Accounting for health and illness: A social psychological investigation

This thesis identifies and describes some of the main accounts for health and illness that are current in British culture, placing them within broader contexts of psychological, sociological, traditional, religious and moral discourses; within broader explanatory frameworks; and, by way of an analysis of these ecological aspects, seeks to illuminate our understanding of such accounting. A combination of Q and ethnographic methods were used to elucidate a variety of alternative ways that people "make sense" of health and illness. Three main studies were conducted. The first two investigated accounting for health and illness within a broad framework of accounts as "explanations"; as moral judgements and prescriptions; and as defining meaning. The third study focussed on the external/internal explanatory framework, and demonstrated that accounting is far more complex than the Wallston and Wallston (1981) "Health Locus of Control Construct' would suggest. Some accounts stressed "internality", some "externality", some a combination of both, and others viewed this construct as non-salient. These latter included accounts about personal autonomy, and, importantly, the 'medical model" account. In the thesis overall, among the accounts identified were ones based upon notions of : "the wonders of modern medicine"; "stress"; "the cultural critique'; 'a healthy lifestyle", 'tradition"; "individual autonomy", 'Theism'; and "Willpower". These accounts are assumed to operate both within individual subjectivity and popular discourse, offering people a variety of complementary 'texts' with which to weave narratives, drawing upon different 'texts" according to situational and other demands. Thus accounting is portrayed as an active, thoughtful and sometimes contradictory 'storymaking" activity, and people as competent negotiators of reality

The time has come for psychology to stop treating qualitative data as an embarrassing secret

Despite the sustained flourishing—both in terms of quantity and quality—of qualitative research in psychology, psychology's establishment ‘gatekeepers’ seem to still be wedded to the dogma that only experimental research and quantitative data are sufficiently robust to be taken seriously. In this paper we make the case against this contempt and call for qualitative research and data to be recognized as valid and epistemologically sound in its own right. Given that its ontology is based upon constructionist assumptions about the nature of the social world, its power to provide nuanced insight into the complexity of humankind is not a problem, but its greatest strength. Our paper therefore starts with a brief review of the ontological and epistemological differences between the two approaches to demonstrate that they are complementary rather than competition. We then make our case, based on two key strategies: first by shedding light on the fact that many (perhaps even most) of psychology's classic experimental studies actually collected qualitative data (in the form of debriefing interviews and the like) and used it to understand what was going on; and then by recent studies that have expressly sought feedback about the hypothesis being purportedly tested. We then recognize the extent to which contemporary researchers are expressing their frustration at the way that they are being forced into a methodological straight jacket, by carrying out their research in ways they view as inauthentic. We end with a call to kerb the methodological dogma that has taken hold of psychology, and to move to a more inclusive approach

Public viewpoints on new non-invasive prenatal genetic tests.

types: Journal ArticlePrenatal screening programmes have been critiqued for their routine implementation according to clinical rationale without public debate. A new approach, non-invasive prenatal diagnosis (NIPD), promises diagnosis of fetal genetic disorders from a sample of maternal blood without the miscarriage risk of current invasive prenatal tests (e.g. amniocentesis). Little research has investigated the attitudes of wider publics to NIPD. This study used Q-methodology, which combines factor analysis with qualitative comments, to identify four distinct "viewpoints" amongst 71 UK men and women: 1. NIPD as a new tool in the ongoing societal discrimination against the disabled; 2. NIPD as a positive clinical application offering peace of mind in pregnancy; 3. NIPD as a medical option justified for severe disorders only; and 4. NIPD as a valid expansion of personal choice. Concerns included the "trivialisation of testing" and the implications of commercial/direct-to-consumer tests. Q-methodology has considerable potential to identify viewpoints and frame public debate about new technologies.Economic and Social Research Counci

Q methodology and a Delphi poll: a useful approach to researching a narrative approach to therapy

Q methodology and a Delphi poll combined qualitative and quantitative methods to explore definitions of White and Epston's (1990) narrative approach to therapy among a group of UK practitioners. A Delphi poll was used to generate statements about narrative therapy. The piloting of statements by the Delphi panel identified agreement about theoretical ideas underpinning narrative therapy and certain key practices. A wider group of practitioners ranked the statements in a Q sort and made qualitative comments about their sorting. Quantitative methods (principal components analysis) were used to extract eight accounts of narrative therapy, five of which are qualitatively analysed in this paper. Agreement and differences were identified across a range of issues, including the social construction of narratives, privileging a political stance or narrative techniques and the relationship with other therapies, specifically systemic psychotherapy. Q methodology, combined with the Delphi poll, was a unique and innovative feature of this study

