1,720,996 research outputs found
Factors influencing adjustment to chronic illness and the role of the self-help group in this process
No full textThe primary aim of this study was two-fold: to determine what influences changes in quality of life (QoL) over time and to determine what aspects of QoL changed over time. There was a particular focus on what role social comparison may play in changes in QoL during the process of adjustment to chronic disease. A longitudinal design was used where QoL was measured at baseline and ten months later at follow-up. To determine these relationships a qualitative study and a pilot study were carried out to develop and validate two new questionnaires. The main study then consisted of a survey where 550 people with Méniére’s disease completed questionnaires at baseline and 301 completed measures of QoL again at follow-up, ten months later. Three different aspects of QoL were measured (functional, goal-oriented, and perceived positive change since the onset of the illness), and baseline predictor variables were classified as the catalyst (disease severity measures), the antecedents (demographic factors and the psychological factors self-esteem, optimisation, and perceived control), and the mechanisms (the social comparison variables). Response shift was also measured using the ThenTest approach. A cross-sectional analysis at baseline showed that social comparison was indeed associated with adjustment after controlling for the antecedents and the catalyst. Longitudinally, support for the main prediction was found where negative social comparison emerged as a primary predictor of worse functional QoL, providing evidence for the influence of social comparison within a self-help group on adjustment. However, those who had been members of the society for longer showed better functional QoL which indicates that the self-help group was having a positive effect on QoL over time. Self-esteem and the perception of movement towards goals emerged as important predictors of functional QoL over time.</p
Assessing subjective change in chronic illness: an examination of response shift in health-related and goal-oriented subjective status
No full textThis study examined changes over time on scales from the Short Form 36 (SF-36) and a new measure of goal-oriented subjective status (the GOSS) which assessed perceived rate of goal approach. Our aim was to determine whether adaptation to a moderately disabling chronic illness was associated with response shift. We also investigated predictors of response shift. At baseline, 301 members of a self-help group for people with Ménière's disease completed the GOSS and SF-36 scales, and potential predictors of response shift. At 10-month follow-up, respondents completed the GOSS and SF-36 again in the conventional manner, and as a Then-test. The GOSS was the only scale that indicated subjective improvement between baseline and follow-up. Then-test results suggested substantial response shift on the SF-36. Severe symptoms and social comparison predicted greater response shift. Less response shift was seen in those with a longer time since diagnosis, longer membership of the self-help group and higher baseline levels of self-esteem and optimism. <br/
Understanding homeopathic decision-making: a qualitative study
No full textBackground: understanding how homeopaths make clinical decisions is important in terms of optimising patient care, yet currently little is understood about this process. Most current literature investigating decision-making has focussed on conventional medicine; to date only two studies, both quantitative, have explored this area, with both studies investigating this in homeopathy. The aim of this qualitative study was to explore how homeopaths make prescribing decisions primarily during their first consultation with a patient. Method: in-depth, semistructured, face to face interviews were carried out with 14 private homeopaths working in private practice. Interpretative phenomenological analysis (IPA) was carried out on the data by 3 researchers. Findings: cognitive processes that homeopaths used in decision-making emerged from the analysis included the use of pattern recognition (P), hypothetico-deductive reasoning (H) and intuition (I), which led to a precise remedy match (R-M). Four themes emerged from the data: three related to the process of making a decision; one theme to those factors that influence this process. These themes fitted into a decision-making model, which we describe: the P.H.I.RM decision-making model. Two further themes emerged, which contributed to the model: the practitioners' awareness of avoiding major bias and the role of the patient practitioner relationship in influencing decision-making. Conclusion: The P.H.I.R-M decision-making model describes how homeopathic practitioners' used an evidence-based process to make decisions. This study also contributes more weight to the accumulating evidence that intuition is a valuable component of decisionmaking for homeopathic practitioners
How does social comparison within a self-help group influence adjustment to chronic illness? A longitudinal study
