"I established a life; I can re-establish it again": Lived experiences of intimate partner violence in Mongolia.

Violence against women persists globally, transcending intersecting backgrounds, such as race, gender, socio-economic status, education, and ableness. The reality remains that women across diverse intersections continue to endure various forms of violence. According to a nationwide study, 30 % of women experience intimate partner violence during their lifetime in Mongolia. The present research adopts an intersectional lens to comprehensively address the survival experiences of Mongolian women who had lived through intimate partner violence. In-depth semi-structured interviews were conducted with 21 participants recruited through purposive sampling, most of whom had ended a relationship involving intimate partner violence. Thematic analysis was used to identify patterns and themes among survival experiences. Although women's experiences varied, intimate partner violence confronted them with the dilemma of maintaining or going against traditional values, including family unity when seeking protection (and safety) for themselves and their children. The women's survival experiences included a combination of building a sense of community and rebuilding a sense of self, while self-contentment was achieved when the women ceased to blame themselves. This study highlights a critical shift in mindset and behavior by investigating the survival experiences of women who defy social norms, prioritizing family unity over personal well-being. Recognition of survivors' efforts to cease self-blame and seek support signifies a crucial advancement in the survival process. The findings suggest a positive trend toward self-empowerment and a willingness to access the necessary resources and support systems. From a practical standpoint, these findings advocate for strengthening current interventions that empower survivors to challenge norms, cease self-blame, and actively seek assistance.

Posttraumatic growth: Experiences of Mongolian and Hungarian survivors of intimate partner violence.

PURPOSE: The purpose of this study is to compare posttraumatic growth (PTG) of Mongolian and Hungarian survivors of intimate partner violence. METHODS: The study employed semi-structured interviews with fifteen women - ten Mongolian and five Hungarian survivors. Thematic analysis identified patterns and themes regarding survivors' PTG. RESULTS: PTG occurred in all participants, and identified themes were; positive changes, strengthened or new relationships and role models, personal strength, interest in advocacy for social change, and new found appreciation of life. Along with learning new skills and knowledge, a sense of security and caring for children were apparent as positive changes as well. Participants acknowledged interpersonal relationships through communities, including parents, colleagues and friends. Personal strengths, such as being trustworthy and optimistic, also contributed to the PTG with realized independence, increased self-confidence, assertiveness and being brave. Participants identified as individuals striving for social justice and being social change agents by involvement in local non-governmental organizations. Appreciation of life was enhanced or encouraged by supportive parents, community and believing in oneself. CONCLUSION: Similarities between Hungary and Mongolian survivors are more than the differences in posttraumatic growth for survivors of intimate partner violence. Posttraumatic growth includes acquiring new skills, aspiring for the future, interpersonal relationships, perseverance, and being social change agents. A sense of security, a sense of autonomy, independence and self-worth were significant common features found in this study.

The wellbeing paradox in Hungarian local sustainable agriculture: a health psychology approach.

BACKGROUND: The literature suggests that farmers' work involves a number of operational difficulties. Although alternative food networks address the majority of their problems, they can potentially generate new hardships. The aim of this study is to examine the situational and engagement-related work difficulties associated with the everyday world of Community Supported Agriculture (CSA) farmers. METHODS: This study used the health psychology approach, namely interpretive phenomenology, to understand the social determinants of farmers' working lives in CSA and to explore mental health challenges within the practices of local sustainable farming. To collect data, semi-structured, in-person interviews were conducted with CSA farmers in Hungary. RESULTS: Our study shows that new modes of consumer-producer connectivity create novel situations and issues which farmers are forced to address. Three personal experiential themes emerge from the data to describe CSA farmers' work difficulties: (1) Conflicted autonomy; (2) The pressure of boxes; (3) Social overload. The difficulties for CSA farmers seem to be rooted in the economic characteristics of alternative agriculture where farmers organize food production for the satisfaction of consumer needs. In addition, structural conditions require several different CSA farmer roles, which could even be conflicting. CONCLUSION: This study provides participants' perspectives on the health and wellbeing costs of sustainable farming. Newer producer-consumer connections require both time and experience and involve extra effort or skills, but farmers often lack these abilities. The results show how perceptions of work processes relate to the general framework of CSA, which necessitates a distinct strategy for farm management.

