Barriers and recommendations for parent-child conversations about pornography.

Introduction: Parents consistently report being worried about the impact of online pornography on their adolescent and pre-adolescent children's development. Yet, most parents do not discuss pornography as part of parent-child conversations about sexuality. The current study sought to identify the barriers to parent-child conversations about pornography. Methods: We present two studies. The first study employed one-to-one interviews to explore parents' (n = 14) beliefs about their role in their child's pornography education. The second study involved the quantitative assessment of Study 1 findings in a sample of parents of pre-adolescent and adolescent children (n = 408). Results: Findings indicate that three overarching themes prevent parents from addressing pornography with their adolescent children, parents' practical ability to discuss pornography, their attitudes toward discussing pornography, and the perceived positive impact of addressing pornography with their adolescent children. Practical ability was most often reported as the greatest barrier to parents engaging in parent-child conversations about pornography. Most notably, parents reported hesitancy in discussing pornography because they did not know how to define pornography or how to address pornography in an age-appropriate way. Fathers were also significantly less likely to believe that talking about pornography was socially acceptable. Discussion: We discuss the implications of these findings and present recommendations for developing a parents' pornography education resource.

Patterns of Sexual Harassment: An Intersectional Approach to Reported Victimization in a Campus Climate Survey of Students at Irish Higher Education Institutions.

This study explores how identifying with multiple minority groups relates to sexual harassment victimization (SHV) among students in higher education institutions in Ireland (n = 6,002). Results show that gender nonconforming and female students were more likely than males to experience SHV. Bisexual or queer and gay or lesbian students were more likely than their heterosexual peers to experience SHV. Students with a physical or cognitive disability were more likely to experience SHV than those who reported no disability, and white students were more likely than minority ethnic groups to experience SHV. When controlling for sexual orientation, gender, and disability status, students who identified as both gay and lesbian and reported a cognitive disability were 8.5 times more likely to experience SHV. Victims of SHV reported having lower scores on perceived institutional support items than those who had not experienced SHV.

Development of a Measure to Assess What Young Heterosexual Adults Say They Learn About Sex from Pornography.

This study involved the development of two new measures to assess what some young heterosexual-identifying adults report learning about sex from pornography. Inventory items were generated from an extensive literature review and six qualitative focus group sessions with young adults (N = 54) aged 18-29 which explored how pornography could be used as a source of sexual information. A total of 135 items pertaining to sexual learning from pornography were produced, reviewed and categorized by a sample of young adults (n = 9), and finally reviewed for item and construct relevance by a panel of pornography, sex education and scale development experts (n = 6). Inventory items were administered to a sample of young adult university students (n = 1306). Two separate exploratory factor analyses were conducted for the female and male datasets. The final factors were reviewed by a panel of young adults = 8) to identify the theme of each factor. Both the SIPI-F and SIPI-M yielded three factors: (1) How to be a good sexual partner, (2) Body aesthetic, and (3) Sexual exploration. Results show that pornography provides information about a range of sex-related topics. Findings also show that more frequent female pornography users reported learning more about how to be a good sexual partner and body aesthetic than less frequent pornography users. The SIPI-F and SIPI-M can be useful for examining a variety of questions regarding the use of pornography as an informal source of sexual information and its correlates.

Coming-Out Experiences of Irish Gay Fathers Who Have Been Heterosexually Married: An Interpretative Phenomenological Analysis.

This study explores how Irish gay fathers, who married heterosexually in a heteronormative culture, assumed a settled gay identity in the Republic of Ireland. A purposive sample of nine men reflected on their experiences of marriage and separation, assuming a gay identity, and social and familial connectivity. Interpretative phenomenological analysis (IPA) indicated the suppression of gay sexual desires before marriage as a result of cultural homophobia. The coming-out process continued during the participants' marriage. Extramarital same-gender sexual desires and/or transgressions co-occurred with existential conflict (remorse) and resulted in marital separation. The marital and family loss was experienced as traumatic, and suicidal ideation occurred for most. All the men assumed an openly gay identity after separating. Many established a family-orientated same-gender repartnership. Results highlight the individuality and significance of the marital and family loss for those who separate after coming out as gay.

