Meaning of fabric orthoses to long-term users with multiple sclerosis: An interpretative phenomenological analysis.

BACKGROUND: Fabric orthoses are elasticated garments designed to provide support to the musculoskeletal system. They may benefit people with multiple sclerosis; however, in this population, their acceptability is largely unexplored. OBJECTIVES: This study aimed to explore the meaning that fabric orthoses hold for people with multiple sclerosis and factors influencing acceptability. STUDY DESIGN: This is a qualitative study using an interpretative phenomenological analysis to explore the meaning ascribed to lived experience. METHODS: Four people with multiple sclerosis participated in face-to-face semi-structured interviews. Two used upper limb orthotic sleeves for involuntary movement control, one used orthotic shorts, and one used a soft ankle brace. Three participants had fabric orthoses they no longer used. Themes were validated by peer review. FINDINGS: Two themes were identified. "Giving back control" describes how perceived physical benefits, such as decreased involuntary movement and improved stability, led to important benefits in autonomy and self-image. Orthoses were not worn longer-term where self-image was not improved. "Learning to live with an orthosis" captures the way in which participants learnt from experience over months or years how to maximize effectiveness and overcome disadvantages. Acceptability was determined specific to the contexts in which the orthoses were used, with the social appropriateness of appearance and the demands of tasks being important considerations. CONCLUSIONS: Fabric orthoses can be acceptable to people with multiple sclerosis. Professionals should be mindful of the active learning process that users engage in as they learn about the pros and cons of orthotic use. Further research into effectiveness is needed.

Parents of school students on childhood overweight: the Weight of Opinion Study.

AIM: The perceptions of parents of school-aged children regarding child and adolescent overweight and obesity were examined. METHOD: Parents with children in primary and secondary schools in socio-economically diverse areas across metropolitan Sydney and rural New South Wales, Australia, were recruited for focus group discussions. Content analysis was used to analyse the focus group transcripts. RESULTS: Participants were concerned about overweight among school-aged children and young people, but were reluctant to address it with their own children. The parents wanted general practitioners to raise the issue, but not other professionals or friends/relations. The participants agreed that schools had an educational role to play in both healthy eating and physical activity, but disagreed about whether schools should regulate foods brought from home or supplied at school. Parents suggested various ways of restricting marketing to children, educating parents and children, increasing opportunities for physical activity and increasing access to healthier foods. CONCLUSIONS: Parents are concerned about overweight among children and adolescents, but are reluctant to take action, and would find it difficult to be effective change agents. There are opportunities for intervention, but they must recognise the salient emotional issues associated with weight and food among parents.

Perceptions of adolescents on overweight and obesity: the weight of opinion study.

AIM: The incidence and prevalence of overweight and obesity are rising around the world. Health promotion planning must be informed by the knowledge, perceptions, motivations and perceived needs of the target population, but little is known about how adolescents perceive overweight and obesity, its causes and solutions. METHODS: A cross-sectional, non-representative sample of 12- to 17-year-old boys and girls (n = 58) attending schools in diverse metropolitan areas and one rural area in NSW, Australia. Focus groups were conducted in 2005 and content analysis was used to identify key themes. RESULTS: The students were aware that overweight was becoming increasingly common. They perceived the negative consequences primarily in psycho-social terms, but were also aware of the long-term physical health consequences. Behaviours, appearance, motivation and self-esteem were used as criteria to judge if a person was overweight and the students distinguished between 'healthy' and 'ideal' (physically attractive) weight. The major barriers to maintaining a healthy weight were home, school and community environments in which fatty/high sugar foods were too easily accessible and where opportunities for participating in physical activity were sometimes limited. Student-identified strategies to address the issue encompassed government policy, advertising and media, schools and home. CONCLUSIONS: The students have a mature and complex understanding of overweight and its potential solutions, making them likely to be creative contributors and responsive to wide-ranging, multi-component interventions.

Mothers of pre-school children talk about childhood overweight and obesity: The Weight Of Opinion Study.

