent force in a young person's life. Methodologically, this is a study that emphasises that living with a chronic illness like IBD involves a significant period of time when illness is absent. Living beyond illness is not limited to doing activities in spite of IBD, but is a concept that is dependent on how young people position themselves and how others position them

Benefits and barriers of cancer practitioners discussing physical activity with their cancer patients

Our aim was to synthesise the existing empirical literature and theoretical perspectives on the physical activity (PA) promotion practices and determinants of cancer clinicians and health professionals. We conducted a narrative review of theory and evidence to develop practice recommendations for improving the promotion of PA to cancer patients. Surveyed health professionals were aware of many benefits of PA for their cancer patients, although only ~40 % promoted PA to selected cancer patients. Walking was the most commonly promoted form of PA, with this promoted to assist patients control their weight and cardiovascular health risk. Barriers to promotion of PA included lack of time and knowledge of PA and behaviour change skills. Health professionals appear interested in promoting PA to their cancer patients, yet encounter several barriers. Further research is warranted to assist health professionals improve their PA promotion. An adapted reflective-impulsive model of social behaviour shows promise for assisting health professionals overcome barriers and provides an evidence-based theoretical framework for improving communication with patients. Universities, hospitals and/or health-care accreditation organisations also have important roles to play in assisting health professionals improve their promotion of PA to patients

"It's about what you've assigned to the salad": Focus group discussions on the relationship between food and mood

Current observational and interventional studies in nutritional psychiatry suggest that healthy dietary patterns rich in fresh whole foods could protect against depressive symptoms, and that unhealthy dietary patterns high in ultra-processed and refined foods could contribute to depressive symptoms. However, no studies have explored detailed subjective accounts behind the food and mood relationship. This study aimed to uncover unknown factors in the human experience with food and mood. Using a phenomenological framework, this focus group study applied thematic template analysis to accounts of over 50 Australians aged between 18 and 72. Three themes were identified from the transcript of the focus groups: (i) reactive and proactive relationships with food, (ii) acknowledgement of individual diversity relating to eating and mental health, and (iii) improving mood by removing food restriction and eating intuitively. The data highlights the complexity of the relationship between food and mood that extends beyond biological mechanisms which could be used to extend current epidemiological and intervention studies in the field of dietary patterns and depression

More than just teaching procedural skills: How RN clinical tutors perceive they contribute to medical students’ professional identity development

BACKGROUND: On their journey to “becoming” doctors, medical students encounter a range of health professionals who contribute to their socialisation into clinical practice. Amongst these individuals are registered nurses (RNs) in clinical practice who are often employed by medical schools as clinical tutors. These RNs will encounter medical students on campus and later in the clinical setting. AIMS: This qualitative study explored RNs’ perceptions of their contribution to medical students’ developing professional identities in order to provide a greater understanding of this process and ultimately inform future curriculum. METHODS: This qualitative study took place in 2012 at one Australian medical school as part of a broader study exploring medical students’ professional identity development from the perspectives of their teachers and trainers. Eight of the nine RNs involved in teaching procedural skills were interviewed. Recorded interviews were transcribed verbatim. Data were analysed inductively by the research team. RESULTS: Two major themes emerged: RNs as change agents and RNs as facilitators of medical students’ transition to the clinical environment. RNs as change agents related to their role modelling good practice, being patient-centred, and by emphasising factors contributing to good teamwork such as recognising and respecting individual professional roles. They facilitated students’ transition to the clinical environment often through personal narratives, by offering advice on how to behave and work with members of the healthcare team, and by being a point of contact in the hospital. CONCLUSION: Based on their descriptions of how they role modelled good practice and how they facilitated students’ transition to clinical practice, we believe that RN clinical tutors do have the experience and expertise in clinical practice and a professional approach to patients to contribute to medical students’ developing professional identities as future doctors