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2.
Med Humanit ; 2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33509802

RESUMEN

Breathlessness is a sensation affecting those living with chronic respiratory disease, obesity, heart disease and anxiety disorders. The Multidimensional Dyspnoea Profile is a respiratory questionnaire which attempts to measure the incommunicable different sensory qualities (and emotional responses) of breathlessness. Drawing on sensorial anthropology we take as our object of study the process of turning sensations into symptoms. We consider how shared cultural templates of 'what counts as a symptom' evolve, mediate and feed into the process of bodily sensations becoming a symptom. Our contribution to the field of sensorial anthropology, as an interdisciplinary collaboration between history, anthropology and the medical humanities, is to provide a critique of how biomedicine and cultures of clinical research have measured the multidimensional sensorial aspects of breathlessness. Using cognitive interviews of respiratory questionnaires with participants from the Breathe Easy groups in the UK, we give examples of how the wording used to describe sensations is often at odds with the language those living with breathlessness understand or use. They struggle to comprehend and map their bodily experience of sensations associated with breathlessness to the words on the respiratory questionnaire. We reflect on the alignment between cognitive interviewing as a method and anthropology as a disciplinary approach. We argue biomedicine brings with it a set of cultural assumptions about what it means to measure (and know) the sensorial breathless body in the context of the respiratory clinic (clinical research). We suggest the mismatch between the descriptions (and confusion) of those responding to the respiratory questionnaire items and those selecting the vocabularies in designing it may be symptomatic of a type of historical testimonial epistemic injustice, founded on the prioritisation of clinical expertise over expertise by experience.

3.
Arts Health ; 13(1): 20-34, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-31038423

RESUMEN

Background: Despite the prevalence of dyspnoea (the pathological term for breathlessness) amongst the general population and the diagnostic importance of dyspnoea for respiratory illness, public awareness of dyspnoea is poor with an estimated two million people with undiagnosed Chronic Obstructive Pulmonary Disorder in the UK. We explore whether therapeutic letter writing is a valuable arts health approach for those living with breathlessness. Methods: Eighty (80) participants took part in 10 workshops held in community-based settings. The overall approach was qualitative. We analysed the data thematically. Results: Informed by theories of story structure, our analysis explores letters written to the breath in terms of there being a protagonist, antagonist, a process of recognition and reconciliation. Conclusions: Writing a letter to the breath facilitates new ways of relating to breathlessness. Letters create a personal narrative and workshops create a public story. Further research should explore whether therapeutic letter writing can support communication about breathlessness with clinicians.

4.
BMC Health Serv Res ; 20(1): 1085, 2020 Nov 26.
Artículo en Inglés | MEDLINE | ID: mdl-33243236

RESUMEN

BACKGROUND: Domestic violence and abuse is a violation of human rights which damages the health and wellbeing of victims, their families and their friends. There has been less research on the experiences and support needs of male victims than those of women. Historically research on men's experiences has not focused on what constitutes effective, needs-led service provision. The aim of this paper was to conduct an integrated mixed methods synthesis of systematic review evidence on the topic of help-seeking by male victims of domestic violence and abuse. METHODS: An integrated mixed methods synthesis approach was taken to enhance our understanding of the complex phenomenon of help seeking by, and service provision to male victims. This process also identifies gaps in the evidence. Using previously identified systematic review data; mixed methods data from four primary-level service evaluation studies, along with expert and patient consultation were used to develop research propositions. Primary-level qualitative interview and survey data from 12 studies of men experiences were mapped onto the propositions to support them. RESULTS: Fourteen propositions were composed. Seven propositions were supported or at least partly supported by the qualitative data. These supported propositions were used to make recommendations for policy and practice particularly concerning service preferences of male victims. The remaining seven propositions were not specifically supported by the qualitative data. These unsupported propositions were used to develop research recommendations concerning the need to further understand the potential blurred boundaries of victim-perpetrator, hybrid perpetrator-victim experiences, men who are/have been victims of childhood sexual abuse and determining the level of risk for men. They also highlight the need to produce better guidance for the response of the police & the criminal justice system. Finally, they highlight the need to produce the most appropriate service for men in terms of access, linkage, substance/alcohol abuse, mental health, sexuality, and race. CONCLUSION: Integrated mixed-methods synthesis of systematic review evidence is a relatively novel approach. This approach can lead to recommendations for policy and practice as well as highlighting gaps in the research agenda as shown in this example.


