The psychosocial experiences of adults diagnosed with coeliac disease: a qualitative evidence synthesis.

BACKGROUND: Coeliac disease is a chronic autoimmune condition associated with intestinal and extraintestinal symptoms. Coeliac Disease is managed through strict adherence to a gluten-free diet, which, though usually effective, is challenging to maintain. This review synthesised qualitative research on the psychosocial experiences of adults living with coeliac disease. METHODS: Keyword searches were conducted of the academic databases CINAHL, EMBASE, MEDLINE, PsychINFO, SCOPUS and Web of Science for articles published (2005-2021), followed by forward and backward searches. Thematic synthesis of included articles was carried out on sections reporting findings or results, discussion, conclusions, and supporting data. The inductive thematic synthesis identified descriptive and analytical themes from the included studies. RESULTS: Of 1284 records identified, 17 articles from 15 original studies were included in the thematic synthesis. The majority of studies were from Europe (76%), with the remainder from North America and Australia. Data represented 371 adults with coeliac disease (72% female; 17-85 years old, diagnosed < 1-42 years ago) across eight countries. Findings identified six analytical themes relating to the psychosocial experience of coeliac disease: 'Living with ongoing risk'; 'Losing more than gluten'; 'A changed identity'; 'A changed relationship with food'; 'The gluten-free diet creates a multifaceted burden'; and 'Learning how to live well with Coeliac Disease'. CONCLUSIONS: Coeliac disease changes adults' psychosocial experiences. Adaptation involves ongoing learning, and development of psychological acceptance facilitates adjustment. Increased public education about coeliac disease may reduce stigma and risk. Psychosocial assessment and support could improve quality of life post-diagnosis.

The roles of motivational interviewing and self-efficacy on outcomes and cost-effectiveness of a community-based exercise intervention for inactive middle-older aged adults.

Increasing physical activity (PA) among inactive middle-older aged adults in rural communities is challenging. This study investigates the efficacy of a PA intervention supporting inactive adults in rural/semirural communities. Inactive participants enrolled on either a single signposting session (n =427) or a multisession pathway combining signposting with motivational interviewing (MI; n = 478). Pre-post outcomes data assessed activity levels (International Physical Activity Questionnaire-Short Form; Single Item Sport England Measure), self-efficacy (New General Self-Efficacy scale [NGSE]) and well-being (five-item World Health Organization Well-Being Index [WHO-5]). Measures were repeated at longitudinal time points (26, 52 weeks) for the MI pathway. Outcomes were contrasted with results from an unmatched comparison group receiving treatment as usual (TAU). Cost-utility (quality-adjusted life years [QALY]-incremental cost-effectiveness ratio) and return on investment (NHS-ROI; QALY-ROI) were estimated for short (5 years), medium (10 years) and long (25 years) time horizons. Both pathways significantly increased participants' PA. The MI pathway resulted in significantly greater increases in PA than signposting-only and TAU. Improvements in psychological outcomes (NGSE; WHO-5) were significantly greater in the MI pathway than TAU. Longitudinal results indicated MI pathway participants sustained increases in light-intensity PA at 52 weeks (p < 0.001; ηp2  = 0.16). Regression analyses found baseline self-efficacy predicted increased PA at 52 weeks, while baseline well-being did not. The relationship between self-efficacy and PA increased successively across time points. However, magnitude of participants' increased self-efficacy did not predict PA at any time point. Both pathways were cost-effective and cost -saving for participants aged ≥61 years from the short time horizon, with the MI pathway having greater ROI estimates. Overall, MI increased efficacy of a signposting PA intervention and was cost-saving for older adults.

Arts-based learning in medical education: the students' perspective.

CONTEXT: Arts subjects are often included in medical school curricula to facilitate the exploration of non-scientific elements of medicine, such as communication, social, political, emotional and spiritual issues. However, little research has reported on students' experience of arts teaching. Performing Medicine is a programme created by the Clod Ensemble theatre company in collaboration with Barts and The London School of Medicine and Dentistry, and the Department of Drama at Queen Mary University, London. Professional artists run a range of workshops exploring issues relating to health care and work to develop students' professional skills in self-presentation, observation, communication, self-care and their understanding of difference. This article presents an analysis of student-written material about Performing Medicine. METHODS: A dataset of written student materials (reflections and feedback), drawn from three academic years (2006-2009), was analysed using the qualitative methods of thematic analysis and word frequency analysis. RESULTS: Five prevalent themes were identified: (i) Acting like a doctor; (ii) Developing broader awareness of others; (iii) The self in focus; (iv) The art of communication, and (v) A place for arts-based teaching within the medical curriculum. The corpus linguistic analysis confirmed and elaborated on the five themes found in the thematic analysis. CONCLUSIONS: Students generally felt that arts teaching made a valuable contribution to the medical curriculum. Many felt the training would reduce 'performance anxiety' in situations such as examinations, presentations and new placements. Group work developed camaraderie and students enjoyed the opportunity to learn new skills through creative writing, theatre and movement sessions. Some sessions developed students' ability to engage with and relate to people from very different backgrounds than their own.