Self-help groups as sites of active citizenship: a qualitative study of the democratising role of self-help in the public sphere

Self-help groups in the United Kingdom continue to grow in number and address virtually every conceivable health condition, but they remain the subject of very little theoretical analysis. The literature to date has predominantly focused on their therapeutic effects on individual members. And yet they are widely presumed to fulfil a broader civic role and to encourage democratic citizenship. The thesis uses qualitative data derived from individual and group interviews with 33 groups in order to provide an outline of the ethos, aims, activities and structural arrangements of a broad range of self-help groups in Nottinghamshire, UK. It then uses these findings as the foundation on which to construct a model of self-help groups’ democratising effects in the public sphere and as a means of differentiating them from other types of ‘health citizenship’ organisation such as new social movements. In order to do this it broadly follows the work of Jurgen Habermas, making use of his concepts of communicative action; system-lifeworld integration; lifeworld autonomy and collective identity as an appropriate framework against which to account for these groups in civic terms. It was found that in their pursuit of personal and collective identities the groups were augmenting individual autonomy through increasing mutual recognition and understanding in the lifeworld. Although at first sight the groups appeared to be structured hierarchically, leaders tended to use their influence to foster a type of communicative equality that sustained the democratic negotiation of these identities. In addition, through their two-way communicative links with the system the groups were adding to the complexity and quality of discourse in the public sphere and increasing the possibility of attaining social consensus. Unlike new social movements who are believed to operate at the protest end of civil society, the self-help groups were oriented to its enabling sector

Self-help groups as sites of active citizenship: a qualitative study of the democratising role of self-help in the public sphere

Self-help groups in the United Kingdom continue to grow in number and address virtually every conceivable health condition, but they remain the subject of very little theoretical analysis. The literature to date has predominantly focused on their therapeutic effects on individual members. And yet they are widely presumed to fulfil a broader civic role and to encourage democratic citizenship. The thesis uses qualitative data derived from individual and group interviews with 33 groups in order to provide an outline of the ethos, aims, activities and structural arrangements of a broad range of self-help groups in Nottinghamshire, UK. It then uses these findings as the foundation on which to construct a model of self-help groups’ democratising effects in the public sphere and as a means of differentiating them from other types of ‘health citizenship’ organisation such as new social movements. In order to do this it broadly follows the work of Jurgen Habermas, making use of his concepts of communicative action; system-lifeworld integration; lifeworld autonomy and collective identity as an appropriate framework against which to account for these groups in civic terms. It was found that in their pursuit of personal and collective identities the groups were augmenting individual autonomy through increasing mutual recognition and understanding in the lifeworld. Although at first sight the groups appeared to be structured hierarchically, leaders tended to use their influence to foster a type of communicative equality that sustained the democratic negotiation of these identities. In addition, through their two-way communicative links with the system the groups were adding to the complexity and quality of discourse in the public sphere and increasing the possibility of attaining social consensus. Unlike new social movements who are believed to operate at the protest end of civil society, the self-help groups were oriented to its enabling sector

Use of social media by self-help and mutual aid groups

This paper explores the use of social media by self-help/mutual aid groups that meet on a regular face-to-face basis. It draws on data from the ESTEEM project, which ran from 2010 to 2013 with the overall aim of developing a range of resources for health and social care practitioners on how to support self-help/mutual aid groups. A re-examination of the interviews and discussions that were undertaken with 21 groups in two UK sites indicated that groups’ use of social media was becoming an increasingly important resource. The findings highlight a range of benefits and limitations with self-help/mutual aid groups using social media and suggest a blurring of boundaries between online and face-to-face groups. For groupworkers involved with self-help/mutual aid groups opportunities in developing groups’ online presence are raised

Being a ‘Self-Help Supporter’: Recognising the roles that community practitioners can adopt in supporting self-help groups

