Symptom onset and the socially sanctioned pathway: the example of diet

Theories of symptom perception do not explain symptom onset, nor why symptoms vary according to culture and time. This article attempts to explain cultural, temporal and individual variation in symptoms, and presents a new three-stage model of symptom onset. First, it is argued that tensions relating to issues of conflict and control arise as an individual interfaces with their social world and that this requires communication. Second, it is suggested that symptoms are embedded with culturally specific meanings which offer up a socially sanctioned pathway as a forum for communication. Third, if this pathway is appraised as personally relevant, the symptoms offered by the pathway will be adopted as the forum for communication. The resulting symptoms are therefore both culturally and personally meaningful. This model is derived from an analysis of the literature on diet, but is also offered as a means to understand the onset of other common symptoms

The value of choice: A qualitative study

Background Providing choice in health care is part of an ongoing policy initiative Aim To explore how people understand choice in health care provision Setting South East England Design of Study A qualitative study using semi structured interviews Method Twenty two people recruited through advertising were interviewed about choice in general and choice in health care in particular. The data were analysed using template analysis. Results Participants grounded their consideration of choice in the NHS within the GP consultation. Four main themes about choice were identified: positive aspects of choice; the appearance of choice; unwanted choice; and the role of information in choice. In particular, there was strong assent to the value of choice in principle and having choice was seen as positive. The provision of choice options, however, was not always associated with the possibility of meaningful choice and participants felt that the appearance rather than the substance of choice was sometimes in evidence. Making – as opposed to having - choice was often unwanted and considered as indicative of erosion in trust in the GP and to occasion regret. Information was seen as a necessary but not sufficient prerequisite of informed choice Conclusion People value having choices rather than making choices but are concerned about choice provision for its own sake rather than choice that is available in a meaningful way. Health care policy that recommends an increase in choice per se may be met with scepticism which could ultimately undermine rather than promote the doctor / patient relationship

Transnational youth mobility trajectories:an ethnography of young people with a migration background between Ghana and Germany

This thesis investigates the ‘transnational youth mobility trajectories’ of migrant youth, meaning all the moves that young people make in their lives, including migrations but also family visits, holidays, internships, and transitions between different school systems. An increasing proportion of young people around the world have a migration background, and recent research shows that many migrant youth in Europe travel regularly to their country of origin. Nevertheless, we know very little about the way mobility affects their lives. As part of the ‘Mobility Trajectories of Young Lives’ project (www.motrayl.com), this thesis focused on Ghanaian-background youth (15-25 years) living in Hamburg. It shows that migrant youth are very mobile, that the frequency and reasons for their mobility change over time, and that mobility has important effects on their lives in the country of residence. Experiences in the country of origin – including schooling, family environments, and other important relationships – can provide valuable resources, like confidence and motivation, and other forms of support that help migrant youth navigate schooling and life in the country of residence

Understanding sustained behavior change: the role of life crises and the process of reinvention

Much research has addressed behavior change but has tended to focus on short term changes. This study aimed to explore the mechanisms behind sustained changes in behavior and involved qualitative interviews with 34 `success stories' who had either lost weight through changes in diet and exercise (n = 24) or stopped smoking (n = 10) and had maintained this change for at least 3 years. The results showed that the majority described how their sustained behavior change had been triggered by a significant life crisis relating to their health, relationships or salient milestones. This initial change was then translated into sustained change if three sustaining conditions were met: the function of the unhealthy behavior was disrupted, the individual perceived that their choice over carrying out the unhealthy behavior had been reduced and they adhered to a behavioral model of their problem. Further, these conditions functioned by enabling a process of reinvention with participants showing a shift in identity toward a new healthier self. The results are discussed in terms of self-regulation and the establishment of a new post-crisis healthier equilibrium

Challenges, strategies and self-efficacy of teachers supporting autistic pupils in contrasting school settings: a qualitative study

There is general support among teachers for inclusion of children with special educational needs, but many lack the confidence and knowledge to support autistic pupils. This can have an adverse effect on their education. Previous studies have explored the attitudes of teachers towards inclusion, but less is known about the experiences of teachers from contrasting school settings regarding autistic pupils. Semi-structured interviews were conducted with twelve teachers from mainstream and special schools. Questions explored the school provision for autistic pupils, including strategies relating to their learning, friendships, bullying and general inclusion. Thematic analysis identified themes describing teachers' challenges supporting autistic children, strategies they adopt to facilitate achievement and the influence of factors such as staff training/expertise, educational ideology, attitudes and the physical environment. Overall, it is argued that, besides the structural differences between mainstream and special schools, there remain a number of additional factors impacting teachers' sense of self-efficacy. These are discussed in relation to recent research perspectives advocating an inclusive educational pedagogy

Evaluation of an Online ‘Teachable Moment’ Dietary Intervention

Abstract Purpose - To evaluate an online ‘teachable moment’ intervention to promote healthy eating for overweight and food intolerance symptoms. Design/methodology/approach – The study involves a 2 x 2 factorial design with two conditions: group (weight loss vs food intolerance) and condition (intervention vs control). The intervention aimed to generate a ‘teachable moment’ by providing knowledge regarding the relationship between food and the problem (overweight or food intolerance), focusing on the negative aspects of the problem, creating a behavioural model, and encouraging hope and reinvention. Participants receiving the intervention (n = 22) completed measures of dietary behaviour and either weight or food intolerance symptoms before receiving the intervention and again one month later. Control participants (n = 20) provided measures but did not receive the intervention. Findings - There were no significant reductions in weight or food intolerance symptoms. However, compared to control participants, participants in the intervention conditions reported greater intentions to eat healthily (p = .01) and improved healthy eating behaviour over time, following both an intention-to-treat (p = .046) and explanatory analysis (p = .042). Practical implications - Encouraging individuals to perceive their everyday situation as a time for change and adopt healthier behaviour early on, may prevent future diet-related medical events. This has benefits for both the individual and for health care costs. Originality/value - A quick and easy to administer online ‘teachable moment’ intervention improves dietary behaviour and can be minimally adapted to suit individuals with differing health needs

Taking Orlistat: Predicting Weight Loss over 6 Months

This study explored the predictors of weight loss following orlistat with a focus on both baseline variables and changes in beliefs and behaviours occurring over the course of taking the drug. Patients (n = 566) prescribed orlistat completed a questionnaire at baseline and after 6 months concerning their weight, beliefs and behaviours. By 6 months the majority had lost some weight and showed improvements in diet. Many had also stopped taking the drug and a large minority reported using it flexibly as a lifestyle drug. Those who lost most weight showed a decrease in beliefs in a medical solution, a decrease in unhealthy eating, an increased belief in treatment control and an increased belief that the unpleasant consequences are both due to their eating behaviour and just part of the drug. When taken with fatty food orlistat causes symptoms such as anal leakage and oily stools. These may encourage some patients to focus on the behavioural aspects of their weight problem thus promoting the dietary changes needed for both short and longer term weight loss. When prescribing orlistat, clinicians should encourage patients to see the consequences as an education as a means to promote the effectiveness of this form of medical management