The relationship between caregivers and daughters' food and body shape scripts: A dyadic analysis.

Research indicates a key role for parenting in a daughter's relationship with food and body shape. One possible mechanism for this translational process is through scripts. The present study used a dyadic design to investigate the relationship between caregivers and daughters' scripts regarding food and body shape. Caregivers (n = 40) and their daughters (n = 40) rated word lists of their current and childhood scripts and caregivers completed an additional measure of their parenting scripts. Non-dyadic analysis showed consistent correlations between daughters' current scripts and their recollections of childhood scripts, and several (but less consistent) correlations between caregivers' current scripts, their own childhood scripts and the scripts they had used as a parent. Dyadic analysis showed consistent correlations between the daughter's current scripts relating to negative eating and both positive and negative body scripts and their caregiver's parenting scripts, and between the daughter's current scripts relating to positive and negative eating and body looking positive and their caregiver's current scripts. No associations were found between the daughter's current scripts and the caregiver's childhood scripts. The results indicate that whilst daughters' current scripts relating to food and body shape are often concordant to those reported by their caregivers, they are more closely linked to what they remember from their childhoods. Further, they suggest that those scripts which do transfer between generations may be more related to body size and negative eating than food per se. Finally, the results suggest that scripts do not inevitably pass across the generations possibly due to parents choosing not to repeat the errors of their own parents or due to the role of factors other than just parenting in creating the scripts we hold.

Multisensory medical illustrations of Buruli ulcer for improved disease detection, help seeking behaviour and adherence to treatment.

Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans and a neglected tropical disease of the skin (skin NTD). Antibiotic treatments are available but, to be effective in the absence of surgery, BU must be detected at its earliest stages (an innocuous-looking lump under the skin) and adherence to prescribed drugs must be high. This study aimed to develop multisensory medical illustrations of BU to support communication with at-risk communities. We used a Think Aloud method to explore community health workers' (n = 6) experiences of BU with a focus on the role of their five senses, since these non-medical disease experts are familiar with the day-to-day challenges presented by BU. Thematic analysis of the transcripts identified three key themes relating to 'Detection,' 'Help Seeking,' and 'Adherence' with a transcending theme 'Senses as key facilitators of health care'. New medical illustrations, for which we coin the phrase "5D illustrations" (signifying the contribution of the five senses) were then developed to reflect these themes. The senses therefore facilitated an enriched narrative enabling the production of relevant and useful visuals for health communication. The medical artist community could utilise sensory experiences to create dynamic medical illustrations for use in practice.

The Role of Social Support and Belonging in Predicting Recovery from Problem Gambling.

Research indicates a role for both social support and belonging in addiction recovery, however little is known about the role of these constructs in the recovery from problem gambling, and whether they relate to the effectiveness of mutual aid groups such as Gamblers Anonymous. The aim of this study was therefore to explore the relationship between social support and belonging, and to assess the role of demographics (including group membership of GA), social support and/or belongingness in predicting gambling addiction recovery in terms of gambling urges and quality of life. Using a cross sectional design, participants identifying as having problem gambling (n = 60) completed an online questionnaire with two independent variables (Social Support and Belonging), two dependent variables (Gambling Urges and Quality of Life) to assess gambling addiction recovery and measures of GA membership. The results showed no significant association between gender, age, ethnicity, education or employment status and gambling urges or quality of life. Membership to GA, and length of membership were significantly associated with gambling recovery indicating that being a member of GA and longer membership was associated with lower gambling urges and higher quality of life. Further, the results showed a high but not perfect correlation between social support and belonging (r(58) = .81, p = < .01). A regression analysis showed that although there was a significant correlation between social support and belongingness, they played different roles in gambling addiction recovery. Social support alone predicted higher quality of life, but not a reduction in gambling urges; belonging (along with being a member of GA) predicted a reduction in gambling urges, but not an increase in quality of life. Social support and belonging have a differential impact on aspects of gambling addiction, and should be considered as different constructs. In particular, whilst the process underpinning reduced gambling urges is membership of GA and the sense of belonging it provides its members, social support per se is a better predictor of quality of life. These findings have implications for the development of treatment for problem gamblers in the future.