Asunto(s)
Víctimas de Crimen , Violencia Doméstica , Delitos Sexuales , Niño , Femenino , Humanos , Masculino , Hombres , Derivación y Consulta , Encuestas y Cuestionarios
5.
Artículo en Inglés | MEDLINE | ID: mdl-32161657

RESUMEN

Background: Domestic violence and abuse (DVA) is common and destructive to health. Post-traumatic stress disorder (PTSD) is a major mental health consequence of DVA. People who have experienced DVA have specific needs, arising from the repeated and complex nature of the trauma. The National Institute for Health and Care Excellence recommends more research on the effectiveness of psychological interventions for people who have experienced DVA. There is growing evidence that mindfulness-based interventions may help trauma symptoms. Methods: Intervention refinement and randomized controlled feasibility trial. A prototype trauma-informed mindfulness-based cognitive therapy (TI-MBCT) intervention will be co-produced following qualitative interviews and consensus exercise with stakeholders. Participants in the feasibility trial will be recruited from DVA agencies in two geographical regions and randomized to receive either TI-MBCT or usual care (self-referral to the Improving Access to Psychological Therapies (IAPT) service). TI-MBCT will be delivered as a group-based eight-week program. It will not be possible to blind the participants or the assessors to the study allocation. The following factors will inform the feasibility of progressing to a fully powered trial: recruitment, retention, intervention fidelity, and the acceptability of the intervention and trial design to participants. We will also test the feasibility of measuring the following participant outcomes before and 6 months post-randomization: PTSD, dissociative symptoms, depression, anxiety, DVA re-victimization, self-compassion, and mother-reported child health. Process evaluation and economic analysis will be embedded within the feasibility trial. Discussion: This study will lead to the development of a TI-MBCT intervention for DVA survivors with PTSD and inform the feasibility and design of a fully powered randomized controlled trial (RCT). The full trial will aim to determine the effectiveness and cost-effectiveness of a TI-MBCT intervention in improving the clinically important symptoms of PTSD in DVA survivors. Trial registration: ISRCTN, ISRCTN64458065, Registered 11 January 2019.

6.
Med Humanit ; 45(3): 294-303, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31371484

RESUMEN

Health research is often bounded by disciplinary expertise. While cross-disciplinary collaborations are often forged, the analysis of data which draws on more than one discipline at the same time is underexplored. Life of Breath, a 5-year project funded by the Wellcome Trust to understand the clinical, historical and cultural phenomenology of the breath and breathlessness, brings together an interdisciplinary team, including medical humanities scholars, respiratory clinicians, medical anthropologists, medical historians, cultural theorists, artists and philosophers. While individual members of the Life of Breath team come together to share ongoing work, collaborate and learn from each other's approach, we also had the ambition to explore the feasibility of integrating our approaches in a shared response to the same piece of textual data. In this article, we present our pluralistic, interdisciplinary analysis of an excerpt from a single cognitive interview transcript with a patient with chronic obstructive pulmonary disease. We discuss the variation in the responses and interpretations of the data, why research into breathlessness may particularly benefit from an interdisciplinary approach, and the wider implications of the findings for interdisciplinary research within health and medicine.


Asunto(s)
Investigación Biomédica/métodos , Disnea , Relaciones Interprofesionales , Conducta Cooperativa , Interpretación Estadística de Datos , Humanos , Comunicación Interdisciplinaria
7.
BMJ Open ; 9(6): e021960, 2019 06 11.
Artículo en Inglés | MEDLINE | ID: mdl-31186243