Recent policies on self-care and personalisation have a strong focus on the value of peers as a means through which understanding and knowledge can be conveyed. This opens up new opportunities for community practitioners to work with groups run for and by peers who share the same health or social situation. Selected findings are presented from a three year Big Lottery funded project ‘ESTEEM’ (2010-13) conducted in two locations in England, focussing on the ways in which community practitioners can best support the ethos and practice of peer led self-help groups in the community. The study involved a sample of 21 SHGs and 26 practitioners who contributed to semi-structured interviews, group interviews and workshops which shaped online national resources and subsequent training programmes. The findings explore the types of relationships and core activities that practitioners have with SHGs. suggesting a nuanced picture of practitioner support to groups in three main areas of activity: organisational development; nurturing members and processes and enhancing and sharing expertise. Building on the findings the discussion considers how practitioners can best support SHGs, whilst crucially respecting the autonomy and integrity of the groups. Five roles that practitioners as a ‘self-help supporter’ can adopt are identified

Exploring Inclusion and Diversity within Undergraduate Teacher Training Programmes in England

This research has been triggered by the consistent references to the increase in the number of children from ethnically diverse population in schools in England and lack of confidence and preparedness of teachers to teach children from diverse backgrounds. A government commissioned Newly Qualified Teachers (NQT) survey encouraged them to respond to questions related to their preparedness and confidence to teach children from all ethnic backgrounds and who have English as additional language, one year after gaining their Qualified Teacher Status (QTS). The aim of this research is to explore the perspectives and challenges of students (referred to as Associate teachers (ATs)) on teacher training programmes related to their knowledge and understanding of inclusion and diversity from the teacher training programmes. This research examined the perceptions of ATs on their final year of the three-year degree on initial teacher education programme and some teacher educators teaching this cohort of students who are programme leaders, year leaders, and other staff, who provide enriching experiences related to diversity. Data was collected through a survey consisting of open questionnaires for teacher educators and ATs were requested to volunteer to respond to questions on an online forum. The online survey was kept open for a short window of four weeks to enable ATs to respond in their own time and ensure anonymity. The responses provided by ATs and Teacher Educators (TEs) have been analysed using qualitative data analysis applying the three steps - Developing and Applying Codes, identifying themes, patterns and relationships and summarizing the data. The data resulted in four themes : concepts and contexts of diversity, experiences on the programme, preparedness to teach and challenges. The ATs and TEs articulate that there was significant impact of the teacher training programme on preparing them to teach children from diverse ethnic backgrounds. They acknowledged the lack of diversity in the placements to teach children from diverse backgrounds as one of the key challenges and barriers faced

Differences in Maternal and Infant Cord Blood Vitamin D Between Racial/Ethnic Groups

Background: Vitamin D deficiency associated with lower 25-hydroxyvitamin D (25(OH)D) concentration is common among individuals with more melanin pigmentation. Low 25(OH)D levels in pregnant women may be related to increased risk of low birth weight and preterm delivery. Still, few studies have assessed how serum levels of 25(OH)D vary between maternal and infant race/ethnicity. Objective: This study aimed to investigate the relationship between 25(OH)D levels in maternal blood and infant cord blood within certain ethnic groups, prematurity status, and low birth weight. Experimental Design:An IRB-approved study enrolled 86 mother-infant pairs. Maternal blood samples and infant cord blood samples were analyzed for 25(OH)D serum levels. Descriptive statistics and Kruskal-Willis tests comparisons were conducted with the use of IBM SPSS Statistics 28 software to assess the relationship between maternal and cord blood 25(OH)D levels in other race/ethnicity groups, birthweight, and preterm birth. Prematurity was categorized into two groups: premature (weeks) and term (≥37 weeks). Birth weight was categorized into two groups: low birth weight (\u3c 2500 g weeks) and not low birth weight (≥2500 g weeks). A p-value of Results:Median levels of 25(OH)D serum were lower in infant’s cord blood (22.52 ng/mL) than maternal blood (38.06 ng/mL). White participants had significantly higher 25(OH)D levels than African American participants in both maternal blood (40.76 ng/mL vs 27.79, p = Conclusion: Our findings suggest a possible association with lower serum 25-hydroxyvitamin D concentration in darker skin pigmentation, even in a small sample size. These results suggest that prematurity and birth weight should be replicated in larger sample sizes of different Race/Ethnic groups, limiting this finding. Further studies should focus on examining differences with larger and more diverse sample sizes. Such research should include measuring Vitamin D intake in pregnancy and clinical outcomes.https://digitalcommons.unmc.edu/surp2021/1008/thumbnail.jp