Global variations in preoperative practices concerning patients seeking primary bariatric and metabolic surgery (PACT Study): A survey of 634 bariatric healthcare professionals.

BACKGROUND: Bariatric and Metabolic Surgery (BMS) is a popular weight loss intervention worldwide, yet few scientific studies have examined variations in preoperative practices globally. This study aimed to capture global variations in preoperative practices concerning patients planned for BMS. METHODS: A 41-item questionnaire-based survey was designed and the survey link was freely distributed on social and scientific media platforms, email groups and circulated through personal connections of authors. The survey included eight parts: basic information; criteria for BMS; preoperative nutritional screening; preoperative weight loss; preoperative diets for liver size reduction; preoperative glycemic control; other laboratory investigations and preparations; decision making, education, and consents. Descriptive statistics were used to analyse data and graphs were used for representation where applicable. RESULTS: Six hundred thirty-four bariatric healthcare professionals from 76 countries/regions completed the survey. Of these, n = 310 (48.9%) were from public hospitals, n = 466 (73.5%) were surgeons, and the rest were multidisciplinary professionals. More than half of respondents reported using local society/association guidelines in their practice (n = 310, 61.6%). The great majority of respondents routinely recommend nutritional screening preoperatively (n = 385, 77.5%), mandatory preoperative diets for liver size reduction (n = 220, 53.1%), routine screening for T2DM (n = 371, 90.7%), and mandate a glycemic control target before BMS in patients with T2DM (n = 203, 55.6%). However, less than half (n = 183, 43.9%) recommend mandatory preoperative weight loss to all patients. Most respondents (n = 296, 77.1%) recommend psychological intervention before surgery for patients diagnosed with psychological conditions. Variations were also identified in laboratory investigations and optimisation; and in the aspects of decision making, education and consent. CONCLUSIONS: This survey identified significant global variations in preoperative practices concerning patients seeking primary BMS. Our findings could facilitate future research for the determination of best practice in these areas of variations, and consensus-building to guide clinical practice while we wait for that evidence to emerge.

Assessing feeder motivations and behaviour within couples using the Feeder Questionnaire.

This study first aimed to provide additional validation for a new tool to measure Feeder Motivations and Behaviour. Second, it aimed to evaluate how feeder motivations and behaviour are enacted within romantic relationships and whether this reflects a reciprocal or linear dynamic. Participants completed the Feeder Questionnaire composed of six motivational subscales (affection; waste avoidance; status; hunger avoidance; offloading; manners) and one subscale to measure feeder behaviour, measures of eating behaviour (restrained, emotional and external eating) and their BMI. Participants were analysed as individuals (n = 190) and within couples as dyads (n = 76 couples). In terms of validation of the measure, analysis using the non-dyadic data showed good internal reliability for all subscales and moderate correlations between feeder behaviour and motivations and measures of eating behaviour. In terms of couple dynamics, dyadic data analysis indicated evidence for reciprocity within couples for BMI, feeder behaviour and feeder motivations relating to waste avoidance, affection, manners and status but not for hunger avoidance or offloading. Dyadic analysis also indicated evidence for a more linear relationship with one participant's feeder behaviour and motivations relating to their partner's emotional and external eating. This study therefore provides further support for the usefulness of the Feeder Questionnaire. The study also indicates that feeder behaviour is complex within couples and may function in a reciprocal way but also with one partner's behaviour impacting upon their partner in a more linear fashion.

Nostalgia, Gratitude, or Optimism: The Impact of a Two-Week Intervention on Well-Being During COVID-19.