RESUMEN

OBJECTIVES: To understand help-seeking by male victims of domestic violence and abuse (DVA) and their experiences of support services by systematically identifying qualitative and mixed-method studies and thematically synthesising their findings. DESIGN: Systematic review and qualitative evidence synthesis. Searches were conducted in 12 databases and the grey literature with no language or date restrictions. Quality appraisal of the studies was carried out using the Critical Appraisal Skills Programme tool. Reviewers extracted first and second order constructs related to help-seeking, identified themes and combined them by interpretative thematic synthesis. SETTING: DVA experienced by male victims and defined as any incident or pattern of incidents of controlling coercive or threatening behaviour, violence or abuse among people aged 18 or over who are or have been intimate partners or family members, regardless of gender or sexuality. PARTICIPANTS: Male victims of DVA. INTERVENTIONS: Any intervention which provides practical and/or psychological support to male victims of DVA including but not limited to DVA-specific services, primary healthcare and sexual health clinics. PRIMARY AND SECONDARY OUTCOME MEASURES: Qualitative data describing help-seeking experiences and interactions with support services of male victims of domestic violence RESULTS: We included twelve studies which were published between 2006 and 2017. We grouped nine themes described over two phases (a) barriers to help-seeking: fear of disclosure, challenge to masculinity, commitment to relationship, diminished confidence/despondency and invisibility/perception of services; and (b) experiences of interventions and support: initial contact, confidentiality, appropriate professional approaches and inappropriate professional approaches. CONCLUSION: The recent publication of the primary studies suggests a new interest in the needs of male DVA victims. We have confirmed previously identified barriers to help-seeking by male victims of DVA and provide new insight into barriers and facilitators to service provision. PROSPERO REGISTRATION NUMBER: CRD42016039999.


Asunto(s)
Violencia Doméstica , Aceptación de la Atención de Salud , Apoyo Social , Víctimas de Crimen/psicología , Violencia Doméstica/psicología , Humanos , Masculino , Investigación Cualitativa
8.
Educ Res Int ; 20192019.
Artículo en Inglés | MEDLINE | ID: mdl-31168420

RESUMEN

Medical school can be a stressful experience for students, resulting in stress-related mental health problems. Policy recommendations from the General Medical Council (GMC), the body responsible for improving medical education in the UK, recommend the use of mindfulness training to increase well-being and resilience to stress. Students participating in an eight-week mindfulness training between Autumn 2011 and Spring 2015 were invited to complete a free text survey at the end of their mindfulness course. In addition, six qualitative interviews were conducted lasting between 60 and 90 minutes. Interviews used a topic guide and were recorded and transcribed verbatim. We used the framework approach to analyse the data. Students reported a new relationship to their thoughts and feelings which gave a greater sense of control and resiliency, an ability to manage their workload better, and more acceptance of their limitations as learners. The small group context was important. Students described improved empathy and communication skills through building inner awareness of thoughts and feelings, noticing judgments, and developing attentive observation. The findings show how resiliency and coping reserve can be developed within medical education and the role of mindfulness in this process. We present a conceptual model of a learnt cycle of specific vulnerability and describe how MBCT intercepts at various junctures in this self-reinforcing cycle through the development of new coping strategies that embrace an "allowed vulnerability."

9.
PLoS One ; 13(11): e0193077, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30481185

RESUMEN

BACKGROUND: Women's experience of domestic violence and abuse (DVA) is associated with mental illness which may not be addressed by domestic violence advocacy. The study aimed to compare the experiences of women receiving a psychological intervention with women receiving usual advocacy in a randomized controlled trial (PATH: Psychological Advocacy Towards Healing), to illuminate the trial results by exploring women's experiences of benefits and difficulties. METHODS: A qualitative study nested within the PATH trial, based in two DVA agencies in the UK. A purposive sample of thirty-one intervention and usual care participants were interviewed up to three interviews over a year. Thematic analysis was carried out, incorporating concepts from the Trans-Theoretical Model of change. FINDINGS: The PATH trial reports a clinically relevant improvement in mental health outcomes for women receiving the intervention compared to usual advocacy. The qualitative study reveals which elements of the intervention were beneficial or problematic, which outcomes were most meaningful and relevant to participants and highlights reasons for variations in adherence. Women valued the educational, psychological and emotional elements of the intervention, they felt safe to explore repressed emotions for the first time and experienced a reduction in self-blame, improved sense of identity and greater self-esteem. They also incorporated new skills and self-help techniques to enable sustainable change. Women receiving usual advocacy reported un-met needs for psychological and emotional support. Adherence was affected by women's 'psychological 'readiness' to engage, the competing demands of practical issues such as housing insecurity, legal proceedings or the availability of child care, and breaks in the continuity of professional care. CONCLUSIONS: Continuity and regularity of sessions with a trained specialist worker was key to women's recovery. Individual assessment of 'readiness' would optimise the timing of delivery to maximise adherence and benefit.


