Representations of illness: patient satisfaction, adherence and coping

Chapter I evaluates the self-regulatory model and other theoretical frameworks which have informed the six empirical studies described in this thesis. Chapter 2 reviews the literature on patients' satisfaction with care, adherence to treatment recommendations and coping with chronic illness. It highlights omissions in the literature which are addressed by the current research. Chapter 3 provides a systematic description of people's representations of 37 different illnesses and examines the basis on which these illnesses are categorized. It was found that beliefs about symptoms, typical sufferer, and treatment were particularly important in discriminating between different illnesses. Using data from interviews with patients visiting their GP (pre- and post-consultation), chapter 4 explores the relationship between patients' representations of their illness, and satisfaction and intentions to follow treatment recommendations. It was found that doctor-patient discrepancies about diagnosis and treatment were the sole predictors of satisfaction, but were not related to intentions. In a follow-up study, chapter 5 investigates the predictors of satisfaction and adherence two weeks after the consultation. Several factors were found to predict satisfaction at time 2, but doctorpatient discrepancies were no longer related to ratings of satisfaction. Belief in the benefits of treatment was the principal predictor of adherence. The primary aim of the two studies described in chapter 6 was to produce a shorter version of the 60-item COPE suitable for assessing coping in patients. The 32-item measure demonstrated construct validity with the longer version and acceptable internal reliability. Chapter 7 explores the relationship between the different stages of the self-regulatory model in diabetic and hypertensive patients. It was found that beliefs about the costs and benefits of treatment were the principal predictors of dietary and exercise adherence. As predicted, strong relationships were found between patients' illness representations, coping strategies and appraisal of functioning. The final chapter surnmarises the findings of the research and concludes that the self-regulatory model is a useful too] for understanding people's responses to illness and adaptation to chronic illness. SuggestionsN verem ade regarding ways in which the self-regulatory model might be extended to incorporate other conceptually compatible models. Theoretical, methodological and practical implications are discussed

Men’s strategies for preserving emotional well-being in advanced prostate cancer: an interpretative phenomenological analysis

Objective This study explores men with advanced prostate cancers’ own practices for promoting and maintaining emotional well-being using Interpretative Phenomenological Analysis. Design Five men with advanced prostate cancer participated in face-to-face, semi-structured, in-depth interviews. Results Within rich narratives of lost and regained well-being, two super-ordinate themes emerged – ‘living with an imminent and uncertain death’ and ‘holding on to life.’ Well-being was threatened by reduced sense of the future, isolation and uncertainty. Yet, the men pursued well-being by managing their emotions, striving for the future whilst enjoying life in the present, taking care of their families and renegotiating purpose. Running through participant’s accounts was a preference for taking action and problem-solving. Sense of purpose, social connectedness and life-engagement were revealed as concepts central to improving well-being, indicating areas which practitioners could explore with men to help them re-establish personal goals and life-purpose. Conclusions The findings also add weight to the evidence base for the potential value of psychological interventions such as cognitive behaviour therapy and mindfulness in men with prostate cancer

Investigating Weather, Climate, and Climate Change Understanding of Appalachian Middle-Level Students

Climate change is an increasingly pervasive global topic, but how much of this discussion is accurately understood by students? Fully comprehending the small fluctuations associated with long term changes in temperature and precipitation is a daunting task for the general public, let alone for middle-level adolescents. This study examines students’ understanding of weather, climate and climate change. Forty-seven students, ages 12-14 from the Appalachian region of the US, were surveyed before, immediately after, and six months after a standards-based unit of instruction. The study utilized a questionnaire developed by Boon (2009) with additional questions related to weather and climate. Qualitative data were analyzed using a constructivist framework and student responses were examined for understanding of the main content ideas. The students’ understandings were analyzed over time for shifts and were also compared with previously published research (Bodzin et al., 2014; Boon, 2009). Students made improvements in some aspects of understanding with instruction but not all gains persisted to six months post instruction. Students’ distinctions between weather and climate were altered by instruction, persisted, and continued to improve with time. Students demonstrated a general understanding of the differences between weather and climate but struggled when asked to apply this knowledge to specific situations. Some improvements in students’ basic understanding of the greenhouse effect were evident, but some of these improvements degraded with time. While instruction was able to temporarily improve understanding of greenhouse gases, and the benefits of the greenhouse effect, overall students did not retain this understanding over the long term

Making sense of illness: the experiences of users of complementary medicine

The present study investigated the experiences of users of complementary and alternative medicine (CAM) using a qualitative approach. In-depth interviews were conducted with 11 frequent users and analysed using interpretative phenomenological analysis (IPA). Results indicated that the patient-practitioner relationship and explanatory frameworks provided by CAM were perceived as important components of the therapeutic process, irrespective of treatment efficacy. CAM served a variety of functions beyond the explicit relief of symptoms by increasing energy and relaxation, facilitating coping and enhancing self/other awareness. It is therefore important that these wider effects are taken into account when evaluating complementary medicine in order to accurately reflect patients' experiences

Engagement with meditation as a positive health trajectory: Divergent narratives of progress in male meditators