Toward a Model of Porn Literacy: Core Concepts, Rationales, and Approaches.

Although some positive outcomes for pornography engagement have been highlighted, researchers and educators have also expressed concerns about youth pornography engagement and have called for porn literacy education to be incorporated into sex education programs. As yet, there is lack of agreement regarding intervention development. This study aimed to engage participants in the identification of relevant curriculum content. Participatory methods of data collection were used with 54 young adults aged 18 to 29 to generate core concepts for porn literacy education, and these concepts were subsequently explored in group interviews. Findings suggest that the proposed learning outcomes should focus on reducing shame regarding pornography engagement and improving critical thinking skills regarding the following sexual health topics: body image comparisons and dissatisfaction; sexual and gender-based violence; fetishising of gay and transgender communities; and setting unrealistic standards for sex. Methods of engagement for porn literacy, gendered differences, and important findings that are specific to lesbian, gay, bisexual, transgender, plus (LGBT+) persons are discussed, and recommendations regarding future research and intervention development are outlined.

Variables affecting first-year student commitment during the transition to college in Ireland.

Third-level student attrition rates internationally are a cause for concern. Thus, student retention and academic success are top priorities for colleges, and students alike. In addition to this, student well-being is a growing public health concern. This study explores the need to incorporate well-being as a predictor in traditionally academically focused models of student persistence during the transition to college. A cross-sectional web-based survey was conducted with 574 first-year students aged 17-22 years attending a university in Ireland to examine the effect of student persistence and well-being variables on student commitment during the transition to college. This study highlights the connection between student academic, social and well-being variables during the transition to college within the fitted models that emerged from the data. Student well-being plays a key role ensuring student persistence during the transition to college. The results support our hypothesis that many student variables have the potential to substantially impact student commitment during the first-year transition to college. These variables include student depression, self-rated health, academic environment, peer connections and perceiving the academic programme to be an appropriate personal choice. It is therefore important for education institutions to acknowledge and address student persistence and student well-being in an integrative way and for traditionally academically focused student retention models to orientate to incorporate student well-being.

Effects of Biopsychosocial Education on the Clinical Judgments of Medical Students and GP Trainees Regarding Future Risk of Disability in Chronic Lower Back Pain: A Randomized Control Trial.

BACKGROUND: Chronic lower back pain (CLBP) is a major health care burden and often results in workplace absenteeism. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions informed by the flags approach, which integrates cognitive and behavioral approaches via identification of biopsychosocial barriers to recovery, have resulted in reduced pain-related work absences and increased return to work for individuals with CLBP. However, research indicates that physicians' adherence to biopsychosocial guidelines is low. OBJECTIVE: The current study examined the effects of a flags approach-based educational intervention on clinical judgments of medical students and general practitioner (GP) trainees regarding the risk of future disability of CLBP patients. DESIGN: Randomized controlled trial (trial registration number: ISRCTN53670726). SETTING: University classroom. SUBJECTS: Medical students and GP trainees. METHODS: Using 40 fictional CLBP cases, differences in clinical judgment accuracy, weighting, and speed (experimental N = 32) were examined pre- and postintervention, as were flags approach knowledge, pain attitudes and beliefs, and empathy, in comparison with a no-intervention control group (control N = 31). RESULTS: Results revealed positive effects of the educational intervention on flags approach knowledge, pain-related attitudes and beliefs, and judgment weighting of psychologically based cues; results are discussed in light of existing theory and research. CONCLUSIONS: Short flags approach-based educational video interventions on clinical judgment-making regarding the risk of future disability of CLBP patients may provide opportunities to gain biopsychosocial knowledge, overcome associated attitude barriers, and facilitate development of clinical judgment-making more aligned with psychological cues.