No full textDespite the growing popularity of self-help groups for people with chronic illness, there has been surprisingly little research into how these may support adjustment to illness. This study investigated the role that social comparison, occurring within a self-help group, may play in adjustment to chronic illness. A model of adjustment based on control process theory and response shift theory was tested to determine whether social comparisons predicted adjustment after controlling for the catalyst for adjustment (disease severity) and antecedents (demographic and psychological factors). A sample of 301 people with Meniere's disease who were members of the Meniere's Society UK completed questionnaires at baseline and 10-month follow-up assessing adjustment, defined for this study as functional and goal-oriented quality of life. At baseline, they also completed measures of the predictor variables i.e. the antecedents (age, sex, living circumstances, duration of self-help group membership, self-esteem, optimism and perceived control over illness), the catalyst (severity of vertigo, tinnitus, hearing loss and fullness in the ear) and mechanisms of social comparison within the self-help group. The social comparison variables included the extent to which self-help group resources were used, and whether reading about other members' experiences induced positive or negative feelings. Cross-sectional results showed that positive social comparison was indeed associated with better adjustment after controlling for all the other baseline variables, while negative social comparison was associated with worse adjustment. However, greater levels of social comparison at baseline were associated with a deteriorating quality of life over the 10-month follow-up period. Alternative explanations for these findings are discussed
Factors important for the measurement of social comparison in chronic illness: a mixed-methods study
No full textOBJECTIVES: The aim of this study was to examine social comparison in illness using a mixed-methods approach that combined inductive exploration of how people used social comparison in this self-help group with a quantitative study of social comparison processes and their relationship to quality of life.METHODS: The qualitative study involved 15 semi-structured interviews with people with Meniere's disease. Themes from the analysis of the interviews informed the development of the Social Comparison in Illness Scale (SCIS), which was then validated in a questionnaire study, in which participants with Meniere's disease (n = 196) completed the SCIS, the previously validated Identification/Contrast social comparison scale, and the SF-36 health status questionnaire.RESULTS: The qualitative study uncovered a wide range of forms of social comparison, including upward, downward and lateral comparison on illness and coping dimensions, as well as comparing solely for informational purposes. The quantitative study indicated that these varied directions and dimensions of social comparison could be mapped onto five reliable categories that were related to quality of life: upward positive and downward positive comparison, upward negative and downward negative comparison, and comparing for information. DISCUSSION: These analyses highlight the complexity of socially comparing in chronic illness, but also confirm the validity of the Identification/Contrast model of social comparison in this context
The use of intuition in homeopathic clinical decision making: an interpretative phenomenological study
Get PDFWhile intuition plays a role in clinical decision making within conventional medicine, little is understood about its use in complementary and alternative medicine (CAM). The aim of this qualitative study was to investigate intuition from the perspective of homeopathic practitioners; its’ manifestation, how it was recognized, its origins and when it was used within daily clinical practice. Semi-structured interviews were carried out with clinically experienced non-National Health Service (NHS) UK homeopathic practitioners. Interpretative phenomenological analysis was used to analyze the data. Homeopaths reported many similarities with conventional medical practitioner regarding the nature, perceived origin and manifestation of their intuitions in clinical practice. Intuition was used in two key aspects of the consultation: (i) to enhance the practitioner–patient relationship, these were generally trusted; and (ii) intuitions relating to the prescribing decision. Homeopaths were cautious about these latter intuitions, testing any intuitive thoughts through deductive reasoning before accepting them. Their reluctance is not surprising given the consequences for patient care, but we propose this also reflects homeopaths’ sensitivity to the academic and medical mistrust of both homeopathy and intuition. This study is the first to explore the use of intuition in decision making in any form of complementary medicine. The similarities with conventional practitioners may provide confidence in validating intuition as a legitimate part of the decision making process for these specific practitioners. Further work is needed to elucidate if these findings reflect intuitive use in clinical practice of other CAM practitioners in both private and NHS (i.e. time limited) setting
Cognitive interviewing techniques: applied in the development of a questionnaire on Functional Electrical Stimulation in Spinal Cord Injury study