Research indicates that brief 2-min positive psychology interventions (PPIs) increase well-being during COVID-19 lockdowns. The present study extended this to assess the effectiveness over two-weeks. Participants (n = 150) were randomly allocated to one of three PPIs; nostalgia, gratitude, best possible self (BPS), or control. The interventions were slightly adapted for the lockdown and were completed three times, every seven days over two-weeks. Well-being measures were completed immediately after the first intervention (T1), after the next two interventions (T2-T3) and at one-week follow-up (T4) (but no baseline measure of well-being was taken). At T1, participants in the nostalgia, gratitude, and BPS intervention had higher self-esteem than those in the control intervention. At T1 and T2, participants in the gratitude and BPS intervention reported higher social connectedness than participants in the nostalgia and control intervention. Then at follow-up (T4), participants in the nostalgia, gratitude, and BPS intervention had lower fear of COVID-19 than those in the control intervention. Overall, the results show the benefits of nostalgia, gratitude and optimism, compared to the control, during lockdown. Supplementary Information: The online version contains supplementary material available at 10.1007/s10902-022-00513-6.

Exploring the experience of Gamblers Anonymous meetings during COVID-19: a qualitative study.

Whilst much research has explored the possible causes and consequences of gambling, Gamblers Anonymous (GA) - one of the most accessed forms of support for gamblers - has been largely overlooked and, to date, only a few studies have explored how members experience this programme. Core to GA is the social interaction between members. From March 2020, however, the COVID-19 pandemic forced GA to move their meetings online. The present qualitative study therefore explored how GA members experienced these online meetings in the absence of actual face to face interactions with others. Individual telephone or video call interviews (n = 21) were carried out with members of GA in the UK and analysed using Thematic Analysis. The results described three main themes: (1) 'practicalities of GA in lockdown', which highlighted the practical benefits of online meetings such as more opportunity to attend different meetings, which in turn expanded participants' perspectives and social networks; (2) 'the importance of relationships in GA', reflecting strong and enduring social networks that were created, maintained, and strengthened by feelings of solidarity; and (3) 'therapeutic elements of the meetings', such as psychological contract making which helped participants to stay abstinent. Transcending these themes was a tension between individual versus group identity with interviewees reporting a shift to focusing more on their own needs rather than those of the group. Overall, whilst still providing a lifeline during COVID-19 and offering some practical benefits, the online GA meetings were not able to completely replicate the value individuals gained from face to face meetings. This transition also resulted in disruptions both to group dynamics and to individual interactions within each group, ultimately resulting in participants behaving more individualistically and less collectively than in face-to-face meetings.

The role of social exposure in predicting weight bias and weight bias internalisation: an international study.

BACKGROUND: Whilst the consequences of weight bias and weight bias internalisation (WBI) have been explored, less is known about the factors contributing to their development. Some research has explored the role of social exposure in weight bias and WBI but has been limited in its definition of exposure and focused solely on western countries. The present study therefore aimed to assess the role of social exposure defined in terms of both population and personal exposure in predicting weight bias and WBI, in an international sample. METHODS: Participants (N = 1041) from 33 countries, aged 18-85 years completed online measures of demographics, weight bias, WBI, and population and personal social exposure. Population exposure was defined using national obesity prevalence data from the World Health Organisation to classify countries as low (obesity rates ≤19.9%; n = 162), medium (20.0-29.9%; n = 672) or high prevalence (≥30%; n = 192). Personal exposure was defined in terms of personal contact and health and attractiveness normalisation. RESULTS: Using regression analysis, greater weight bias was significantly predicted by being younger, male, less educated, and personal exposure in terms of normalisation beliefs that thinner body types are healthier and more attractive, greater daily exposure and overall exposure to thinner friends. The strongest predictors of weight bias (adj R2 = 13%) were gender (ß = -0.24, p < .001), and personal exposure in terms of normalisation beliefs that thinner body types are more attractive (ß = -0.13, p = .001). The strongest predictors of WBI (adj R2 = 6%) were attractiveness normalisation (ß = -0.23, p < 0.001) and participants' perceived body shape (ß = -0.27, p < 0.001). Population exposure did not predict either weight bias or WBI. CONCLUSIONS: Personal exposure is more important than population exposure in predicting both weight bias and WBI. Findings hold implications for improving the wellbeing and lived experiences of those living with overweight and obesity.

