1,721,079 research outputs found
The therapeutic relationship in remote support for self management of chronic dizziness
No full textTelephone-delivered therapy is often used to deliver support as it can help overcome barriers that may previously have prevented patients with chronic illness from accessing key services. Very little research has looked at the therapeutic relationship during telephone support for people self-managing a chronic illness. the empirical work in this thesis is nested within a randomised controlled trial (RCT) of self-management of chronic dizziness, a condition that can be debilitating with serious consequences. This thesis explored the role of the therapeutic relationship during telephone support for using booklet-based vestibular rehabilitation (VR) to self-manage chronic dizziness.A meta-analysis of telephone delivered therapy for chronic illness was conducted to examine whether or not telephone therapy can affect physical health outcomes. Eight RCTs (1093 patients) were included, and the results found that telephone delivered therapy significantly improved physical health outcomes in people with chronic illness (d = 0.225, 95% Cl = 0.105, 0.344). A qualitative study of people's experiences of self-managing chronic dizziness using booklet-based VR with or without telephone support (n=33) identified themes characterising people's experiences, thoughts and feelings about these models of VR delivery. Findings indicated that participants valued telephone support. Quantitative analysis examining predicators of outcome (n=112) found that the therapeutic relationship predicted change in handicap, and was related to greater enablement, although it was not related to change in dizziness symptoms. A final mixed methods study aimed to evaluate the development of the therapeutic relationship using Roter Interaction Analysis System to examine recorded therapy sessions. This study found patient centredness during therapy to be related to the therapeutic relationship. Exploratory analyses identified specific features of patient-centredness that may be related to better and worse alliance. A qualitative analysis of high and low patient centred therapy sessions found that high patient centredness sessions were more likely to include general chat, encouragement, reassurance, and therapists were more responsive to participant cues. Low patient centred sessions were more likely to include participant concerns and therapists not responding to participant cues.This thesis identified a number of potential elements of telephone support that may be important for the development of the therapeutic relationship in patients self-managing dizziness
Carers’ views of topical-corticosteroid use in childhood eczema: a qualitative study of online discussion forums
No full textBackground: Childhood eczema is very common and can have substantial impact on quality of life. One of the main treatments is topical-corticosteroids, but these are often under-used by parents/carers for reasons that include concerns about safety.Objectives: To explore understandings and concerns about topical-corticosteroids amongst parents/carers of children with eczema who had posted messages in online forums.Methods: A qualitative study of messages and their resultant discussions about topical-corticosteroids for childhood eczema posted by parents/carers on two UK-based discussion forums.Results: Ninety-five forum users involved in 27 discussions relating to topical-corticosteroid use in childhood eczema were identified dating from 2003–2015. Analysis of discussions highlighted three themes: 1) diverse beliefs about the use of topical-corticosteroids, 2) uncertainty and confusion about using/applying topical corticosteroids, 3) seeking to resolve conflicting advice received offline and advice on navigating health services. People expressed a general sense of cautiousness about topical-corticosteroids, wide-ranging concerns and considerable confusion, for instance about potency or safe duration of use. They sought advice from other forum users who they perceived as having experiential expertise. Some posts attempted to reassure that topical-corticosteroids were safe if used correctly, but overall the discussions seemed likely to amplify existing concerns.Conclusions: Given the prevalence of concerns and uncertainties about topical-corticosteroids, signposting parents/carers of children with eczema towards detailed, credible information about how to use topical-corticosteroids safely would be beneficial. In the absence of such information, parents/carers are likely to turn to online discussion forums where, although much useful support and advice can be found, the credibility of advice cannot be assured.<br/
Understanding patient experiences of self-managing chronic dizziness: a qualitative study of booklet-based vestibular rehabilitation with or without remote support
No full textObjective: this study explores participants’ experience of self-management of dizziness using booklet-based vestibular rehabilitation (VR), with or without expert telephone support.Design: semistructured qualitative interviews were conducted.Setting: participants were recruited from primary care practices as part of a large RCT.Participants: interviews were carried out with 33 people (10 men and 23 women; age 27–84) self-managing chronic dizziness using booklet-based vestibular rehabilitation, with or without expert telephone support.Results: data were analysed using inductive thematic analysis. The majority of participants in both groups reported a positive experience of VR therapy, with many participants reporting an improvement in their dizziness symptoms since undertaking the therapy. Participants in the telephone support group felt that a genuine relationship developed between them and their therapist within three short sessions, and described their therapy sessions as reassuring, encouraging and motivational.Conclusions: the VR treatment booklet appears to be a valued tool for self-managing chronic dizziness and people appreciate receiving remote telephone suppor
The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis
No full textPurpose: The aim of this study was to identify communication features that may affect thedevelopment of the therapeutic relationship during telephone support sessions for peopleundertaking self-directed therapy.Methods: Recorded telephone support sessions of 61 peoplewith chronic dizziness were analysed for communication behaviour using the Roter InteractionAnalysis System (RIAS). Working alliance was assessed and was correlated with the RIAS todetermine whether communication behaviour affected the therapeutic relationship. Thematicqualitative analysis of support sessions was then carried out to explore the content of sessionswith high or low levels of person-centredness.Results: The level of person-centredness wasrelated to the therapeutic relationship. High person-centred sessions were more likely toaddress concerns and include therapist reassurances about the safety of the treatment and itsside effects.Conclusion: It is possible for rehabilitation therapists to build a strong therapeuticrelationship very quickly and over the telephone. Person-centred communication is importantfor the development of the therapeutic relationship during telephone-delivered support.This research suggests how person-centred communicative behaviours, such as reassurance,encouragement and approval could be incorporated into practic
An International trial of an interactive website designed for people with low health literacy
No full textThe person-based approach to intervention development: application to digital health-related behavior change interventions
