How do new/recent mothers experience unwanted harm thoughts related to their newborn? A thematic analysis.

Objective: The aim of this qualitative research study was to explore how new/recent mothers experience intrusive, infant-related harm thoughts (IRHTs). Background: New/recent mothers' experiences of IRHTs remain a taboo topic, yet several studies indicate such thoughts are common. Understanding the normal experience of such thoughts is needed to improve the postpartum experiences of mothers, and clinical practice. The aim was to elicit a fuller, critical understanding of the experience of harm thoughts in a mixed, non-clinical sample, exploring how they are understood, managed and shared by women. Methods: Semi-structured interviews were conducted with eight new/recent mothers who had experienced IRHTs related to their youngest child, born within the last two years. Data were analysed with Thematic Analysis. Findings: The results yielded three core themes: Heightened emotions; Constructions of motherhood and maternal identity; Costs and benefits of sharing. Conclusion: Findings corroborate previous literature showing that IRHTs commonly occur among non-clinical postpartum mothers, highlighting their intense emotional impact, and barriers to women reporting them due to stigma. Results also highlighted ways in which the pervasive ideology of motherhood informed mothers' meaning-making of IRHTs. Recommendations include discussing the ideology of motherhood with pregnant women and partners and facilitating open, normalising discussion of IRHTs.

GP experience and understandings of providing follow-up care in prostate cancer survivors in England.

Survival times for prostate cancer have increased substantially, meaning more survivors will be discharged to General Practitioners' (GP) services. The detection of recurrence and monitoring of symptoms and long-term side-effects in prostate cancer survivors requires the active involvement of GPs in their follow-up care. In order to address this, the transition and discharge from hospital to primary care must be managed effectively. The objective of this study was to examine the preparedness, concerns and experiences of GPs in relation to their role in providing follow-up care to prostate cancer survivors. Purposive sampling was used to recruit GPs with experience in providing care to prostate cancer survivors. Twenty semi-structured telephone interviews were conducted with GPs across England. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Participants described their current role in the follow-up pathway, a number of challenges and barriers in assuming this role, and potential ways to resolve these and improve their involvement. They expressed a range of views about their preparedness and willingness to take over follow-up care after discharge for this group of patients. GPs had reservations about workload, lack of resources, expertise and deficiencies in communication with hospitals. Findings from this study suggest that GPs will be ready to take over the follow-up care of prostate cancer survivors if better information, additional training and adequate resources are provided and communication lines with hospital specialists are clear. Understanding the issues faced by GPs and overcoming identified barriers to providing follow-up care to prostate cancer survivors will provide the insight necessary to make the process of transferring care from secondary to primary teams a more straightforward task for all stakeholders.

Adolescent and caregivers' experiences of electronic adherence assessment in paediatric problematic severe asthma.

This study explored the experiences of adolescents and their caregivers regarding adherence to inhaled corticosteroids which are assessed through an electronic monitoring device (EMD). These devices are increasingly being used for assessing medication adherence, yet there is little information about patient's experience of these tools. Semi-structured interviews were conducted with eight adolescents with severe asthma, aged 11-15 years, who were electronically monitored as part of their care, along with their caregivers. Interviews were analysed using thematic analysis. Three themes were identified: 'they were trying to help me get better', 'checking up and catching out' and 'who is responsible?' The themes highlighted differences in priorities between participant groups, the impact of monitoring on the healthcare relationship and the dilemma of transferring responsibility for asthma management to adolescents. The findings suggest it is important for healthcare professionals to engage with patient's preferences and priorities when introducing EMDs.

The experiences of high intensity therapists delivering cognitive behavioural therapy to people with intellectual disabilities.