The Social Construction of Conspiracy Beliefs: A Q-Methodology Study of How Ordinary People DefineThem and Judge Their Plausibility

Little is known about ordinary people’s understandings of conspiracy beliefs and how these understandings relate to the perspectives of researchers and scholars. Working within a social constructionist epistemological framework, we conducted a Q-methodology study aiming to identify a range of lay perspectives on two key topics: the defining features of conspiracy beliefs; and aspects considered important in judging their plausibility. Fifty-six people (32 men and 24 women), recruited via regional UK Facebook groups, sorted their agreement with a set of statements on each of the two topics. A principal component analysis, followed by varimax rotation, was performed on each data set. Five accounts about the defining features of conspiracy beliefs were identified: that they are false, illogical and harmful; that they are forms of political critique; that there are varied types; that they are entertaining but ineffectual; and that they are held by a self-reinforcing minority. Four accounts about their evaluation were identified: conventional realist criteria; the importance of personal judgement; skeptical realism; and the assessment of critical thinking. The findings are discussed in the context of the literature and limitations of the study are considered. Implications for research and educational and policy interventions are outlined

Exploring the psychological rewards of a familiar semirural landscape: connecting to local nature through a mindful approach

This study analyses a 53,000 word diary of a year engaging with nature through over 200 trips to a semi-rural landscape. Thematic analysis revealed two themes; the transition from observer to nature connectedness and the ways in which the natural environment was experienced once a connection was made. These themes are discussed in relation to theories that seek to explain the positive effect of nature and nature connectedness. The findings are important as they suggest that repeated engagement with local semi-rural countryside can lead to a mindful approach and psychological rewards that do not require travel into the wilderness. The work informs further research into outcomes and processes of nature based interventions such as: trip frequency, duration and diary keeping

A socially situated approach to inform ways to improve health and wellbeing

NoMainstream health psychology supports neoliberal notions of health promotion in which self-management is central. The emphasis is on models that explain behaviour as individually driven and cognitively motivated, with health beliefs framed as the favoured mechanisms to target in order to bring about change to improve health. Utilising understandings exemplified in critical health psychology, we take a more socially situated approach, focusing on practicing health, the rhetoric of modernisation in UK health care and moves toward democratisation. While recognising that within these new ways of working there are opportunities for empowerment and user-led health care, there are other implications. How these changes link to simplistic cognitive behavioural ideologies of health promotion and rational decision-making is explored. Utilising two different empirical studies, this article highlights how self-management and expected compliance with governmental authority in relation to health practices position not only communities that experience multiple disadvantage but also more seemingly privileged social actors. The article presents a challenge to self-management and informed choice, in which the importance of navigational networks is evident. Because health care can become remote and inaccessible to certain sections of the community, yet pervasive and deterministic for others, we need multiple levels of analysis and different forms of action

Concepts of adversity, risk, vulnerability and resilience: A discussion in the context of the 'Child Protection System'

This paper explores the concepts of adversity, risk, vulnerability and resilience in the context of child protection systems with the aim of contributing to the debate about the ways in which risk of ‘harm’ and ‘abuse’ are conceptualised at different stages of the lifespan and in relation to different groups of people. The recent developments in the policy and legislative framework for state intervention on behalf of children in the UK are described and linked with an exploration of the underlying assumptions about abuse and neglect. Concepts of adversity, risk, vulnerability and resilience and the ways in which the complexity of the routes and pathways to ‘harm’ pose a challenge to the current UK state protective system are discussed

Domain-based perceptions of risk:a case study of lay and technical community attitudes towards managed aquifer recharge

Despite growing water scarcity, communities in many parts of the developed world often reject technically and economically sound options for water augmentation. This paper reports findings from a study investigating risk perceptions associated with a proposed Managed Aquifer Recharge scheme in Australia. Q-Methodology was used to compare decision-making frameworks of lay community and „technical expert‟ participants. Technical expert participants were also asked to approximate the decision-making framework of a „typical‟ community member. The emerging contrasts between lay community frameworks and those approximated by technical experts suggest that there are prevailing yet errant assumptions about lay community attitudes towards new technologies. The findings challenge the characterisation of the lay community and technical experts as being in entrenched opposition with one another