Asunto(s)
Víctimas de Crimen/psicología , Violencia Doméstica/psicología , Salud Mental , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Investigación Cualitativa , Derivación y Consulta , Estrés Psicológico/psicología , Adulto Joven
10.
BMJ Open Respir Res ; 5(1): e000309, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29955365

RESUMEN

Introduction: Dyspnoea has been defined as a 'subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity'. However, the majority of available dyspnoea measures treat it as a single entity and rely on quantitative methodology. We propose that qualitative research can enhance our understanding of dyspnoea, in particular, how perception varies so much among patients with similar disease states. In this paper, we focus on how a specific type of inner attention-mindfulness-may alter perceptions of dyspnoea. The aim is to characterise mindfulness attention, which impacts on perceptions of dyspnoea and relate these to the multidimensional model of dyspnoea. We explore how an individual can change their perception and therefore relationship to similar disease states. Method: 22 patients with asthma or chronic obstructive pulmonary disease were recruited from primary and secondary care to an 8-week course in mindfulness-based cognitive therapy (MBCT). 12 patients took part in an in-depth qualitative interview 2 months after completing the MBCT course. Data were recorded, transcribed and then analysed using a framework approach, drawing on components of the multidimensional model of dyspnoea (multidimensional dyspnoea profile, MDP). Results: We found that MBCT training involves developing three types of mindful attention (broad attention, informative attention and re-directive attention), which impact on perceptions of the sensory dimension of dyspnoea. MBCT appears to target affective and sensory perceptions articulated in the MDP model. Conclusion: More research is needed into how mindfulness-based interventions may mediate the relationship between affective experience and the sensory perception of dyspnoea symptoms.

11.
BMC Public Health ; 18(1): 204, 2018 01 31.
Artículo en Inglés | MEDLINE | ID: mdl-29386030

RESUMEN

BACKGROUND: Diagnosis with Type 2 Diabetes is an opportunity for individuals to change their physical activity and dietary behaviours. Diabetes treatment guidelines recommend theory-based, patient-centred care and advocate the provision of support for patient motivation but the motivational experiences of people newly diagnosed with diabetes have not been well studied. Framed in self-determination theory, this study aimed to qualitatively explore how this patient group articulate and experience different types of motivation when attempting lifestyle change. METHODS: A secondary analysis of semi-structured interview data collected with 30 (n female = 18, n male = 12) adults who had been newly diagnosed with type two diabetes and were participants in the Early ACTID trial was undertaken. Deductive directed content analysis was performed using NVivo V10 and researcher triangulation to identify and describe patient experiences and narratives that reflected the motivation types outlined in self-determination theory and if/how these changed over time. RESULTS: The findings revealed the diversity in motivation quality both between and within individuals over time and that patients with newly-diagnosed diabetes have multifaceted often competing motivations for lifestyle behaviour change. Applying self-determination theory, we identified that many participants reported relatively dominant controlled motivation to comply with lifestyle recommendations, avoid their non-compliance being "found out" or supress guilt following lapses in behaviour change attempts. Such narratives were accompanied by experiences of frustrating slow behaviour change progress. More autonomous motivation was expressed as something often achieved over time and reflected goals to improve health, quality of life or family time. Motivational internalisation was evident and some participants had integrated their behaviour change to a new way of life which they found resilient to common barriers. CONCLUSIONS: Motivation for lifestyle change following diagnosis with type two diabetes is complex and can be relatively low in self-determination. To achieve the patient empowerment aspirations of current national health care plans, intervention developers, and clinicians would do well to consider the quality not just quantity of their patients' motivation. TRIAL REGISTRATION: ISRCTN ISRCTN92162869 . Retrospectively registered.