Tocopherol Content of Maternal Breast Milk and Impact on Neonatal Growth

Background: Vitamin E is a fat-soluble nutrient consisting of α-, β-, δ-, and γ-tocopherol isoforms that has established effects on neonatal growth in utero. Higher maternal plasma tocopherol concentrations in pregnancy are associated with increased neonatal weight, length, and head circumference percentiles at birth. However, less is known about the impacts of tocopherols on post-natal growth. Since many neonates consume maternal breast milk as their post-natal nutrient source, it is important to understand the tocopherol content of breast milk and associations with neonatal growth. Significance of Problem: Although the tocopherols demonstrate positive associations with neonatal growth in utero, the role of these breast-milk-derived nutrients on post-natal growth is unclear. Enhanced understanding of these relationships can help clinicians and mothers ensure ideal nutrition and growth in their neonates. Hypothesis: We hypothesize there will be positive correlations between maternal breast milk tocopherol concentrations and post-natal growth parameters in neonates. Experimental Design: Breast milk samples were collected from postpartum mothers (N=24) whose neonates were admitted to the neonatal intensive care unit (NICU) and analyzed for α-, δ-, and γ-tocopherol concentrations using high performance liquid chromatography (HPLC). Neonatal anthropometric percentiles at 36 weeks corrected gestational age (CGA) and discharge were collected from the medical record. The Fenton growth chart was used for neonates born \u3c37 weeks CGA and the WHO growth chart for neonates born \u3e37 weeks CGA. Spearman correlations assessed the relationships between breast milk tocopherol concentrations and neonatal growth percentiles. A p-value \u3c0.05 was statistically significant. Results: 70% of neonates were born preterm (median CGA=35.9 weeks). At 36 weeks CGA, median growth percentiles were 59.9 for weight, 68.4 for length, and 60.9 for head circumference. At discharge, median growth percentiles dropped to 33.6, 41.6, and 48.3, respectively. Breast milk concentrations of α- and γ-tocopherol were significantly correlated to increased neonatal length percentile at 36 weeks CGA (both R=0.70, both p=0.016), with γ-tocopherol concentration also correlating with increased weight percentiles at 36 weeks CGA (R=0.62, p=0.033). There were no significant associations between breast milk tocopherol content and discharge growth percentiles. Conclusions: This study demonstrates the potential role of increased maternal breast milk tocopherol content on post-natal growth at 36 weeks CGA for preterm neonates. Limitations of this study include a small sample size and variability among neonates in total breast milk consumption prior to reported growth measures. Future research should assess total breast milk intake in neonates and evaluate neonatal plasma tocopherol concentrations.https://digitalcommons.unmc.edu/chri_forum/1048/thumbnail.jp

Assessing The Impact Of Socioeconomic Status On Maternal And Cord Serum Omega-3 Polyunsaturated Fatty Acid Levels