In the pitfall of expectations: An exploratory analysis of stressors in elite rhythmic gymnastics.

The present study explored the types of stressors faced by rhythmic gymnastics athletes, their parents, and coaches. Semi-structured interviews with 12 participants-four gymnasts, five coaches, and three parents-were analyzed using reflexive thematic analysis in a theory-driven framework. The categorizations of sport-related stressors for the parents, coaches, and gymnasts were based on existing theories. The results showed that both the gymnasts and the coaches predominantly noted mastery-avoidance goals in terms of performance, while the interviews with parents mostly indicated performance-avoidance goals. All three groups of participants consistently reported a detrimental atmosphere in rhythmic gymnastics. For instance, they emphasized the stress related to inadequate communication between the concerned parties. Moreover, all parties believed that having a lean body was linked to success in the competitive world of rhythmic gymnastics. The present study provides insight into some of the potential major stressors and the related subjective experiences affecting athletes socializing in the same sporting environment.

Identifying Types of Eco-Anxiety, Eco-Guilt, Eco-Grief, and Eco-Coping in a Climate-Sensitive Population: A Qualitative Study.

BACKGROUND: Climate change is one of the greatest challenges of the 21st century and it can affect mental health either directly through the experience of environmental traumas or indirectly through the experience of emotional distress and anxiety about the future. However, it is not clear what possible subtypes of the emerging "psychoterratic" syndromes such as eco-anxiety, eco-guilt, and eco-grief exist, how much distress they may cause, and to what extent they facilitate ecofriendly behavior. METHODS: We analyzed semi-structured interviews (N = 17) focusing on the thoughts, emotions, and behaviors related to climate change by using a combination of inductive and deductive qualitative methods. RESULTS AND CONCLUSIONS: The interviews revealed six eco-anxiety components, eight types of eco-guilt, and two types of eco-grief that help to understand the multifactorial nature of these phenomena. The six categories of coping strategies are in line with traditional coping models, and they are linked in various ways to pro-environmental behavior and the management of negative emotions. The results can help practitioners to gain a deeper understanding of emotions related to climate change and how to cope with them, and researchers to develop comprehensive measurement tools to assess these emotions.

Folktales of Recovery - From Addiction to Becoming a Helper: Deep Structures of Life Stories Applying Propp's Theory: A Narrative Analysis.

Addiction research suggests that recovery narratives share common structural elements. For further investigation of this topic, the current study invoked Propp's folktale theory and method to identify narratemes within retrospectives to depict the stages of recovery. Semi-structured interviews were recorded about the experiences of six recovering helpers who had been sober for a minimum of five years and worked as a professional for at least one year. A deductive narrative analysis was carried out. From the 31 Proppian narratemes, 28 were identified and different recovery stories were threaded into a commonly shared narrative strand, where the hero's relationship and struggle with the villain (drug) are depicted in process. Applying Propp's narratemes to analyze recovery stories is a new development that seems applicable according to our results, as it is consistent with fairytale therapy within addiction treatment, which helps the lost wanderer to create structure in their life.

The recovery of homicidal people diagnosed with schizophrenia and schizoaffective disorder-An interpretative phenomenological analysis.

Objective: Identity recovery in people diagnosed with schizophrenia who have committed homicide poses several difficulties. Premorbid mental illnesses, the experience of psychosis, and the absence of cohesive ego functions may result in the inability to integrate the homicidal act into self-identity. Problems with integration increase the risk of recidivism and further mental problems. The aim of the present research was to explore how homicidal people diagnosed with schizophrenia make sense of their actions, and how they identify with the homicide. Method: Six semi-structured interviews were conducted at a long-term psychiatric home with people who had committed homicide and who had been diagnosed with schizophrenia. The interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA), an idiographic method rooted in phenomenologist traditions that focuses on how participants experience and make sense of events in their lives, and how those events affect their identity and sense of self. Results: Three personal experiential themes were established as a result of the analysis: (1) homicide and responsibility; (2) homicide and self; and (3) control over threats to self and self-evaluation. (1) Homicide was often reported to have been committed in a non-conscious, delusional state that may have led to the loss of self-determination. (2) Our interviewees struggled to integrate their acts into their identities. They distanced themselves from the crime or held multiple, parallel interpretations of the act. (3) Recovering patients experienced the constant threat of entering into a delusional reality and losing control. The importance of control was central to their self-evaluation. The patients appeared to distance themselves from the homicidal act and to regard their delusional selves as a threat to their lives. Conclusion: Therapy aimed at bolstering self-control, supporting the integration of the fragmented self, and raising awareness of the connections between delusional reality and standard, intersubjective reality may be helpful in reducing the instability of the self. Therapy aimed at processing complex grief and loss of family is also needed.