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Dieta/psicología , Ejercicio Físico/psicología , Estilo de Vida Saludable , Motivación , Adulto , Anciano , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Investigación Cualitativa
12.
Health Expect ; 21(3): 585-596, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29222832

RESUMEN

BACKGROUND: Long-term conditions (LTCs) in children require a high level of self-management. Written action plans (WAPs) have been advocated to guide decision-making and support self-management but there is uncertainty about how WAPs "work" and what aspects are important for successful implementation. OBJECTIVE: To review and synthesize existing qualitative evidence about the design and use of WAPs across childhood LTCs. METHOD: We undertook a systematic search of the literature (Medline, EMBASE, CiNAHL, PsycInfo, Web of science) from inception to May 2015; critically appraised included studies; and synthesized the findings, drawing on normalisation process theory. RESULTS: 3473 titles were screened and 53 papers read in full. Nine studies (four key, two minor and three of poor quality) contributed to our analysis, predominantly work on asthma from the USA and in specialist settings. WAPs may help to alleviate user worry and boost confidence. Confidence to act was closely linked to feelings of responsibility and authority. The value and use of WAPs are determined by multiple factors, and varies between different user groups. Logistical challenges include sharing a WAP between different stakeholders and keeping it up to date. Colour coding and pictures may enhance the appeal and usability of WAPS. CONCLUSION: WAPs are complex interventions but our understanding of their use and value in children with LTCs is limited. WAPs need to meet the needs of users who have different requirements/levels of understanding and confidence according to their different roles. Future research into WAPs needs to be both disease and context-specific.


Asunto(s)
Enfermedad Crónica/terapia , Planificación de Atención al Paciente , Pediatría , Automanejo , Asma , Niño , Enfermedad Crónica/psicología , Humanos , Investigación Cualitativa , Escritura
13.
Trials ; 18(1): 496, 2017 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-29065916

RESUMEN

BACKGROUND: Depressive symptoms are usually managed within primary care and antidepressant medication constitutes the first-line treatment. It remains unclear at present which people are more likely to benefit from antidepressant medication. This paper describes the protocol for a randomised controlled trial (PANDA) to investigate the severity and duration of depressive symptoms that are associated with a clinically significant response to sertraline compared to placebo, in people presenting to primary care with depression. METHODS/DESIGN: PANDA is a randomised, double blind, placebo controlled trial in which participants are individually randomised to sertraline or placebo. Eligible participants are those who are between the ages of 18 to 74; have presented to primary care with depression or low mood during the past 2 years; have not received antidepressant or anti-anxiety medication in the 8 weeks prior to enrolment in the trial and there is clinical equipoise about the benefits of selective serotonin reuptake inhibitor (SSRI) medication. Participants who consent to participate in the trial are randomised to receive either sertraline or matching placebo, starting at 50 mg daily for 1 week, increasing to 100 mg daily for up to 11 weeks (with the option of increasing to 150 mg if required). Participants, general practitioners (GPs) and the research team will be blind to treatment allocation. The primary outcome will be depressive symptoms measured by the Patient Health Questionnaire-9 (PHQ-9) at 6 weeks post randomisation, measured as a continuous outcome. Secondary outcomes include depressive symptoms measured with the PHQ-9 at 2 and 12 weeks as a continuous outcome and at 2, 6 and 12 weeks as a binary outcome; follow-up scores on depressive symptoms measured with the Beck Depression Inventory-II, anxiety symptoms measured by the Generalized Anxiety Disorder-7 and quality of life measured with the Euroqol-5D-5L and Short Form-12; emotional processing task scores measured at baseline, 2 and 6 weeks; and costs associated with healthcare use, time off work and personal costs. DISCUSSION: The PANDA trial uses a simple self-administered measure to establish the severity and duration of depressive symptoms associated with a clinically significant response to sertraline. The evidence from the trial will inform primary care prescribing practice by identifying which patients are more likely to benefit from antidepressants. TRIAL REGISTRATION: Controlled Trials ISRCTN Registry, ISRCTN84544741 . Registered on 20 March 2014. EudraCT Number: 2013-003440-22; Protocol Number: 13/0413 (version 6.1).