Adding insult to brain injury: young adults' experiences of residing in nursing homes following acquired brain injury.

PURPOSE: There is general consensus that adults under age 65 with acquired brain injury residing in nursing homes is inappropriate, however there is a limited evidence base on the issue. Previous research has relied heavily on third-party informants and qualitative studies have been of questionable methodological quality, with no known study adopting a phenomenological approach. This study explored the lived experiences of young adults with brain injury residing in aged care facilities. METHODS: Interpretative phenomenological analysis was employed to collect and analyze data from six semi-structured interviews with participants regarding their experiences of living in nursing homes. RESULTS: Two themes were identified, including "Corporeal prison of acquired brain injury: broken selves" and "Existential prison of the nursing home: stagnated lives". Results illustrated that young adults with acquired brain injury can experience aged care as an existential prison in which their lives feel at a standstill. This experience was characterized by feelings of not belonging in a terminal environment, confinement, disempowerment, emptiness and hope for greater autonomy through rehabilitation. CONCLUSION: It is hoped that this study will provide relevant professionals, services and policy-makers with insight into the challenges and needs of young adults with brain injury facing these circumstances. Implications for rehabilitation This study supports the contention that more home-like and age-appropriate residential rehabilitation services for young adults with acquired brain injury are needed. As development of alternative accommodation is a lengthy process, the study findings suggest that the interim implementation of rehabilitative care in nursing homes should be considered. Taken together with existing research, it is proposed that nursing home staff may require training to deliver evidence-based rehabilitative interventions to those with brain injury. The present findings add support to the call for systemic change in Ireland, to clarify the acquired brain injury care pathway and establish integrated rehabilitation services.

The female spouse: A process of separation when a husband 'comes out' as gay.

This study investigated the stories of heterosexual women who experienced a husband coming out as gay and a consequential marital separation. Interpretative phenomenological analysis (IPA) was used. Loss, anger, spousal empathy and concerns regarding societal prejudice were reported. Additional stress was experienced when others minimised the experience due to the gay sexual orientation of their husband. Experiencing positive communication with their husband during and after the disclosure aided the resolution of the emotional injury experienced by them. They all eventually 'let go' of their husband. This involved a process of reconceptualising the self as separated. Findings indicate the importance of supporting women to re-focus on their needs during and following marital dissolution. The importance of non-judgemental support for marital loss, rather than a focus on the gay sexual orientation of the spouse, was highlighted.

Judgement analysis of case severity and future risk of disability regarding chronic low back pain by general practitioners in Ireland.

Chronic low back pain is a major healthcare burden that has wide ranging effects on the individual, their family, society and the workplace. However, appropriate management and treatment is often difficult, as a majority of cases are non-specific in terms of underlying pathology. As a result, there are extensive differences in both individual patient preferences for treatment and treatment decisions amongst general practitioners. The current study examined the clinical judgements of GPs in Ireland, regarding fictional patients' case severity and future risk of disability, through judgement analysis. Judgement analysis (JA) is an idiographic regression modelling technique that has been utilised in extant healthcare research for the purpose of allocating weighting to judgement criteria, or cues, observed by professionals in their clinical decision-making. The primary aim of the study was to model two critical information utilisation tasks performed by GPs with regard to CLBP-in combining information cues to form a judgement about current case severity and a judgement about the same patient's risk of future disability. It was hypothesised that the judgement weighting would differ across the two judgements and that judgements regarding future risk of disability would be less consistent among GPs than judgements about case severity. Results from the regression-based judgement analysis and subsequent follow-up statistical analysis provided support for both study hypotheses. Study findings are discussed in light of theory and research on judgement, clinical decision-making and chronic low back pain.

How Do Individuals Develop Alcohol Use Disorder After Bariatric Surgery? A Grounded Theory Exploration.