The impact of active or passive food preparation versus distraction on eating behaviour: An experimental study.

Research indicates a role for attention in the perception of hunger and food intake. The present experimental study aimed to explore the impact of attention to food cues through either active or passive food preparation, versus attention away from food cues through a non-food distraction task on eating behaviour using a preload/taste test design. Female participants (n = 80) were randomly allocated to one of four conditions: active food preparation (making a wrap); passive video preparation (watching video of researcher making a wrap); distraction (a non-food colouring task); no time control. Measures of desire to eat (hunger, fullness, motivation) were taken before and after the interventions. Food intake was measured in terms of mass of wrap consumed and snacks consumed at a subsequent taste test. The results showed greater wrap consumption for active and passive food preparation and the control groups compared to the distraction intervention. Further, the results showed that active food preparation resulted in increased hunger and motivation to eat and that passive food preparation resulted in increased motivation to eat. No changes were found following distraction. To conclude, attention to food cues through both active and passive food preparation can increase both food intake and the desire to eat. The implications for promoting changes in eating behaviour are discussed.

Identification of factors influencing motivation to undertake time-restricted feeding in humans.

The interaction between time of day and energy intake, termed chrono-nutrition, has received considerable recent interest. One aspect of chrono-nutrition with potential to benefit long-term cardio-metabolic health is time-restricted feeding (TRF). Current support for TRF primarily derives from animal research, although recent small-scale human studies indicate possible translational benefit. Whether free-living humans, however, can incorporate TRF into their daily lives is poorly understood. This study reports data from participants (n = 608) who completed an online questionnaire to investigate daily routine, likelihood of TRF incorporation within work vs free-days, and key considerations influencing TRF uptake. The majority of participants reported a typical daily feeding window (time between first and last energy intake) of between 10 and 14 h on workdays and free days, 62.7 and 65.5% respectively. Likelihood of adherence to TRF declined with an increase in the proposed restriction of the feeding window by 0.5 to 4-h per day. We then examined data from participants with a typical daily feeding window of 12+ h on workdays (n = 221) and free-days (n = 223) to investigate the likelihood of using TRF, and the most important considerations in making this decision. Of these participants, (n = 132) on workdays and (n = 125) on free days would likely reduce their feeding window by 3-h. Multiple regression analysis revealed that key considerations determining the likelihood of adopting TRF were: cost, time availability, and perceived health benefits (on workdays); wake time, bed time, time availability, motivation to change and perceived health benefits (on free-days). These data provide novel information regarding public attitudes towards TRF and highlight important aspects to be considered when translating controlled laboratory studies to public dietary advice.

Evaluating Interoceptive Crossover between emotional and physical symptoms.

Symptom perception is complex and influenced by a number of psychological factors, including interoceptive ability and alexithymia. Some individuals may have difficulty distinguishing between internal signals, such as emotions and physical symptoms, however research in this area is sparse. The current study aimed to explore the incidence and nature of this phenomenon, labelled, 'Interoceptive Crossover'. 239 individuals completed an online survey and rated the perceived similarity between a range of emotions (e.g., Sad, Happy, Afraid and Calm) and physical symptoms (e.g., Stomach Pain, Fatigue/Tiredness, Headache and Abnormal Heartbeat) to assess the incidence and nature of Interoceptive Crossover. Individuals demonstrated crossover between emotions and physical symptoms. Some crossovers were more unsurprising and reported by a greater proportion of the sample, such as Afraid and Abnormal Heartbeat (74.5%); Sad and Fatigue (29.4%) and Afraid and Shortness of Breath (58.5%). Other crossovers were less prevalent in the sample and more unexpected such as Satisfied with Headache (1.2%); Bored with Back Pain (5.95%) and Happy and Back Pain (0.4%). Overall, individuals demonstrate Interoceptive Crossover of emotions and physical symptoms and some crossovers are more prevalent whilst others are rare and unexpected. This phenomenon needs further study with respect to relevant constructs including alexithymia and interoception.