Asunto(s)
Afecto/efectos de los fármacos , Antidepresivos/uso terapéutico , Depresión/tratamiento farmacológico , Inhibidores de la Captación de Serotonina/uso terapéutico , Sertralina/uso terapéutico , Adolescente , Adulto , Anciano , Antidepresivos/efectos adversos , Protocolos Clínicos , Depresión/diagnóstico , Depresión/psicología , Método Doble Ciego , Inglaterra , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Cuestionario de Salud del Paciente , Calidad de Vida , Proyectos de Investigación , Inhibidores de la Captación de Serotonina/efectos adversos , Sertralina/efectos adversos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
14.
BMJ Open ; 7(4): e014519, 2017 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-28473513

RESUMEN

OBJECTIVES: Our aims were to investigate discrepancies between depressed patients' GlobalRating of Change (GRC) and scores on the Patient Health Questionnaire depression module (PHQ-9). Our objectives were to ascertain patients' views on the source and meaning of mismatches and assess their clinical significance. DESIGN: Qualitative study nested within a cohort, in a programme investigating the indications for prescribing antidepressants that will lead to a clinical benefit. SETTING: Primary care practices in north-west England. PARTICIPANTS: We invited 32 adults with a recent diagnosis of depression and evidence of mismatch between GRC and PHQ-9 Scores to participate. Of these, 29 completed our interviews; most were women, identified as white British, had high school education or higher, were employed or retired and had been depressed for a long time. MAIN MEASURES: We conducted semistructured interviews with a topic guide, focusing on experiences of depression; treatment experiences and expectations; effectiveness of the questionnaires; reasons for the mismatch; and social factors. Interviews were transcribed and subjected to interpretative phenomenological analysis. RESULTS: We identified four themes as explanations for mismatch between GRC and PHQ-9: perceptions that GRC provided a more accurate assessment of current mental state than PHQ-9; impact of recent negative or positive life events on either measure; personal understanding of depression as normally fluctuating, and tendency to underscore on PHQ-9 as a means of self-motivation; and lack of recall. CONCLUSIONS: The combined used of the PHQ-9 and a more open question better captures the patient's unique experiences of mental health. This approach ascertains the relevance of symptoms to the individual's experience and influences treatment decisions. STUDY REGISTRATION: This study was an element of NIHR Programme Grant RP-PG 0610 10048.


Asunto(s)
Antidepresivos/uso terapéutico , Depresión/diagnóstico , Cuestionario de Salud del Paciente , Atención Primaria de Salud , Investigación Cualitativa , Adulto , Interpretación Estadística de Datos , Depresión/tratamiento farmacológico , Inglaterra , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Pautas de la Práctica en Medicina/estadística & datos numéricos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
15.
Br J Gen Pract ; 66(643): e78-84, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26823268

RESUMEN

BACKGROUND: Self-administered questionnaires, such as the Patient Health Questionnaire (PHQ-9), are regularly used in clinical practice to guide prescribing or to measure recovery and response to treatment. There are concerns that patients are not all interpreting the questionnaire items in the same way. Cognitive interviewing is a research technique that identifies 'interpretative measurement error' (IME). IME is distinct from traditional components of measurement error, such as not reading the question as worded, or recording answers inaccurately. AIM: To use cognitive interviewing techniques to explore patterns in answer mapping and comprehension of the PHQ-9 questionnaire to ascertain whether the measure captures meaningful symptoms of low mood. DESIGN AND SETTING: Qualitative study using cognitive interviewing techniques and card sorting in six GP practices in Bristol. METHOD: The study recruited 18 participants at the point of entry to a longitudinal primary care depression cohort study, PANDA (the indications for Prescribing ANtiDepressants that will leAd to a clinical benefit). Participants were interviewed 2, 4, and 6 weeks after their baseline visit. Cognitive interviews were digitally recorded. Analysis used the digital audio file, rather than verbatim transcripts, as it retained important features needed for analyses. RESULTS: Cognitive interviewing revealed that items on the PHQ-9 are interpreted in a range of ways, that patients often cannot 'fit' their experience into the response options, and therefore often feel the questionnaire is misrepresenting their experience of meaningful symptoms of low mood. CONCLUSION: The PHQ-9 may be missing the presence and/or intensity of certain symptoms that are meaningful to patients. Clinicians should adopt caution when using it.