Objective: Studying personal narratives can generate understanding of how people experience physical and mental illness. However, few studies have explored narratives of engagement in health positive behaviours, with none focusing on men specifically. Thus, we sought to examine men’s experiences of their efforts to engage in and maintain healthy behaviours, focusing on meditation as an example of such behaviour. Design: We recruited 30 male meditators, using principles of maximum variation sampling, and conducted two in-depth interviews with each, separated by a year. Main outcome measures: We sought to elicit men’s narratives of their experiences of trying to maintain a meditation practice. Results: We identified an overall theme of a ‘positive health trajectory,’ in particular, making ‘progress’ through meditation. Under this were six main accounts. Only two articulated a ‘positive’ message about progress: Climbing a hierarchy of practitioners, and progress catalysed in other areas of life. The other four reflected the difficulties around progress: Progress being undermined by illness; disappointment with progress; progress ‘forgotten’ (superseded by other concerns); and progress re-conceptualised due to other priorities. Conclusion: Men’s narratives reveal the way they experience and construct their engagement with meditation – as an example of health behaviour – in terms of progress

Typologies of caregiving: Understanding support needs of carers across four continents

Background Caregivers play an essential role in supporting people living with Alzheimer’s disease globally. Cross-country research on caregivers’ experiences of coping is a prerequisite to developing useful trans-cultural guidelines for support organisations. While some coping strategies of caregivers globally have been identified, these are neither well understood or elaborated, nor linked effectively into carer support offerings. Methods In partnership with Alzheimer’s Disease International (ADI) and Roche, we conducted in-depth qualitative interviews with photo-elicitation with 34 caregivers from UK, US, Brazil, and South Africa to understand critical factors in coping during and after the pandemic. Inductive narrative analysis of data and participant generated images coded to dominant themes (Relationships and Caring role) were developed with input from global and national charity and industry sectors. Results We uncovered four caregiving styles: Empaths used emotion-focused strategies to construct their caring role ('put yourself in that person’s shoes’). They tended to develop strong coping skills, but needed psychosocial support and time specific information. Organisers used problem-focused strategies and sought information and training early on ('I’m a pretty good expert now’). They developed strong narratives of organisation, advocacy and expertise. Non-identifiers managed some aspects of the caring role but felt isolated and lacked knowledge and expertise ('do everything I can…there’s nobody else’). They sought others to manage disease related support. Reluctants struggled with unwanted caring duties ('I didn’t sign up for this’). They needed support in coming to terms with their loved one’s diagnosis and professional help with the day-to-day caring role. Conclusion Our findings highlight the need for tailored user-driven support offerings, that begin with the individual carer’s experiences and needs. Our typology will be used in the communication and development of findings and best practice guidelines to inform charities and policy makers about cost effective ways of tailoring support to fit individual carer circumstances globally

Circulating histone concentrations differentially affect the predominance of left or right ventricular dysfunction in critical illness.

OBJECTIVES:Cardiac complications are common in critical illness and associated with grave consequences. In this setting, elevated circulating histone levels have been linked to cardiac injury and dysfunction in experimental models and patients with sepsis. The mechanisms underlying histone-induced cardiotoxicity and the functional consequences on left ventricle and right ventricle remain unclear. This study aims to examine dose-dependent effects of circulating histones on left ventricle and right ventricle function at clinically relevant concentrations. DESIGN: Prospective laboratory study with in vitro and in vivo investigations. SETTING:University research laboratory. SUBJECTS:Twelve-week old male C57BL/6N mice. INTERVENTIONS:Cultured cardiomyocytes were incubated with clinically relevant histone concentrations, and a histone infusion mouse model was also used with hemodynamic changes characterized by echocardiography and left ventricle/right ventricle catheter-derived variables. Circulating histones and cardiac troponin levels were obtained from serial blood samples. MEASUREMENTS AND MAIN RESULTS:IV histone infusion caused time-dependent cardiac troponin elevation to indicate cardiac injury. At moderate sublethal histone doses (30 mg/kg), left ventricular contractile dysfunction was the prominent abnormality with reduced ejection fraction and prolonged relaxation time. At high doses (≥ 60 mg/kg), pulmonary vascular obstruction induced right ventricular pressure increase and dilatation, but left ventricular end-diastolic volume improved because of reduced blood return from the lungs. Mechanistically, histones induced profound calcium influx and overload in cultured cardiomyocytes with dose-dependent detrimental effects on intracellular calcium transient amplitude, contractility, and rhythm, suggesting that histones directly affect cardiomyocyte function adversely. However, increasing histone-induced neutrophil congestion, neutrophil extracellular trap formation, and thrombosis in the pulmonary microvasculature culminated in right ventricular dysfunction. Antihistone antibody treatment abrogated histone cardiotoxicity. CONCLUSIONS:Circulating histones significantly compromise left ventricular and right ventricular function through different mechanisms that are dependent on histone concentrations. This provides a translational basis to explain and target the spectral manifestations of cardiac dysfunction in critical illness

Vigilance and Avoidance of Threat in the Eye Movements of Children with Separation Anxiety Disorder

The vigilance-avoidance attention pattern is found in anxious adults, who initially gaze more at threatening pictures than nonanxious adults (vigilance), but subsequently gaze less at them than nonanxious adults (avoidance). The present research, using eye tracking methodology, tested whether anxious children show the same pattern. Children with separation anxiety disorder or no mental disorder viewed pairs of pictures, while the direction of their gaze was tracked. Each picture pair showed one picture of a woman separating from a child, the other picture of a woman reuniting with a child. The results supported the vigilance-avoidance model in children. Although the two groups' gaze direction did not differ during the first second of viewing, anxious children gazed significantly more at separating (threatening) pictures than nonanxious children after a period of 1 s. But after 3 s the pattern reversed: anxious children gazed significantly less at the separating pictures than nonanxious children