"This is not life, this is just vegetation"-Lived experiences of long-term care in Europe's largest psychiatric home: An interpretative phenomenological analysis.

PURPOSE: Understanding the experiences of long-term care (LTC) may help to improve care by assisting mental health professionals and allowing mental health policies to be customized more effectively. DESIGN AND METHODS: Semistructured interviews were analyzed using interpretative phenomenological analysis (IPA). FINDINGS: Three main themes emerged as a result: 1. Perception of selves, 2. Experience and representation of the institution, 3. Maintenance of safe spaces. PRACTICE IMPLICATIONS: Communication with patients, investigation of their identity processes, and relationship toward their past and present self during LTC might aid in well-being and sense of congruency in their identities. Nurses should encourage patients to keep connected with their memories and past selves through different activities.

Rehabilitation From Addiction and Chronic Illnesses: A Comparative Analysis of the Narratives of Hungarian Patients.

BACKGROUND: In Hungary the psychological care provided during the rehabilitation of patients with chronic illnesses is insufficient. Patients with addiction, on the other hand, appear to make more use of psychological services. Narratives of patients recovering from addiction and patients with various chronic illnesses were examined in order to gain a better understanding of psychological phenomena during rehabilitation. METHODS: Semi-structured interviews were carried out. Narrative and thematic analysis was used in order to determine the structure and characteristics of patients' narratives. RESULTS: The narratives of patients recovering from addiction were found to be more structured and uniform; they identified with their illness and played an active role in their recovery. Patients with a chronic illness mainly recounted passive events and physical difficulties. Stigmatization was mentioned by both groups. IMPLICATIONS FOR PRACTICE: The level of stigmatization experienced by patients with a chronic illness may be one of the reasons why they use healthcare services more frequently than patients with an addiction. The authors believe that teaching patients to provide good narratives about suffering from and recovering from chronic illnesses may aid them in the rehabilitation process. An adaptive mixture of different illnesses and addiction narratives might be beneficial in the recovery process of various patient groups.

New psychoactive substance use as a survival strategy in rural marginalised communities in Hungary.

BACKGROUND: New psychoactive substance (NPS) use has become a widespread phenomenon among marginalised communities in Hungary. Since 2010, a growing number of reports in grey literature and anecdotal information among professionals have become available on NPS use among previously unaffected groups, such as people living in rural, socioeconomically deprived communities. In our research, we aimed to explore NPS use among these communities. METHODS: We conducted a mixed method research with convergent parallel design. Data collection took place in 2017 in marginalised communities in villages in two regions in Hungary, where 150 questionnaires were recorded and 50 interviews were conducted with current NPS users. RESULTS: According to the survey results, NPS is very easy to access, synthetic cannabinoid receptor agonist (SCRA) are easily bought in marginalised rural communities (79% found SCRA easy to obtain). Both SCRA and synthetic cathinones are used regularly; 57% of SCRA users and 37% of synthetic cathinone users used the respective substance at least once a week in the past 30 days. Besides NPS, sedative use (without prescription) and alcohol consumption are common among the respondents. 17% of the sample has already injected NPS. The overwhelming majority of the respondents rated regular consumption of NPS as "very dangerous" (SCRA: 75%, synthetic cathinones 72%). NPS users have limited knowledge of consequences and the social and health treatment options available. Most themes in the interviews are associated with surviving stress, crisis and anxiety, as well as the wish to escape from insecurity and chaotic life. Positive effects of substance use (community, joy, energy) are rarely present. CONCLUSION: People who use drugs (PWUD) living in these rural communities face the consequences of the rural risk environment: easy access to NPS, inadequate access to services, poor labour market situation and attributions of marginalised groups, for example disaffiliation. NPS use is not a recreational activity in this population; individuals mainly use NPS to get away from reality, problems, pain, poverty and marginalisation. NPS use is a survival strategy. Effective responses have to address substance use and social integration; we need complex interventions addressing structural factors.