No full textThis paper describes an approach that we have evolved for developing successful digital interventions to help people manage their health or illness. We refer to this as the “person-based” approach to highlight the focus on understanding and accommodating the perspectives of the people who will use the intervention. While all intervention designers seek to elicit and incorporate the views of target users in a variety of ways, the person-based approach offers a distinctive and systematic means of addressing the user experience of intended behavior change techniques in particular and can enhance the use of theory-based and evidence-based approaches to intervention development. There are two key elements to the person-based approach. The first is a developmental process involving qualitative research with a wide range of people from the target user populations, carried out at every stage of intervention development, from planning to feasibility testing and implementation. This process goes beyond assessing acceptability, usability, and satisfaction, allowing the intervention designers to build a deep understanding of the psychosocial context of users and their views of the behavioral elements of the intervention. Insights from this process can be used to anticipate and interpret intervention usage and outcomes, and most importantly to modify the intervention to make it more persuasive, feasible, and relevant to users. The second element of the person-based approach is to identify “guiding principles” that can inspire and inform the intervention development by highlighting the distinctive ways that the intervention will address key context-specific behavioral issues. This paper describes how to implement the person-based approach, illustrating the process with examples of the insights gained from our experience of carrying out over a thousand interviews with users, while developing public health and illness management interventions that have proven effective in trials involving tens of thousands of users
The person-based approach to planning, optimising, evaluating and implementing behavioural health interventions
No full textThis year the digital health research team at University of Southampton’s Centre for Clinical and Community Applications of Health Psychology is celebrating ten years of the LifeGuide research programme (www.lifeguideonline.org). This research programme was initiated by developing the unique LifeGuide software, which has enabled researchers to create, modify and adapt digital interventions quickly and efficiently, without needing input from programmers. Over the course of a decade of developing numerous interventions that have proved consistently engaging and effective (e.g. Little et al., 2013; Little et al., 2016; Little et al., 2015), we have come to realise that the most important output from this research for the wider research community is not the LifeGuide software (which will soon be superseded by newer technology) but our successful methods for intervention development. We refer to these methods as the ‘Person-Based Approach’ (PBA, Yardley, Morrison, Bradbury, & Muller, 2015) to intervention development, which we see as an essential complement to theory- and evidence-based approaches
GPs’ perspectives on acne management in primary care: a qualitative interview study
No full textBackground: acne is a common skin condition, affecting most adolescents at some point. While guidelines recommend topical treatments first-line, long courses of oral antibiotics are commonly prescribed.Aim: to explore GPs’ perspectives on managing acne.Design and setting: qualitative interview study with GPs in South West England.Method: GPs were invited to participate via existing email lists used by GP educators to disseminate information. Purposive sampling was used to recruit a range of participants by sex, number of years in practice, and whether their practice was rural or urban. Semi-structured telephone interviews followed an interview guide and were audiorecorded and transcribed. Data were explored using inductive thematic analysis facilitated by NVivo software (version 11).Results: a total of 102 GPs were invited, of whom 20 participated. Analysis revealed uncertainties regarding topical treatments, particularly around available products, challenges regarding side effects, and acceptability of topical treatments. GPs generally either perceived topical treatments to be less effective than oral antibiotics or perceived pressure from patients to prescribe oral antibiotics due to patients’ views of topical treatments being ineffective. GPs described a familiarity with prescribing oral antibiotics and expressed little concern about antimicrobial stewardship in the context of acne. Some seemed unaware of guidance suggesting that antibiotic use in acne should not exceed 3 months, while others spoke about avoiding difficult conversations with patients regarding discontinuation of antibiotics.Conclusion: GPs expressed uncertainty about the use of topical treatments for acne and either felt that treatments were of low effectiveness or perceived pressure from patients to prescribe oral antibiotics
Explaining sex differences in infants’ preferences for groups
No full textSocial organization of a species influences myriad facets of individuals’ behavior. Much research indicates that human social organization consists of males in large groups and females in smaller groups or interacting with individuals. This study analyzed the initial factors that produce greater preferences for groups by human male versus female infants. To this end, using a looking preference paradigm, fifty-nine 6–8-month-old infants viewed individual versus group images of actual children. On the basis of several controls, results demonstrated that male more than female infants are attracted to the complex level of stimulation provided by groups. Discussion centers on further identifying male versus female patterns of group interaction from a perceptual and cognitive standpoint
50 A qualitative study of public online discussion forums: exploring parents’ concerns about children’s sleep problems and views about online, community and primary care support
No full textIntroduction Chronic insomnia is common in children. Behavioural interventions are effective.1 A systematic review (pending publication) revealed UK research about primary healthcare (PC) management is limited. Parents seek advice online,2 however, no published research to date has explored parents’ discussions online about PC management. This qualitative study explored (in online discussions) parents’ concerns/expectations about children’s sleep problems, awareness of online, PC, and community management resources, and perceptions of management within PC.Methods Two public online discussion forums were searched for parents’ discussions about children’s sleep problems. Eligible threads were analysed with Braun and Clarke’s reflexive thematic analysis.Results Ninety-three threads were included.Five main themes were developed. Parents had many ‘concerns about children’s sleep problems’ and were emotional/practical support for one another: ‘parents experiences or sharing advice online as a resource’. Parents expressed little regarding PC but had ‘mixed experiences and perceptions of community-based PC professionals’ and ‘limited experiences and perceptions of general practice’. They often discussed ‘other resources for supporting parents with child sleep problems’ (e.g. apps, private sleep consultants).Discussion Parents may have unmet management needs, act as resources for one another, and use non-healthcare resources, however the accuracy of these resources must be explored. The management of chronic insomnia within PC specifically must be further explored.This study/project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care
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