The impact of body diversity vs thin-idealistic media messaging on health outcomes: an experimental study.

The recent rise in body dissatisfaction and weight bias has led to a call to the media to increase the diversity of their imagery, in efforts to challenge the thin-ideal. Therefore, this study aimed to evaluate the effects of both body diversity and thin-ideal interventions on health outcomes. Female participants (n = 160) were randomly allocated into an intervention group: body diversity; thin-ideal; control. They completed measures of body satisfaction, body compassion, internalisation of the thin-ideal, weight bias and behavioural intentions at baseline and post-intervention. The results showed significant differences between groups for weight bias and intentions to eat healthily. Specifically, those in the body diversity intervention group reported a greater reduction in weight bias compared to the other conditions. Further, those in the thin-ideal intervention group reported a greater increase in intentions to eat healthily compared to the other conditions. There were no differences between groups for body satisfaction, body compassion, internalisation of the thin-ideal and behavioural intentions to exercise and manage weight. In conclusion, exposure to body diversity images reduced weight bias whereas exposure to the thin-ideal promoted intentions towards healthy eating. These findings therefore offer empirical evidence for the impact of using different types of imagery to change different health outcomes.

How do children make food choices? Using a think-aloud method to explore the role of internal and external factors on eating behaviour.

Research indicates that eating related problems, body weight and eating habits often start in childhood and track through to adulthood. To date, however, little is known about how children conceptualise food and the factors involved in their decision making processes. This qualitative study aimed to explore children's understanding of food and how this influences their food related decisions. Children (n = 27) aged 9-10 took part in a think-aloud study and voiced their thoughts whilst making different meals and snacks using pictures of food. Data were analysed using thematic analysis which described 3 core themes: i) drivers of food decisions (hunger, health, liking, emotions, availability) ii) sources of these drivers (parents, peers, routine); iii) polarised reasoning whereby food was often dichotomised as good or bad. Transcending these themes was the degree of deliberation whereby children showed decision making as automatic, considered or sanctioned. Finally, overarching their accounts was the notion of the transitioning child with children illustrating the shift between being a passive child whose decisions were made for them and an active child with autonomy and agency. The results illustrate the ways in which children begin to internalise the messages of others as they grow older which they incorporate into their own schema. These messages in turn form part of their heuristic system which enable less sanctioned decisions as children take ownership of their own eating behaviour. The results are discussed in terms of the implications for decision making and a framework for developing interventions.

Exposure to body diversity images as a buffer against the thin-ideal: An experimental study.

There has recently been a call for the use of more diverse images by the media to promote body satisfaction. This experimental study evaluated the impact of body diversity images and whether these could act as a buffer against thin-ideal norms. Female participants (n = 106, aged 16-30 years) completed measures of body compassion, body and face satisfaction before and after random allocation to images reflecting one of three interventions: control, body diversity and thin-ideal. Attitudes towards thin-ideal images were also assessed. The results showed significant differences between groups for overall body compassion, the body compassion subtype of body kindness, body satisfaction and face satisfaction with those viewing the body diversity images reporting higher scores after exposure compared to the other two groups. Those in the body diversity group also displayed more negative attitudes towards thin-ideal images compared to controls. No between groups differences were found for body compassion subtypes relating to common humanity, motivated action and body criticism or positive attitudes to the thin-ideal images. In sum, exposure to body diversity images had a positive impact on body kindness and overall body compassion and body satisfaction providing experimental support for the use of diversity images as a buffer against thin-deals.

Creating a teachable moment in community pharmacy for men with prostate cancer: A qualitative study of lifestyle changes.