Voices of Temporary Sobriety - A Diary Study of an Alcohol-Free Month in Hungary.

Background: Temporary abstinence from alcohol as a challenge could support self-knowledge, self-care, and health consciousness in several ways. Objectives: The present study explored Dry November participants' personal experiences and coping strategies during a one-month abstinence period. The research is embedded in the Hungarian context of drinking habits, culture, society, and alcohol policy. Methods: This qualitative study comprised the thematic analysis of 23 participants' diaries, reported twice a week for 30 days (in November 2017), to identify and understand the common experiences of temporary sobriety. Results: Three main themes emerged from the analysis: challenge, community, and relationship toward alcohol and abstinence. Results showed that there are no categorical differences between successful and non-successful participants. Conclusions: The present research demonstrated that during the challenge, rather than simply saying 'no' to alcohol, participants utilized other refusal strategies to avoid social confrontation.

HIV among people who inject drugs in Hungary.

BACKGROUND: Before 2014 (the year of closure of the two largest needle exchange programs in Hungary, which halved the number of available syringes in the country despite increased injecting risk practices) no HIV was reportedly acquired in Hungary among people who inject drugs (PWIDs) who were not also men who had sex with other men (MSM). In 2014, one and in 2015 two non-MSM PWIDs were newly diagnosed with HIV who supposedly became infected in Hungary, and both incident HIV cases in 2015 were diagnosed in the AIDS stage. In addition, two new (albeit supposedly imported) non-MSM PWID cases were also registered in the first three quarters of 2016, one of which subsequently was diagnosed with and then died of AIDS. At the same time, the prevalence of HCV doubled among PWIDs (from 24% to 49% in Hungary and from 34% to 61% in Budapest). CASE PRESENTATION: The case that we discuss in this paper is a male PWID, who was diagnosed with HIV and AIDS in May of 2015 and then died of AIDS the next month. His HIV infection status was detected with delay, and then appeared in the official statistics as an incident PWID HIV case and an incident PWID AIDS case, but not as an incident PWID AIDS death. No contact tracing followed, even though it would have been relatively easy considering the circumstances. To our knowledge, no HIV post-exposure protocol exists in hospitals, in case of HIV exposure due to an eventual needle-stick injury. CONCLUSIONS: Our paper draws attention to recently published HIV and AIDS surveillance data, and shows the failure of the system. While sounding the alarm based on three newly detected PWID HIV cases in the past 2 years may be premature, there are definitely serious problems in the HIV detection and tracing system among PWIDs in Hungary.

The experience of voice hearing and the role of self-help group: An interpretative phenomenological analysis.

BACKGROUND: Auditory verbal hallucinations (AVHs) played an important role in the psychiatric diagnostics, but in the last few decades the diagnostic-free complex phenomenological understanding of the phenomena of voice hearing became the focus of studies. MATERIALS: Six semi-structured interviews with recovering voice hearers were conducted and analysed using interpretative phenomenological analysis (IPA). DISCUSSION: The self-help group gives significant help in identification and dealing with the voices; therefore, it serves as turning point in the life story of voice hearers. CONCLUSION: Applying self-help group in clinical context contributes to better outcomes in treatment of voice hearers.

Assessing the experience of using synthetic cannabinoids by means of interpretative phenomenological analysis.