AIM: To investigate the perceptions of parents of young children aged 2-5 years regarding childhood overweight and obesity. METHODS: Parents with children in seven pre-schools and long day-care centres from diverse socio-economic areas across metropolitan Sydney and one rural area were recruited for focus groups. Focus group transcripts were analysed using content analysis. RESULTS: Providing food was an emotional issue for the mothers in this study. They were more concerned about their young children being underweight than overweight, and this increased their stress around children's eating. Food treats were perceived as entitlements. Mothers did believe that they were responsible for their children's eating, but acknowledged the influence of other environmental factors related to food retail and marketing. Practical and safety issues limited opportunities for their children to be physically active beyond the formal child-care setting. Parents had practical suggestions for solutions to some of the barriers they experienced, and wanted support for their role. CONCLUSIONS: The emotional intensity of the mothers' perceptions about their children's eating and weight status suggests that interventions, including communications, need to go beyond information and engage with parents' emotions. Some food concerns were actually related to broader parenting issues and indicate the potential value for interventions to focus on behavioural parenting techniques. Preventive interventions need to acknowledge the issues faced by parents and support their role directly, such as through making healthy and active behaviours easily available, and indirectly, through providing local services, including early childhood services.

Benefits and challenges of providing transitional rehabilitation services to people with spinal cord injury from regional, rural and remote locations.

OBJECTIVE: To identify the factors influencing participation and outline the benefits and challenges of providing transitional rehabilitation for people with spinal cord injury (SCI) from rural and regional locations. DESIGN: Grounded Theory analysis of service records and policy documents. SETTING: One transitional rehabilitation service for people with SCI. PARTICIPANTS: Service records of 40 individuals with SCI from non-metropolitan locations who participated in transitional rehabilitation and 29 individuals with SCI who declined transitional rehabilitation over a two-year period. INTERVENTIONS: Home-based transitional rehabilitation programs offered by a multidisciplinary team including physiotherapy, occupational therapy, nursing and social work. MEASURES: Participation was measured using the percentage of people from non-metropolitan locations who decline transitional rehabilitation. The benefits and challenges of transitional rehabilitation were identified using open, axial and selective coding of service records. RESULTS: People with SCI from non-metropolitan areas were underrepresented among transitional rehabilitation participants, with 69% of those declining transitional rehabilitation coming from regional or rural areas. The study identified five functions of transitional rehabilitation that presented both benefits and challenges of this model in assisting people from non-metropolitan locations. These included: (1) the identification, education, coordination and funding of local care providers; (2) family involvement in rehabilitation; (3) contact with social and community supports; (4) specialist support to problem-solve discharge needs; and (5) skill acquisition and transfer in a community environment. CONCLUSIONS: The transitional rehabilitation model offers many advantages over traditional hospital-based rehabilitation but still faces challenges in offering an equitable model for people with SCI from non-metropolitan locations.

Australian GPs' perceptions about child and adolescent overweight and obesity: the Weight of Opinion study.

BACKGROUND: GPs can potentially play a significant role in assessing weight status, providing advice, and making referrals to address overweight and obesity and its consequences among children and adolescents. AIM: To investigate the perceptions of GPs about overweight and obesity in children and adolescents, including the extent to which they perceive it as a concern, the factors they see as causal, what actions they consider might be needed, and their sense of responsibility and self-efficacy. DESIGN OF STUDY: A cross-sectional qualitative study of GPs' perceptions. SETTING: General practice and primary health care services in the state of New South Wales, Australia. METHOD: Focus groups using a structured protocol were conducted with samples of GPs. Groups comprised a mix of male and female GPs from a range of cultural backgrounds and working in practices in low, medium and high socioeconomic areas. Data were recorded and transcribed. Content analysis was used to identify key themes. RESULTS: Many GPs are concerned about the increasing prevalence of childhood overweight and obesity. They are committed to dealing with the medical consequences, but are aware of the broad range of social causes. GPs perceived that parents are sensitive about this topic, making it difficult for them to raise the issue directly in clinical practice, unless they use lateral strategies. GPs were confident about providing advice, with some managing the problem independently, while others preferred to refer to specialised services. GPs perceived that there were significant barriers to patient compliance with advice. CONCLUSION: Whereas some GPs manage patients' lifestyle change directly, including children's weight management, others prefer to refer. Programmes, service delivery systems, and resources to support both approaches are required.