OBJECTIVE: It is well established that exercise and lifestyle behaviours improve men's health outcomes from prostate cancer. With 3.8 million men living with the disease worldwide, the challenge is creating accessible intervention approaches that lead to sustainable lifestyle changes. We carried out a phase II feasibility study of a lifestyle intervention delivered by nine community pharmacies in the United Kingdom to inform a larger efficacy study. Qualitative interviews explored how men experienced the intervention, and these data are presented here. METHODS: Community pharmacies delivered a multicomponent lifestyle intervention to 116 men with prostate cancer. The intervention included a health, strength, and fitness assessment, immediate feedback, lifestyle prescription with telephone support, and reassessment 12 weeks later. Three months after receiving the intervention, 33 participants took part in semistructured telephone interviews. RESULTS: Our framework analysis identified how a teachable moment can be created by a community pharmacy intervention. There was evidence of this when men's self-perception was challenged and coupled to a positive interaction with a pharmacist. Our findings highlight the social context of behaviour change with men identifying how their lifestyle choices were negotiated within their household. There was a ripple effect as lifestyle behaviours made a positive impact on friends and family. CONCLUSIONS: The teachable moment is not a serendipitous opportunity but can be created by an intervention. Our study adds insight into how community pharmacists can support cancer survivors to make positive lifestyle behaviour changes and suggests a role for doing rather than just telling.

'Snack' versus 'meal': The impact of label and place on food intake.

Eating behaviour is influenced by both cognitions and triggers in the environment. The potential difference between a 'snack' and a 'meal' illustrates these factors and the way in which they interact, particularly in terms of the label used to describe food and the way it is presented. To date no research has specifically explored the independent and combined impact of label and presentation on eating behaviour. Using a preload/taste test design this experimental study evaluated the impact of label ('snack' vs. 'meal') and place ('snack' vs. 'meal') of a preload on changes in desire to eat and subsequent food intake. Eighty female participants consumed a pasta preload which labelled as either a 'snack' or a 'meal' and presented as either a 'snack' (standing and eating from a container) or a 'meal' (eating at a table from a plate), generating four conditions. The results showed main effects of label and place with participants consuming significantly more sweet mass (specifically chocolate) at the taste test when the preload had been labelled a 'snack' and more total mass and calories when the preload had been presented as a 'snack'. No label by place interactions were found. The results also showed a combined effect of both label and place with those who had eaten the preload both labelled and presented as a 'snack' consuming significantly more in terms of nearly all measures of food intake than those in the other conditions. To conclude, label and presentation influence subsequent food intake both independently and combined which is pertinent given the increase in 'snacking' in contemporary culture.

Predictors of burnout and health status in Samaritans' listening volunteers.

Samaritan listening volunteers provide emotional support to people in distress or suicidal. Samaritans' has high volunteer turnover, which may be due to burnout. This study evaluated the role of demographic and psychosocial factors in predicting Samaritans listening volunteers' burnout and health status. Samaritans' listening volunteers (n = 216) from seven branches across UK completed an online survey to assess their levels of burnout (emotional exhaustion, depersonalisation, personal accomplishment), subjective health status, coping, empathy and social support. Overall, listeners showed low levels of burnout and good health. Regression analysis revealed that higher emotional exhaustion was predicted by younger age and avoidant coping style; higher depersonalisation was predicted by lower empathy fantasy and higher avoidant coping style; lower personal accomplishment scores were predicted by higher empathy personal distress and worse health status was predicted by more hours per week spent on listening duties, lower social support and higher avoidant coping style. Overall, different factors influenced different facets of burnout. However, higher use of avoidant coping style consistently predicted higher burnout and worse health status, suggesting avoidant coping is an important target for intervention.

Exploring the Impact of Intraoperative Interventions for Pain and Anxiety Management During Local Anesthetic Surgery-A Systematic Review and Meta-Analysis.