BACKGROUND: New psychoactive substances (NPS) have been increasingly consumed by people who use drugs in recent years, which pose a new challenge for treatment services. One of the largest groups of NPS is synthetic cannabinoids (SCs), which are intended as a replacement to cannabis. While there is an increasing body of research on the motivation and the effects associated with SC use, little is known about the subjective interpretation of SC use by the people who use drugs themselves. The aim of this study was to examine the experiences and personal interpretations of SC use of users who were heavily dependent on SC and are in treatment. METHODS: A qualitative research method was applied in order to explore unknown and personal aspects of SC use. Semi-structured interviews were conducted with six participants who had problematic SC use and entered treatment. The research was conducted in Hungary in 2015. We analyzed data using interpretative phenomenological analysis (IPA). RESULTS: Participants perceived SCs to be unpredictable: their initial positive experiences quickly turned negative. They also reported that SCs took over their lives both interpersonally and intrapersonally: the drug took their old friends away, and while initially it gave them new ones, in the end it not only made them asocial but the drug became their only friend, it hijacked their personalities and made them addicted. CONCLUSIONS: Participants experienced rapid development of effects and they had difficulties interpreting or integrating these experiences. The rapid alteration of effects and experiences may explain the severe psychopathological symptoms, which may be important information for harm reduction and treatment services. Since, these experiences are mostly unknown and unpredictable for people who use SCs, a forum where they could share their experiences could have a harm reducing role. For a harm reduction point of view of SCs, which are underrepresented in literature, it is important to emphasize the impossibility of knowing the quantity, purity, or even the number of different SC compounds in a particular SC product. Our study findings suggest that despite the adverse effects, including a rapid turn of experiences to negative, rapid development of addiction and withdrawal symptoms of SCs, participants continued using the drug because this drug was mostly available and cheap. Therefore, a harm reduction approach would be to make available and legal certain drugs that have less adverse effects and could cause less serious dependence and withdrawal symptoms, with controlled production and distribution (similarly to cannabis legalization in the Netherlands).

"Someone Else's Problem": New Psychoactive Substances in the Online Hungarian Media.

Media monitoring is an important method to inform public health and prevention services about emerging health issues, such as new psychoactive substances (NPS). This study assessed the portrayal of NPS in online Hungarian media in 2015 using qualitative content analysis. Hungarian online media considers the dealer to be the main cause of drug use, which is portrayed as a problem for youth, poor people, minorities, and rural populations. The point of view of the articles is externalized, and so is the solution offered by them. From the perspective of the police or using a biomedical approach, the articles suggest that drug use is an individual (someone else's) problem, and the perspectives of insiders (such as users or addiction treatment professionals) are absent. The media portrays low socioeconomic background and the hopelessness of disadvantaged rural and mostly minority populations as the roots of NPS use, and misses the pressing incapability of health care emergency and drug treatment services to cope with the problem. The dominant portrayal of police raids is rarely counterbalanced by voices of active or recovering drug users or professionals in addiction treatment and harm reduction, who could offer a systematic solution to the apparent rapid spread of NPS use.

[Assessing identity formation of synthetic cannabinoid products' users - an interpretative phenomenological analysis].

INTRODUCTION: The psychoactive substance addiction often leads to change in identity and the formation of the "user self". During recovery this "user self" or the "spoiled identity" (as Goffman described it) transforms into the identity of recovery. Due to the novel symptoms of synthetic cannabinoid products (SCPs), a new type of psychoactive substances and the lack of previous research the identity work of SCPs users is unpredictable. The aim of this study was to examine how the users of SCPs interpret their experiences delivered from SCPs consumption and how do they perceive the identity, for this we assessed the interpretative phenomenological analysis (IPA). METHOD: Based on the method of IPA a purposive sample was recruited, including 6 males (their age was between 20 and 27) who were self-identified SCPs users. They had been using the drug for 2-6 years, and before the analysis they were abstinent for at least one month. Semi-structured interviews were conducted and analyzed using IPA. RESULTS: During the analysis two master themes emerged; 1. The impact of SCPs use experience on self and identity formation, and 2. The transformed self and the user self. CONCLUSIONS: the experiences of SCPs users can be compared with some specificities of traumatic experience; therefore, the experience of SCPs use may be treated as a particular type of trauma. As a result, the resources of SC users to change their self and construct a new non-addict identity are limited, which may mean a significant obstacle in recovery. Hence, treatment should focus on identity work more emphatically.

[The experience of auditory hallucination and the role of self-help groups: an interpretative phenomenological analysis]. / A hanghallás élménye és az önsegito csoport szerepe: interpretatíve fenomenológiai analizisen alapuló kutatás.