BACKGROUND: Bariatric surgery is the most effective treatment for severe obesity. However, following Roux-en-Y gastric bypass (RYGB) surgery, a small minority of patients develop new-onset alcohol use disorder (AUD), the aetiology of which is poorly understood. AIM: The aim is to construct a theory to explain the development of AUD among a sample of individuals who reported problematic drinking following RYGB. METHOD: Semi-structured interviews were conducted with eight RYGB patients diagnosed with AUD attending a multi-disciplinary outpatient weight management service at a public hospital in the Republic of Ireland. A constructivist grounded theory methodology was used to analyse interview transcripts. RESULTS: Participants' main concern was identified as 'unresolved psychological issues' which were managed by 'external coping mechanisms', namely, 'eating to cope'. After RYGB, comfort eating was no longer possible to the same extent. Following a 'honeymoon period', participants' need for an external coping mechanism resurfaced. 'Filling the void' provides a framework to explain how participants managed the symptoms of their unresolved psychological issues through 'behavioural substitution', that is, drinking alcohol instead of eating. CONCLUSION: The theoretical framework of 'filling the void' adds to contemporary research that conceptualises AUD behavioural substitution as 'addiction transfer' by describing the process by which the phenomenon occurs as well as the characteristics of participants. The clinical implication of this research is to advocate for a reshaping of treatment of RYGB patients, with increased psychological input following surgery.

Factors Influencing the Application of a Biopsychosocial Perspective in Clinical Judgement of Chronic Pain: Interactive Management with Medical Students.

BACKGROUND: Though there is wide support for the application of biopsychosocial perspectives in clinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequate training or attitudes favoring a biomedical approach. Recent research has indicated that despite such explanations, both established general practitioners (GP) and medical students account for some psychosocial factors when making clinical judgements regarding chronic pain cases, but report not being likely to apply these in real-world, clinical settings due to numerous factors, including available time with patients. Thus, it is evident that a greater understanding of clinical judgement-making processes and the factors that affect application of these processes is required, particularly regarding chronic pain. OBJECTIVES: The aims of the current study were to investigate medical students' conceptualizations of the factors that influence application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain using interactive management (IM), model the relationships among these factors, and make recommendations to chronic pain treatment policy in light of the findings. STUDY DESIGN: The current study used IM to identify and model factors that influence the application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain, based on medical students' conceptualizations of these factors. SETTING: Two university classrooms. METHODS: IM is a systems thinking and action mapping strategy used to aid groups in developing outcomes regarding complex issues, through integrating contributions from individuals with diverse views, backgrounds, and perspectives. IM commonly utilizes the nominal group technique and interpretive structural modeling, which in this context were employed to help medical students identify, clarify, and model influences on the application of biopsychosocial perspectives in treating chronic pain patients. RESULTS: Results of IM group work revealed 7 core biopsychosocial approach application categories: GP attitudes, cost, GP knowledge, time, patient-doctor relationship, biomedical factors. and patient perception. GP attitudes was the most critical driver of all other competencies in the system, with cost and GP knowledge revealed as secondary drivers. LIMITATIONS: Potential differences in level of prior biopsychosocial perspective knowledge across participants and a potentially small sample size (though consistent with past research and appropriate for an exploratory study of this nature - for purposes of achieving the depth and richness of the deliberation and qualitative insights revealed by participants using the IM methodology). CONCLUSIONS: Results from this study may be used to both recommend further research on the identified factors influencing application of biopsychosocial perspectives in treatment of chronic pain and support amendment to extant health care policy, particularly with respect to cost, GP attitudes, and knowledge. Though this research claims neither that the influences identified are the only influences on biopsychosocial application, nor the order of their importance, the research does contribute to an on-going effort to better understand the factors that influence doctors in their treatment of chronic pain.Key words: Chronic pain, biopsychosocial, medical education, clinical judgement, interactive management, pain management.