Asunto(s)
Cognición/fisiología , Trastornos del Humor/diagnóstico , Atención Primaria de Salud/métodos , Psicometría/métodos , Investigación Cualitativa , Encuestas y Cuestionarios , Adulto , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Trastornos del Humor/epidemiología , Trastornos del Humor/fisiopatología , Reino Unido/epidemiología
16.
Health Expect ; 19(3): 557-69, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-25088009

RESUMEN

BACKGROUND: Engaging clients in psychotherapy by managing their expectations is important for therapeutic success. Initial moments in first sessions of therapy are thought to afford an opportunity to establish a shared understanding of how therapy will proceed. However, there is little evidence from analysis of actual sessions of therapy to support this. OBJECTIVE: This study utilised recorded session logs to examine how therapists manage clients' expectations during the first two sessions of online Cognitive Behavioural Therapy (CBT). METHODS: Expectation management was investigated through conversation analysis of sessions from 176 client-therapist dyads involved in online CBT. The primary focus of analysis was expectation management during the initial moments of first sessions, with a secondary focus on expectations at subsequent points. ANALYSIS: Clients' expectations for therapy were most commonly managed during the initial moments of first sessions of therapy. At this point, most therapists either produced a description outlining the tasks of the first and subsequent sessions (n = 36) or the first session only (n = 108). On other occasions (n = 32), no attempt was made to manage clients' expectations by outlining what would happen in therapy. Observations of the interactional consequences of such an absence suggest clients may struggle to engage with the therapeutic process in the absence of appropriate expectation management by therapists. CONCLUSION: Clients may more readily engage from the outset of therapy when provided with an explanation that manages their expectation of what is involved. Therapists can accomplish this by projecting how therapy will proceed, particularly beyond the initial session.


Asunto(s)
Terapia Cognitivo-Conductual , Depresión/terapia , Satisfacción del Paciente , Relaciones Profesional-Paciente , Adolescente , Adulto , Anciano , Terapia Cognitivo-Conductual/métodos , Comunicación , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Grabación en Cinta , Resultado del Tratamiento , Adulto Joven
17.
Sociol Health Illn ; 38(3): 442-58, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26403218

RESUMEN

This paper explores ideas of symbolic violence inherent in the research encounter (Bourdieu 1999). After defining symbolic violence and how the concept enters into domestic violence and abuse (DVA) research, we discuss the challenges arising from a (DVA) survivor taking on the role of interviewer in a qualitative study nested within a UK primary care based trial: IRIS (Identification and Referral to Improve Safety). KS, a survivor of DVA, conducted interviews with 12 women who had been referred to a domestic violence agency by primary care clinicians taking part in the IRIS trial in two UK cities (Bristol and east London) during 2009. Field notes were kept during all of the research meetings with KS and these were included in analysis. Our analysis maps the research pathway of 'non-violent communication' and discusses the role of social symmetry and proximity in the research encounter. We conclude that while a welcoming disposition, empathy and active listening are all generic skills to qualitative research; if a researcher can enter fieldwork with a claim of social proximity and symmetry, their use of these generic skills is enhanced through a process of shared objectification and empowerment talk. We explore the limitations of social proximity, its relationship to feminist and anthropological theories of 'insider' research and its relevance to primary care research.


Asunto(s)
Violencia Doméstica , Atención Primaria de Salud/ética , Ensayos Clínicos Controlados Aleatorios como Asunto/ética , Sobrevivientes/psicología , Conducta Cooperativa , Femenino , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Proyectos de Investigación , Reino Unido
18.
Med Teach ; 37(7): 611-630, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25945945

RESUMEN

BACKGROUND: General practice is increasingly used as a learning environment in undergraduate medical education in the UK. AIM: The aim of this project was to identify, summarise and synthesise research about undergraduate medical education in general practice in the UK. METHODS: We systematically identified studies of undergraduate medical education within a general practice setting in the UK from 1990 onwards. All papers were summarised in a descriptive report and categorised into two in-depth syntheses: a quantitative and a qualitative in-depth review. RESULTS: 169 papers were identified, representing research from 26 UK medical schools. The in-depth review of quantitative papers (n = 7) showed that medical students learned clinical skills as well or better in general practice settings. Students receive more teaching, and clerk and examine more patients in the general practice setting than in hospital. Patient satisfaction and enablement are similar whether a student is present or not in a consultation, however, patients experience lower relational empathy. Two main thematic groups emerged from the qualitative in-depth review (n = 10): the interpersonal interactions within the teaching consultation and the socio-cultural spaces of learning which shape these interactions. The GP has a role as a broker of the interactions between patients and students. General practice is a socio-cultural and developmental learning space for students, who need to negotiate the competing cultures between hospital and general practice. Lastly, patients are transient members of the learning community, and their role requires careful facilitation. CONCLUSIONS: General practice is as good, if not better, than hospital delivery of teaching of clinical skills. Our meta-ethnography has produced rich understandings of the complex relationships shaping possibilities for student and patient active participation in learning.