INTRODUCTION: the aim of this study was to examine and to understand the experience of voice hearing, the meaning and participants' relationship with their voices. And also to explore what 'recovery' means in this context, and the role of self-help group. METHOD: six semi-structured interviews were conducted and analyzed using interpretative phenomenological analysis (IPA). Emerging themes were identified and clustered into master themes, then interpreted. SUBJECTS: 6 (3 females, 3 males) voice hearers, recovering from psychosis. RESULTS: Analysis resulted in four master themes to represent the key points of life story interviews; the role of voices (first master theme), relationship with voices (second master theme); asymmetric and symmetric relational concept, position of voices (outside or inside). The third and fourth master theme refer to the role of self-help group, and the method applied by the group. CONCLUSION: applying self-help group in clinical context contributes to better outcomes in treatment of voice hearers.

A needle in the haystack--the dire straits of needle exchange in Hungary.

BACKGROUND: The two largest needle exchange programs (NEPs) in Hungary were forced to close down in the second half of 2014 due to extreme political attacks and related lack of government funding. The closures occurred against a background of rapid expansion in Hungary of injectable new psychoactive substances, which are associated with very frequent injecting episodes and syringe sharing. The aim of our analysis was to predict how the overall Hungarian NEP syringe supply was affected by the closures. METHODS: We analyzed all registry data from all NEPs in Hungary for all years of standardized NEP data collection protocols currently in use (2008-2014) concerning 22 949 client enrollments, 9,211 new clients, 228,167 client contacts, 3,160,560 distributed syringes, and 2,077,676 collected syringes. RESULTS: We found that while the combined share of the two now closed NEPs decreased over time, even in their partial year 2014 they still distributed and collected about half of all syringes, and attended to over half of all clients and client contacts in Hungary. The number of distributed syringes per PWID (WHO minimum target = 100) was 81 in 2014 in Hungary, but 39 without the two now closed NEPs. CONCLUSIONS: There is a high probability that the combination of decreased NEP coverage and the increased injection risk of new psychoactive substances may lead in Hungary to a public health disaster similar to the HIV outbreaks in Romania and Greece. This can be avoided only by an immediate change in the attitude of the Hungarian government towards harm reduction.

Veni, vidi, vici: The appearance and dominance of new psychoactive substances among new participants at the largest needle exchange program in Hungary between 2006 and 2014.

BACKGROUND: There has been an almost exponential growth in the number of new psychoactive substances (NPS) on the drug markets in Europe during the past decade. While most users of NPS use them by routes other than injecting, percutaneous use of NPS is associated with very frequent injecting episodes and paraphernalia sharing. METHODS: We assessed to what extent new clients between 2006 and 2014 (N=3680) at Blue Point, Hungary's largest needle exchange program, exhibited a shift during these years in the drugs they primarily injected. RESULTS: Until 2010, 99% of clients injected either heroin or amphetamines. After 2010, however, there was a "replacement chain" of new substances, with one appearing and disappearing after the other: between 2010 and 2014, NPS under five names appeared and gained dominant prevalence (from 0% to 80%), and gradually replaced first the two "traditional" drugs amphetamine and heroin (which diminished to 17% together in 2014) and later each other. We also saw an increase in the proportion of female and older clients. CONCLUSIONS: While our findings are restricted to injected NPS, they suggest that NPS affect the vast majority of the population of people who inject drugs not only in terms of drug use patterns, but maybe also in terms of demographics. Given that over 80% of people who inject drugs use NPS and injecting NPS is associated with increased injecting risks, harm reduction services should be made more available to avoid an epidemic of blood-borne infections.

New cases of HIV among people who inject drugs in Hungary: False alarm or early warning?

Between 2009 and the first quarter of 2014, only one case of HIV (contracted outside Hungary) was detected among PWIDs in Hungary. However, more recent evidence suggests increased sharing of injecting paraphernalia among PWIDs. This is linked to the emergence of new designer drugs that require frequent injection, alongside funding cuts to the Hungarian needle exchange program (NEP) which has reduced access to sterile injecting equipment. During the past five years in Hungary, drug use has become increasingly discussed in moral as opposed to public health terms, and drug consumption has been re-criminalized. The largest NEP in Hungary was closed because of political pressure and government funding for regular HCV/HIV testing/counselling and seroprevalence studies among PWIDs has been stopped. This paper describes the detection of two new cases of HIV infection in PWIDs attending two NEPs in Budapest in May 2014. These new cases may indicate an unfolding HIV outbreak among PWIDs-similar to those reported in Greece and Romania. Yet the question remains: If no further HIV cases are detected, is this because there are no new cases or because there are no testing facilities for PWID?