Effectiveness of a biopsychosocial e-learning intervention on the clinical judgements of medical students and GP trainees regarding future risk of disability in patients with chronic lower back pain: study protocol for a randomised controlled trial.

INTRODUCTION: Chronic lower back pain (CLBP) is a major healthcare problem with wide ranging effects. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions that identify biopsychosocial barriers to recovery have been observed to lead to successfully reduced pain-related work absences and increased return to work for individuals with CLBP. Modern conceptualisations of pain adopt a biopsychosocial approach, such as the flags approach. Biopsychosocial perspectives have been applied to judgements about future adjustment, recovery from pain and risk of long-term disability; and provide a helpful model for understanding the importance of contextual interactions between psychosocial and biological variables in the experience of pain. Medical students and general practitioner (GP) trainees are important groups to target with education about biopsychosocial conceptualisations of pain and related clinical implications. AIM: The current study will compare the effects of an e-learning intervention that focuses on a biopsychosocial model of pain, on the clinical judgements of medical students and trainees. METHODS AND ANALYSIS: Medical student and GP trainee participants will be randomised to 1 of 2 study conditions: (1) a 20 min e-learning intervention focused on the fundamentals of the flags approach to clinical judgement-making regarding risk of future pain-related disability; compared with a (2) wait-list control group on judgement accuracy and weighting (ie, primary outcomes); flags approach knowledge, attitudes and beliefs towards pain, judgement speed and empathy (ie, secondary outcomes). Participants will be assessed at preintervention and postintervention. ETHICS AND DISSEMINATION: The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee. The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN53670726; Pre-results.

When Parents Separate and One Parent 'Comes Out' as Lesbian, Gay or Bisexual: Sons and Daughters Engage with the Tension that Occurs When Their Family Unit Changes.

The experiences of Irish sons and daughters born into heterosexually-organised parental partnerships/unions whose parents have separated and one has come out as Lesbian, Gay or Bisexual (LGB) were explored through a grounded theory approach. 15 adult children (over the age of 18 years), who varied in age when their parents separated and one disclosed as LGB, were interviewed. The primary concern that emerged centred on participants having to adjust to their parents' being separated, as opposed to their parent being LGB. This involved engaging with the tension that arose from the loss of the parental union, which involved changes to the home environment and adapting to new parental partners and family units. Heightened reflection on sexual orientation and an increased sensitivity to societal LGB prejudice were specifically associated with a parent coming out as LGB. How parents negotiated disclosing the changes to others, the level of support available to parents, and how capable parents were at maintaining the parent-child relationship had an impact on the tension experienced by sons and daughters. Participants moved from initially avoiding and resisting the family changes that were occurring to gradual consonance with their altered family environments. Concluding directions for research and clinical considerations are suggested.

Experiences of chronic low back pain: a meta-ethnography of qualitative research.

Chronic low back pain (CLBP) is associated with a number of costly disability-related outcomes. It has received increasing attention from qualitative researchers studying its consequences for personal, social, and health care experiences. As research questions and methods diversify, there is a growing need to integrate findings emerging from these studies. A meta-ethnography was carried out to synthesise the findings of 38 separate qualitative articles published on the subjective experience of CLBP between 1994 and 2011. Studies were identified following a literature search and quality appraisal. Four themes were proposed after a process of translating the meaning of text extracts from the findings sections across all the articles. The themes referred to the undermining influence of pain, its disempowering impact on all levels, unsatisfying relationships with health care professionals, and learning to live with the pain. The findings are dominated by wide-ranging distress and loss but also acknowledge self-determination and resilience. Implications of the meta-ethnography for clinicians and future qualitative research are outlined, including the need to study relatively unexamined facets of subjective experience such as illness trajectory and social identity.

Freedom, invisibility, and community: a qualitative study of self-identification with asexuality.