BACKGROUND: People with intellectual disabilities (ID) should be able to access the Improving Access to Psychological Therapies (IAPT) programme, currently a main provider of mainstream mental health services in England. IAPT offer cognitive behavioural therapy (CBT) to individuals experiencing mental health problems, although its effectiveness for people with ID, when delivered within IAPT, is unclear. METHOD: Ten high-intensity therapists took part in semi-structured interviews, analysed using thematic analysis, regarding their experiences of delivering CBT to people with ID in IAPT. RESULTS: The rigidity of the IAPT model appears to offer a poor fit with the needs of people with ID. Therapists appeared uncertain about how to modify CBT and highlighted training and service development needs. CONCLUSIONS: Findings suggest barriers to accessing IAPT largely remain unaddressed where people with ID are concerned. Services may need to reconsider what constitutes appropriate reasonable adjustments to ensure equitable access.

Early improvement in eating attitudes during cognitive behavioural therapy for eating disorders: the impact of personality disorder cognitions.

BACKGROUND: The personality disorders are commonly comorbid with the eating disorders. Personality disorder pathology is often suggested to impair the treatment of axis 1 disorders, including the eating disorders. AIMS: This study examined whether personality disorder cognitions reduce the impact of cognitive behavioural therapy (CBT) for eating disorders, in terms of treatment dropout and change in eating disorder attitudes in the early stages of treatment. METHOD: Participants were individuals with a diagnosed eating disorder, presenting for individual outpatient CBT. They completed measures of personality disorder cognitions and eating disorder attitudes at sessions one and six of CBT. Drop-out rates prior to session six were recorded. RESULTS: CBT had a relatively rapid onset of action, with a significant reduction in eating disorder attitudes over the first six sessions. Eating disorder attitudes were most strongly associated with cognitions related to anxiety-based personality disorders (avoidant, obsessive-compulsive and dependent). Individuals who dropped out of treatment prematurely had significantly higher levels of dependent personality disorder cognitions than those who remained in treatment. For those who remained in treatment, higher levels of avoidant, histrionic and borderline personality disorder cognitions were associated with a greater change in global eating disorder attitudes. CONCLUSIONS: CBT's action and retention of patients might be improved by consideration of such personality disorder cognitions when formulating and treating the eating disorders.

The experiences of young people with Epidermolysis Bullosa Simplex: a qualitative study.

The objective of this study was to explore the experiences of young people with Epidermolysis Bullosa Simplex (EBS). Eleven participants aged 10 -14 years were interviewed and Interpretative Phenomenological Analysis was employed. A key theme was 'self as different'. This related to experiences of negative treatment and exclusion from peers; a lack of understanding of others about the condition; and a sense of the self as 'wrong'. Findings indicate the importance of providing appropriate psychological and peer support, as well as wider community education and intervention, as part of the holistic treatment of young people with this chronic, painful and visible skin condition.

Re-constructing masculinity following radical prostatectomy for prostate cancer.

Prostate cancer is common in older men. Surgical treatment involving removal of the prostate can result in temporary or permanent erectile dysfunction (ED) and incontinence and have a major impact on men's masculine identity. Seven men were interviewed about their experiences and concerns following prostatectomy, and the transcripts were analysed employing Foucauldian Discourse Analysis to identify the ways in which they constructed their masculinity. Participants drew upon four main discourses when discussing the impact of surgical treatment on their sense of masculinity: masculine identity and sexual activity, ED as a normative experience, mental resilience and vulnerability. Penetrative sex was constructed as central to a masculine identity, but inability to achieve this was normalised in terms of the ageing process. Stereotypically masculine qualities of emotional control and rationality were drawn on in describing their reaction to the diagnosis and treatment of cancer but they also experienced a new-found sense of physical vulnerability. The findings are discussed in terms of their implications for the clinical management of ED post-surgery and helping men adjust to life following treatment.

Lower urinary tract symptoms in men: self-perceptions and the concept of bother.