19.
Behav Cogn Psychother ; 43(6): 732-43, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24960277

RESUMEN

BACKGROUND: Engaging clients from the outset of psychotherapy is important for therapeutic success. However, there is little research evaluating therapists' initial attempts to engage clients in the therapeutic process. This article reports retrospective analysis of data from a trial of online cognitive behavioural therapy (CBT) for depression. Qualitative and quantitative methods were used to evaluate how therapists manage clients' expectations at the outset of therapy and its relationship with client retention in the therapeutic intervention. AIMS: To develop a system to codify expectation management in initial sessions of online CBT and evaluate its relationship with retention. METHOD: Initial qualitative research using conversation analysis identified three communication practices used by therapists at the start of first sessions: no expectation management, some expectation management, and comprehensive expectation management. These findings were developed into a coding scheme that enabled substantial inter-rater agreement (weighted Kappa = 0.78; 95% CI: 0.52 to 0.94) and was applied to all trial data. RESULTS: Adjusting for a range of client variables, primary analysis of data from 147 clients found comprehensive expectation management was associated with clients remaining in therapy for 1.4 sessions longer than those who received no expectation management (95% CI: -0.2 to 3.0). This finding was supported by a sensitivity analysis including an additional 21 clients (1.6 sessions, 95% CI: 0.2 to 3.1). CONCLUSIONS: Using a combination of qualitative and quantitative methods, this study suggests a relationship between expectation management and client retention in online CBT for depression, which has implications for professional practice. A larger prospective study would enable a more precise estimate of retention.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Internet , Cooperación del Paciente , Actitud del Personal de Salud , Comunicación , Femenino , Humanos , Masculino , Relaciones Profesional-Paciente , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Resultado del Tratamiento
20.
Br J Gen Pract ; 64(620): e151-8, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24567654

RESUMEN

BACKGROUND: Women experiencing domestic violence and abuse (DVA) are more likely to be in touch with health services than any other agency, yet doctors and nurses rarely ask about abuse, often failing to identify signs of DVA in their patients. AIM: To understand women's experience of disclosure of DVA in primary care settings and subsequent referral to a DVA advocate in the context of a DVA training and support programme for primary care clinicians: Identification and Referral to Improve Safety (IRIS). DESIGN AND SETTING: A service-user collaborative study using a qualitative study design. Recruitment was from across IRIS trial settings in Bristol and Hackney, London. METHOD: Twelve women who had been referred to one of two specialist DVA advocates (based at specialist DVA agencies) were recruited by a GP taking part in IRIS. Women were interviewed by a survivor of DVA and interviews were recorded and transcribed verbatim. Analysis was thematic using constant comparison. RESULTS: GPs and nurses can play an important role in identifying women experiencing DVA and referring them to DVA specialist agencies. GPs may also have an important role to play in helping women maintain any changes they make as a result of referral to an advocate, by asking about DVA in subsequent consultations. CONCLUSION: A short time interval between a primary care referral and initial contact with an advocate was valued by some women. For the initial contact with an advocate to happen as soon as possible after a primary care referral has been made, a close working relationship between primary care and the third sector needs to be cultivated.


Asunto(s)
Violencia Doméstica/prevención & control , Medicina General , Defensa del Paciente , Atención Primaria de Salud , Derivación y Consulta/organización & administración , Violencia/prevención & control , Salud de la Mujer , Adulto , Anciano , Anciano de 80 o más Años , Conducta Cooperativa , Violencia Doméstica/psicología , Educación Médica Continua , Femenino , Medicina General/organización & administración , Humanos , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Investigación Cualitativa , Revelación de la Verdad , Reino Unido , Violencia/psicología
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