PURPOSE: To compare the effectiveness of audiovisual and relaxation-based intraoperative interventions for their impact on intraoperative pain and anxiety. DESIGN: Systematic review and meta-analysis. METHODS: The following databases were searched for articles published between 1990 and January 2014: MEDLINE, PsychINFO, CINAHL, and Web of Science. Twenty randomized trials meeting the following inclusion criteria were included; adult participants undergoing elective outpatient surgery under local anesthetic using a form of distraction-based intraoperative intervention for the management of anxiety and pain. FINDING: Thirty percent of studies reviewed found that intraoperative interventions improved patient experience in comparison to treatment as usual, 20% of studies were inconclusive, and 50% of studies found that interventions during surgery provided no benefit. CONCLUSIONS: Both relaxation-based and audiovisual interventions were found to be efficacious for pain and anxiety management during surgery under local anesthetic. This review indicates that relaxation-based interventions could be more effective than audiovisual interventions for managing intraoperative anxiety.

How do mothers manage their preschool children's eating habits and does this change as children grow older? A longitudinal analysis.

The practices mothers adopt in relation to feeding their children have been identified as important predictors of children's quality of diet. However, most studies of the impact of these practices on quality of children's diets have been cross-sectional in design, limiting conclusions about change and causality. Previous research has called for qualitative exploration of the way these practices are used in a real-life setting. This study set out to address these gaps in knowledge. At baseline, mothers recruited to a community-based intervention study and who had a preschool child, completed a questionnaire about their use of covert and overt control practices, child food neophobia and demographics. The quality of children's diets was assessed using a validated food frequency questionnaire. Both questionnaires were repeated with the mothers two years later. Complete data at both time points were available for 228 mother-child pairs. Four focus group discussions were conducted with 29 mothers of preschool children to explore their experiences of feeding young children. Mothers who increased their use of overt control had children whose level of food neophobia also increased (P = 0.02). Mothers who used more covert control had children with better quality diets at both time points (P = <0.01) and mothers who increased their use of covert control over the two year follow-up had children whose diet quality improved (P = 0.003). These associations were independent of confounders such as mother's level of education. In the focus groups, mothers suggested that feeding young children was stressful and that control was often relinquished in order to reduce conflict at mealtimes. Supporting parents to adopt more covert techniques to control their children's eating habits may be an effective way of improving the quality of young children's diets.

A thematic analysis of experiences of varicose veins and minimally invasive surgery under local anaesthesia.

AIMS AND OBJECTIVES: To gain insight into the experience of living with varicose veins and undergoing minimally invasive surgery under local anaesthesia in a private clinic. BACKGROUND: Minimally invasive surgery under local anaesthesia is replacing traditional surgical stripping for the treatment for varicose veins. Conscious surgery has previously been associated with elevated levels of anxiety and some associated pain. There is limited research exploring the experiences of patients undergoing varicose vein surgery under local anaesthesia. DESIGN: Qualitative semi-structured interviews with 20 patients who took part in a mixed methods study exploring the effects of distraction on intra-operative pain and anxiety. METHODS: Participants were interviewed eight weeks post surgery about their experiences before, during and after surgery. Interviews were analysed using thematic analysis. RESULTS: Four themes were captured (1) negative emotions associated with symptoms, (2) unpreparedness for the surgical process, (3) feeling cared for and (4) improvements in well-being. An overarching theme of relationships was identified. Overall, varicose veins had a detrimental impact on quality of life prior to surgery. Patients felt unprepared for their procedure and experienced the operation as anxiety provoking and uncomfortable. This was much helped by the support of nursing staff in the theatre. Post surgery, patients' quality of life was reported as improved. CONCLUSIONS: More emphasis needs to be placed on preparing patients for surgery under local anaesthesia. The role of the nurse is central to creating a caring, relaxed environment which could improve patient experience. RELEVANCE TO CLINICAL PRACTICE: Patients' experiences of varicose veins and their treatment both influence, and are influenced by relationships with others at all stages of the management process. Nurses play an important role in improving patient experience during surgery and care needs to be taken to ensure that patients understand and accept the processes of surgery and recovery.