Background: Omega-3 (n-3) polyunsaturated fatty acids (PUFAs) modulate inflammation throughout the lifespan and are essential in fetal growth and development. Previous studies have demonstrated that individuals with lower socioeconomic status (SES) may be at risk for low intake of n-3 PUFAs; however, no research has compared the concentrations of these nutrients present in maternal and cord serum between markers of SES. Significance of Problem: Individuals with low serum levels of n-3 PUFAs may suffer from unfavorable birth and pregnancy outcomes. Therefore, it is important to identify populations who may have decreased serum levels of these nutrients in order to provide nutritional recommendations to optimize prenatal care. Objective: The purpose of this study is to assess the relationship between markers of SES and levels of n-3 PUFAs in maternal and cord serum in a group of patients delivering at a Midwest Academic Medical Center. Methods: An IRB-approved study enrolled mother-infant pairs (n=55) at the time of delivery for collection of maternal and cord serum samples. n-3 PUFA levels quantified included Eicosapentaenoic acid (EPA), Docosahexaenoic acid (DHA), and total n-3 PUFAs. Markers of SES include private vs public insurance, income ≤150% of the poverty line vs \u3e150%, and college degree earners vs no college degree. Descriptive statistics were run for all variables. The Mann-Whitney U test was used to assess differences in n-3 PUFA levels between SES groups. A p\u3c0.05 was considered statistically significant. Results: Median gestational age at delivery was 39.3 weeks in this cohort. Significantly higher nutrient levels were present in college-educated mothers vs less than college-educated mothers for maternal EPA (9.44 µg/mL vs 5.13 µg/mL, p=0.010), cord EPA (1.88 µg/mL vs 1.40 µg/mL, p=0.011), cord DHA (37.96 µg/mL vs 32.80 µg/mL, p=0.014), and total cord n-3 PUFAs (44.23 µg/mL vs 39.34 µg/mL, p=0.024). Median cord EPA levels were significantly higher in those with private insurance compared to public (1.79 µg/mL, 1.18 µg/mL, p=0.022). Additionally, median cord EPA levels were significantly higher in those \u3e150% the poverty line (1.79 µg/mL, 1.10 µg/mL, p=0.030). No other significant differences were observed between SES groups and n-3 PUFA levels. Conclusion: Our findings suggest that individuals with lower SES may be at risk for lower serum levels of n-3 PUFAs in pregnancy, which could predispose them to adverse birth and pregnancy outcomes. Future studies should focus on replicating these results in a larger, more heterogeneous sample and should consider analyzing additional markers of SES.https://digitalcommons.unmc.edu/chri_forum/1051/thumbnail.jp

Evaluation of Tocopherol Isoforms in Maternal Breast Milk and Their Relationship with Maternal Dietary Intake

Background: Vitamin E is an essential, fat-soluble nutrient with four isoforms: α-, β-, δ-, and γ-tocopherol. These isoforms differentially modulate inflammation and show variable associations with perinatal outcomes, such as preterm delivery and Apgar scores. However, little is known about the role of these isoforms on post-natal outcomes and their presence in maternal breast milk, a neonate’s ideal nutrition source. Significance of Problem: To analyze the role of tocopherols on post-natal growth and inflammation, it is critical to first assess their presence in maternal breast milk. Relating these measures to maternal dietary intake can advance our understanding of breast milk micronutrient composition and provide an avenue for counseling lactating mothers on the importance of maternal nutrition to ensure their neonate’s health. Experimental Design: Breast milk samples were collected from postpartum mothers (N=24) whose infants were admitted to the neonatal intensive care unit (NICU) and analyzed for α-, δ-, and γ-tocopherol concentrations using high-performance liquid chromatography (HPLC). Maternal dietary intake was assessed using the Harvard Food Frequency Questionnaire. Median tocopherol concentrations and isoform proportions were generated for breast milk concentrations and intake values. Tocopherol intake adequacy was defined using the Institute of Medicine’s recommendation of 19mg of α-tocopherol daily. Mann-Whitney U-tests compared median breast milk tocopherol concentrations between intake adequate vs. deficient mothers and assessed for differences in isoform proportions between dietary intake and breast milk samples. A p-value \u3c0.05 was statistically significant. Results: 63.6% of mothers had deficient tocopherol intake (median daily intake=15.3mg α-tocopherol). Median concentrations of α-, δ-, and γ-tocopherol (ug/L) in breast milk samples were 3866.5, 768.1, and 118.6, respectively. There were no significant differences in breast milk tocopherol concentrations between intake adequate vs. deficient mothers. For both dietary intake and breast milk, α-tocopherol had the highest relative proportion (MBM=83%, intake=52%), followed by γ-tocopherol (MBM=14%, intake=39%) and δ-tocopherol (MBM=3% intake=8%). Proportions of δ- and γ-tocopherol were significantly higher in dietary intake compared to maternal breast milk (both p\u3c0.001). Conclusions: This study highlights the prevalence of overall tocopherol intake deficiency and increased proportional consumption of δ- and γ-tocopherol among lactating mothers. It also suggests a mechanism for maintaining breast milk α-tocopherol concentrations despite intake deficiency. Differences in the proportions of tocopherol isoforms between breast milk and intake measures further indicates that proportions of individual tocopherol isoforms in breast milk are influenced by factors other than dietary intake.https://digitalcommons.unmc.edu/chri_forum/1049/thumbnail.jp