OBJECTIVE: To explore the meaning that men attach to their experiences of having lower urinary tract symptoms (LUTS) and to understand 'bother' in the context of those meanings. PATIENTS AND METHODS: Sixteen men with symptoms suggestive of LUTS and/or an enlarged prostate were recruited from the outpatient urology clinic of a London teaching hospital. They were assessed before or shortly after their first appointment, during which demographic information, including age, occupation, marital status and ethnicity, was obtained and an individualized repertory grid was completed. Each man also completed the International Prostate Symptom Score, which included an item measuring overall bother, and the Hospital Anxiety and Depression Scale. RESULTS: Most participants held very negative views about what it meant to have prostate problems and viewed them as being associated with old age. Nevertheless, they also had reasonably high levels of self-esteem. However, there was evidence that these had been higher before they had prostate problems, and that self-esteem might decline over time. Bother was related to symptom scores and to anxiety. Also, a perception that other people, particularly their partner, saw them in a more negative light because of their symptoms was associated with higher levels of bother. CONCLUSIONS: The findings suggest that men attempt to preserve a sense of a relatively youthful and intact 'self' in the face of advancing years and a progressive disease that was viewed as being associated with old age. Overall, these men had a reasonably secure self-image and they deployed a range of cognitive strategies to maintain this. Bother appears to be a combination of symptom severity, psychological distress, negative evaluations of the condition and beliefs about the reactions of others. Reducing anxiety and challenging negative stereotypes and expectations that others would view them negatively if their problems were known might reduce bother. Attending to these factors could enable watchful waiting to be optimized by reducing bother. Trials to evaluate interventions drawing on these principles would be valuable.

Men's experiences of having lower urinary tract symptoms: factors relating to bother.

OBJECTIVE: To gain an understanding of men's experiences of having lower urinary tract symptoms (LUTS) and of bother, a principle determinant of whether a patient has an intervention for LUTS. PATIENTS AND METHODS: Data were collected on 75 patients with LUTS presenting to a urology outpatient clinic. Men completed a questionnaire asking about their symptoms, bother, mood and perceptions about LUTS. RESULTS: Most participants scored within the normal range for anxiety and depression, and expressed a moderate level of distress. They were to some extent bothered by their symptoms. Most men perceived LUTS as a long-term problem but felt unable to control their symptoms. The results suggest that bother reflects men's overall distress with having LUTS. Bother appears to be related to symptom severity, self perception, social limitation and the impact of LUTS. Embarrassment and social anxiety relate strongly to bother. CONCLUSION: Several psychological factors relate to bother; it may be possible to reduce bother using a brief psychological intervention.

Masculinity, infertility, stigma and media reports.

There is growing concern about the health of men in the developed West. Compared with women they have higher rates of morbidity and mortality and are less likely to seek out and employ medical services. Several authors have drawn on social constructionist models, such as the concept of hegemonic masculinity, to account for these gender differences in risk and behaviour. One might anticipate that certain conditions, such as male infertility, would be perceived as posing a particular threat to conventional views of masculinity. There is some support for this, although there is little research into the social construction of male infertility. In this study Discourse Analysis was employed to analyse newspaper accounts of a reported decline in sperm counts in order to study the way in which infertility and masculinity were represented and constructed in the media. The results indicate a construction of fertility as being in crisis and of male infertility as conflated with impotence. Men were positioned as vulnerable and threatened by forces outside their control. The accounts drew on a range of stereotypically masculine reference points, such as warfare and mechanical analogies. These results are consistent with concepts of hegemonic masculinity and suggest that men are offered a highly restricted set of options in terms of perceiving and representing their bodies and their health.

Men and chronic illness: a qualitative study of LUTS.

In order to determine how men react to and manage chronic conditions 16 men with Lower Urinary Tract Symptoms (LUTS) were interviewed to examine the relationship between detecting symptoms and seeking medical help, perceptions of symptoms and the impact of symptoms on daily life. Transcripts were analysed employing IPA and four major themes identified: Uncertainty/Trying to understand, Implications, Ways of coping and Self-concept/Identity. Uncertainty about the nature and origins of their condition and its gradual onset contributed to the delay in seeking medical advice. Men adopted a range of coping strategies to manage their symptoms. Implications for primary health care consultations are considered.