No full textThe aim of this paper is to illustrate the application of a technique, Cognitive interviewing, which was used in the development of three questionnaires to determine the views of use of Functional Electrical Stimulation (FES) by people with Spinal Cord Injury (SCI), Health Care Professionals (HCP) and researchers working in SC
Exploring the views on the current and future use of functional electrical stimulation in spinal cord injury: a questionnaire development study
No full textIntroductionFor nearly half a century FES has been used in the treatment and management of physical problems encountered by people with SCI, such as bladder and bowel control, pain relief, and improvement of movement. Despite intensive research and development, only a small percentage of people who potentially benefit use FES illustrating with the translation from research to clinical practice. Although there has been growing recognition and some research (e.g. 1, 2) exploring the user’s perspective, little research has been carried out within the UK which can be used to guide the future use of FES in SCI. AimThe aim of this study was to explore views of people with SCI, healthcare professions and researchers about the current and future use of FES.MethodsThe design of the study was qualitative employing a focus group approach. A total of eight focus groups lasting between 90 to 120 minutes were carried out with people recruited from a FES researcher’s network and spinal centres throughout the UK. Participants were selected using a purposive sampling technique to ensure that the sample was diverse in terms of age, level and severity of injury and whether they had previous experience of using FES.ResultsThematic analysis identified five categories of themes relating to the different 1) decision to use FES, 2) physical improvements, 3) doing something active, 4) lack of resources, and 5) future use of FES. Key issues effecting the uptake and use of FES seemed to relate to resource issues, carrying out screening and checking the suitability of patients, and the lack of agreed protocols and procedures regarding the application of FES. Discussion and ConclusionsThese findings can be seen as a starting point to try and understand issues regarding the current and future use of FES in the UK. We have started to provide an outline of key issues related to the translation and application of FES research into clinical practice and illustrated some of the critical issues that require further investigation. These findings can be used to develop a series of questionnaires to explore the extent to which these beliefs are held by the wider SCI community.<br/
Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study
Get PDFBackground: patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management.Methods: a qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae.Results: participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge); were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house.Conclusions: these participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development and service provision planning, could have avoided many of the difficulties highlighted by this stud
A Quantitative Investigation Exploring the Psychological and Physiological Aspects of Individual Resilience, Rumination and Recovery
Get PDFThe psychological resilience literature has identified the need for clarity aboutwhether individual resilience should be considered a stable character trait or a dynamicprocess, and if there are biological markers of resilience. This thesis addressed the gaps in theliterature by assessing changes in resilience over time and psychological, physiological andwork-related factors associated with resilience.A systematic review and four quantitative research studies were conducted. Thefindings from most papers in the systematic review suggested resilience remains relativelystable over time with some minor fluctuations. This finding was partially supported in Study1, using a three-wave longitudinal study utilising the Connor-Davidson Resilience Scale (CDRISC) and the Resilience Scale for Adults (RSA) (N = 134). The model identified items ofthe CD-RISC were more trait based and the RSA contained a comparable percentage ofresidual trait and state factors. In Study 2, results from a two-wave study conducted duringthe Covid-19 pandemic and two years prior identified no group changes in employee’sresilience over time (N = 137) but identified individual fluctuations in resilience. In Study 3,results from a cross-sectional study suggested employee’s resilience mediates the associationbetween psychological job demands and work-related rumination (affective rumination anddetachment, N = 377) when working from home. Finally, Study 4 identified those with highresilience demonstrate enhanced cardiovascular recovery (heart rate variability, bloodpressure) following acute stress (N = 72).In summary, the results of this thesis suggest that the complexity of resilience may notbe able to be captured using psychometric resilience scales and the content of these scalesshould be explored further. The importance of resilience in recovery from work and acutestress has been highlighted amongst the need for additional support in the workplace toensure employees are happy and healthy at work
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