A significant body of research is now emerging on the subjective meaning of asexuality. This study explored how self-identification as asexual is managed, both as a threat to the self-concept and a source of personal meaning. A total of 66 self-identified asexuals were recruited from an asexuality internet community and responded to open-ended questions on an online survey. Of these, 31 participants identified as female, 15 as male, 18 gave a different label such as genderqueer or androgynous, and two did not provide information on gender. A thematic analysis of the transcripts resulted in three themes. Socially, asexuality attracted denial and resistance due to incompatibility with heteronormative societal expectations. Despite the threat to self-integrity arising from asexuality being socially rejected, it was typically assimilated as a valued and meaningful orientation on an intra-personal level, aided by information and support from the online community. A second level of threat to self arose whereby other self-identifications, especially gender, had to be reconciled with a non-sexual persona. The accommodation made to other elements of the self was reflected in complex sub-identities. The findings were interpreted using identity process theory to understand how threats arising from self-identifying as asexual are managed. Although asexuality emerges as an orientation to sexuality that can be reconciled with the self, its invisibility or outright rejection in society constitute an on-going challenge.

Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial.

INTRODUCTION: Internet-delivered psychological interventions among people with chronic pain have the potential to overcome environmental and economic barriers to the provision of evidence-based psychological treatment in the Irish health service context. While the use of internet-delivered cognitive-behavioural therapy programmes has been consistently shown to have small-to-moderate effects in the management of chronic pain, there is a paucity in the research regarding the effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) programme among people with chronic pain. The current study will compare the clinical-effectiveness and cost-effectiveness of an online ACT intervention with a waitlist control condition in terms of the management of pain-related functional interference among people with chronic pain. METHODS AND ANALYSIS: Participants with non-malignant pain that persists for at least 3 months will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. The control group will be a waiting list group and will be offered the ACT intervention after the 3-month follow-up period. Participants will be assessed preintervention, postintervention and at a 3-month follow-up. The primary outcome will be pain-related functional interference. Secondary outcomes will include: pain intensity, depression, global impression of change, acceptance of chronic pain and quality of life. A qualitative evaluation of the perspectives of the participants regarding the ACT intervention will be completed after the trial. ETHICS AND DISSEMINATION: The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee (12/05/05). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN18166896.

A young person's game: immersion and distancing in bar work.

Previous research indicates that bar workers report high levels of alcohol consumption, but the bar work experience itself has been little studied as a means to understand health threats associated with this job role. The subjective experience and meaning of bar work was explored in this study by interviewing current and ex-bar workers from a district in an Irish city that had a high density of bars and busy tourism industry. A total of 12 participants took part in focus groups (FGs) and seven in individual interviews. Four themes were identified in a thematic analysis. The central depiction of bar work was of an initial immersion in an intensive lifestyle characterised by heavy drinking, with subsequent distancing from the extremes of the lifestyle. The participants affiliated strongly with the bar work occupational identity, which included alcohol use in group scenarios for drinking during work, after work and on time off. The bar work lifestyle was most intense in the 'superpub' environment, characterised by permissive staff drinking norms and reported stress. Although an important identity, bar work was ultimately a transient role. The findings are considered in relation to research on occupation-specific stress and alcohol use, social identity and developmental needs in young adulthood.

A risk to himself: attitudes toward psychiatric patients and choice of psychosocial strategies among nurses in medical-surgical units.

Psychiatric patients are liable to stereotyping by healthcare providers. We explored attitudes toward caring for psychiatric patients among 13 nurses working in general hospitals in Ireland. Participants thought aloud in response to a simulated patient case and described a critical incident of a patient for whom they had cared. Two attitudinal orientations were identified that correspond to stereotypical depictions of risk and vulnerability. The nurses described psychosocial care strategies that were pragmatic rather than authentically person-centered, with particular associations between risk-oriented attitudes and directive nursing care. Nurses had expectations likely to impede relationship building and collaborative care. Implications arising include the need for improved knowledge about psychiatric conditions and for access to professional development in targeted therapeutic communication skills.